Tag: ACA

Member Post

 

What parts of Republican healthcare reform can be implemented independently of others? What can be done immediately and without a comprehensive bill?  For example: Is there any reason Republicans cannot enable selling of insurance across state lines without reference to any other change?  Preview Open

Join Ricochet!

This is a members-only post on Ricochet's Member Feed. Want to read it? Join Ricochet’s community of conservatives and be part of the conversation. Join Ricochet for Free.

The Deceitful Numbers – Great and Small – of the ACA

 

If you’re like me, and I know I am, you waste a lot of time at the office reading Ricochet and looking at your friends’ posts on Facebook. Wait, no boss, I’m not online at work at all. I’m reading Ricochet and Facebook at home! I made a joke about America’s unhealthy love of the internet! (Is he gone? Okay …)

For several days, at least since the new Congress began the repeal process for the Affordable Care Act (ACA), my liberal and Progressive friends on Facebook have been engaged in full bore linear conniption fits over the vote. It’s hard to sort through these because they are frequently nested within full bore linear conniption fits over cabinet member hearings in Congress, and so on.

Richard Epstein breaks down the complicated path to replacing Obamacare without destabilizing America’s healthcare system.

Can Modern Healthcare Ever Be “Affordable?”

 

shutterstock_424979290So Obamacare was expensive and will be dismantled. But it’s a good bet that healthcare costs will continue to rise. Have we ever seen them fall? No, we’ve only seen increases slow down temporarily. What’s going on?

Back in the day doctors were just one of a number of tradesmen that hawked their wares like haberdashers, plumbers, dentists, barbers, lawyers, palm readers, etc. They all got paid in a fee-for-service fashion. The haberdasher sold you a shirt, the plumber cleaned out a clog, the dentist yanked a molar, the barber gave you a cut and a shave, the lawyer filed a deed, the palm reader said you were a loser, and the doctor stitched up your head after you stumbled out of a bar on a festive Saturday night.

Then they handed you a bill and you paid up, or if they knew you they took the money first. It was a simple transaction. If you couldn’t afford their services you either did it yourself or did without. Life was a lot less complicated, and a lot shorter by the way.

How Obamacare Might Turn into Trumpcare. Or Is it Ryancare?

 

112316healthGoldman Sachs takes its best shot at outlining a possible future for US healthcare reform:

Our best guess is a continuation of the tax credits and Medicaid grants, but in a different form. At this early stage, our expectation is that Congress will enact a new system that continues to provide for an expanded Medicaid program and tax credits to pay for insurance premiums, but with significant changes in the way those resources are allocated. In our view, the best guide to how Congress and the Trump Administration might reform the current system is in House Speaker Paul Ryan’s plan released in June 2016. It would provide for:

  • Tax credits for individual market health insurance. The plan would provide refundable, advanceable tax credits (essentially the same concept as a monthly payment from the government) to purchase health insurance on the private market. Unlike the current program, which is based on the average premium and adjusted based on income, the proposed credit would be adjusted only based on age.
  • Repeal of the coverage mandates and partial repeal of insurance market reforms. The proposal would eliminate the mandates on employers to provide coverage and individuals to obtain it. It would loosen the rules regarding pre-existing conditions and premium variation, most importantly by specifying that premiums for the oldest enrollees can be no more than 5 times the premium for the youngest members (the current ratio is 3:1). This would encourage younger (i.e., healthier) enrollees to join. For older enrollees, House Republicans propose to use federal funds to subsidize “high risk pools” to cap premiums once they reach a certain level.
  • Partial reversal of the Medicaid expansion. The House plan would offer states a choice between a “block grant” – a lump sum provided to states roughly equal to what they currently receive excluding the cost of the Medicaid expansion—or a per-capita payment that would roughly equal current spending per-enrollee spending but would grow more slowly than health costs.

Not a bad guess. Also don’t expect any changes until 2019 at the earliest. And who knows how the prospect of big changes will affect insurer participation. I would also note that this might reduce spending vs. the current baseline, but certainly means higher spending than in the pre-Obamacare era. Interesting to see how Republicans handle that, assuming budget deficits and “small government” are still relevant issue within the party.

