Tag: "ObamaCare"

Obamacare’s Premium Hikes Are Much Bigger Than You’ve Been Told

Healthcaredotgov(A version of this Health Alert was published by Forbes.)

Yesterday was the last date for open enrollment in Obamacare’s third season. Since October, at least six independent and credible sources have confirmed rate increases 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.

Obamacare’s Cost per Beneficiary Explodes with Shrinking Enrollment

CBOThe Congressional Budget Office’s latest budget estimate shows Obamacare’s costs per beneficiary have exploded, as enrollment in Obamacare’s broken exchanges collapses. January’s update estimates 2016 exchange enrollment at 13 million people (p. 69).  Although the Administration had previously downgraded its estimate of Obamacare enrollment, this is the first significant change by the non-partisan CBO.

What is really shocking is the January update still estimates tax credits, which subsidize insurers participating in exchanges, will cost taxpayers $56 billion this year (p. 182). That amounts to about $4,308 per enrollee (although not all are subsidized). Back in March 2010, CBO estimated that 21 million people would be covered in exchanges in 2016, for a total cost of $59 billion in tax credits (pp. 20-23). That would amount to about $2,810 per enrollee.

Obamacare Joins Pile of Unfunded Liabilities

index1(A version of this Health Alert was published by the Orange County Register.)

The congressional vote last month to fund the government through next September, while extending some special-interest tax breaks and introducing some new ones, was the first time a majority of Republicans voted in favor of Obamacare. It looks like Congress’ alternative to Obamacare is deficit-financed Obamacare.

While failing to cut one penny of Obamacare spending, the so-called “taxibus” (tax extenders plus omnibus spending) cut almost $40 billion in Obamacare tax revenue by “temporarily” delaying three taxes for a year or two: the medical device excise tax, the health insurance fee and the excise tax on high-cost employer benefit plans.

Make no mistake: all three taxes are harmful and should be eliminated. However, just kicking them down the road without making any effort to cut Obamacare spending does nothing to repeal the Affordable Care Act.

Trouble Paying Medical Bills: Uninsured Do Better Than Obamacare Insured

iStock_000007047153XSmall(A version of this Health Alert was published by Forbes.)

The Centers for Disease Control and Prevention’s National Center for Health Statistics conducts thorough research on health insurance coverage. Recently published early results of the latest National Health Interview Survey have been misrepresented in the media to show that Obamacare is reducing the number of uninsured Americans, and that the number of people having trouble paying for health care has dropped as a result.

Actually, this is not the case. The data show some factor other than Obamacare has caused the survey’s respondents to state that they are having less trouble paying medical bills than in previous years. We know this because those who remained uninsured improved their ability to pay medical bills more than those who got coverage through Obamacare.

Only 45 million Americans under 65 years old reported they were in families with problems paying medical bills in 2015. In 2011, the number was 57 million. That drop of 12 million corresponds with a significant increase in health insurance coverage. The number without insurance dropped by 18 million, from 46 million to 28 million, while the population increased by about three million.

So, it looks like two thirds of the 18 million people insured after Obamacare took hold have no more worries about medical bills. Hooray for Obamacare, right? Not at all. In fact, it is those who remained uninsured who account for the biggest share of the decrease in the number of Americans with troubles paying medical bills.

Who Pays Obamacare’s “Slacker Mandate”? Workers with No Kids!

LGBT-ACA-ADThe “slacker mandate” is the provision in Obamacare requiring employer-based health plans to offer benefits to adult dependents of their workers, up to age 26. I previously discussed research showing the mandate reduced work among adults, aged 19 to 26, and increased the time they spend socializing, sleeping, and exercising.

What about the financial costs of the mandate? Speak to an insurance agent or benefits consultant and they will tell you the cost are fully borne by working parents. In the old days, employer-based health insurance was offered to workers in three sizes: Single, couple, or family. It did not matter how many kids you had. Today, each dependent adds to the premium. So, the “slacker mandate” is paid for by the working parents. That is not really a problem for society. However, there is more to the story.

A remarkable study published by the National Bureau of Economic Research concludes this happened. The slacker mandate reduced wages among workers without children by $211 a month, but did not reduce wages among workers with children (either minor or adult) by a statistically significant amount.

