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
The newly-reported results of the ORBITA clinical trial caught my eye this week. Patients with chronic, stable angina with severe coronary blockages were randomized to angioplasty+stenting vs. ongoing medical therapy alone. Interestingly, the medical therapy patients also received a “sham” cardiac procedure, so the patients were blinded to whether or not they had actually received PCI. There was no significant improvement in angina symptoms with PCI, as measured by exercise duration. Does this mean that the huge number of stents placed annually in the US for angina symptoms is not money well-spent?
Continue reading Health Policy Updates: November 4 2017
This week, a bipartisan bill emerged to stabilize the ACA insurance market. It remains unclear whether this compromise proposal will enjoy enough support to pass.
“Alexander said the deal he struck with Murray would extend CSR payments for two years and provide states ‘meaningful flexibility’ under the ACA, allowing them to make changes to insurance offerings as long as the plans had ‘comparable affordability,’ which is a slightly looser definition than the existing one…The framework would also allow insurers to offer catastrophic insurance plans to consumers aged 30 and older on ACA exchanges, while maintaining a single risk pool…”
Sarah Kliff at Vox.com gave the shortest, quickest rundown of the different ACA insurance subsidies, and exactly how the recent Trump executive order would change things:
“The Trump administration is not ending insurance subsidies. Instead, they have created a policy where they spend more money to insure fewer people — something you probably won’t see on the president’s Twitter feed.”
Continue reading Health Policy Updates: October 22 2017