Tag Archives: American Health Care Act

What Would Happen if Obamacare is Not repealed, Part 2

The New York Analysis of Policy and Government concludes its two-part review of what would occur if Obamacare is not repealed.

It is, perhaps, a pointless intellectual exercise to speculate on Obamacare’s impact if it’s not repealed, largely because, regardless of what Congress does, it is collapsing on its own.

Tyler Durden, writing for Zero Hedge, explains that “If Obamacare enrollments continue their current trend and insurers continue to hike premiums at alarming rates then Republicans may not have to worry about ‘repealing and replacing Obamacare’ as it might just work itself out “naturally”.

The House Ways and Means Committee  found that “Since the Obamacare exchanges opened for business on October 1, 2013, they have struggled to deliver quality, affordable health insurance options to Americans… Here’s a closer look at how Obamacare is failing across America:

  • PREMIUM SPIKES: Premium rates for the 2017 individual health insurance market may increase by an average of 24 percent, forcing many Americans to pay hundreds more a month to keep their coverage.

Wall Street Journal“The danger for insurers and supporters of the law now is that high prices and limited choices further deter low-risk people from signing up, and that the increases continue and become irreversible.” — Rate Increases for Health Plans Pose Serious Test for Obama’s Signature Law, October 18, 2016

Philadelphia Inquirer“In a bid to keep at least one insurer on the exchange in every county, ‘the department allowed insurers to adjust their rate filings …’ regulators said in a filing approving an average rate increase of 28.4 percent for individual plans.” — Without Aetna and United Healthcare, Philly Area Faces Hefty Increases for Affordable Care Act Rates, October 17, 2016

Omaha World-Herald“About 82,000 Nebraskans will pay more than expected for individual health insurance next year because Blue Cross won’t offer policies on the Affordable Care Act’s exchange.” — With Blue Cross’ Exit, Nebraskans Can Expect Even Higher Health Premiums through Obamacare, October 14, 2016

Associated Press“Minnesota’s Democratic governor said Wednesday that the Affordable Care Act is ‘no longer affordable’ … while addressing questions about Minnesota’s fragile health insurance market, where individual plans are facing double-digit increases after all insurers threatened to exit the market entirely in 2017.” — Democrat Dayton: Health Law ‘No Longer Affordable’ for Many, October 12, 2016

Bloomberg“Minnesota will let the health insurers in its Obamacare market raise rates by at least 50 percent next year, after the individual market there came to the brink of collapse.” — Near ‘Collapse,’ Minnesota to Raise Obamacare Rates by Half, September 30, 2016  

The Denver Post“Residents who buy their health insurance themselves will pay 20 percent more on average next year … In some parts of rural Colorado, premium increases will top 40 percent.” — Colorado Health-Insurance Rates to Jump 20 Percent on Average for Individual Buyers in 2017, September 20, 2016

The Boston Globe“Thousands of people who buy subsidized health insurance will face substantial premium increases — an average of 21 percent — if they want to keep the only plan that gives them access to certain prestigious Boston hospitals.” — Premiums Soar 21 Percent for Popular Health Plan, September 9, 2016

  • CO-OP CLOSURES: 74 percent (17 out of 23) of Obamacare co-ops have collapsed, wasting billions of taxpayer dollars and kicking hundreds of thousands of Americans off of their insurance.

The Washington Post“17 co-ops have either collapsed or been ordered to close by state regulators because of their financial fragility, leaving hundreds of thousands of people to scramble for new coverage.” — Maryland’s ACA Health Co-Op Will Switch to For-Profit to Save Itself, October 3, 2016

The Record“Health Republic Insurance of New Jersey will shut down for next year, forcing 35,000 people to find new insurance by Jan. 1 … The shutdown leaves just two companies doing business on HealthCare.gov, the Affordable Care Act marketplace for New Jersey.” — Health Republic Insurance of New Jersey’s Demise Exposes Flaws of Obamacare, October 2, 2016

