ACA/Obamacare: Unconstitutional Without the Repealed Mandate?

'A coalition of 20 U.S. states sued the federal government on Monday over Obamacare, claiming the law was no longer constitutional after the repeal last year of its requirement that people have health insurance or pay a fine.

Led by Texas Attorney General Ken Paxton and Wisconsin Attorney General Brad Schimel, the lawsuit said that without the individual mandate, which was eliminated as part of the Republican tax law signed by President Donald Trump in December, Obamacare was unlawful.

“The U.S. Supreme Court already admitted that an individual mandate without a tax penalty is unconstitutional,” Paxton said in a statement.“With no remaining legitimate basis for the law, it is time that Americans are finally free from the stranglehold of Obamacare, once and for all,” he said.' Twenty States Sue the Federal Government Seeking to End Obamacare, Reuters, 02.26/2018

Link to the entire article appears below:

https://www.reuters.com/article/us-usa-healthcare/twenty-states-sue-federal-government-seeking-end-to-obamacare-idUSKCN1GB06R

The Forgotten Yet Equally Important Dimension of Healthcare: The Supply Side

"What happens when a company defined by utterly ruthless efficiency sets its sights on the flabbiest part of the U.S. economy? We shall see, now that Amazon has announced that it–along with Warren Buffett’s Berkshire Hathaway and the banking behemoth JPMorgan Chase–will be entering the dominion of health care.

“The three of our companies have extraordinary resources, and our goal is to create solutions that benefit our U.S. employees, their families and, potentially, all Americans,” said JPMorgan chairman Jamie Dimon on Jan. 30, treading lightly (“potentially”) on the enormous implications (“all Americans”) that were apparent. As it takes shape, the as-yet-unnamed joint enterprise will nominally serve, without seeking profit, only the 1.2 million people who work for the three companies.

But the clear and worthy goal is to confront the Gorgon that has stymied politicians for decades."

"The U.S. health care system is the antithesis of Silicon Valley. Grossly inefficient and user-unfriendly, it may be the least transparent enterprise outside the Kremlin–and just as awash in money. The $3.3 trillion that Americans spent on health care in 2016 was close to Germany’s entire GDP that year. It accounted for an astounding 18% of the U.S. gross domestic product–twice the share other developed countries typically spend on health–and produced a return on investment that would get any CEO fired. Life expectancy in the U.S. is actually going down." - What Happens When Amazon Takes on Health Care, 02/01/2018, time.com

Link to the entire article appears below:

http://time.com/5128377/amazon-and-friends-takes-on-a-new-industry-health-care/

ACA/Obamacare: Why Were Coverage Gains So Tepid? Why Do So Many Remain Uninsured?

"Friends and foes of the Affordable Care Act (ACA) alike tend to target the relative effectiveness of the (soon-to-be-repealed) individual mandate as the key factor behind relatively higher levels of insurance coverage since the law was enacted in 2010. 

ACA supporters might wish that the mandate was much stronger, but they still claim that its repeal will trigger rising premiums and leave millions more Americans uninsured in the years ahead.

Many ACA foes often can’t decide whether repealing the mandate remains the key to unraveling Obamacare or if it simply should be eliminated as a matter of principle, regardless of the cost and coverage consequences.

Spoiler alert: They were both wrong about the past. They are likely to remain mistaken about the future.

In reality, overall coverage gains under the ACA hit a modest, but relatively stable, plateau well before last month’s tax-cutting budget reconciliation law decided to eliminate further penalties under the individual mandate as of 2019. Those initial reductions in the number of uninsured Americans were due primarily to expanded eligibility for Medicaid and, secondarily, to generous subsidies for lower-income enrollees in state-based health insurance exchanges. 

The less-explored question involves why Obamacare’s overall combination of taxpayer subsidies, expanded insurance programs, health benefits requirements, AND coverage mandates had so much less of an effect than the law’s architects envisioned.

It turns out that many of the nominally uninsured still have other alternatives to health care than just through heavily-subsidized Medicaid and exchange-based insurance. You might call such uncompensated care either an option for “implicit insurance” or a hidden tax on acquiring more formal coverage.

Health policy researchers Amy Finkelstein, Neale Mahonem and Matthew Nolowidigdo unravel the puzzle in a recent National Bureau of Economic Research paper. They explain why there is less “demand” than expected for the increased “supply” of subsidized coverage for lower income individuals and more limited take up of subsidized coverage than once predicted.

