The impact of ObamaCare on doctors and patients, companies inside and outside the health sector, and American workers and taxpayers

This week, President Obama published an President Obama published an article in the Journal of the American Medical Association that is likely to be his last and most comprehensive defense of the Affordable Care Act — a.k.a. Obamacare — while in office. Not surprisingly, it’s a rather one-sided accounting.

The president says the law has reduced the number of uninsured Americans, slowed the pace of rising health-care costs, and improved access to high-quality health care for millions of Americans. He also says more progress would have been made if not for the “hyperpartisanship” infecting Washington. He betrays no hint of self-awareness that perhaps his own conduct and statements, and the manner in which the law was pushed through Congress and enacted, might have been causes of the deep divisions in health-care policy that have persisted throughout his presidency.

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Health spending in the U.S. grew to $3.2 trillion in 2015, fueled partly by the expansion of health insurance to millions of people under the Affordable Care Act, according to a new estimate published in the journal Health Affairs.

The study also looks forward, projecting that through the next decade, national health spending will climb at 5.8 percent per year, on average, to encompass a fifth of the economy by 2025.

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President Obama reflected upon the Affordable Care Act in an article published this week in the Journal of the American Medical Association. He acknowledged the law’s shortcomings and outlined what he believes to be the next steps in health care reform.

The President concluded, “Policy makers should build on progress made by the Affordable Care Act by continuing to implement the Health Insurance Marketplaces and delivery system reform, increasing federal financial assistance for Marketplace enrollees, introducing a public plan option in areas lacking individual market competition, and taking actions to reduce prescription drug costs.”

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Centrist Democrats appear reluctant to join their party’s embrace of a public option for ObamaCare.

The idea of adding a government-run insurance option to compete with private insurers is making a comeback in the Democratic Party, with President Obama endorsing the idea Monday, two days after presumptive Democratic presidential nominee Hillary Clinton emphasized a public option as part of an effort to win over Bernie Sanders and his supporters after a contentious primary.

But among more centrist members of the Senate, where the “public option” was stopped in 2009, there is little enthusiasm for the idea.

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Bernie Sanders formalized the Democratic Party’s left turn on Tuesday, finally endorsing Hillary Clinton and praising her for embracing so many of his ideas. “We have begun a political revolution to transform America, and that revolution continues,” the Vermont socialist said—and the latest evidence for his boast is the revival of ObamaCare’s “public option.”

This liberal ambition—a new health-care entitlement akin to Medicare for all middle-class Americans under age 65—couldn’t pass a Democratic Congress in 2010. Mrs. Clinton revived the public option over the weekend, and now President Obama is also lending his support, in an op-ed that appears under his byline in this week’s Journal of the American Medical Association.

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The Republican assertion that the administration is spending on health insurance subsidies without required congressional authority hasn’t gotten much news coverage. Many people dismiss it as yet another time-wasting attempt by Republicans to undermine the president’s signature domestic policy achievement.

But the central issue goes beyond health care to the fundamental division of federal power, particularly in a time of deep fissures between the legislative and executive branches.

Congress is supposed to approve every penny of federal spending. But the institution is in such partisan disarray that the appropriations process barely functions, giving rise to the temptation for presidents to assert greater power over the purse, marginalizing Congress.

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Hillary Clinton reaffirmed her support on Saturday for creating a “public option” within Obamacare and allowing people to enroll in Medicare at age 55.

The presumptive Democratic presidential nominee also called for a substantial increase in funding in medical clinics that serve low-income Americans, fully embracing a proposal from Sen. Bernie Sanders (I-Vt.).

While Clinton has long supported the creation of new government-run insurance options and reiterated that support several times this year, Saturday’s statement comes three days before she is scheduled to make her first joint campaign appearance with Sanders ― who has championed government-run insurance and federally financed clinics throughout his career and during his own bid for the presidency.

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In 2013, one Affordable Care Act component taking effect — a medical device excise tax — imposed a new financial burden on American Laboratory Products Co.

The 2.3 percent tax on revenue took a bite out of the company’s bottom line, “no question about it,” said Sean Conley, president of the family-owned-and-operated Alpco. “This obviously has an impact on where our funds go and makes it a bit more challenging to continue to create new jobs.”

The controversial medical device tax was a focus of conversation Friday when U.S. Sen. Kelly Ayotte visited the company for a discussion and tour.

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As Hillary Clinton prepares to take another big step toward supporting liberal calls for universal health care coverage, a new study concludes that Donald Trump’s proposals for replacing Obamacare would strip nearly 18 million mostly low-income Americans of their current coverage.

The study by the non-partisan Center for Health and Economy provides the first detailed analysis of the presumptive GOP nominee’s scattershot proposals on health care. They include removing barriers to the sale of health insurance across state lines, expanding the use of health savings accounts to mitigate the cost of high-deductible insurance policies and allowing households to deduct premiums from their taxable income.

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The release of the House GOP health-care plan last month was a milestone event in the long-running debate over the future of health care in the United States. Republican leaders had been promising to repeal and replace the Affordable Care Act — a.k.a. Obamacare — since it was enacted in 2010. But this is the first time that GOP leaders in Congress have presented a plan that could accurately be described as “the Republican alternative.” If the GOP is in a position in Congress to take up health-care legislation in 2017 (or later), this plan will almost certainly be the starting point.

House Speaker Paul Ryan deserves the credit for making this happen. He announced last fall after taking over the speakership that he wanted the GOP to offer a proactive agenda in order to give voters a clear idea of what Republicans would do if given the opportunity to govern. He followed through on that promise by getting his House colleagues to support plans for top-to-bottom reform of most key responsibilities of the federal government.

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