Our Health Policy Matters

There's a simple reason why (after more than a decade) Donald Trump and the Republicans have no plan to replace Obamacare. I'll explain in a few minutes. But first, some background. When the Affordable Care Act (or Obamacare) was passed in 2010, it was an effort to expand health care coverage to a lot of people who needed it, while controlling their costs. It had certain key provisions, not the least of which were that people couldn't be denied coverage for pre-existing conditions, that all chronic diseases needed to be covered fairly, and lifetime coverage caps had to be lifted. The problem was that if you left matters to insurers to set insurance premiums based on what this would cost, the price of insurance would rise dramatically. So the government took a look at three different programs and ultimately put them together into one system. For people whose income was so low that they couldn't afford any real cost-sharing, the government expanded Medicaid. For elders...

My wife Pam and I bought private long term care insurance about twenty years ago. It’s a pretty good deal. For about $100 per month, we will someday – when we need it – be eligible for up to $200 a day toward either home health care or nursing home care. Add it up – it could save us hundreds of thousands of dollars as we age. I’ve been a big supporter of long-term care insurance since I was a Connecticut State Legislator in the 1980s. But to be honest, it’s never quite gotten the traction it should have. One of the reasons is that when people are young and healthy, they aren’t thinking about what their long-term care needs might be thirty or forty years down the road. But that’s when premiums would be most affordable. The bigger problem is that it’s really hard for insurers to predict the costs of long-term care that far in advance, too. The costs of care often far exceed those that are estimated way in advance. As a result, the policies that Pam and I have aren’t even offered anymore...

I have at least two members of my immediate family who would be affected directly by the so-called Better Care Reconciliation Act (BCRA). It could cost them – and others like them – their money and their lives. The Senate bill released this week has two important improvements over the House American Health Care Act. First, like Obamacare but unlike the House version, it requires insurers to continue to offer coverage in the regular marketplace to people with pre-existing conditions. Second, it corrects a major flaw in the Affordable Care Act – as interpreted by the Supreme Court – by extending health insurance subsidies to everyone below poverty who is ineligible for Medicaid. Today, the poorest pay the same as the richest for health insurance, because the subsidies are limited to those between 100 and 400 percent of poverty. That’s the good news. But it all quickly unravels after this. Here are ten reasons why. First, while pre-existing conditions are cove...

I have at least two members of my immediate family who would be affected directly by the so-called Better Care Reconciliation Act (BCRA). It could cost them – and others like them – their money and their lives. The Senate bill released this week has two important improvements over the House American Health Care Act. First, like Obamacare but unlike the House version, it requires insurers to continue to offer coverage in the regular marketplace to people with pre-existing conditions. Second, it corrects a major flaw in the Affordable Care Act – as interpreted by the Supreme Court – by extending health insurance subsidies to everyone below poverty who is ineligible for Medicaid. Today, the poorest pay the same as the richest for health insurance, because the subsidies are limited to those between 100 and 400 percent of poverty. That’s the good news. But it all quickly unravels after this. Here are ten reasons why. First, while pre-existing conditions are cove...

The Affordable Care Act amendment offered by House leadership yesterday seems well-intended. But it falls far short of the “repeal and replace” promises that have been made for years. Instead of offering better health insurance, more choices, and greater affordability as promised, the draft proposal pushes more people into private health insurance exchanges, through which insurers will offer poorer coverage at a higher cost.  Older adults will immediately pay as much as 60 percent more for their health insurance. All individuals will find themselves subjected to a new “individual mandate,” disguised as a 30 percent premium surcharge for those who lose their coverage for more than two months and for those 26 year olds who fail to enroll as soon as they leave their parents’ policies. A new high risk pool for those with chronic diseases will become a multi-billion dollar unfunded mandate on the states by 2026. Employers will no longer have to provide insurance ...

The Affordable Care Act amendment offered by House leadership yesterday seems well-intended. But it falls far short of the “repeal and replace” promises that have been made for years. Instead of offering better health insurance, more choices, and greater affordability as promised, the draft proposal pushes more people into private health insurance exchanges, through which insurers will offer poorer coverage at a higher cost.  Older adults will immediately pay as much as 60 percent more for their health insurance. All individuals will find themselves subjected to a new “individual mandate,” disguised as a 30 percent premium surcharge for those who lose their coverage for more than two months and for those 26 year olds who fail to enroll as soon as they leave their parents’ policies. A new high risk pool for those with chronic diseases will become a multi-billion dollar unfunded mandate on the states by 2026. Employers will no longer have to provide insurance ...

As Congress works through the challenge of changing Obamacare, how the federal government pays its share of Medicaid dollars will be part of the debate. At first, Medicaid was designed primarily to offer to people with chronic conditions the long-term care benefits that Medicare did not. It pays much of our nation’s nursing home bill.  It was later expanded to provide safety net insurance to low income families, especially for women and children. Medicaid is a federal/state partnership program. The states design their own programs within federally-established rules, and the federal government reimburses half (or more) of the state’s cost. The Affordable Care Act added a new wrinkle to the cost-sharing formula.  For those states that expanded the Medicaid program to serve even more people, including uninsured single adults, it offered 90+ percent reimbursement for the new populations.  To date, 32 states have expanded. What’s wrong with Medicaid? Medicaid costs...