The bottom line is that the nominally uninsured (before and after Obamacare’s implementation) pay only a small share (one-fifth to one-third) of their medical expenses. Hence, they value formal health insurance at substantially less than its full cost to insurers providing such coverage. 

Among the sources of other financing for care provided to the uninsured are federal and state subsidies for uncompensated care, such as Disproportionate Share Hospital (DSH) payments (reduced more gradually and later than originally envisioned under the ACA), as well as part-year insurance coverage, direct care programs, and private donations.

The federal Emergency Medical Treatment and Active Labor Act (EMTALA) also requires hospitals to provide “emergency care” to screen and stabilize uninsured patients on credit. Nonprofit hospitals claim provision of charity care as one of the primary ways to fulfill their community benefit requirements for tax-exempt status. Retroactive look-back coverage under Medicaid also has provided a further modest financial cushion for some providers treating the nominally low-income uninsured.

Keep in mind, too, that the accounting lines between charity care and bad debt are far from clear cut, and they can be adjusted somewhat to match the financial reporting needs of nonprofit versus for-profit providers. Recovery rates for uncompensated care provided to low-income uninsured individuals with few assets are limited (roughly 10-20 percent at best) and further shielded by personal bankruptcy protections.

So, while financial and medical life for lower-income uninsured individuals is far from  comfortable or stable, Finkelstein, Mahonem, and Nolowidigdo find that these various backup “options” do reduce the willingness of low-income individuals to pay for the full --and in many cases even the generously subsidized, out-of-pocket -- premium costs of insurance coverage. For example, other research by Finkelstein estimates that adults living below the Federal Poverty Level would be willing to pay only 20 to 50 cents per each dollar of Medicare insurance coverage spent on their “behalf,” and they would rather give up Medicaid than pay the insurance costs of providing it." - The Real Hidden Tax on Increased Insurance Coverage, economics21.org, 01/25/2018

Link to the entire essay appears below:

https://economics21.org/html/real-hidden-tax-increased-insurance-coverage-2816.html

ACA/Obamacare: And About that Canadian Health-Care Model

"An Ontario doctor says health-care wait times have reached “insane” lengths in the province, as one of her patients faces a 4.5-year wait to see a neurologist.

When Dr. Joy Hataley, a family practice anesthetist in Kingston, Ont., recently tried to send a patient to a neurologist at the Kingston General Hospital, she received a letter from the specialist’s office telling her that the current wait time for new patient referrals is 4.5 years.

The letter said that, if the delay is “unacceptable” to Dr. Hataley, she should instead refer the patient to a neurologist in Ottawa or Toronto.

Dr. Hataley said she's used to hearing back from specialists who are unable to see her patients for months, and even up to 2.5 years. But a 4.5 year wait is "insane," she told CTVNews.ca in a telephone interview." -  'It's insane': Ont. patient told she'd have to wait 4.5 years to see neurologist, CTVNews.ca, 11/02/2017

Link to the entire report appears below:

https://www.ctvnews.ca/health/it-s-insane-ont-patient-told-she-d-have-to-wait-4-5-years-to-see-neurologist-1.3661114

ACA/Obamacare: The Recent Tax Bill and Obamacare

Q: How did "Obamacare" wind up in the tax bill?

A: The Senate version repeals the Affordable Care Act's tax penalties on people who don't have health insurance. That would result in government savings from fewer consumers applying for taxpayer-subsidized coverage, giving GOP tax writers nearly $320 billion over 10 years to help pay for tax cuts.
What's more, repealing the fines would deal a blow to the Obama-era health law after a more ambitious Republican takedown collapsed earlier this year.

Q: Those fines have been very unpopular, so how could repealing them undermine the health law? Other parts of the ACA will remain on the books.

A: Premiums will go up, and that's never popular. The fines were meant to nudge healthy people to get covered. Because insurance markets work by pooling risks, premiums from healthy people subsidize care for the sick.

Without some arm-twisting to get covered, some healthy people will stay out of the pool. That's likely to translate to a 10 percent increase in premiums for those left behind, people more likely to have health problems and need comprehensive coverage, says the Congressional Budget Office.

The CBO also estimated that 13 million more people would be uninsured in 2027 without the penalties. If they have a serious accident or illness, uninsured people get slammed with big bills, and taxpayers wind up indirectly subsidizing the cost.

