Is Obamacare Still a Campaign Issue?

Drew Altman: “Campaign rhetoric may give the impression that the ACA is a threshold issue for Republican voters, but polling indicates that it is just one of many issues GOP voters care about.”

“In the Kaiser Family Foundation’s August tracking poll, 69% of Republican registered voters said they would consider a candidate’s views on the ACA as one of many factors determining their vote; just 12% said they would ‘only vote for a candidate who shares their views on the ACA.’ Eighteen percent said this issue would not be a factor in their vote. The findings suggest that Republican candidates are not likely to win many primary votes based solely on their ACA positions.”

“Separately, a challenge for those candidates offering replacement plans is that Republican voters are somewhat divided on what they would like Congress to do next about the ACA … There is no groundswell of support–at least not yet–among the Republican base for replacement plans. That could be because there is no consensus replacement idea around which to coalesce, or because voters are tiring of the debate, or for other reasons.”

“Overall … it’s not clear that any position will distinguish one candidate from the others in a crowded field.”


Republicans Support State Marijuana Laws

Christopher Ingraham: “By significant margins, Republican voters in the early primary states of Iowa and New Hampshire say that states should be able to carry out their own marijuana laws without federal interference. Sixty-four percent of GOP voters in Iowa say that states should be able to carry out their own laws vs. only 21 percent who say that the federal government should arrest and prosecute people who are following state marijuana laws.”

“These numbers come from recent surveys conducted by Public Policy Polling and commissioned by reform group Marijuana Majority. They come as some GOP candidates, such as Gov. Chris Christie (N.J.) and Sen. Marco Rubio (Fla.), have stepped up their anti-marijuana rhetoric in recent weeks.”

“Marijuana policy is not a make-or-break issue like jobs or the economy for most voters. But in a crowded primary field, it could mean the difference between, say, a seat at the main debate table and relegation to the sidelines.”

Repealing Obamacare Would be a ‘Spectacular Upheaval’

Paul Waldman argues that the health care plans proposed by the GOP candidates “all share one feature, the thing that tells you that they aren’t even remotely serious about this issue: they will take as their starting point that the entire Affordable Care Act should be repealed.”

“It shows that they’re completely unwilling to grapple with both the health care system as it exists today, and how incredibly disruptive the wholesale changes they’re proposing would be. Walker’s plan even says, ‘unlike the disruption caused by ObamaCare, my plan would allow for a smooth, easy transition into a better health care system.’ This is the health care equivalent of thinking the Iraq War would be a cakewalk.

“The reality is that repealing the ACA now that it has been implemented would mean a complete and utter transformation of American health care … You can’t pretend that unwinding them all would be anything resembling a ‘smooth, easy transition.’”

“That doesn’t mean that repeal is impossible, just that it would be a spectacular upheaval, one that I promise you Republicans have no genuine appetite for.”

States Continue to Report Declines in Their Uninsured Rates

Baltimore Sun: “A new survey shows that Ohio’s uninsured rates for children and adults have each dropped by about half since 2012. According to the 2015 Ohio Medicaid Assessment Survey, the state’s uninsured rate for adults fell to 8.7 percent in 2015, while the rate of uninsured children was 2 percent.”

Kaiser Health News: “The number of uninsured California adults under the age of 65 dropped by more than 15 percent between 2013 and 2014 because of the Affordable Care Act, including California’s Medi-Cal expansion, according to data released Tuesday.”

“’We’re seeing the biggest drop in the uninsured population in a generation,’ said David Dexter, communications coordinator for the California Pan-Ethnic Health Network, an advocacy group.”

A Closer Look at Walker and Rubio Obamacare Alternatives

Margot Sanger-Katz sums up Walker’s proposal: “Obamacare gives federal money to poor people to help them get health insurance. Scott Walker, Wisconsin’s governor, has a replacement plan. It would give federal money to old people instead.”

“The Republican plans differ substantially from Obamacare in their vision of how the money should be doled out, and what it should be used to buy. The Walker and Rubio proposals call for a much less regulated insurance market, where the federal government exercises little oversight over the products in the market.”

“Their plans are also much less concerned about ensuring health care access for the poor. In addition to rolling back Obamacare, both would also reduce future federal spending on state-administered Medicaid programs.”

“Wealthier people, on the other hand, could fare better under [Walker’s] plan, as long as they’re healthy. They would get more federal money to buy insurance plans, and they would have the choice of buying cheaper, less comprehensive plans than those offered under Obamacare rules.”

“Both plans, however, would strip away Obamacare’s myriad health insurance regulations … States would have the authority to impose insurance rules, so some markets might have more restrictions. But the plan would also allow people to buy insurance sold in any state, meaning all Americans would have access to the least regulated products.”

The Obamacare ‘Repeal and Replace’ Predicament Persists

National Journal: “Republican presidential candidates are starting to get to the ‘replace’ part of their pledges to repeal and replace Obamacare. Wisconsin Gov. Scott Walker and Sen. Marco Rubio of Florida rolled out plans Tuesday. But with specific policy proposals comes real scrutiny and the risk that Americans won’t like what they see.”

“There wasn’t much in Walker or Rubio’s proposals that hasn’t floated around conservative wonk circles for years, but the value is that they have a plan at all. Walker readily pointed that out.”

Jonathan Chait: Rubio and Walker’s “fundamental dilemma is that Obamacare provides a popular benefit to millions of voters. Appealing to the conservative base demands they eliminate the program that provides this benefit. Appealing to the general election requires them to promise something to compensate the victims of repeal. How will they fund that something? This is the basic problem that for decades has prevented Republicans from offering a health-care plan. Rubio and Walker show that they still have no answer.”

