Why it matters: Health care costs are one of the top issues voters say they care about, but any plan to address them would likely need to be bipartisan.
Forget the Affordable Care Act: The future of our health care system will be shaped by a much bigger and broader fight — one that will likely culminate with a 2020 choice between private markets and an authentic government-run program in the form of a Bernie Sanders-style Medicare for All.
The bottom line: The cost of health care — both for individuals seeking coverage and the government seeking sustainability — promises to return as the biggest domestic issue once the Trump obsession burns off.
. . .
The next great health care war is already starting. It’ll be about costs this time, not coverage, and Democrats are the ones firing the first shots — though neither party has a complete strategy just yet.
Why it matters: After a bruising, decade-long fight over the Affordable Care Act, plenty of candidates and lawmakers would love to keep their distance from the politics of health care. But the issue is so personal, and the system is so dysfunctional, that may be impossible.
CBO is anticipating a 21% jump in the cost of federal subsidies this year, driven by a 34% jump in premiums for the “benchmark” plans to which those subsidies are pegged.
But after that, CBO expects a big slowdown. Federal spending on the ACA’s premium subsidies will likely grow by about 5% per year for the rest of the next decade, the budget office said. Those annual increases are mainly a result of rising health care costs.
. . .
Sens. Lamar Alexander and Susan Collins have proposed a market stabilization package that would include funding for the Affordable Care Act’s cost-sharing reduction subsidies for three years, three years of federal reinsurance at $10 billion a year, additional ACA waiver flexibility for states, and expanded eligibility for “copper” plans.
. . .
Here’s what the Department of Health and Human Services could do:
- Relax rules so companies of all sizes can take advantage of HRAs. Medium-sized and large employers want the same option of setting up HRAs for workers to buy ACA coverage, said Chris Condeluci, who worked on the ACA as a Senate GOP staff attorney.
- Now that the individual mandate has been repealed, the administration could open the door for companies “to provide funds to buy noncompliant coverage,” said Gary Claxton, a vice president at the Kaiser Family Foundation.
. . .
Using 2017 data: Out of 9,201,805 healthcare.gov enrollees, here’s how many would win and lose if the insurer subsidies were now funded:
- Winners: 682,712 unsubsidized exchange enrollees enrolled in middle-of the-road “silver” plans
- Losers: 1,621,325 enrollees who receive premium subsidies and don’t have silver plans
- Likely losers: 1,706,780 enrollees with silver plans and incomes between 200%-400% of the federal poverty level.
. . .
American workers have not seen their wages grow in tandem with the success of their employers.
Meanwhile, health spending has been growing faster than the broader economy. Health benefits consequently are getting more expensive for employers to offer, and companies are responding by making employees shoulder more of their own health care costs — either through higher premiums or higher out-of-pocket costs, like deductibles and copays.
. . .
Now that Congress has passed a bill funding the Children’s Health Insurance Program — more than three months after funding expired — the clock is ticking as lawmakers work at putting together a package to stabilize the individual insurance market.
. . .
It is generally assumed that the biggest obstacle to a national health plan like Medicare for All will be the large tax increase needed to pay for it. But new polling shows another challenge: Almost half of the American people don’t know that they would have to change their current health insurance arrangements if there was a single-payer plan.
. . .