McConnell: Republicans Will Roll Back Obamacare

The Hill: “Senate Majority Leader Mitch McConnell (R-Ky.) on Tuesday said he does not have a timeline for using reconciliation to repeal ObamaCare, but indicated that Republicans would look to roll back as much of the law as they can.”

“’I don’t have a time to give you, but we’re certainly going to consider using budget reconciliation for repealing as much of ObamaCare as is reconcilable,’ McConnell told reporters. ‘There’re certain rules that have to be applied to what is reconcilable and that’s an active consideration, as you can imagine.’”

“The Republican budget sets a deadline of July 24, just 10 days away, for the relevant committees to come up with a reconciliation plan. But even after that deadline, the Senate could still use reconciliation until the end of the congressional session in 2016.”

The Politics of Obamacare Still Favors Democrats

Josh Kraushaar: “Understanding the politics of the president’s health care law has never been complicated. It was barely passed through Congress despite huge Democratic majorities in 2009, became the driving force behind the GOP’s takeover of the House in 2010, and again was the leading issue Republicans campaigned on to retake the Senate in 2014. Nearly 15,000 advertisements aired about Obamacare in the last week of last year’s midterms, and 94 percent of the messaging was negative. One week later, Republicans won nine Senate seats and netted their largest House majority since the 1920s. For Republicans, it has been the political gift that keeps on giving.”

“Yet even though public opinion remains unfavorable towards the law, Democrats remain in denial about its political standing.”

Jonathan Chait: “Kraushaar has lovingly tended the flickering flame of health-care repeal for years. In 2013, he predicted that barring ‘an unlikely fourth quarter comeback,’ Congressional Democrats would soon join with Republicans to repeal the law over a presidential veto.”

“Of course, Republicans have been urging other Republicans to come up with a common-sense, patient-centric health-care plan since the health-care debate began six years ago. They have remained stuck in the same unsolvable problem: Their actual health-care policy ideas are either all less popular than the specific policies in Obamacare, unworkable, or both.”

Will Mergers Scuttle Benefits of Health Care Reform?

“The 2010 healthcare reform law was supposed to promote competition among insurers, and for many policyholders it’s done just that. These days, though, the insurance industry is going through a wave of mergers that threatens to leave consumers with fewer choices,” the Los Angeles Times reports.

“There’s no single motivation behind the mergers, although they all reflect the changing economics of healthcare. In some, the buyers are seeking bigger stakes in privately run Medicaid and Medicare plans, whose ranks are burgeoning because the 2010 law extended Medicaid to more low-income Americans and because the baby boom generation has reached retirement age.”

“The Affordable Care Act encourages insurers to scale up in part by requiring 80% to 85% of the premiums they collect to be spent on patient care, limiting profit margins. As a consequence, the quickest way for some insurers to increase profits is to buy another insurer’s customers and spread costs over a wider base. Having a bigger share of the market also helps them negotiate lower rates with doctor groups and hospital chains; hospitals have been consolidating for the same reasons. This race to consolidate among providers and insurers has been developing for years, but the 2010 law kicked it into a higher gear by offering higher payments for better coordinated care.”

Americans’ Positive Views on Obamacare at a New High

Gallup: “Shortly after the Supreme Court in late June turned back a second legal challenge to the 2010 Affordable Care Act, Americans’ approval of the law rose to 47%, the highest level since 2012. Still, Americans are as likely to disapprove as to approve of the law.”

Do you generally approve or disapprove of the 2010 Affordable Care Act, signed into law by President Obama that restructured the U.S. healthcare system?

“Americans’ views of the ACA have improved in recent months, but because they were more negative about it previously, now they are merely divided in their assessments of it. The Supreme Court’s decision may have helped boost Americans’ views of the law, giving it further legitimacy.”

“Additionally, changes in Americans’ party affiliation since last fall could be a factor in the public’s more upbeat assessment of the ACA. Americans also view Obama more positively now than they did last fall, and given his close association with the law, more positive opinions of him may translate to more positive opinions about Obamacare.”

The Next Set of Obamacare Threats

Pew Trusts: “With its ruling in King v. Burwell last month, the U.S. Supreme Court likely settled the question of whether President Barack Obama’s signature Affordable Care Act will survive. Whether and when the health law will be fully implemented in all 50 states is a different question.”

“’With the King decision behind us, the drumbeats for Medicaid expansion are increasing,’ said Matt Salo, executive director of the National Association of Medicaid Directors. ‘There is movement in every state. They’ll get there. Maybe not today and maybe not this year, but they’ll get there soon.’”

“That’s the hope of health care industry groups and legions of consumer advocates. Major business organizations and local and county governments are also onboard. Following the high court’s decision, President Obama vowed to do all he can to persuade states to opt in before he leaves office in 18 months.”

“But in the mostly Southern and Midwestern states that have rejected expansion, opposition shows little sign of abating.”

It’s July. Where’s the Obamacare Repeal?

Politico: “July was supposed to be the big month for Obamacare repeal in Congress. But Senate Republicans are downplaying expectations that they’ll use a powerful budget tool called reconciliation to undo Obamacare through a simple majority vote this summer — and conservatives are none too pleased.”

“But Senate Republicans are downplaying expectations that they’ll use a powerful budget tool called reconciliation to undo Obamacare through a simple majority vote this summer — and conservatives are none too pleased.”

“Delays might not sit well with House conservatives, who have voted to dismantle Obamacare dozens of times and were eager for the Senate, under Republican control for the first time in Barack Obama’s presidency, to do the same.”

