Brookings Institution: “Now that Republicans control both Congress and the White House, talk of repealing and replacing the Affordable Care Act (aka ‘Obamacare’) has accelerated. But as Americans nationwide voice concerns in congressional town halls about repeal, the process may not proceed as rapidly as ACA opponents had hoped. What are the pitfalls to repeal, and what are the possibilities for reform, of the Affordable Care Act? It’s a subject that Brookings experts have long-studied and on which they have many policy recommendations. A collection of some of the most recent analyses and recommendations are presented below…”
“When then-Gov. Mike Pence faced the worst public health crisis to hit Indiana in decades, he turned to Obamacare — a program he vilified and voted against,” Brianna Ehley writes for Politico.
“In 2015, as a rash of HIV infections spread through rural southern Indiana, state health officials parachuted into Scott County and enrolled scores of people into Obamacare’s expanded Medicaid program so they could get medical care and substance abuse treatment. Many were addicted to opioids and had contracted HIV by sharing dirty needles.”
“Two years later, Pence is helping to lead the Republican effort to dismantle the program that helped him halt the deadly outbreak in an impoverished swathe of Indiana.”
Doug Tieman: “The problem is so massive that it has no simple solution. It will require cooperation and coordination among policymakers, health care professionals, and communities. The 2016 passage of the Comprehensive Addiction and Recovery Act and the 21st Century Cures Act gives governors a unique opportunity to work with the federal government to obtain funds intended to address this epidemic. As governors prepare their budgets, which policies should they and their legislatures implement to help those in addiction’s throes?”
Tieman suggests improving physician training, partnering with schools to prevent future generations from abusing, improving care transitions to facilitate recovery, and expanding access to addiction medications.
NPR: “The researchers looked at California, Florida, Michigan, North Carolina and Texas, interviewing state regulators, health providers, insurers, consumer organizations, brokers and others to understand why insurance companies chose to enter or leave markets, how state regulations affected decision-making and how insurers built provider networks.”
“Despite the political diversity of the five states, some common lessons emerged.”
“Everyone expects Congress to change the Affordable Care Act, but no one knows exactly how. The uncertainty has one group of people, the homeless, especially concerned. Many received health coverage for the first time under Obamacare; now they’re worried it will disappear,” Pam Fessler reports for NPR.
“Health Care for the Homeless President Kevin Lindamood said that before Obamacare, only 30 percent of the patients they saw had health insurance. The group provides health care to people without homes as well as others who are in transition to more settled lives.”
“‘Now [it’s] 90 percent of our clients, from 30 percent insured to 90 percent insured, either through Medicaid or Medicare,’ he said. ‘That’s a transformation.'”
New York Times: “For those who believe the primary goal of the law should have been to bring health insurance to more Americans, the rational answer should be: Yes, Obamacare succeeded. More than 20 million Americans gained health coverage through the law.”
“For those who believe the primary goal of the law should have been to make health insurance affordable to all who want it, the rational answer is: No, Obamacare did not achieve uniform affordability. Health care in the United States remains the most expensive in the world, and coverage remains out of the financial reach of many Americans.”
“For those who believe the primary goal of the law was to make Americans healthier, the answer has to be: It is too soon to tell.”
“One thing is clear, though — the Affordable Care Act has shifted the nation’s baseline expectations for how health care should work. Its successes have pushed Republican politicians, like Mr. Trump, into making expansive promises to provide insurance to all Americans. Its failures have become focal points, too, leading to calls for lower insurance deductibles and for more choices in doctors and hospitals.”
New York Times: “A number of Republican health care policy proposals that seemed out of favor in the Obama era are now being given new life. One of these involves Medicare, the government health insurance program primarily for older Americans, and is known as premium support.”
“Right now, the federal government subsidizes Medicare premiums — those of the traditional program, as well as private plan alternatives that participate in Medicare Advantage. The subsidies are established so that they grow at the rate of overall per enrollee Medicare spending. No matter what Medicare costs, older Americans can be sure that the government will cover a certain percentage of it. That’s the main thing that panics fiscal conservatives, because that costs the government more each year.”
“Premium support could quiet that fear. Subsidies would be calculated so they don’t grow as quickly, thus protecting the federal government (that is, taxpayers) from runaway spending.”
Stuart Butler: “Former President Obama’s impulse to conduct an intensive intervention to major fix parts of the U.S. health system was understandable, but unwise. Seeking to replace the Affordable Care Act (ACA) with another intensive intervention would also be very unwise.”
“To appreciate why, consider the scale of such undertakings. In 2015, total U.S. health spending reached $3.2 trillion. That is larger than the economy of Britain or France. Indeed, if the U.S. health system were a separate country, according to World Bank data it would be the fifth-largest economy in the world… It’s not only the scale involved. Health care is also highly complex and ever changing; a law altering one part triggers unanticipated changes elsewhere.”
“This means legislation in a complex sector like health care must always be crafted to permit continuous adaptation, and never a truly finished product. Health care legislation must incorporate a process of evolution, not seek to achieve a lasting form of ‘intelligent design.’ Tearing up one huge and rigid statute and replacing it with another is doomed to fail.”
“American life spans are rising, and as they are, health care spending is, too. But longevity is not contributing to the spending increase as much as you might think… The real culprit of increased spending? Technology,” Austin Frakt writes for The New York Times.
“Every year you age, health care technology changes — usually for the better, but always at higher cost. Technology change is responsible for at least one-third and as much as two-thirds of per capita health care spending growth. After accounting for changes in income and health care coverage, aging alone can explain only, at most, a few percentage points of spending growth — a conclusion reached by several studies.”
Washington Post: “The rate of abortions in the United States has fallen to its lowest level since the 1973 Supreme Court decision Roe v. Wade, according to a report out today from the Guttmacher Institute, a research organization that supports abortion rights.”
“The researchers identify two main factors driving down the incidence of abortion. The first is a drop in the rate of unintended pregnancy, driven primarily by an increase in the use of long-term contraceptive measures, like IUDs, that are highly effective. The Guttmacher report notes that the use of these contraceptives increased by 36 percent between 2009 and 2012, and even higher among younger and lower-income women, two groups who are particularly at risk for unplanned pregnancy.”
Pew Research: “As the debate continues over repeal of the Affordable Care Act and what might replace it, a growing share of Americans believe that the federal government has a responsibility to make sure all Americans have health care coverage…”
James Pethokoukis: “The most obvious compromise is to fix and stabilize ObamaCare — such as deregulating the insurance exchanges — not repeal and replace it with something brand new.”
“But that’s just a start. Republicans should go even farther than reforming ObamaCare. They should expand it.”
“Imagine an America where ObamaCare was so robust, where the exchanges were such a crackling hotbed of free-market activity and competition, that everyone purchased insurance this way, and no longer counted on their employers (or the government) for health coverage.”
Ryan Cooper: “Perhaps the most monstrous thing about the American medical system — and the bar for that title is high indeed — is predatory billing.”
“A great many medical providers adjust their prices based on how defenseless the patient is, and bleed the weakest ones for every last red cent, often with preposterously inflated charges for things like aspirin and bandages. A 2015 study looked at the worst price gougers in the country and found 50 hospitals that charged uninsured people roughly 10 times the actual cost of care.”
“Key to this practice is something called “balance billing,” and it’s why the American Medical Association is strongly supporting Donald Trump’s pick of Rep. Tom Price (R-Ga.) to lead the Department of Health and Human Services, which oversees Medicare. Balance billing is forbidden for Medicare enrollees, but Price wants to allow it — thus allowing doctors and hospitals to devour the nest eggs of thousands of American seniors.”