If you want to keep your doctor, you might have to pay more for it, Obamacare architect Zeke Emanuel said today on Fox News Sunday:
All eyes have been focused on the functionality of the HealthCare.gov website — or the lack thereof — since its launch October 1. But another rolling disaster is underway that is much more significant: Despite the president’s assurances to the contrary, virtually everyone — not just the 15 million Americans with individual policies — will feel the brunt of Obamacare’s sweeping changes. Once members of the public begin to see the costly changes to their health plans and the limits on their access to doctors, the issue will dominate the debate through 2014.
Earlier this year, the president asserted that “for the 85 to 90 percent of Americans who already have health insurance . . . their only impact is that their insurance is stronger, better, more secure than it was before. Full stop. That’s it. They don’t have to worry about anything else.” And as recently as November 14, the president claimed that “when I said you can keep your health care, I’m looking at folks who’ve got employer-based health care; I’m looking at folks who’ve got Medicare and Medicaid — and that accounts for the vast majority of Americans.”
Health Care Policy and Marketplace Review: Is Obamacare Responsible For the Recent Slowdown in Health Care Costs?December 6, 2013
Is Obamacare even partly responsible for the slowdown in health care costs?
That is silly.
First, Obamacare is not a health care reform law; it is a health insurance reform law. No one on either side of the debate has ever argued anything different.
Does the law have some limited cost containment features in it?
Yes. But these are either pilot projects or are years from being fully implemented.
The 2017 Project study (online at 2017project.org) examines premiums and subsidies for plans sold through Obama-care exchanges in the 50 largest counties in the United States (excluding Massachusetts, which Obama-care allows to play by different rules, and Hawaii and Maryland, where the state-based exchanges weren’t working and thus did not allow for data-collection). Those 50 counties comprise more than 29 percent of the U.S. population. The study compares the costs and subsidies under Obamacare for various ages and incomes, in 5-year and $5,000 increments, starting with a 21-year-old making $20,000.
The findings are striking. Consider a 26-year-old (newly ineligible for Mom and Dad’s coverage) making $30,000 a year. Across these 50 counties, the average cost of the cheapest subsidized plan—the cheapest “bronze” plan—available to someone of that age from the Obama-care exchanges would be $2,134 a year. That’s roughly three times the cost of the cheapest plan this person could have bought pre-Obamacare, according to figures from the Government Accountability Office. Meanwhile, this 26-year-old’s taxpayer-funded subsidy, on average, would be $482, or just 23 percent of the premium. By contrast, a 61-year-old making that same $30,000 would, on average, get a subsidy of $4,018, covering 82 percent of the $4,885 premium for someone of that age.
Critics, however, say they see little evidence that the law will lead to significant cost savings.
“These claims are just as groundless as the ones that misled so many Americans to believe they would be able to keep their previous coverage,” argued Charles Blahous, a former Bush administration official now at the Mercatus Center at George Mason University.
To be sure, the Affordable Care Act will lead to a drastic bump in health spending by the government starting next year, with an estimated nine million Americans signing up for Medicaid and perhaps as many as seven million buying a subsidized health plan through the government exchanges. But economists expect the underlying rate of spending growth to remain low.
2014 federal insurance exchange: Evaluation of insurer participation and consumer choice – Milliman InsightDecember 2, 2013
The Center for Consumer Information and Insurance Oversight (CCIIO) has released insurer plan information for the federally facilitated exchanges in 34 states for the individual exchange market and 32 states for the Small Business Health Options Program (SHOP) exchange market, since the state and federal exchanges opened October 1, 2013. This gives consumers and the health insurance industry the first opportunity to view the landscape of the new exchange market (also known as Health Insurance Marketplaces).
The federally facilitated exchange data released by CCIIO provides insight into the makeup of the insurance marketplaces. The number of existing insurers participating, new entrants, and plan designs available on the federally facilitated exchanges varies greatly between states and within states at the county level. Premium and plan information for each plan offered in the federal exchange is provided by state, exchange rating area, and county. Similar data for the state exchanges has not been released in a consolidated fashion at the time this report was published.
In some states, market share in the individual and small group markers may be minimally impacted by the exchange marketplace. However, in states that have insurers with significant current market share declining to participate in the exchanges, or in states with new Medicaid or CO-OP insurers entering the market, market share may change significantly in a short period of time.
As state-based exchanges begin to release similar data, it will be insightful to understand whether the types of observations illustrated in this report are consistent between state and federally operated exchanges. This report will be updated in the future as additional data is made available.
The CEA paper also touts Obamacare’s changes to Medicare, claiming that these cuts will lead to system-wide efficiency gains. But, again, exactly the opposite result is likely to occur. One of the most significant changes targets the private sector component of the program, called Medicare Advantage, with $200 billion in cuts over ten years. These cuts will force millions of seniors out of the Medicare plans they like and want to keep and back into the fragmented and inefficient fee-for-service component of Medicare. The CEA paper claims that changes in Medicare can lead to spillover effects in the rest of the health system. That is true. But there’s also abundant research showing that high enrollment in Medicare Advantage leads to cost reductions in fee-for-service and the commercial market too. That’s because hospitals and physician participating in more efficient Medicare Advantage plans tend to practice in a similar fashion for their non-Medicare Advantage patients too. Cutting Medicare Advantage simply puts more people into costly and inefficient fee-for-service medicine, with no real prospect of improved cost performance anytime soon.
American Action Forum Director of Regulatory Policy Sam Batkins discusses the 254 corrections made to regulations related to the Affordable Care Act
I remain a fan of the EITC, but I confess that as a matter of practical administration, I\’m not at all sure of how to substantially reduce its persistent problem of overpayments in a cost-effective manner. Part of the answer probably involves finding ways to simplify the rules and the interface with recipients, so that eligibility can be more clear-cut. In addition, I suspect that practical problems that cause a mix of over- and underpayments for the EITC will be dwarfed by the practical problems and error rates in deciding about eligibility for subsidies in the health insurance exchanges–even if or when the web interface itself becomes functional.
The claim this time is that the health-care \”cost curve is bending, and the ACA is a significant part of the reason.\” That was what David Cutler —an influential Harvard economist and senior health-care adviser in Mr. Obama\’s 2008 presidential campaign—wrote in a Washington Post WPO -0.71% op-ed on Nov. 10.
The president jumped on this theme in his press conference on Nov. 14. \”I\’m not going to walk away from something that has helped the cost of health care grow at its slowest rate in 50 years,\” he said. On Wednesday, the White House Council of Economic Advisers published a report claiming that \”the ACA is contributing to the recent slow growth in health care prices and spending.\”
These assertions border on nonsense.