Q: So just taking away an unpopular penalty would destabilize the health insurance law?

A: Repealing the fines is part of a broader context. - Q&A: Tax bill impacts on health law coverage and Medicare, Newser, 12/05/2017

Link to the entire article appears below: 

http://www.newser.com/article/4729348d72844801ae4686e91afbb1fb/qa-tax-bill-impacts-on-health-law-coverage-and-medicare.html

ACA/Obamacare: Eliminating the Individual Mandate

“There are powerful reasons to kill ObamaCare's individual mandate to buy health insurance. This regressive tax has fallen primarily on modest earners who face a choice of paying a fine or buying the cheapest $7,000-deductible plan, which may be of little use until long after their finances are in distress.

Yet how the individual mandate is eliminated makes all the difference in the world. If done while easing up on ObamaCare's counterproductive rules — from the employer mandate to coverage options that have led just as many people to leave subsidies on the table as to claim them — getting rid of the mandate could facilitate a big step toward universal coverage.

But getting rid of the mandate in the way Republicans propose, as a $300 billion pay-for that will help keep the cost of tax legislation under the $1.5 trillion maximum allowed under Senate rules, would not only ensure that millions of people drop their insurance on top of the 28 million already uninsured, but it would deepen already-daunting fiscal challenges and seriously undermine any hope of fixing our troubled individual insurance market for the foreseeable future.

Understanding the true impact of repealing the individual mandate is necessary for making sense of the Joint Committee on Taxation's official score of the Senate tax legislation. Because millions of individuals would give up their health insurance tax subsidies, JCT found that households earning up to $40,000 a year would face an ever-larger tax hike equal to $6.4 billion in 2021 alone (or a $4.4 billion tax hike once the effect of the corporate tax cut is considered).

Republicans say, in essence, "No harm, no foul." If people are voluntarily dropping coverage, that hardly amounts to a tax increase. Yet the GOP argument that people would be giving up coverage they don't want, while technically true, depends on a flawed presumption that all those millions of people with modest incomes would reject health insurance, not because of a lack of affordability, but because they would prefer to be uninsured.

Just consider a scenario in which people were able to use their available health insurance subsidy to cover the full cost of a high-deductible or catastrophic health insurance policy and have at least $200 left over for a Health Savings Account deposit — $100 of which could be cashed out if left unspent at year end.

If there were this kind of flexible option that included free cash on the table, the word would get out and there likely wouldn't even be any need for advertising to get close to 100% enrollment among the subsidy-eligible group.

While this hypothetical isn't necessarily an ideal model, it is eminently possible to combine the health care security Democrats insist upon with the freedom that Republicans believe in, killing the mandate while dramatically reducing premiums and continuing to provide moderate-income households ample reason to get covered instead of rolling the dice.

The key point is that every dollar of the projected savings from killing the individual mandate depends on keeping ObamaCare just as consumer unfriendly as it was in 2017. In other words, taking those savings – all that extra tax revenue lying around because even more people leave their health insurance tax credits unclaimed — and applying it to tax cuts means that a significant chunk of the funding now available for health insurance premium tax credits will essentially disappear, all but ruling out consumer-friendly and coverage-increasing reforms of the ACA in a fiscally fraught future.” - The Right Way To Kill ObamaCare's Individual Mandate, Investor’s Business Daily, 11/28/2017

Link to the entire article appears below:

https://www.investors.com/politics/policy-analysis/the-right-way-to-kill-obamacares-individual-mandate/

Note: Yet another interesting demand-side argument. However, “affordability” of healthcare and hence the price of health insurance is a supply-side and demand-side phenomena. Moreover, health insurance price is, in the main and upon normal occasion, a reflection of the price to supply healthcare. The constant stream of demand-side arguments is going to do little to affect the supply-side price. More importantly, the supply-side price is not strictly a result of market forces as much as it is a function of special interest legislation and certificate of need (CON) legislation providing the conduit of distorted price and limited competition that the providers within the greater supply-side enjoy at the expense of the consumer of healthcare.

ACA/Obamacare: Math Quest Edition

"A headline this week in The Hill shocked me: "ObamaCare enrollment strong in third week of sign-ups." The Hill is a serious, well-respected, non-partisan news source. But any reader taking this headline at face value would be seriously misled about what is really going on with Obamacare enrollments during this fifth open enrollment season.

