Sens. Lamar Alexander and Patty Murray say they have reached an agreement on a bipartisan Obamacare deal to fund a key insurance subsidy program and provide states flexibility to skirt some requirements of the health care law.
There is no assurance that the agreement will get to the Senate floor, however. Republicans on Tuesday were lukewarm about the prospect of resuming debate over whether to try to prop up Obamacare after multiple failed GOP attempts to repeal the law.
The deal would include funding through 2019 for Obamacare’s cost-sharing program, which President Donald Trump cut last week. It would allow states to use existing Obamacare waivers to approve insurance plans with “comparable affordability” to Obamacare plans, Alexander said. But it would notably not allow states to duck the law’s minimum requirements for what a health insurance plan must cover.
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Revised waiver language in the Alexander-Murray bill requires states to “provide coverage and cost sharing protections against excessive out-of-pocket spending that are of comparable affordability, including for low-income people, people with serious health needs, and other vulnerable populations.”
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Seeing, hearing, reading, and feeling the new grassroots ferment among progressive Americans for a single-payer health care system, my gut reaction is: I get it. As newly documented in Elizabeth Rosenthal’s book, An American Sickness,1 and the Commonwealth Fund’s report, Mirror, Mirror 2017,2 our health care system provides shockingly poor value and outcomes, and rests on a foundation of greed. It deserves fundamental change.
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The actress Julia Louis-Dreyfus announced on Twitter that she has been diagnosed with breast cancer. We all wish her a speedy and complete recovery. Still, this would not normally be a topic for The Apothecary, except that in making her announcement, she used her diagnosis as a plug for “universal health care,” with the implication that universal health care would improve survival rates. Actual data from countries around the world, with and without so-called universal health care, do not support that contention.
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The #3 reason Medicare-for-All as conceived by Senator Sanders is a bad idea is because of the inevitable rationing it will produce. In other well-known single-payer systems, this rationing takes several forms, including restrictions on the availability of treatments or, more commonly, rationing by waiting.
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The #2 reason this plan is a bad idea is the enormous amount of waste it would create due to moral hazard. Moral hazard is the technical term used by health economists, but it refers to something every reader intuitively understand even if the term itself is unfamiliar. If you give something to someone for free, they will use more of it and they also will be less likely shop vigorously for a lower price. In short, such consumers will typically use more and pay more (i.e., be willing to accept a higher price) for “free” services.
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With one exception, every tax known to man shrinks the economy to some extent resulting in a loss of welfare for consumers and producers [1]. That is, “whatever you tax, you get less of,” whether that be labor, consumption of various products, capital or anything else policymakers have figured out how to tax. The exact amount the economy shrinks (which in turn determines the size of the associated welfare losses to consumers and producers) depends upon exactly what is taxed.
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Obamacare has not done much to slow the growth of health care costs. Government actuaries project that health spending will grow 5.8% a year over the next decade — substantially faster than growth in the economy. Could Republican proposals to sell health insurance across state lines bend the cost curve and make premiums health plans more affordable ?
The idea seems simple enough. Right now, if you are buying your own health insurance, that coverage must be sold by an insurer regulated in your state. Instead of a national market, health insurance is sold in 51 state markets (including D.C.) with differing regulations.
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Congress should enact waiver legislation that clarifies the availability of federal subsidies for the purposes of evaluating waivers’ deficit neutrality, including all potential federal spending that could be offset by a waiver, and evaluates its impact over a long (8-10 year) time period after an initial pilot period. Federal “guardrails” to prevent unintended consequences on patient outcomes and the deficit should focus on collecting data on costs and impact on vulnerable populations, while expanding consumer choices around affordable, high quality plan options.
Congress should also instruct HHS to create a set of standardized, expedited waivers that could be quickly approved, to enhance confidence in the process. Congress should also allow states to form multi-state compacts to share costs and develop the necessary implementation infrastructure.
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Senate Minority Leader Chuck Schumer says he and his colleagues are ready to work with Republicans on an adjustment to the ACA “that stabilizes markets, that lowers premiums.” However, framing the purpose of the talks in this way discourages rank-and-file Republicans to participate in negotiation that has the singular purpose of shoring up the ACA. What is needed is a thorough, top-to-bottom negotiation between both parties over fundamental aspects of the entire health system. For example: How much flexibility should states have to run Medicaid? What can be done to bring more cost discipline to the entire system? What can be done to ensure major health entitlement programs are affordable over the long-term?
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