Tag Archives: ACA

Here’s Why 24 Million People Still Don’t Have Health Insurance

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http://www.thefiscaltimes.com/2016/08/19/Here-s-Why-24-Million-People-Still-Don-t-Have-Health-Insurance

Despite its seemingly endless political and financial travails, Obamacare has taken a big bite out of the number of uninsured Americans since it was enacted in 2010. An estimated 20 million more people are now covered by private health insurance obtained through subsidized government exchanges or expanded Medicaid for the poor.

But as the curtain begins to ring down on President Obama’s administration, roughly 20 million to 24 million people still lack health insurance, a huge piece of unfinished business that will be left to the next president and a new Congress to address. And that raises two interesting questions: precisely who are the uninsured today and why haven’t they been able to obtain coverage?

A national survey by the Commonwealth Fund conducted last February through April finds “notable shifts” in the demographic composition of the uninsured since the Affordable Care Act first took effect in 2014.

A quick snapshot of the detailed findings tells the stories of millions of people either purposefully rejecting health care insurance, not qualifying for a federal program, or being unaware of their options to acquire coverage.

Obamacare Faces New Challenge as the Uninsured Rate Plateaus

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http://www.thefiscaltimes.com/2016/11/03/Obamacare-Faces-New-Challenge-Uninsured-Rate-Plateaus

Amid the administration’s latest drive to sign up millions of Americans for Obamacare coverage, a new government study warns that the uninsured rate may have plateaued after years of dramatic decline.

There were roughly 28 million uninsured Americans during the first six months of this year, a significant change from the 48 million consumers who lacked coverage at the time of the enactment of the Affordable Care Act in 2010. Government-subsidized health insurance policies for low and middle-income people, along with an expansion of the Medicaid program in more than half of the states, have helped more than 20 million uninsured people obtain coverage.

The Impact of Obamacare, in Four Maps

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Three years into the Affordable Care Act, there remain places where many people still lack health insurance. But their share keeps shrinking.

The share of people without health insurance keeps falling.

Since 2013, when the major provisions of Obamacare went into effect, the uninsured rate has fallen in every state. And some states that you might not expect have led the way.

The news about the Affordable Care Act has been grim lately: The price of health plans in new marketplaces is up, and choice is declining in many places. But amid the difficulties, new data highlight the law’s effectiveness in getting coverage for millions of Americans.

Over all, the gains are substantial: a seven-percentage-point drop in the uninsured rate for adults. But there remain troublesome regional patterns. Many people in the South and the Southwest still don’t have a reliable way to pay for health care, according to the new, detailed numbers from a pair of groups closely tracking enrollment efforts. Those patterns aren’t an accident. As our maps show, many of the places with high uninsured rates had poor coverage before the Affordable Care Act passed. They tend to be states with widespread poverty and limited social safety nets. Look at Mississippi and Texas, for example.

But many of the places that have reduced their uninsured rates the most had similar characteristics in 2013. Look at Kentucky and Arkansas. Over the years, you can see them diverge sharply from their neighbors.

 

Big Changes and Big Risks Are Ahead for Health Policy

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The election outcome itself could create more problems for the ACA. The insurance plans sold on the law’s exchanges have already experienced substantial losses due to adverse selection, leading many insurance companies to pull back on their participation. The prospect of a Trump administration steering ACA implementation may be enough to convince some of the insurers still offering products on the exchanges in 2017 to rethink their plans. If more insurance companies head for the exits, the exchanges could become even less stable than they already are.

The “replace” part of “repeal and replace” has always been the tricky part for ACA opponents, and that will also be true for the incoming Trump administration. During the campaign, Trump offered only the vaguest outline of a plan that wouldn’t come close to serving as a starting point for a workable proposal. The ACA, for all of its problems, brought many low-income households into insurance coverage, through an expansion of the Medicaid program and through heavy subsidization of the insurance plans offered on the exchanges. Unless Trump wants to preside over a massive increase in the number of Americans without health insurance during his presidency, he will have to offer a plan that ensures households with low incomes can secure health insurance in some new way.

Repeal Would Be Even Worse Than Obamacare

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I wouldn’t say the mood among Republicans is exactly giddy. Even Fox News seemed a little bit stunned by the news that Donald Trump had been elected president of the United States. But these past 12 hours, one priority has joined #NeverTrumpers and those who want to Make America Great Again: time to repeal Obamacare.

I’ll believe it when I see it.

Can Republicans pass a bill repealing Obamacare lock, stock and barrel? Technically, yes. They have control of the House and the Senate. Democrats in the Senate could filibuster, but I doubt the filibuster survives Trump’s term in any event, so I don’t see this as a permanent obstacle.

