Source: JB Silvers, The Conversation, July 12, 2017
…. The latest development has been the inability of Republicans to even agree on their own proposal and, worse yet, what should come next if it fails. Should they repeal the Affordable Care Act and worry about a replacement later or just try to “fix” the ACA now?
But the problem is much deeper than just a policy fix. As a former health insurance CEO and professor of health finance, it seems clear to me that Republicans are making five key implicit assumptions that are inherently problematic:
1. If it’s your own money, you’ll be more careful in how you’ll spend it. ….
2. Many or most poor people (Medicaid recipients) can work and should contribute to pay for insurance. ….
3. Government restrictions are holding back insurers from competition that would drive costs lower. ….
4. Physicians should be the only ones making care decisions (with the consent of their patients) since they know best. ….
5. Government should help people – but not too much. ….
Source: Allen Dobson, Joan DaVanzo, Randy Haught, Commonwealth Fund, June 2017
From the abstract:
Issue: Safety-net hospitals play a vital role in our health care system, delivering significant care to Medicaid, uninsured, and other vulnerable patients. The American Health Care Act (AHCA) would make changes to Medicaid that would substantially reduce federal funding, resulting in potential adverse effects on safety-net hospitals and the populations they serve.
Goal: Examine how the AHCA Medicaid provisions, which the Congressional Budget Office estimates will reduce federal Medicaid spending by $834 billion over 10 years, will affect the financial status of safety-net hospitals.
Methods: The Dobson | DaVanzo Hospital Finance Simulation Model uses Medicare Hospital Cost Report data for 2015 and assumptions regarding how states will respond to the AHCA Medicaid provisions to estimate the financial impact on safety-net hospitals.
Key Findings: Beginning in 2020 the financial status of safety-net hospitals will deteriorate as Medicaid coverage is reduced and the per-capita spending limits proposed in the AHCA grow. By 2026 total margins will drop to 0.5 percent compared with estimates under current law of 2.9 percent—representing an 83 percent reduction in net income for safety-net hospitals. Small rural safety-net hospitals and safety-net hospitals treating the largest proportion of low-income patients would be hurt the most.
Source: Emily Gee, Center for American Progress, June 27, 2017
….The Center for American Progress has estimated how many Americans would lose coverage by state and congressional district based on the CBO’s projections. By 2026, on average, about 50,500 fewer people will have coverage in each congressional district. Table 1 provides estimates by state, and a spreadsheet of estimates by state and district can be downloaded at the end of this column…..
H.R. 1628, Better Care Reconciliation Act of 2017
Source: Congressional Budget Office, Cost Estimate, no. 52849, June 26, 2017
From the summary:
CBO and JCT estimate that enacting the Better Care Reconciliation Act of 2017 would reduce federal deficits by $321 billion over the coming decade and increase the number of people who are uninsured by 22 million in 2026 relative to current law.
Source: Simon Haeder, The Conversation, June 7, 2017
Despite many assertions to the contrary, Senate leaders are now saying they want to vote on the replacement bill for Obamacare before the month is out. Front and center is the planned transformation of America’s Medicaid program, which covers 20 percent of Americans and provides the backbone of America’s health care system. …. To understand how the ACHA’s proposed changes to Medicaid would affect people and our health care system, let’s look more closely at the program….
Source: Matt Bruenig, Jacobin, June 2, 2017
Don’t believe the critics: a new report shows California’s single-payer plan is eminently affordable.
Economic Analysis of the Healthy California Single-Payer Health Care Proposal (SB-562)
Source: Robert Pollin, James Heintz, Andrew Glyn, Peter Arno, Jeannette Wicks-Lim, University of Massachusetts-Amherst, Political Economy Research Institute (PERI), May 2017
SB 562 (Lara) – The Healthy California Act (pdf)
Source: State of California, Senate Comittee on Appropiations, Senate 2017-2018 Regular Session, Version: April 17, 2017
Source: Richie Bernardo, WalletHub, March 20, 2017
…According to estimates by the nonpartisan Congressional Budget Office, the recently proposed American Health Care Act — unofficially going by the names “Trumpcare” and “Ryancare” — would raise the average health-insurance premium for an individual policyholder by 15 to 20 percent just one or two years from now and lower federal subsidies. In contrast, the CBO projected, average Obamacare premiums would decrease 10 percent by 2026.
In order to gauge the AHCA’s impact on people who buy their own insurance, WalletHub’s analysts compared the differences in premium subsidies that the average households in 457 U.S. cities would receive under Obamacare and Trumpcare. Read on for our findings, commentary from a panel of experts and a full description of our methodology….
Source: Congressional Budget Office, Cost Estimate, publication no. 52486, March 13, 2017
From the summary:
CBO and JCT estimate that enacting the American Health Care Act would reduce federal deficits by $337 billion over the coming decade and increase the number of people who are uninsured by 24 million in 2026 relative to current law.
Source: CQ Magazine, Vol 75 no. 8, March 13, 2017
President Donald Trump’s campaign promises on health care could become a bitter pill for his supporters. Related:
The Status of Repeal/Replace
Medicaid Administrative Changes Possible
Source: Economic Policy Institute, 2017
Across the country, 29.8 million people would lose their health insurance if the Affordable Care Act were repealed—more than doubling the number of people without health insurance. And 1.2 million jobs would be lost—not just in health care but across the board.
Source: Gary Claxton, Larry Levitt, and Karen Pollitz, Kaiser Family Foundation, Issue Brief, February 2017
From the overview:
Significant changes to the Affordable Care Act (ACA) are being considered by lawmakers who have been critical of its general approach to providing coverage and to some of its key provisions. An important area where changes will be considered has to do with how people with health problems would be able to gain and keep access to coverage and how much they may have to pay for it. People’s health is dynamic. At any given time, an estimated 27% of non-elderly adults have health conditions that would make them ineligible for coverage under traditional non-group underwriting standards that existed prior to the ACA. Over their lifetimes, everyone is at risk of having these periods, some short and some that last for the rest of their lives.
One of the biggest changes that the ACA made to the non-group insurance market was to eliminate consideration by insurers of a person’s health or health history in enrollment and rating decisions. This assured that people who had or who developed health problems would have the same plan choices and pay the same premiums as others, essentially pooling their expected costs together to determine the premiums that all would pay.
Proposals for replacing the ACA such as Rep. Tom Price’s Empowering Patients First Act and Speaker Paul Ryan’s “A Better Way” policy paper would repeal these insurance market rules, moving back towards pre-ACA standards where insurers generally had more leeway to use individual health in enrollment and rating for non-group coverage.1 Under these proposals, people without pre-existing conditions would generally be able to purchase coverage anytime from private insurers. For people with health problems, several approaches have been proposed: (1) requiring insurers to accept people transitioning from previous coverage without a gap (“continuously covered”); (2) allowing insurers to charge higher premiums (within limits) to people with pre-existing conditions who have had a gap in coverage; and (3) establishing high-risk pools, which are public programs that provide coverage to people declined by private insurers…..
Compare Key Elements of ACA Repeal and Replace Proposals with New Interactive Tool