Donald Trump’s White House and congressional GOP leaders are coalescing around an agenda focused on slashing taxes and repealing Obamacare early next year, a blueprint that could potentially avoid an intraparty clash over infrastructure investment early in Trump’s presidency.
On Wednesday morning, incoming White House Chief of Staff Reince Priebus said that the GOP will concentrate on budgetary issues and health care reform in the first nine months of the year. That largely overlaps with House Speaker Paul Ryan and Senate Majority Leader Mitch McConnell’s focus on tax reform and Obamacare repeal and suggests the party will spend much of its energy and momentum on those two issues.
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Next year, taxpayers will fork over nearly $10 billion more to cover double-digit premium hikes for subsidized health insurance under the ACA, according to a study from the Center for Health and Economy. The study estimates that the cost of premium subsidies under the ACA will rise from $32.8 billion currently to $42.6 billion. Under current law, “you get a premium increase, you pour more money in,” said economist Douglas Holtz-Eakin, founder of the Center for Health and Economy. “The concern is that will feed more premium increases.” If the health care law is repealed next year, it is still yet to be seen what the remaining carriers participating in the ACA exchanges will do in 2018. It is also unclear how supportive Congress will be for subsidies going into a system slated to disappear.
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Republicans are searching for a way to capture savings from repealing Obamacare in a piggybank they could later use to fund a replacement.
It’s not clear how or if such a maneuver would work, but if Republicans are successful, it could overcome the tricky political problem of paying for whatever health reform they try to put in the Affordable Care Act’s place.
The idea is to bankroll an Obamacare replacement that would start several years down the road with funds derived from repealing the law itself. A repeal bill Congress passed early this year, and President Obama vetoed, would have saved $516 billion over a decade, according to the Congressional Budget Office.
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It didn’t take long for Republican leadership in both houses of Congress to get over the shock of winning the election last month and start gaming out a repeal plan. The details remain under discussion, but House speaker Paul Ryan, Senate majority leader Mitch McConnell, and Vice President-elect Mike Pence (who is working closely with Ryan and McConnell on repeal) are already coalescing around a rough legislative framework. The plan might be summed up as: repeal, delay, replace. More precisely, Republicans plan to repeal most of the law, delay the implementation of most of that repeal for at least two years—and figure out what to replace it with in the interim.
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In new research for the Mercatus Center, I argue that one of the central aims for the ACA replacement should be to reduce government bias toward comprehensive insurance. Policymakers should instead focus on realigning incentives, removing government mandates and regulations, and directing government financial support to consumers instead of to insurers and providers. Doing so would lead consumers and providers to make decisions that lead to greater value from the massive amounts of money we spend each year on health care.
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In a new study by the Mercatus Center at George Mason University, Senior Research Fellow Brian Blase notes that successful, sustainable reform must simultaneously improve healthcare quality and put downward pressure on prices. The only surefire way to achieve this is by replacing the ACA’s government-centric approach with a consumer-centric approach that realigns incentives, unleashes market forces, and increases competition.
As Congress and the incoming Trump administration consider how to replace the ACA, they should aim to (1) reduce the government bias in favor of comprehensive insurance, (2) fundamentally reform Medicaid by better aligning incentives of states to be concerned about the value of spending, and (3) expand market-oriented reforms such as HSAs [Health Savings Accounts]. States should support these efforts by reducing insurance mandates and eliminating state rules that restrict competition and innovation.
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Tennessee taxpayers, beware. President Obama’s administration is quietly implementing one last massive taxpayer-funded bailout for special interests.
This bailout would prop up the Affordable Care Act only months before the law will likely be repealed.
So which special interests are getting your money? Health-insurance companies. Six years ago, health insurers were some of the Affordable Care Act’s biggest fans. They lobbied for the law because they thought it would be a financial windfall — it literally forces Tennesseans to buy their product.
But instead of finding gushers of cash, they’re drowning in red ink. Health insurers in Tennessee and across the country lost $3.2 billion in 2014 and over $10 billion in 2015. This year’s losses will be even higher.
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During 2015, the growth in both individual-market and employer-group coverage resulted in a net increase in private-market coverage of 2 million individuals. For individual-market policies, enrollment increased by a bit more than 1.12 million individuals. For the employer-group-coverage market, enrollment in fully insured plans declined by 932,000 individuals, while enrollment in self-insured plans increased by 1.86 million individuals. The net effect of those changes was an increase of 926,000 in the number of individuals with employer-sponsored coverage in 2015.
Public program enrollment in Medicaid and the Children’s Health Insurance Program (CHIP) increased by almost 2.77 million individuals in 2015. As in 2014, the change in Medicaid enrollment in 2015 differed notably between states that adopted the ACA’s Medicaid expansion and states that did not. States with the ACA’s Medicaid expansion in effect experienced Medicaid enrollment growth of almost 2.13 million people, while in the states without the expansion in effect, Medicaid enrollment grew by 640,000 individuals.
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One of the most frequently heard claims from the Obama administration is that Obamacare is responsible for insuring 20 million adults who were previously uninsured. But Heritage Foundation research shows the administration’s figure is off by a few million.
It is important to note that the administration’s coverage estimates are based on survey data rather than calculating the actual change in coverage in different markets. Though surveys can provide useful information, they are not as precise as using enrollment data taken directly from insurance companies.
A recent analysis by The Heritage Foundation’s Edmund Haislmaier and Drew Gonshorowski uses the more accurate method, taking actual enrollment data from Medicaid and private insurance companies to assess the impact Obamacare has had on coverage.
The researchers found that just over 14 million people gained coverage from the end of 2013 to the end of 2015. Of those 14 million, 11.8 million gained their insurance through Medicaid and 2.2 million through private coverage.
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The current situation presents an opportunity to replace the Affordable Care Act with a more sustainable bipartisan law. But repeal must wait until a consensus is built around a replacement plan. Not doing so – starting with repeal and delay – threatens to destabilize the individual market and harm not only those who receive subsidies from the ACA, but also everyone who now purchases insurance in the individual market.
Estimates show that premiums would jump at least 20 percent and cause 4.3 million to lose health insurance as soon as next year, and that’s nothing compared to the damage that would be inflicted if a replacement plan subsequently failed to emerge. The current version of repeal through reconciliation, leaving in place the ACA’s insurance market reforms, would nearly destroy the individual market if its provisions took effect, causing 30 million people in total to lose health insurance, leaving more uninsured than before the ACA.
Fixing the ACA is important, but replacing it with a durable plan to make health coverage broadly affordable will take time and constructive bipartisan collaboration.
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