Meet the Doctor Trump Picked to Dismantle Obamacare

President-elect Donald Trump’s selection of Rep. Tom Price of Georgia as the next secretary of the U.S. Department of Health and Human Services is an outstanding choice.

It is hard to imagine a candidate more qualified to serve in this crucial position, especially at a time when America’s health care economy is undergoing a major transition. He is not only a well-schooled expert in the nuances of complex public policies, but also an excellent communicator and debater.

An orthopedic surgeon by profession, Price began his public career as a member of the Georgia state Legislature. With over 12 years of service in the House of Representatives, including his service as chairman of the pivotal House Budget Committee, he has emerged as one of the most knowledgeable and effective members of Congress on federal budget and health policy.

Given his background as a state official, one can expect that he will be especially supportive of innovative health reforms at the state level.

Price’s approach to health policy, in particular, is best understood by an examination of his legislative record. He is the author of numerous bills and amendments, most notably the Empowering Patients First Act, a highly detailed legislative proposal that would repeal the Affordable Care Act and replace it with patient-centered provisions that would control costs and expand coverage in the private health insurance markets.

A number of Price’s proposals have been incorporated into the House Republican alternative to the failing Affordable Care Act, proposed under the leadership of House Speaker Paul Ryan.

Price’s measure would provide individual tax relief for health insurance for Americans to own and control their health insurance policies, just as they own and control their life insurance policies, making coverage fully portable and secure, from job to job and through different stages of life, without today’s outdated tax or regulatory penalties.

Patient choice of coverage combined with intense competition in the health insurance markets would not only control costs, but also stimulate innovation in benefit design and health care delivery.

By providing individual tax relief for health insurance, Price’s measure would remedy the central weakness in America’s health insurance markets, long recognized by health policy analysts and economists, including the late Nobel laureate Milton Friedman: the inflationary, dysfunctional, and inequitable federal tax treatment of health insurance.

Price has also proposed the creation of independent health insurance pools for more affordable coverage in the individual and small group markets, and also a change in the law allowing association health plans, enabling small business owners to band together across state lines.

Moreover, similar to Trump, Price supports strengthening and enhancing health savings accounts by allowing increased contributions and greater flexibility in the use of these accounts, as well as permitting individuals to buy health plans licensed in other states.

For ordinary Americans, the best reason to celebrate Trump’s choice: Price himself is a doctor. Today, doctors are demoralized by the reams of rules and regulations and paperwork imposed on them by politically-driven, bureaucratic third-party payment arrangements—a morass eating into their precious time and energy. Their patients, of course, are the ones who suffer the most.

With Price taking the helm of American health policy, doctors and patients alike have sound reasons to hope for a welcome and long-overdue change.

The post Meet the Doctor Trump Picked to Dismantle Obamacare appeared first on The Daily Signal.

Electing to ‘Opt Out’ of Obamacare

Steven Lopez has gone without health insurance for 15 years, and the Affordable Care Act hasn’t changed his mind. Once again this year he will forgo coverage, he said, even though it means another tax penalty.

Last tax season, the 51-year-old information technology professional and his family paid a mandatory penalty of nearly $1,000, he said. That’s because they found it preferable to the $400 to $500 monthly cost of an Obamacare health plan.

“I’m paying $6,000 to have the privilege of then paying another $5,000 [in deductibles],” said Lopez, who lives in Downey, a suburb of Los Angeles. “It’s baloney — not worth it.”

While millions of people have gained coverage through the Affordable Care Act, an estimated 28 million Americans remain uninsured. And preliminary data shows that about 5.6 million paid a tax penalty rather than buy health insurance in 2015, according to The New York Times.

In California alone, 3.8 million people under 65 remain without health insurance.

Now, amid the uncertain future of Obamacare in a Trump administration, some resisters like Lopez are feeling vindicated and other consumers simply don’t see the need to sign up. Still others, according to Affordable Care Act advocates, are eager to take advantage of what will likely be at least one more year of subsidized coverage.

Doreena Wong, a project director at the Los Angeles-based nonprofit Asian Americans Advancing Justice, said consumers have already begun to express doubts on whether they should bother enrolling. That is despite redoubled efforts in recent days by the state and federal exchanges to encourage signups.

“I do think the election result will impact our ability to enroll as many people as we’d like to,” she said. “Some people may ask: If it’s going to be dismantled, why sign up?”

Weiyu Zhang, a health educator and enrollment counselor with Asian Americans Advancing Justice, has enrolled 10 people since the election.

“Every single one has brought up the election and has expressed concern about signing up,” Zhang said. People are asking whether subsidies might go away and whether premiums will rise or fall, Zhang said.

“Based on my knowledge, there’s only so much I can tell them,” Zhang said. “What we know is that changes will not happen immediately, and if they want coverage in 2017, they should sign up.”

Getting rid of the ACA in its entirety on day one of the Trump administration is practically impossible, said Erin Trish, an assistant research professor in public policy at the University of Southern California. Although Republicans to date have offered no official replacement plan, what’s expected is a different approach with a less regulated health insurance market, Trish said.

Even before the election, health policy experts believed the 2017 enrollment period, which ends Jan. 31, would be key to determining the future of Obamacare.

