Affordable Care Act aka Obamacare 2012-16

15 December
Opinion: He won’t actually take away my insurance, will he?
(NYT) “I kept hearing informed voters, who had watched the election closely, say they did hear the promise of repeal but simply felt Trump couldn’t repeal a law that had done so much good for them.”
Linger on that last phrase: simply felt Trump couldn’t repeal a law that had done so much good for them.
It comes from Sarah Kliff of Vox, who went to Corbin, Ky., to interview people who had received health insurance from Obamacare — and then voted from Donald Trump.
To some extent, they understood what they were doing, that their insurance was a result of Obamacare, and that Trump vowed to repeal it. They voted for him anyway, because they liked other things about him and because they figured he wouldn’t really get rid of their insurance. If anything, they hoped he would fix the parts they didn’t like, just as he promised.
But there is no magical fix for Obamacare. Our health care system is a messy hybrid of the public and private sectors. Obamacare eschewed radical change — which would have been even less popular, given the disruptions — for progress within the current framework. And the law has done far more good than bad, by expanding insurance coverage and helping slow the growth of medical costs.
The Republican Party has essentially tied itself to a magical solution: getting rid of the law while keeping its benefits. The party does seem committed to repealing major parts of the law early in 2017, as Nicholas Bagley of the University of Michigan laid out in a smart tweetstorm yesterday. Yet Republicans could cause a lot of anger and frustration if they stick to their plan.
How do they solve their dilemma — a dilemma with real-life consequences for many people? It’s one of the biggest mysteries of 2017. I’ll continue to hope that those Kentucky voters have their optimism rewarded, but it’s a deeply wishful form of optimism.
The full Opinion report from The Times follows, including Faysal Itani on what comes after Aleppo falls and Mark Galeotti on how to fight Putin. I also recommend thinking about the question David Pozen poses: If the Electoral College doesn’t have a role to play now, shouldn’t it be abolished?
David Leonhardt, Op-Ed Columnist

29 November
Donald Trump picked an Obamacare critic as his health secretary. Tom Price, a former orthopedic surgeon, has advocated replacing Obamacare with a plan of tax credits, health savings accounts, and lawsuit reforms. Trump is also expected to name consultant Seema Verma to lead the Centers for Medicare and Medicaid Services.
(Reuters) Trump cast Price and Verma as a “dream team” to help him once he takes office on Jan. 20 with his campaign pledge to repeal Obamacare, the health law formally known as the Affordable Care Act. Since its enactment in 2010, it has been a target of Republican attacks.
Price has characterized Obamacare as “doing real harm to American families” and has co-sponsored legislation to replace it.
Verma helped Pence, the Indiana governor, add conservative pieces to Medicaid coverage for the state’s poor by requiring beneficiaries to make contributions to health savings accounts. She also worked on Medicaid reform programs in Iowa, Ohio, Kentucky and Tennessee.
Chuck Schumer, a top Senate Democrat, was among defenders of the law who criticized Price’s selection. “Nominating Congressman Price to be the HHS secretary is akin to asking the fox to guard the hen house,” Schumer said.

25 November
(NYT)  The president-elect and Republicans in Congress are vowing to repeal much or all of the Affordable Care Act
More people in Florida than in any other state got insurance through the new exchanges. Many refuse to believe that a benefit they count on would be taken away. (Many in Florida Count on Obama’s Health Law, Even Amid Talk of Its Demise)
But open enrollment for 2017 is underway, and Americans are steadily signing up or renewing their coverage.

14 November
Better Off Before Obamacare?
People are now spending larger shares of their income on health care than before Obamacare, but that’s not because of the law—it’s because health-care costs are growing faster than incomes.
(The Atlantic) Before the law, which Trump has said he would repeal, health insurance was cheaper for a few, but outright unattainable for many.
Repealing Obamacare is Republican voters’ biggest priority for the Trump administration, according to a recent Politico/Morning Consult poll. People who are unhappy with the Affordable Care Act overwhelmingly voted for Trump, and now 74 percent of Republicans want it gone.
The frustration with the health law is understandable; many people are struggling to afford medical care even if they have insurance. The problem is, it’s not clear Americans would have been better off had Obamacare never been passed.
First, some people might be confused about what, exactly, they’re angry at. When we talk about “Obamacare,” we’re talking primarily about the 12.7 million people who are buying individual insurance coverage through state marketplaces or Healthcare.gov. Roughly 60 million people voted for Trump last week, so they can’t all be on Obamacare exchange plans. More than half of all non-elderly Americans still get insurance through work, and premiums on employer-based plans are actually growing more slowly than average. (About a third of Americans are either on Medicare or Medicaid, and the rest are uninsured. Only about 4 percent are on the exchanges.)
Before Obamacare, insurance premiums on the individual market were rising by about 10 percent a year. But, it’s important to note, the cost of any given person’s health plan purchased this way depended on how sick they were. Insurance companies could charge people more if they had cancer, for example, or deny them coverage entirely. Insurers were partly able to keep costs down just by keeping sick people off their plans. Under Obamacare, insurers can’t do that anymore.
In 2014, right after most of the Affordable Care Act sprang into action, a middle-of-the-road plan—the “second-lowest cost silver-level” plan—was between 10 and 21 percent cheaper than a similar plan was before the ACA in 2013. So concluded an analysis published in Health Affairs in July by the economists Loren Adler and Paul Ginsburg, two health-care experts at the Brookings Institution.

