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ASSOCIATED PRESS
Democratic presidential candidate Hillary Clinton listens to Dr. Christopher Beckett, CEO of Williamson Health and Wellness Center during a tour an exam room of the facility in Williamson, W.Va.
WASHINGTON >> With the hourglass running out for his administration, President Barack Obama’s health care law is struggling in many parts of the country. Double-digit premium increases and exits by big-name insurers have caused some to wonder whether “Obamacare” will go down as a failed experiment.
If Democrat Hillary Clinton wins the White House, expect her to mount a rescue effort. But how much Clinton could do depends on finding willing partners in Congress and among Republican governors, a real political challenge.
“There are turbulent waters,” said Kathleen Sebelius, Obama’s first secretary of Health and Human Services. “But do I see this as a death knell? No.”
Next year’s health insurance sign-up season starts a week before the Nov. 8 election, and the previews have been brutal. Premiums are expected to go up sharply in many insurance marketplaces, which offer subsidized private coverage to people lacking access to job-based plans.
At the same time, retrenchment by insurers that have lost hundreds of millions of dollars means that more areas will become one-insurer markets, losing the benefits of competition. The consulting firm Avalere Health projects that seven states will have only a single insurer in each of their marketplace regions next year.
Administration officials say insurers set prices too low in a bid to gain market share, and the correction is leading to sticker shock. Insurers blame the problems on sicker-than-expected customers, disappointing enrollment and a premium stabilization system that failed to work as advertised. They also say some people are gaming the system, taking advantage of guaranteed coverage to get medical care only when they are sick.
Not all state markets are in trouble. What is more important, most of the 11 million people covered through HealthCare.gov and its state-run counterparts will be cushioned from premium increases by government subsidies that rise with the cost.
But many customers may have to switch to less comprehensive plans to keep their monthly premiums down. And millions of people who buy individual policies outside the government marketplaces get no financial help. They will have to pay the full increases or go without coverage and risk fines. (People with employer coverage and Medicare are largely unaffected.)
Tennessee’s insurance commissioner said recently that the individual health insurance market in her state is “very near collapse.” Premiums for the biggest insurer are expected to increase by an average of 62 percent. Two competitors will post average increases of 46 percent and 44 percent.
But because the spigot of federal subsidies remains wide open, an implosion of health insurance markets around the country seems unlikely. More than 8 out of 10 HealthCare.gov customers get subsidies covering about 70 percent of their total premiums. Instead, the damage is likely to be gradual. Rising premiums deter healthy people from signing up, leaving an insurance pool that’s more expensive to cover each succeeding year.
“My real concern is 2018,” said Caroline Pearson, a senior vice president with Avalere. “If there is no improvement in enrollment, we could see big sections of the country without any plans participating.”
If Republican Donald Trump wins the White House, he’d start dismantling the Affordable Care Act. But Clinton would come with a long list of proposed fixes, from rearranging benefits to introducing a government-sponsored “public option” as an alternative to private insurers. Not all her ideas would require congressional action.
“She is going to find it important to continue to expand health care,” said Joel Ario, a former Obama administration official who’s now with the consulting firm Mannatt Health.
People in the Clinton camp say she recognizes that as president she’d have to get Obama’s law working better, and is taking nothing off the table.
A look at some major ideas and their prospects:
PUBLIC OPTION
Clinton’s primary rival, Vermont Sen. Bernie Sanders, advocated “Medicare for all” and that pushed Clinton to a fuller embrace of government-run insurance. But Democrats could not get a public option through Congress even when they had undisputed control. Whichever party wins the Senate in November, the balance is expected to be close and Republicans are favored to retain control of the House.
While a new national insurance program seems a long shot, Obama’s law allows states to experiment. “I think the public option is more likely to be tested at a state level,” Sebelius said.
SWEETENING SUBSIDIES
Clinton has proposed more generous subsidies and tax credits for health care, which might also entice more people to sign up. But she’d have a tough time selling Republicans. It may be doable in the bargaining around budget and tax bills, but Democrats would be pressed to give up some of the health law’s requirements, including a premiums formula that tends to favor older people over young adults.
