“Six months ago, a House Republican campaign official listed the top three issues that would propel the party’s candidates to victory in the midterm election: “Obamacare, Obamacare, Obamacare.”.
It was a strategy that worked well in 2010, when GOP electoral gains were fueled primarily by a high-profile campaign to repeal the newly passed Affordable Care Act.
But now, months removed from the political storm that resulted from the botched rollout of the law and as more Americans begin receiving healthcare under the program, many Republicans have a more nuanced view of its importance.
House Republicans are broadening their once-singular focus on the healthcare law and headed into an extended summer break without delivering on their promise to advance an alternative.”
“Court decisions can have huge policy implications. Because judges are not policy experts, statistical modelers or economists, and because these are inexact sciences anyway, the policy implications of judicial rulings may not be fully appreciated when they are made.
A good example is the 2012 U.S. Supreme Court ruling that made Medicaid expansion optional for states. It’s hard to imagine that the justices had any idea that their decision would leave 4.8 million low-income people in a coverage gap without insurance in states that chose not to expand, or that 10 million slightly higher-income people would get tax credits to help them buy coverage in those same states. (Not that those things may, or should have, changed the justices’ conclusion.)
Now let’s consider Halbig v. Burwell, a case in which recent appeals court rulings made headlines. Halbig, which raises questions about whether the U.S. government can provide tax credits to people in federal- as well as state-run insurance exchanges, is still churning through the courts.
What if the plaintiffs prevail in Halbig, denying tax credits to moderate-income people in states with federal health insurance exchanges? The map below shows the potential combined effect of the 2012 Supreme Court decision and a plaintiffs’ victory in Halbig. (To be clear, the courts are not considering the earlier Medicaid ruling as part of Halbig, but the combined effect would be real.)”
“If being uninsured were no big deal, presumably Obamacare never would have been enacted. The whole premise of the law is that being uninsured is a bad thing, so it’s well worth wielding a few carrots and sticks to get people into coverage. Unfortunately, Obamacare has had to break more than a few eggs along the way. One of the presumably unintended consequences of this misguided law is the fashion in which it encourages some young adults to become uninsured. These are the very young people that the Exchanges need to sign up for coverage if they are to avoid a death spiral.
It may seem puzzling that a law that both hands out subsidies to encourage coverage and imposes penalties on those who do not could possibly increase the incentive to become or remain uninsured.”
“Did you hear the great news? According to the latest Medicare Trustees report, “Medicare isn’t going bankrupt,” and Vox has a chart to prove it! Not only that, “slow health cost growth has improved Medicare’s financial outlook, extending the program’s trust fund to last until 2030.” That’s four years longer than last year’s forecast!
It all sounds great until you hear what Vox unaccountably elected not to tell its readers. All those rosy Medicare predictions are based on a scenario that no one with any common sense should believe.” As PolitiFact.com pithily puts it: “There are good reasons to question whether things will pan out that way.” Indeed, you don’t exactly have to be a mind-reader to see that the Medicare actuaries also don’t believe this scenario which is precisely why they again (as they have done routinely in 2011, 2012, and 2013) released an alternative fiscal scenario that is far more likely to transpire.
Medicare Part A Actually Will Grow 2-1/2 Times As Fast As Vox Says
When Vox says the trust fund will last another four years, that’s a reference to the Part A Hospital Trust Fund. Under the so-called “projected baseline” used in the Trustees’ report, the trust fund will indeed last until 2030. But that baseline portends cuts in hospital payment rates so drastic that Obamacare-mandated reductions in payments to hospitals so drastic that:
•Hospital payments for both Medicare and Medicaid will be 38% lower than the amounts paid by private health insurers by the year 2030 (Figure 1).
•Eventually, payment reductions to hospitals will mean they are paid 59 percent less by Medicare and Medicaid than by private health insurers!””
“In an oped for Politico, I explain why ObamaCare architect Jonathan Gruber’s 2012 admissions that “if you’re a state and you don’t set up an Exchange, that means your citizens don’t get their tax credits” matter to the ongoing litigation over the Obama administration issuing those subsidies in federal Exchanges, and why Gruber’s attempts to explain his own words away are not credible. Shortly after submitting that piece, I learned Oklahoma Attorney General Scott Pruitt found Gruber’s remarks relevant enough to ask a federal court hearing one of those cases to take notice.
Gruber’s repeated remarks contradict the Obama administration’s legal argument, made in Halbig v. Burwell and three related lawsuits, that it is implausible that Congress would have conditioned those subsidies on states establishing Exchanges. His remarks likewise contradict the amicus briefs Gruber himself filed in two of those cases. (Here’s my response to those briefs.)”