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Tag Archives: ObamaCare


A First Step For Health Reform

By Peter RoffWashington Times

ANALYSIS/OPINION:

It’s beginning to look like the Republicans have pretty much abandoned their promise to “repeal and replace” Obamacare. Considering they don’t have the votes to do it this does not come as a big surprise. If they want to remain in power though, they have to come up with something.

Fortunately, President Donald Trump is leading and may announce as soon as Thursday a plan to bring the cost of prescription drugs down using market forces rather than mandates. Working through Health and Human Services Secretary Alex Azar, the administration is expected to strongly endorse price competition though the formulary process (developing a list of approved drugs selected to provide the most value) as the key to controlling drug costs.

This is what the voters want. According to several recent polls controlling drug costs is one of the three or four issues most important to people deemed likely to vote in the next elections. Therefore, it’s fortunate good policy and good politics are intersect this way.

Even common-sense approaches to controlling costs — like moving prescription drugs from Medicare Part B to Medicare Part D to increase the government’s ability to negotiate on price — will face fierce opposition on Capitol Hill from drug makers (PhRMA spent $150 million in advertising in favor of Obamacare passage) and from those who believe a Bernie Sanders-style single payer approach is the only reform Congress should even think about enacting.

It’s up to House Speaker Paul Ryan and Senate Majority Leader Mitch McConnell whether they want to follow Mr. Trump’s lead and go further. They’ve been burned, badly, by their failure to “repeal and replace” and with their colleagues are reluctant to take up the issue again.

From a political standpoint, that would be an epic fail leading to serious consequences for the GOP’s congressional majority. Rather than wipe the slate clean, they can utilize now-proven concepts used by pharmacy benefits managers, or PBMs, to produce savings for consumers. Again, this is something the voters want.

No one has to go all in at first. Moving drugs to Medicare Part D as a demonstration project for certain therapeutic classes could be the first step toward future, system-wide reform if, as it is almost certain to do, it works.

On the formulary side, the idea of allowing approved plans to cover just one drug per category or class within Medicare’s protected classes rather than two would also increase the government’s bargaining power on behalf of patients. That could be a tough sell in a town where drug companies spend millions on lobbyists to make sure that profits stay high, but as part of a package of reforms coming out of HHS to lower drug prices and reduce out-of-pocket costs it would just be one of many changes producing cheaper health care without compromising quality or access.

The changes the administration is expected to make can be enacted quickly and efficiently. Costs will come down in the near term in a way meaningful to most consumers. In the long run there’s still much to be done.

Obamacare did not deliver on its promise: People lost the health care they liked, what they could get was more expensive, year by year, and the range of choices available to them contracted. The only way to fix that permanently, as health care experts Grace-Marie Arnett and Marie Fishpaw explained recently, is for Congress to take up a plan addressing three big goals: 1) lower costs and improve patient choices, 2) give states flexibility and resources to achieve these goals, and 3) set federal guardrails so people can choose private coverage if they don’t like the options their state provides.

As Ms. Arnett and Ms. Fishpaw put it, America needs health care reform that recognizes “what works in Massachusetts will not work in Mississippi or Missouri or Montana. What works in big cities will not work in rural areas. In response, we would provide states with greater flexibility and new resources to serve as stewards in returning freedom and choice over health decisions to patients.”

To get to that point, the GOP needs a bigger majority in the U.S. Senate and to hang on in the U.S. House of Representatives. Right now, the Republicans look to be losing seats in the House and probably the majority. That would be the end of real reform. A Democratic majority will define reform as an increase in the role for government and a taxpayer-funded bailout of insurance plans.

What Mr. Trump is supposedly getting ready to propose may not just save health care but may also save the Republican majority, which cannot get through the election without addressing the issue. Finding and supporting ways to cut the cost of prescription drugs may be, in the short run, the only option left.


ObamaCare Is The Real Junk Insurance, And It’s Killing People

Investor’s Business Daily

We keep hearing about how short-term health plans are “junk insurance.” Really? Compared to ObamaCare’s high-deductible HMOs, or Medicaid’s long and often deadly waits?

A new study finds that at least 21,900 people on Medicaid have died waiting for treatment in states that expanded Medicaid eligibility under ObamaCare.

The reason, the Foundation for Government Accountability report says, is that ObamaCare opened Medicaid up to millions of able-bodied non-poor adults. That created a surge in demand for scarce Medicaid resources, forcing the poor to wait longer for services.

