Before the passage of ObamaCare’s 2,400 pages of coercive mandates and profligate spending, the federal government had already largely wrecked the market for individually purchased insurance, in three interconnected ways.
First, it had effectively established two different health insurance markets—employer-based and individually purchased—by treating them differently in the tax code. Second, it had given an attractive tax break for employer-based insurance while denying it for individually purchased insurance (except for the self-employed). Third, having effectively split the market in two while favoring the employer-based side, it had made it hard for people to move from the employer-based market to the individual market, as it had allowed insurers to treat previously covered conditions as “preexisting.”
A popular conservative alternative, then, would repeal every word of ObamaCare while fixing this longstanding inequity in the tax code.
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Amid rising drug and health care costs and roiling market dynamics, the spokesperson for the nation’s health insurers is predicting substantial increases next year in ObamaCare premiums and related costs.
Without venturing a specific percentage increase, Marilyn Tavenner, the president and CEO of America’s Health Insurance Plans, said in an interview with Morning Consult that the culmination of market shifts and rising health care costs will force stark increases in health insurance rates in the coming year.
The warning to consumers from Tavenner, the former administration official who headed the Center for Medicare and Medicaid Services and oversaw the disastrous launch of HealthCare.gov, the ObamaCare website, comes at a time of growing uncertainty about the evolving makeup of the ObamaCare health insurance market.
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As part of an ObamaCare initiative meant to reward quality care, the Centers for Medicare and Medicaid Services is allocating some $1.5 billion in Medicare payments to hospitals based on criteria that include patient-satisfaction surveys. Among the questions: “During this hospital stay, how often did the hospital staff do everything they could to help you with your pain?” And: “How often was your pain well controlled?”
To many physicians and lawmakers struggling to contain the nation’s opioid crisis, tying a patient’s feelings about pain management to a hospital’s bottom line is deeply misguided––if not downright dangerous. “The government is telling us we need to make sure a patient’s pain is under control,” says Dr. Nick Sawyer, a health-policy fellow at the UC Davis department of emergency medicine. “It’s hard to make them happy without a narcotic. This policy is leading to ongoing opioid abuse.”
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UnitedHealth is withdrawing from most of the 34 ObamaCare Exchanges in which it currently sells, citing losses of $650 million in 2016. A recent Kaiser Family Foundation report indicates UnitedHealth’s departure will leave consumers on Oklahoma’s Exchange with only one choice of insurance carriers.
Michael Cannon of the Cato Institute explains five results of UnitedHealth’s withdrawal from the exchanges:
1. UnitedHealth’s departure shows ObamaCare is suffering from self-induced adverse selection.
2. UnitedHealth’s departure is bad news for other carriers.
3. UnitedHealth’s departure shows ObamaCare premiums will continue to rise.
4. There will be more exits.
5. UnitedHealth’s departure shows quality of coverage under ObamaCare will continue to fall.
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The CEA presentation is notable in reflecting the core components of ACA advocates’ case for the law. It is fourteen slides long, and I find that its points break down into five main themes (in my own words):
- The ACA represents a historic expansion of health insurance coverage.
- The ACA is achieving policy goals such as reducing patient harm and hospital readmissions.
- The ACA is helping to slow the growth of health care costs.
- The ACA has been good for job creation.
- The ACA is improving the federal fiscal outlook.
Health plans will be required to dock hospitals at least 6 percent of their payments if they do not meet certain quality standards, or give them bonuses of an equal amount if they exceed the standards.
The plan, to be implemented over seven years, is based on a similar strategy pursued by the federal agency that oversees the government-run Medicaid and Medicare health insurance programs.
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Donald Trump’s healthcare plan is a “whipsaw of ideas” and an “incoherent mishmash that could jeopardize coverage for millions of newly insured people,” according to conservative health policy experts. Mr. Trump’s health care platform “resembles the efforts of a foreign student trying to learn health policy as a second language,” according to AEI’s Tom Miller. AEI’s Jim Capretta adds that replacing the ACA would require a “herculean effort, with clear direction and a clear vision of what would come next. I just don’t see that in Trump’s vague plans to repeal the law and replace it with something beautiful and great.” Trump must “discard some of his ideas, like the importation of prescription drugs, because they would be damaging and unworkable,” according to Grace-Marie Turner. “And he has to flesh out his other proposals with much more detail if he hopes to persuade voters that he has a credible plan to replace Obamacare.” Robert Laszewski, a former insurance executive, called Mr. Trump’s health care proposals “a jumbled hodgepodge of old Republican ideas, randomly selected, that don’t fit together.”
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Health jobs grew more than two thirds faster than non-health jobs in March, they comprised 37,000 (17 percent) of nonfarm civilian jobs added (215,000).
There is significant increase in health services jobs under Obamacare. It is unlikely we will bend the curve of health spending as long as we keep adding relatively unproductive health services jobs.
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In January, CMS proposed overhauling the way it evaluates if and how much money ACOs are saving in the Medicare Shared Savings Program (MSSP). Under the revised methodology, the agency would adjust cost benchmarks based on regional rather than national spending data when an ACO signs up for a second three-year contract period.
Of 434 ACOs participating in the program, only 22 have chosen to participate in tracks that include downside risk.
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The Affordable Care Act’s tax increases are many, two are front and center this month: the individual and employer mandates. They were both supposed to increase coverage, but in reality they’re limiting career opportunities and taking more out of families’ and individuals’ wallets.
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