The weird web we weave when we ask government to regulate health care

In a recent piece for the print magazine, I wrote that the Republican party, however ineptly and inadvertently, might have stumbled into a health-care policy that actually works. Obamacare still exists for all those who want it: The law’s subsidies ensure that the poor and middle class can buy insurance for a reasonable percentage of their incomes, and the exchanges have robust protections for people with preexisting conditions. The individual mandate is dead this year, so people who don’t want insurance don’t have to buy it. Through executive action, the Trump administration has broadened access to non-Obamacare-compliant forms of insurance that are far cheaper than anything available through the exchanges. And any state that doesn’t like the new arrangement is free to pass its own laws reinstating the old one.
https://www.nationalreview.com/2019/02/report-obamacare-changes-benefiting-consumers/

The Lawbreaking President Remembered

An incredible read. A small slice:
"One federal court found the Obamacare subsidy unconstitutional, and the case is working towards the Supreme Court. But, then again, no administration in memory was stopped more often by courts, often by unanimous SCOTUS decisions. Whether it was ignoring the Senate in making appointments or claiming to rewrite employment law, Obama tried to function without constitutional restraints."
http://thefederalist.com/2018/05/10/obama-legacy-deserves-destroyed/

Testament to the Competence of Government

Shouldn't have been started.
The administration lied in selling the product and used questionable tactics in the legislative phase.
The rollout was bungled.
Events unfolded in ways unanticipated by government executive and politicians.
The technology was ineffective to meet the challenge and poorly implemented by government.
Costs were far higher than expected.
The supposed urgency that led to the action was apparently false in hindsight.

Obamacare or the Iraq War? Yes, both. But government is actually supposed to be dealing with national security, even though we know government is essentially incompetent, there's some excuse for incompetence when completing constitutionally assigned responsibilities.

WTF is government doing messing about in health care markets when over the last 60 years it has done nothing but make things worse?  Hubris - when the humans act as if they are gods.

http://www.nationalreview.com/article/450095/obamacare-death-spiral-exchange-enrollment-down-29-percent

Obamacare Options

A better Republican strategy would be designed around Ryan’s stated goal. It would begin with the understanding that Obamacare’s worst features are its overregulation of health insurance and its centralization of regulation in Washington, D.C. The way Obamacare regulates insurers’ treatment of people with preexisting conditions, the benefits they have to offer, and the difference between what they can charge the young and the old have raised premiums and deductibles, resulted in insurance policies that are not attractive to the young and healthy, and so made the exchanges shaky at best in much of the country even with the help of the individual mandate.

Republicans already have a set of legislative ideas (if not yet actual legislation) that builds on that insight. The main Republican alternative to Obamacare — advanced in different forms by Senators Bill Cassidy, Orrin Hatch, Richard Burr, and Marco Rubio, by the House Republicans, and by Tom Price, Trump’s nominee to be secretary of health and human services — is to create a much less regulated market.

http://www.nationalreview.com/article/444564/obamacare-republicans-repeal-replace-strategy-congress-paul-ryan

Opposed to Obamacare, Divided About Obamacare

The main problem is that Republicans are a diverse bunch who opposed Obamacare for a variety of reasons. Those most focused on shrinking the size and reach of the federal government thought Washington was already too involved in health care and should pull back, not expand its role or raise taxes to pay for new health spending. Those preoccupied with personal freedom balked at being required to buy health insurance. Others thought the widespread use of insurance to fund health care was already driving health spending too high and objected to further expanding health insurance. Still, others thought broadening health coverage was a desirable goal, but that the subsidies and regulations that Obamacare used to accomplish this goal were poorly designed and transferred too much power from the states to Washington. All of these Republicans could agree on trashing Obamacare, but they did not have a common intellectual basis for designing a replacement and they still don’t. 
http://www.realclearhealth.com/articles/2017/02/09/why_is_it_so_hard_for_republicans_to_replace_obamacare_110432.html

Obamacare Be Gone

They will also deal with the difficult political task of reforming a massive expansion of Medicaid (the vast majority of Obamacare’s “newly insured” are actually new welfare recipients). They will have to answer Kristof’s claims that “millions of Americans will lose insurance, and thousands more will die unnecessarily each year because of lack of care.” Republicans will have to convince voters that opening up affordable and competitive markets without coercion is preferable to preserving unsustainable state-run programs that grow in perpetuity.
http://thefederalist.com/2017/01/06/gop-does-have-a-plan-to-replace-obamacare-thats-what-scares-democrats/

