Health care spending continues to increase – the rate of increase in 2016 was 4.3%, down from 5.8% in 2015 but still greater than inflation. Health care now takes up 17.9% of the US economy. The out-of-pocket costs borne by patients, though, are up more sharply.
“A shift toward insurance plans that transfer more of the burden of health care costs onto patients helped fuel the rise in out-of-pocket costs. In 2016, 29 percent of people who receive insurance through employers were enrolled in high-deductible plans, up from 20 percent in 2014. The size of the deductibles also increased over this time period, a 12 percent increase in 2016 for individual plans, compared with a 7 percent increase in 2014.”
Health care cost growth is back on the rise, as reported in Health Affairs. During 2014 and now 2015, health care spending has increased at a rate faster that inflation, after having move in line with inflation for the first few years post-recession. That means health care is a growing share of the US GDP again.
There has been immediate hypothesizing about the future of Obamacare given the election result. Sarah Kliff at Vox.com expects that full repeal is a real possibility, and emphasizes that his “replacement” plan would lead to an additional 21 million uninsured Americans.
“In broad terms, Trump’s plan looks a lot like the dozen or so other Republican Obamacare repeal plans that have come out over the past few years. Trumpcare allows insurance companies to go back to refusing coverage for preexisting conditions, a key barrier to coverage before Obamacare’s coverage expansion. The plan would, according to outside analysts, increase the number of uninsured Americans by 21 million people.”
Health Affairs’ Timothy Jost gets into the weeds of the ACA’s different components, and discusses which can still effectively be reversed and which have already become too ingrained to undo.
“Immediate repeal of the ACA and presumably restoring the law that preceded it would likely bring the Medicare program, for example, to a halt until new rules could be written. The ACA is inextricably interwoven into our health care system and is not going away immediately.”
The federal government recently confirmed that health insurance premiums on the Obamacare exchanges will be, as previously warned, getting significantly more expensive next year. There is a lot of variation, with prices going up by a lot more in some states and actually declining in others, but the overall average increase is going to be about 22%.
The beginning of last week saw the second presidential debate, in which health care policy finally got some attention. I will include some discussion of the various points that the candidates raised below.
Kaiser Health News unpacks Donald Trump’s statements about increasing insurance prices under Obamacare:
“There are several reasons for the increases. One is that insurers charged premiums that were simply too low to begin with, and now they are catching up in order not to go broke. Another goes back to the CBO prediction above, about employers sending workers to the individual market to buy their own insurance.”
Sarah Kliff at Vox.com does her best simply to translate what the two candidates were proposing (or were trying to propose):
“…it is possible to decode what actually happened. Clinton defended the Affordable Care Act while offering a blunter critique of the law than the Obama administration typically does — while Trump mostly attacked Obamacare for its costs, while offering an Obamacare repeal proposal that would leave millions uninsured.”
“More than anything, ACA requires pragmatic, bipartisan problem-solving in an era of divided government and unprecedented polarization exemplified by Trump’s nomination itself. Our next president must find a way to work within that environment. I didn’t hear much tonight – or on any night – about how this might be done.”