A project of the Galen Institute

Issue: "Social Impact"

Robert Moffit PhD: Five Years Later: Obamacare’s Dim Prospects

MedPage Today
Thu, 2015-04-23
Although the Affordable Care Act (ACA) was enacted 5 years ago, 2014 was the first year of implementation for most of the health law's major provisions. In fact, it turned out to be a glitch machine. Defying the expectations of even the law's most ardent critics, Obamacare's rollout of the federal online health exchange was a disaster, combined with the cancellation of millions of private health insurance policies (if you "liked" your plan, too bad), a delay in reporting requirements of the employer mandate, and new administrative exemptions from the individual mandate penalty. Nonetheless, the Obama administration's allies insist that the law is "working" and that it will even become popular with the majority of Americans with the passage of time. The law's congressional supporters, they hope, will reap political benefits rather than political retribution.

J. Kevin A. McKechnie: HHS Challenges HSA Plans

The Institute for HealthCare Consumerism
Tue, 2015-04-21
King vs. Burwell is on the horizon. If the plaintiffs are successful, so goes the theory, subsidies end in 37 exchanges operated by the Department of Health and Human Services and serviced by HealthCare.gov. Coverage gets more expensive, and people won’t be able to afford their policies. But, this outcome was foretold all the way back in the Senate mark-up of the proposed ACA legislation. Purposely requiring subsidies in state-run exchanges remains the incentive for states to set them up. The administration did not expect so many states elected not to set up their own exchanges, and it is now a big problem. As was noted in 2009 by critics of the bill, if states don’t hand out subsidies, people won’t be able to afford to buy coverage. In the health savings account industry, the problem is compounded. The ACA law also created a perpetual rule change engine.

Marty Makary: The ObamaCare Effect: Hospital Monopolies

The Wall Street Journal
Mon, 2015-04-20
During the 2008 financial crisis, “too big to fail” became a familiar phrase in the U.S. financial system. Now the U.S. health-care system is heading down the same path with a record number of hospital mergers and acquisitions—95 last year—some creating regional monopolies that, as in all monopolies, will likely result in higher prices from decreased competition.

Peter Ubel: Under Obamacare, Competition Is Costly For Consumers

Forbes
Mon, 2015-04-20
Normally, market competition is good for consumers. More competition generally means competitors are battling each other to lower their prices and/or raise the quality of their goods. But when it comes to Obamacare, the market is working backwards, at least for people receiving health insurance subsidies through the exchanges. The more competitive the marketplace, often the more people have to pay for insurance. How did this happen? The Affordable Care Act, aka Obamacare, created a series of exchanges where people can shop for health insurance if they don’t already receive it from the government (e.g. Medicare or Medicaid) or from their employer. The exchanges are a pro-market approach to healthcare reform. But they aren’t a simple market, by any means. In part, they are complicated because most people purchasing insurance through the exchanges receive subsidies. If you earn less than 400% of the federal poverty limit, you’ll probably qualify.

Ben Boychuk: Playing the specialty drug lottery

The Sacramento Bee
Fri, 2015-04-17
My son Benjamin has a serious growth hormone deficiency. He’ll be 13 years old in May but could easily pass for a boy of 8 or 9. In fact, many 8- and 9-year-olds are taller than him. He’s a full head shorter than all of his pals in seventh grade. Although his mother and I don’t have medical degrees, we medical degrees, we had Benjamin’s diagnosis pegged when he was 3 years old and still wearing clothing for an 18-month-old. Several trips to his pediatrician along with a couple simple tests to assess Benjamin’s bone age confirmed with data what we could see with our own eyes. Our boy wasn’t just in the bottom percentile in average height for kids his age – he was in the sub-basement

David Mills: Is It True? Do Doctors Really Loathe Obamacare?

Healthline News
Wed, 2015-04-15
Doctors in the United States appear as bitterly divided over the Affordable Care Act as the general public. The Affordable Care Act (ACA), also called Obamacare, has been a lightning rod since it was signed into law in 2010. Five years after its enactment, the healthcare reform legislation still divides the American public.

Testimony of the Hon. Tevi D. Troy, Ph.D.

United States Congress
Wed, 2015-04-15
House Committee on the Education and the Workforce Subcommittee on Health, Employment, Labor, and Pensions Hearing on “Five Years of Broken Promises: How the President’s Health Care Law is Affecting America’s Workplaces” Tuesday, April 14, 2015 Mr. Chairman, Mr. Ranking Member, Members of the Committee, My name is Tevi Troy, and I am the President of the American Health Policy Institute, adjunct fellow at Hudson Institute, and a former Deputy Secretary of the U.S. Department of Health and Human Services, as well as a former senior White House Domestic Policy Aide. The American Health Policy Institute is a 501(c)3 think tank dedicated to studying the issue of employer sponsored health insurance and highlighting the challenges employers face in offering care to their employees and their dependents.

Holtz-Eakin: If Individual Mandate Axed, 7 Million Fewer Insured But $191 Billion Saved

Inside Health Policy
Wed, 2015-04-15
Repealing the ACA's individual mandate would result in 7 million fewer insured Americans in 2025 but would reduce federal spending on financial assistance by $191 billion, American Action Forum President Douglas Holtz-Eakin, who backs axing the mandate, told the House Ways and Means health subcommittee Tuesday.

Caroline Pearson: Exchanges Struggle to Enroll Consumers as Income Increases

Avalere
Thu, 2015-04-09
New analysis from Avalere finds that while exchanges have succeeded in enrolling very low-income individuals, they continue to struggle to attract middle and higher income enrollees. Specifically, as of the close of the 2015 open enrollment period, exchanges using HealthCare.gov had enrolled 76 percent of eligible individuals with incomes between 100 and 150 percent of the federal poverty level (FPL) or $11,770 to $17,655. However, participation rates declined dramatically as incomes increase and subsidies decrease. For instance, only 16 percent of those earning 301 to 400 percent FPL picked coverage through an exchange, even though they may be eligible for premium subsidies. “People receiving more generous subsidies are expected to enroll in the exchanges at higher rates. However, participation levels decline as incomes increase, even among individuals who would be eligible for both premium subsidies and cost-sharing reductions,” said Elizabeth Carpenter, director at Avalere.

Joel Zinberg: A King v. Burwell ruling for the plaintiffs may not equal death spirals

AEI
Mon, 2015-04-06
During the recent oral argument in King v. Burwell — the Supreme Court case deciding if providing subsidies to buy health insurance in the 36 states utilizing federal health care exchanges is allowed under the Affordable Care Act (ACA) — Justice Kennedy suggested that disallowing subsidies might be unconstitutionally coercive because “states are being told either create your own exchange, or we’ll send your insurance market into a death spiral.” Are “death spirals” real, or just a way to frighten the public? The death spiral will purportedly happen like this: disallowing federal exchange subsidies will make insurance less affordable for the 87% of federal exchange enrollees currently receiving subsidies. These people will no longer be required to buy insurance since the ACA’s individual mandate only applies to individuals who have access to affordable insurance.

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