The Hill's reporter correctly notes that "the pace of sign-ups has exceeded last year: In the first 26 days of last year's open enrollment period, 2.1 million people signed up compared to the 2.3 million people who signed up the first 18 days of this year's period."

Those figures imply that the daily rate of sign-ups this year is outpacing last year's rate by 58% [originally reported as 28%: Update #2]. Surely that is evidence of strong enrollment, no?

The reason it is not is buried at the tail-end of the story where the reporter notes "the enrollment period ends Dec. 15, which is about half as much time as people had to sign up last year."

Yipes! If enrollees have only half the time to sign up, then by pure arithmetic, the daily enrollment pace needs to be double last year's in order for total enrollment at the end of the enrollment period to match the level reach at the end of last year's enrollment period: 12,216,003.


But if current enrollment is 158% [originally reported as 128%: Update #2] of last year's when it needs to be 200%, a more accurate way to frame this year's performance would be to say that Obamacare is on track to sign up 21% [originally reported as 36%: Update #2] fewer enrollees than last year (i.e., 158/200=79% which would mean signing up 21% fewer). [originally reported as 128/200=64% which would meaning signing up 36% fewer: Update #2]. That's a pretty bad news story rather far removed from the rosy picture painted by The Hill's headline." -  No, Obamacare Enrollment Is Not Strong, Not By A Longshot, Forbes, 11/24/2017

Link to the entire article appears below:

https://www.forbes.com/sites/theapothecary/2017/11/24/no-obamacare-enrollment-is-not-strong-not-by-a-longshot/#439262b4919d

Bernie-Care (Medicaid for All) and the Magical Moment of Cost Effectiveness.

“Robert Frank made the familiar cost-effectiveness case in the New York Times earlier this summer, and, as usual, it left me with more questions than answers. Frank made three points. First, administrative costs are lower in single-payer systems. Second, single-payer systems save money by not having to advertise. Third, the government can use its monopoly on demand to negotiate lower fees paid to providers.

Even if all three points are true, it is unclear why they are unique to health care. Someone arguing for single-payer plumbing or single-payer automotive maintenance would probably make the same points. To what extent is the case for single-payer health care different from the case for government financing of all goods and services? Frank doesn’t say.

As for whether costs are indeed lower, “you get what you pay for” would seem to apply regardless of whether the payer is the government or a private insurance plan. Want better fraud detection? Administrative costs have to go up. Want more program utilization? Increase advertising costs. Want better doctors? Compensate them more. How a single-payer system is supposed to change this basic relationship between cost and quality is not clear.

Compare health care with education. Public schools are essentially single-payer education systems within the areas they cover. When was the last time we heard anyone argue that public schools are a great tool for containing education costs? When has Bernie Sanders or any Democrat called for the government to push down teacher salaries in order to save money? Any suggestion that teachers should be paid less is met with the obvious counter-argument that teaching quality would suffer. And yet single-payer health care, which comes with the explicit promise to pay doctors less, is supposed to reduce costs without reducing quality. By what magic?” - The Single-Payer ‘Cost-Effectiveness’ Mystery, national review.com, 09/14/2017


Link to the entire essay appears below:

http://www.nationalreview.com/corner/451384/single-payer-health-care-cost-effectiveness

What is the “Skinny Repeal” of ACA/Obamacare?

“There is an alternative, if not a very satisfying one. Republicans seem to be able to achieve near-unity on ending the individual mandate, allowing insurers to offer discounts for younger people, protecting taxpayers from having to subsidize abortion coverage, and giving states some freedom to relax regulations. They should work for legislation that achieves these goals and includes as much Medicaid reform as 50 senators are prepared to tolerate.

 Republicans should not claim that such legislation would repeal and replace Obamacare, since it would not, and should make it clear that additional legislation will be needed in the future. The conservative holdouts should be prepared to judge this limited legislation based on whether it gives people more freedom to choose the health insurance they want, not on whether it does everything for which Republicans have been campaigning over the last seven years.” - Don’t Settle for Nothing, National Review, 07/18/2017

Link to the entire article appears below:

http://www.nationalreview.com/article/449616/republican-health-care-bill-fails-obamacare-repeal-mitch-mcconnell

Health Care Prices, Government Instituted Single Payer Plans and Political Answers to Economic Problems

ACA/Obamacare: When Saving $2,500 Per Year Really Means Spending $2,928 Per Year

“The Congressional Budget Office score of the American Health Care Act shows that the bill will reduce deficits by $119 billion over the next decade and result in 23 million more people being uninsured by 2026. This leaves the impression that people would be better off if Obamacare were unchanged. But a new report from the Department of Health and Human Services dispels this myth.

