Is health care reform finding its footing—or fatally flawed? MIT economist and Affordable Care Act (ACA) expert Jonathan Gruber and Cato Institute Director of Health Policy Studies Michael Cannon share opposing viewpoints on the current state of reform.
Massachusetts’ reform failed to reduce racial and ethnic disparities | Physicians for a National Health ProgramApril 2, 2015
Massachusetts reform was not associated with significantly lower overall or racial and ethnic disparities in rates of admission to hospital for ACSCs. In the US, and Massachusetts in particular, additional efforts might be needed to improve access to outpatient care and reduce preventable admissions.
Obamacare has so far functioned as an income transfer program in which middle income people finance Medicaid expansions and health insurance subsidies for the poor and near-poor. Most uninsured middle class people have so far declined to purchase insurance because the coverage isn’t worth the price. Their taxes are subsidizing coverage for others. It seems unfair to hit them with an additional tax for refusing to buy insurance for themselves, especially when that coverage is less valuable than the coverage they are subsidizing for others.
Obamacare’s “pay more, get less” regime has made remaining uninsured an economically rational decision even for millions of people who are eligible for subsidies. Which may explain why the government is underachieving in its efforts to persuade millions of people to buy a product they just don’t think is worth the price.
Obama’s Equal Employment Opportunity Commission has sued New Jersey–based Honeywell, as well as Orion Energy Systems and Flambeau. The latter two enterprises are headquartered in Wisconsin. These companies’ efforts to follow Obamacare have landed them in federal court. In Obama’s America, even cooperative companies face federal wrath.
“The fact that the EEOC sued is shocking to our members,” Business Roundtable vice president Maria Ghazal told Reuters, which broke this story. “They don’t understand why a plan in compliance with the ACA is the target of a lawsuit. . . . This is a major issue to our members.”
In a November 14 letter to Health and Human Services secretary Sylvia Burwell, Treasury secretary Jack Lew, and Labor secretary Thomas Perez, Business Roundtable president John Engler wrote, “If employers believe that complying with the letter of the law can still result in enforcement actions, it will send a chilling effect across the country.”
Non-citizens granted any sort of legal status by a congressional immigration deal or Executive fiat would immediately become eligible under Obamacare’s Basic Health Program BHP provisions for taxpayer-subsidized, Obamacare-compliant private health insurance plans, with better benefits and lower premiums than U.S. citizens.Such persons could also receive “cost-sharing” subsidies under Obamacare.The Senate comprehensive immigration reform bill, S.744 passed earlier this year, purports but fails to prevent persons newly granted “legal status” from receiving Obamacare subsidies.An HHS final rule issued in March extended Basic Health Program benefits to aliens lawfully present in the country from 0-200 percent of the official Federal Poverty Line FPL when the statute explicitly states that no lawfully present aliens above 133 percent of FPL are eligible.The statute clearly limits who is eligible for the BHP, but HHS’ rule opens the door to others being deemed eligible, contrary to the law, and without congressional approval.
David A. Hyman is the H. Ross & Helen Workman Chair in Law and director of the Epstein Program in Health Law and Policy at the University of Illinois Urbana-Champaign, as well as an adjunct scholar at the Cato Institute. Earlier this month, Hyman gave the following erudite presentation on the implementation of the Patient Protection and Affordable Care Act – which he calls PPACA, not “ObamaCare” or “the Affordable Care Act” – at a faculty seminar hosted by the University of Chicago’s MacLean Center for Clinical Medical Ethics.
Greg Fann, Wakely Consulting Group | Implications of Individual Subsidies in the Affordable Care Act—What Stakeholders Need to UnderstandMay 13, 2014
However, the following sections will illustrate that the subsidies will primarily benefit older people, as premium rates for younger people are more likely to be considered “affordable” before a subsidy adjustment. This reality is either unknown or overlooked when reliance on premium subsidies is the automatic explanation of why there is no reason to be concerned that young people may choose not to enroll in the individual exchanges.
The concern that young people will not enroll in enough levels to support the sustainability of the individual market is further strained by the widely known ACA provision requiring employers to allow children under the age of 26 to enroll or remain on their parents’ plans, as well as age compression of the individual market premiums that will discourage younger members from enrolling compared to premiums they would pay if age rating were on an actuarially appropriate basis. A detailed illustration of the premium subsidy calculation and resulting net premiums by age and income level is provided below.