According to the Center for Health and Economy—H&E for short—the Coburn-Burr-Hatch plan will actually cover slightly more people than Obamacare. “By 2023,” H&E writes, “the number of insured under the proposal is estimated to be 1 percent higher than under current law.” That’s despite the fact that the GOP plan doesn’t contain an individual mandate or an employer mandate, and despite or because it repeals most of the other regulatory impositions of Obamacare.In addition, the plan would reduce the deficit over ten years by a total of $1,473 billion. As I mentioned, the biggest chunk of the deficit reduction comes from changing the tax treatment of employer-sponsored health insurance.
So It Turns Out That The Senate Republican Plan To Replace Obamacare Raises Taxes — And That’s A Good Thing – ForbesJanuary 31, 2014
This is not a coincidence; advocates of bold, activist government want to forget all the inequalities it creates. So it is with Obama. His signature achievement, the Affordable Care Act, is one of the most grossly unfair pieces of legislation to become law in modern times. Underwritten by a logroll among elite interests as varied as the drug manufacturers and the feminist left, it is an enormous redistribution of wealth from the young to the old, the healthy to the sick, without due regard to socioeconomic status.
Nearly half of the 114 hospitals and doctor groups that began Accountable Care Organizations under the health law in 2012 managed to slow Medicare spending in their first year, but only 29 of them saved enough money to qualify for bonus payments, the Centers for Medicare and Medicaid Services said Thursday.
CMS called the results “very promising”—particularly for the first year of a program that involved significant changes in the delivery of health care. But the fact that more than half the ACOs didn’t achieve savings underscores the challenges that remain in curbing health-care costs this way.
Editor’s note: average savings among the 29 ACOs receiving bonus payments amounted to ~$10 million per ACO. In a separate program, of the 32 Pioneer ACOs, 9 qualified for bonus payments generating savings of $147 million or ~$15 million apiece. There are 360 ACOs serving 12% of the Medicare population. Medicare spending was $574 billion in 2012, so these ACOs served patients accounting for ~$69 billion in spending. Thus, total savings represent 0.6% of total Medicare spending on Medicare patients. If every one of these had saved $10 million, the savings would have amounted to 5.2% of spending.
From a Jan. 27 letter to Sen. Harry Reid and Rep. Nancy Pelosi from Terry O’Sullivan, general president of the Laborers’ International Union of North America, and D. Taylor, general president of the Unite Here labor union:
Once we realized the [Affordable Care Act] would not let us keep the health care we had, we spent three years presenting the Administration with reasonable fixes to the ACA’s problems. All of them were rejected and the proposed regulations [regarding multi-employer health and welfare trust fund and other self-funded plans] offer virtually no assistance toward any of these solutions.
We were bitterly disappointed upon reading the proposed regulations put forward by the Administration. If the Administration honestly thinks that these proposed rules are responsive to our concerns, they were not listening or they simply did not care. We have examined various health exchanges and should members be forced to purchase insurance on an exchange, their out of pocket costs are likely to be significant, reaching into the thousands of dollars even if they are eligible for a subsidy under the act. It would be a sad irony indeed if the signature legislative accomplishment of an Administration committed to reducing income inequality cut living standards for middle-income and low-wage workers. [Emphasis added]
Two days after the 2012 challenges to the Affordable Care Act were argued and three months before they were decided by the Supreme Court, Adam Teicholz wrote this in The Atlantic: “Blogs – particularly a blog of big legal ideas called Volokh Conspiracy – have been central to shifting the conversation about the mandate challenges.” Paul Clement, the lead attorney who contested the law, agrees: “[I]f ever a legal blog and a constitutional moment were meant for each other, it was the Volokh Conspiracy and the challenge to the Affordable Care Act.” As Clement adds in his foreword to A Conspiracy Against Obamacare: The Volokh Conspiracy and the Affordable Care Act (Palgrave-MacMillan, 2014), edited by Trevor Burrus, he is friends with Eugene Volokh, “who clerked for Justice Sandra Day O’Connor the same year [he] clerked for Justice Antonin Scalia.”
The Provider Access Index (PAI) is based on a patient survey conducted by economists at the University of Minnesota to measure the quality of physician networks and access to care in the non-elderly insurance market. This index provides a tool for evaluating the effect of health policy reforms on the ability of patients to seek out desired doctors and specialists. H&E uses plan-specific, expected PAI to compute an aggregate PAI for the market, including Medicaid. Plan-specific PAI values range from a low of 1.0 for Medicaid to a high of 5.0 for large-network preferred provider organizations (PPO), reflecting low provider choice for Medicaid beneficiaries relative to the large network of physicians available to PPO members.
The US health care sector is large and growing – health care spending in 2011 amounted to $2.7 trillion and 18% of GDP. Approximately half of health care output is allocated via markets. In this paper, we analyze the industrial organization literature on health care markets focusing on the impact of competition on price, quality and treatment decisions for health care providers and health insurers. We conclude with a discussion of research opportunities for industrial organization economists, including opportunities created by the US Patient Protection and Affordable Care Act.