INCREMENTAL CHANGES
Whether it’s fixing a “family glitch” that can prevent dependents from getting subsidized coverage, requiring insurers to cover more routine services outside the annual deductible, or reworking the premium stabilization program for insurers, incremental changes seem to offer a president Clinton her easiest path.
MEDICAID EXPANSION
Expect a Clinton White House to tirelessly court the 19 states that have yet to expand Medicaid for low-income people. She’d ask Congress to provide the same three full years of federal financing that early-adopting states got under the health law. GOP governors would demand more flexibility with program rules.
“I’m just hoping that reality begins to sink in when she is inaugurated,” Sebelius said. “If the law is not going to go away, then let’s make it work.”
The Public Option seems the best bet; but, it should be could with price controls. Britain tells it’s doctors how much they will make, we should probably do the same. And, of course, we should extend that to medical suppliers as we have found how unscrupulous they can be.
Great idea! Price controls. Maybe the government should tell JustBobF how much he can make while he’s on a waiting list for care. I don’t suppose any of the government officials were unscrupulous when Obamacare was force fed to the country.
Oh, yes. Let’s be like the Brits–and have some bureaucrat decide when we are too old to warrant lifesaving medical care or a hip replacement because central planning ala the Soviet Union and various people’s republics are so, so effective.
Britain’s doctors are employees of the NHS, like Kaiser doctors are for Kaiser.
Canada’s are private doctors who bill to the provincial health plans.
They negotiate rates with the health plans, which are like an insurance company.
With US PPO’s the doctors also negotiate rates,
The patient may have to pay part of it, but they have agreed to only bill at a certain rate.
The ACA was supposed to be Obama’s legacy achievement. The implosion of Obamacare should be the I told you so of the century. The only people that couldn’t see this coming are the profoundly uninformed, the hopelessly gullible and the willfully ignorant. It was rushed through without any of the democrats responsible for it having read or understood it. Speaker Pelosi insultingly stated “we have to pass the bill to find out what is in it”. Barrycare’s architect, Jon Gruber had nothing but contempt for the electorate stating they had to rely on “the stupidity of the American voter” to ensure the bill’s passage. Let’s not forget Barry reassuring us multiple times that we could keep our doctor if we liked our doctor. Mr. Trump needs to hang this betrayal of the citizenry around the neck of Hillary Clinton and all democrats for that matter. Good going dems.
Klastri (aka Kurt on Kauai or kauai).. You said OBAMACARE is O’s signature law that IS his LEGACY.
How’s it working?
Typical Gruber voters. Obama pees on their head and they sing and dance in the “rain.” If you like your liar, you can keep your liar.
Crooked Hilliary. Four more years. She should start by telling the voters why she should be POTUS instead of talking stink. This lady has no class.
If she had ANY class, she never would have settled for a lying, white trash sexual predator who pulled her down into the gutter, taught her how to lie and embroiled her in one scandal after another.
When one thinks back to the time of the wholesome, eager, mid-western ‘Goldwater Girl’ of 1964 about to go off to Wellesley, then it becomes apparent how fast she went over to the dark side – – and with such gusto.
No surprise: her hero in college, Saul Aulinsky, dedicated his book to Satan. In Hillary Diane Rodham he found the perfect acolyte, willing, able and ready to worship at his altar of evil.
She’ll be above the law again, her party and party voters will fall on deaf ears and blank minds and say my dumb voters won’t know the difference. They just want me be the first woman to be a president. That’s America today, corrupt as ever, love it or leave it.
Biggest scam ever pulled on American, by their own politicians. OneBigAssMistakeAmerica is almost out the door, and it looks like your average dumb American is about to make another very big mistake.
Nixon are was a good experiment but sadly it is not working due to medicine not being a free market. So might as well drop the pretest and go entirely with a single pay system. Medicare for all. Yes the system may not be perfect but at least everyone will be covered and the medical industrial complex won’t be able to keep ripping people off like with that pen that was in the news.
