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.
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.
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.
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.
ObamaCare Watch | Dire Predictions About the Effects of AHCA’s Per Capita Allocations Find No Support in the CMS Data – ObamaCare WatchJune 16, 2017
The American Health Care Act (AHCA) would establish per capita Medicaid allocation levels, beginning in 2020, as part of changes to give states more flexibility and incentives to improve care delivery and costeffectiveness in their Medicaid programs that now cover an estimated 72 million Americans. Although some have suggested that the allocation levels would produce large reductions in federal Medicaid spending, a comparison of projected per capita Medicaid spending under AHCA with baseline projections prepared by the Centers for Medicare and Medicaid Services (CMS) suggests that these limits would achieve virtually no federal Medicaid savings.
No matter what happens to the Republicans’ troubled health bill in Congress, Trumpcare is here to stay.The Trump administration has already begun to transform the health insurance market, wielding executive power to rewrite coverage rules, slash Obamacare’s marketing budget and signal an all-out assault on his predecessor’s health care law. And Republicans have high expectations the administration will take additional measures to unwind Obamacare, such as targeting its contraception coverage requirement at the center of two recent religious liberty cases at the Supreme Court.
For better or for worse, it is nearly impossible for the ACA’s insurance exchanges to implode to the extent that its detractors have long predicted. To understand why, it is important to understand how the subsidies and regulations in the ACA work. The ACA employs “price-linked subsidies.” That is, the premium subsidy consumers receive is based on the actual prices for insurance on the exchanges. In addition, the ACA’s regulatory framework caps the out-of-pocket expenses faced by consumers.