Repeal and Revise

[WestVirginiaRebel]

City Journal:

The election of Donald Trump as president, along with the Republican Party’s retention of both houses of Congress, sets the stage for the long-promised repeal and replacement of the Affordable Care Act (ACA), popularly known as Obamacare. Obamacare boosters warn that repeal would throw 20 million Americans who have gained health insurance coverage through the law back into the ranks of the uninsured overnight. The truth is more complex. Nearly half of the coverage gains made during Obama’s presidency had nothing to do with ACA provisions and will survive repeal. Many other newly insured people will keep their coverage—if changes are made to health-care financing, and if two popular ACA provisions President-elect Trump has spoken favorably of are retained.

 

It helps to understand who gained coverage under the ACA. MIT economist Jonathan Gruber, one of Obamacare’s chief architects, reported in the New England Journal of Medicine that 63 percent of the coverage gains owed to increased Medicaid enrollment. Nearly 70 percent of that Medicaid coverage increase (44 percent of the overall coverage increase) came from people who were already eligible for Medicaid coverage before ACA passage. This had nothing to do with the ACA’s Medicaid eligibility expansion. Previously eligible people enrolled in states that did and didn’t expand Medicaid. Gruber claimed that they signed up due to “the ACA’s streamlining of the application process for Medicaid, removal of onerous asset tests for determining eligibility for most applicants and increased public awareness about insurance coverage options.” But improved enrollment procedures are not dependent on the ACA. These previously eligible enrollees will remain insured after the ACA is repealed.

 

More than 2.3 million previously uninsured young adults between the ages of 19 and 25 gained coverage through their parents under the ACA. This provision is popular and inexpensive—the 19-25 age group is healthy and cheap to insure—and Trump has signaled that he will retain it. Adding this group (representing at least 12 percent of the coverage gain) to the previously eligible Medicaid enrollees means that more than half of those who gained coverage would retain it after ACA repeal.

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How to save health care after Obamacare.

[Valin]

Most of the remaining ACA coverage gains are attributable to people receiving subsidies to purchase insurance on the ACA exchanges. Immediate repeal would be unfair to people currently enrolling in ACA exchanges for 2017. But the subsidy/exchange regime is a mess. ACA subsidies are available to purchase only exchange plans. Insurers are abandoning the exchanges, leaving 68 percent of U.S. counties with two or fewer insurers to choose from. Nearly all exchange plans lock patients into narrow provider networks with no coverage outside the network. Moreover, exchanges must offer only plans that meet the generous and expensive ACA minimum essential benefits package. Premiums are rising 25 percent on average this year.

 

 

It should also be pointed out that the copays and deductibles make it (almost) impossible for people to avail themselves of the insurance.