The impact of ObamaCare on doctors and patients, companies inside and outside the health sector, and American workers and taxpayers
Single-payer is back on the docket in California. Late last month, Assembly Speaker Anthony Rendon announcedthat he’d formed a special committee “to develop plans for achieving universal health care in California.”
Rendon has been under pressure from progressive activists all summer, ever since he shelved SB 562, a bill passed by the state Senate on June 1 that would put all the state’s residents into a new, state-run single-payer healthcare system. At the time, he deemed it “woefully incomplete.” SB 562 did not specify how, exactly, the state would pay for single-payer.
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Donald Trump’s gleeful deal with the Democrats—ratcheting up the debt ceiling, as well as the ire of the Republican establishment—puts John Cogan’s mind on 1972. Starting in February of that year, the Democratic presidential candidates engaged in a bidding war over Social Security to gain their party’s nomination. Sen. George McGovern kicked off the political auction with a call for a 20% increase in monthly payments. Sen. Edmund Muskie followed suit, as did Rep. Wilbur Mills, chairman of the Ways and Means Committee. Former Vice President Hubert Humphrey, never one to be outdone, offered a succulent 25%.
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eHealth, Inc. CEO Scott Flanders endorsed the Department of Health and Human Service’s (HHS) decision to reduce and rethink the Affordable Care Act’s (ACA or Obamacare) navigator program, which spent over $62 million to enroll 81,000 people in Obamacare in 2017 ($768 per enrollment).
“Secretary Price has an obligation to the American people to use their money effectively and efficiently, and the navigator program failed on both fronts,” said Scott Flanders, CEO of eHealth, Inc. “The navigator program’s results are discouraging, but HHS’ decision to acknowledge that failure and try something else is a positive step for government.”
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Health and Human Services announced that the agency will alter the funding structure for ObamaCare “navigators.” These are the community outfits the Obama Administration paid to steer folks through the Affordable Care Act’s subsidies and penalties. Last year the Obama Administration handed out $62.5 million in grants for open enrollment for 2017, and the period arrives again in November.
One grantee took in $200,000 to enroll a grand total of one person. The top 10 most expensive navigators collected $2.77 million to sign up 314 people, and it would have been much cheaper to offer to pay all of their premiums for a year. All told, the navigators last year enrolled about 81,000 people, less than 1% of the total.
The Trump Administration will tie grants to performance.
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In an effort to promote medical breakthroughs, the 21st Century Cures Act tries to create an “information commons”: a government-regulated pool of data accessible to all health researchers, regardless of background, training or motive.
Although speeding research is a noble goal, there’s little evidence that patients are willing to sacrifice their privacy the way that the 21st Century Cures Act requires.
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While Republicans fret over how many taxpayer-funded patches they will have to stick on ObamaCare to keep it on life-support, Democrats are already moving on to their real goal: a government-run, single-payer healthcare system.
Moderate Republicans like Sen. Lamar Alexander (R-Tenn.) are hoping to find bipartisan support for legislation that will save the individual (i.e., non-group) health insurance market and keep the ObamaCare exchanges from collapsing.
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The government says about 500,000 fewer Americans had no health insurance the first three months of this year, but that slight dip was not statistically significant from the same period in 2016.
Progress reducing the number of uninsured appears to have stalled in the last couple of years, and a separate private survey that measured through the first half of 2017 even registered an uptick.
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It looked just like a campaign launch, from the line winding around the Fellowship Chapel Church, to the tailgaters giving away hot dogs, to the 2,000 voters who eventually packed inside.
But when Sen. Bernie Sanders (I-Vt) and Rep. John Conyers Jr. (D-Mich.) arrived, there were no waving signs. They were there to kick off the push for universal health care, with legislation queued up for September, and no expectation that the Republican-controlled Congress would pass it.
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In Part 1, we learned that real per capita health spending saw a 25-fold increase the 8 decades starting in 1929 even as real per capita GDP grew only 5-fold during the same period.
In Part 2, we learned that annual excess growth in inflation-adjusted health spending above and beyond general economic growth has been a persistent phenomenon: from 1929 to 2015, the average rate of growth in real per capita health spending (4.1%) was slightly more than double the rate experienced in the rest of the economy (2%).
Today we will examine the consequences of this outsized growth in health spending: health spending–which includes both spending on health services (“health care”) as well as health insurance–absorbs an ever-growing fraction of the economy and government spending (in this post, my term “health spending” is equivalent to the official government term used by actuaries at the Centers for Medicare and Medicaid Services: National Health Expenditures or NHE: it includes both spending for medical care services/supplies/medications as well as health insurance and the attendant administrative costs borne by health care providers and health insurers; in short, it includes everything).
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A recent study by Express Scripts Holding found that about a quarter of Medicaid patients were prescribed an opioid in 2015. Wisconsin Sen. Ron Johnson presents intriguing evidence that the Medicaid expansion under ObamaCare may be contributing to the rise in opioid abuse. According to a federal Health and Human Services analysis requested by the Senator, overdose deaths per million residents rose twice as fast in the 29 Medicaid expansion states—those that increased eligibility to 138% from 100% of the poverty line—than in the 21 non-expansion states between 2013 and 2015.
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