“Would people enroll? Would premiums stabilize after this year and increase at a normal pace? What would the risk pool look like?” were questions experts were already asking, Trish said. “But this election has definitely thrown things for a loop.”

She said the election’s effect on this year’s open enrollment period could go either way. Rather than opting out, many people might consider it important to get covered in case ACA replacement options hinge on whether people had coverage in place, Trish said.

According to the U.S. Department of Health and Human Services, more than 100,000 people signed up for coverage the day after the election.

“Maybe people see this as one last opportunity, or perhaps they want to show their support for the ACA,” Trish said. “Who knows?”

Lopez said repeal is fine with him. Being penalized for not being insured is absurd, he said.

“We should not be forced to buy health insurance. The government should not be in the business of forcing us to buy anything,” he said.

Yet, even as a critic, Lopez does see some positive in the health law. He believes getting rid of the preexisting condition exclusion, for example, was a good thing.

So what happens if Lopez becomes ill? He must pay out of pocket.

Last year, he needed a colonoscopy. The best price he found was at a community clinic, where the procedure would cost him $2,000.

Not satisfied with the price, he traveled south to Tijuana. There, $2,000 covered a lot more: the colonoscopy, an electrocardiogram and hemorrhoid surgery, which he had been putting off because of cost.

If necessary, he’d do it again, he said.

For most Americans, cost continues to be the top barrier to health coverage. In 2015, 46 percent of uninsured adults of varying ages, ethnicities and income levels said they didn’t have coverage because it was too expensive, according to a Kaiser Family Foundation survey. (Kaiser Health News is an editorially independent program of the Kaiser Family Foundation.)

Kathy Eller, 56, a janitor from Paducah, Ky., hasn’t had insurance for more than a decade, and she plans to opt out this year as well, she said. Sometimes she worries about her health, but not enough to pay a $250 monthly premium, which is what the most affordable Obamacare plan would cost her, she said.

“I smoke way too much and I’m overweight,” Eller said. “I go to the doctor once every six months for my high blood pressure medication and only pay $50 for it.”

Before she lost her employer-based coverage 10 years ago, Eller underwent several surgeries for a skin infection caused by a bacteria known as MRSA.

If she were to get severely ill again, she wouldn’t be able to pay for it, and she doesn’t think she’d seek treatment.

“The way I see it, I’m 56, and my family doesn’t live very long — into their 60s, maybe 70s,” she said. “I wouldn’t want to put that financial burden on my husband, he doesn’t need that.”

Last tax season, Eller was fined close to $800 for not having health insurance. Eller said she is indifferent to the possible repeal of Obamacare. “It hasn’t helped me much, but I know it’s helped a lot of people,” she said.

Shannon Drees, 26, a student from Orlando, Fla., hopes possible reversal of the Affordable Care Act could lower premiums for young, healthy people. She has not had health insurance since she was 21, when she was dropped from her parents’ plan before the ACA provision allowing young adults to stay on those plans until age 26 took effect.

“I don’t have outstanding health issues, it’s much cheaper to pay a penalty,” she said.

Last tax season, she was fined $500. That’s still less expensive than the estimated yearly cost in premiums for plans she looked into, she said.

Many of her friends, about the same age, are in the same boat. Unless they are covered by an employer, they are not insured, she said. She said she does not visit the doctor much and uses Planned Parenthood for birth control.

“For me, it’s about the math,” Drees said of getting health insurance. “Hopefully one day I’ll be able to afford it again.”

This story was produced by Kaiser Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

The post Electing to ‘Opt Out’ of Obamacare appeared first on The Daily Signal.

Republicans Begin to Unite Around Obamacare Repeal Plan

House and Senate budget leaders along with conservative lawmakers, are beginning to unite around a proposal that would avoid a filibuster from Senate Democrats and put a bill repealing key provisions of Obamacare on President-elect Trump’s desk not long after his inauguration—a bill that is likely to earn his signature.

Republicans’ talks of repealing the Affordable Care Act became a possibility following Trump’s victory over Democratic presidential nominee Hillary Clinton last week.

In the days following the election, scholars and lawmakers began floating plans to unravel the health care law.

But now, House and Senate budget leaders have endorsed a proposal that involves Congress passing two budget resolutions—one for 2017 and one for 2018—early next year, the first of which would instruct lawmakers to use a budget tool called “reconciliation” to dismantle the health care law.

Under reconciliation, legislation under consideration by the Senate needs just a simple majority, 51 votes, to pass, blocking a filibuster by Senate Democrats.

Because Congress failed to pass a budget resolution for 2017—a proposal stalled in the House—budget experts say Republicans could pass a revamped fiscal roadmap for next year, one that includes reconciliation instructions for Obamacare’s repeal.

To ease the transition for consumers, that reconciliation bill would likely have a delayed enactment date to give congressional Republicans time to craft and pass a replacement plan.

After passing a budget resolution for 2017, GOP lawmakers could then craft a second budget resolution for 2018, which could also include reconciliation instructions to tackle another legislative priority, such as an overhaul of the tax system.