“If the Supreme Court had eliminated federal subsidies under Obamacare in two-thirds of the states, the GOP would have moved quickly to use reconciliation to deal with the fallout.”

“But timing is only a sliver of the issue. The caucus is split into several camps on how to approach reconciliation.”

Uninsured Rate Falls to Record Low Level

Gallup: “The uninsured rate among U.S. adults aged 18 and older was 11.4% in the second quarter of 2015, down from 11.9% in the first quarter. The uninsured rate has dropped nearly six percentage points since the fourth quarter of 2013, just before the requirement for Americans to carry health insurance took effect. The latest quarterly uninsured rate is the lowest Gallup and Healthways have recorded since daily tracking of this metric began in 2008.”

Percentage Uninsured in U.S. by Quarter



What’s Next in the Obamacare Battle?

Drew Altman: “The Supreme Court’s ruling in King v. Burwell defused a political and policy crisis over the Affordable Care Act, but how long any cooling-off period lasts, or whether one exists at all, could affect efforts to address remaining implementation challenges.”

“Political attacks can take a toll on the law and sour the policy environment. Consider a shift that occurred during the Republican presidential primaries in 2011. The gap between favorable and unfavorable opinion on the law was dead even that April. In October, after GOP candidates had railed against the law for months on the campaign trail and in televised debates, the gap had widened to 51% against the ACA and 34% for it.”

Dylan Scott in the National Journal: “Congressional Republicans are not going to leave the law alone. They will keep trying to chip away at it and pick off unpopular or controversial pieces of the Affordable Care Act. For the White House, that means at some point it will have to decide whether its renewed swagger means it can reject anything and everything the GOP comes up with, whatever the circumstances.”

“Coming off their legal triumph, Obama and top administration officials are saying all the right things: We’re willing to consider changes—if they make sense to us.”

Alan Fram in the Associated Press: Republicans could “try sending Obama veto-bait legislation designed to show voters how they’d reshape the nation’s health care system — if only Republicans could agree on what to do.”

Healthcare Costs Not Predicted to Skyrocket

The Hill: “Out-of-pocket healthcare costs have increased modestly over the last year, according to a new study – a sign that prices are not skyrocketing under ObamaCare as some critics had predicted. “

“The total amount of money that a patient spent per visit increased 3.5 percent over the last year, according to data from a study published Health Affairs on Tuesday. That amounts to about $1 per visit, including copayments and deductibles.”

“The study, completed by the Robert Johnson Wood Foundation, included data from about 15,000 physicians.”

“Kathy Hempstead, who directs coverage issues at the Robert Wood Johnson Foundation, described it as a ‘moderate increase.’ It is likely a result of the focus on preventative care under the healthcare law and of the insurers’ strategy to encourage primary care over more costly specialty care, according to the study.”

Vaccine Panic Largely Among Rich, White Americans

Washington Post: “New data from a Pew Research Center poll examining American attitudes about a range of scientific issues suggests that the way that white, black and Latino adults think about vaccines is helping to drive another pretty complex but important health trend.”

“Parents who delay or avoid vaccines are largely, but certainly not exclusively, white, well-educated and well-to-do or outright rich.”

“The Pew data released Wednesday reveals some differences in the way that white parents think about vaccine safety compared to black and Latino ones — but not the type you would expect. White parents were far more likely to describe vaccines as safe but ranked behind Latino parents and just above the share of black moms and dads when it comes to whether the government should mandate vaccines.”

Pew Research Center June 30, 2015

Obama is the Health-Care Industry President

Philip Bump: “In the past three months, the health-care industry has added 135,000 jobs … Over the 78 months of Obama’s presidency, the industry has lost jobs in only three — all between May and December 2013. Otherwise: Up, up, up.”

“When we analyzed industries last December, with the November jobs data, you could see that the percentage growth in health care tracked pretty steadily with overall employment. Oil and gas, with far fewer employees, had grown much faster since the depths of the recession, thanks to the oil boom in North Dakota, Texas and Oklahoma.”

“So what’s Obama’s legacy? … If the percentage of oil and gas jobs slips, health care will become the bigger growth industry by both metrics.”

“Obama’s legacy was secured in part by the Supreme Court decision to uphold Obamacare last week. With these numbers, we might as well go ahead and call him the health-care industry president.”

Could California’s New Vaccine Law Be a Model for Other States?

Katie Palmer in Wired writes that California’s new vaccine mandate “is a prime opportunity to carefully study the effects of legislation like this on both vaccination and disease rates.”

“Just take a look at the vaccination rates in other states, compared to where they stand on the two types of exemptions: religious and personal belief. The top-vaccinated state in the nation, Mississippi, is one of the only two states that doesn’t allow either exemption. Hey! Look at that! A correlation! But traveling down the list, the connection between exemption status and vaccination rate gets a little murkier. West Virginia, the other no-exemption state, doesn’t appear in the list of the top-ten vaccination rates (it’s number 18), and three states that allow both types of exemptions appear in the top-ten list.”


“If you look broadly at these figures, though, it does seem like states with more exemptions are more likely to have low vaccination rates. Now is the time to test that hypothesis. California is at a historical inflection point. If public health researchers and politicians can look carefully at the state of the state’s vaccination rates and disease numbers before and after SB277 is enacted, they’ll get a powerful tool to either support more bans of these exemptions—several of which are on the table in other states right now—or drive the United States toward different, perhaps more effective strategies to reduce vaccine-preventable disease. Let’s see what comes out of the lab.”