Did Obamacare reduce un-insurance in 2015, or not? | TheHill

January 16, 2016

That total of $52.6 billion helped reduce the number of uninsured by 8.8 million on net in 2014, an average per capita cost of nearly $6,000.

Of course, the government incurred other costs in getting ObamaCare up and running—financing the creation of exchanges, launching its website, bankrolling star-crossed co-ops, promoting enrollment, and undertaking other efforts to implement and hype the law. Then there were the costs ObamaCare imposed on households and businesses—cancelled policies, premium hikes, higher deductibles, narrow physician networks, erroneous subsidy payments that resulted in loss of coverage among low-income households, a tax on the uninsured, and new levies on insurance premiums, drugs and medical devices—all of which have combined to make the law unpopular.

The eventual Democratic presidential nominee will nonetheless cite the reduction in the uninsurance rate as proof that ObamaCare has succeeded.  That is a mistake.  Though most Americans favor government intervention to make health insurance more widely available to people with low-incomes and pre-existing medical conditions, they chafe at the disruption the law has inflicted on their own coverage.  They will likely be as skeptical of presidential candidates who declare the law a success as they are of those who merely insist on its repeal.

Source: Did Obamacare reduce un-insurance in 2015, or not? | TheHill

Are Certificate-of-Need Laws Barriers to Entry? How They Affect Access to MRI, CT, and PET Scans | Mercatus

January 13, 2016


CON Regulations Have a Negative Effect on Nonhospital Providers

  • The association of a CON regulation with nonhospital providers is substantial, ranging from −34 percent to −65 percent utilization for MRI, CT, and PET scans.
  • Nonhospital providers in CON states experience significant decreases in the utilization of imaging services compared to hospital providers.

CON Regulations Have No Effect on Hospitals, Thus Increasing Their Market Share

  • CON regulation has no measurable effect on hospitals’ utilization of imaging services. The volume of services provided in hospitals is not affected by CON regulation.
  • This may explain why hospital providers have a stronger market presence in CON states than in non-CON states.

Consumers Are Driven to Seek Imaging Services in Non-CON States

  • CON regulations are associated with 3.93 percent more MRI scans, 3.52 percent more CT scans, and 8.13 percent more PET scans occurring out of state.
  • CON regulations may have a negative effect on consumers because patients living in CON states have to travel out of state more often than patients living in non-CON states. This propensity for traveling out of state to obtain medical services might be attributable to any of several factors: higher costs, a smaller selection of services, or restricted access to care.


CON laws act as barriers to entry for nonhospital providers and favor hospitals over other providers. In consequence, consumers of MRI, CT, and PET scanning services are driven to seek these services either out of state or in hospitals. More research is needed to determine whether additional costs and barriers in the healthcare industry restrict specific market providers and affect where procedures occur.

Source: Are Certificate-of-Need Laws Barriers to Entry? How They Affect Access to MRI, CT, and PET Scans | Mercatus

Yet Another Illegal ACA Tax Regulation, by Andy Grewal

October 14, 2015

I have previously written about various IRS regulations that contradict the clear language of tax code Section 36B. I recently re-examined the regulations and was only mildly surprised to find another provision that plainly exceeds the IRS’s rulemaking powers. Here, the IRS has simply discarded the statute’s joint return requirement for a segment of taxpayers (abused or abandoned spouses). Although one naturally pauses before criticizing the IRS for actually having a heart, the regulation presents an opportunity for tax avoidance and will lead to illegal penalty collections from employers.

Source: Yet Another Illegal ACA Tax Regulation, by Andy Grewal

33 Million Americans Still Don’t Have Health Insurance | FiveThirtyEight

October 14, 2015

Nearly 9 million people gained insurance last year, a win for “Obamacare” as the president’s signature health care law expanded Medicaid and opened health insurance exchanges. And yet, 33 million Americans, 10.4 percent of the U.S. population, still went without health insurance for the entirety of 2014. Millions more were uninsured for at least part of the year.1 New data released this month shows they were disproportionately poor, black and Hispanic; 4.5 million of them were children.

Source: 33 Million Americans Still Don’t Have Health Insurance | FiveThirtyEight

Health Care Compact States Choose Autocracy Over Democracy – US News

October 13, 2015

In a bold effort “to protect individual liberty and personal control over Health Care decisions,” nine states have approved a Health Care Compact to claim some autonomy from the Affordable Care Act, Medicare and Medicaid; two other states are considering joining them. The problem, however, is that in health care, most of the compact’s signatory states have poor records with respect to individual liberty and personal control over care.

The controls and strictures that these states place on patients and health care providers differ from the Affordable Care Act in style, but not in spirit. In both, the central guiding principles are paternalism and protectionism. The states, or their appointed medical boards, forbid patients and providers from using safe, effective modes of care and protect the finances and turfs of doctors, hospitals and others by shielding them from competition.

Source: Health Care Compact States Choose Autocracy Over Democracy – US News

The Growing Gap in Life Expectancy by Income: Implications for Federal Programs and Policy Responses | The National Academies Press

September 27, 2015

The U.S. population is aging. Social Security projections suggest that between 2013 and 2050, the population aged 65 and over will almost double, from 45 million to 86 million. One key driver of population aging is ongoing increases in life expectancy. Average U.S. life expectancy was 67 years for males and 73 years for females five decades ago; the averages are now 76 and 81, respectively. It has long been the case that better-educated, higher-income people enjoy longer life expectancies than less-educated, lower-income people. The causes include early life conditions, behavioral factors (such as nutrition, exercise, and smoking behaviors), stress, and access to health care services, all of which can vary across education and income.

Source: The Growing Gap in Life Expectancy by Income: Implications for Federal Programs and Policy Responses | The National Academies Press

An Overdue Budget Reform: Prohibit Double-Counting of Medicare Savings | Economics21

September 26, 2015

Some reforms, however, might be especially worthwhile insofar as they would simply make it more likely that budget results conform to lawmakers’ manifest intent. This piece will describe one such concept. In essence, it would prohibit future double-counting of Medicare Hospital Insurance (HI) savings, to ensure that future fiscal outcomes are consistent with the longstanding intent that both Social Security and Medicare HI be operated as self-financing programs.

There is currently an enormously expensive loophole in the budget rules. By law, Social Security and Medicare HI are only permitted to spend when there are positive balances in their respective trust funds. They must constrain benefit spending if trust fund reserves are depleted. Despite this restriction of law, current scorekeeping rules instead assume the law governing these programs will be changed to permit full payment of all scheduled benefits irrespective of trust fund spending authority. This results in a scorekeeping baseline assuming much higher spending than permitted under current law.

Source: An Overdue Budget Reform: Prohibit Double-Counting of Medicare Savings | Economics21