Unaffordable Care Act

 

Barack ObamaThe defenders of the Affordable Care Act are running out of excuses for the dismal performance of its health care exchanges. It is now old news that many uninsured individuals are unable, even with sizeable subsidies, to purchase health care coverage from private health care providers. As Yale Professor Jacob Hacker notes in his recent op-ed for the New York Times, the ACA has indeed faced “a rocky six months.” Average anticipated premium increases are running at 25 percent; major insurers like Aetna, UnitedHealth, and Humana have either pulled out of the program entirely or cut back their operations; and one recent tally reports that 16 of the 23 health care co-ops, with over 800,000 enrollees, have shut down, with at least six others on economic life support.

What should be done to respond to this unfortunate situation? The defenders of the ACA want to double-down on the current system by introducing a “public option” that was excluded from the original legislation. President Obama endorsed that position in a communication published recently in the Journal of the American Medical Association. After ignoring the problems with the individual health care exchanges, he suggests “Congress should revisit a public plan to compete alongside private insurers in areas of the country where competition is limited. Adding a public plan in such areas would strengthen the Marketplace approach, giving consumers more affordable options while also creating savings for the federal government.” That same line is echoed by Hacker who dismisses any notion that the public option will lead to a single-payer system, by making the tart observation that the wholesale withdrawal of private insurers from the marketplace has already resulted in a single-payer system in the five states whose exchanges will be serviced by only a single ACA provider next year, with the prospect of still more to come.

Unfortunately, President Obama and Professor Hacker, with their public option rescue plan, misunderstand the source of the current difficulties. The key problem is not monopoly power. It is runaway costs brought on by foolish regulations that no public option can cure. If the system is to survive, which is doubtful, it needs to be fundamentally redesigned.

If I Didn’t Know Obamacare Was Working Great, This Might Worry Me

 

Obamacare-train-wreck-002In times of trouble and crisis, one can find solace and stability in first principles. Example: “The Affordable Care Act is working just fine. No need to worry — ever.”

So when I read news that, on first take, would seem to possibly suggest — maybe, I dunno — Obamacare is not working just fine and one should worry … well, back to first principles.

This from Wall Street Journal reporters Anna Wilde Mathews and Stephanie Armour:

Is Obamacare Really Dead?

 

23 21 19 18 17 15 14 13 12 CO-OPs offering plans in 25 22 20 19 18 17 16 15 14 states

There’s currently a lot of talk about Obamacare heading into a “death spiral,” which most of Ricochet’s readership predicted before Barack, Nancy and Harry whipped, bribed, and bamboozled a Democrat-led Congress to drag ACA across the reconciled finish line.

National Review’s free market proponent Kevin Williamson wrote a great article “Obamacare is Dead” which is being joyfully retweeted among the conservative Twitterverse.

Member Post

 

With more Obamacare co-ops closing their doors the death spiral is upon us (don’t look for the MSM to report this). After personally losing my Dr. of over 15 years (who no longer takes individual policies) my deductible is now so high I pay for EVERYTHING out of pocket by negotiating cash prices, including prescriptions. My […]

Join Ricochet!

This is a members-only post on Ricochet's Member Feed. Want to read it? Join Ricochet’s community of conservatives and be part of the conversation. Join Ricochet for Free.

Member Post

 

I have many liberal friends with whom I do not discuss politics at all, ever.  I do sometimes comment to them when they get a little overly excited about how Obamacare is paying for their birth control.  Their birth control and well-visits mean that others necessarily have less care.  The system as it is designed, […]

Join Ricochet!

This is a members-only post on Ricochet's Member Feed. Want to read it? Join Ricochet’s community of conservatives and be part of the conversation. Join Ricochet for Free.

Are Nurse Unions Needed to Fight Obamacare?

 

shutterstock_172496525Recently, I uttered words that I swore would never escape my lips: “I think, maybe, it’s time that the nurses come together and do something. Like … make a union.”