Using this two-budget approach to repeal Obamacare would give Republicans the chance to put a bill dismantling the health care law on President-elect Trump’s desk soon after his Jan. 20 inauguration, lawmakers said.

“I think having the opportunity to have two reconciliation bills as opposed to one, two reconciliation processes as opposed to one, is wise,” House Budget Committee Chairman Tom Price, R-Ga., told CQ.

Senate Budget Committee Chairman Mike Enzi, R-Wyo., also endorsed the plan, according to Politico.

Enzi told Politico that this double reconciliation strategy would allow Republicans to address their top legislative initiatives without having to worry about filibusters from Senate Democrats.

Price and Enzi are at the helm of the committees that draft the budget resolutions that would include reconciliation instructions.

Not only have Congress’s budget leaders endorsed the use of reconciliation to dismantle the health care law, but the strategy also earned the support of House conservatives, who have long said they have an obligation to voters to repeal the Affordable Care Act.

“Health care will be better and more affordable when Obamacare is repealed, plain and simple,” Rep. Jim Jordan, R-Ohio, told reporters Wednesday. “Everyone understood that as a huge issue in the election.”

“We have to use the reconciliation process, so let’s do it the right way, but let’s do it as quickly as we possibly can,” he continued. “It was part of the mandate that the American people sent to this town last week.”

Congressional Republicans have voted more than 60 times to repeal Obamacare and were only successful in getting a repeal bill, passed using reconciliation, to President Barack Obama’s desk earlier this year.

Because the GOP will lack the 60 votes needed to overcome a filibuster from Senate Democrats—Republicans will hold 52 seats in the next Congress—Rep. Matt Salmon, R-Ariz., said reconciliation is the only way to ensure such a bill gets to Trump.

“The only guarantee is to go through reconciliation. The Senate will never get a repeal of Obamacare off the floor. They’ve never been able to get an appropriations bill off the floor,” Salmon told reporters Wednesday. “So when it comes to heavy lifting for something as major as this, it’s probably going to have to be like we did it through the reconciliation process again.”

To successfully repeal Obamacare using reconciliation in 2017, congressional Republicans could follow a blueprint they mapped out in 2015.

That year, GOP lawmakers drafted a budget resolution for 2016 that included instructions for budget committees in both chambers to draft a reconciliation bill repealing the Affordable Care Act.

Their legislation ultimately repealed the law’s individual and employer mandates, Medicaid expansion, tax credits, and the medical device and Cadillac taxes. The reconciliation bill also stripped the government of its authority to run Obamacare’s state and federal exchanges, and lessened the fines for failing to comply with the mandates to $0.

Both chambers of Congress ultimately passed the bill, but Obama vetoed the legislation.

House Republicans then attempted to override the president’s veto, but lacked the two-thirds majority needed to do so.

Now that Republicans will control both the executive and legislative branches in 2017, GOP lawmakers have said they plan to follow through on their promises to repeal Obamacare.

Just one day after Trump won the presidency, Republican leaders were laying out their agenda for the 115th Congress, with the health care law topping the list.

“I would be shocked if we didn’t move forward and keep our commitment to the American people,” Senate Majority Leader Mitch McConnell said last week.

Republicans have discussed a replacement for the Affordable Care Act, though an official bill doesn’t yet exist.

Several GOP lawmakers have drafted their own individual proposals over the last few years, and Speaker Paul Ryan rolled out a replacement plan in June under the Wisconsin Republican’s “Better Way” agenda.

According to CQ, it’s unclear if the GOP’s plan would be included in a reconciliation bill repealing the health care or when a proposal would be rolled out.

The post Republicans Begin to Unite Around Obamacare Repeal Plan appeared first on The Daily Signal.

What Obama Got Wrong in His Latest Defense of Obamacare

On Monday, President Barack Obama remarked during a press conference on the likely demise of his health care law as President-elect Donald Trump and a Republican-controlled Congress have vowed to make full repeal of Obamacare a top priority next year.

As debate over Obamacare’s repeal and replacement is getting started in Congress, it’s important to clarify some of the misleading claims made by Obama.

First, he claimed that because of Obamacare, 20 million people now have health insurance that didn’t have it before. The administration has previously reported that 17.7 million people gained coverage from late 2013 to early 2016, with an additional 2.3 million young adults gaining coverage from 2010-2013.

However, the administration’s figures are estimates based on survey data rather than calculating the actual change in coverage in different markets.

The Heritage Foundation has measured the changes since Obamacare’s major coverage expansion provisions began in 2014 using actual enrollment data for Medicaid and private insurance and found that the coverage gains for 2014 and 2015 are just over 14 million people, with 11.8 million of those gaining coverage through the law’s Medicaid expansion.

Unfortunately, the Medicaid program has a poor track record in providing access to quality care, especially in comparison to private health insurance. Moreover, Obamacare’s Medicaid expansion cost about 50 percent more than it was projected to in 2015, adding to existing concerns about the program’s financial sustainability.

In addition, Obama made the oft-repeated claim that Obamacare has bent the health care cost curve downward. But in fact, the decline in health spending growth largely occurred prior to the implementation of Obamacare and has been mostly attributed to the Great Recession.

Obamacare’s coverage expansion provisions will cost more than $1.8 trillion over 2017-2026 and the provisions that are supposed to pay for that new spending have always been questionable.

