Escalating premiums, higher plan deductibles, higher out-of-pocket maximums, and narrowing provider networks are all manifestations of the basic flaws in Obamacare’s public policy architecture. One effect is that Obamacare’s maximum out-of-pocket limits are higher than those for HSA-compatible plans. As a result, over half of all plan designs offered on Healthcare.gov in 2018 have out-of-pocket maximums that are too high for the plan to qualify as HSA-compatible. Congress needs to get back to work on repairing the damage done to the individual insurance market by Obamacare.
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New data from insurance company regulatory filings show that enrollment in the individual health insurance market declined significantly last year—by 10 percent, or 1.8 million people.

Over the three years prior to the implementation of Obamacare (2011 through 2013), enrollment in the individual market was basically stable—fluctuating narrowly between 11.8 million and 12 million persons. With the introduction of Obamacare, enrollment jumped to 16.5 million in 2014, peaked at 17.7 million in 2015, and then declined to 17.1 million in 2016.

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Policymakers should provide consumers more freedom to choose the insurance coverage that is best for their families. A useful first step: rescinding an Obama Administration–imposed federal rule that improperly limits the sale and renewal of short-term limited-duration (STLD) health insurance policies. While this will afford consumers some relief, Congress should go further by supporting Trump Administration efforts to provide access to more affordable insurance by replacing Obamacare with a solution that returns resources and flexibility to the states. Taken together, these steps provide policymakers concrete options that would do much to help consumers find affordable alternatives to Obamacare policies.
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83% agree if private insurance companies lose money selling health insurance under the Obamacare program, taxpayers should not have to bail them out to cover their losses.

67% agree subsidies to insurance companies are not only a bailout for the companies but also hide the fact that Obamacare is failing.

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Key Takeaways

  1. It appears that Congress, backed by powerful special interests in the health care industry, is getting ready to bail out, once again, Obamacare’s a failing program.
  2. The bottom line: Taxpayers still end up paying more over the next several years for a failing health insurance scheme.
  3. We are witnessing the evolution of a classic government failure, and Congress is getting ready to reward that failure with another round of corporate bailouts.

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Congress reportedly is contemplating appropriating more federal funding to prop up the Affordable Care Act (ACA, also known as Obamacare) and its harmful policy regulations. The radical and unnecessary changes in insurance regulations made by the ACA created much bigger problems in the insurance market that upended existing federal and state regulation of health insurance, destabilized the individual health insurance market, and resulted in higher costs and fewer choices. Ultimately, Congress can help Americans who are suffering from higher costs and premiums by resuming efforts to address the cause of this suffering by repealing and replacing Obamacare itself. Instead of a bailout, a good place to start would be to give states the flexibility to stabilize their markets.
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The seismic effects of the Affordable Care Act on insurance markets continue to be felt nearly eight years after its enactment. Premiums for individual coverage more than doubled between 2013 and 2017. Much of that increase resulted from Obamacare’s new regulations. Some regulations-such as essential health benefits and actuarial value requirements-had discrete effects on premiums. A cluster of regulations prohibiting medical underwriting, requiring the issuance of coverage, and banning pre-existing condition exclusions under any circumstances collectively had the largest effect on premiums. Additional provisions of the ACA, such as those that induced costly enrollees with other coverage options to migrate to the subsidized individual market, also drove up premiums. The Trump Administration has taken some steps to help mitigate these challenges, but legislative action is the most effective approach. The Graham-Cassidy proposal offers a starting point for policymakers seeking to address these issues, by providing a conceptual framework for empowering states to repair or ameliorate much of the market dislocation resulting from Obamacare.
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Insurer participation and competition in Obamacare declined again in 2018 at both the state and county levels. In 2017, nearly one-third of counties (32.8 percent) had only one insurer offering exchange coverage. In 2018, more than half (51.3 percent) of all counties face that situation. Many insurers have exited the exchanges; ones that remain offer higher premiums and narrow network plans. The emerging norm appears to be one in which major metropolitan areas have two or three insurers offering exchange coverage, while less-populous areas have only one. A health insurance monopoly offering overly expensive coverage that pays for only a very limited set of providers is deeply unattractive, especially to customers who previously enjoyed choice in both their insurance and medical care. Not surprisingly, consumers are looking to Congress and the President for help in escaping the soaring costs and shrinking choices that characterize the ACA exchanges.

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Calls to fund CSRs and other payments to insurers in 2018 are rooted partly in a fundamental misunderstanding of why Obamacare premiums continue to rise. Although premium increases are to some degree attributable to the Administration’s cancellation of CSR payments, premium increases were considerable even for policies unaffected by the Administration’s decision.

Lavishing billions of federal dollars on the insurance industry in 2018 is misguided policy. Insurers have secured another round of rate hikes and, with them, billions more in federal premium subsidies. Nor are federal dollars necessary for a state to operate a successful risk-mitigation program, as Alaska has shown.

Trying to rush CSR and reinsurance payments out the door in 2018 will result in wasteful and unnecessary spending, and is more likely to create confusion than to produce the predictability lawmakers seek.

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The Medicaid status quo is not effectively serving the health care needs of the disabled, elderly, children, and pregnant women in poverty. Policymakers should ignore hyperbolic political rhetoric claiming that conscientious reforms to secure and improve the safety net for Medicaid’s core populations and to provide better options for coverage and care to others will result in a situation in which “thousands will die.” Obamacare expanded the poorly performing Medicaid and claimed success for doing so. These new recipients can fare better under a new system that broadens their access to quality care. A Medicaid premium support program can accomplish that worthy end.
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