Trouble Paying Medical Bills: 2015 Versus 2005

iStock_000007047153XSmallAfter having read my colleague Devon Herrick’s Health Alert discussing the New York Times’ survey (conducted with the Kaiser Family Foundation) of adults having trouble paying medical bills, I had a look back and compared the 2015 results to those a similar survey from 2005. The results are almost exactly the same!

Despite a large decrease in the proportion of working-age people categorized as “uninsured” (even though many have actually become dependent on Medicaid, a joint state-federal welfare program, instead of actual insurance) one quarter of us still have trouble paying medical bills.

  • In 2015, 15 percent spent “all or most” of their savings on medical bills. In 2005, it was 12 percent.
  • In 2015, 10 percent “borrowed money from friends or family” and nine percent “increased credit card debt.” In 2005, eight percent reported “borrowing money or taking out another mortgage.”
  • In 2015, 32 percent “put off/postponed getting health care you needed.” In 2005, 29 percent of adults report “they or someone in their household skipped medical treatment, cut pills, or did not fill a prescription in the past year because of the cost.”
  • In 2015, three percent declared personal bankruptcy because of medical bills, the same as 2005.

Health Insurers’ Collapsing Obamacare Consensus

Marilyn Tavenner, CEO of AHIP

M. Tavenner, CEO of AHIP

The health insurance industry is undergoing a crisis of consensus on how to respond to the failure of Obamacare. That is the only way to interpret the departure of another large, national carrier, Aetna, from America’s Health Insurance Plans (AHIP). This follows UnitedHealth Group’s departure from the industry’s trade group last June:

Those misgivings manifested most recently during the debate over ObamaCare when the so-called “big five” — UnitedHealthcare, Anthem, Aetna, Humana and Cigna — formed their own informal coalition.

Another healthcare executive, who asked for anonymity in order to speak freely, said that, for some, “there’s a sense that AHIP has become a one-trick pony for the Obama administration,” referring to the goal of advancing ObamaCare.

With the country’s first- and third-largest health insurers gone from its ranks, the insurance group could see problems arise from the divisions between large and small companies.

(Peter Sullivan & Megan R. Wilson, “Aetna departure a major blow for insurers group,” The Hill, January 5, 2016).

Unpopular Individual Mandate Fails to Make People Buy Insurance

doctor-mom-and-sonJust before Christmas, Congress voted to deficit fund Obamacare by imposing moratoria on a number of Obamacare taxes that are unpopular with interest groups. Left in place was the unpopular individual mandate to buy health insurance, which has no organized interest to lobby against it. Nevertheless, it is the most unpopular part of Obamacare.

The New York Times reports that a number of relatively high-income earners are choosing to remain uninsured, or even drop Obamacare coverage, and pay the fine instead:

Bleak Future for Obamacare’s “Beneficiaries”

woman-with-child(A version of this Health Alert was published by the Daily Caller.)

One might be forgiven for thinking health insurers are cracking under the strain of Obamacare’s broken insurance exchanges. But don’t be fooled: it is the 10 million Obamacare enrollees who are in trouble, not the insurers.

To be sure, new nonprofit cooperative insurers, set up with special subsidies to compete in the exchanges, have had a terrible run. They deliberately underpriced their premiums to gain market share, expecting the federal government to bail out their losses. Once the Republicans took over the House of Representatives, then the Senate, this became unlikely. As a result, the administration announced in November that 12 of 23 nonprofit cooperative insurers were shutting down.

However, these nonprofit cooperative insurers, which did not exist before Obamacare, are not important overall. That is why UnitedHealth Group’s November 19 announcement that it is losing $500 million on the Obamacare exchanges and might withdraw from Obamacare in 2017 is a big deal. Just a few weeks earlier, UnitedHealth Group had announced it would expand into 11 new states’ Obamacare markets.

Congress Set To Deficit Fund Obamacare Almost $40 Billion

iStock_000007047153XSmallI had always feared that Congress’ alternative to Obamacare was deficit funded Obamacare, and it looks like that is coming to pass. This is being done through the so-called “taxibus”, a legislative package that combines popular “tax extenders” (items like research and development tax credits that are legally temporary but practically permanent) with funding the federal government through September 2016.

The bill proposes a couple of years delay in three Obamacare taxes: The medical-device excise tax, he health insurance fee, and the excise tax on high-cost employer benefit plans. All three taxes are bad. However, the bill just delays them without cutting any Obamacare spending.