Bloomberg“Most of the original 23 co-ops have failed, dumping more than 800,000 members back onto the ACA markets over the last two years … With more of the nonprofits on the brink of folding, the situation for the remaining providers looks dire.” — Shaky Obamacare Market Adds to ‘Death Spiral’ Fears, September 23, 2016

FoxNews.com“Health Republic Insurance of New Jersey is folding after the state’s insurance commissioner put the Obamacare co-op in ‘rehabilitation’ due to its hazardous financial condition.” — Another ObamaCare Co-Op Folds, Leaving Only 6 Remaining, September 13, 2016

  • FEWER, IF ANY, CHOICES: More Americans are finding themselves with fewer health care options as insurers exit the Obamacare exchanges.

Bloomberg“A growing number of people in Obamacare are finding out their health insurance plans will disappear from the program next year, forcing them to find new coverage even as options shrink and prices rise.” — More Than 1 Million to Lose Obamacare Plans as Insurers Quit, October 14, 2016

Washington Post“More than 250,000 people in North Carolina are losing the health plans they bought under the Affordable Care Act because two of the three insurers are dropping out — a stark example of the disruption roiling marketplaces in many parts of the country.” — In North Carolina, ACA Insurer Defections Leave Little Choice for Many Consumers, October 14, 2016

Washington Examiner“Blue Cross’s exit [from Tennessee] is part of a nationwide trend of insurers pulling back from the Affordable Care Act marketplaces after experiencing heavy financial losses. Independent analysts have said one-third of the country may have just one Obamacare insurer next year.” — Obamacare Customers Lose Access to Top Tennessee Hospital, October 13, 2016

Forbes“The exit of other major insurers means that 85% of North Carolinians needing Obamacare coverage will have only 1 insurance company to choose from in 2017.” — Mixed News For Obamacare In North Carolina As Blues Plan Opts To Remain In Obamacare Exchange, September 25, 2016

Alaska Public Media: “Alaskans shopping for individual health insurance on the federal exchange will only be able to choose from one insurer when open enrollment starts on November 1st.” — Alaskans Endure Rising Insurance Costs, September 21, 2016

Star-Telegram“After three years of growth, which culminated in six health insurers offering 63 plans last year, the Affordable Care Act marketplace likely will fall to just one insurer for Tarrant County residents in 2017 … Having just one insurance company to choose on the exchange will limit medical options.” — Local Consumers Left with Few Options on Obamacare Exchange, September 16, 2016”

Allowing Obamacare to die a natural death, without any repealer by Congress, might be a viable political strategy.  But the damages left to the American health care system by this failed concept would leave substantial hardships in its wake.

What Happens if Obamacare Isn’t Replaced

The New York Analysis of Policy and Government presents a two-part examination of what would happen if Obamacare isn’t replaced. 

There has been a great deal of discussion about the impact of replacing Obamacare. Perhaps more attention should be paid to what would happen if Obamacare is NOT replaced.

A Washington Free Beacon report  quotes Aetna CEO Mark Bertoline, noting that “Obamacare Will Continue to Deteriorate If Nothing Happens…” Aetna has announced that it will leave Obamacare exchanges in Iowa and Virgina. Bertoline also stressed thata reinsurance pool would be a better solution for really sick individuals…When you talk to a lot of constituents who have $6,000 deductibles, live in the five eastern counties of Colorado where there isn’t a doctor, a $6,000 deductible is not helpful.”