The DHHS report shows that premiums in the individual market exchanges increased by 105 percent in the 39 states using Healthcare.gov from 2013 to 2017. This is equivalent to $244 per month in additional premium payments for people buying insurance through the exchanges, or $2,928 over the course of a year. People not eligible for exchange subsidies are fully exposed to these increases, while taxpayers will bear the brunt in the form of higher outlays for subsidies for enrollees who are eligible.

Despite the promises that Obamacare would “cut the cost of a typical family's premium by up to $2,500 a year,” average premiums on the exchanges more than doubled over this period. In some states, such as Alabama and Alaska, the average premium more than tripled.

The high average increase is not driven by a few outliers, as 23 out of the 39 states included in the analysis experienced premium increases in excess of 105 percent. Only three states, North Dakota, New Hampshire, and New Jersey, had cumulative premium increases below 50 percent.” - Memo to CBO: Obamacare Is Unsustainable, economics21.org, 05/24/2017

Link to the entire article appears below:

https://economics21.org/html/memo-cbo-obamacare-unsustainable-2364.html

ACA/Obamacare: Say Goodbye to Aetna

“Health insurance company Aetna (AET) announced Wednesday it will completely withdraw from the ObamaCare marketplace in 2018, a decision Health and Human Services Secretary Tom Price perceived as a sign of continued instability in the health care sector under the Affordable Care Act.”

‘“At this time [we] have completely exited the exchanges,” Aetna said in a statement to FOX Business.

In April Aetna said it would not participate on the state exchanges in Virginia next year and last week committed to pulling out of Iowa. In 2016 the insurer sold plans across fifteen states. It trimmed that position to just four states at the outset of 2017, citing financial losses.

“Our individual Commercial products lost nearly $700 million between 2014 and 2016, and are projected to lose more than $200 million in 2017 despite a significant reduction in membership. Those losses are the result of marketplace structural issues that have led to co-op failures and carrier exits, and subsequent risk pool deterioration,” the company said Wednesday.’ - Aetna to Completely Pull Out of ObamaCare Exchanges by 2018, fox business.com, 05/10/2017

Link to the entire article appears below:

http://www.foxbusiness.com/markets/2017/05/10/aetna-to-completely-pull-out-obamacare-exchanges-by-2018.html

The Highly Misused Terms of "Health care", "Medical care" and "Medical insurance".

"Media reports say that 20 million Americans will lose their “health care” under the Republican plan to replace ObamaCare, as if health care is like a cellphone, wallet, or item of clothing unintentionally left somewhere or stolen by someone.

Such confusion about “health care” stems from the misuse of the term itself. In common usage, the term “health care” is used as a synonym for “medical care” and “medical insurance,” although these terms have widely different meanings. This is more than an issue of semantics. There are serious policy implications of using the wrong words, and the misuse reflects an entitled attitude among the populace and lazy thinking by the media, academia, and politicians.

Health care means taking care of one’s health. It’s what one does to stay healthy—namely, to have a heathy diet, exercise, not abuse alcohol or drugs, and avoid risky behaviors.

Medical care or treatment is what you seek from medical professionals when you have a medical problem and aren’t in good health.

Medical insurance is what you obtain to protect yourself financially from a catastrophic illness or injury requiring expensive medical treatment. In insurance terms, you pool the risk with others."

-  Stop Misusing the Term "Health Care", FEE, 03/16/2017

Link to the entire article appears below:

https://fee.org/articles/stop-misusing-the-term-health-care/

An Examination of Healthcare Price and Efficiency: The Third Party Payer Effect

Certificate-of-Need Laws [CON] and How Restricting Supply Leads to Higher Health-care Prices

“More than four decades ago, Congress passed and President Ford signed the National Health Planning and Resources Development Act of 1974. The act withheld federal funds from states that failed to adopt certificate-of-need (CON) laws regulating healthcare facilities. CON laws require healthcare providers wishing to open or expand a healthcare facility to first prove to a regulatory body that the community needs the planned services.”

