US Policy Changes Vol.1 (Healthcare Vol.1)

Here are three articles on healthcare. The election of Donald J. Trump and the re-election of a Republican-controlled House and Senate will usher in big #policychanges. Excerpts are on our own.

Is Obamacare failing? (8/24/2016) | @sarahkliff @voxdotcom‏
… @Penn’s Zeke Emanuel pegged it at 2025. @MIT’s Jonathan Gruber estimated 2050. … Major health insurers @Aetna and @UnitedHealthGrp have soured on the law, sharply reducing participation in the marketplaces. Obamacare’s insurance markets have, in turn, become increasingly less competitive. The health research firm @avalerehealth estimates that 36 percent of the marketplaces’ rating regions will only have a single health plan. … “The exchange population — 85 percent of which qualifies for financial assistance — looks a lot like the Medicaid population,” says Michael Adelberg… “And with it, we’re seeing the start of the ‘Medicaid-ization’ of exchange plans: narrow networks with no frills.” …
The uninsured rate has consistently declined since the health law’s insurance expansion launched in 2014. The most recent @Gallup data shows that 11 percent of Americans currently lack health insurance — the lowest rate the group has ever recorded. … @CDCgov reported that only 9.1 percent of Americans lacked insurance in 2015. … oc-uninsured
“It’s important to step back and think about what would be happening right now if there was no Affordable Care Act,” says @nicholas_bagley, an assistant professor at @UMichLaw… “Premiums would be much higher now than they are under any kind of reasonable estimate.”
…the law is helping these people gain access to medical services that were previously out of reach… Even when there are large premium spikes, more than 80 percent of marketplace enrollees have subsidies that ensure their monthly fees remain affordable. … consumers would shop for coverage the “same way you’d shop for a plane ticket on Kayak or a TV on Amazon. …
…five states — Alaska, Alabama, North Carolina, Oklahoma, and Wyoming — that only have one insurance plan signed up to sell in 2017. … currently one county in Arizona that has no health plans signed up to sell. …individual mandate, which they found to be too weak and poorly enforced, leading to lower-than-expected enrollment among healthy, young adults. …right now they’re about 28 percent of the marketplace population.
…Uwe Reinhardt at @Princeton … points out that it’s not the case that partnerships with private insurers can’t work to expand coverage. There are other countries like Germany and Switzerland that have, for decades now, achieved universal coverage working with private plans. … They mandated the benefits each insurer covers and how much each medical service costs. They also set up much stronger laws to force consumers to buy coverage.
… Medicaid… usually pays low reimbursement rates to hospitals and providers, so it doesn’t get big brand-name facilities into its networks. In 2011, one-third of doctors nationwide said they didn’t accept Medicaid patients. … The vast majority of Obamacare’s enrollees are low-income: 81 percent earn less than 250 percent of the poverty line ($29,000 for an individual or about $60,000 for a family of four). …
… @Centene… came into Obamacare knowing how to target those people, as @stltoday reporter @samanthann …narrowly focusing on low-income individuals who have lost their Medicaid eligibility and need to find a private health insurance plan.
… The average employer-sponsored plan for a family of four cost $17,545 last year. Why would companies keep paying for coverage when they could pay a relatively small penalty ($2,000) to shift workers to the public marketplace? … 12.7 million enrollees this year — 8.3 million less than @USCBO projected in 2015. … Between 2015 and 2016, only one-third of marketplace enrollees kept the same plan. …

This Princeton health economist thinks Obamacare’s marketplaces are doomed (8/25/2016) | @sarahkliff @voxdotcom
UR: … We’ve had two actual death spirals: in New Jersey and in New York. New Jersey passed a law that had community rating but no mandate, so that market shrank quickly and premiums were off the wall. You look at New York and the same thing happened; they had premiums above $6,000 per month. The death spiral killed those markets. What we do have in the Affordable Care Act is the mandate, so it will be a slower process. …
… litigation over the commerce clause …

Trump and the GOP can absolutely repeal Obamacare — and 22 million people would lose health insurance (11/9/2016) | @sarahkliff @voxdotcom
… One party rule… “They have a death blow to the Obamacare health coverage expansion,” says @HealthStewBlog, a @HarvardChanSPH professor… Republicans could use the reconciliation process to take apart key Obamacare pillars, requiring a simple majority rather than the 60 votes needed to overcome a filibuster. … But Senate rules also allow bills to pass with a simple majority if they only relate to spending, a process known as reconciliation. …
… HR 3762… includes taxes on health insurers, hospitals, and medical device manufacturers and a Medicare payroll tax of 0.9 percent that the law levied on Americans who earn more than $200,000 (or $250,000 for a married couple). … The repeal plan would reduce the deficit by between $281 billion and $193 billion… House Republicans passed HR 3762 on October 23, 2015, and the Senate followed on December 3, 2015. President Obama vetoed the bill…
House Republicans did publish a document outlining their Obamacare replacement plan this summer, called “A Better Way.” …block-granting Medicaid and allowing insurance sales across state lines. … the Senate hasn’t weighed in.” …