The GOP’s Obamacare Repeal Conundrum: Then What?

National Journal: “Every Republican 2016 presidential hopeful is going to start their health care policy platform with repealing the Affordable Care Act. It is a central tenet of the faith.”

“But what then? … There has been no vigorous debate that shapes a white paper into real policy.”

There are three schools of thoughts within the GOP on health care: “One wants to effectively revert to a pre-Obamacare world. Another acknowledges the new reality that Obamacare has created and encourages conservatives to consider what’s politically viable in that world. The third would say that Republicans should yield the coverage side of health care reform to liberals and work on the best free-market alternative they can muster without measuring it against the ACA.”

“Tax treatment of health insurance … is a big one, because employer-based health insurance covers almost half of the U.S. population, and a big reason for that is employer contributions are excluded from taxes. You start messing with that, and you risk a lot of people getting worried that they’re going to lose a plan they like. (Sound familiar?)”

“Repealing Obamacare means scrapping its Medicaid expansion and tax subsidies, both of which have helped millions of poorer Americans purchase private insurance. Which leaves the question of how you provide some kind of safety net for that population, which has historically been less likely to be insured and most at risk of medical bankruptcy.”

Health Care Reform Promises the Unexpected This Tax Season

With the Affordable Care Act’s individual mandate entering into force this year, National Journal looks at a number of possible scenarios of how tax season might play out.

“Almost 7 million people picked plans through the exchanges and were eligible for subsidies last year. Half of them will end up owing the government money… The reason for this is because income—which is tied to the size of subsidies—can be very difficult to predict ahead of time. Most people elect to receive these subsidies in advance, when they enroll in health coverage, forcing them to predict what they’ll make. If this prediction is off (as it often is), they’ll have to reconcile it with what they actually made when they file their taxes.”

“Another 45 percent of people enrolled on an exchange and receiving subsidies will have a more pleasant tax-season experience: They’ll get money from the government. These people overestimated their income and have been paying more than the government says they should for their health insurance.”

“There’s a smorgasbord of possibilities, a mix-and-match of expectations, subsidies, penalties, and reporting requirements. Some people will both get some money back and pay a fine… But for all the potential complexity, for three-quarters of taxpayers, filling out their tax forms will require very little headache, as long as they are insured. These people will only have to check a box saying they have health coverage.”

Obamacare’s Prophets of Disaster

Pual Krugman: Representative Pete Sessions of Texas “recently set a new standard when he declared the cost of Obamacare ‘unconscionable.’ If you do “simple multiplication,” he insisted, you find that the coverage expansion is costing $5 million per recipient. But his calculation was a bit off — namely, by a factor of more than a thousand. The actual cost per newly insured American is about $4,000.”

“Whatever your overall view of the Affordable Care Act, one indisputable fact is that it’s costing taxpayers much less than expected — about 20 percent less, according to the Congressional Budget Office. A senior member of Congress should know that, and he certainly has no business making speeches about an issue if he won’t bother to read budget office reports.”

Krugman asserts that this is “how it’s been all along with Obamacare,” with “the prophets of disaster … pretending that the bad things they said would happen have, in fact, happened.”

“In short, when it comes to the facts, the attack on health reform has come up empty-handed. But the public doesn’t know that. The good news about costs hasn’t made it through at all: According to a recent poll by, only 5 percent of Americans know that Obamacare is costing less than predicted, while 42 percent think the government is spending more than expected.”

Beshear Offers Kentucky as Obamacare Model for Red States

Kentucky Gov. Steve Beshear (D) “is touting his state as an example of making ObamaCare work in a Republican stronghold,” The Hill reports.

“The state has drawn national attention for setting up its own ObamaCare marketplace and expanding Medicaid under the law.”

Said Beshear: “Let me be clear: We welcome the attention, because we know we have boldly seized the opportunity to change the course of history in our state… Look, I’m well aware of the so-called ‘politics’ of the ACA. President Obama didn’t get a lot of votes in Kentucky. We’re represented in the Senate by two high-profile Republicans who have no love for either the president or his signature program. But there’s a huge disconnect between the rank partisanship of national politics and governors whose job it is to help beleaguered families, strengthen work forces, attract companies and build a balanced budget.”

The Sugar Industry’s Fingers in the Government Candy Jar

Washington Post: “Decades-old documents have surfaced showing that the powerful U.S. sugar industry skewed the government’s medical research on dental care—and ultimately what officials recommended for American diets.”

“Sugar industry leaders advocated for policies that did not recommend people eat less sugar, according to an archive of industry letters dating back to the 1950s … And the government listened, according to a new report published in the journal PLOS Medicine.”

“How did the industry wield so much power?”

“For one, the sugar industry had a strong presence in the subcommittee that developed the very research priorities that later guided dental care policies. A task force committee that was set up by the government to set research priorities for [its National Caries Program] included many doctors and scientists who were also working closely with the sugar industry. These committee members were also part of another group called the International Sugar Research Foundation, which was established by the sugar industry.”

“It’s no surprise then that the research plan laid out by the government ended up looking eerily similar to what the sugar industry had proposed.”

“These days, the sugar industry might not wield the same level of power it did when these documents were written, but it still spends a lot of money to get its way.”

Why Congress Won’t Unite Behind an Obamacare Alternative

National Review: “With Obamacare at the center of the policy battles in Washington, Republicans in Washington aren’t sure they want to force legislation written in the halls of Congress on the party’s presidential nominee. Ryan, now the chairman of the House Ways and Means Committee, is working on a replacement plan that might unite House Republicans. But on the Senate side, there is more hesitancy to coalesce around a single Obamacare alternative. Some senior senators prefer to wait for a presidential nominee to propose a replacement plan, and so the upper chamber is hanging back.”

