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

February 12, 2017

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


The stealth Republican force behind Obamacare repeal – POLITICO

February 11, 2017

He also believes Republicans should focus on the biggest problems first. At the top of the list is flagging insurance exchanges, which are suffering from high premiums and low competition, even if they represent just 4 percent of those insured in the United States.“That’s where we need to send in the rescue team,” Alexander says.From there, he wants Republicans to turn to Medicaid expansion — which Republicans will keep and potentially even broaden, he says — before eventually addressing problems with the country’s patchwork of employer-sponsored health care plans. In essence, Alexander is trying to triangulate an approach that can become law.

Source: The stealth Republican force behind Obamacare repeal – POLITICO


President Trump’s Historic Debt Dilemma | Committee for a Responsible Federal Budget

February 9, 2017

As President Donald Trump begins his term, he faces perhaps the most daunting fiscal situation of any incoming president. President Trump enters office with high levels of debt, rising deficits, major trust funds facing shortfalls, and no agreement on how to address these challenges.

Source: President Trump’s Historic Debt Dilemma | Committee for a Responsible Federal Budget


How Donald Trump can Keep His Campaign Promises, Grow the Economy, Cut Tax Rates, Repatriate Offshore Earnings, Reduce Income Inequality, Keep Jobs in the United States, and Reduce the Deficit by David S. Miller :: SSRN

February 8, 2017

This paper discusses President Trump’s tax proposals and the House Republicans’ Blueprint, and makes a number of suggestions that would allow President Trump to keep all of his tax policy campaign promises and some others.

One component of the plan includes: The Blueprint does this. Instead of using a current law baseline, it uses a “current policy baseline”, which would assume that Congress extents expiring provisions. This change saves $400 billion more over the 10-year budget window. Second, the Blueprint uses a baseline that assumes that all of the revenue-raising provisions of the Affordable Care Act (“ACA”) are repealed. This includes the individual mandate tax, the 3.8% Medicare tax, and the tax on highcost (“Cadillac”) employer-provided healthcare plans. This repeal of the ACA taxes would reduce revenue by approximately $1.1 trillion over 10 years so this change in the baseline allows the Blueprint to raise $1.1 trillion less to attain budget neutrality. Together these two changes would move the goal post by $1.5 trillion dollars. This allows a $1.5 trillion tax cut without increasing the deficit a penny, at least on paper

Source: How Donald Trump can Keep His Campaign Promises, Grow the Economy, Cut Tax Rates, Repatriate Offshore Earnings, Reduce Income Inequality, Keep Jobs in the United States, and Reduce the Deficit by David S. Miller :: SSRN


Survey Finds Few Primary Care Doctors Support Obamacare Repeal | RealClearHealth

February 4, 2017

A new survey of primary care physicians found that only 15 percent supported a complete repeal of the Affordable Care Act and large majorities wanted to keep major provisions of the law also known as Obamacare.

Source: Survey Finds Few Primary Care Doctors Support Obamacare Repeal | RealClearHealth


Price-Linked Subsidies and Health Insurance Markups

February 2, 2017

Subsidies in many health insurance programs depend on prices set by competing insurers – as prices rise, so do subsidies. We study the economics of these “price-linked” subsidies compared to “fixed” subsidies set independently of market prices. We show that price-linked subsidies weaken price competition, leading to higher markups and subsidy costs for the government. We argue that price-linked subsidies make sense only if (1) there is uncertainty about costs/prices, and (2) optimal subsidies increase as prices rise. We propose two reasons why optimal health insurance subsidies may rise with prices: doing so both insures consumers against cost risk and indirectly links subsidies to market-wide shocks affecting the cost of “charity care” used by the uninsured. We evaluate these tradeoffs empirically using a structural model estimated with data from Massachusetts’ health insurance exchange. Relative to fixed subsidies, price-linking increase prices by up to 5%, and by 5-10% when we simulate markets with fewer insurers. For levels of cost uncertainty that are reasonable in a mature market, we find that the losses from higher prices outweigh the benefits of price-linking.

Source: Price-Linked Subsidies and Health Insurance Markups


ObamaCare: CBO report shows full repeal is better than partial repeal | TheHill

February 2, 2017

But Senate rules do, in fact, allow repeal of ObamaCare’s insurance regulations through the special “budget reconciliation” process that requires only 51 votes to approve legislation. Even if the Senate parliamentarian misinterprets those rules — and this would be an egregious misinterpretation — a majority of the Senate can overrule that misinterpretation.In short, the question is not whether Republicans can repeal the regulations. It is whether they have the will.

Source: ObamaCare: CBO report shows full repeal is better than partial repeal | TheHill