Writing for the Journal of American Physicians and Surgeons, Dr. Lawrence R. Huntoon, M.D.states:

“ObamaCare is designed to cheat both patients and physicians. It destroys patient choice and often disrupts continuing long-term patient-physician relationships. By implementing extremely high deductibles, co-pays, and out-of-pocket maximums, ObamaCare creates the illusion of coverage at the cost of unacceptably high premiums…In order to survive, physicians who depend on third-party payment will need to take appropriate legal measures to limit financial losses caused by ObamaCare. Many will likely reassess their plan participation as financial losses and bureaucratic impediments to care increase. Third-party-free practice models will become more attractive to many physicians. And, unfortunately, physicians who opt for hospital-subsidized employment in an attempt to escape the adversities of ObamaCare will only exacerbate the loss of choice for patients and the rationing of care by the so-called Accountable Care Organizations. Patients will also come to recognize that they are paying a very high price for the illusion of coverage under ObamaCare. As patients increasingly realize that, for the most part, they will be spending their own money for medical care during any given year, they will begin to look for better value in their medical care. Third-party-free physicians, who are able to provide timely access to care, and more face-to-face time with patients at an affordable cost, will become more attractive to many patients. Likewise, as high deductibles, high co-pays, and unlimited out-of-pocket costs are a reality under ObamaCare, health savings accounts will become more attractive to more patients. If one is going to spend one’s own money, one might as well spend tax-free money as opposed to after-tax money. “

A major concern about Obamacare has been its detrimental impact on full-time employment, a problem that would continue if the law remains in effect. Writing for Forbes last September,  Michael C. Cannon noted: “Four percent of large employers are reducing hiring because of the cost of providing health benefits to them… ObamaCare will depress wages for high-skilled workers by 1.3 percent and for low-income workers by 3 percent.”

The harsh economic impact of Obamacare doesn’t receive adequate attention.  Casey B. Mulligan writes in Side Effects and Complications: The Economic Consequences of Health-Care Reform that the economy, and particularly employment, are detrimentally affected.

Edward Morrissey, writing for the Fiscal Times,  concurs. He cites a Goldman Sachs study that demonstrates that employers have reduced full-time positions in favor of part-time ones that don’t require them to provide health insurance. That trend will continue if Obamacare is not repealed.

The continued existence of Obamacare-related taxes also would serve as an ongoing drag on the economy. Americans for Tax Reform’s John Kartch  lists the $1 trillion in taxes that would be repealed if the legislation were overturned:

Obamacare Individual Mandate Tax

Obamacare Employer Mandate Tax

Obamacare’s Medicine Cabinet Tax

Obamacare’s Flexible Spending Account tax

Obamacare’s Chronic Care Tax

Obamacare’s HSA withdrawal tax.

Obamacare’s 10% excise tax on small businesses with indoor tanning services.

Obamacare health insurance tax.

Obamacare 3.8% surtax on investment income.

Obamacare medical device tax.

Obamacare tax on prescription medicine.

Obamacare tax on retiree prescription drug coverage.

The Report concludes tomorrow. 

Why Obamacare has to be Replaced

The New York Analysis of Policy and Government continues its review of the reasons Obamacare had to be replaced.

Government mandates for the inclusion of coverage for treatment modes unwanted and unneeded by many serves to unnecessarily increase costs.

Cato Institute study notes:

“Like the federal government, all states increase the cost of health insurance by requiring consumers to purchase certain types of coverage, whether or not they want it. Many states require consumers to purchase coverage for services that many consider quackery, such as acupuncture (12 states), chiropractors (44 states), and naturopathy (4 states). Thirty-three states require consumers to purchase at least 40 types of mandated coverage. States have also required consumers to purchase coverage for medical treatments that later proved harmful to health, such as hormone replacement therapy (4 states) and high-dose chemotherapy with autologous bone marrow transplant for breast cancer (at least 1 state, Minnesota). States impose many additional regulations on insurance pools, from premium taxes to rules limiting insurers’ ability to manage utilization. The Congressional Budget Office estimates that, on average, state regulations increase the cost of health insurance by 13 percent. States prevent individuals (and employers) from avoiding unwanted regulatory costs by prohibiting them from purchasing health insurance from states with more consumer-friendly regulations.