Indeed, many of the law’s taxes have been delayed, changed, or waived for certain years—meaning that much more of Obamacare’s spending is unpaid for, adding to the burden of future generations.

Obama also said that “people who have health insurance are benefiting in all sorts of ways that they may not be aware of,” such as free mammograms and different insurance protections. While that may be true, there are also millions of American families that are very aware of the increase in cost caused by those new mandated benefits.

For example, in 2017, on the Obamacare exchanges in 39 states, the average premium increase for the benchmark plan will be 25 percent. For families with coverage through their employer, the Kaiser Family Foundation finds that average premiums have increased $4,372 from 2010 to 2016.

Then Obama asked, “What happens to those 20 million people that have health insurance? Are you going to just kick them off and suddenly they don’t have health insurance?”

Trump and leaders in Congress have repeatedly assured Americans that there will be a smooth transition from Obamacare to the new reforms. Indeed, when Congress passed a repeal of major pieces of Obamacare in 2015 (vetoed by Obama), the bill included a two-year delay to ensure no one would abruptly lose coverage.

Since 2010, Obamacare has proved time and again that its flawed policies cannot work. Now, with drastically increased health care costs and decreased choices, Obamacare’s repeal and replacement is more important than ever.

The post What Obama Got Wrong in His Latest Defense of Obamacare appeared first on The Daily Signal.

How Republicans Can Start to Dismantle Obamacare With a Trump Presidency

The GOP’s long-discussed dreams of repealing Obamacare became closer to reality early Wednesday morning when Donald Trump was elected president.

Six years after President Barack Obama signed the Affordable Care Act into law and after more than 60 attempts to repeal it, Republicans now have a good chance to advance their own agenda.

While on the campaign trail, Trump repeatedly promised voters that he would repeal Obamacare if he was elected president and even called on congressional Republicans to call a “special session” to move forward with rolling back the law.

“Obamacare has to be replaced,” Trump said earlier this month during a stop in Pennsylvania. “And we will do it, and we will do it very, very quickly. It is a catastrophe.”

Now, following Trump’s defeat of Democratic presidential nominee Hillary Clinton, Republicans are laying the groundwork for dismantling the Affordable Care Act next year.

“I don’t think it’s going to be a sentence-per-sentence destruction of the bill, but I do think that substantial chunks of it are in really grave danger,” Seth Chandler, a visiting scholar at George Mason University’s Mercatus Center and a professor at the University of Houston Law Center, told The Daily Signal.

Republicans need 60 votes in the Senate to pass a bill repealing the health care law and would fall short of that threshold in the new Congress, where the GOP will hold at least 52 seats.

But GOP lawmakers are likely to use a budget tool called reconciliation—a procedure used in the Senate that allows a bill to pass with 51 votes—to roll back key provisions of Obamacare and avoid a Democratic filibuster.

The GOP-led House and Senate passed a budget resolution last year that included instructions to use reconciliation to repeal Obamacare and were ultimately successful in getting it to Obama’s desk, where it was vetoed.

The bill called for the repeal of the individual and employer mandates, Medicaid expansion, tax credits, medical device tax, and Cadillac tax. It also stripped the government of its authority to run the exchanges set up under the law and lessened the fine for failing to comply with the mandates to $0, which was needed to abide by Senate rules.

GOP leaders in the House and Senate haven’t committed to using reconciliation again next year to dismantle the Affordable Care Act, but House Speaker Paul Ryan said Wednesday the law is “collapsing under its own weight.”

“This Congress, this House majority, this Senate majority has already demonstrated and proven we’re able to pass legislation and put it on the president’s desk,” Ryan, R-Wis., said during a press conference. “Problem is, President Obama vetoed it. Now, we have a President Trump who has promised to fix this.”

Ryan’s counterpart in the Senate, Majority Leader Mitch McConnell, also said Wednesday that Obamacare’s repeal is a priority for the GOP-led Senate.

“It’s pretty high on our agenda as you know,” McConnell, R-Ky., said. “I would be shocked if we didn’t move forward and keep our commitment to the American people.”

As Congress considers and crafts a reconciliation bill rolling back key aspects of Obamacare, Trump can take steps on his own to “make the Affordable Care Act’s life miserable,” Chandler said.

The first thing the president-elect can do is end cost-sharing reductions, Chandler said, which are payments the federal government makes to insurance companies that provide silver-level plans to consumers.

“The Affordable Care Act is fragile enough that doing this one thing of refusing to pay the cost-sharing reduction payments will be enough to strike a mortal blow,” he said.

The House filed a lawsuit against the Obama administration in 2014 over the cost-sharing reductions on the grounds that the Department of Health and Human Services was using money that Congress never appropriated.

That lawsuit is currently weaving its way through the courts, but Chandler argued that Trump can stop cost-sharing reductions on his first day in office. Doing so would likely cause insurance companies to leave Obamacare’s exchanges and cancel policies, Chandler said.

Such action on the part of insurers would have a significant impact on consumers, but it could be used as a “starting point” for negotiations with congressional Democrats over a replacement for the health care law.