2 November
(The Atlantic) Health and Safety: Back in the U.S., Donald Trump yesterday convened a “meeting talking about health care,” at which medical professionals spoke in support of the nominee’s health plan. But the specifics of that plan aren’t very clear. Despite his promise of a solution for “repealing and replacing Obamacare,” Trump’s plan seems to boil down to people simply paying their own medical bills outright. That’s not to say the current system is perfect—far from it. For example, though one of Obamacare’s biggest achievements has been expanding access to birth control, gaps in insurance coverage and states’ failure to expand Medicaid mean millions of low-income women still aren’t able to get it.
Trump’s Health Plan: Pay Your Own Medical Bills Using Money You Saved  OUCH – pretty harsh review.

28 October
Figuring out how Obamacare is faring has always been hard.
(NYT Opinion)  It’s been hard because many Republicans are rooting for the law to fail and try to make any flaw sound existential. And it’s been hard because we in the media haven’t always done a good job covering the law. We tend to sensationalize its problems, rather than distinguishing between routine ones and truly worrisome ones.
The recent spike in premiums — raising the cost of many insurance plans — is a real problem. But it’s also contained to the smaller part of Obamacare’s coverage expansion, and it’s a problem that could be easily solved by a functioning Congress.
First, some context: The 260 million or so Americans who receive health insurance through their employer, Medicare or Medicaid (including through Obamacare’s Medicaid expansion) are unaffected by the prices increases. The increases instead apply to the 10 million people who buy coverage on one of the private-insurance exchanges established by the law. Even among those 10 million, the vast majority receives government subsidies that will largely or partly cancel out the price increase.
So why do I say the price increases are a real problem? Because those insurance exchanges are vital to the idea of universal coverage in this country. Without them, many people who don’t qualify for government insurance or aren’t covered through their job will be stuck without good medical care.
The spike in premiums is a sign that not enough healthy people are signing up for the exchanges. Without healthy people to balance out the sick, insurance stops being insurance and becomes terribly expensive.
The basic solution is straightforward. It involves increasing the subsidies for lower-income families — while also increasing the penalties for people who refuse to sign up for health insurance. The overall cost of this fix would be modest, and a better functioning Republican Party would have no problem agreeing to a compromise. It would preserve a robust role for the private market, after all.
The more boldly liberal solution is to create a so-called public option on the exchanges — a government insurance plan anyone could buy. In a Times Op-Ed today, Jacob Hacker — one of the architects of the public option — makes the case for it.
I’ll confess to being torn about whether the public option is a more complex solution than the current problem requires. I encourage you to read Hacker’s piece – and also this recent Times piece raising questions about the public option. If you have thoughts after doing so, send me an email, at Leonhardt@nytimes.com.
David Leonhardt, Op-Ed Columnist

Making a killing under Obamacare: The ACA gets blamed for rising premiums, while insurance companies are reaping massive profits
Health insurance costs are rising, but why? Let’s take a close look at health insurance companies’ soaring profits
(Salon) Just days before the next open enrollment period was to begin under the Affordable Care Act, President Barack Obama’s signature health care law, Americans received some sobering news about how much more they’ll pay yet again for health insurance, an annual cost that’s already straining many household budgets.People seeking midlevel plans through the public HealthCare.gov exchange will see premiums jump 25 percent on average in 2017, the Department of Health and Human Services said on Monday. The 154 million Americans who receive their coverage through their employers won’t be hit as hard, but they, too, can expect an average premium increase of 4 percent to 5 percent, while handing over about 9 percent more in deductibles, according to a Commonwealth Fund report released on Wednesday.
While Americans continue to be hammered by rising health care costs, and while congressional lawmakers (with their taxpayer-subsidized health care) do nothing to lower cost of pharmaceuticals and medical care, one group is reaping a windfall in profit: health insurance companies and their investors.