Hurt by Obamacare

More than 200 million have been hurt by it. Count them: 155 million with employer-provided plans whose deductibles have soared thanks to the ACA, plus the 11 million paying ACA penalties for not enrolling, plus hundreds of thousands of part-time workers whose hours were slashed by employers dodging the mandate, and 55 million seniors harmed when Medicare funding cuts bankrolled Obamacare.

https://spectator.org/trumps-path-to-obamacare-repeal/

I think there's a legit argument that deductibles have to be higher to incentivize better self care, a more competitive market and other more complex reasons with relation to health care cost control.  However, Obamacare is not doing that, it's just raising deductibles.  Higher deductibles with lower costs for care with more choices for patients, insurers and caregivers - and lower premiums for the healthy - is the winning formula.

Biggest Policy Flop in a Generation

By now, everyone knows that Obamacare is the public-policy flop of this generation. With the latest news of premiums increasing 22 percent, insurance companies dropping out, rising taxes and less completion, this is truly the Hindenburg of health plans.
http://www.realclearpolitics.com/articles/2016/11/01/obamacare_implosion_exposes_web_of_lies_and_deceit_132214.html

Every. Promise. Broken.

Obamastupidplan

Now reality is confirming what the critics predicted. ObamaCare’s regulatory mix—benefit mandates, requiring insurers to sell coverage to all comers, and narrow ratings bands that limit how much premiums can vary by health status—was tried by several states in the 1980s and ’90s. Every one saw the same results that are now unspooling nationally: high and rising costs, low and declining enrollment, and less insurer and provider competition.

The Affordable Care Act was supposed to solve these predictable disruptions with subsidies and a mandate to buy insurance or pay a penalty. But most people don’t think ObamaCare plans provide value for the money, especially if they are non-subsidized.
http://www.wsj.com/articles/accountability-for-obamacare-1477435661

Death Spiral, Meltdown, Obamacare's Flaws Make Themselves Known

Man, such a surprise, no one could have seen this coming.

Tennessee is ground zero for ObamaCare’s nationwide implosion. Late last month the state insurance commissioner, Julie Mix McPeak, approved premium increases of up to 62% in a bid to save the exchange set up under the Affordable Care Act. “I would characterize the exchange market in Tennessee as very near collapse,” she said.

Then last week BlueCross BlueShield of Tennessee announced it would leave three of the state’s largest exchange markets—Nashville, Memphis and Knoxville. “We have experienced losses approaching $500 million over the course of three years on ACA plans,” the company said, “which is unsustainable.” As a result, more than 100,000 Tennesseans will be forced to seek out new coverage for 2017.

BlueCross is only the latest insurer to head for the exits. Community Health Alliance, the insurance co-op established under ObamaCare, is winding down due to financial failure, leaving 30,000 people without coverage. UnitedHealthcare said in April it is departing Tennessee’s exchange after significant losses. That’s another 41,000 people needing new plans.
http://www.wsj.com/articles/obamacares-meltdown-has-arrived-1475709560

Bravo, Central Planners - Well Done

Most will miss the primary lesson - central planning never works.

Minnesota will let the health insurers in its Obamacare market raise rates by at least 50 percent next year, after the individual market there came to the brink of collapse, the state’s commerce commissioner said Friday.
The increases range from 50 percent to 67 percent, Commissioner Mike Rothman’s office said in a statement. Rothman, who regulates the state’s insurers, is an appointee under Governor Mark Dayton, a Democrat. The rate hike follows increases for this year of 14 percent to 49 percent.
“It’s in an emergency situation -- we worked hard and avoided a collapse.” Rothman said in a telephone interview. “It’s a stopgap for 2017.”
On average, rates in the state will rise by about 60 percent, said Shane Delaney, a spokesman for MNSure, the state’s marketplace for Obamacare plans. About 250,000 people, or 5 percent of the state’s population, were covered under plans bought on the individual market, including plans bought on the Affordable Care Act markets as well as outside it.
http://www.bloomberg.com/news/articles/2016-09-30/near-collapse-minnesota-insurers-up-obamacare-rates-by-half

"Turn out the lights, the party's over ..."

