Republicans Search for a New Case Against Obamacare

The Hill: “Republicans are shifting their line of attack on ObamaCare, abandoning assertions that few people are taking advantage of the law for new arguments that enrollees are getting stuck with low-quality insurance plans.”

“Speaking on the Senate floor last week, Wyoming Sen. John Barrasso did not mention the number of people who have signed up; he instead focused on the caliber of the coverage, saying, ‘there is a difference between coverage and care. He pointed to narrow provider networks under ObamaCare plans as limiting people’s access to care.”

“Republicans have also pointed to a survey released this week showing that most emergency room doctors have seen an increase in patients, despite the law’s intention to reduce the need for people to rely on emergency rooms for care.”

“As for private insurance under the law, a Commonwealth Fund study released Tuesday notes that about half of plans offered through ACA marketplaces had narrow networks that limit choices of doctors. While the study notes that this type of plan also existed before ObamaCare, it says the law could be encouraging private insurers to keep costs down. “

EPA Clean Power Plan Could Save Thousands of Lives

New York Times: “New carbon emissions standards that were proposed last year for coal-fired power plants in the United States would substantially improve human health and prevent more than 3,000 premature deaths per year, according to a new … study, led by researchers at Syracuse and Harvard Universities.”

“The researchers calculated three different outcomes using data from the Census Bureau and detailed maps of the more than 2,400 fossil-fuel power plants across the country.”

“The model with the biggest health benefit was the one that most closely resembled the changes that the Environmental Protection Agency proposed in a rule in June.”

“Researchers calculated that the changes in the E.P.A. rule could prevent 3,500 premature deaths a year and more than 1,000 heart attacks and hospitalizations from air-pollution-related illness.”

“The largest declines in pollution — and consequent benefits to health — would happen in states in the Ohio River Valley, including Pennsylvania and Ohio, which have some of the highest levels of emissions, researchers said.”

Medicaid Enrollment Nears 12 Million

The Hill: “More than 11.7 million more people have health insurance through Medicaid or the Children’s Health Insurance through ObamaCare, new data show.”

“The new report from the Obama administration shows that as of the end of February, there were over 11.7 million more people enrolled in the programs compared to the period before October 2013, when ObamaCare’s coverage expansion went into effect.”

“The numbers come on top of another 11.7 million people who signed up for private insurance through the law’s marketplaces.”

A Split in Priorities for Republicans and Democrats

Wall Street Journal:  “Members of the two political parties are split over which issues are most important for the government to address, with Republicans giving much higher priority to national security issues than do Democrats, a new Wall Street Journal/NBC News poll finds.”

“Asked which issues should be the federal government’s top priorities, Republican primary voters’ top three issues were national security, the deficit and the issue of job creation and economic growth. Democratic primary voters, by contrast, named jobs first, followed by health care and climate change.”

“In the new survey, some 27% of Republican primary voters named national security and terrorism as the government’s highest priority, compared with only 13% of Democratic primary voters who picked that as the top priority.”

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Obamacare Boosts Medicare Savings With New Program

The Hill: “A pilot program created under ObamaCare to change Medicare’s payment system saved almost $400 million and will be expanded, the administration announced Monday.”

“An independent report released by the Department of Health and Human Services on Monday finds that the pilot program saved Medicare more than $384 million across 2012 and 2013.”

“Under the program, groups of doctors agree to accept lump payments under Medicare instead of individual payments for each service they provide, as in the traditional Medicare payment system.”

“’The Affordable Care Act gave us powerful new tools to test better ways to improve patient care and keep communities healthier,’ HHS Secretary Sylvia Mathews Burwell said in a statement.”

Emergency Room Visits Continue to Climb

Wall Street Journal: “Emergency-room visits continued to climb in the second year of the Affordable Care Act, contradicting the law’s supporters who had predicted a decline in traffic as more people gained access to doctors and other health-care providers.”

“A survey of 2,098 emergency-room doctors conducted in March showed about three-quarters said visits had risen since January 2014. That was a significant uptick from a year earlier, when less than half of doctors surveyed reported an increase. The survey by the American College of Emergency Physicians is scheduled to be published Monday.”

“Medicaid recipients newly insured under the health law are struggling to get appointments or find doctors who will accept their coverage, and consequently wind up in the ER, ACEP said. Volume might also be increasing due to hospital and emergency-department closures—a long-standing trend.”

“More than 40% of emergency physicians said they expect emergency-room visits to increase if the Supreme Court rules that subsidies provided to people who obtain insurance on the federal exchange are invalid. The court is expected to rule by late June.”


How Are Hospitals Faring Under Obamacare? Pretty Good

The Hill: “Medicaid expansion under ObamaCare is giving a lift to hospitals’ finances, a new study from the nonprofit Kaiser Family Foundation finds.”

