Tag: "ObamaCare"

Congress Uses “Reconciliation” to Push Deficit-Funded Obamacare

Congressional Republicans are using a procedural tool called “reconciliation” to repeal a miniscule number of Obamacare provisions, according to Chris Jacobs of the Conservative Review:

Lost in the noise amidst Speaker Boehner’s resignation last week was the House of Representatives’ decision to begin moving its budget reconciliation bill. Earlier this spring, conservatives voted for the budget blueprint in both the hope and expectation that the reconciliation bill coming from that budget would be used to put full repeal of Obamacare on President Obama’s desk. But based on the newly released legislative proposals, those expectations have been disappointed.

Just as important, however, the Obamacare legislative proposals are limited to the following provisions:

  1. Repeal of the law’s auto-enrollment mandate for employers;
  2. Repeal of the Prevention and Public Health “slush fund;”
  3. Repeal of the individual mandate;
  4. Repeal of the employer mandate;
  5. Repeal of the tax on medical devices;
  6. Repeal of the “Cadillac tax” on high-cost employer health plans; and
  7. Repeal of the Independent Payment Advisory Board (IPAB).

That’s it. Under the proposed reconciliation instructions, a grand total of seven out of Obamacare’s 419 legislative sections—just over one percent of the law—would actually be repealed.

Oscar and The Changing Health Insurance Landscape

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

Yesterday, the Senate Judiciary Committee’s Subcommittee on Antitrust, Competition Policy and Consumer Rights held a hearing on “Examining Consolidation in the Health Insurance Industry and Its Impact on Consumers,” at which the CEOs of Anthem and Aetna testified.  Both of these health insurers have announced friendly take-overs of two other insurers, Cigna and Humana.

One indicator regulators use to determine whether a business combination will reduce competition is whether there are significant barriers to entry in the industry. If there are, new competitors will not exploit openings created by incumbents’ consolidation. During the hearing, the CEOs of Anthem and Aetna each (independently) pointed to Oscar, a new health insurer with highly pedigreed investors, as evidence that health insurance is an easy business to enter.

Oscar is indeed an interesting enterprise, which has attracted fawning coverage in the business press both for its innovation and the quality of its investors. Nevertheless, Oscar is a curious start up, because it focuses exclusively on a market – Obamacare exchanges – in which insurers are taking on a lot of pain.

15 Percent of Obamacare’s Second Season Enrollees Were Gone by June 30

Obamacare’s second enrollment season closed around the end of February, with 11.7 million signed up. By March 31, that had dropped to 10.2 million who actually paid their first month’s premium. New data from the administration report that number dropped further to 9.9 million by June 30.

What is also notable is that the entire drop of paid enrollees occurred in states using the federal exchange, not state-based exchanges (for which enrolment stayed at 2.7 million). There is no word on whether the drop-outs got employer-based coverage, descended into Medicaid, or stayed uninsured. 423,000 were dropped by the administration because of lack of documentation of citizenship or immigration status.

A stable market? Not quite, I guess.

Why Is There No Car Care Crisis?

employer coverage 300(A version of this Health Alert was published by RealClearPolicy.)

Our health care is in “crisis.” We seem to have achieved the remarkable result of spending too much money while not ensuring access for enough people. Every politician says so, and most citizens agree. Indeed, no presidential candidate can be viewed as credible without proposing a health reform “plan.”

Hillary Clinton has sworn to protect and uphold the Affordable Care Act against all right-wing conspirators; Bernie Sanders has long advocated a government-monopoly, single-payer system; and Republican contenders will continue to roll out plans to “repeal and replace Obamacare” that will immediately come under attack by conservatives and libertarians as “Obamacare-lite.”

Let’s put the crisis in perspective. According to actuaries at the federal government, spending on health care per person in 2014 was $9,176. Yet according to the American Automobile Association (AAA), the average cost of operating and maintaining an average sedan in 2014 was $8,876 — almost exactly the same as health spending. Of course, not everyone owns a car, but most of us do. According to IHS Automotive, an industry research firm, 253 million cars traveled America’s roads last year. According to the Census Bureau, there were 239 million of us aged 18 through 84; that’s slightly more than one car per person in prime driving years.