So pay Hawaii physicians even less?
What will this do to our shortage of Hawaii physicians?
How about at least one Democrat read the entire bill. I wonder if Pelosi now knows what in it since this thing was passed or is she still clueless about it.
This story seems a lot like Honolulu’s rail scheme. Both government programs need a great deal of imagination to think they are practical solutions. Both are very expensive tax payer funded programs. Never have we been so misled by unfulfilled or simply untrue promises made by our politicians.
Having shot ourselves in one foot with the now-failing Obamacare, Hillary will inevitably opt to shoot us in the other foot with another stab at single payer health care— it’s in her socialist DNA.
Do you guys know medicare rates for doctors are HALF? Let me tell you do the same job for half the pay
Let’s look at the UK’s National Health Service. The UK has a single payer scheme i.e. medicare for all. Yes care is “free” but wait times for specialized care are out of control. In addition the NHS is plagued with doctor shortages (guess that’s what happens when the gov’t tells doctors how much they can earn) and low worker morale. Look no further than the scandalous manner in which our veterans are treated – or not treated – by the Veterans Administration. The problems with gov’t administered health care are well documented but progressives willfully ignore them with the crazy notion that “free” health care is a right. It’s all part of the totalitarian dream. Disarm the populace, control their access to health care, regulate free speech via political correctness and regulate every aspect of life under the false assumption of man caused global warming. It’s time for the folks to man-up and quit looking to central government as mommy and daddy.
In my opinion the most wicked part of the ACA is the individual mandate.
It almost seems like the ACA was a scheme to put everyone under the thumb of the federal government and the IRS, using this nasty trick.
I have heard nightmares of people who were making good money, lost their jobs and were then stuck with a huge fine because they no longer had health insurance within the allowed time period.
At the same time, freeloaders who do not work at all, get it for free because they have had no salary to speak of.
The phony excuse for the mandate is that it is necessary to do this because if you do not have everyone forced into the scheme, there will not be enough healthy people to pay for the sick people.
This problem could have been easily solved by simply funding the ACA out of general revenue taxes.
Taking Canada as an example, people are not forced to join, there is no such big fat IRS federal foot on the throat of every man woman and child.
In fact, the federal government does not even run it, each province runs its own plan.
There is a long list of things that are wrong with it.
It seems to have been a remarkably stupid idea.
Not that what we had before was all that great.
But we need to do much better than this.
In my opinion the worst part of the ACA is the individual mandate.
It almost seems like the ACA was a scheme to put everyone under the foot of the federal government.
I have heard nightmares of people who were making good money, lost their jobs and were then stuck with a huge fine because they no longer had health insurance within the allowed time period.
At the same time, freeloaders who do not work at all, get it for free because they have had no salary to speak of.
The excuse for the mandate is that it is necessary to do this because if you do not have everyone forced into the scheme, there will not be enough healthy people to pay for the sick people.
This problem could have been easily solved by simply funding the ACA out of general revenue taxes.
Taking Canada as an example, people are not forced to join.
In fact, the federal government does not even run it, each province runs its own plan.
There is a long list of things that are wrong with it.
It seems to have been a remarkably bad idea.
Not that what we had before was all that great.
But we need to do much better than this.
Absolutely agree. The mandate is nothing more than a tax for something you don’t have. On top of that, you’re subsidizing the medical coverage for the lower income, welfare recipients, and the lazy .
“If there is no improvement in enrollment, we could see big sections of the country without any plans participating.” This was pointed out YEARS ago and still, the poorly planned out ACA was rammed down the throats of the American taxpayers. Who is Hillary going to blame this on if she wins the election? Barry? The Dems who voted for it? The Supremes who gave it their blessing?
As if any more proof were needed the rapid failure of Barrycare is evidence of his unfitness to lead (too late now). Looks he can’t lean on the ACA for his legacy. He will have to find another achievement to bring him immortality. Maybe the hostage swap that released a traitorous US Army soldier for 5 Taliban fighters, or the deal with Iran that virtually insures they will go nuclear, or trans restrooms in public schools.