death knell for Obamacare?

[12/21/16] Federal health officials Wednesday touted a record 6.4 million customers sign-ups on the federal Obamacare marketplace HealthCare.gov so far this open enrollment season — topping last year's pace during the same time period by 400,000 customers.

And they sharply warned that insurance coverage gains under Obamacare could be lost if President-elect Donald Trump and Congressional Republicans follow through on their threats to repeal the Affordable Care Act. Those threats have led some would-be HealthCare.gov customers to ask whether they should sign up for coverage for 2017, officials revealed.

"The American people don't want to go backwards," said U.S. Health and Human Services Department Secretary Sylvia Burwell, who cited analysis that has projected up to 30 million people would lose coverage if Obamacare were to be repealed without a replacement plan in place.

"These are people's cancer therapies, diabetes medications and mental health treatments on the line," Burwell told reporters during a conference call.

"Every one of the 6.4 million people enrolled represents a story about how the Affordable Care Act has changed health care in America, and why coverage matters," she said.

"We're going to keep moving forward, we're going to finish open enrollment by enrolling more people than ever," said Burwell, who in late January is set to be replaced as HHS secretary by Trump's nominee to the department, Rep. Tom Price, R-Ga.

[11/10/16]  WASHINGTON — Donald Trump's election ushers in a time of high anxiety for people with health insurance under President Barack Obama's law, which expanded coverage to millions but has struggled to find widespread public acceptance.

While repeal now seems likely, that may take Congress months. A replacement for the 2010 health care law could take even longer, and may retain some of its features. Republicans are saying they want to protect people who now are covered from losing health care in the shift.

Voters "don't want Washington to fix Obamacare, they want to make health care affordable," said House Ways and Means Chairman Kevin Brady, R-Calif., whose committee oversees much of health care. "I'm confident we will have more truly affordable health care for just as many Americans."

"It's our goal to dismantle Obamacare and actually focus on lowering the cost of coverage for people," said Sen. John Barrasso, R-Wyo., a member of the Republican leadership. "It's a commitment on behalf of Congress and the president-elect to get this done."

[10/25/16] Obamacare premiums to rise 25% in 2017

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[8/30/16] 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.”