Commonwealth Fund’s Red Herring on Obamacare Risk Selection

One of this blog’s consistent themes is that Obamacare encourages insurers to seek to enroll health people in exchanges, and shun sick people. A new study from the Commonwealth Fund insists that is not the case, concluding that “insurers aren’t seeking lower-risk customers outside the ACA exchanges as some feared,” and “the ACA’s insurance reforms are working in the individual market.”

I will share the study’s conclusion, then explain the red-herring hypothesis it is meant to test:

Gallup Confirms Obamacare Increased Welfare Dependency

I did not bother to discuss Gallup’s July update on the drop in uninsured Americans, because it was substantively the same as the teaser released in March, which showed most of the increase in health insurance was actually Medicaid, which is welfare dependency.

Gallup has just released a state-by-state report, concluding Medicaid expansion and establishing a state exchange almost doubled the reduction in uninsured. Of the two, I cannot imagine setting up a state exchange is a big factor, because beneficiaries get the same tax credits in state or federal Obamacare exchanges. Obamacare mostly increased Medicaid dependency.

Obamacare Now Hurts Republican Politicians More than Obama

index1(A version of this Health Alert was published in the San Francisco Chronicle on August 10, 2015.)

Polls consistently show that Obamacare is unpopular. Back in April 2010, the month before the law was signed, 46 percent of all adults surveyed had a favorable view of the Affordable Care Act, while just 40 percent had an unfavorable view, according to the Kaiser Family Foundations’ regular tracking poll. Things have not changed much since then.

Yet, the law now appears to be hurting Republicans politicians more than Democrats. It looks like Congressional Republicans, who have controlled both chambers of Congress since January, are running out of excuses for failing to advance a comprehensive proposal to repeal and replace Obamacare.

Obamacare Exchanges: Trusted, Verified, Disliked

Remember Ronald Reagan’s principle for negotiating arms deals with the Soviet Union? “Trust, but verify.”

Well, Obamacare customers have trusted and verified the insurance policies they can buy on Obamacare’s exchanges, but they don’t like what they get. This according to a survey conducted by the Deloitte Center for Health Solutions:


The Cost of Over Insurance: National Health Expenditures Rising Again

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

Actuaries at the Centers for Medicare & Medicaid Services, the government agency that runs those programs, have released their estimates of national health spending for 2014 through 2024:

Health spending growth in the United States is projected to average 5.8 percent for 2014–24, reflecting the Affordable Care Act’s coverage expansions, faster economic growth, and population aging. Recent historically low growth rates in the use of medical goods and services, as well as medical prices, are expected to gradually increase.

The health share of US gross domestic product is projected to rise from 17.4 percent in 2013 to 19.6 percent in 2024.

It is a little too easy to say that this outbreak of higher health spending is just due to Obamacare. To be sure, Obamacare has increased health spending with only marginal improvement in access to care. However, the population is aging, too; and the actuaries also take account the positive relationship between economic growth and health spending. The actuaries expect the economy to be relatively strong over the next decade, and estimate the rate of growth of health spending will exceed the rate of growth of Gross Domestic Product by only 1.1 percent. This is less excessive than in most recent decades. Yet, it is still excessive, and a change for the worse.

New Evidence That Obamacare Is Working?

Obamacare supporters are excited by a research article suggesting Obamacare is working to increase access to care. In an article published in JAMA: The Journal of the American Medical Association, researchers followed up respondents to the Gallup-Healthways Well-Being Index (which I’ve discussed previously.)

Yes, in an absolute sense, their access to care improved. According to the Huffington Post’s Jonathan Cohn, this means “Another Argument From Obamacare Critics Is Starting To Crumble.”

Oh dear. Even Citizen Cohn admits “The picture from the raw data is a little muddled” and “like all academic studies, this one will be subject to scrutiny that, over time, could call its findings into question.” Well, I won’t call them into question, just point out what is obvious from the abstract itself: Obamacare is dong a terrible job increasing access to care.