Republicans’ failure—so far—to repeal and replace Obamacare has breathed new life into the single-payer dream. In June, the majority of Americans told Pew that the government has the responsibility to ensure health coverage for everyone, and 33 percent say this should take the form of a single government program. The majority of Democrats, in that poll, supported single payer. A June poll from the Kaiser Family Foundation even found that a slim majority of all Americans favor single payer.
Thousands of North Carolina residents have been exempt from the Affordable Care Act and got to keep their old health insurance, paying significantly less for their coverage than those insured under the ACA.
But that’s about to come to an end for 50,000 customers of Blue Cross and Blue Shield of North Carolina. In 2018, they will have to switch to ACA plans, in some cases paying twice as much or more for health insurance.
The unsurprising part is CBO’s expectation that if CSR subsidies are withdrawn, sponsors of silver plans will hike premiums substantially.
The surprising part is that CBO found that not only would this generally not hurt low-income participants, it would on balance benefit them – especially older Americans below 400 percent of the poverty line. The primary losers, under CBO’s analysis, would be federal taxpayers. Add it all up, and terminating the CSR subsidies would paradoxically lead to a substantial increase in progressive income redistribution.
Democratic lawmakers delayed the onset of the Cadillac plan tax from 2013 to 2018 in the 2010 reconciliation bill that enacted parts of the ACA. More recently, lawmakers delayed it again, postponing its effective date to 2020. The distaste for the Cadillac tax is clearly bipartisan, as the House Republicans’ American Healthcare Act — their ACA repeal-and-replace bill — would further delay the tax to 2025, and the Senate’s version of this bill would push it off to 2026.
Instead of kicking the can farther down the road, a different approach to dealing with employer-sponsored insurance is needed. In a new Mercatus Center report, we discuss some potential options available to policymakers.
The number of people with individual health-insurance coverage is shrinking. Despite $146 billion in federal subsidies to low-income households and well-capitalized insurers, 2.6 million fewer people had individual policies in March 2017 than in March 2016, a drop of nearly 15 percent.
from a policy standpoint, Medicare-for-All is probably the hardest way to get there. In fact, a number of experts who tout the benefits of single-payer systems say that the Medicare-for-All proposals currently on the table may be virtually impossible to enact. The timing alone would cause serious shocks to the system. Conyers’s House bill would move almost everyone in the country into Medicare within a single year. We don’t know exactly what Bernie Sanders will propose in the Senate, but his 2013 “American Health Security Act” had a two-year transition period. Radically restructuring a sixth of the economy in such short order would be like trying to stop a cruise ship on a dime.
Unleashing the technology of health care is another salient argument for repealing Obamacare. In “The Patient Will See You Now: The Future of Medicine in Your Hands” (2015), Eric Topol (also interviewed in this compelling EconTalk podcast by Russ Roberts) describes the revolutionary changes in health care driven by the democratization of data, a veritable “Gutenberg Moment” in which people are empowered with information through their smartphones just as they were with books from the printing press. Presently the government is in the center of health care, but it should be the individual consumer instead.