Tag: "ObamaCare"

The Price is Right! Trump’s Choice Indicates Push to Repeal and Replace Obamacare

220px-Tom_PriceDonald Trump’s choice of Dr. Tom Price as his nominee for U.S. Secretary of Health & Human Services indicates the Trump Administration will make a serious effort to repeal and replace Obamacare with patient-centered health reform.

After some initial signs of hesitation at actually trying to achieve this six-year old campaign promise, Obamacare’s opponents can now be confident that skilled leadership will wage a sophisticated and likely successful effort to restart health reform. Here are four reasons why:

The White Man’s Burden: More Drinking, Drugs, and Suicides Since 2000

Senior Man ThinkingMore nonsense has been written about white nationalism/supremacy in the wake of Donald Trump’s election than anyone should have to read. So, it is a pleasure to find some actual data analysis on the role of non-college educated white citizens in the success of the Trump candidacy, especially versus Mitt Romney’s failed 2012 campaign.

The Economist has estimated health status explains the Trump vote better than being a non-college educated white citizen does. The sicker you are, the more likely you are to have voted for Mr. Trump. Non-college educated whites are also likely to be sicker, so the two variables are not independent. Nevertheless:

Will Trump Really Kick 22 Million Off Health Insurance?

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

Now that repeal of Obamacare is within striking distance, Obamacare’s supporters and the media are aghast at over 20 million people potentially losing their overly expensive health insurance.

If Republican politicians cannot overcome this objection, they will never move forward with repealing and replacing Obamacare. U.S. Senator Lamar Alexander, Chairman of the Senate’s Health, Education, Labor, & Pensions (HELP) Committee anticipates it will take “several years” to transition out of Obamacare to a patient-centered health system.

Why would Republican politicians balk at fulfilling a promise on which they have campaigned successfully since 2010? The answer lies in the swamp which President-elect Trump promises to drain – Washington, DC. Remember every industry in the health sector acceded to Obamacare in 2010 because it would permanently divert funds from the rest of the economy into the health sector.

What Will TrumpCare Look Like?

Five people waiting in waiting roomPresident-elect Donald Trump made repealing Obamacare the cornerstone of his campaign. Now that he has won, his future administration is faced with the daunting task of unraveling nearly seven years of Obamacare.  It will not be easy. The most pressing goal should be to replace all the costly provisions in Obamacare with the consumer-friendly health plans most Americans prefer. In the process, reformers must change the way medical care is financed so that consumers have control over their health care dollars as well as the means to pay for medical care over their lifetimes.

Bill Clinton Is Right: Obamacare is Crazy for Workers

Five college students.(A version of this Health Alert was published by The Hill.)

Bill Clinton’s pre-election criticism of Obamacare reflected a good understanding of labor economics. In October, he explained:

So you’ve got this crazy system where all of a sudden 25 million more people have health care and then the people who are out there busting it, sometimes 60 hours a week, wind up with their premiums doubled and their coverage cut in half. It’s the craziest thing in the world.”

Clinton was referring to high marginal income tax rates that Obamacare imposes on workers through the design of its tax credits, which get clawed back in a very unfair way. The Administration recently confessed premiums for the benchmark Obamacare plans are going up 25 percent, on average. Trying to appease angry enrollees, the Administration feebly claims tax credits reduce net premiums people pay.

Nobody is satisfied by this excuse. However, even if Obamacare premiums were reasonable, they would still punish the people for whom Bill Clinton claims to speak. The more you work, the more you earn; and the more you earn, the higher net premium you pay. This is not a characteristic of the employer-based group market in which most of us participate.

Obamacare Coverage 10 Percent Less Expensive Than Job-Based Benefits

nnScholars at the Urban Institute, staunch defenders of Obamacare, have previously struggled to find ways to report Obamacare’s good news by pointing out “there is no meaningful national average” of premium hikes. More recently, they have concluded that Obamacare coverage is 10 percent less expensive than employer-based coverage.

Comparing average employer-based premiums to the second-lowest cost Silver benchmark Obamacare plans, the Urban Institute scholars found lower Obamacare premiums in 38 states plus Washington, DC. These are the unsubsidized Obamacare premiums, adjusted for age, actuarial value, and utilization associated with actuarial value.