Number of Uninsured Drops By 15 Million

“The number of people without health insurance continues to decline and has dropped by 15.8 million, or one-third, since 2013,” the New York Times reports.

“The decline occurred as major provisions of the Affordable Care Act took effect. The law expanded coverage through Medicaid and through subsidies for private insurance, starting in 2014. In the first three months of this year, the National Center for Health Statistics said, 29 million people were uninsured. That was seven million fewer than the average for 2014, after a reduction of 8.8 million from 2013 to 2014.”

“The data may bolster Democrats’ claims that the law is working as they intended, but it is unlikely to prompt Republicans to let up on criticism of the law, which was passed without any Republican votes.”

Obamacare’s Steady Progression

Washington Post: “Obamacare’s opponents have heralded reports from various parts of the country warning of double-digit percentage increases in insurance premiums proposed over the past couple of months. (These are premiums for individuals buying insurance on ACA marketplaces; employer-sponsored plans, which most Americans have, are not the primary focus of the law.) For example: Even after regulator review, Oregon’s largest ACA marketplace insurance plan will hike its 2016 premiums by 25 percent, and its second largest by 33 percent.”

“Big increases in the price of one insurance product, however, don’t necessarily represent overall trends. The Kaiser Family Foundation has produced a comprehensive study of 2016 premium increases and found that benchmark plans in 10 states and the District are rising an average of only 4.4 percent. Some insurers are decreasing their premiums by double digit percentages next year; others are increasing them by double digit percentages; many others are seeing relatively modest changes. The Department of Health and Human Services found in June that ‘most people will be enrolled in plans with proposed rate increases of less than 10 percent.'”

“True, average numbers won’t be comfortable to those facing double-digit premium increases in an insurance plan they like. Yet these customers aren’t locked into that plan. An HHS study released Thursday found that market competition increased markedly in 2015, and Obama administration officials predict it will again in 2016. People, in other words, have options.”

Why Spending More on Health Care Is Actually a Good Thing

Megan McArdle: “In recent years, health care cost growth has slowed down. This is great news for the federal budget, and for those of us who, you know, get health care occasionally. Unfortunately, researchers from the Centers for Medicare and Medicaid Services project that the good news may be over. With the population aging, the economy recovering, and Obamacare expanding coverage, they expect health care cost growth to average almost 6 percent over the next decade.”

“That’s not all bad news. The population is aging because people are living longer. And economic recovery will give us more income to pay our higher health care costs. The newly insured are presumably pretty happy about it too. So there’s no reason to go into paroxysms of mourning over this news. However, it does cast light on a debate that has been going on for some time: why growth in health expenditures has gone down.”

‘Trumpcare’ Looks a Lot Like Obamacare

Sahil Kapur in Bloomberg: “Donald Trump says Obamacare is ‘very bad’ and needs to go. ‘Repeal and replace with something terrific,’ he told CNN on Wednesday.”

“What would the terrific replacement be? The Republican presidential front-runner was vague, but health experts say that a number of the broad replacement ideas he outlined sound similar” to Obamacare.

“Trump proposed: competing private plans (which Obamacare exchanges provide for); protecting hospitals from catastrophic events (which Obamacare deals with by requiring people to get insurance so they don’t pass on their emergency care costs), and government plans for low-income people who get sick and lack options (which Obamacare does by expanding Medicaid).”

“‘He should take a closer look at the ACA, he might like it,’ said Timothy Jost, a leading expert on Obamacare who supports the law. ‘What he is proposing does look a lot like the ACA.'”

“As Obama does in promoting his plan, Trump emphasized the value of universal coverage. That includes people ‘at the lower end’ of the income spectrum, he said, who won’t get ‘the finest plan’ but deserve to be covered. He was unapologetic about his goal to help provide health care for low-income people, even if it costs him the Republican nomination.”

Obamacare Led to Increased Competition

USA Today: “Competition among insurers offering plans on the federal health care exchange rose between last year and this year, tamping down growth in premiums, says a federal report released Thursday.”

“The report says 86% of people eligible for qualified health plans on had access to at least three insurers this year, up from 70% in 2014. Nearly 60% of U.S. counties saw a net gain of at least one insurer, 8% saw a loss, and 33% saw their numbers unchanged, the report says.”

“Competition affected how much people paid for their plans, the report says, with premium growth between 2014 and 2015 for benchmark (second-lowest cost) silver plans 8.4 percentage points lower in counties that gained insurers than in other counties. In fact, a net gain of one insurer was associated with a 2.8 percentage point drop in the rate of benchmark premium growth.”

“The average growth rate in the benchmark premium was 2%, the report says.”

California’s Obamacare Success: A Model for the Nation?

Kaiser Health News: “A statewide survey has found that newly insured Californians no longer rank health care costs as their top financial concern. It has dropped below other essentials such as housing, utilities and gasoline.”

“About two-thirds of Californians who were uninsured in 2013 now have health insurance, according to the survey by the Kaiser Family Foundation, which was released Thursday.”

“The Kaiser Family Foundation survey found the recently insured are largely satisfied with their coverage, including 83 percent of Medi-Cal enrollees and 63 percent of Californians who purchased private plans on the Covered California exchange. One positive, according to the survey respondents, was that they are having an easier time getting medical attention.”

KFF CA tracking 600

“The survey also found a striking reduction in the percentage of recently insured Californians who struggled to pay medical bills: 23 percent said they faced difficulties, down from 45 percent in 2013.”