Another approach ignored by those who enacted Obamacare was tort reform. A study by the South Carolina Policy Council analyzed the problem. “…medical malpractice tort reform…seeks to obtain a better balance between holding doctors accountable for mistakes and protecting physicians from frivolous lawsuits. In practice, medical tort reform seeks to cap the amount of monetary damages awarded in medical negligence cases. The impetus for this is escalating costs for doctors and insurance companies, on the heels of multimillion dollar settlements to individuals and multibillion dollar settlements to states…Estimates of the cost total of medical malpractice civil cases range from $252 billion (by the Tillinghast-Towers Perrin actuarial firm) to $865 billion by the Pacific Research Institute (PRI). PRI’s estimate includes $589 billion in wasteful spending that accounts for lost future productivity and lost sales ($367 billion) caused by less innovation. While not all tort costs are wasteful — tort law is imperative in a free market system to maintain the rule of law — there is plenty of room for reform…doctors feel they must practice defensive medicine in order to avoid being sued. This practice entails prescribing tests or treatments for patients whose symptoms would not ordinarily require such procedures…Dr. William Jackson, a radiologist at Beaufort Memorial Hospital, says most people would be amazed at how many defensive medicine lab tests are ordered every day.”

As the Republican majority in Congress moves to address the Obamacare crisis, conservatives are asserting that marketplace concepts such as interstate competition, tort reform, and consumer choice in treatment coverage is not being emphasized in the initial phase. GOP leadership is emphasizing a gradual approach, centered around tax credits for purchasing private policies.

The Wall Street Journal reports that “Sen. Rand Paul (R., Ky.) reintroduced… a bill to repeal most of the 2010 health law without replacing it, a measure that cleared the last Congress when President Barack Obama, a Democrat, was in office. Conservative groups view that bill, which Mr. Obama vetoed, as a gold standard. GOP leaders’ decision to back away from that bill now that Mr. Trump is president is causing friction. Sen. Ted Cruz (R., Texas) amplified the message when he left a Thursday afternoon meeting with Senate Majority Leader Mitch McConnell (R., Ky.) and a handful of other Republicans and said the House bill couldn’t pass the Senate and needed to be changed.”

But Congressional leadership favors a three-part approach, notes the Wall Street Journal. “The leaders plan to first pass the current bill repealing much of the law and offering some Republican-backed elements in their place…The second phase would have Health and Human Services Secretary Tom Price use his administrative power to undo other ACA provisions. The third step would be the hardest—persuading enough Democrats to go along with a set of non-budget health-care bills that would take 60 votes to pass the Senate.Mr. Trump has said letting insurers sell policies in every state would be part of the third phase. But conservatives insist that proposal should be included in the current legislation, since they doubt the likelihood of winning over enough Democrats to pass it.”

Conservatives do approve of portions of the reform bill, reports Townhall, “Compared to Obamacare, GOPCare reduces the role of the federal government in the healthcare system, gives more authority and flexibility to states, spends less, taxes less, regulates less, and coerces less. The individual and employer mandates are gone. Infamous tax hikes like the medical device tax are gone (and in other cases, delayed or reduced). Obamacare’s subsidy system is dismantled by 2020 and supplanted with refundable tax credits for lower-to-upper-middle-income individuals and families, ranging from $2,000 to $14,000 annually…Caps on tax-free contributions to Health Savings Accounts are also raised considerably, almost doubling under this bill.  The conservative Republican Study Committee is out with a pretty balanced memo on the positives and negatives of the draft legislation, noting several shifts towards more coverage and more spending over the weekend.”

Some of the very few popular portions of Obamacare would be maintained. “People with pre-existing conditions are protected…Also, lifetime expenditure caps from carriers remain disallowed, and adult children are permitted to remain on their parents’ plan through age 26.

 On the other hand, conservatives are concerned that the growth in Medicaid may be unchecked. Fiscal conservatives opposed the expansion…Obamacare’s status quo would remain in place until 2020, at which point the new law would ‘transition Medicaid into a system in which each state receives a certain amount of money for each of its residents in the program and has more flexibility over how the program functions. That allocation would revert to per person spending levels from 2016 and then grow each year at the rate of medical inflation. However, states would still receive enhanced Obamacare-levels of spending for individuals who were grandfathered in by having enrolled in expanded Medicaid before 2020…Many conservatives want the Medicaid expansion done away with entirely.”

