Republicans’ Twist on an Obamacare Solution

Greg Sargent asks, in light of recent comments by Senate Majority Leader Mitch McConnell, “how can Republicans simultaneously argue that the American people must be ‘protected’ from the damage that undoing Obamacare will do — from the damage that will ensue from a Court decision unraveling subsidies that are crucial to the law’s basic functioning — without implicitly conceding that the right response is to reverse the immediate impact of the decision, and cleanly restore the subsidies?”

“Republicans will argue that the post-King chaos is the fault of the law itself, and not the fault of the Court decision (which Republicans urged on) that is knocking out a key pillar of it. In this telling, the cause of all the damage will be that Obamacare held out the false promise of economic security for millions, in the form of expanded coverage, but that security was then snatched out from under all those people (thanks to Obummer’s incompetence) when the Court clarified what the law actually says. All this is only the latest way in which Obamacare is hurting countless Americans.”

“That’s pretty damn slick. But it doesn’t answer the question of what Republicans will do in response.”

San Francisco Moves to Add Warning Labels on Sugary Drinks

Wall Street Journal: “Likening the fight against soda to the old public-policy wars over tobacco, San Francisco city officials unanimously voted Tuesday on a package of ordinances that would make it the first in the U.S. to require health warnings on ads for sugary drinks.”

“Before it can be enacted, the proposal first has to pass another vote before the San Francisco Board of Supervisors next week, and then goes before the mayor.”

“Advocates hope the passage will spark similar legislation in cities and states across the country.”

“The proposal, believed to be the first of its kind in the U.S., is part of a package of ordinances meant to curb the consumption of sugary drinks—including some juices, some flavored milks and sports drinks with added sugar—in the city, which sponsors say play a large role in health problems.”

“Billboards or other advertisements for sugary beverages would include this language: ‘WARNING: Drinking beverages with added sugar(s) contributes to obesity, diabetes, and tooth decay. This is a message from the City and County of San Francisco.’”

Obamacare Contingency Plans Are Few and Far Between

L.A. Times: “Millions of Americans could soon lose health insurance when the Supreme Court decides the latest challenge to the Affordable Care Act this month, but states have made few concrete plans to deal with the potential fallout, and they may get little help from Washington, President Obama warned Monday.”

“Just two states whose residents are in jeopardy — Pennsylvania and Delaware — have outlined strategies for preserving subsidies, however.”


Obamacare in the crosshairs

“Oregon, Nevada and New Mexico have officially established their own marketplace, but use the federal website to allow consumers to purchase health plans. That approach could shield their residents, depending on how a court ruling is written.”

“But replicating that arrangement may require states to collect fees from insurance companies and to pay the federal government for using Those steps will probably require approval from GOP-controlled legislatures in most states, a huge political barrier. The process would also take time.”

Health Spending Growth Rate Expected to Slow for 2016

The Hill: “The growth in private sector U.S. healthcare spending is expected to slow next year, but continues to rise at a rate above the rest of the economy, according to a new report.”

“The report from PricewaterhouseCoopers projects that private sector healthcare spending will grow by 6.5 percent in 2016. That is a slight reduction from the 6.8 percent growth that was projected for this year, and down from around 10 percent in 2008.”

“Still, healthcare costs continue to grow faster than the rest of the economy, raising concerns about the future. Health spending is currently at 17.4 percent of the economy. ”


Republicans Face a Growing Predicament on Obamacare

Jonathan Chait argues that if the King v. Burwell lawsuit succeeds, “the Republicans in Congress will find themselves in the same position as when they shut down the government. They will be demanding policy concessions in return for doing something they agree has to happen. Holding out for concessions in those circumstances is very hard. The pressure inevitably grows for the House leadership to bring a Democratic bill to the floor and let it pass with a handful of Republican votes.”

“Alternatively, Congress could remain gridlocked, and leave it to each state to fix the problem by establishing its own exchange, assuming such a course is technically possible. But that would simply replicate at the state level the same dilemma Republicans can’t navigate at the national level: How can Republican elected officials navigate between a public that does not want to throw innocent people off the life-saving care they get through Obamacare, and an activist base demanding they do exactly that?”

More Evidence Obamacare is Working

U.S. News & World Report: Sorry to break it to you, but President Barack Obama’s health care law seems to be working.