“Various Senate Republicans have health-care-reform ideas, but majority leader Mitch McConnell (R., Ky.) hasn’t put his imprimatur on any particular attempt to ‘conceive an alternative’ to Obamacare, according to one Senate aide. ‘McConnell’s big, big contribution to the entire thing has been keeping Republicans united against Obamacare,’ the GOP aide says.”

“In the absence of congressional consensus, the debate is moving to the presidential stage. Former governor Jeb Bush (R., Fla.), for instance, proposed replacing the ‘monstrosity’ of Obamacare with a plan that would provide people with catastrophic coverage.”

Evidence of Extreme Inefficiencies in the Health Care Industry

Sarah Kliff: “A lipid panel is one of the most basic blood tests in modern medicine … And that all makes it a bit baffling why, in California, a lipid panel can cost anywhere between $10 and $10,000. In either case, it is the exact same test.”

“For this research, published in August in the British Medical Journal, [researchers] compiled reams of data about how much more than 100 hospitals charged for basic blood work. The prices these facilities charged consumers were all over the map.”

“The charge for a lipid panel ranged from $10 to $10,169. Hospital prices for a basic metabolic panel (which doctors use to measure the body’s metabolism) were $35 at one facility — and $7,303 at another.”

“For every blood test that the researchers looked at, they found pretty giant variation:”

blood tests

What does this tell us about American health care? “For one, there’s not much price transparency: it’s really hard to know whether one hospital is charging $10 or $10,169 because prices are rarely listed.”


Which States Will Be Hardest Hit if SCOTUS Guts Subsidies?

Wall Street Journal: “Florida, North Carolina and Texas would be among the states hardest hit if their health-insurance subsidies are struck down by the Supreme Court. Those states had the highest number of consumers who were eligible for tax credits when selecting a plan on the federal website, government data show.”

“Affordable Care Act enrollment figures released Tuesday give the most up-to-date snapshot of which states would bear the brunt of any loss of subsidies.”

“In Florida, about 1.6 million people who picked a plan on the federal site were eligible for financial assistance, according to the new report. In Texas, more than one million were eligible; in North Carolina, more than 550,000; and in Pennsylvania, more than 430,000.”

7.7 Million Will Qualify for Obamacare Subsidies

The Hill: “Nearly nine in 10 people who signed up for healthcare from the federal government this year qualify for subsidies, the Obama administration announced Tuesday.”

“A total of 7.7 million people would receive subsidies this year in the roughly three-dozen states using – a figure that has held steady since ObamaCare’s first year.”

“The Obama administration touted the figure Tuesday to show that the vast majority of people in states using the federal exchange rely on subsidies as the Supreme Court weighs a case that could eliminate them.”

“‘These numbers show just how important the tax credits are to millions of Americans and to the insurance markets in those states,’ said Health and Human Services Secretary Sylvia Mathews Burwell, pointing to states like Texas, Florida and North Carolina.”

A Growing Fear of a Massive Healthcare Meltdown

The Hill: “Republicans are under pressure to prove they can avert a massive healthcare meltdown if the party wins its latest ObamaCare battle in the Supreme Court this spring.”

“While top Republicans in the House and Senate said this week that they are nearing a consensus on their efforts to create a back-up plan for the subsidies, almost no details have been shared about the half-dozen plans unveiled in the last two weeks. Most of the proposals are drawing criticism from their fellow conservatives behind the scenes.”

“’It’s a couple lines in an op-ed. Who knows what it really means? In some of those, they may not know, frankly,’ said one conservative strategist and former Hill healthcare staffer.

“Creating even a temporary solution for ObamaCare subsidies is a huge dilemma for the GOP-controlled Congress. Some Republicans have even said, albeit quietly, that the party could be better off if the administration’s policy survives the Supreme Court challenge.”

“’Then we won’t be put into a really difficult spot and can move on. There is something really appealing about that,’ one GOP Senate aide said.”

An Increase in Vaccine Skeptics?

Gallup: “A slight majority of Americans, 54%, say it is extremely important that parents get their children vaccinated, down from the 64% who held this belief 14 years ago. Another 30% call it ‘very important’ — unchanged from 2001. The rest, 15%, consider it “‘omewhat,’ ‘not very’ or ‘not at all important,’ up from 2001.”

Trend: How important is it that parents get their children vaccinated -- extremely important, very important, somewhat important, not very important, or not at all important?

“The discussion of vaccine disadvantages may be having some effect, as the percentage who say vaccines are extremely important is down slightly. Additionally, a small segment of the population remains skeptical about the benefits or safety of vaccines — including 9% who say vaccines are more harmful than the diseases they are designed to protect, and 6% who say certain vaccines can cause autism.”

In a related story, the Seattle Times reports that “new research from Washington State University finds that scare tactics aimed at vaccine skeptics may actually make the problem worse, not better.”

“Emotional appeals about the health risks of skipping shots and heart-tugging photos of unvaccinated kids sick with measles or whooping cough appear to backfire among those most suspicious of medical experts.”

Obamacare Enrollment Nearing 12 Million

Huffington Post: “Close to 12 million people are covered by health insurance plans purchased from an Obamacare exchange, Health and Human Services Secretary Sylvia Mathews Burwell said at the White House Monday. More than half of these enrollees are new to the program.”

“The enrollment total surpasses the Department of Health and Human Services’ projections, but is lower than what the Congressional Budget Office expected.”

“‘Nearly 11.7 million Americans signed up or were re-enrolled through the marketplace as of Feb. 22,’ Burwell said. ‘We are finally moving the needle on reducing the number of uninsured.'”