One conservative source, The Daily Signal, emphasizes: “The key problem with the draft House health care bill is that it fails to correct the features of Obamacare that drove up health insurance costs. Instead, it mainly tweaks Obamacare’s financing and subsidy structure. Basically, the bill focuses on protecting those who gained subsidized coverage through the law’s exchange subsidies and Medicaid expansion, while failing to correct Obamacare’s misguided insurance regulations that drove up premiums for Americans buying coverage without government subsidies.”

 

Obamacare Repeal Delayed

As we went to press, The House of Representatives has announced that it will delay its vote on repealing and replacing Obamacare.

The debate over how to replace the already collapsing Obamacare system has been one of the most contentious in the current Congress. There is little dissent in the need to undo the Affordable Care Act, (ACA) passed in relative secrecy. (Former speaker Nancy Pelosi’ comment “We have to pass the bill before you can see what’s in it” ranks as one of U.S. history’s most memorable examples of legislative incompetence.)

The reality is, no matter which party took control of the federal government in 2016, Obamacare would have required major surgery—or perhaps even a mercy killing. A Heritage analysis outlines the massive problems:

  • 5 million lost prior insurance plans—President Obama’s promises that “you can keep your plan” and “you can keep your doctor” were completely untrue, and private sector enrollment increased by only 2.7 million, and exchange enrollment is only half of what was projected.
  • Average deductibles are $12,000
  • Premiums have increased by 25%
  • 70% of counties have no choice of insurance providers
  • 78% of Obamacare co-ops have failed, at a cost of $1.9 billion
  • Medicaid spending has increased by $1 trillion—paid for by an equal amount of tax increases. Medicaid patients under Obamacare have received a lesser quality of care
  • 5 million full time jobs were lost because the Affordable Care Act actually serves as a disincentive to hire full time employees

Obamacare hurt both young and old.

Although allowing young people to remain covered under their parents’ coverage until age 26, once they aged out, they were forced to buy policies that were overpriced due to mandated coverage of issues not typically affecting them. Indeed, a key part of the financing strategy for Obamacare was the subsidization of young, healthy individuals for the rest of the covered population.

At the other end of the age spectrum, seniors were hurt because, as Heritage outlines, Obamacare cuts $716 billion  from Medicare over the next 10 years, according to the Congressional Budget Office (CBO), and uses these “savings” from Medicare to fund other entitlement expansions mandated by Obamacare. Medicare becomes a cash cow for Obamacare, and the Medicare “savings” from payment cuts are not put back into making Medicare solvent. Such massive payment cuts do impact Medicare benefits, as well as seniors’ access to those benefits.

Dissent against Obamacare by seniors, unless repeal occurs, is expected to grow dramatically. As noted by Modern Healthcare:  in December: “A bipartisan coalition of hundreds of healthcare organizations is urging the new Congress to immediately repeal an advisory board that has not yet been filled but would be charged with finding cuts to Medicare. The Independent Payment Advisory Board was created by the Affordable Care Act. During debate of the ACA, some opponents labeled the board a ‘death panel’ that would make decision about end-of-life treatment. It is actually meant to make cuts to Medicare in the case that spending growth exceeds projections.”

It is reasonable to assert that Obamacare’s failure is attributable to the imposition of government-centric solutions to a health insurance affordability problem significantly caused by government action.

Laws and regulations that prohibit competition by health care insurers across state lines guarantee monopoly practices and prices. The National Conference of State Legislatures  reports that “Insurance firms in each state are protected from interstate competition by the federal McCarran-Ferguson Act (1945), which grants states the right to regulate health plans within their borders. …The result has been a patchwork of 50 different sets of state regulations; the cost for an insurer licensed in one state to enter another state market is often high.”

The Report continues tomorrow