“Some efficiency measures … appear to be working. In the June 2015 issue of Health Affairs, researchers looked at the Hospital Readmissions Reduction Program. The program allowed the Centers for Medicare and Medicaid Services to penalize hospitals with high rates for patients being readmitted within 30 days of treatment of certain conditions. Historically, there hasn’t been much financial motivation for U.S. hospitals to decrease readmission rates … A lack of data transparency on readmission rates and patient outcomes also meant hospitals could largely keep these numbers to themselves.”

A graphic showing the decline in the 30-day readmission rates for Medicare patients in New York.

“Not anymore. Under the program, CMS will eventually be able to charge a penalty of 3 percent of the hospital’s total Medicare reimbursement. The program started at 1 percent in October 2012.  The researchers looked at the readmission rates for patients at New York hospitals in 2008, before the law went into effect, and in 2012. They found a reduction in readmission rates and some evidence that the benefits were spilling over for non-Medicare patients as well.”

States Look for Alternative Obamacare Rescue Plans

The Hill: “It may be easier than expected for states to save their ObamaCare subsidies, if the Supreme Court rules against the law this month.”

“Two states — Pennsylvania and Delaware — said this week they would launch their own exchanges, if needed, to keep millions of healthcare dollars flowing after the decision. Both want to use existing pieces of the federal health insurance exchange, like its website and call center — a path that would be far less costly than the way most other states have created their exchanges.”

“If those plans win approval, many of the other 36 states that stand to lose their subsidies could then pursue a similarly simple strategy.”

“But that would spell trouble for Republicans who view the King v. Burwell case as their best chance yet to dismantle President Obama’s healthcare law. GOP members of Congress have repeatedly said they must create a backup plan for states so that they are forced to make ObamaCare ‘fixes.’”

“While a state-based exchange is not defined in the Affordable Care Act, experts say the commonly understood definition has been blurred since the rollout of the law, as more states share technology.”

Public to SCOTUS: Don’t Demolish Obamacare

Washington Post: “The Affordable Care Act hangs in the balance in the Supreme Court for the second time in three years, but the public has rendered a judgment ahead of the court’s ruling. By a margin of 55 percent to 38 percent, more people say the court should not take action to block federal subsidies in states that didn’t set up their own exchanges, according to a new Washington Post-ABC News poll.

“Public opinion on providing subsidies splits in predictably partisan ways — but not overwhelmingly so. Nearly two-thirds of Democrats (65 percent) say the court should not take action to block health insurance subsidies. Fifty-five percent of Republicans say the court should rule against the subsidies. Independents side with keeping subsidies, 57 percent to 36 percent.”

“The disconnect in the new poll — that a majority opposes the law, while a nearly equal majority does not want the Supreme Court to rule against it — is driven by political independents as well as Republicans. Independents oppose the law 56 percent to 35 percent. But they also want a ruling in favor of subsidies by almost exactly the same margin.”

Is Radical Innovation the Key to Lowering Health Care Costs?

“Though introducing more consumer choices and competition among health care suppliers certainly affects health care prices,” writes Veronique de Rugy, “nothing would have as radical an impact on prices and quality in the health care industry as revolutionary innovation.”

“For that, we must first free the health care supply from the many constraints imposed by federal and state governments and the special interests they serve. At the federal level, that means, among other things, radically reforming the Food and Drug Administration… Others suggest getting rid of federal and state regulations that prevent people from having access to more and better information about drugs, medical devices and procedures; forbid them to try new, unapproved drugs when they or their loved ones are terminally ill; and preclude doctors from offering new treatments to their patients.”

“Indeed, people often are better-suited to know what is best for them than bureaucrats in Washington. Moreover, these reforms would be important first steps to allow tech innovators to work their magic in health care. This would result in spectacular reductions of health care costs — making the need for health insurance much less important than it is now. “

Pennsylvania Governor Eyes Launching State Exchange

Pennsylvania Governor Tom Wolf (D) “formally proposed setting up a state-based insurance marketplace, potentially protecting hundreds of thousands of Pennsylvania residents from the consequences of a Supreme Court decision that could gut Obamacare later this month,” Kaiser Healh News reports.