“Trump holds a very powerful card in his hand,” Chandler said.

In addition to ending cost-sharing reductions, Trump can also begin the rulemaking process to roll back several regulations implemented under Obamacare, including the contraception mandate and the essential benefits requirement.

The controversial contraception mandate, which was challenged before the Supreme Court this year, requires employers to provide their workers with health insurance plans that cover contraceptives and abortion-inducing drugs.

Under the essential benefits requirement, health insurance plans must cover a number of health care services, which include ambulatory patient services, emergency services, maternity and newborn care, and preventive and wellness services.

After Obamacare became law in 2010, Republicans pledged to repeal it while campaigning during the 2014 midterm and 2016 general elections but haven’t been successful.

Obamacare’s fourth open enrollment period began last week, and consumers have until Dec. 15 to purchase coverage that begins in January.

Though 20 million Americans gained health insurance coverage under Obamacare, many consumers have seen their premiums and deductibles increase over the last three years.

Monthly premiums for plans sold on Obamacare’s federal exchange next year will rise by an average of 25 percent, and consumers have fewer choices than they have had in the past.

Ryan and House Republicans rolled out the House GOP’s replacement plan for Obamacare in June, which starts with repealing the Affordable Care Act.

The plan, part of Ryan’s “Better Way” agenda, maintains few of Obamacare’s provisions, such as a measure allowing those under the age of 26 to remain on their parents’ plans, but would also reform Medicaid and loosen regulations on health savings accounts.

Trump unveiled his own health care plan during the campaign, which includes measures to allow insurers to sell policies across state lines and to turn Medicaid into a state block grant program.

Republicans haven’t coalesced around one alternative to the health care law. But Sen. John Barrasso, R-Wyo., said Wednesday the GOP would ensure consumers have a “smooth transition” from the current health care system to a new one once Obamacare is repealed.

“People had significant disruption in their lives already,” Barrasso said. “We want a smooth transition—as smooth as possible. We’re moving away from Obamacare to patient-centered care and putting competition back in the system.”

The post How Republicans Can Start to Dismantle Obamacare With a Trump Presidency appeared first on The Daily Signal.

How Republicans Can Start to Dismantle Obamacare With a Trump Presidency

The GOP’s long-discussed dreams of repealing Obamacare became closer to reality early Wednesday morning when Donald Trump was elected president.

Six years after President Barack Obama signed the Affordable Care Act into law and after more than 60 attempts to repeal it, Republicans now have a good chance to advance their own agenda.

While on the campaign trail, Trump repeatedly promised voters that he would repeal Obamacare if he was elected president and even called on congressional Republicans to call a “special session” to move forward with rolling back the law.

“Obamacare has to be replaced,” Trump said earlier this month during a stop in Pennsylvania. “And we will do it, and we will do it very, very quickly. It is a catastrophe.”

Now, following Trump’s defeat of Democratic presidential nominee Hillary Clinton, Republicans are laying the groundwork for dismantling the Affordable Care Act next year.

“I don’t think it’s going to be a sentence-per-sentence destruction of the bill, but I do think that substantial chunks of it are in really grave danger,” Seth Chandler, a visiting scholar at George Mason University’s Mercatus Center and a professor at the University of Houston Law Center, told The Daily Signal.

Republicans need 60 votes in the Senate to pass a bill repealing the health care law and would fall short of that threshold in the new Congress, where the GOP will hold at least 52 seats.

But GOP lawmakers are likely to use a budget tool called reconciliation—a procedure used in the Senate that allows a bill to pass with 51 votes—to roll back key provisions of Obamacare and avoid a Democratic filibuster.

The GOP-led House and Senate passed a budget resolution last year that included instructions to use reconciliation to repeal Obamacare and were ultimately successful in getting it to Obama’s desk, where it was vetoed.

The bill called for the repeal of the individual and employer mandates, Medicaid expansion, tax credits, medical device tax, and Cadillac tax. It also stripped the government of its authority to run the exchanges set up under the law and lessened the fine for failing to comply with the mandates to $0, which was needed to abide by Senate rules.

GOP leaders in the House and Senate haven’t committed to using reconciliation again next year to dismantle the Affordable Care Act, but House Speaker Paul Ryan said Wednesday the law is “collapsing under its own weight.”

“This Congress, this House majority, this Senate majority has already demonstrated and proven we’re able to pass legislation and put it on the president’s desk,” Ryan, R-Wis., said during a press conference. “Problem is, President Obama vetoed it. Now, we have a President Trump who has promised to fix this.”

Ryan’s counterpart in the Senate, Majority Leader Mitch McConnell, also said Wednesday that Obamacare’s repeal is a priority for the GOP-led Senate.

“It’s pretty high on our agenda as you know,” McConnell, R-Ky., said. “I would be shocked if we didn’t move forward and keep our commitment to the American people.”

As Congress considers and crafts a reconciliation bill rolling back key aspects of Obamacare, Trump can take steps on his own to “make the Affordable Care Act’s life miserable,” Chandler said.

The first thing the president-elect can do is end cost-sharing reductions, Chandler said, which are payments the federal government makes to insurance companies that provide silver-level plans to consumers.

