In what will be a busy week in Washington, the Republican House hopes to take another whack at ObamaCare reform, a large chunk of which is Medicaid. As if this were not enough to handle, Donald Trump promises a “big announcement” Wednesday about his tax plan, which will likely include cuts in the corporate tax rate.
Let us stipulate that Medicaid reform and corporate tax cuts are both excellent initiatives. Done properly, each would offer Americans, including those at the lower end of the income scale, a better deal than they have now. Unfortunately, pitching health-care reform as the way to help “pay for” corporate tax cuts undermines the best arguments for both.
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Given the damage wrought by Obamacare, it’s understandable that so many Americans want a comprehensive overhaul of our health sector. But single-payer is one of the few approaches to health policy with a worse track record than Obamacare. What proponents of government-run medicine ignore is that the policy has been an utter disaster everywhere it’s been tried—from Canada, to the UK, to America’s own experiment in single-payer care, the Veterans Health Administration. The only way to ensure that Americans have access to timely, affordable, high-quality care is by creating a competitive healthcare market—not a government healthcare monopoly.
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As congressional Republicans’ efforts to repeal and replace the Affordable Care Act remain in limbo, the Trump administration and some states are taking steps to help insurers cover the cost of their sickest patients, a move that industry analysts say is critical to keeping premiums affordable for plans sold on the law’s online marketplaces in 2018.
This fix is a well-known insurance industry practice called reinsurance. Claims above a certain amount would be paid by the government, reducing insurers’ financial exposure and allowing them to set lower premiums.
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House GOP leaders during a members-only conference call Saturday vowed to avoid a government shutdown and said they’re closer to a deal to repeal and replace Obamacare, according to members who participated on the call.
But Speaker Paul Ryan also downplayed the possibility of a vote next week, the same sources said. The Wisconsin Republican said the chamber will vote on a conference-wide deal when GOP whips are confident they have the votes for passage — but not until then.
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Although insurers have generally remained profitable overall since implementation of the Affordable Care Act, many companies participating in the individual market – where most of the major market reforms took place in 2014 – experienced substantial losses in this market in the early years of reform. The individual market is where just 7% of the U.S. population gets their insurance (and thus also represents a small share of most health insurers’ business), but the stability of the market and willingness of insurers to continue to participate is essential to the ACA’s success. Going into 2017, there were a number of high-profile exits and premium increases, raising concerns over the stability of the individual market. Although some local markets are likely fragile, the Congressional Budget Office expects the ACA individual market to remain stable across most part of the country.
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Republicans have put themselves in a deep hole on ObamaCare, both politically and on the health-market merits, but maybe they’ll grab the rescue line now dangling in front of them. A potential compromise among the House’s contentious GOP factions could begin the climb out.
The chance to revive the failed repeal-and-replace bill developed this week when the House Freedom Caucus’s Mark Meadows and the centrist Tuesday Group’s Tom MacArthur struck a tentative deal. Their compromise would allow states to seek waivers to opt out of most of ObamaCare’s insurance mandates.
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As House Republicans regain momentum in their quest to replace Obamacare, GOP moderates have done something unexpected: they’ve focused not broadly on covering the uninsured, but specifically on protecting those with pre-existing conditions. There’s a reason for that, and it has to do with wildly exaggerated claims that Democrats made when they were passing the law in 2009 and 2010.
The vast majority of Americans who are uninsured aren’t without coverage because of a health problem. They’re uninsured because of an economic problem: the problem that American health care costs too much, especially for lower-middle-income Americans who earn too much to qualify for government assistance.
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Fresh hopes for resuscitating the American Health Care Act are pegged to an amendment being offered by Rep. Tom MacArthur (R-N.J.) that aims to attract enough conservatives and moderates so the measure can pass in the House. The tentative deal would allow states to apply for limited waivers from some of ObamaCare’s regulatory requirements if they establish a high risk pool to protect sicker enrollees. While some senior White House administration officials suggested that a vote will occur next week, Speaker Ryan won’t bring it up unless he knows there are enough votes for passage.
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Insurance executives, as well as the head of the trade group America’s Health Insurance Plans, met with Seema Verma, administrator of the Centers for Medicare and Medicaid Services, on Tuesday. Insurers have been pressuring administration officials and lawmakers to fund the ACA’s cost-sharing reduction payments. Insurers have struggled to adjust to the individual marketplaces since the ACA created the exchanges, and the ACA’s uncertain political future has only added to the questions they face as they approach the June 21 deadline for filing their 2018 premium rate requests. That will be the first indication of how the individual exchanges fare next year.
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