- 56% say Medicaid should target set spending to the disabled, elderly, children, and pregnant women in poverty based on their specific needs.
- 62% say it is a bad thing that Medicaid expansion spends money on childless adults, rather than the most vulnerable populations the program was designed to serve.
- 57% say it is a bad thing that Obamacare gave states higher reimbursements for adding able-bodied adults to Medicaid than for serving the elderly and disabled.
Current federal tax policy treats workers and their families who do not or cannot get health insurance through employment-based coverage unfairly and contributes to disruption in coverage when employees change jobs. Obamacare imposes a hefty excise tax on expensive employer coverage, a punitive measure that adds to the complexity of the current health care system.
Congress should repeal Obamacare’s Cadillac tax and set a simple cap on the employer exclusion. In addition, Congress should create a new type of individual tax relief that would be available to everyone, regardless of where they purchase coverage. Together, these policies would help to ensure that the federal government is not favoring one type of coverage or consumer over another and would go a long way toward restoring a functioning market in health care that is responsive to consumers.
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Obamacare is a proven policy failure. Congress and the Trump Administration must completely repeal the law, beginning by seizing the opportunity to accomplish as much of repeal as possible through the reconciliation process. Congress must focus on the fundamentals: equalizing the tax treatment of health insurance; restoring commonsense regulation of health insurance; and addressing the serious need for reform in Medicare and Medicaid by adopting policies that give individuals control over their health care. High quality health care means all Americans should be free to choose a health care plan that meets their needs and reflects their values. Congress must act now to repeal Obamacare and replace it with a new set of options that empower Americans, not government.
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One of the stated aims of the Affordable Care Act was to increase competition among health insurance companies. That goal has not been realized, and by several different measures the ACA’s exchanges offer less competition and choice in 2017 than ever before. Now in the fourth year of operation, the exchanges continue to be far less competitive than the individual health insurance market was before the ACA’s implementation. Moreover, insurer participation in the law’s government-run exchanges has declined over the past two years and is now at the lowest level yet. This lack of insurer participation leaves exchange customers in 70 percent of U.S. counties with no insurer choice, or a choice between merely two insurers.
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While the final figures will be somewhat different once the more complete end of year data is available, at this point it is reasonable to expect that for the three-year period of 2014 through 2016, the net increase in health insurance enrollment was 16.5 million individuals. Of that figure, 13.8 million were added to Medicaid and 2.7 million were the net increase in private-sector coverage enrollment.
In general, enrollment data indicate that the implementation of the ACA appears to have had three effects on health insurance coverage: (1) a substantial increase in individual-market enrollment; (2) an offsetting decline in fully insured employer-group plan enrollment; and (3) a significant increase in Medicaid enrollment in states that adopted the ACA Medicaid expansion.
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During 2015, the growth in both individual-market and employer-group coverage resulted in a net increase in private-market coverage of 2 million individuals. For individual-market policies, enrollment increased by a bit more than 1.12 million individuals. For the employer-group-coverage market, enrollment in fully insured plans declined by 932,000 individuals, while enrollment in self-insured plans increased by 1.86 million individuals. The net effect of those changes was an increase of 926,000 in the number of individuals with employer-sponsored coverage in 2015.
Public program enrollment in Medicaid and the Children’s Health Insurance Program (CHIP) increased by almost 2.77 million individuals in 2015. As in 2014, the change in Medicaid enrollment in 2015 differed notably between states that adopted the ACA’s Medicaid expansion and states that did not. States with the ACA’s Medicaid expansion in effect experienced Medicaid enrollment growth of almost 2.13 million people, while in the states without the expansion in effect, Medicaid enrollment grew by 640,000 individuals.
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It is vital that the new Administration, Congress, and state officials orchestrate a smooth and methodical transition for the repeal of Obamacare. For this smooth transition to take place, Congress should act immediately to initiate repeal and the Administration should take aggressive administrative actions to stabilize the private market for the upcoming 2018 plan cycle. The Administration, Congress, and the states should then coordinate efforts to begin the process to have a set of reforms in place for the 2019 plan cycle.
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Health insurance enrollment data for 2014 shows that the number of Americans with health insurance increased by 9.25 million during the year. However, the vast majority of the increase was the result of 8.99 million individuals being added to the Medicaid rolls. While enrollment in private individual-market plans increased by almost 4.79 million, most of that gain was offset by a reduction of 4.53 million in the number of people with employment-based group coverage. Thus, the net increase in private health insurance in 2014 was just 260,000 people.