Urban Institute – Health Stew

Both Sides Now on the ACA at AEI

On Friday, December 16 I participated in a panel on the future of U.S. health reform at the new headquarters of the American Enterprise Institute at 1789 Massachusetts Avenue in Washington DC (note the street address number). There were two panels on the program called “What’s Next for Health Care?”

AEI’s Joe Antos and James Capretta were the session moderators. Former Urban Institute Chief Bob Reischauer and I, respectively, were the ACA defenders on each of the two panels.

Feel welcome to watch the full session below — my panel starts about 1 hour into the 2 hour event which was also shown on CSPAN.

What I picked up from the session is lots of uncertainty on the Republican/ conservative side on how to proceed, both on process and substance. Some of them are now suggesting the need for a 4-year transition, not 2 or 3 are previously discussed. Repealing and replacing the ACA is not going to be easy for them.

Meanwhile, please check out this new column by Noam Levey in the LA Times: “Trump and the GOP are charging forward with ObamaCare repeal, but few are eager to follow.” Levey could not identify “a single major organization representing patients, physicians, hospitals or others who work in the nation’s healthcare system (that) backs the GOP’s Obamacare strategy.” Neither can I.

The Republicans’ ObamaCare death march is getting more interesting every day as we move closer to the cliff.

Creating Better Affordability in the Affordable Care Act

Every day, so many reports emerge about aspects of ObamaCare/ACA that it’s difficult to decide which ones to note. Here’s one I note today from the Urban Institute – “After King v. Burwell: Next Steps for the Affordable Care Act” written by the always perceptive Linda Blumberg and John Holahan.

The report’s basic and important message is this: though it has vastly increased health insurance security and affordability for millions of vulnerable Americans, the Affordable Care Act is not affordable enough. Knowing what we know now, the law needs better affordability for millions of Americans who need access to subsidized insurance that includes more affordable premiums and stronger cost sharing protections:

“The premium and cost-sharing structures established under the law were delineated with the intention of meeting specific budget targets that now seem overly constraining. As a result, several problems occurred. Premium tax credits are substantial, but they are still inadequate for many individuals and families, given their incomes. Similarly, many individuals with modest incomes may struggle to afford the Level of cost-sharing required in the plans for which the premium tax credits are pegged. Premium tax credits are tied to a product with cost-sharing requirements that significantly exceed the typical large employer-sponsored plan. In particular, older individuals with incomes just above the current tax credit eligibility range face high premiums relative to their incomes, and because they tend to use more medical care than do their younger counterparts, they face a total bill for premiums plus out-of-pocket spending that can be very high.”

Continue reading “Creating Better Affordability in the Affordable Care Act”

The Good News and the Bad — Another ACA Day

If you’re like me — and I pray you’re not — your email inbox drowns every day with news about the ACA and health policy in every imaginable direction. Sometimes, two messages get juxtaposed next to each other in ways that illuminate a higher truth. I felt that way today.

First, came an email update from the Urban Institute and their Elevate the Debate project. Just look at these headlines, all based on newly released data:

Big things, good news. I am especially impressed with the drop in uninsurance among adults with chronic health conditions such as diabetes, cardiovascular disease, hypertension, and asthma. Real progress and something to feel good about.

Then, the next email is from the Blue Cross Blue Shield Foundation of Massachusetts offers a wealth of new data on rising health insurance costs, especially deductibles and other cost sharing, confronting Massachusetts health consumers: Rising Health Care Costs in Massachusetts: What It Means for Consumers. What it means is not encouraging:

“The impact of these changes in health insurance products can be seen in spending trends, which show that by 2013, nearly one in ten adults spent over 10 percent of income on out-of-pocket health care costs. For an insured family of four with an income three times the federal poverty level (about $71,000 in 2013), that represents a burden of more than $7,000 per year over and above the cost of insurance premiums.”

Lots of progress and good news, and lots of discouraging trends as well. The the Blue Cross data only covers Massachusetts, the same trends are in evidence all over the nation, and worse in many other states. In the polarized craziness of the ACA, the news has to be all good or all bad, with no room for ambiguity or complexity. That’s not real and that’s not life.

The ACA is responsible for some of the most important gains in social and economic justice in our lifetime. And, we still have many vitally important gaps to close and gains yet to be made. That’s reality.