“Many lawmakers on both sides of the aisle agree universal health insurance is the central goal of successful healthcare reform. The left sold the Affordable Care Act on this promise; the right hopes to do the same with an alternative plan set to be unveiled later this year.

Both sides are trying to fix the wrong problem. Universal health insurance is profoundly different from better healthcare, and so long as reformers focus on the former, the latter will continue to deteriorate.”

“The most important, and uncertain, provision of Obamacare remains the individual mandate.

Obamacare’s authors believed it was crucial to the viability of the law to impose a new obligation on U.S. citizens and legal residents to enroll in government-approved health insurance. This new obligation was to be enforced by a penalty on the non-compliant, collected through the income tax.”

“Don Berwick – who, as administrator of the Centers for Medicare and Medicaid Services, oversaw large chunks of the early implementation of the Affordable Care Act – is trying to shake up the health policy world again. He ran CMS from July 2010 to December 2011, and left because Senate Republicans blocked his confirmation to lead the agency permanently. Now, more than two years later, he is a long-shot Democratic candidate for governor of Massachusetts and the heart of his platform is a single-payer health plan.”

“Two of the most controversial questions in health care reform are whether government-sponsored expansions of health insurance coverage like ObamaCare and RomneyCare save lives, and if so whether other policies could save more lives per dollar spent. “Changes in Mortality After Massachusetts Health Care Reform,” published today in the Annals of Internal Medicine, presents evidence suggesting RomneyCare may have saved lives, but at a very high cost.”

“In recent opeds for the Los Angeles Register and the Orange County Register, I explain how ObamaCare’s requirement that insurers cover people with pre-existing conditions at the same price as healthy people dramatically reduces the risks associated with not having health insurance, and therefore creates a perverse incentive for people to drop their coverage and wait until they get sick to re-enroll.”

“Even if Obamacare really has enrolled 8 million Americans through its health insurance exchanges, that’s not good enough. For the exchanges to work, people must enroll and stay enrolled.
If too many enrollees drop out, premiums will climb until the exchanges collapse.”

“Today is March 31, 2014: in theory, the last day you can sign up for coverage under the subsidized Obamacare insurance exchanges. If you’ve been a regular reader of this space, you know that the numbers routinely paraded by the Obama administration regarding Obamacare website sign-ups don’t tell us much about the actual number of uninsured individuals who have gained coverage. A new study from the RAND Corporation indicates that only one-third of exchange sign-ups were previously uninsured.”

“Earlier today, Marilyn Tavenner of the Centers for Medicare and Medicaid Services announced that “more than 6 million Americans have signed up for coverage through the Health Insurance Marketplaces since October 1, thanks to the Affordable Care Act.” Given all of the technical problems that dogged healthcare.gov last October, this is an impressive turnaround. But it sheds little light onto the two questions most analysts are focused on. First, how many of those signing up have paid their first month’s premium, thereby activating coverage? And second: How many of those with coverage were previously uninsured? At this point, we have no definitive answers.”

“Obamacare continues to fall short of the lofty predictions about it — and here are two new charts to prove it. The charts, included as part of a Congressional Budget Office (CBO) presentation over the weekend, summarize the CBO’s cost estimates of the law in the three years since its passage. The charts show that in every instance, the CBO’s estimate of the number of uninsured has risen, as has the number of workers who will lose coverage under their existing employer plans:”

“If all states implement the Affordable Care Act, 18 million more people will be enrolled in Medicaid by the end of 2016. Even if some states opt out, the program is poised for a huge expansion. But having insurance does not guarantee access to health care. Policymakers need to explore and reduce the barriers Medicaid patients face as millions join an already overburdened system.”