“The Affordable Care Act is fragile enough that doing this one thing of refusing to pay the cost-sharing reduction payments will be enough to strike a mortal blow,” he said.

The House filed a lawsuit against the Obama administration in 2014 over the cost-sharing reductions on the grounds that the Department of Health and Human Services was using money that Congress never appropriated.

That lawsuit is currently weaving its way through the courts, but Chandler argued that Trump can stop cost-sharing reductions on his first day in office. Doing so would likely cause insurance companies to leave Obamacare’s exchanges and cancel policies, Chandler said.

Such action on the part of insurers would have a significant impact on consumers, but it could be used as a “starting point” for negotiations with congressional Democrats over a replacement for the health care law.

“Trump holds a very powerful card in his hand,” Chandler said.

In addition to ending cost-sharing reductions, Trump can also begin the rulemaking process to roll back several regulations implemented under Obamacare, including the contraception mandate and the essential benefits requirement.

The controversial contraception mandate, which was challenged before the Supreme Court this year, requires employers to provide their workers with health insurance plans that cover contraceptives and abortion-inducing drugs.

Under the essential benefits requirement, health insurance plans must cover a number of health care services, which include ambulatory patient services, emergency services, maternity and newborn care, and preventive and wellness services.

After Obamacare became law in 2010, Republicans pledged to repeal it while campaigning during the 2014 midterm and 2016 general elections but haven’t been successful.

Obamacare’s fourth open enrollment period began last week, and consumers have until Dec. 15 to purchase coverage that begins in January.

Though 20 million Americans gained health insurance coverage under Obamacare, many consumers have seen their premiums and deductibles increase over the last three years.

Monthly premiums for plans sold on Obamacare’s federal exchange next year will rise by an average of 25 percent, and consumers have fewer choices than they have had in the past.

Ryan and House Republicans rolled out the House GOP’s replacement plan for Obamacare in June, which starts with repealing the Affordable Care Act.

The plan, part of Ryan’s “Better Way” agenda, maintains few of Obamacare’s provisions, such as a measure allowing those under the age of 26 to remain on their parents’ plans, but would also reform Medicaid and loosen regulations on health savings accounts.

Trump unveiled his own health care plan during the campaign, which includes measures to allow insurers to sell policies across state lines and to turn Medicaid into a state block grant program.

Republicans haven’t coalesced around one alternative to the health care law. But Sen. John Barrasso, R-Wyo., said Wednesday the GOP would ensure consumers have a “smooth transition” from the current health care system to a new one once Obamacare is repealed.

“People had significant disruption in their lives already,” Barrasso said. “We want a smooth transition—as smooth as possible. We’re moving away from Obamacare to patient-centered care and putting competition back in the system.”

The post How Republicans Can Start to Dismantle Obamacare With a Trump Presidency appeared first on The Daily Signal.

Exit Poll Reveals What Americans Think About Obamacare, Obama’s Policies

Almost half of voters nationwide, 45 percent, think Obamacare “went too far” in its attempts to reform the American health care system, according to an exit poll released by NBC News Tuesday.

Thirty-one percent of voters said the law “did not go far enough,” while 18 percent said it “was about right.”

When asked what kind of policies the next president should pursue, most voters expressed a desire for a change of course.

A plurality of voters, 46 percent, said the next president should pursue more conservative policies than President Barack Obama did, while 29 percent of voters thought the next president should continue the current administration’s policies.

Just 18 percent said the next president should pursue policies that are more liberal than Obama’s.

Obamacare has struggled to gain public support, with 54 percent of Americans opposing the law this past April, and just 44 percent supporting it, according to a Pew Research Center survey.

The post Exit Poll Reveals What Americans Think About Obamacare, Obama’s Policies appeared first on The Daily Signal.

Obamacare’s Squeeze Play on Middle-Class Taxpayers

Taxpayers are being squeezed financially in Obamacare’s tightening vice.

On one side, taxpayers already are funding Obamacare entitlements, notwithstanding President Obama’s high-profile promise to spare middle-class Americans from new taxation. Liberals in Congress and elsewhere are seeking remedies, among them heavier taxpayer subsidies and bigger deficits, that will squeeze taxpayers even more.

On the other side, those whose income is too high to qualify for subsidies must pay for overly expensive Obamacare coverage without any assistance.

Obamacare’s mandates and excessive insurance regulations, which drive excessive costs, apply to all health plans in the individual market, whether offered in or out of the exchanges.

If persons get coverage in the individual market outside the exchanges, with no tax relief or subsidy to offset their coverage, they are the hardest hit by Obamacare’s skyrocketing premium and deductible hikes.

Taxes and the Middle Class

Let’s talk taxes. During the intensifying congressional debate on Obamacare, on Aug. 11, 2009, Obama said: “My belief is, is that it should not burden people who make $250,000 a year or less.”

This was — and is — pure nonsense.

Over the next 10 years, the Affordable Care Act will raise $832 billion in taxes, fees, and penalties.

Most of Obamacare’s tax increases affect middle-class Americans, either directly or indirectly. The individual mandate penalty — which the Supreme Court ruled a “tax penalty” — is one that, curiously, mostly affects lower-income Americans.

