Trump's Full Court Press on healthcare

[RunningMn9]

The ACA has succeeded at expanding coverage and reining in costs, so of course Republicans hate it...even though it enshrines for-profit insurance in law.

It succeeded in reining in cost GROWTH. It sure as shit did not rein in costs. It very slightly bent the cost growth curve.

[Unagi]

The ACA has succeeded at expanding coverage and reining in costs, so of course Republicans hate it...even though it enshrines for-profit insurance in law.

It succeeded in reining in cost GROWTH. It sure as shit did not rein in costs. It very slightly bent the cost growth curve.

Like nothing ever before it, in our entire lifetime.

Is that correct?

[Smoove_B]

It has also provided access to an additional ~45 million people over the last decade, both from the marketplace and Medicaid expansions (which the GOP fights/resists at every corner).

I fully admit my bias here, but as someone that fully believes every child in America should be given 2 meals a day through schools, the cost element isn't my top concern. To be clear, we should be trying to control cost but my experience is cost is use to completely eliminate thing that genuinely make society better.

[Kraken]

Well, by two of the most objective measures -- infant mortality and life expectancy -- the US is still at/near the bottom of the pack. The ACA was a good start, but was never meant to be the end state. It only became that because we have one party that's determined to see it fail.

[RunningMn9]

The ACA has succeeded at expanding coverage and reining in costs, so of course Republicans hate it...even though it enshrines for-profit insurance in law.

It succeeded in reining in cost GROWTH. It sure as shit did not rein in costs. It very slightly bent the cost growth curve.

Like nothing ever before it, in our entire lifetime.

Is that correct?

I’m not sure what you are getting at. This law, that was the first national attempt to solve a problem that it had (relatively) recently created, was the first to have any impact?

Yes, that’s probably true. My post wasn’t an anti-ACA post, although it is generally speaking a bad law that didn’t go nearly far enough. My post was simply to clarify the notion that it reined in costs.

In 2006, my family’s health insurance cost about $9000 per year. In 2023, it cost $64000 per year. And in every conceivable way, I pay more out of pocket for healthcare than I have ever paid before.

[LordMortis]

In 2006, my family’s health insurance cost about $9000 per year. In 2023, it cost $64000 per year. And in every conceivable way, I pay more out of pocket for healthcare than I have ever paid before.

When I see how much extra companies pay insure families over single people, I'm amazed at how much they eat. I always felt I got the shaft on that. People would sit in meetings and bitch about paying an extra $200 out of pocket a month to insure their family when the reality is the company was allowing them over $2000 a month benefit I did not receive. The costs are insane. In 2006 we had Cadillac plan. When I left the company the agent insisted we were in a great plan but it was on the middle end of bronze ACA plans and at way more than the unsubsidized ACA cost.

Currently an unsubsidized reasonable silver ACA HMO plan in Michigan should be about $9000 as a base with about $7500 max OOP costs in addition. Insuring a family I am guessing would be 3x that if the pool methods are similar to the way companies do it. No vision. No dental. Now I'm not sure how the ACA availability influences pricing. If the ACA disappeared and pre existing conditions limitations were re instated with limits on coverage but no limits on charges, what happens? I dunno. Not even in the zip code as someone who calculates such things.

Oddly enough I was prepared to pay that unsubsidized cost, still cheaper than COBRA (which I could have voluntarily left but this only became apparent when I applied for ACA coverage). I was hoping to get in under subsidy but I got denied entirely and put on medicaid instead, as my investment income is too small. I'm ecstatic with how much medicaid costs me (basically nothing) but it really limits who I can see and those poor people are so overworked that care for chronic illness is much less convenient than it was. OtOH, strictly from a personal financial sense, I'm willing to the the hoops and inconveniences and delays and limits on prescriptions to see $16000 a year stay in my pocket. I'm especially thankful for this because when I left my job, I did not budget for getting nailed by a car and actually doing less for myself nor did I budget for the inflation insanity to happen right after quit.

Thanks tax payers! But please do try to remember I paid in to that kitty for 40 years.

[LawBeefaroni]

In 2006, my family’s health insurance cost about $9000 per year. In 2023, it cost $64000 per year. And in every conceivable way, I pay more out of pocket for healthcare than I have ever paid before.

That is not necessarily reflective of overall cost of care, it's reflective of shifting the burden of cost of care.

Since 2000, medical care CPIU is up about 120%. in perspective, all other goods/services are up about 85%. Which isn't nothing but it's still a far cry from the 700% increase in your individual insurance costs.



