Tag: "ObamaCare"

King v. Burwell: How Congress and President Obama Can Win

Perhaps within a few minutes, and certainly no later than next Monday morning, we will learn the Supreme Court’s verdict on King v. Burwell, the lawsuit alleging Obamacare tax credits in at least 34 states are illegal.

Victory for the plaintiffs will stop tax credits to health insurers covering most Obamacare beneficiaries, causing those individuals to face the full cost of their premiums. Congress and the president will have a responsibility to respond.

Unfortunately, Congressional leaders appear unwilling to accept this opportunity, publicly lamenting that the president would veto any bill passed in response to King v. Burwell.

We can do better. In a special publication published by NCPA, I propose six reform “buckets”, which should satisfy the priorities of both Congress and the president, should King prevail.

Lead more about our King v. Burwell proposal at this link.

King v. Burwell: Fix Obamacare’s Job Killing Tax Credits

(A versio30-ways-to-cut-your-health-care-costsn of this Health Alert was published by Forbes.)

You read that headline right: It is not only those who pay Obamacare taxes who suffer, but those who receive them. That’s because the tax credits are calculated so perversely that people who receive them actually get punished for working more hours. In the wake of the Supreme Court’s forthcoming decision on King v. Burwell, which will determine whether tax credits paid in at least 34 states are legal, fixing this should be a priority for Congress and President Obama.

For the first time since 2012, the Congressional Budget Office has done a comprehensive estimate of the costs and benefits of Obamacare. The new estimate concludes that repealing Obamacare would increase Gross Domestic Product by 0.7 percent over the next ten years. The primary reason is the disincentive to work contained in the design of the tax credits.

Of course, President Obama is not going to repeal Obamacare. Nevertheless, in the wake of King v. Burwell, much of this problem can be alleviated without doing violence to the president’s goal of increasing coverage, as I describe in a new study from the National Center for Policy Analysis (NCPA).

Employer Benefit Plans’ Subsidy of Obamacare Increased

The administration has just increased the amount it will play plans under one of the “3 R’s” of Obamacare. Reinsurance, risk corridors, and risk adjustment are three mechanisms the administration uses to protect insurers from losing money in Obamacare.

Last year, I focused my efforts on limiting risk corridors, which exposed taxpayers to a potentially unlimited liability. This had a largely successful legislative result in Congress. Now, reinsurance has become a problem. As Ed Haislmaier of The Heritage Foundation has explained, reinsurance taxes all plans, including those covering the employer-based group market, to reduce risk in Obamacare.

Well, the administration collected more money than it expected from this tax:

Medical Device Excise Tax Repeal? Not So Fast

As discussed a few days ago, the House of Representatives has voted to repeal Obamacare’s medical device excise tax. The tax itself, obviously, is harmful. However, putting this at the top of the “to do” list for the repeal effort is a curious priority.

Some conservatives are turning against the notion of repealing the tax on its own. Here’s Jeff Anderson of the 2017 Project:

Repealing Obamacare Would Grow Economy; Reduce Number of Insured by 10 Million

I have asked, and the Congressional Budget Office has answered.

I have been urging the CBO to do a comprehensive estimate of all the effects of the Affordable Care Act, effectively for the first time since 2012. It did so last week. The main take-away is that “repealing the ACA would increase GDP by about 0.7 percent in the 2021–2025 period, mostly because provisions of the law that are expected to reduce the supply of labor would be repealed.”

CBO concludes repeal would increase deficits. However, this effect is much smaller than previous estimates, because this is the first time CBO has used so-called “dynamic scoring” – taking macroeconomic effects of repeal into account – instead of just the simple (“static”) book-keeping type of estimate:

Health Spending Up, Up, and Away

The Quarterly Services Survey (QSS) is Census Bureau report that we should be watching to see how health costs are climbing. This blog last looked at it in September 2014. Fortunately, Dr. Drew Altman, CEO of the Kaiser Family Foundation has been keeping a close eye on it. His conclusion:

New Evidence Health Spending Growing Faster Again

Analysis of the survey data shows that health spending was 7.3% higher in the first quarter of 2015 than in the first quarter of last year. Hospital spending increased 9.2%. Greater use of health services as well as more people covered by the ACA appear to be responsible for most of the increase. People are beginning to use more physician and outpatient services again as the economy improves. The number of days people spent in hospitals also rose. (Drew Altman, “New Evidence Health Spending Growing Faster Again,” Wall Street Journal, June 11, 2015)

The growth in number of days spent in hospital is very disconcerting. It had been on a downward trend for years. (See page 300 of this CDC report.)

