Thursday was the deadline for the fourth open enrollment period under Obamacare, and administration officials tried to put a happy face on the health reform, but a pair of studies this week highlight escalating problems.
The nonpartisan Center for Health and Economy estimated that it will cost almost $10 billion more next year to subsidize millions of Americans who buy health insurance on the online exchanges created by the law, formally known as the Affordable Care Act. Meanwhile, The Heritage Foundation disputed the government’s official enrollment statistics, arguing the net gain in the insured outside of the expansion of Medicaid has been minimal.
“All the indications I’ve heard are that the repeal is going to happen relatively early next year.”
That news likely will only embolden Republican lawmakers who have tried for years to repeal Obamacare and soon will have a president who will not stand in the way.
“All the indications I’ve heard are that the repeal is going to happen relatively early next year,” said Brian Blase, a senior research fellow at George Mason University’s Mercatus Center.
Health and Human Services Secretary Sylvia Burwell told CNN’s “New Day” program Thursday that 4 million new people have enrolled and that the numbers are moving up.
“It’s a product people want and need,” she said.
But The Heritage Foundation study calls that basic premise into question. The government officially estimates that 20 million Americans have gotten health insurance as a result of Obamacare.
“They don’t talk about where those numbers come from,” said Alyene Senger, a policy analyst at the Washington-based think tank. “They don’t break that down.”
Enrollment Figures Not as Rosy
Senger said the federal government bases its estimate on survey data. But Heritage researchers Edmund Haislmaier and Drew Gonshorowski used actual enrollment figures from Medicaid and private insurance companies to calculate that the true increase is closer to 14 million as of the end of 2015 after accounting for people who lost health insurance during the period beginning with the first year of the heath exchanges in 2014.
Medicaid and the Children’s Health Insurance Program accounted for most of the gains, with an additional 11.8 million people getting coverage from those programs at the end of 2015. In the private insurance market, 5.9 million more people bought insurance in 2014 and 2015, but 3.6 million fewer people had coverage through an employer-sponsored insurance program.
Senger said Medicaid had serious problems before the Affordable Care Act, including a shortage of doctors. She said that by some estimates, a third of physicians do not accept new Medicaid patients, often because of low reimbursement rates.
“Those problems have only been exacerbated by adding 14 million people to the program,” she said. “We should have reformed the broken Medicaid program rather than just dumping 14 million people in it.”
The Center for Health and Economy study estimated that the average monthly subsidy provided to lower-income Americans who buy insurance on the online marketplace will increase by $76 or 26 percent, to $367 in 2017. That works out to a $9.8 billion increase overall, with the taxpayer cost zooming from $32.8 billion to $42.6 billion.
Blase, the George Mason researcher, said that should be no surprise given that overall cost of health care is rising so fast. Just before the election, the Department of Health and Human Services acknowledged that the average cost of the second-cheapest “silver” plan sold to 27-year-olds on the exchanges would rise 25 percent next year.
“That’s the reason that the subsidies are going up so much,” said Blase, a former staffer on the House Committee on Oversight and Government Reform.
[lz_table title=”Insurance After Obamacare” source=”Heritage Foundation”]Type of Insurance,Change 2013-15
Individual market,5.86 million
Employer market,-3.6 million
|Total private market,2.27 million
|Total change,14.02 million
Senger said it is a sign that original projections by the Congressional Budget Office that the Affordable Care Act would reduce the budget deficit could turn out to be wrong. The CBO also misfired on its projection that 26 million Americans would be covered under the new law. In addition, the Medicaid expansion has been nearly 50 percent more expensive than expected.
Even with Republican majorities in both houses of Congress and President-Elect Donald Trump pledging to repeal Obamacare, killing the law will be no easy task. At least part of it could be repealed the same way it was passed — through a process known as “budget reconciliation,” which requires only a simply majority in the Senate. Congress used that process last year to repeal the law, but Obama promptly vetoed it.
60 Votes Might Be Necessary
Parts of the law placing costly coverage mandates on insurance companies, however, may be subject to a 60-vote threshold to overcome a Democratic filibuster. If Democrats block it, Blase said, Trump could investigate whether he can use waivers provided for in the law to lift the burden on insurance firms. He said Trump also might be able to follow the precedent set by Obama, who delayed or changed many aspects of the Affordable Care Act without explicit congressional authority.
“They would explore all of those options,” he said.
Blase, who this week wrote a paper outlining how Congress should go about repealing the law, said lawmakers should take the opportunity to undertake a comprehensive reform of Medicaid. Instead of compensating doctors, hospitals, and other health care providers, he said, the government should set up and fund health savings accounts for Medicaid recipients.
He said it probably could be done more cheaply than the $6,000 average cost per enrollee and that giving the money directly to recipients would increase the incentive for them to be more thoughtful consumers.
“When people feel an ownership of the money, they make better decisions,” he said.
Blase said state-run, high-risk pools or federally subsidized reinsurance programs could be the solution for seriously ill people and folks with costly pre-existing medical conditions.
Congress will need time to work out those details. Under the emerging plan, Congress would quickly repeal the law but phase out the subsidies over two or three years while lawmakers hash out the provisions.
“Replace should happen by time they take their August recess,” Blase said. “They need to have a replacement passed as early in 2017 as possible.”
Obamacare critics argue that while the law expanded the ranks of the insured, it did little to constrain rapidly rising costs or make it easier for those who have insurance to actually see doctors.
“I don’t think coverage is the only mark to grade the ACA by,” said Senger, the Heritage scholar.