“In 1986—as evidence mounted that CON laws were failing to achieve their stated goals—Congress repealed the federal act, eliminating federal incentives for states to maintain their CON programs. Since then, 15 states have done away with their CON regulations. A majority of states still maintain CON programs, however, and vestiges of the National Health Planning and Resources Development Act can be seen in the justifications that state legislatures offer in support of these regulations. Policymakers claim CON regulation is intended to:

ensure an adequate supply of healthcare resources,

ensure access to health care for rural communities,

promote high-quality health care,

ensure charity care for those unable to pay or for otherwise underserved communities,

encourage appropriate levels of hospital substitutes and healthcare alternatives, and
restrain the cost of healthcare services.

Research, however, shows that CON laws fail to achieve these laudable goals. In fact, by limiting supply and undermining competition, CON laws may undercut each of these aims.”

“CON programs limit the introduction and expansion of a wide variety of medical services and equipment, such as rehabilitation centers, nursing home beds, and medical imaging technologies. The process for obtaining a CON can take years and tens or even hundreds of thousands of dollars. By definition, CON programs restrict supply, making them unlikely to ensure an adequate supply of healthcare resources. Research on the supply of dialysis clinics and hospice care facilities finds that CON programs do, indeed, restrict the supply of both.”

“Unlike other regulatory regimes, such as occupational licensure and scope-of-practice rules, CON regulations do not specifically aim to improve quality. That is, CON regulators typically do not attempt to assess whether providers are qualified to do their jobs, focusing instead on whether there is an economic “need” for their services. Nevertheless, CON advocates sometimes claim that because CON regulations reduce the number of institutions providing care, they will cause more procedures to be performed by the institutions that do obtain permission. Thus, the argument goes, practitioners in CON states will tend to see more patients with the same conditions and therefore might become more specialized and proficient. This theory must be weighed against competing theories that suggest that competition tends to increase quality, especially when regulations prevent price competition.”

“As economists Jon Ford and David Kaserman put it, “To the extent that CON regulation is effective in reducing net investment in the industry, the economic effect is to shift the supply curve of the affected service back to the left. . . . The effect of such supply shifts is to raise . . . [the] equilibrium price.” The empirical evidence on how CON regulation affects cost has been consistent with economic theory, showing that CON regulation tends to increase the cost of healthcare services.” Certificate-of-Need Laws, Mercatus Center, 04/17/2017

Link to the entire essay appears below:

https://www.mercatus.org/publications/certificate-of-need-laws-goals

ACA/Obamacare: Before and After the Waiver of Pre-existing Conditions and the Advent of Community Rating

“As Republicans continue to debate the specifics of their plan to repeal and replace the Affordable Care Act (ACA or ObamaCare), two provisions have taken center stage: “Guaranteed Issue,” the requirement that insurers offer policies to all applicants, and “Community Rating,” the requirement that they offer all policies at the same price, regardless of risk factors like health, lifestyle, or even gender.

These rules were obviously designed to allow people with pre-existing conditions to purchase health coverage, and to equalize the premiums paid by everyone. But as nice as that sounds, the experience of different states shows that these rules don’t benefit many consumers and aren’t the best way to foster functional and fair insurance markets.”

“Before the ACA, everyone was guaranteed a policy in every state. First, employer-based or group carriers could not deny you coverage due to a pre-existing condition. Second, if you kept continuous coverage and followed the requirements of the 1996 Health Insurance Portability and Accountability Act (HIPAA), you had the right to buy an individual insurance policy with no exclusions for pre-existing conditions.

HIPAA required that a carrier could not raise your rates nor drop you if you developed a condition after the policy was in place. Sadly, the architects of the ACA misled people about these protections, saying they didn’t exist, and many people still believe that today.”

“While guaranteed issue and community rating may sound nice in theory, in reality, they don’t work out as intended. Unfortunately, these rules can create bad incentives. By raising the cost of insurance for healthy people, these rules can discourage some people from buying insurance until they become sick, when they will still be guaranteed a policy.”

