The thing about health policy “news” is that the same stories keep popping up over and over. This week we were treated to another episode of the long-running drama, “Repeal and Replace,” and also a sequel to that summertime favorite, “Premium Apocalypse.”
In this edition of “R&R” we “learn” House Republicans are readying their ACA replacement (they really really mean it this time). Except it turns out they won’t actually produce an alternative bill that could be compared to the ACA and scored by CBO so people could see how it might be financed, who would lose or gain coverage, or have to pay more or less, or anything like that. Instead, it will be a “conceptual proposal.” I wonder if it will include any “magic asterisks” like the Ryan budget proposals? Meanwhile, two Republican legislators, Senator Cassidy (R-LA) and Rep. Sessions (R-TX), did unveil an actual proposal. While it is unclear if it will ever get to the CBO, we can say a few things about the proposal now. Specifically, it offers more help to the affluent while putting millions of lower-income households who depend on Medicaid (which would be block granted) and ACA sliding-scale credits (which would be shifted to a flat amount too low to make insurance affordable) at risk.
Since summer movies are coming out, it is entirely fitting that we get another sequel to “Premium Apocalypse.” (I’ve lost track on whether this is PAIII or PAIV). Health care premiums are skyrocketing and the world (or at least the ACA) is coming to an end – send for the Avengers! No wait, wrong movie. How about we send for some real policy analysts. It turns out that while rates in the ACA marketplaces do seem likely to increase more than last year, actual increases are likely to be (wait for it…) not as high as some headlines would lead you to believe.
Based on early filings, the average proposed increase for the two lowest-cost silver plans is about 7.5 percent this year, while a similar analysis last year found proposed increases for a similar set of plans floating around 2.75 percent. Higher this year to be sure, but not all that surprising in a new market in which insurers are still developing an understanding of claims experience. And of course, as in years past, final rates are likely to be lower than those sought in initial filings. At the same time, lost in the scary headlines is the news that underlying increases in health care costs continue to be modest. That, along with the fact that premium tax credits adjust to rising health costs (a feature absent from the Cassidy/Sessions bill), suggests that the future looks pretty good for the ACA. And guess what? People actually like the coverage they are getting courtesy of the ACA and it is helping them get access to health care they would otherwise not be able to afford.
Is Single-Payer Making A Comeback?
With Bernie Sanders championing “Medicare For All,” it seems that public support for single-payer health care is back on the rise. Not only that, but it turns out that a bunch of people who often get reported as supporting ACA repeal are not waiting on a conservative replacement plan but are looking for a more publicly financed alternative instead. But let’s not get too excited. First, many questions about how a single-payer plan could actually be implemented remain. Not only that, but it is worth remembering that public opinion on single-payer is somewhat fickle, especially when proposals are subjected to sustained attack (as they inevitably are.) But perhaps most vexing is the political challenge of enacting reform through the same political process that enacted the ACA. We shouldn’t forget that even with large Democratic majorities in the House and the Senate, Congress could not pass a relatively weak version of the public option – a far less sweeping reform. With majorities of that size nowhere on the horizon, it seems that the only realistic conclusion, at least for the foreseeable future is, “You Can’t Get There from Here (Cue REM.)
For Nerds Only
A couple of interesting recent developments:
First, the House Ways and Means Committee released legislation that, among other things, would make some attempt to adjust the Medicare readmissions penalty program to take into account the challenges of caring for large numbers of low-income patients. While the legislation is not perfect and its prospects in the Senate are, how shall we say, “uncertain,” Congressional recognition that the readmissions penalty may need an overhaul is a welcome development. And speaking of paying for outcomes, a new report out from researchers at the Harvard, T.H. Chan School of Public Health raises questions about whether the Hospital Value-Based Purchasing program is having its desired effect. Maybe the readmissions program is not the only part of the “pay for value” effort that needs some tweaking.