Since October, at least six independent and credible sources have confirmed rate increases on the ObamaCare exchanges will be in the double digits. However, these are gross premium hikes. Net premium hikes paid by enrollees are distorted by tax credits paid to insurers. These badly designed tax credits have a number of perverse consequences. It is widely understood that they impose disincentives to work. What is less well understood is that the tax credits are so badly designed that they impose a ratchet effect causing net premium hikes greater than the gross premium hikes. According to new research published by the National Center for Policy Analysis, this effect is concentrated among ObamaCare enrollees in the lowest income brackets.
Daniel Mitchell at the Cato Institute has proposed a “golden fiscal rule:” ensure that government spending, over time, grows more slowly than the private economy. This is an idea that should command support from fiscal conservatives on both sides of the aisle, not just libertarians.
Mr. Mitchell has done a more than adequate job demonstrating that “nations that imposed genuine spending restraint for multiyear periods reaped big benefits.” But we also know that growth in federal health spending continues to outstrip growth in the economy. As I have stated repeatedly in other posts, ObamaCare has not eliminated the nation’s long term spending problem. My purpose in this post is to show how dramatically non-health spending (including defense) if we were to adopt the golden fiscal rule.
Blue Cross and Blue Shield of NC is expecting to lose more than $400 million on its first two years of Obamacare business. According to this morning’s News and Observer, “The dramatic deterioration in Blue Cross’ ACA business is causing increasing alarm among agents and public health officials.” In response to its bleak experience with the ObamaCare exchange, the company has decided to eliminate sales commissions for agents, terminate advertising of ObamaCare policies, and stop accepting applications on-line through a web link that provides insurance price quotes–all moves calculated to limited ObamaCare enrollment.
Chris Conover of Duke University’s Center for Health Policy & Inequalities Research explains what we can learn from North Carolina’s experience.
Yesterday, in its budget and economic outlook for the next decade, the Congressional Budget Office substantially changed its short-term Affordable Care Act estimates in ways that show the law is performing far worse than expected. CBO’s new projection of 13 million exchange enrollees in 2016 is nearly 40% below previous expectations. CBO’s also projects that the average subsidy per enrollee in 2016 will increase by about 18% relative to its March 2015 ACA estimate—an indication that enrollees are both less healthy and poorer than the agency originally projected.
The law being implemented today is in many ways quite different than the law passed by a very temporary super-majority of Democrats back in 2010. It is highly likely that the ACA-as-implemented could not possibly have secured enough votes for passage in March 2010.
Likewise, we already know that neither the ACA-as-enacted nor ACA-as-implemented could possibly secure majority support in today’s Congress. Not only do all Republican presidential candidates want the law repealed and replaced, but so does the current front-runner in the New Hampshire Democratic primary.
Too many in the general public do not realize that five provisions of Obamacare have already been repealed.
One of the many factors that can cause a health insurance system to fail is “adverse selection,” a phenomenon in which those who know they will make higher-than-average claims are disproportionately likely to enroll and pay premiums. The inevitable results is a rapid increase in premiums, which encourages even more marginal consumers to forgo insurance, leaving average claims, and therefore premiums, to increase even further.
One approach to limit this problem is to limit the time frame during which enrollment is permitted. Why have limited open enrollment periods? The idea is that without them – that is, if anyone could enroll in health plans whenever they want – people could “game the system,” enrolling when they need health care, and disenrolling when they don’t.
One reason why the anger over ObamaCare has subsided somewhat could be that more than 70 significant changes have been made to the law since it was enacted in 2010—delaying, weakening, and eliminating some of its more onerous and burdensome provisions. The law that is being implemented is not the one Congress passed.
By our updated count at the Galen Institute, at least 43 of the changes to the Affordable Care Act have been made unilaterally by the Obama administration, 24 have passed Congress and been signed into law by President Obama, and three were made by the Supreme Court, which had to rewrite the law to uphold it.
Yesterday, the nonpartisan Congressional Budget Office released its annual ten-year Budget and Economic Outlook. The document contains the CBO’s updated estimates for economic growth, employment, and the nation’s fiscal health. The most notable change was to enrollment in Obamacare’s health insurance exchanges. The CBO, bowing to reality, slashed their 2016 estimates of exchange enrollment from 21 million to 13 million. Furthermore, the CBO implied that it expects exchange enrollment to peak at 16 million: a far cry from the 24 million it predicted last March.
Sen. Sanders claims he can provide free health care for all Americans even while saving $6.3 trillion over the next 10 years. In truth, the actual cost of the Sanders health plan will be at least 40% more than he claims. In the worst case, it will be 49% higher.
Moreover, the increase in federal taxes required to fund his plan will not be the $13.8 trillion claimed by the economics professor who is advising Sanders, nor even the $28 billion estimated by fellow Forbes colleague Avik Roy: the new federal taxes required to fund the Sanders health plan will be $36.3 trillion!
In short, the Sanders health plan would require a 71% increase in federal spending over the next decade.
In their final debate before they face Democratic primary voters, Hillary Clinton and Bernie Sanders traded sharp jabs on health care. Pundits focused on how the barbs would affect the horse race, whether Democrats should be bold and idealistic (Sanders) or shrewd and practical (Clinton), and how Sanders’ “Medicare for All” scheme would raise taxes by a cool $1.4 trillion. (Per. Year.) Almost no one noticed the obvious: the Clinton-Sanders spat shows that not even Democrats like the Affordable Care Act, and that the law remains very much in danger of repeal.