There’s still a wee bit of a problem, however, which is that they have to get Republicans to vote for a repeal.

I have no doubt that Republicans would like to vote for something they can call “repealing Obamacare.” The problem is that repealing Obamacare will involve getting rid of two provisions that are really, really popular: “guaranteed issue” (insurers can’t refuse to sell insurance to someone because of their health status) and “community rating” (insurers can’t agree to sell a policy to some undesirable customer for a million dollars a year; the company has to sell to everyone in a given age group at the same price).

These two provisions are consistently popular with voters across the spectrum. Unfortunately, they tend to send health insurance markets into what’s known as a “death spiral”: People know they can always buy insurance if they get sick, so a lot of them don’t buy insurance until they get sick. Because the sick people are really expensive to cover, insurers have to raise the price of the insurance, which means that the healthiest people left in the pool drop their insurance, which means the price of the insurance goes up. … After a few rounds of this, everyone has a guaranteed right to buy insurance — but the sticker price is astronomical.

Obamacare is built to counter this problem — with subsidies to bring down the price for many Americans, with a mandate for individuals to buy insurance or face tax penalties, with rules on enrollment timing to complicate “gaming the system.” These are the unpopular parts of Obamacare.

Repeal will involve getting rid of the unpopular bits. But it will also involve getting rid of the popular bits. Republicans will be under enormous pressure to repeal just the unpopular parts, which would, of course, make the individual market even more dysfunctional than it is now. I wish good luck to President Trump or to any member of Congress who explains to voters that if they want the popular parts, they need the unpopular parts too. Believe me, I’ve tried.

So I suspect that “Repeal Obamacare” will meet the same fate as Social Security reform. Legislators were gung ho. Even the base was sort of theoretically in favor of it. President George W. Bush made it his signature initiative for his second term. But the more that Bush talked about what Social Security reform would actually involve, the more he spooked voters.  Even though his party had control of both the House and the Senate, Bush eventually had to admit he couldn’t get it done. His own party would not back him in the face of voter resistance.

Obamacare defenders vow ‘total war’

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http://www.politico.com/story/2016/11/obamacare-defenders-vow-total-war-231164

Donald Trump is pictured. | Getty

Shell-shocked Democrats on Capitol Hill are preparing to make a fight for Obamacare their top priority in the opening days of the Trump administration, with leading advocacy groups ready to wage “total war” to defend President Barack Obama’s universal health care program and his domestic policy legacy.

“We’ve got the battle of our lifetime ahead of us,” Ron Pollack, executive director of advocacy group Families USA, said the day after Donald Trump was elected on a pledge to repeal the Affordable Care Act, which now the law that covers 22 million people. “We’re going to have a huge number of organizations from all across the country that will participate in this effort.

But their options are limited. They have enough votes to block a total repeal of the law on Day One of a Trump administration. But they can’t block Republicans from passing targeted legislation in the coming months, and Trump — like Obama before him — can pick up a pen as early as Jan. 20 and use executive powers to block, change, or put on hold key elements of the massive six-year-old legislation.

The road to repeal is more complex than Trump acknowledged on the campaign trail. The law is baked into the health care system, touching every American’s life and a fifth of the economy.

But with the Republican sweep of both the executive and legislative branches, expectations for big and bold action are high.

California Faces Major Reversal If Trump, Congress Scrap Health Law

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California Faces Major Reversal If Trump, Congress Scrap Health Law

Attendees speak with heath care volunteers during the WeConnect Health Enrollment Information & Wellness Event in Oakland, California, U.S., on Saturday, Sept. 21, 2013. The battle over Obamacare is taking on political importance as Democrats hope a successful roll-out among Hispanics will further bind those voters to the Democratic Party and undermine Republican efforts to build more support before the 2016 presidential election. Photographer: David Paul Morris/Bloomberg via Getty Images

California has a lot to lose if President-elect Donald Trump and the Republican-led Congress fulfill their campaign pledge to repeal Obamacare.

The Golden State fully embraced the Affordable Care Act by expanding Medicaid coverage for the poor and creating its own health insurance exchange for about 1.4 million enrollees. Supporters held California up as proof the health law could work as intended.

But now President Barack Obama’s signature law is in serious jeopardy and California officials are left wondering what Republicans in Washington may put in its place.

“There is no doubt that Obamacare is dead,” said Robert Laszewski, a health care consultant and expert on the California insurance market. “The only question is just exactly how Republicans will get rid of it.”

Health policy experts don’t expect Republicans to immediately kick millions of people off their insurance policies. Instead, they predict lawmakers may repeal parts of the law and allow for some transition period for consumers while a replacement plan is put together.