I have been vehemently and rabidly anti-union all my voting life. The daughter of a member of the California Teachers Association, I was introduced at a tender age to the many evils of unions. I was taught the different ways that unions manipulate members, abuse their dues, provide money to pet political causes, and make life difficult for the teachers. In public school, however, I was taught all of the ways that the teachers’ union was magnanimous, benevolent, and essential to a Good Education.

The hospital I work for has tried very hard to ensure that no unions take hold here. In conservative Orange County, this has not been too difficult: We are all afraid of the overreaching sight of Big Brother. We have rallied together to proclaim our independence from unions, our ability to directly negotiate with our managers, and to voice our happiness that we do not pay dues for services that we do not receive.

Member Post

 

On Tuesday March 24 I went to my ophthalmologist for my yearly eye exam. (My Dad lost sight in one eye because his optometrist failed to diagnose his glaucoma, so given that family history, I go to an ophthalmologist from Will’s Eye Hospital in Philadelphia.) I write this because when I approached the counter to […]

Join Ricochet!

This is a members-only post on Ricochet's Member Feed. Want to read it? Join Ricochet’s community of conservatives and be part of the conversation. Join Ricochet for Free.

Member Post

 

            Should the Supreme Court decide that subsidies are not available for Federally established exchanges, the pressure to provide relief for millions of people who relied on them will become enormous. Of course, Republicans who oppose doing anything will be called cold-hearted and uncaring.   Preview Open

Join Ricochet!

This is a members-only post on Ricochet's Member Feed. Want to read it? Join Ricochet’s community of conservatives and be part of the conversation. Join Ricochet for Free.

Member Post

 

   Nothing new here, this bit has been percolating for a few months now. However I only recently came across it myself and thought some here might perhaps be interested. This is Jonathan Gruber, an MIT economist who helped to fashion the ACA. This bill was written in a tortured way to make sure the CBO […]

Join Ricochet!

This is a members-only post on Ricochet's Member Feed. Want to read it? Join Ricochet’s community of conservatives and be part of the conversation. Join Ricochet for Free.

Liberal Commentators Unserious and Undemocratic Response to Halbig

 

Liberal commentators endorse a peculiar method of statutory interpretation to support their claim that Obamacare (“the ACA”) provides for subsidies on both State and Federal Exchanges. They argue that the private intent of specific legislators and even staffers should replace the plain text of the statute. This method of interpretation would prove unworkable and inconsistent with democratic norms.

In one particularly egregious example of this argument, the Washington Post‘s Greg Sargent cites a draft of Obamacare that was passed by a Senate committee but never became law. This unpassed version of the law explicitly authorized subsidies on Federal Exchanges. Sargent claims this version of the law embodies Congress’s “true intent.” He wants courts to ignore the bill that was actually passed and to effectuate the supposed will of Congress.

Obamacare Subsidies Ruled Illegal!

 

After holding us in suspense for almost two weeks beyond the expected date for the decision, a panel of the D.C. Circuit Court of Appeals has ruled on Halbig v. Sebelius. In a 2-1 ruling, the court held that the text of the Affordable Care Act only allows subsidies for insurance policies purchased through state established exchanges. Thus, the subsidies currently being paid to those who purchased through the federal exchange (the overwhelming majority of all policies) are illegal.

This is a really big deal. Though the ruling will certainly be appealed, first to an en banc panel of the D.C. Circuit and then probably to the Supreme Court, Obamacare will essentially collapse if the panel’s ruling is upheld. Stay tuned.

Member Post

 

Do you have a health insurance overhaul that’s falling short of its goals?  Are public approval ratings falling below 40%, 30% or even 25%?  Is your party facing the unpleasantly difficult midterm reelections?  Try this one weird trick to save your law, public opinion and your midterms!  Simply set a ridiculously low bar for success!  […]

Join Ricochet!

This is a members-only post on Ricochet's Member Feed. Want to read it? Join Ricochet’s community of conservatives and be part of the conversation. Join Ricochet for Free.