After years of being a central political question, health care is on the back burner. Both parties contain experts and activists who want to make major changes to health policy. But for now, both parties’ politicians are wary. Democrats are, as usual, more interested in the subject than Republicans, but they are somewhat divided about what to do next and in any case are not yet in a position to enact anything. Republican politicians, meanwhile, seem to have concluded from their failed efforts to repeal and replace Obamacare that the whole issue is best avoided. It is not surprising, then, that talk of a bipartisan deal to shore up Obamacare’s insurance exchanges has petered out.
. . .
Having failed to repeal the Affordable Care Act, congressional Republicans now want to create a new corporate welfare program to save it. Here’s a better idea: Congress and the administration should give states more latitude to clean up the mess—at no additional cost to the federal government. That is a central recommendation of a new study co-authored by Doug Badger, Senior Fellow at the Galen Institute, and Rea Hederman, Vice President of Policy at The Buckeye Institute. The study examines congressional and federal proposals that surfaced throughout last year in the broader context of the “repeal and replace” debate. The most promising ideas to repair broken insurance markets emanated not from Washington, but from the states. Read the full Mercatus Center study here.
. . .
The Center for American Progress’s new “Medicare Extra for All” proposal is a repackaged version of the congressional Democrats’ 2009’s “public option” proposal. It imagines that large savings can be generated by extending Medicare’s price controls for hospital care, beyond the elderly and disabled, to the purchase of hospital care for other patients. Individuals and employers would be allowed to buy into the system, to take advantage of these discounted rates. Yet, the monopoly power which has inflated prices for hospital care provided to privately funded patients is a deliberate product of policy, intended to sustain the solvency of hospitals in counties across the United States, which would be unviable in a competitive market.
. . .
Congressional Republicans were elected to repeal Obamacare. They may run this year as the politicians who saved it. Since late last year, GOP leaders have been planning to pump tens of billions of dollars’ worth of new federal spending into the veins of insurance companies that are hemorrhaging red ink on the Obamacare exchanges.
The transfusion is expected to be a concoction of two bills. The first, championed by Sens. Lamar Alexander (R., Tenn.) and Patty Murray (D., Wash.), would appropriate cost-sharing-reduction payments to insurers. The second, sponsored by Sens. Susan Collins (R., Maine) and Bill Nelson (D., Fla.), would give insurers an additional $10 billion (and perhaps more) in federal cash.
. . .
Because this exemption applies to employer-sponsored insurance but not individual coverage or out-of-pocket spending, it encourages group plans over consumer control. It should not be seen as sacred. However, the cap imposed by the Cadillac tax will become increasingly tight over time, which risks pushing Americans into public entitlements rather than empowering them as consumers. Policymakers should keep the Cadillac tax from biting too deeply — but a better way to end the tax bias toward employer-based plans would be to extend the tax exemption to health care that individuals purchase by themselves.
. . .
Seemingly lost in the news of last week’s big tax-cut victory for the GOP was the repeal of the individual mandate — the Obamacare provision that required Americans to have health coverage or else pay a penalty. This is, to borrow a phrase from Vice President Joe Biden, a “big f***ing deal.” It is a big victory for conservatives, who disdained the mandate as government coerciveness. But from a broader perspective, the rise and fall of the mandate is yet another example of how Congress struggles to regulate the national economy.
. . .
The Senate this week is expected to vote on a tax bill that includes a controversial provision to repeal Obamacare’s tax penalty on the uninsured. Democrats and some conservative policy analysts fret that if Congress scuttles the so-called individual mandate, insurance premiums will rise.
The reverse may be closer to the truth: Premiums for Obamacare policies next year will be so high that millions will be exempt from the tax penalty whether Congress repeals it or not. Even the skimpiest coverage now costs so much that many uninsured people with six-figure incomes will be exempt.
. . .
Lots of observers, including some very well placed ones in Congress, argue that health care will just be put aside now for a time and will wait for a later opportunity. They say it’s time to turn to tax reform. The “put it aside” argument assumes that the Trump administration will just continue to administer Obamacare as it has been, which is unlikely. This fall we may well see a much expanded “hardship exemption” for the individual mandate that could render the mandate essentially void, and the administration may also stop providing funds for cost-sharing reduction payments if Congress does not appropriate money for them.
. . .
The last train is leaving Reconciliation Station. Republican efforts to repeal and replace Obamacare — derailed just weeks ago — now seem back on track. GOP senators Lindsey Graham of South Carolina, Bill Cassidy M.D., of Louisiana, Dean Heller of Nevada, and Ron Johnson of Wisconsin seek 47 more votes (including, if necessary, that of Vice President Mike Pence, to break a 50–50 tie) to pass their legislation within the Senate’s filibuster-proof reconciliation window. It closes September 30. Having snored through August, Republicans are scrambling to keep the repeal/replacement pledges that secured them the House, Senate, and White House.
. . .
The ACA spends more than twice as much on expanding Medicaid as it does on premium tax credits for the exchange. By consolidating funding for both entitlements, Graham-Cassidy allows states to pool resources to increase the attractiveness and stability of the individual market. In doing this, it meets a clear need, but it also facilitates more thorough reform by repealing the individual mandate and potentially allowing fairly priced, fully competitive insurance to be offered outside of the exchanges. It also greatly expands the flexibility and potential uses of Health Savings Accounts. France presses Trump to reconsider climate deal
. . .