“A ruling against the Affordable Care Act could end insurance subsidies for millions of people who live in the 37 states – including Pennsylvania, New Jersey, and Delaware – that rely on the federal marketplace. The 13 that set up state marketplaces two years ago would not be affected. Pennsylvania is one of two states to apply to set up an exchange.”

“It is unclear whether the Republican-dominated General Assembly would have to approve Wolf’s proposal, although it does control funding. Neither the administration nor Republicans in the legislature indicated any urgency in moving forward until the Supreme Court rules.”

Who Wins if SCOTUS Obamacare Case is Struck Down?

National Journal: “What if Obamacare’s conservative challengers lose King v. Burwell?

“If that question seems less sexy in a policy sense, that’s because it is. Essentially, if the Court decides the federal government is on the right side of the law, nothing happens; business continues as usual in all 50 states’ Obamacare exchanges. People keep their insurance as is. But politically, an Obama administration win would mean volumes.”

“The decision would validate the White House’s faith in the president’s signature domestic accomplishment. And it would give Democrats the platform to say some variation of ‘I told you so’ after standing their ground over the past couple of months, refusing to engage in conversations asking how they would fix Obamacare because, as they keep repeating, the Court isn’t going to break it.”

“For Republicans, aside from the disappointment of losing their second Supreme Court challenge against the Affordable Care Act in three years, they would lose perhaps their only true bargaining chip—the health insurance of some 10 million people—against the White House to make any substantive changes to Obamacare this year.”

Healthcare Premiums Could Skyrocket if Obamacare Challenge Succeeds

Washington Post: “About 6.4 million Americans would lose health insurance subsidies if the Supreme Court rules in favor of an Obamacare challenge later this month, but the potential effect of a ruling varies dramatically by state.”

“Costs would rise in each of the 34 states affected by a potential ruling, with the largest spikes in Mississippi, Utah and Alaska, where the cost of the average monthly premium would rise by more than 500 percent, according to a new Kaiser Family Foundation analysis. Arizona would see the smallest hike, of 132 percent.”

Obamacare Rate Increases: It’s Too Soon to Make Predictions

Margot Sanger-Katz comments on the proposed insurance rate increases for 2015.

“Some of the rate increases are substantial. But for several reasons, simply looking at the current numbers can be misleading.”

“The rate proposals under review right now are just that: proposals. Last year, many big rate requests were later amended under pressure from regulators. Some of the increases that look hefty now may turn out to be more modest.”

“Because the federal government reviews only plans with requested increases of more than 10 percent, for many states that’s all that’s published on the federal website. That may lead some people to draw a distorted picture of what’s happening to insurance rates, since only the biggest increases are currently searchable.”

“The federal government is on the hook for subsidies linked to that particular second-cheapest ‘silver’ plan. That means that the taxpayer bill for Obamacare will go up only if those plans are getting more expensive. This year, they rose modestly, on average. It’s too soon to predict next year, since we don’t know all the prices yet. But, again, most premium increases won’t hit the government’s bottom line as long as two low-cost plans remain in each market.”

Republicans’ Obamacare Alternative: Just a Public Relations Stunt?

Jonathan Cohn argues that the Republicans aren’t serious about proposing a Republican alternative to Obamacare.

“The Ways and Means chairman, Rep. Paul Ryan (R-Wis.), has said repeatedly that his party will have a contingency plan ready to go if the court sides with the law’s challengers. He’s also vowed, again and again, to craft an Obamacare alternative that will achieve better results at lower costs. It’s the same set of promises that countless other Republican leaders have made, although Ryan would seem uniquely positioned to deliver on them.”

“But take a look at the official agenda for the Ways and Means Committee on Tuesday … Here’s what you won’t see: contingency plans for the upcoming Supreme Court ruling or alternative schemes for expanding insurance coverage.”

“The cynical explanation (offered most recently by Salon’s Simon Maloy) is that Republican leaders aren’t serious about crafting a plan — that all the vague promises of ‘off-ramps’ and ‘transitions’ away from Obamacare have been a public relations stunt, designed to make potential swing votes on the Supreme Court, particularly Chief Justice John Roberts, feel more comfortable about issuing a decision that could create so much chaos for the millions of Americans who can’t get health insurance without those federal tax credits.”