Will the last one out of ObamaCare please turn off the lights?

That's a question that health insurers and individual Americans both may want to start pondering. Recent events such as the departure of the insurance company Aetna from the vast majority of state exchanges show that ObamaCare is entering the death spiral that experts have long predicted. Insurers are now heading for the exit, fast — and consumers won't be far behind them.

In the wake of massive losses, insurance companies are instinctively engaging their fight-or-flight instincts. The two big insurers remaining on state exchanges — Anthem Blue Cross and Blue Shield, and Cigna — are still evaluating the risks of a collapsing system, trying to determine if they should abandon the ObamaCare exchanges altogether or cope with the realities of increasingly high-cost care and coverage.
http://www.investors.com/politics/commentary/obamacares-death-spiral-has-begun/

Swinging for the Fences, Using a Balsa Bat

But to explain why they should have done something else, I should first explain why I think that what we’re seeing now was predictable. The answer is that long before the exchanges opened, many critics warned that its weak mandate – the fines for failing to participate are modest -- would result in rampant gaming of the system by people who signed up only when they got sick.

The weakness of the mandate, like other flaws in the law, was politically necessary because the law was already quite unpopular, and its supporters couldn’t afford to alienate a single other voter. So they passed what they could and hoped to fix it later. However, the unpopularity of the law meant that there was a strong risk that they wouldn’t be able to fix it later, and indeed that is where we now find ourselves.

I don’t mean to suggest that the law has been an utter failure by the standards of its architects. They have not achieved anything close to universal coverage, but they did manage to reduce the number of uninsured people by somewhere between a quarter and a third. However, I think that if they had been a little less stuck on the idea of attacking every problem at once, they might have passed a less ambitious plan that would nonetheless have expanded coverage substantially, with far fewer risks to either the system or the Democratic Party.
https://www.bloomberg.com/view/articles/2016-08-29/modesty-could-have-averted-the-anguish-of-obamacare

Really? No, not really, I was just kidding about that Obamacare lowering prices thing.

Last week, Brian Blase highlighted a more serious Brookings analysis that contradicts Adler and Ginsburg's claims. That analysis, a genuine study by Amanda Kowalski for Brookings's Economic Studies program, found the following: "Across all states, from before [Obamacare's implementation] to the first half of 2014, enrollment-weighted premiums in the individual health insurance market increased by 24.4 percent beyond what they would have had they simply followed state-level seasonally adjusted trends." In other words, Obamacare apparently increased premiums by about 24 percent versus what they otherwise would have been.
http://www.weeklystandard.com/no-obamacare-has-not-lowered-premiums/article/2003615

"I'm not dead yet. I think I'll go for a walk."

And even with the mandate in place, some people appear to be gaming the system. A top actuary for insurer Highmark told the Times that in Pennsylvania, roughly 250 of its beneficiaries on had already incurred more than $100,000 in expenses this year. "People use insurance benefits and then discontinue paying for coverage once their individual health care needs have been temporarily met," he said, driving up the cost of coverage for everyone. Last year, UnitedHealth also indicated that individuals buying coverage and dropping it was driving losses.

As all this is happening, of course, insurers are bailing on the system, unable to make the numbers add up.

It's not an exact replica of the Washington state experience, but there are certainly similarities. The underlying point of all of this is that if the law's exchanges remain on their current wobbly trajectory, its dysfunction is nearly certain to grow. And the rough negotiations between Aetna and the administration may make insurers who are already losing money even more wary of further participation in the system.

That means that the prospect of significant further reforms may soon be on the table—which will likely include everything from poorly conceived state-based single-payer plans to poorly conceived federal health insurance systemsto, ah, poorly conceived conservative reforms. If anything, reforming health reform will be even more difficult than the initial project.

https://reason.com/blog/2016/08/17/the-return-of-the-obamacare-death-spiral

Damned if you do/don't ...

This week the Administration also released a July 5 letter from Aetna in response to a Freedom of Information Act request. Democrats claim the document shows CEO Mark Bertolini conditioning Aetna’s ObamaCare cooperation on merger approval.