The special taxes on medical goods and services are passed on to the middle class, such as Obamacare taxes on drugs, health insurance, and medical devices. Likewise, middle-class retirees are affected by the law’s elimination of the business tax deduction of 28 percent for drug coverage.

Consider also Obamacare’s additional tax increase, in which the Medicare payroll tax jumps from 2.9 percent to 3.8 percent. Though initially confined to a tiny cohort of “the rich” — single persons with annual incomes of $200,000 and couples with annual incomes of $250,000 — the Medicare tax increase will relentlessly push its way down deep into the American middle class.

Because the tax is not indexed to inflation, Medicare trustees now project that an estimated 79 percent of all workers eventually will pay the higher Medicare payroll tax.

Taxpayer Subsidies

Let’s also talk health insurance costs. Low-income folks are largely insulated from the premium shocks.

Under the Affordable Care Act, a person with an income between 100 percent of poverty ($11,770) and 400 percent of poverty ($47,080 ) is eligible for a sliding scale of premium “tax credits” if, and only if he or she buys a health plan in the Obamacare insurance exchanges.

For most enrollees, these “tax credits” aren’t really conventional tax credits, because they’re not credited against anybody’s federal income or payroll taxes. They are simply taxpayer subsidies.

Nonetheless, given the big, impending premium hikes averaging 25 percent nationwide in 2017, these subsidies largely shield enrollees (about 85 percent) from Obamacare’s explosive costs. The higher one’s income on the statutory scale of income eligibility, the smaller the subsidies.

Likewise, if a person enrolled in an exchange plan has an annual income of 250 percent of the poverty level ($29,425) or less, that person is eligible for “cost-sharing” subsidies.

Deep Trouble

For 2017, the average “silver plan” deductibles are estimated to be $3,572 for single coverage and $7,474 for family coverage. Because of cost-sharing subsidies, eligible low-income persons also are insulated from big out-of-pocket costs.

But a large chunk of the American middle class earns too much (more than 400 percent of the poverty level) to qualify for either the premium tax credits or the cost-sharing subsidies.

If these persons don’t have, or have lost, employer-sponsored health coverage, they are in deep trouble.

They can risk going “bare” with no insurance – certainly a cheaper, yet risky option — and pay the relatively small price of taking that big risk by coughing up the individual mandate’s tax penalty. Or, instead of joining the ranks of the uninsured, they can enroll in health coverage outside the Obamacare exchanges.

The number of persons who buy health coverage outside the exchanges — about 10 million people altogether – is almost the same as those who are enrolled in the Obamacare exchanges, according to the data. But if these persons enroll in the individual insurance plans operating outside the exchanges, they are, as noted, unprotected from the full shock of the impending premium increases and explosive out- of- pocket costs.

One could argue that persons who aren’t eligible for subsidies and who enroll in coverage outside the exchanges can find insurance options that are somewhat more generous because they have broader provider networks, assuming they can afford them.

These folks invariably are taxpayers, like their neighbors who get coverage at their place of work, but they have no tax relief to offset the cost of their more expensive coverage.

Especially Tough

Plans on and off the exchanges are under the same benefit and insurance rules of the Affordable Care Act. The levels of coverage, with some exceptions, are categorized under the same metallic tiers — platinum, gold, silver, and bronze.

On the Obamacare exchanges, the so-called “silver” plans –the standard plans eligible for both sets of taxpayer subsidies — naturally dominate.

Outside the Obamacare exchanges, the distribution of the metallic coverage tiers is quite different. Recent research indicates that expensive (high premium) “gold” plans have 25 percent of the individual market outside the exchanges (compared to just 12 percent on the exchanges), while 38 percent of the plans offered on the individual market were lower premium “catastrophic” or “bronze” plans with big deductibles.

This could be especially tough for persons buying coverage outside the exchanges.

Next year, persons on the exchanges who choose a “bronze” plan face an average deductible of $6,000 for single coverage and $12,393 for family coverage. Persons buying coverage outside the exchanges also face even higher premiums and deductibles.

For middle-class families who find themselves in this situation, buying health insurance would be akin to taking out a second mortgage. People buying individual health insurance don’t even enjoy individual tax relief for their coverage unless they are self-employed.

A Genuine Free Market

In 2017, the new president and Congress should junk Obamacare’s complicated, confusing, and dysfunctional subsidy program and replace it with a simpler, more rational, and more cost-conscious system.

At the heart of that reform — as the late Nobel laureate Milton Friedman of the University of Chicago and a generation of conservative economists have argued for decades — must be the provision of individual tax relief for health insurance.

Such a new system would promote a genuine free market in health care without the excessive tax and regulatory penalties. It also would enable Americans to control their health care dollars and decisions.

That, once again, would be an enormous improvement in the lives of millions of Americans, and a positive, even revolutionary, change in the giant health care sector of the economy.

The post Obamacare’s Squeeze Play on Middle-Class Taxpayers appeared first on The Daily Signal.

Obamacare Revealed as Masterpiece of Government’s Failed Central Planning

Obamacare, a veritable fountain of unintended consequences, is a 21st century showcase of government central planning. Let’s be clear. This is what President Obama wanted.