An insurance plan that you can’t use? That’s junk insurance. Continue reading


One State Pursues ‘End of ObamaCare’

By Fred Lucas • Fox News

Texas AG Ken Paxton and Wisconsin AG Brad Schimel on the lawsuit to end ObamaCare and the future of DACA.

Idaho has become ground zero in a new ObamaCare fight, with officials pursuing major changes that could serve as a national model for other states looking to expand insurance options in defiance of the law – even as Democrats warn of higher costs for vulnerable customers.

As soon as April, Blue Cross of Idaho is planning to make new options available.

That’s after Gov. Butch Otter and Lt. Gov. Brad Little co-signed an executive order asking the Department of Insurance to seek creative ways to make health coverage more affordable. The move opened the door for plans that don’t adhere to ObamaCare coverage requirements – though with the Trump administration testing similar ideas, the state may be unlikely to face much resistance from the White House.

The state’s insurance department now aims to let insurers sell cheaper, less comprehensive plans that officials project Continue reading


Liberals Have A New Plan To Take Over The Health Care System. What You Need To Know.

By Christopher Jacobs • The Federalist

The Center for American Progress proposed a plan for government-run health care Thursday, which the liberal think tank calls “Medicare Extra.”

Unlike Bernie Sanders’ single-payer system, which would abolish virtually all other forms of insurance, the plan would not ban employer coverage outright — at least not yet. In broad strokes, CAP would combine Medicaid and the individual insurance market into Medicare Extra, and allow individuals with other coverage, such as employer plans, traditional Medicare or VA coverage, to enroll in Medicare Extra instead.

Page 4 of the proposal makes it clear this plan is not moderate, and it would shift the health care market firmly into the government’s control: “Newborns and individuals turning age 65 would be automatically enrolled in Medicare Extra. This auto-enrollment ensures that Medicare Extra would continue to increase in enrollment over time. [Emphasis mine.]”

The goal of CAP’s plan is to grow government, and to grow dependence on government. The paper omits many important policies, such as how to pay for the new spending. Here are some of the major objectives and concerns.

If You Like Your Obamacare, Too Bad

After attacking Republicans for wanting to “taking away health insurance from millions,” CAP would … take away health insurance from millions. The plan would effectively eliminate Obamacare’s insurance exchanges, and all individual health insurance: “With the exception of employer-sponsored insurance, private insurance companies would be prohibited from duplicating Medicare Extra benefits, but they could offer complementary benefits during an open enrollment period.”

Other sections of the plan (discussed further below) suggest that private insurers could offer Medicare Choice coverage as one element of Medicare Extra. CAP indicates that persons purchasing coverage on the individual market would have a “choice of plans.” But didn’t Obamacare promise that already — and how’s that working out? For that matter, what happened to that whole “If you like your plan, you can keep it” concept?

Moreover, the plan would also “integrate” Medicaid into Medicare Extra, “with the federal government paying the costs.” CAP provides few details on how exactly that “integration” would work, but suffice it to say that the able-bodied adults covered by Obamacare’s Medicaid expansion could face some interesting transitions as a result of this plan.

Mandatory Health Insurance — And A $12,550 Tax
The plan reinstates a mandate to purchase health insurance: “Individuals who are not enrolled in other coverage would be automatically enrolled in Medicare Extra … Premiums for individuals who are not enrolled in other coverage would be automatically collected through tax withholding and on tax returns.”

While the plan says that those with incomes below the tax filing threshold “would not pay any premiums,” it excludes one important detail — the right to opt out of coverage. Therefore, the plan includes a mandate, enforced through the tax code, and with the full authority of the Internal Revenue Service. (Because you can’t spell “insurance” without I-R-S.) The plan indicates that for families with incomes between 150 and 500 percent of the poverty level, “caps on premiums would range from 0 percent to 10 percent of income. For families with income above 500 percent of [poverty], premiums would be capped at 10 percent of income.”

In 2018, the federal poverty level stands at $25,100 for a family of four, making 500 percent of poverty $125,500. If that family lacks employer coverage (remember, the plan prohibits individuals from buying any other form of private insurance), CAP would tax that family 10 percent of income — $12,550 — to pay for its Medicare Extra plan.

Moreover, the plan does not specify whether it caps the 10 percent threshold for families over 500 percent of poverty at the actual cost of premiums. (For instance, would a family with income of $200,000, but premium costs of $15,000, pay only their premium cost of $15,000, or $20,000 as 10 percent of their income?) If the latter, it would represent an even greater cost on middle-class families.

Wasteful Overpayments Controlled By Government Bureaucrats
As noted above, the plan would allow insurers to bid to offer Medicare Choice coverage, but with a catch: Payments provided to these plans “could be no more than 95 percent of the Medicare Extra premium.” CAP claims that “this competitive bidding structure would guarantee that plans are offering value that is comparable with Medicare Extra.”