Obamacare’s Shrinking Revenues: Medical Device Excise Tax

The House of Representatives voted today to repeal Obamacare’s medical device excise tax, the 2.3 percent tax levied on medical devices sold in the U.S. The tax is certainly harmful. Whether it deserves the highest priority is another question.

The bill was scored by the Congressional Budget Office (CBO), which determined that it will increase the deficit by over $24 billion in the next 10 years. We seldom see explicit budget scores of individual Obamacare taxes. This score overlaps the original 2010 CBO score for four years, 2016 through 2019. Comparing the two scores (see Table 1) shows how much the taxes estimated revenues have shrunk – 36 percent, from $12.7 billion to $8.1 billion over the period.

Obamacare Payments to Health Insurers Wildly Inaccurate

debtThe Office of the Inspector General of the U.S. Department of Health & Human Services has concluded that the administration has no clue if the billions of dollars it is paying to health insurers as Obamacare tax credits and cost-sharing subsidies are accurate:

We determined that CMS’s internal controls (i.e., processes put in place to prevent or detect any possible substantial errors) for calculating and authorizing financial assistance payments were not effective. Specifically, we found that CMS:

  • relied on issuer attestations that did not ensure that advance CSR payment rates identified as outliers were appropriate,
  • did not have systems in place to ensure that financial assistance payments were made on behalf of confirmed enrollees and in the correct amounts,
  • did not have systems in place for State marketplaces to submit enrollee eligibility data for financial assistance payments, and
  • did not always follow its guidance for calculating advance CSR payments and does not plan to perform a timely reconciliation of these payments.

The internal control deficiencies that we identified limited CMS’s ability to make accurate payments to QHP issuers. On the basis of our sample results, we concluded that CMS’s system of internal controls could not ensure that CMS made correct financial assistance payments during the period January through April 2014.

Just another day of Obamacare news.

Responding to King v. Burwell: Give Benefits to People, Not Health Insurers

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

The Supreme Court is expected announce its decision on King v. Burwell soon. The case hinges on whether Obamacare tax credits can be paid in states that did not establish their own exchanges. If the plaintiffs win, health insurers will lose tax credits that allow them to offer artificially low premiums to Obamacare beneficiaries. About seven million people will suddenly be asked to pay full premiums for their plans. To be blunt, they will freak out, and many will drop out of Obamacare, putting the president’s signature achievement in jeopardy.

This gives Congress the opportunity to present the president with reforms that, while falling well short of the promise to “repeal and replace Obamacare,” can address some of its worst shortcomings. Here is one suggestion: Every single penny of Obamacare’s federal spending on health benefits goes to insurers. Not one penny goes to beneficiaries themselves. How about giving that money to beneficiaries directly, and allowing them to decide how much to spend on medical care directly, instead of premiums to health insurers?

Pa., Del. to Identify as State-Based Exchanges

There seems to be a trend in the United States of people formerly identifiable as a person with one set of easily recognized characteristics deciding that they “identify” as having another set of characteristics.

This is also happening with Obamacare exchanges. The Supreme Court will soon announce its decision in King v. Burwell, resolving the question of whether Obamacare tax credits can be paid in states using the federal exchange (healthcare.gov) or only states with their own exchanges. Some states with federal exchanges are trying to “identify” them as state exchanges.

Pennsylvania is one. Delaware is too, but it is called a State Partnership Marketplace. These State Partnership Marketplaces are not defined in the Affordable Care Act. The law defines clear blue sky between state and federal exchanges, and that tax credits can only flow through state exchanges. This difference was supposed to create the incentive for states to establish exchanges. It did not work.