Still, the personal and financial impact for the state could be jarring. The number of uninsured Californians would more than double to 7.5 million people if the Affordable Care Act was repealed, according to a recent study by the Urban Institute.

Researchers also said California stands to lose an estimated $15 billion annually in federal funding for Medicaid expansion and insurance subsidies — more than any other state. That loss of federal money would make it difficult for California to pursue health reform on its own.

Winners and losers in the health-care industry under President Trump

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https://www.washingtonpost.com/news/wonk/wp/2016/11/09/winners-and-losers-in-the-health-care-industry-under-president-trump/?utm_campaign=CHL%3A+Daily+Edition&utm_source=hs_email&utm_medium=email&utm_content=37396635&_hsenc=p2ANqtz-_aZfGmLhlqwRrHfyWGaWVnP2SQe2RHw8m3kbimVOST7YMyMDvZ_OTnMxlqsd-LmZGL6bFWQzYvKA4rnjFsD0fmc46A2Q&_hsmi=37396635

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With much about President-elect Donald Trump’s health-care agenda still unclear, the health-care industry’s initial response to his election has been scattered. Hospital stocks were down. Health insurers’ stock prices were mixed. Pharmaceutical and biotech stocks, on the other hand, got a big bump.

Trump’s clearest policy position in health care has been his commitment to repealing the Affordable Care Act and replacing it with another policy. But the responses to his election varied in large part because the details of exactly what would replace the Affordable Care Act and how that transition would occur have been vague. Without knowing those details, it’s hard for investors to have a clear response, said Benjamin Isgur, a leader in the PwC Health Research Institute.

“These health organizations are like large ships, and you can’t turn them on a dime,” Isgur said. “When you think back to what it took to get ready for the ACA, for many health-care companies, it was two to three years of developing plans and provider networks and marketing plans. . . . There’s a lot of work that is required to implement any new program.”

 

No Matter What, Congress Will Act On Health Care Next Year

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http://healthaffairs.org/blog/2016/11/07/no-matter-what-congress-will-act-on-health-care-next-year/

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When Congress passed the Medicare Access and Children’s Health Insurance Program (CHIP) Reauthorization Act (MACRA) last year, House Energy and Commerce Committee Chairman Fred Upton (R-MI) said “stick a fork in it; it’s finally done.” While some elements—especially Medicare’s long-flawed Sustainable Growth Rate formula—were permanently remedied, other provisions were temporarily addressed by the bill and come due again in September or December of next year.

So, while the presidential candidates and others consider broad-based health care policies, the passage of which in the near term is dubious, there is a wide array of issues we can bank on Congress taking up, likely in one, consolidated legislative package.

Funding for the CHIP program may be the foremost among these issues, accompanied by a batch of expiring Medicare “extenders” that Congress typically addresses before they lapse. These provisions, which used to reliably hitch a ride on perennial “doc fix” legislation, are expected to travel together in a bill that, along with Food and Drug Administration user fee reauthorizations, is among a few must-pass health bills in 2017. The package will begin to take shape early in the next Congress and ideally gain focus by spring to give states lead-time for budgetary planning, especially with regard to the CHIP and Medicaid components.

Last year, Senate Democrats pushed for a four-year CHIP funding reauthorization, which would have aligned CHIP funding with the Affordable Care Act’s reauthorization of the program itself through 2019. Their efforts fell short in MACRA, although a two-year funding reauthorization keeps the program in the clear until Sept. 30, 2017.

While it’s early to predict what will be included, we anticipate the following potential items will likely be considered in this CHIP funding and Medicare extenders package:

The 2016 Election Reveals The Differences On Health Care Are Deeper Than Ever

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http://healthaffairs.org/blog/2016/11/07/the-2016-election-reveals-the-differences-on-health-care-are-deeper-than-ever/

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We are nearing the grand finale of our long and disheartening election opera, one we dare not ignore because the outcomes matter so much. While the election results will not be determined by public reactions to the Affordable Care Act, the ACA’s fate will be mightily determined by Tuesday’s outcomes. What have we learned about our collective health future over the past 18 months and what might this mean for our health system’s future?

Public Opinion On Health Reform Is As Frozen Today As It Was In Spring, 2015

Kaiser monthly tracking polls show reliably unfavorable attitudes toward the ACA, slightly beating favorables, and stuck since 2014 in 40 percent purgatory. The advantages millions of Americans feel from ACA insurance coverage expansions and other access reforms are balanced by those who now blame the ACA for everything bad that happens in health care. The misnamed Pottery Barn rule—“if you break it, you own it”—applies here even though the dish was broken well before the ACA. Beyond this, if there is one thing on which both sides of the new Republican divide concur, it is a deep hostility towards ObamaCare. The election cycle seems to have only hardened these views.