Average Family Premiums Rose 4% to $21,342 in 2020, Benchmark KFF Employer Health Benefit Survey Finds

Annual family premiums for employer-sponsored health insurance rose 4% to average $21,342 this year, according to the 2020 benchmark KFF Employer Health Benefits Survey. On average, workers this year are contributing $5,588 toward the cost of family coverage, with employers paying the rest.

The survey was conducted from January to July as the COVID-19 pandemic and economic crisis unfolded and may not capture its full impact on costs and coverage. The annual change in premiums is similar to the year-to-year rise in workers’ earnings (3.4%) and inflation (2.1%), though over time what employers and workers pay toward premiums continues to rise more quickly than wages and inflation. Since 2010, average family premiums have increased 55%, at least twice as fast as wages (27%) and inflation (19%).

[Pyperkub]

More data on ACA and Costs:

So how do we think about the effects of the ACA on health care costs? When thinking about health costs, it is important to “mind your Ps and Qs”—which in this case means thinking carefully about the ACA’s impact on prices, care utilization (or the quantities of care used), and interactions between the two. The ACA had both direct and indirect effects on prices and care utilization, and these varied by market sector. Below we review prior work on the cost implications of the ACA. Then we analyze the direct and indirect effects of the ACA on Medicare, Medicaid, and the private insurance market, evaluating whether or not the ACA affected prices, quantities of care used, or both. We also discuss trends that affected all sectors or “spilled over” from one sector to others. We conclude with some thoughts about whether or not the slower spending growth experienced since the ACA’s passage will continue into the future.

Bottom line:

The direct effects of the ACA on Medicare payments, Medicaid spending on the newly eligible, and federal subsidies for Marketplace coverage can be reasonably well described and understood. The Congressional Budget Office estimated the direct effects of these changes on the federal budget repeatedly throughout the past decade in projecting the costs of ACA repeal, and it found that the on-budget costs of greater coverage were larger than the payment-related savings in Medicare—although not by much per year in the context of overall health spending. Similarly, there were other major changes in health spending that observers can agree were not triggered by the ACA or that were at most distally related. These changes include innovations in drug therapies, which have a development pipeline as long as or longer than our experience with the ACA to date; higher deductibles for consumers; and higher reimbursement rates for providers as the economy has recovered and providers have consolidated. Research indicates that provider consolidation predated the ACA’s value-based payment models...

Disentangling the exact effects of a major piece of legislation from underlying trends is nearly impossible, but it is also nearly impossible to deny that the ACA has had far-reaching cost effects on the entire health care industry. The most politically salient examples of high health care costs—including those due to the introduction of new drugs and out-of-network billing—are virtually unrelated to the ACA, while cost growth for health services in Medicare, Medicaid, and even Marketplace plans seems to be settling into a “new normal” slower rate. Whether or not these trends persist in the future depends on continued action in all of these sectors,

[Smoove_B]

Really would have been nice to retire this thread. Now it's evergreen:

"The Republican plans — they don't say they are going to repeal the ACA, but their collection of policies could amount to the same thing or worse," said Sarah Lueck, vice president for health policy at the Center on Budget and Policy Priorities, a research and policy institute. "It could happen through legislation and regulation. We're on alert for anything and everything. It could take many forms."

...

While neither Trump nor his GOP allies have elaborated on what they would change, House Speaker Mike Johnson said last month that the ACA needs "massive reform" and would be on the party's agenda should Trump win.

So what is likely to happen?

Make changes through Congress

Congress could theoretically change the ACA without a single Democratic vote, using a process known as "reconciliation." The narrow margins by which Republicans control the House and Senate mean just a handful of "no" votes could sink that effort, though.

Many of the more ambitious goals would require Congress. Some conservatives have called for changing the funding formula for Medicaid, a federal-state government health insurance program for low-income and disabled people.

...

Change through inaction

Trump could also opt to bypass Congress. He did so during his previous tenure, when the Department of Health and Human Services invited states to apply for waivers to change the way their Medicaid programs were paid for — capping federal funds in exchange for more state flexibility in running the program. Waivers have been popular among both blue and red states for making other changes to Medicaid.

"Trump will do whatever he thinks he can get away with," said Chris Edelson, an assistant professor of government at American University. "If he wants to do something, he'll just do it."

...

Change through executive orders and rule-making

In the meantime, Trump could initiate changes from his first day in the Oval Office through executive orders, which are directives that have the force of law.

"The early executive orders will give us a sense of policies that the administration plans to pursue," said Allison Orris, a senior fellow at the Center on Budget and Policy Priorities. "Early signaling through executive orders will send a message about what guidance, regulations, and policy could follow."