The ACA Repeal
Multiple outlets reported on the release of the Senate’s Obamacare repeal bill, named the Better Care Reconciliation Act (BCRA). Like the House bill (the American Health Care Act, or AHCA), BRCA would wind down federal funding of the Medicaid expansion, albeit over a few years. In the long term, however, it would actually cut the program more deeply by reducing the rate of growth of Medicad’s new per capita payments, beginning in 2025. Like the AHCA, it would repeal almost all of Obamacare’s taxes, mainly benefiting the rich and healthcare corporations. Also like AHCA, it would eliminate both the individual and employer mandate, although unlike it there would be no penalty for being uninsured, as well as no risk rating. It would additionally broaden Obamacare’s waiver program, which would allow states to fundamentally restructure their individual insurance market, for instance they might choose to eliminate the requirement that health plans cover all essential health benefits or have a particular actuarial value. I described the bill in a negative light in the Guardian, where I compared it to cyanide, a vampire, and (you’ll have to read it) water crackers.
Vox [06-19-17, Dylan Scott] interviewed almost 20 lobbyists and other healthcare experts, and reports that the healthcare industry has deliberately chosen to not strongly oppose the Obamacare repeal, as seen by the absence of any sort of PR blitz, unlike with previous legislative healthcare fights. In part the industry wants to continue to be able to influence the Trump administration’s agenda, and in part it does not want to provoke its wrath, Scott suggests. Notably, the repeal of Obamacare means different things for different healthcare sectors, though many sectors stand to gain from tax breaks contained in both the House and Senate bill.
Modern Healthcare [06-22-17, Shelby Livingston] describes how the BCRA could prove highly profitable for many insurers, insofar as it repeals the ACA’s taxes on insurers, increases the age band (allowing older individuals to be charged higher premiums), temporarily extends cost-sharing subsidies, provides some $112 billion to stabilize insurance markets, and permits states to set the set their own medical-loss-ratio (potentially allowing insurers to spend a lower percentage of premiums on healthcare). On the other hand, the law could hurt insurers who mainly are in the business of insuring low-income individuals via Medicaid HMOs.
Reuters [06-22-17, Lewis Krauskopf] reported that healthcare stocks—including insurers—shot up sharply in the wake of the release of the Senate Obamacare repeal bill, BCRA.
Vox [06-23-17, Nicholas Bagley] carried an article exploring the potential implications of BCRA’s “crazy waivers.” According to Bagley, a provision in BCRA would widen the waiver clause of the ACA enormously, essentially giving any state the ability to obtain a waiver as long as it doesn’t improve the deficit. As he describes, this could allow states to eliminate all sorts of insurance protections, including out-of-pocket maximums and essential health benefits; additionally, it could also potentially effectively eliminate annual and lifetime limits of insurance coverage, not merely in the individual market in one state, but for everybody—throughout the country.
Vox [06-23-17, Dylan Scott] reported on how the insurance industry is reacting to the ongoing Obamacare repeal. Scott notes that there are many things that insurance companies like about the BCRA, particularly its repeal of the ACA’s taxes and the money provided for a stabilization funds. Although there are some provisions that could be bad for insurers’ bottom lines, Scott quotes from investment analysts who describe it as a positive.
The Washington Post [06-18-17] had an editorial arguing that single payer had an “astonishing” price tag, and could only generate real savings cuts by reducing “standards of access and comfort” for patients, reducing physician pay, and closing rural health facilities.
I wrote a response to the Post’s editorial in Jacobin].
STAT [06-23-17, Damian Garde and Adam Feuerstein] report how the Food and Drug Administration’s approval of betrixaban (trade name: bevyxxa) despite a failed phase 3 trial might signal the beginning of a laxer era at the agency, now headed by Scott Gottlieb.