Can Trump really ‘fire’ ObamaCare by himself? Yes … and no | TheHill

January 10, 2017

Both Affordable Care Act (ACA) opponents and supporters tended to exaggerate how much immediate harm Trump would do to the outgoing Obama administration’s legacy healthcare program.

The new president certainly “could” swing a wrecking ball against what remains of the troubled effort to expand insurance coverage under tighter federal government control and substantial taxpayer subsidies. His toolkit of potential executive branch actions is large and varied, but it is not unlimited. The more important questions involve how Trump wants to utilize those powers, and for what objectives.

Source: Can Trump really ‘fire’ ObamaCare by himself? Yes … and no | TheHill


Medicaid reform: The elephant in the room – AEI

January 6, 2017

While headlines fixate on the future of the Affordable Care Act’s health insurance exchanges, a more consequential fight is brewing over the future of Medicaid. Proposed reforms would affect tens of millions of Americans and state governments across the country. Previous attempts have failed, however, and longstanding roadblocks may sink this administration’s efforts as well.

Source: Medicaid reform: The elephant in the room – AEI


Can a Continuous Coverage Requirement Produce a Healthy Insurance Market? | RAND

January 6, 2017

Like the individual mandate, a continuous coverage requirement is intended to discourage individuals from waiting until they become sick to purchase insurance. Such a requirement has teeth because individuals who let their coverage lapse risk being denied coverage in the future. When they attempt to re-enter the market, insurers can charge higher prices, withhold coverage of specific health conditions, or deny coverage altogether.

Compared to the limited penalties imposed by the individual mandate, the financial penalties and loss of consumer protections for pre-existing conditions may provide a much stronger incentive to purchase insurance. Economic intuition suggests that an insurance market based on a continuous coverage requirement could perform well, but there is little direct evidence on how well it might work in practice. Designing a replacement for the ACA poses a number of challenges for policymakers.

Source: Can a Continuous Coverage Requirement Produce a Healthy Insurance Market? | RAND


Learning From CBO’s History Of Incorrect ObamaCare Projections

January 4, 2017

As Congress readies legislation to repeal and replace the Affordable Care Act (ACA), Congressional Budget Office (CBO) estimates will play an important and respected role as they did in the passage of the law in 2010. We now know that many of CBO’s projections of important aspects of the ACA have significantly differed from actual outcomes. In this piece, I highlight CBO’s key past errors in projecting effects of the ACA. They can largely be grouped into two categories. First, CBO projected that the exchanges would be stable by now with more than twice as many enrollees as they currently have, rather than suffering from severe adverse selection in most states as they now are. Second, CBO projected that the ACA Medicaid expansion would be much smaller and less expensive than it has turned out to be.

Source: Learning From CBO’s History Of Incorrect ObamaCare Projections


The Problems With ‘Repeal And Delay’

January 3, 2017

Republican leaders in Congress and the incoming Trump administration have said that they plan to move quickly to repeal the Affordable Care Act (ACA) in the early weeks of 2017, with a delay in the date of when key aspects of the repeal would become effective until perhaps 2019 or 2020. This is the so-called “repeal and delay” option. They have also pledged to replace the law in separate legislation, or a series of bills, that would come later, although it is not clear what the replacement would look like or when it would pass.

We do not support this approach to repealing and replacing the ACA because it carries too much risk of unnecessary disruption to the existing insurance arrangements upon which many people are now relying to finance their health services, and because it is unlikely to produce a coherent reform of health care in the United States. The most likely end result of “repeal and delay” would be less secure insurance for many Americans, procrastination by political leaders who will delay taking any proactive steps as long as possible, and ultimately no discernible movement toward a real marketplace for either insurance or medical services.

Source: The Problems With ‘Repeal And Delay’


The Affordable Care Act: Moving Forward in the Coming Years by Lawrence O. Gostin, David A. Hyman, Peter D. Jacobson :: SSRN

December 23, 2016

President Barack Obama signed the Affordable Care Act (ACA) in 2010 with no Republican support. The ACA has been politically divisive ever since, with the House repeatedly voting for repeal. Earlier this year, Congress successfully passed a repeal, with the Senate using a legislative process called “reconciliation,” which requires only a simple majority for certain tax and spending bills. However, Congress failed to override a presidential veto.

President-elect Donald Trump pledged to “repeal and replace” the ACA, but would keep the most popular features: (1) guaranteed issue — health plans must enroll applicants regardless of pre-existing conditions; and (2) dependent coverage — health plans must keep dependent children on their parents plan until age 26. Although his reform package has not been announced, it will likely include health savings accounts (HSAs), cross-border insurance sales, Medicaid block grants to states, and a cap on non-economic damages.

In this Viewpoint, we examine potential reforms of the ACA through the lens of empirical evidence to find whether they are likely to be effective, particularly in ensuring access to health insurance at a reasonable cost, and in a stable insurance market. We conclude that the public has a right to expect their representatives to find common ground and adopt evidence-based policies that expand coverage at a reasonable cost.

Source: The Affordable Care Act: Moving Forward in the Coming Years by Lawrence O. Gostin, David A. Hyman, Peter D. Jacobson :: SSRN


Want to Get Rid of Obamacare? Be Careful What You Wish For – The New York Times

December 17, 2016

The findings suggest that people would fight hundreds of times harder to retain the health benefits they currently possess than they would to acquire those same benefits if they lacked them. The scale of the losses at stake for Obamacare is staggering. A study by the Urban Institute estimates that a repeal would result in almost 30 million Americans losing their health coverage. Research on loss aversion thus suggests that the repeal would precipitate a political firestorm of epic proportions.