Tag Archives: Underinsured

California Dreamin’ in a post-Trump healthcare world

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The consensus among policymakers and observers: Not good.

“At risk is insurance coverage for literally millions of Americans,” said Anthony Wright, executive director of the advocacy group Health Access California.

Jim Lott, who teaches healthcare policy at USC and Cal State Long Beach and was the longtime executive vice president of the Hospital Association of Southern California, noted that even if parts of the law are preserved the way Trump suggests, it would still be imperiled.

“If you don’t have an employer mandate and an individual mandate, the market would self-destruct,” Lott said. “It will create havoc.”

Barcellona, an attorney by training, concurred with Lott. “The law matters and these federal programs are conditioned on the act being implemented in a certain way,” he said.

Barcellona also brought up a consequence that would be utterly disastrous for millions of middle-class Americans: If the ACA is eliminated in the middle of a calendar year, it could put them on the hook for repaying billions of dollars in premium tax credits.

Donald Trump is about to face a rude awakening over Obamacare

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https://www.washingtonpost.com/news/wonk/wp/2016/11/12/donald-trump-is-beginning-to-face-a-rude-awakening-over-obamacare/?utm_source=RealClearHealth+Morning+Scan&utm_campaign=c672ab1b84-EMAIL_CAMPAIGN_2016_11_12&utm_medium=email&utm_term=0_b4baf6b587-c672ab1b84-84752421

After reiterating his promise to repeal and replace the Affordable Care Act, President-elect Donald Trump has indicated that he may keep two of the law’s most popular provisions. One is straightforward enough — children up to age 26 being allowed to stay on their parents’ plan. The other — preventing insurance companies from denying coverage because of preexisting conditions — offers a perfect illustration of why Trump and most of the other Republicans critics of Obamacare don’t understand the health insurance market.

Let’s say that in the beautiful new world of “repeal and replace,” insurers are required to sell you insurance despite the fact that your kid has a brain tumor. Insurance companies know what to do with that. Their actuaries can calculate that kids with brain tumors typically require (I’m making this number up) about $200,000 a year in medical care. So they’ll offer to sell you a policy at an annual premium of $240,000.

At this point your response will probably be that such an outcome is not fair. When the law says insurance companies can’t discriminate on the basis for preexisting conditions, surely what it means is that they have to charge roughly the same price for health insurance, irrespective of your preexisting condition. In the language of insurance, that’s called “guaranteed issue at community rates.”

Unfortunately, in the states that have tried guaranteed issues at community rates, the insurance markets have collapsed. That’s because if you guarantee everyone the right to buy health insurance at community rates, then some consumers will game the system. The young and healthy ones won’t buy any health insurance at all — they’ll go without until they are diagnosed with diabetes or a brain tumor or get hit by a truck crossing the street. And when that happens, they will immediately call up Aetna or Anthem and exercise their right to buy health insurance at the low community rate, irrespective of their medical condition. It won’t be long before insurance companies begin losing a ton of money and are forced either to raise premiums through the roof or stop writing policies altogether.

Here’s why Trump is already waffling on Obamacare

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https://www.washingtonpost.com/posteverything/wp/2016/11/12/heres-why-trump-is-already-waffling-on-obamacare/

President-elect Donald Trump is already signaling that he might backpedal on his promise to repeal the Affordable Care Act, telling the Wall Street Journal Friday that he’d consider hanging onto popular Obamacare provisions such as “the prohibition against insurers denying coverage because of patients’ existing conditions, and a provision that allows parents to provide years of additional coverage for children on their insurance policies.”

His apparent reluctance to scrap the entire ACA is understandable. In the long run, waffling on repeal will probably be less painful than causing a health-care catastrophe. Trump capitalized on Republicans’ long dislike of the Affordable Care Act by focusing on news, in the last weeks of the campaign, that premiums would increase sharply for many Americans purchasing insurance through its exchanges. But he didn’t promise a pared-down health-care regime. He promised to repeal and replace Obamacare with a plan that would cover everyone, offer more choice and cost less.

