Tag Archives: Sarah Kliff

Health Policy Updates: July 16 2017

On Thursday, the Senate released its latest version of its Obamacare-repeal bill, known as the BCRA. Vox.com ran a brief explainer on the key provisions that have changed since prior versions, including a shift towards low-premium (and low-coverage) plans:

“The bill will include a provision based on a proposal by Sen. Ted Cruz (R-TX), which allows health plans to offer skimpy coverage options so long as they have at least one plan that covers a robust set of benefits. The insurance industry opposes the policy, calling it ‘infeasible’ and fearing it would create ‘greater instability.'”

Politico ran a similar outline of the bill’s contents.

The GOP efforts at health care reform, overall, continue to be a “solution in search of a problem.”

“The GOP health care bill doesn’t even have pretextual justifications. Republican leaders like to claim that Trumpcare is necessary because Obamacare is “collapsing” into a “death spiral,” but not only is Trumpcare non-responsive to a death spiral, the death spiral they posit as the basis for Trumpcare is wholly fabricated.”


The supposed urgency behind Obamacare repeal is that it is “collapsing.” This doomsday claim is a bit premature, however, as the exchanges have continued creep along slowly but surely. In fact, a new report out from Kaiser appears to show that the Obamacare insurance exchanges are looking healthier than ever.

“Early results from 2017 suggest the individual market is stabilizing and insurers in this market are regaining profitability. Insurer financial results show no sign of a market collapse…Although individual market enrollees appear on average to be sicker than the market pre-ACA, data on hospitalizations in this market suggest that the risk pool is stable on average and not getting progressively sicker as of early 2017. Some insurers have exited the market in recent years, but others have been successful and expanded their footprints, as would be expected in a competitive marketplace.”


The ongoing challenge for the GOP in passing health care legislation is that different GOP senators have different goals. Some want sustained Medicaid spending, others want even deeper cuts. The NY Times gives a summary of which senators are breaking with the party line to request more changes to the bill – and which senators are pulling in opposite directions.


More great writing on Medicaid by Aaron Carroll and Austin Frakt this week. This time, the topic at hand is the idea that private insurance is inherently “better” insurance than Medicaid. This is one of the chief arguments among Medicaid critics (typically, the GOP) that Americans would be better off by defunding Medicaid and transitioning people to some for of private plans. While it is true that some doctors do not accept Medicaid, causing access problems, in general Medicaid is actually better than private insurance. Medicaid simply pays more of your medical costs; that is, it has lower “cost sharing” requirements – low/no deductibles, copayments, and coinsurance.

And based on well-established research, having low cost sharing is important for the quality of health care that people receive…

“The Senate’s health care plan, for example, would offer much less generous plans. A 64-year-old woman with an income of $11,400 would face a deductible of at least $6,000. For her, such a plan is not better than Medicaid; it is most likely much worse if she is also sick. Because of the deductible, the care she’d need would be financially out of reach.”


Kaiser Health News has recently started a new health policy news podcast called “What the Health.” I just listened to episode #3, a conversation including Margot Sanger-Katz at the NYTimes and Sarah Kliff at Vox.com about the politics behind the BCRA.

I’ll be a new subscriber! Highly recommended.


 

Health Policy Updates: July 1 2017

The CBO report on the Senate’s ACA repeal bill – BCRA – came out on Monday. There are a lot of details, but you can read the general summary here. Since a picture is worth 1,000 words, I think their predictions can best be captured in a single picture – which Alvin Chan and Sarah Kliff at Vox.com have produced from the CBO’s numbers.

CBO projections for uninsurance rates after BCRA passage

If repealing Obamacare was the goal, it looks like BCRA would achieve that. This bill, if it becomes law, would erase all of the insurance coverage gains made over the last 5 years, and effectively take us back to the pre-Obamacare era.

Continue reading Health Policy Updates: July 1 2017

Health Policy Updates: June 25 2017

The big news of the week was the release of the Senate health care bill – the “Better Care Reconciliation Act” – on Thursday.

The NYTimes reports:

“The bill, drafted in secret, is likely to come to the Senate floor next week, and could come to a vote after 20 hours of debate…The premise of the bill, repeated almost daily in some form by its chief author, Mr. McConnell, is that ‘Obamacare is collapsing around us, and the American people are desperately searching for relief.'”

Sarah Kliff at Vox.com runs through the contents in a condensed explainer.

“In aggregate, these changes could be advantageous to younger and healthier enrollees who want skimpier (and cheaper) benefit packages. But they could be costly for older and sicker Obamacare enrollees who rely on the law’s current requirements, and would be asked to pay more for less generous coverage.”

Dylan Matthews summarized all of the (many) groups of people who will be worse off if this act becomes law:

“We don’t know for sure how many people will lose health coverage, but there are a number of reasons to think the number will be bigger than the 23 million the Congressional Budget Office estimated would lose insurance under the bill that passed the House in May. The Senate bill cuts Medicaid more slowly but more deeply, and unlike that bill, it lacks any incentive for individuals to stay insured. It repeals the individual mandate and replaces it with nothing.”

Continue reading Health Policy Updates: June 25 2017

Health Policy Updates: June 18 2017

The more serious Republicans get about repealing Obamacare, the more insurance companies feel at risk in continuing to offer exchange plans. And the more insurance companies pull out of the exchanges, the worse Obamacare looks and the clearer the rationale for repeal. Are we in a spiral is actually leading towards the ACA’s repeal?

“Meanwhile, across the nation, health insurance plans are beginning to flee the Obamacare marketplace. They’ve cited the uncertainty around the health care law’s future, sown by congressional Republicans and the Trump administration. The number of counties with zero health plans signed up to sell 2018 coverage keeps growing. The possibility that Republicans will repeal Obamacare or drive it into collapse is an increasingly real one. That’s a reality where millions fewer have health insurance and lower-income Americans struggle to afford coverage.”

Continue reading Health Policy Updates: June 18 2017

Health Policy Updates: June 10 2017

We’re back!

After a couple weeks away for travel, with a LOT that I’ve missed in the interim, here are some of the events and new ideas out over the last week.

First off, the Senate continues to deliberate on health care legislation, with varying degrees of confidence as to whether it will go anywhere. Conservative (though reality-based!) health policy wonks Lanhee Chen and James Capretta have continued to advocate for the incorporation of auto-enrollment into health care reform. This would present a way to “nudge” more healthy people into health insurance – a positive outcome – without the “big-government” personal mandates that Conservatives tend to bristle at.

“Even with the ACA’s penalties for going uninsured, large numbers of Americans are forgoing coverage and either paying additional tax penalties for doing so or applying for an exemption from the law’s individual mandate…If [the AHCA is] enacted, Congressional Budget Office forecasts there would be much lower take-up of insurance under the GOP’s plan than under the ACA…A well-designed automatic enrollment program can help boost enrollment into coverage whatever the design of the overall system.”

Continue reading Health Policy Updates: June 10 2017