As Congress works to repeal President Barack Obama’s signature health law, Kentucky Republican Gov. Matt Bevin is already at work unwinding some of its provisions in his state.
Mr. Bevin has dismantled the state’s health-insurance exchange, moving patients to the federal website last year. He has proposed introducing new conditions for recipients of Medicaid, the federal-state health program for the poor, that would require patients to pay premiums of up to $15 a month and perform employment-related or community-service activities, among other provisions
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GOP senators are trying to strike a balance that’s proving difficult: lowering healthcare insurance premiums for young adults while shielding older people from massive price hikes.
At issue is an ObamaCare provision that essentially caps how much insurers can charge older people for premiums.
Republicans want to raise that cap, saying it vastly undercharges older people for their healthcare services, creating higher costs for younger, healthier adults.
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Republican senators on Thursday urged Health and Human Services Secretary Tom Price to reverse an Obama-era regulation that places restrictions on short-term health insurance plans.
The plans do not contain the same comprehensive list of benefits mandated by Obamacare, instead allowing people to choose what they want covered. The greater the number of provisions, the higher the premiums tend to be.
In a letter to Price, 14 senators asked for the plans to go back to being allowed to cover people for 364 days. Customers are not allowed to be enrolled in short-term plans for more than 90 days because of a regulation created by former President Barack Obama.
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Employers and other private purchasers of medical services have played an important role in spurring health care delivery system and payment reform. The development of managed care has been accelerated by federal and state policies over the years but originated with private sector purchasers. Other models, such as accountable care organizations and bundled payments, were initially designed by employers seeking to improve value in the coverage they offered to their employees. These models are now being used to improve quality and lower costs in Medicare and Medicaid.
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Standing in front of Air Force One in Cincinnati with two small-business owners, President Trump recounted how they “have had their lives completely upended by the disaster known as Obamacare.” One saw her choice of doctors shrink while her premiums and out-of-pocket costs soared, he said. The other has curtailed new investments in his company to maintain employees’ health benefits. The president’s comments came following a White House visit with GOP congressional leaders in which the president said he was confident Senate Majority Leader Mitch McConnell (R., Ky.) could “get a bill across the finish line this summer” that would overturn much of the 2010 health law and enact Republican measures in its place.
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The Congressional Budget Office is not politically biased. But its work is beset by challenges that run much deeper than that: They are structural, and require us to think about both the CBO and the larger congressional budget process in which it plays a part in terms of institutional reform. When legislation is built around eccentricities in the CBO model, as Obamacare was in some key respects, the CBO finds itself confronted with some very strange problems. One is the tendency of the CBO to model competition as having minimal effect on costs while modeling price controls to be efficient and effective. Competition is obviously much more difficult to model than mandates and price controls, but the agency’s experience with Medicare Advantage and the Medicare prescription-drug benefit suggests that it tends to significantly understate the effects of competition — which obviously has consequences for its scoring of reforms intended to increase the market orientation of the health-care system.
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Senate Republicans are struggling to agree on health reform, and the biggest divide concerns Medicaid. The problem is that too many seem to accept the liberal line that reform inevitably means kicking Americans off government coverage.
This narrative serves the liberal goal of scaring the public to preserve ObamaCare, but center-right and even liberal states have spent more than a decade improving a program originally meant for poor women and children and the disabled. Even as ObamaCare changed Medicaid and exploded enrollment, these reforms are working, and the House bill is designed to encourage other states to follow.
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One of the nation’s biggest health insurers says it will not return to Ohio’s public insurance exchanges next year, a decision that could open more holes in the Affordable Care Act’s increasingly thin system for helping people buy coverage.
The move announced Tuesday by Anthem could leave shoppers in 20 counties without an option for buying individual coverage on the exchange unless another insurer steps in.
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Boosting enrollment is also important for stabilizing the individual insurance market. Currently, under the ACA, the markets are less stable than they could be, or should be, because there are too few younger and healthier enrollees. Automatic enrollment would boost enrollment into insurance among this group of potential customers, and thus help create a more balanced risk pool.
We believe that automatically enrolling Americans eligible for tax credits into no-premium health plans should be an important component of a renewed effort at health reform. Many of the uninsured who do not make plan selections on their own can be enrolled into plans that provide true insurance against significant or catastrophic health events.
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According to Robert Wood Johnson Foundation data that looks at state markets where all insurers must sell plans that meet Obamacare standards, regardless of how they’re purchased, more than half of the 22 million people who buy their own insurance use Obamacare marketplaces, where most of them get a federal tax credit to help pay for coverage. The rest buy directly from an insurer or broker, and they do not get a tax credit. Supporters of the Affordable Care Act hoped the law would spur more competition among insurers across the country. But so far, the law has not delivered on that promise, especially in states that never had much competition. Even before Obamacare, there have always been two distinct markets: states that still have plenty of competition and states that rely heavily on one or two insurers. In 15 states, eight or more insurers offer Obamacare plans. They are mostly the same ones where no single insurer had a dominant share of the market in 2013, before the law was enacted. But the 19 states that currently have fewer than five carriers statewide are all ones where a single insurer had more than half of the overall market before Obamacare.
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