“Before the ACA, 43 states allowed the sale of “true insurance.” Rates were based on your potential of claims, so carriers could inquire about your health conditions, occupation, and lifestyle choices. This provided an incentive to practice a healthy lifestyle because your premium would be lower if you did. Most applicants received very affordable rates since most people are healthy. Unlike the proponents of the ACA claimed, scores of common conditions like mild allergies and even elevated blood pressure and cholesterol were accepted. In fact, 87 percent of applicants received coverage, even with their pre-existing conditions.

Others who had delayed applying until they developed a serious condition or were expecting an expensive claim were offered a guaranteed plan through a carrier or through a high-risk pool. High-risk pools offer a variety of plans from different insurers to high-risk customers at subsidized rates. Those rates were typically up to 150 percent of standard rates and were funded partially through a state tax on carriers, the premiums of enrollees, and an occasional grant from the federal government.


These higher rates were only charged to a few people, and they were similar rates to what everyone is now paying under the ACA. As more people buy private plans before they develop a serious condition, rates will remain low and fewer people will be buying in the subsidized high-risk pools.” - Obamacare’s pre-existing condition rules sound nice but don’t work, 04/10/2017, 
thehill.com


Link to the entire article appears below:

http://origin-nyi.thehill.com/blogs/pundits-blog/healthcare/328174-obamacare-misled-americans-about-pre-existing-conditions-now

ACA/Obamacare: Cross Subsidy as a Hidden and Inefficient Tax

“But the great puzzle of health care policy: Just why is it, to accommodate this worthy goal, must your and my health care and insurance be so deeply regulated and so thoroughly dysfunctional? As one small example, why does a 20 minute skin check with the resident of my dermatologist generate a phoney baloney bill for over $1000, meaning a cash and carry market for such a simple, elastically demanded, and perfectly predictable service is impossible?

Why, in order to provide for the unfortunate, do we not simply levy taxes, and pay for charity care, and leave the rest of us alone? Regular Americans have jobs, buy houses, buy TVs, cars, and smartphones, negotiate the complexities of 401(k) and IRA plans, cell phone contracts, frequent flyer programs; hire the complex professional services of contractors, car mechanics, lawyers and accountants, and deal with the insane complexity of our tax system.”

“I think the answer is relatively simple. Our political system is allergic to the word "tax." Instead of straightforwardly raising taxes in a non-distortionary way (a VAT, say), and providing charity care or subsidies -- on budget, please, where we can see it -- our political system prefers to fund things by forcing cross subsidies.

Medicare and medicaid don't pay what the service costs, because we don't want to admit just how expensive that service is. So, large hospitals make up the difference by overcharging you and me instead. The poster child (though not really a cost driver) is emergency room care. The government passed a law saying hospitals must provide emergency room care for free. But money does not grow on trees, so again you and me (via private insurance) must get overcharged to cross-subsidize. The ACA tried to force young healthy wealthy (not getting subsidies) to vastly overpay for insurance, to cross subsidize the poorer and sicker.

This might seem like a wash. OK, if instead of paying taxes, it makes you feel good to pay business class prices for health insurance, what the heck. Economically, a cross-subsidy works the same as a tax. In fact, we do have Europe-size taxes and subsidies, we just hide them.

But it's not a wash. Cross-subsidies are dramatically less efficient than taxes. Choosing cross-subsidies over taxes is indeed the second original sin of health care and insurance regulation. Cross-subsidies cannot stand competition.

If as now you and I are grossly overpaying for health care and insurance, to cross-subsidize others, a competitive market would come along and peel us off. A local skin-check clinic could offer that service for $50.

Low prices, efficiency, and innovation in the provision of services like health care come centrally from competition, and especially disruptive competition. With no competition -- especially no entry by new doctors, hospitals, clinics, insurance companies -- costs spiral up. As costs spiral up, the cost of the charity care spirals up. As that spirals up, the size of the cross-subsidies spirals up. As that spirals up, the need to restrict competition spirals up.”


“Bottom line: Much of the pathology of health care and health insurance comes from this second original sin, choosing cross-subsidies rather than straightforward taxes. Cross-subsidies require the government to stop competition, so an initially clever way of hiding taxes eventually builds into a monstrously inefficient system. (That's a key point. Initially, it is about the same. But the cross subsidy system gets more and more inefficient over time.)

