I come to bury IPAB, not to praise it.
Like Brutus and his co-conspirators wielding the knife against Julius Caesar, the budget deal Congress passed in the early morning hours of February 9 put to death an idea whose time apparently never came and, now never will. The Independent Payment Advisory Board (IPAB), created in the Affordable Care Act (ACA), is history.
It is a rare moment when Republicans and Democrats agree on something they don’t like about the ACA. Behind IPAB’s demise is a belief that Congress shouldn’t delegate its powers to determine Medicare’s rules and a massive political force that reinforced that belief.
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The most significant federal entitlement reform in our lifetime was a little noticed provision that Democrats included in the Affordable Care Act (Obamacare). The provision garnered almost no attention from the mainstream media or even from most conservative commentators. Yet according to the Medicare Trustees report that followed, this one provision eliminated $52 trillion of unfunded federal government liability – an amount that was more than three times the size of the US economy.
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Here’s what the Department of Health and Human Services could do:
- Relax rules so companies of all sizes can take advantage of HRAs. Medium-sized and large employers want the same option of setting up HRAs for workers to buy ACA coverage, said Chris Condeluci, who worked on the ACA as a Senate GOP staff attorney.
- Now that the individual mandate has been repealed, the administration could open the door for companies “to provide funds to buy noncompliant coverage,” said Gary Claxton, a vice president at the Kaiser Family Foundation.
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The Center for American Progress proposed a plan for government-run health care Thursday, which the liberal think tank calls “Medicare Extra.”
Unlike Bernie Sanders’ single-payer system, which would abolish virtually all other forms of insurance, the plan would not ban employer coverage outright — at least not yet. In broad strokes, CAP would combine Medicaid and the individual insurance market into Medicare Extra, and allow individuals with other coverage, such as employer plans, traditional Medicare or VA coverage, to enroll in Medicare Extra instead.
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Earlier this week, the Trump administration restored Obama-era rules that allow individuals to buy affordable insurance plans that aren’t bound by Obamacare’s costly regulations. Here’s the low-down on how those plans could affect your insurance choices.
Overcharging the healthy to undercharge the sick
Obamacare’s most significant change to the U.S. health care system was that it introduced an entirely new layer of federal regulations for individuals and families who buy their own health insurance directly, instead of getting it from their employer or from a government program like Medicare or Medicaid. Prior to 2014, these “individual market” or “nongroup” plans were regulated solely at the state level.
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