Monday, June 27, 2016

An Obamacare Schadenfreude Update

The almost invariably sensible Megan McArdle catches Obamacare Premiums Going Up. Again. Now What?
. . . In health insurance markets, this phenomenon is known as the adverse-selection death spiral. Basically, every time the price of insurance goes up, many of the people in the insurance pool who use the least health care decide that it makes more sense to go without the insurance and bear the risk themselves, and they drop their coverage. That means you’re left with the more expensive patients to cover, which means the average cost goes up, which means prices have to go up … and, well, you get the idea. The price the market eventually finds may be so high that very few people want to buy the insurance.

Now, there are factors weighing against this, most notably the mandate and the subsidies. So far, the mandate seems to have had very little effect on people's propensity to buy insurance. I’ve been careful to say in the past that that might change, because the mandate penalties were phased in over a few years and are only now at full strength. However, next year will pretty much tell us whether the mandate is going to work. If we don’t see a substantial increase in the number of people buying insurance for 2017, then it will be safe to say that the mandate was too weak, and that we are not going to get the hoped-for surge of young, healthy people into the Obamacare exchanges. Which, in turn, will be bad news for prices.
In the past, Megan has doubted the death spiral, but it seems she might be softening her optimism.

And another one bites the dust: Blue Cross Blue Shield of Minnesota announces exit from Obamacare exchange

And just as I'm resigning myself to using it: Obama is gutting Medicare. Watch him push grandma off the cliff:
The president’s Medicare reforms make it harder for seniors to get joint replacements. His new payment rules shortchange doctors, discouraging them from accepting Medicare in the first place. New ER rules clobber seniors with bills for “observation care.” Under ObamaCare, hospitals get bonuses for spending less per senior, despite having higher death rates and infection rates.
The House unveils its Obamacare replacement plan—and have you heard about it?. Not if you read the Washington Post, the New York Times or watch the networks. All you hear is how many times they tried to repeal Obamacare. Megan McArdle again: Republicans Have a Shot at Replacing Obamacare
So if the Republicans want to get rid of Obamacare, they have to actually come up with something that can semi-plausibly be presented as a replacement. Over the last few years, they’ve settled on a bunch of pieces that make up the cornerstone of their approach:
  1. Limiting the tax subsidy for employer-sponsored health insurance;
  2. Selling health insurance across state lines;
  3. Tort reform;
  4. Tax-advantaged health savings accounts;
  5. Flat (though age-rated) refundable tax credits for purchasing health insurance;
  6. Allowing insurers more flexibility to charge different prices by age group;
  7. Getting rid of the mandates (individual and employer), community rating, and guaranteed issue, as well as a lot of the regulatory mandates for benefit levels;
  8. Guaranteeing renewal and portability -- which is to say, if you had insurance, and you get sick, you can still buy insurance at normal rates, not rates that are risk-rated for your illness;
  9. High-risk pools for people who didn’t have insurance when they got sick, but now want to buy it;
  10. Block granting Medicaid for states who want it.
These things form the core of the new Republican plan released Wednesday. Though “new” is kind of a strong word; most of this stuff has been around for a while.
. . .
Would the Republican plan work? Define “work.” If this plan passed, could it operate roughly as described? Probably, yes. I would have some worries about adverse selection with the mandate gone -- but given that being able to obtain cheap coverage in the future relies on obtaining it now, not that many worries. Of course, the numbers are not very specific, so we don’t know how much it would cost. . .
Obama Administration Forces California Churches to Pay for Abortions. For Democrats, it "abortion über alles."
Churches in California are officially subject to an onerous state regulation that requires them to pay for abortions, thanks to a ruling by the Obama administration.

The troubling situation began in 2014 when the California Department of Managed Health Care reclassified abortion as a “basic health service” under the Affordable Care Act and ordered all insurance plans in the state to begin covering surgical abortions immediately. Even churches are not exempt from funding abortions.

The churches filed a lawsuit against the regulation last October, and it has been moving through the courts.

They also asked the Obama administration to uphold the Weldon Amendment — federal law that protects conscience rights. But, today, the HHS Office of Civil Rights released the results of its investigation into the California abortion mandate, stating it found no violation and is closing its investigation of the complaints without further action.

OCR’s decision is based on a flawed reading of the Weldon amendment. They argue that the Weldon amendment only protects health insurance plans, and not the purchasers of such plans, and state that the insurance companies have not complained.
It's not that I mind abortion, it's that I mind being forced to pay.

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