The less-explored question involves why Obamacare’s overall combination of taxpayer subsidies, expanded insurance programs, health benefits requirements, AND coverage mandates had so much less of an effect than the law’s architects envisioned.
It turns out that many of the nominally uninsured still have other alternatives to health care than just through heavily-subsidized Medicaid and exchange-based insurance. You might call such uncompensated care either an option for “implicit insurance” or a hidden tax on acquiring more formal coverage.
Health policy researchers Amy Finkelstein, Neale Mahonem and Matthew Nolowidigdo unravel the puzzle in a recent National Bureau of Economic Research paper. They explain why there is less “demand” than expected for the increased “supply” of subsidized coverage for lower income individuals and more limited take up of subsidized coverage than once predicted.
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Republicans in Congress and the Trump administration failed to fulfill their commitment to repeal and replace the Affordable Care Act (ACA) in 2017, but they did succeed in repealing the tax penalties enforcing the law’s individual mandate, starting in 2019.
The GOP still might try again to fully repeal and replace the ACA in 2018, perhaps with a modified version of the Graham-Cassidy legislation. However, with Republicans now down to a 51-seat majority in the Senate and some House and Senate members facing difficult mid-term elections this November, it will be even more challenging to get a sweeping rollback of the ACA through Congress in 2018 than it was in 2017.
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Democrats and activists fought off Obamacare repeal last year by stoking public outrage and stirring protests. Now they want to make the health law the defining issue in 2018 races at the congressional, state and local levels. The grassroots groups at the forefront of the Obamacare fight are expanding their focus to rally opposition to virtually all Republican efforts to alter the health care system, hoping to capitalize on the backlash to repeal and turn it into a wave of victories come November.
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