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%.
Sarah Kliff at Vox.com explains what this means:
“In either case, these numbers are bad news for Obamacare — we just don’t know how bad, exactly, the news is at this point.”
The NYTimes offers a summary as well:
“Most people are unaffected by the rate increases because they get their insurance through an employer or are covered through government programs like Medicare, Medicaid or the Department of Veterans Affairs.”
Continue reading Health Policy Updates: October 29 2016
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.”
Harold Pollack was not impressed by the ideas that were put forward:
“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.”
This thought piece in the NYTimes’ Upshot column uses an analogy of a football team eating at an all-you-can-eat buffet to describe the problems of adverse selection and moral hazard as they relate to the ACA/Obamacare insurance exchanges. The author (Margot Sanger-Katz) doesn’t use the term “death spiral,” but that sure seems to be where the concerns she raises are leading…
“The restaurant analogy is useful here, too. Imagine two all-you-can-eat buffets. One offers iceberg lettuce, chicken wings and macaroni. Its competitor offers the usual fare, plus lobster, and it charges a bit more. Guess which buffet will attract lobster lovers?…That sort of problem can get worse over time. As the companies increase prices to compensate for having sicker patients, fewer healthy people will buy the insurance.”
It appears that Donal Trump has put his money where his mouth is in terms of supporting the anti-vaccine movement.