Liberals in Congress meticulously designed the Affordable Care Act’s insurance exchanges as powerful regulatory bodies. They defined the kinds of insurance plans, benefits, and medical treatments and procedures the plans must offer; set all of the insurance rules; determined the permissible premium and deductible levels; and organized the most complex and confusing premium subsidy program imaginable.

So, federal government control was, and is, comprehensive. They planned it all.

President Obama’s most high-profile promises, reinforced by “progressive” propaganda, have yielded the following: Americans have less consumer choice, less market competition, exploding insurance premiums, ridiculous deductibles, fewer doctors, a narrowing of provider networks — no, you can’t necessarily “keep” your doctor — and the looming prospect of ever bigger burdens on taxpayers.

Through it all, the Obama administration’s academic and media allies have remained fiercely loyal.

Last year, New York Times columnist Paul Krugman hailed the health care law as “a portrait of policy triumph.” This year, New York magazine’s Jonathan Chait opined: ‘The policy rationale for repealing the Affordable Care Act continues to disintegrate, while the political conditions to replace it with an alternative have collapsed entirely.”

Let’s also be clear about something else: What “progressive” politicians want, and their academic and media cheerleaders like, most Americans don’t want or like.

Regardless of the outcome of the presidential election, Obamacare, heading into Year Seven, remains persistently unpopular — with more and more people saying the law is hurting them.

Moreover, the law is not working as officially anticipated. The proof is in the data.

For 2016, the Congressional Budget Office initially projected 21 million people would enroll in the exchanges. The reality: Only about 11 million enrolled.

For 2017, the Obama administration is projecting 13.8 million will sign up for coverage in the exchanges. You can bet, however, that the actual number who remain will be significantly less.

According to the Kaiser Family Foundation, 17 million more persons have health insurance in 2016 compared to 2013. But the so-called “market” is churning rapidly.

Examining complete enrollment data for the 2014 to 2015 period, a Heritage Foundation analysis shows that enrollment in individual insurance (mostly exchange enrollment) increased by 5.8 million, while total private employer market enrollment fell by almost 3.6 million.

This means that total private market coverage over that two-year period increased by almost 2.3 million. On the other hand, Medicaid coverage jumped by almost 11.8 million.

So, Obamacare is mostly a major Medicaid expansion. The law is not encouraging Americans’ enrollment in a robust, well-functioning private insurance market; it’s discouraging it.

Consider insurer supply. President Obama promised health insurance market competition would blossom. In 2014, Urban Institute analysts, examining the impact of the law in 10 states, concluded: “The Affordable Care Act has resulted in considerable competition.”

A Heritage analysis in 2014, however, examining insurers’ participation in all 50 states, came to a different conclusion; it found a 21.5 percent reduction in the number of insurers nationwide, reflecting the transition from 2013 to 2014.

During that big transition, millions lost their health insurance plans whether they liked them or not. Liberal commentators dismissed these losses as the elimination of “junk plans” or “substandard plans,” meaning they imposed excessive out-of-pocket costs or provided insufficient coverage.

But today enrollees on the Obamacare exchanges face standard “silver” plan deductibles that average $3,572 for single coverage and $7,474 for family coverage. For the lowest cost “bronze” plans, deductibles amount to roughly $6,000 for single coverage and $12,393 for family coverage.

Taxpayers subsidize the vast majority of exchange enrollees, more or less heavily, depending on their income. Eligibility for insurance premium subsidies ranges from 100 percent to 400 percent of the federal poverty level, and the lowest income enrollees benefit the most.

Even so, the Kaiser Family Foundation finds that 40 percent are dissatisfied with their premiums and 46 percent are unhappy with their deductibles.

For any person making in excess of $47,080 per year — a large chunk of America’s middle class — there are no Obamacare taxpayer subsidies for either premiums or deductibles for individual insurance. Unless he or she is self-employed, there is not even any tax relief.

These folks, of course, can buy outside the Obamacare exchanges, where they are likely to secure broader provider networks in the standard health plans, but they pay even higher premiums and deductibles. But they can’t just buy health plans tailored to their personal wants and needs.

Meanwhile, the meltdown of health insurance competition intensifies. In 2017, 15 new insurers will enter the exchanges, but 83 insurers are dropping out. Moreover, according to the latest Heritage review of the data, one third of all U.S. counties (32.8 percent) will have only one insurer and another third (35.9 percent) will have only two insurers.

So, private insurance plans fail, fewer doctors are in the exchanges, Americans have less choice and face less competition. To keep supply up, the administration and its congressional allies want to bail out insurance companies — with more subsidies. To keep demand from falling through the floor, several “progressive” proposals would increase taxpayer subsidies to alleviate the law’s ugly impact on enrollees’ cost sharing.

The most far-reaching proposal would offset all out-of-pocket costs in all private insurance, both in and out of the exchanges. That would be enormously costly for taxpayers, and explode the nation’s deficit by as much as $90 billion in 2018.

No surprises here. The tacit premise of Washington’s central planners is that anything they screw up can be fixed. Just add more government micromanagement and more taxpayers’ dollars.

The post Obamacare Revealed as Masterpiece of Government’s Failed Central Planning appeared first on The Daily Signal.