It was a populist approach to health care that wasn’t new. Sixteen years ago, in “The America We Deserve,” he wrote: “I’m a conservative on most issues, but a liberal on this one,” an appeal that didn’t hurt candidate Trump. But President Trump is likely to find the issue challenging. Repeal requires only the will of Congress. Replacement is subject to the laws of economics and mathematics, which aren’t on his side.

In the campaign, Trump proposed replacing the Affordable Care Act with a tax deduction for individuals who pay for health insurance out of pocket. Like all tax deductions, such a deduction is worth more to people with higher tax rates. But most of those who would be left without coverage by an ACA repeal are lower-income individuals with tax rates that are already low. Thus, the benefit they’d receive from a deduction doesn’t come close to the financial hit they would experience from an ACA repeal. Independent estimates suggest repeal would cause about 20 million people to lose coverage, only one-quarter of whom would purchase insurance with the deduction. The rest wouldn’t be able to afford it.

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.

Analysis: Time for GOP to prove it has a better plan for healthcare reform

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http://www.fiercehealthcare.com/payer/analysis-time-for-gop-to-prove-it-has-a-better-plan-for-healthcare-reform?utm_medium=nl&utm_source=internal&mrkid=959610&mkt_tok=eyJpIjoiTnpkaFpqRm1ZVEZpWkdZMiIsInQiOiJxY1NBT1ZDbGdDQWsxVzRQQ21iOVwvcEVkOFdDVTBIUG9hZWllQ0tiYmFuM2lUVU52Y2JGWkxnNW9BWDJhTWNZSTVTR2QwVmdTYWdIQkFPWGdxZ3FRWlwvRXVuSFFvZ2pKa3NaTUlwU0M1YmVJPSJ9

With Donald Trump headed to the White House and his party firmly in control of Congress, Republicans will finally have a chance to prove what they’ve been saying all along: that they can produce a better version of healthcare reform than the Affordable Care Act.

It’s clear that the ACA is as imperiled as it has ever been. Trump has fervently vowed to repeal it–and with Republican control of both chambers of Congress, he may well get his wish. After all, the law’s most visible component, the exchanges, are on shaky ground as it is, with premiums rising and some health insurers retreating from the marketplaces.

Plus, President Barack Obama’s last attempt at convincing Republicans to work on fixing the ACA–not repealing it–fell on deaf ears even before the party’s resounding victory Tuesday.

What gets lost in all the talk about the ACA’s uncertain future, though, is the fact that while some insurers have struggled to make a profit in the individual marketplaces, there are other aspects of the law to which they have become quite attached.

Take Medicaid expansion, an idea championed by Democrats (and even once embraced by Vice President-Elect Mike Pence) that has been a boon to insurance companies in the form of lucrative managed care contracts. Some companies that specialize in slimmed-down Medicaid plans have also thrived on the exchanges where others have floundered.

Then there’s the ACA’s provisions that encourage the transition to value-based payments, which insurers have embraced and largely retooled their business models to reflect. Accountable care organizations, for example, have sprung up like wildfire, producing promising results for some companies.

A wholesale repeal of the ACA would also erase the law’s historic gains in reducing the uninsured rate. Though many of the newly insured have turned out to be costlier to cover than expected, such a move would still rob insurers of millions of new customers.

The question, then, becomes what will replace the law–and that’s where it gets interesting.

Trump has a plan, but it is short on details. Perhaps most visibly, he has advocated for selling insurance across state lines–a timeworn GOP talking point that many experts agree is not feasible. He would also repeal Medicaid expansion and convert Medicaid federal matching funds into a block grant, the latter of which would drastically cut Medicaid funding and coverage.

One analysis from The Commonwealth Fund says that his plan could add nearly 20 million peopleto the ranks of the uninsured, and even more if his Medicaid proposals come to fruition.

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.