With the reconciliation tax bill headed towards passage, it looks like the individual mandate may be done for.
In the lead-up, I had heard conflicting reports of how the repeal of the individual mandate would affect the rest of Obamacare going forward – everything from “meh” to “instant death spiral.” A couple of resources to get a handle on where we are at:
- Julie Rovner’s “What the Health” podcast at Kaiser focused on mandate repeal this week.
- Sarah Kliff addressed the question in a recent article.
“Economists roundly expect premiums to rise if the individual mandate disappears, as healthier people exit the market, leaving behind a sicker, more expensive insurance pool. Some Americans may gladly exit the marketplace, happy to no longer pay insurance premiums. But there would also be those who exit unwillingly, people who want to buy coverage but cannot afford the rising cost of health insurance.”
Continue reading Health Policy Updates: December 16 2017
It has not been a good week for US health care.
This week the Senate passed “a health care bill disguised as a tax cut.” The result, argues Sarah Kliff, will be a sweeping change to many parts of the US health care system, starting with (per the CBO) 13 million Americans dropping health insurance coverage.
“First, the bill repeals the individual mandate, a key piece of Obamacare that requires most Americans get covered. Economists expect its elimination to reduce enrollment in both the Affordable Care Act’s private marketplaces and Medicaid by millions. The money saved will be pumped into tax cuts for the very wealthy. The bill also includes tax cuts so large that they would trigger across-the-board spending cuts — including billions for Medicare. The last time Medicare was hit with cuts like this, patients lost access to critical services like chemotherapy treatment.”
Continue reading Health Policy Updates: December 3, 2017
Just when you thought Obamacare repeal was over, it’s back – this time, as part of the GOP tax reform effort.
“The revised Senate tax bill will repeal the individual mandate, according to multiple reports. Repealing the mandate — which is the gear that makes the Affordable Care Act tick — would save more than $300 billion over 10 years, but only because millions fewer Americans would have health insurance, according to the Congressional Budget Office. It also means higher premiums, because the younger, healthier people who have an incentive to buy insurance rather than pay the mandate would be expected to exit the market while the sicker people stay in.”
Continue reading Health Policy Updates: November 19 2017
From the NEJM, on future directions of the ACA reforms:
“It is increasingly likely that the administration will drop enforcement of the individual mandate. The mandate’s penalty is supposed to be levied on individuals who go without coverage for 3 months, but the federal exchange was still enrolling people in April, and one has only to claim an unspecified hardship to be exempted from the penalty. Moreover, political fallout would be severe if the Internal Revenue Service tried to withhold tax refunds from low-income families
Vox.com interviews Peter Orszag (former CBO director, who I have hearted for a long time) on health care costs:
“We have had incredibly good news over the past three to five years. If I’d been told when I was director of either CBO or OMB that we would have a 12-month period when Medicare spending was basically flat in nominal terms… I would have thought impossible and yet that’s exactly what we’re living through.
From McKinsey, a report on what kinds of health care networks
are becoming available to consumers under ACA plans. Taken as an “observational study,” it does look like narrow-network plans are doing a better job of containing costs:
“Compared to plans with narrowed networks, products with broad networks have a median increase in premiums of 13 to 17 percent (when the analysis is controlled for payor, product type, rating area, and metal tier); the maximum increase is 53 percent. Across the country, close to 70 percent of the lowest- price products are built around narrow, ultra-narrow, or tiered networks
Hat tip to Eric Yoder
A fascinating piece on how the rules we docs set for ourselves (ie, what defines “hypertension” as opposed to “normal blood pressure”) affect how we act:
“Put simply: if you arrive at the doctor’s office with a blood pressure reading of 145/90, you’re about as likely to be treated as someone with a reading of 160/90, even though the evidence much more strongly favors the latter treatment. Overall, the data appears to point to a heavy reliance — perhaps too heavy — on rules in medical decision-making.”
A disturbing trend of health care providers moving to affluent areas, away from underserved/poor areas where they are needed most:
“The Post-Gazette/Journal Sentinel analysis shows that nearly two-thirds of the roughly 230 hospitals opened since 2000 are in wealthier, often suburban, areas. As health systems open those facilities, they have been closing their urban counterparts. The number of hospitals in 52 major cities in the United States has fallen from its peak of 781 in 1970 to 426 in 2010, a drop of nearly 46%, according to a separate study.”