What Brookings Experts Are Saying About Obamacare Repeal/Replace

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…”

How Mike Pence Used Obamacare to Halt Indiana’s HIV Outbreak

“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.”

What Worked With Obamacare? Lessons From 5 States

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.”

Grading Obamacare: Successes, Failures and ‘Incompletes’

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.”

A Republican Plan for Medicare Gets a Revival

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.”


The Case for Replacing Obamacare Incrementally

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.”

Blame Technology, Not Longer Life Spans, for Health Spending Increases

“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.”

An ObamaCare Compromise That Republicans and Democrats Can Both Love

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.”