As Congress works through the challenge of changing Obamacare, how the federal government pays its share of Medicaid dollars will be part of the debate. At first, Medicaid was designed primarily to offer to people with chronic conditions the long-term care benefits that Medicare did not. It pays much of our nation’s nursing home bill.  It was later expanded to provide safety net insurance to low income families, especially for women and children. Medicaid is a federal/state partnership program. The states design their own programs within federally-established rules, and the federal government reimburses half (or more) of the state’s cost. The Affordable Care Act added a new wrinkle to the cost-sharing formula.  For those states that expanded the Medicaid program to serve even more people, including uninsured single adults, it offered 90+ percent reimbursement for the new populations.  To date, 32 states have expanded. What’s wrong with Medicaid? Medicaid costs...

Obamacare will insure 2 million fewer people in 2014 than previously reported.  That number is in a new report just released by the Congressional Budget Office (CBO). That may come as a surprise to you.  But it isn’t the biggest surprise in the report for me.  I’ll explain why later.  First, let’s review the new numbers. Last May, the CBO estimated that seven million people would sign up for insurance through exchanges this year.  That number is not a surprise – it has been reported widely in the media. It also estimated that nine million previously uninsured people would be enrolled in Medicaid or CHIP.  In other words, a total of 16 million people would obtain coverage this year through Obamacare. But last week, CBO released updated estimates .  It now says that only 6 million will sign up through the exchanges this year, and only 8 million will enroll in Medicaid or CHIP.  Because some of the people who would have si...

Obamacare will insure 2 million fewer people in 2014 than previously reported.  That number is in a new report just released by the Congressional Budget Office (CBO). That may come as a surprise to you.  But it isn’t the biggest surprise in the report for me.  I’ll explain why later.  First, let’s review the new numbers. Last May, the CBO estimated that seven million people would sign up for insurance through exchanges this year.  That number is not a surprise – it has been reported widely in the media. It also estimated that nine million previously uninsured people would be enrolled in Medicaid or CHIP.  In other words, a total of 16 million people would obtain coverage this year through Obamacare. But last week, CBO released updated estimates .  It now says that only 6 million will sign up through the exchanges this year, and only 8 million will enroll in Medicaid or CHIP.  Because some of the people who would have si...

Now that 2014 and Obamacare are both here, there will be plenty of stories about Affordable Care Act implementation.  Some will be newsworthy; but others will just be history.  Last week, we got our first history story characterized as exploding news. The Washington Post reported on a newly-released Harvard study that analyzed the impact of the 2008 Oregon Medicaid expansion on hospital emergency department visits.  The study found that there was a 40 percent increase in the number of emergency department visits made by the new Medicaid enrollees. For the Post article, an MIT health economist (I guess no Harvard ones were available!) commented  that he viewed it “as part of a broader set of evidence that covering people with health insurance doesn’t save money,” something he went on to characterize as a “misleading motivator for the Affordable Care Act.” And Forbes went farther, claiming the study results are “ undermining [the] central rationale...

Now that 2014 and Obamacare are both here, there will be plenty of stories about Affordable Care Act implementation.  Some will be newsworthy; but others will just be history.  Last week, we got our first history story characterized as exploding news. The Washington Post reported on a newly-released Harvard study that analyzed the impact of the 2008 Oregon Medicaid expansion on hospital emergency department visits.  The study found that there was a 40 percent increase in the number of emergency department visits made by the new Medicaid enrollees. For the Post article, an MIT health economist (I guess no Harvard ones were available!) commented  that he viewed it “as part of a broader set of evidence that covering people with health insurance doesn’t save money,” something he went on to characterize as a “misleading motivator for the Affordable Care Act.” And Forbes went farther, claiming the study results are “ undermining [the] central rationale...

As we gaze this week at the wonderland we call Congress, it might amaze us that Congress actually shut down the federal government over the implementation of the Affordable Care Act. Rep. John Culberson of Texas grinned like a Cheshire Cat as he explained it this way in an outlandish interview on CNN, “we do not want the federal government socializing health care as they have in England and in France.” This is socialized medicine?  Really? He wasn’t content to leave it there, adding a new “sacred” right to the Constitution to explain further his position. “The right to be left alone as Americans is probably our most important right.” As the Mad Hatter would say, “Why, you might just as well say that ‘I see what I eat is the same as I eat what I see.’”  But Representative Culberson was on a roll.  Literally.  This was two days after he was reported to have shouted “let’s roll!” as House Republicans concluded a caucus in which they re-affir...

As we gaze this week at the wonderland we call Congress, it might amaze us that Congress actually shut down the federal government over the implementation of the Affordable Care Act. Rep. John Culberson of Texas grinned like a Cheshire Cat as he explained it this way in an outlandish interview on CNN, “we do not want the federal government socializing health care as they have in England and in France.” This is socialized medicine?  Really? He wasn’t content to leave it there, adding a new “sacred” right to the Constitution to explain further his position. “The right to be left alone as Americans is probably our most important right.” As the Mad Hatter would say, “Why, you might just as well say that ‘I see what I eat is the same as I eat what I see.’”  But Representative Culberson was on a roll.  Literally.  This was two days after he was reported to have shouted “let’s roll!” as House Republicans concluded a caucus in which they re-affir...

As President Obama begins his second term, he does so with an expansive vision for America. “America's possibilities are limitless,” he said in his inaugural address , “for we possess all the qualities that this world without boundaries demands:  youth and drive; diversity and openness; an endless capacity for risk and a gift for reinvention.   My fellow Americans, we are made for this moment, and we will seize it - so long as we seize it together.” There are many potential roadblocks toward achieving that bold vision.  One is the myth that entitlement reform must be a part of it. The reason that entitlement reform is at the top of some political agendas has nothing to do with the growth in entitlement programs today. Some people with these agendas don’t like any government-run programs and won’t listen to the facts about them.  Those who do look at the facts see the rapid growth in Medicare and Medicaid spending through 2009.  Accor...