We would be far better off to admit this; raise explicit taxes enough to provide the charity end of our care, and let health insurers and care givers compete for the rest of us, as airlines, computer makers, and everyone else does. The politician's job is to explain to people that what they pay more in taxes they will more than make up in lower health care and insurance costs.” - The second original sin of healthcare regulation, John Cochrane, 04/05/2017

Link to the entire essay appears below:

http://johnhcochrane.blogspot.com/2017/04/the-second-original-sin-of-healthcare.html


　

　


　

ACA/Obamacare: The 3 1/2 Page Replacement [S.222] for the 2,700 Page Obamacare Legislation. No way! Way!

“U.S. Senator and physician Rand Paul introduced S. 222, the Obamacare Replacement Act, to provide Congress with a health care plan grounded in broadly supported conservative reforms that is ready for an immediate vote after Obamacare is repealed. Dr. Rand Paul’s proposal would expand access to higher-quality, lower-cost health care for more Americans, regardless of medical history.

The Obamacare Replacement Act empowers the American people to: 1.) Choose inexpensive insurance free of government dictates; 2.) Save unlimited amounts in a health savings account (HSA) and have wider options for using those funds; 3.) Buy insurance across state lines; and 4.) Join together in voluntary associations to gain the leverage of being part of a large insurance pool." - Rand Paul Introduces His Own Obamacare Replacement Plan – Read All 4 Pages Here! cscmediagroupus.com, 03/08/2017

Link to the entire article appears below:

http://www.cscmediagroupus.com/robert-zerfing/rand-paul-obamacare-replacement


Note: You can download all three and one-half pages of S.222 near the end of the article.

ACA/Obamacare: The Alternative Cash-only, No Insurance, Price-displaying Business Model of Health-Care

“How does Clinica Mi Pueblo offer these medial services at the “most affordable prices possible”? Here’s how: the clinic operates on a cash-only basis, with transparent prices that are listed both on the clinic’s website and on the wall at each clinic. Further, the clinic accepts no insurance, and it will not submit insurance claims on patients’ behalf. If patients have insurance, they can easily take the paperwork the clinic provides and file an insurance claim on their own. Reducing the costly, time-consuming mountain of paperwork associated with insurance, Medicare and Medicaid is one of the main reasons that cash-only medical clinics can keep their costs down and prices so low and affordable. That’s the same business model that keeps surgery costs so low/affordable at the Surgery Center of Oklahoma, the “free market-loving, price-displaying, state-of-the-art, AAAHC accredited, doctor owned, multi-specialty surgical facility in central OK” that has been featured on CD many times over the years.

So how does the cash-only, no insurance, price-displaying business model of the Clinica Mi Pueblo compare to medical coverage under Obamacare? Well, deductibles for individuals enrolled in the lowest-priced Obamacare health plans will average more than $6,000 in 2017, and families enrolled in bronze plans will have average deductibles of more than $12,000. Importantly, the deductible is the amount of money patients must personally pay out of pocket for health services before Obamacare insurance policies cover any medical costs. And what about the monthly Obamacare premiums? A 40-year-old unsubsidized bronze Obamacare plan patient will pay slightly more than $350 per month this year for their “health coverage” with a deductible of more than $6,000. And that’s supposed to somehow be “affordable” health care? In contrast, spending $350 per month out-of-pocket at Clinica Mi Pueblo, instead of going toward an Obamacare plan that provides almost no actual medical care, would actually purchase quite a lot of actual medical services.

Bottom Line: For routine medical care (annual physicals, flu shots, routine office visits, X-Rays, ultrasounds, MRIs, blood tests, etc.) most Americans, especially younger, healthier patients, would be much better off with a cash-only medical clinic like Clinica Mi Pueblo than with Obamacare, no? Under Obamacare, a 40-year-old American pays more than $4,200 per year in premiums. The out-of-pocket limit for an Obamacare plan is $7,150 this year but that doesn’t include the monthly premiums, so an individual could pay more than $11,000 out-of-pocket this year before his or her health plan would start to pay 100% of the costs of covered benefits. Only in some fantasy world of Big Government progressives and collectivists would that ever be considered an “affordable” health care system!” - An antidote for Obamacare: Cash only medicine with transparent pricing and no insurance — the future of medicine?, AEI, 03/26/2017

Link to the entire article appears below:

https://www.aei.org/publication/an-antidote-for-obamacare-cash-only-medicine-with-transparent-pricing-and-no-insurance-the-future-of-medicine/


　

ACA/Obamacare: Obamacare Reform and the Political Impossibility of Rolling Back Established Entitlements