It does no such thing. By paying private plans only 95 percent of the government-run plan’s costs, the bidding structure guarantees that private plans will provide better value than the government-run plan. Just as CAP decried “wasteful overpayments” to private insurers in Medicare Advantage, the CAP proposal will allow government bureaucrats to control billions of dollars in wasteful federal government spending on Medicare Extra.

Costs To States

As noted above, CAP envisions the federal government taking over Medicaid from the states, “given the continued refusal of many states to expand Medicaid and attempts to use federal waivers to undermine access to health care.”

Translation: “If you don’t do exactly what we demand, we will punish you.” For a similar reason, the paper notes that legislation implementing the plan should “leave little to no discretion to the Administration on policy matters” — because Congress doesn’t try to micro-manage enough of the federal government as it is.

But the plan also requires states to continue to make maintenance-of-effort payments even after the federal government takes Medicaid away from state jurisdiction. Moreover, the plan by its own admission “giv[es] a temporary discount [on the maintenance-of-effort provisions] to states that expanded their Medicaid programs” under Obamacare — effectively punishing states for a choice (i.e., to expand or not expand) that the Supreme Court made completely voluntary. And finally, it requires “states that currently provides benefits … not offered by Medicare Extra … to maintain those benefits,” leaving states perpetually on the hook for such spending.

Would Employer Coverage Really Remain?

The plan gives employers theoretical options regarding their health coverage. Employers could continue to offer coverage themselves, subject to certain minimum requirements. Alternatively, they could enroll their employees in Medicare Extra, with three possible sources of employer funding: Paying 70 percent of workers’ premiums, making maintenance-of-effort payments equal to their spending in the year preceding enactment, adjusted for inflation, or “simpler aggregated payments in lieu of premium contributions,” ranging from 0 to 8 percent of payroll. (The plan would exempt employers with under 100 full-time equivalent workers from making any payments.)

Two questions linger over these options: First, would employer coverage remain? CAP obviously wishes that it would not in the long-term, while recognizing the political problems associated with an abrupt transition. Second, could employers game the system among the various contribution options? While details remain unclear, any plan that sets up two systems (let alone four) represents a classic arbitrage opportunity. If employers act rationally, they could end up reducing their own costs in a way that significantly increases the federal government’s obligations.

Higher Health Spending

CAP advertises its plan as providing “zero or low deductibles, free preventive care, free treatment for chronic disease” — the source of 75 percent of American health care spending — and “free generic drugs.” It would also expand coverage of long-term care services not covered by Medicare (and only partially covered by Medicaid). But all this “free” stuff won’t come cheap.

In analyzing Bernie Sanders’ health care plan, the liberal Urban Institute estimated that it would increase overall health spending by 22.1 percent. Notably, the Urban researchers estimated that Sanders’ plan would raise spending by people who currently have health insurance by almost the same amount, or 15.1 percent, because the lack of cost-sharing will encourage individuals to increase their consumption of care. With the CAP plan apparently proposing that government fully subsidize more than three quarters of health care spending, its proposal will increase health care costs almost as much as Sanders’.

The CAP plan proposes measures to lower costs — namely price controls (i.e., Medicare dictating prices to doctors, hospitals, and drug companies), with some token references to other policies like bundled payments and limiting the tax preference for employer-sponsored insurance. But if those proposals go the way of Obamacare’s “Cadillac tax” — potentially never implemented because politicians of both parties lack the discipline to control health care spending — then the plan will only raise health costs rather than lower them.

Something For Nothing

The plan proposes that families with incomes below 150 percent of poverty ($37,150 for a family of four this year) pay for their coverage the princely sum of … zero dollars. No premiums, no deductibles, no co-payments. Zero. Zip. Zilch. Nada.

And while CAP does not include specific ideas to pay for all the associated new spending, the concepts it does propose largely involve taxing “the rich” (which includes small businesses).

While it doesn’t work as it should — most people “get back” far more than they “pay in” — at least Medicare makes an attempt to have all individuals pay for coverage through the payroll tax. CAP’s plan amounts to a transfer of wealth from one group to another.

Even The New York Times this week highlighted dissent from middle-class families upset at the thought of having to pay for low-income individuals to receive “free” Medicaid. So, CAP might want to rethink what Bill Clinton called “the craziest thing in the world” — making middle-class families pay even more for mandatory insurance ($12,550, anyone?) while certain families contribute not so much as a dime for coverage — along with just about every other element of its health care plan.


