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

Obamacare does not have a mandate. Wait: Has Marco Rubio proposed an individual mandate? The Cato Institute’s Michael Cannon and James Capretta of AEI have engaged in a spirited and informative point-counterpoint on that question here at NRO. Cannon writes that Rubio’s Obamacare-replacement plan is built “around an individual mandate.”  Capretta responds by noting that Rubio proposes to repeal all of Obamacare, including “the requirement that all Americans buy government-approved health insurance,” commonly known as the individual mandate.

Pulling Americans from Obamacare’s wreckage should be among the next president’s most urgent priorities. Costs are rising, choices contracting, and regulation metastasizing. Reform will not be easy to achieve. Replacing Obamacare will require open and robust discussion, a process that is more likely to succeed if we’re all speaking the same language and using words to inform, not inflame.

Last week at the Houston GOP presidential debate, Marco Rubio hammered Donald Trump on his ignorance of health care policy. “What is your plan, Mr. Trump?” asked Rubio. “The lines around the states,” Trump feebly responded. When Trump was asked if his plan had any other provisions, Trump said “no, there’s nothing to add.” That embarrassing performance has led the Trump campaign to put out what now purports to be the official Donald Trump health reform plan. And all you need to know to understand this plan is that it bears little relation to the things Trump has actually said on health care.

Donald Trump on Wednesday laid out for the first time how he will reform the U.S. health care system after repeatedly pledging to “repeal and replace Obamacare with something much better.”

Trump published a seven-point health care reform plan that calls for repealing Obamacare, breaking down state barriers that prevent the sale of health insurance across state lines and making individuals’ health insurance premium payments fully tax deductible.

The reforms, which Trump calls “simply a place to start,” are aimed at broadening access to health care, making health care more affordable and improving the quality of care, according to the plan published on Trump’s campaign website.

The vast majority of Americans have not benefited from Obamacare, according to a poll released by National Public Radio, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health Monday.

56 percent of Americans polled said they don’t believe the Affordable Care Act has directly impacted them. Of those surveyed who said it did have a direct impact, more said health care reform has been overall detrimental rather than positive — coming in at 25 percent and 15 percent respectively.

Senator Rubio is proposing to fix a longstanding problem in federal tax law. He wants to make sure that all Americans get a comparable tax break for health insurance, regardless of whether or not they get their insurance through their place of work. For many years, federal law conferred a generous tax break for health insurance only on employer-paid premiums, which are excluded from the taxable compensation of workers for both income- and payroll-tax purposes.

Obamacare’s defenders would say that Obamacare fixed this problem by giving households credits that they can use when they buy insurance through the law’s “exchanges.” But the Obamacare credits are not connected in any way with the value of the tax benefit for employer-provided coverage, they are income-tested and thus phase out for middle-income families, and they can be used only to purchase heavily regulated plans.

Rubio’s proposal would truly level the playing field by first getting rid of Obamacare and then giving Americans who buy insurance on their own, rather than through their place of work, a tax credit of roughly comparable value to the tax break conferred on an employer plan of average cost.

The State Department released the last batch of Hillary Clinton’s emails on Monday, and the exercise has been instructive about her recklessness with classified material. But as a side note, we ought to memorialize what President Obama’s aides were telling Mrs. Clinton about the Affordable Care Act, which was the opposite of what their boss was telling the public.

Despite her duties as top diplomat, Mrs. Clinton found time to follow ObamaCare’s progress in Congress, and she received regular updates from Neera Tanden, then a White House health staffer. Ms. Tanden is now president of the liberal Center for American Progress, Mrs. Clinton’s economic policy shop.

The insurance industry must be kicking itself for backing ObamaCare. Several have since posted big losses and it looks like Blue Cross Blue Shield got the losing end of the stick, too.

Fitch Ratings looked at nearly three dozen BCBS companies and found that 23 saw a decline in earnings that totaled $1.9 billion in the first nine months of last year, while 16 had net losses.

Blue Cross Blue Shield of Michigan lost $622 million from January through September last year. Blue Cross plans in Texas, Oklahoma, New Mexico and Montana lost $442 billion. And those in Pennsylvania, Delaware and West Virginia lost $266 million.

The reason is ObamaCare.

Or as Fitch puts it: “Cost and utilization trends from state insurance exchanges from the Affordable Care Act have been higher than anticipated and are the primary drivers of declining earnings.”

When pressed during last Thursday night’s campaign debate in Houston for details of his proposed plans for replacing Obamacare after it is repealed, presidential candidate Donald Trump (?-NY) once again sputtered out something about eliminating “those lines” that states draw in regulating health insurance. What that exactly means involves some Trump-Land-to- Policy-World translation, and a little primer on what’s usually understand and misunderstood in this area of health policy.

Trump appears to be borrowing some of the language behind a traditional conservative Republican health reform proposal, which involves facilitating competition in health coverage through the sale and purchase of insurance products across states. It’s sometimes referred to as interstate competition or competitive federalism, or even just “consumer choice.”

Cato’s Michael Cannon has doubled down in his latest Forbes column on his outrageous claim that,“Yes, Marco Rubio’s Obamacare Replacement Plan — Tax Credits — Is An Individual Mandate.”

Sen. Rubio’s health policy plan provides an advanceable, refundable tax credit that can be used to purchase insurance. This idea is a centerpiece of free-market health policy. It would create fairness by equalizing the tax treatment of health insurance between those currently receiving employer-based health insurance and those who are shut out of this market.  It would allow portability of coverage, make costs more transparent, and turn down the fires on the inflation-generating tax exclusion for job-based health insurance.

Cannon explains the Rubio tax credit this way: “If you purchase a government-approved health plan, you could save, for example, $2,000 on your taxes. If you don’t, you pay that $2,000 to the government. That is exactly how Obamacare’s individual mandate works.”

Political uncertainty isn’t the only threat to the Affordable Care Act’s future. Cracks also are spreading through a major pillar supporting the law

Health insurance exchanges created to help millions of people find coverage are turning into money-losing ventures for many insurers.

The nation’s largest, UnitedHealth Group Inc., could lose as much as $475 million on its exchange business this year and may not participate in 2017. Another major insurer, Aetna, has questioned the viability of the exchanges. And a dozen nonprofit insurance cooperatives created by the law have already closed, forcing around 750,000 people to find new plans.

More insurer defections would lead to fewer coverage choices on the exchanges and could eventually undermine the law, provided the next president wants to keep it.