This is some gall. Aetna was answering a June 28 “civil investigative demand,” in which Justice’s antitrust division specifically asked how blocking the merger would “affect Aetna’s business strategy and operations, including Aetna’s participation of the public exchanges related to the Affordable Care Act.”

Soliciting sensitive internal information that Aetna is legally compelled to provide—and then making it public to sandbag the company—is the behavior of political plumbers, not allegedly impartial technocrats. If police tried this, it’d be entrapment.

http://www.wsj.com/articles/the-aetna-mugging-1471475229

Cut Premiums by $2500? Not So Much

Last week, Brian Blase highlighted a more serious Brookings analysis that contradicts Adler and Ginsburg's claims. That analysis, a genuine study by Amanda Kowalski for Brookings's Economic Studies program, found the following: "Across all states, from before [Obamacare's implementation] to the first half of 2014, enrollment-weighted premiums in the individual health insurance market increased by 24.4 percent beyond what they would have had they simply followed state-level seasonally adjusted trends." In other words, Obamacare apparently increased premiums by about 24 percent versus what they otherwise would have been.
http://www.weeklystandard.com/no-obamacare-has-not-lowered-premiums/article/2003615

Obama's Parting Gift

The last thing Democrats want to contend with just a week before the 2016 presidential election is an outcry over double-digit insurance hikes as millions of Americans begin signing up for Obamacare.

But that looks increasingly likely as health plans socked by Obamacare losses look to regain their financial footing by raising rates.

Just a week after the nation’s largest insurer, UnitedHealth Group, pulled out of most Obamacare exchanges because it anticipates $650 million in losses this year, Aetna’s CEO said Thursday that his company expects to break even, but legislative fixes are needed to make the marketplace sustainable.

http://www.politico.com/story/2016/04/obamacare-rate-hikes-a-looming-political-headache-for-democrats-222663

It would be only too sweet if this becomes the issue that tips the election.

Were You Paying Attention?

For those who were paying attention, none of this is a surprise. It was always a fantasy to think that more government intervention was going to improve a health care system that already was cumbersome and expensive because of previous government interventions.

By the way, IBD isn’t the only outlet to notice the ongoing disaster of Obamacare.

Let’s look at some other recent revelations.

Chris Jacobs writes, “For millions of Americans, the Left’s insurance utopia has rapidly deteriorated into a bleak dystopia,” while “the ‘cheaper prices’ that the president promised evaporated as quickly as the morning dew.”

John Graham explains that “CBO estimates Obamacare will leave 27 million uninsured through 2019 – an increase of almost one quarter” and that “CBO estimates 68 million will be dependent on the [Medicaid] program this year through 2019 – an increase of almost one third in the welfare caseload.”

https://fee.org/articles/obamacare-strikes-out-on-affordability-savings-coverage/?utm_source=newsletter&utm_medium=email&utm_campaign=fee_daily&mkt_tok=eyJpIjoiWlRJM04yVmtOak0wTldGaCIsInQiOiJpQVQ0SmRyZWpXeTFqYmgydndmN3ZEOFNCK2lDOTkwaDV1dkVDcjBNdkIyOGdTblRtdTRNQjY2anB4bGJ1cythNWpTb3FBTDJ1dWllNk5zcE10S3BQTldQZFBBNWVDUVN1SFlhTCtqZ3c2bz0ifQ%3D%3D

Easy to Predict Stuff - Another Government Failex

An easily predictable development ... unless you just love everything government touches.

ObamaCare rates will skyrocket next year, according to its former chief. Enrollment is tumbling this year. And a big insurer is quitting most exchanges. That’s what we learned in just the past few days.

Marilyn Tavenner, CEO of America’s Health Insurance Plans, revealed that she expects ObamaCare premium hikes “to be higher than we saw previous years,” including last year, which saw double-digit rate increases across the country.

Tavenner, for those who don’t know, was head of the Centers for Medicare and Medicaid Services until early 2015, which means she helped bring ObamaCare to life. In November 2014, she was boasting how “the Affordable Care Act is working to improve competition and choice among marketplace plans.”

http://www.investors.com/politics/editorials/obamacare-suffers-three-major-blows-in-one-week/