Trump Pushes Low-Cost, ObamaCare Alternative Health Plans

Fox News

The Trump administration moved Tuesday to allow health insurers to sell lower-cost, less-comprehensive medical plans as an alternative to those required under ObamaCare – in a plan that drew swift protest from congressional Democrats.

The proposed regulations would allow insurers to sell individual consumers “short-term” policies that can last up to 12 months, have fewer benefits, and come with lower premiums.

The plans also would come with a disclaimer that they don’t meet the Affordable Care Act’s consumer protection requirements, such as guaranteed coverage. Insurers could also charge consumers more if an individual’s medical history discloses health problems.

But at a time of rising premiums, Trump administration officials touted the option as a boost for those who need coverage but don’t qualify for the Affordable Care Act’s subsidies and would otherwise face paying the full premium cost.

Continue reading


The Ground Is Shifting Under Obamacare

By Scott Rasmussen • Real Clear Politics

President Trump has perfected the art of antagonizing his opponents with provocative tweets. He demonstrated this skill recently in declaring that the tax reform act, by repealing the Obamacare mandate, had effectively repealed Obamacare.

This generated a number of stories from left-­leaning pundits pointing out that there’s a lot more to Obamacare than the mandate. Sarah Kliff, writing for Vox.com, noted that many Republican voters believed the president and hoped that would bring an end to efforts to undo the rest of Obamacare.

But many Republicans in Congress seem intent on continuing to fight for repeal of the controversial law. A skeptical report in The Hill noted that the GOP had tried and failed to accomplish that goal in 2017. In their view, “nothing significant has changed since then that would now make the path easier. In fact, the obstacles appear even greater now that Democrat Doug Jones has been elected to the Senate from Alabama.”

Continue reading


Study Suggests Medicaid Is A ‘Persistently Inferior’ Form Of Health Coverage

By Christopher Jacobs • The Federalist

How many individuals would knowingly want to enroll in a form of health coverage with “persistently inferior” outcomes? It’s a good question, as a new study released last week suggests that Medicaid provides those persistently inferior outcomes in the nation’s largest state, raising more questions about the program that represents the bulk of the coverage expansion under Obamacare.

What This Study Looked Into

The study, published in the Journal of the American Medical Association Oncology, used a California data registry to compare cancer survival outcomes across multiple forms of insurance and nearly two decades (1997-2014). The study classified patients based on four forms of insurance: Private coverage; Medicare; other public coverage, about three-quarters (74 percent) of whom were Medicaid patients; and the uninsured. Continue reading


CBO: Repealing Obamacare’s Individual Mandate Would Reduce Deficit By $338 Billion

By Ali Meyer • Washington Free Beacon

Repealing the Affordable Care Act’s individual mandate would reduce the federal deficit by $338 billion in the next decade, according to a projection from the Congressional Budget Office.

The individual mandate requires that Americans purchase health insurance or pay a penalty to the Internal Revenue Service for not having coverage. A recent Taxpayer Advocate Service report found that roughly 4 million Americans paid an average penalty of about $708 this year for a total of $2.8 billion.

The budget office predicts that eliminating the mandate would reduce the deficit by $338 billion from 2018 to 2027 and would decrease the number of those with health insurance by 4 million in 2019 and by 13 million in 2027. Even with this loss, the report says that markets would remain stable in almost all areas of the United States over the next decade. Continue reading


Analysis: Obamacare premiums to rise by average of 34 percent in 2018

by Kimberly Leonard • Washington Examiner

The price of premiums for Obamacare’s mid-level plans are set to rise by an average of 34 percent next year, according to an analysis by the consulting firm Avalere Health.

These mid-level, or silver, plans are considered to be benchmark plans for people who sign up for Obamacare’s health insurance. Premiums for bronze, gold, and platinum plans will rise by an average of 18 percent, 16 percent, and 24 percent, respectively, compared to last year.

Average premium increases varied by state, the analysis found. Iowa will have the highest jump in average silver premium, of 69 percent, while Alaska will have a decrease in premiums of 22 percent. Alaska’s plan was lower this year because the state set up a reinsurance program in which state and federal funds paid for the medical claims of high-cost enrollees. Continue reading


Unless Congress Acts, Delayed Obamacare Tax On Health Insurance Takes Effect Next Year

By John Daniel Davidson • The Federalist

At the risk of interrupting our endless culture wars with some boring policy health policy news, congressional Republicans are on track to allow a brand new Obamacare tax to take effect next year, making health insurance even more expensive for millions of Americans. Beginning in January 2018, an Obamacare tax on health insurance plans for individuals and small businesses will go into effect—unless the GOP-controlled Congress delays it.

