“Every health-care system in the world rations care in some way, either through bureaucratic fiat (Scandinavia, the U.K.), waiting lists (Canada), or price (that’s us). One can argue about which of these rationing mechanisms is fairest or most efficient, but let’s not pretend that it won’t occur.”
“Only a few years ago, the party was united behind three reforms that are consistent with individual empowerment and limited government: (1) a universal health refund that transfers all government tax and spending subsidies to ordinary citizens each year with no strings attached other than the requirement that it be used for health care, (2) a flexible Health Savings Account that allows people to manage some of their own health care dollars and (3) pre-existing condition protection for people who lose their insurance because of government policies.
For well over a decade House Speaker Paul Ryan (R-WI) was a steadfast supporter of all three ideas, including replacing tax and spending subsidies for health care and health insurance with a universal tax credit. John McCain ran on these ideas in the 2008 election. The legislative embodiment of McCain’s plan was the Patients Choice Act, which Ryan cosponsored in 2009 along with Devin Nunes (R– CA) in the House and Tom Coburn (R–OK) and Richard Burr (R–NC) in the Senate.”
“The American Health Care Act (AHCA), proposed by the House leadership, was not about health care. It was about taxes. Over and over, Ryan said he needed to do health reform before tax reform. In particular, he said he needed to reduce Obamacare taxes by $1 trillion and to reduce spending by more than $1 trillion.As noted, a tax cut tied to health care is part of good health reform. But the Ryan tax cut wasn’t tied to health care. It consisted of repealing the very revenues that were funding Obamacare. (See below.) Since the tax cut took money out of the system, the spending cuts paired with it also removed money from the system.”
Two scholars at the renowned Brookings Institution, Loren Adler and Paul Ginsburg, have published an analysis finding that “average premiums in the individual market actually dropped significantly upon implementation of the ACA [Affordable Care Act].” This contrasts with a plethora of evidence, including a rigorous 2014 Brookings study, showing the ACA significantly increased premiums. In this post, I discuss methodological concerns with the Adler and Ginsburg approach as well as evidence that leads most scholars to reach a very different conclusion.
Obamacare has been disastrous for health insurers, like UnitedHealth Group, billions have been wasted on state exchanges, which are hanging by a thread, and the law’s enrollment projections (calculated by the CBO three years ago) were off by 24 million for 2016. Now, more Americans are opting to pay the penalty and remain uninsured because it makes more sense for their finances. No wonder why this law is unpopular. Oh, and did I mention that premiums are projected to rise (again) this year. Given the expensive nature of the Obamacare market, some insurers are dropping like flies, giving Americans in some rural areas just one choice when it comes to their health care. Of course, some folks are worried about monopoly dynamics
So far it’s just an editorial. But it is an editorial that proposes two bold ideas that no other Republican presidential candidate has been willing to endorse: (1) tax relief for the purchase of health insurance should be the same for everyone – whether insurance is acquired at work, in the marketplace or in an exchange, and (2) the best form of tax relief is a fixed sum tax credit.
Although Rubio is a self-described conservative, these are not right wing ideas. In fact, I believe that most health policy experts on the left and the right agree with him. (More on that below.)
For most of the post-World War II period we have had two parallel tax systems with regard to health care and health insurance. Employer sponsored health plans have been treated one way. Individually purchased health insurance has been treated a different way. Under Obamacare, we have created a third parallel system (Medicaid expansion) – all treating people at the same income level very differently.
So the Obama administration had projected newly eligible Medicaid enrollees would cost about $50 less than other Medicaid-enrolled adults, but they actually cost nearly $1,000 more. Nice.
Let’s pretend a non-partisan, unelected committee had drafted a health reform plan to be reviewed and debated by the people of each state and then voted on with a simple up or down vote. If a minimum of 38 states passed it, then it would become the law of the land. Let’s assume this health reform plan contained the following characteristics:
Read the entire article via Defending Public Policy: What’s in a Name? | Robert Nelson, MD | LinkedIn.
Here are some facts and some data from a Rand study published May 6, 2015:
- ACA was signed into law in March of 2010.
- The ACA insurance exchanges (referred to as ObamaCare) were launched in 2013 with first open enrollment starting in October of 2013 .
- 22.8 million people gained coverage between September 2013 and February 2015 and 5.9 million lost their coverage for variety of reasons, for a net increase of 16.9 million new insured out of 42.7 million deemed uninsured.
There you have it! ObamaCare is responsible for adding 16.9 million more people to the rolls of the insured. No debate needed.
But what about the 4.4 million jobs that the market created between September 2013 and October 2015? Those new jobs, combined with more workers returning to full-time work, led to a net of 8 million more people receiving employer-sponsored health benefits according to the Rand Study published in Heath Affairs.
John Graham of the National Center for Policy Analysis believes, as do many others, that if not for ObamaCare these job numbers and indeed the entire economy would be better off, including more covered by employer-sponsored benefits.
ObamaCare was not the only thing going on at the time of this study. Excluding the 1st quarter of 2014, all of 2013 and 2014 recorded steady increases in GDP of about 3% each quarter. Even though occurring at a slow pace compared to other recoveries, there was some degree of economic growth for the three years preceding the study; which does translate into job growth along with increasing benefits such as health coverage. The beginning of persistently positive job growth started in December of 2010.
Here is a legitimate question everyone should be asking: What if the recession of 2008 had never happened, would we still have seen the same gains in insured status on net, regardless of the starting point? We need to think through this in order to know the real effect of ObamaCare on increasing the number of insured.