August 23, 2017
RAND research offers insights about the likely impact of repealing or revising the ACA. RAND’s research on the ACA makes use of an updated version of the RAND COMPARE microsimulation model, which predicts the effects of health policy changes at state and national levels. Using COMPARE, researchers have examined the impact of many configurations of health insurance in the United States, including:
- maintaining the ACA with no changes
- repealing the law with no replacement
- replacing the law with a single payer system
- replacing the law with other measures that address coverage expansions through Medicaid and the individual market
Source: The Future of U.S. Health Care: Replace or Revise the Affordable Care Act? | RAND
August 17, 2017
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.
Source: A Tax Reform President Trump Should Like, and You Should Too | Manhattan Institute
August 9, 2017
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.
Source: The tech policy case for repealing Obamacare | Technology and Innovation Blog » AEIdeas
August 4, 2017
On health care, the president has made it clear that he does not care what is in a bill to repeal and replace Obamacare, so long as he can say he achieved that goal. At various points, he was for the House repeal-and-replace plan, for the clean “repeal-and-delay” bill that Republicans passed in 2015, and for Senator Mitch McConnell’s last-ditch “skinny repeal” plan, which really was just a repeal of the tax penalties enforcing the Affordable Care Act’s individual mandate. When the Senate bill failed last week, it was clear that even if a bill did ever emerge from a House-Senate conference, it couldn’t pass in the Senate with major Medicaid reforms or with any real replacement of the major subsidy provisions of the ACA. Republicans are now saying “we were so close” to achieving victory, but the “skinny repeal” plan was the only thing that came close. And that shows the GOP is not, in fact, close to agreement on a workable plan to replace the ACA.
Source: The Republicans’ Budget Mess | RealClearPolicy
August 1, 2017
As rightly determined by federal district judge Rosemary Collyer back in May of 2016 in a strong 38-page opinion, the payments by President Obama (and President Trump) were and are illegal. Insurers receiving them have effectively been receiving stolen funds. The Constitution prohibits drawing any money from the Treasury except “in Consequence of Appropriations made by Law.” Congress has enacted various statutes making it a crime to pay money from the United States Treasury for which no appropriation exists. It’s real simple. Congress never appropriated any money for this program. And the efforts to twist other appropriations into CSR appropriations are, as even some ACA supporters have the courage to admit, pretty lame. This is why Judge Collyer actually enjoined the payments from being made, although she had enough modesty to hold off activating the injunction until there was time to resolve an appeal. That appeal has been pending, now, for more than a year, without any action being taken.
Source: President Trump Now Fully Justified In Cutting Off Illegal Cost Sharing Reduction Payments
August 1, 2017
Universal catastrophic coverage (UCC) would make an excellent centerpiece for the next round of healthcare reform. In fact, UCC is not even particularly new to the conservative playbook. Respected thinkers like Martin Feldstein, who would go on to serve as Ronald Reagan’s chief economic adviser, promoted the idea already in the 1970s. In 2004, Milton Friedman, then a fellow at the Hoover Institution, also endorsed the concept. UCC would make healthcare affordable, both for the federal budget and for American families. And because it would throw no one off the healthcare roles—not 22 million people, not 2 million, not anyone—it offers a realistic chance of the bipartisanship that polls show both the Republican and Democratic rank and file want.
Source: How the GOP Can Win on Healthcare | The American Conservative
July 28, 2017
How much are low-income individuals willing to pay for health insurance, and what are the implications for insurance markets? Using administrative data from Massachusetts’ subsidized insurance exchange, we exploit discontinuities in the subsidy schedule to estimate willingness to
pay and costs of insurance among low-income adults. As subsidies decline, insurance take-up falls rapidly, dropping about 25% for each $40 increase in monthly enrollee premiums. Marginal enrollees tend to be lower-cost, consistent with adverse selection into insurance. But across the entire
distribution we can observe – approximately the bottom 70% of the willingness to pay distribution – enrollee willingness to pay is always less than half of own expected costs. As a result, we estimate
that take-up will be highly incomplete even with generous subsidies: if enrollee premiums were 25% of insurers’ average costs, at most half of potential enrollees would buy insurance; even premiums subsidized to 10% of average costs would still leave at least 20% uninsured. We suggest an important role for uncompensated care for the uninsured in explaining these findings and explore normative implications.
Full report: https://scholar.harvard.edu/files/mshepard/files/finkelstein_hendren_shepard_SubsidizingInsurance.pdf