What to make of this finding?

Divided on Obamacare, Trump and Clinton Both Threaten Medical Innovation

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

Confident Doctors

The recently announced 25 percent rise in Obamacare health insurance premiums has brought renewed attention to health policy. As this is my last column before Election Day, it is time to review how the presidential candidates would address the continuing challenge of skyrocketing health costs.

We should not kid ourselves that Obamacare’s failure is enough to cause the next President or Congress to act energetically to fix the problems Obamacare exacerbated. The interest groups which brought us Obamacare have cut bait and moved on. The health care sector – interests for which the $3.35 trillion spent on health care counts as revenue rather than cost – has bigger fish to fry.

Although insurers are losing money in Obamacare’s exchanges, they are far more concerned with employer-based group benefits, Medicare Advantage, and Medicaid managed care than Obamacare exchanges. Obamacare exchanges cover fewer than 13 million people at any time during the year; and only about four million stick with Obamacare coverage throughout the year. Those poor souls comprise a powerless political constituency, unlike employers or seniors on Medicare.

Obamacare 2017 Premium Hikes 25 Percent. What Next?

p_kleyman_medicut_500x279The Administration has confessed the average 2017 Obamacare premium hike for the benchmark (second-lowest cost) Silver plan will be 25 percent. (Back in June, it looked like the hike would be 16 percent.)

Don’t worry, says the Administration, tax credits will ensure beneficiaries only pay a fraction of their premiums. It is true, very few people would buy Obamacare plans without the tax credits the Administration cheers. However, that is not a sign the plans are “affordable,” but only that taxpayers are bearing more of the burden.

Nor do the tax credits actually prevent people from sticker shock. In fact, the design of the tax credits usually makes the net premium hike higher than the gross premium hike. For example, the average premium hike next year in California will be 13.2 percent, but a 56-year old woman in Los Angeles just learned her premium will jump 57 percent next year.

Hillary’s Campaign to Lower Drug Costs is a Real Downer

captureSpending on prescription drugs has grown tremendously over the past few decades. This is mainly due to the increase in the number of diseases and conditions treated using drug therapy. The truth is: most drugs are dirt cheap! However, a small portion — maybe 1 or 2 percent — are rather costly. As a result of that small percentage, drug prices have become a campaign issue accompanied by plethora of bad ideas.

Early in his campaign, Donald Trump even came out with some doozies, such as having the government negotiate drug prices for Medicare and importing drugs from abroad (that is: importing other countries’ price controls). He has since ceded these populist talking points to Hillary in favor of free-market ideas. He now advocates getting government out of the way, allowing competition to flourish. He understands that bureaucratic red tape at the U.S. Food and Drug Administration often prevents competition from holding drug prices in check.

Hillary Clinton is another story.

Premiums For Employer-Based Family Health Insurance Up One Fifth Since Obamacare

The Kaiser Family Foundation/Health Research Educational Trust has released its 2016 Employer Health Benefits Survey. The survey covers almost 1,900 private and public (non-federal) employers. The results show Obamacare has not reduced premiums, which have increased by one fifth for family plans since 2011.

The good news is the proportion of beneficiaries with “High-Deductible Health Plans with a Savings Option” (HDHP/SOs) has increased from 20 percent to 29 percent in two years. Only four percent of covered worker were in such plans in 2006, and 17 percent in 2011. (In 2015, a HDHP had to have a minimum deductible of $1,300 for single coverage and $2,600 for family. The “Savings Option” would be a Health Savings Account or Health Reimbursement Arrangement.)

These plans were first available in 2005, and correspond with an immediate slowdown in the rate of growth of employer-based benefits. In real terms (adjusted for changes in the Consumer Price Index), dropped from double digits in the early 2000s to single digits after 2005 and bottoming out at an increase in premium of just two percent in 2009. There was an immediate jump of 11 percent in 2011, Obamacare’s first year. Since then, both High Deductible Health Plans and the burden of Obamacare have continued to grow. This struggle has resulted in mid-single digit premium growth.

See Figure I below the fold: