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

Jonathan Gruber, the embattled Massachusetts Institute of Technology economist whose comments about President Barack Obama’s health law touched off a political furor, worked more closely than previously known with the White House and top federal officials to shape and influence the law, according to previously unreleased emails.

Long before there was the Affordable Care Act, presidential candidate and Democratic front-runner Secretary Hillary Clinton was advocating for her own version of health care reform, popularly known as “Hillarycare.” While the Clintons failed to successfully implement Hillarycare, a little over a decade later, President Barack Obama passed “Obamacare,” which effectively overhauled the United States health care system. While the general refrain in the media touted that Obamacare was different than Hillarycare, the two are actually very similar in structure and regulation.

The Affordable Care Act created a new kind of “cooperative” heralded by supporters of health reform. These Consumer Operated and Oriented Plans, chartered and regulated by the states, would compete with for-profit health-insurance companies and were meant to appease disgruntled advocates of a single-payer and “public option” model for the nation’s health-care system.

Most of the 13 state-run public health insurance have collectively spent $4.8 billion in federal funding during their first 17 months of operations and face serious cash-flow problems, according to a website named after the late conservative commentator Andrew Breitbart.

And with major insurance carriers seeking HIX premium increases of up to 51% in some states, the report suggested marketplace mergers as one political solution. It noted that both Covered California and Vermont Health Connect significantly overestimated enrollment and now must slash advertising, outreach and technology services.

The Congressional Budget Office (CBO) has just released a report on the budgetary and economic effects of repealing the Affordable Care Act (ACA). Press reports reflect what CBO has reported pursuant to its scoring instructions – specifically, that relative to its scorekeeping baseline, repeal of the ACA would worsen the federal deficit but bolster the economy. CBO’s new inclusion of economic feedback with the score – finding that the ACA’s adverse economic effects make the deficit $216 billion worse over the next decade than it otherwise would be – is naturally fostering additional attention. Less noted, however, is the important fact that CBO’s analysis actually indicates that repealing the ACA would lower, not increase, federal deficits.

America’s biggest health insurers are about to get even bigger, driven into a wave of consolidation by Obamacare’s new regulations and markets.
Anthem’s disclosure Saturday that it’s offered about $47 billion for Cigna Corp. is the first public confirmation the deal-making is in full swing. Cigna rejected the offer on Sunday, despite Anthem’s attempt to pressure Cigna’s board by taking the offer public. Anthem, Aetna Inc. and UnitedHealth Group Inc. all are poised to emerge as buyers or sellers when the dust settles.

The five largest commercial health insurers in the U.S. have contracted merger fever, or maybe typhoid. UnitedHealth is chasing Cigna and even Aetna; Humana has put itself on the block; and Anthem is trying to pair off with Cigna, which is thinking about buying Humana. If the logic of ObamaCare prevails, this exercise will conclude with all five fusing into one monster conglomerate.

Many American conservatives oppose universal health insurance because they see it as fundamentally antithetical to a free society. “If we persevere in our quixotic quest for a fetishized medical equality we will sacrifice personal freedom as its price,” wrote a guest editorialist in the ]Wall Street Journal in 2009. But according to the Heritage Foundation, a leading conservative think tank, ten nations freer than the United States have achieved universal health coverage. It turns out that the right kind of health reform could cover more Americans while increasing economic freedom.

The fiscal year 2016 budget resolution passed by Congress in May requires the Congressional Budget Office and the Joint Committee on Taxation to include the macroeconomic feedback effects of changes in policy on the budget when evaluating major legislation (CBO and JCT are the official number crunchers of Congress).

Specifically, Section 3112 of the resolution requires CBO and JCT to “incorporate the budgetary effects of changes in economic output, employment, capital stock, and other macroeconomic variables resulting from such major legislation.”

Voters will weigh many factors when assessing the Republican candidates for president in 2016, including their professional experience, leadership qualities, political dispositions, and other important attributes. These are all important considerations, of course. But governing is mainly a question of deciding on a policy and then implementing it. And so voters will be eager to hear what the candidates would actually do if elected.

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