“The study finds hospitals’ charity care costs fell by 40 percent in states that expanded Medicaid, compared to just 6 percent in states that did not. As more people gained coverage through Medicaid, the need for charity care fell.”

Kaiser Family Foundation’s study examined the the early experiences with the ACA by Ascension Health, the delivery subsidiary of the nation’s largest not-for-profit health system.

Figure ES-1: Change in Ascension Health Hospital Discharges and Revenue by Payer, 2013-2014


KFF: “Ascension hospitals in expansion states saw an increase (8.2 percent) in Medicaid revenue from 2013 to 2014 and a 63.2 percent decrease in revenue from self-pay. Hospitals in non-expansion states actually saw a 9.4 percent decline in Medicaid revenue over the same period and a slight increase (2.6 percent) in revenue from self-pay. Growth in Medicaid revenue from outpatient care outpaced increases in inpatient revenue in expansion states, suggesting that these hospitals experienced greater increases in demand for outpatient care from new Medicaid patients compared to inpatient care.”



Conservatives Cling to Obamacare Repeal Options

Politico: “Conservatives are adamant that reconciliation … be used to pass a repeal of the health care law. They believed GOP leaders were on board.”

“But as House and Senate lawmakers have met to hash out a compromise budget over the past few weeks, conservatives noted that House Republican leaders have been talking about leaving their options open.”

“House Republicans have already voted more than 50 times to try to defund, alter or overturn the health care law that conservatives despise. The latest effort, if it happens, would no doubt fail, too — and there are some indications that GOP leaders are ready to move on. But getting a bill to President Barack Obama’s desk and forcing him to veto it would send a powerful symbolic message to the Republican base that House conservatives haven’t given up on scuttling the law.”

“Bill Flores (R-Texas) and Sen. Mike Lee (R-Utah) released a joint statement last week urging budget conferees to focus on repeal. They’re considering a ‘Dear Colleagues”’letter to fellow Republicans to press their case.”

“’Though there are many important reforms to be addressed by Congress, reconciliation is a tool that works best when it is focused and precise,’ the statement read. Both lawmakers ‘support using narrow reconciliation language which is focused on the full repeal of Obamacare.’”

A Republican Zombie Apocalypse of 2016?

Paul Krugman argues that among Republican presidential contenders, there is a “deep attachment to long-refuted ideas … Whoever finally gets the nomination for 2016 will have multiple zombies as his running mates.”

“Consider, for example, the zombification of the debate over health reform. Before the Affordable Care Act went fully into effect, conservatives made a series of dire predictions about what would happen when it did.

“In reality, the act has produced a dramatic drop in the number of uninsured adults; premiums have grown much more slowly than in the years before reform; the law’s cost is coming in well below projections; and 2014, the first year of full implementation, also had the best job growth since 1999.”

“So why has the Republican Party experienced a zombie apocalypse? One reason, surely, is the fact that most Republican politicians represent states or districts that will never, ever vote for a Democrat, so the only thing they fear is a challenge from the far right. Another is the need to tell Big Money what it wants to hear: a candidate saying anything realistic about Obamacare or tax cuts won’t survive the Sheldon Adelson/Koch brothers primary.”

“Whatever the reasons, the result is clear. Pundits will try to pretend that we’re having a serious policy debate, but, as far as issues go, 2016 is already set up to be the election of the living dead.”

Those Who See Obamacare as a Success Are Growing

Sarah Kliff in Vox comments on the latest poll from YouGov: “They do seem to indicate Americans warming up to Obamacare when you ask the question a slightly different way. Instead of asking whether Americans approve or disapprove of the health law, the YouGov poll asks if people think the law has been ‘more of a success’ or ‘more of a failure.’ And the results show that, over the past two years, more people consider the law a success:”

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“The same trend shows up on a different question, about whether the health care law ought to be repealed — or expanded or kept the same. Opinion in favor of expanding the law or leaving it as is keeps edging upwards, and has actually now become a more popular option than repealing the law.”

“Who’s changing their minds? YouGov polling finds that it’s not Republicans becoming more positive, but rather Democrats who didn’t like the law at first starting to warm up to it.”

A Big Jump in Obamacare Customer Satisfaction

The Hill: “People who bought coverage through ObamaCare are generally more satisfied than those with other types of insurance, according to a new national survey.”

“ObamaCare customers rated their satisfaction over the last year as 696 out of 1,000, compared to the 679-point rating by customers with employer-based plans, according to a large survey by the consumer research firm J.D. Power. Customer satisfaction has increased sharply from ObamaCare’s tumultuous first year.”

“New enrollees rated their experience at  670 — a significant 55 points higher than the previous year, when ObamaCare exchanges were plagued by website failures … Satisfaction was highest in the 10 states that rely on a partnership with the federal government, which includes Arkansas, Oregon and West Virginia. That rating was 716 out of 1,000.”