They’ve delayed it before. The tax was in place from 2014 to 2016, but in December 2015, Congress placed a one-year moratorium on collecting the tax for all of 2017, an estimated $13.9 billion. If the tax is allowed to go back into effect next year, it’ll be at a higher level, hauling in an estimated $14.3 billion and affecting more than 11 million households buying insurance on the individual market and 23 million households who are insured through small employers. Continue reading


Obamacare’s Out-of-Pocket Costs for Specialty Drugs Increases 16% in One Year

by Ali Meyer • Washington Free Beacon

Out-of-pocket costs for specialty drugs under the Affordable Care Act increased 16 percent from 2016 to 2017, according to a report from HealthPocket.

While prescription drug coverage comes standard with Obamacare plans, not all medications prescribed to individuals will be paid for.

“For a plan to help pay for a drug, the drug must first be included on the health plan’s formulary,” the report states. “Drugs that are off-formulary are not only paid for completely out-of-pocket by the enrollee but those expenses do not count towards the annual cap on out-of-pocket spending.” Continue reading


Obamacare lies resurfacing

By Stephen Moore • Washington Post

The danger of a Republican bailout of Obamacare is mounting with every passing day. A group of “moderate” Republicans calling themselves the Problem Solvers Caucus is quietly negotiating with Democratic leaders Nancy Pelosi and Chuck Schumer to throw a multi-billion dollar life line to the Obamacare insurance exchanges.

This bailout, of course, would be an epic betrayal by a Republican Party which has promised to repeal and replace the financially crumbling Obama health law.

Republicans who are “negotiating” this bipartisan deal, such as Sen. Lamar Alexander of Tennessee, object to the term “bailout” for this rescue package. The left prefers the euphemism “stabilizing the insurance market.” Continue reading


GOP Tweaks To Pre-Existing Conditions Will Likely Affect Just 0.5 Percent Of Americans

By Scott Ehrlich • The Federalist

On the day the American Health Care Act passed the Republican-controlled House of Representatives, the hashtag #IAmAPreExistingCondition was trending on Twitter. At the time I saw it, there were about 65,000 tweets on it.

Earlier that day, I had read in a different article that at its peak only 115,000 were members of the Pre-Existing Condition Insurance Plan (PCIP), a high-risk insurance program established as a bridge between pre-Obamacare coverage and the establishment of its exchanges. This brought to mind two key realizations: people care very much about those with pre-existing conditions and want to see them taken care of, but it’s also not a huge number of people and it’s very hard and expensive to insure them no matter what mechanism Americans use.

How People with Pre-Existing Conditions Get Insurance Continue reading


The ‘Conservatives Are Doomed’ Gambit

Wall Street Journal

Barack Obama emerged from his short-lived political retirement on Sunday to call on Members of Congress to show the “political courage” to preserve ObamaCare. But wait. That plea doesn’t square with the deluge of recent stories predicting that Republicans have doomed their majority in 2018 by voting last week to repeal ObamaCare. How does it take “political courage” to oppose something that everyone claims is politically suicidal?

Perhaps because the predictors of Republican doom could be wrong. The midterm election is still 18 months away, and many events will intervene that could influence the result. But even if the campaign does turn on repealing ObamaCare, we’d argue that the politics are better for Republicans if they pass their reform and fulfill a campaign promise than if they fail and then duck and cover.

Start with the safe assumption that the Democratic base will be highly motivated to vote next November no matter what Republicans in Congress do. The left will be eager to repudiate President Trump, and that means trying to retake the House and Senate. House Republicans can’t do much to deflate that liberal enthusiasm, any more than Democrats could deter the tea party in 2010. Continue reading


Aetna to Exit All Obamacare Exchanges in 2018 After Experiencing Hundreds of Millions in Losses

By Ali Meyer • Washington Free Beacon

Aetna, one of the nation’s largest health insurers, has announced that it will exit all Affordable Care Act exchanges in 2018 after experiencing massive losses in 2016 and 2017.

Aetna announced in August of last year that it would scale back its participation in the Obamacare exchanges in 2017—from operating in 778 counties to 242—citing losses of more than $430 million since January 2014. At that time, the company said it would still operate in four states: Delaware, Iowa, Nebraska, and Virginia.

Earlier this month, the company said it would exit the exchanges in both Iowa and Virginia, saying the insurer has continued to face profitability headwinds from individual commercial products. The company even went so far as to set aside a fund to buffer it from projected losses. Continue reading


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