2015

26 June

Barack Obama is officially one of the most consequential presidents in American history

(Vox) After Thursday’s Supreme Court ruling, there’s no longer any doubt: Barack Obama is one of the most consequential presidents in American history — and he will be a particularly towering figure in the history of American progressivism.
National health insurance has been the single defining goal of American progressivism for more than a century. There have been other struggles, of course: for equality for women, African-Americans, and LGBT people; for environmental protection; against militarism in Southeast Asia and the Middle East. But ever since its inclusion in Teddy Roosevelt’s 1912 Bull Moose platform, a federally guaranteed right to health coverage has been the one economic and social policy demand that loomed over all others. It was the big gap between our welfare state and those of our peers in Europe, Canada, Australia, New Zealand, and Japan.
And for more than a century, efforts to achieve national health insurance failed. Roosevelt’s third-party run came up short. His Progressive allies, despite support from the American Medical Association, failed to pass a bill in the 1910s. FDR declined to include health insurance in the Social Security Act, fearing it would sink the whole program, and the Wagner Act, his second attempt, ended in failure too. Harry Truman included a single-payer plan open to all Americans in his Fair Deal set of proposals, but it went nowhere. LBJ got Medicare and Medicaid done after JFK utterly failed, but both programs targeted limited groups.
Richard Nixon proposed a universal health-care plan remarkably similar to Obamacare that was killed when then–Sen. Ted Kennedy (D-MA) walked away from a deal to pass it, in what Kennedy would later call his greatest regret as a senator. Jimmy Carter endorsed single-payer on the campaign trail, but despite having a Democratic supermajority in Congress did nothing to pass it. And the failure of Bill Clinton’s health-care plan is the stuff of legend.
Then, on March 23, 2010, President Obama signed the Affordable Care Act into law. It wasn’t perfect by any means. It wasn’t single-payer; it lacked a public option, or all-payer rate-setting. And it still left many uninsured. But it established, for the first time in history, that it was the responsibility of the United States government to provide health insurance to nearly all Americans, and it expanded Medicaid and offered hundreds of billions of dollars in insurance subsidies to fulfill that responsibility.
To pay for it all, the Affordable Care Act cut back on Medicare spending and hiked up taxes on rich people’s investment income and health plans. It effected a massive downward redistribution of income. It’s one of the most startlingly progressive laws this country has ever enacted.

8 March
Once Again, Obamacare Is Turning Out To Be Cheaper Than Expected
Here’s some good news: the latest report from the CBO has reduced its estimate of the cost of Obamacare. This is due partly to a slight decrease in the number of people CBO expects to be covered, but mostly due a lower estimate of the cost of insurance premiums. Thanks to this, federal subsidies are estimated at $209 billion less over a ten-year period, and the cost of CHIP and Medicaid is estimated at $73 billion less. However, there are also reductions in expected revenues from Obamacare’s excise tax, so the net reduction amounts to $142 billion over ten years. The table below tells the story.

4 March
In Anti-Obamacare Case, Ruth Bader Ginsburg Questions the Foundation of the Lawsuit
The Supreme Court justice zeroes in on whether the plaintiffs even have a basis to sue.
(Mother Jones) During the Supreme Court oral arguments Wednesday morning in King v. Burwell, the case that threatens to destroy Obamacare, Justice Ruth Bader Ginsberg wasted no time in grilling the attorney seeking to eviscerate the Affordable Care Act about a significant technical matter that could blow up his case. As soon as Michael Carvin, the Jones Day partner representing the four plaintiffs named in the anti-Obamacare suit, started his opening statement, Ginsburg interrupted him with a slew of questions about whether his plaintiffs had a recognizable injury that would allow the case to proceed. A plaintiff, she declared, “has to have a concrete stake in the question…you would have to prove the standing if this gets beyond the opening door.”

2014

7 November
9 Reasons Why The Challenge To Obamacare Could Fail
(HuffPost) The ruling in King v. Burwell will hinge on whether the plaintiffs can prove that President Barack Obama’s signature health care law does not provide tax credits to Americans in more than 30 states who purchased health insurance through the federal exchange, built by the Department of Health and Human Services. The law clearly provides those same credits to people who bought insurance through the state exchanges.
“At the time of the ACA’s enactment, it was well understood that without the subsidies, the individual mandate was not viable as a mechanism for creating a stable insurance market.”
“The ACA would be self-defeating if taxpayers who purchase insurance from an HHS-created Exchange are deemed ineligible to receive subsidies.”
“The majority opinion ignores the obvious ambiguity in the statute and claims to rest on plain meaning where there is none to be found.”
“Simply put [the law] interpreted as Appellants urge would function as a poison pill to the insurance markets in the States that did not elect to create their own exchanges. That is surely not what Congress intended.”
“It makes little sense to think that Congress would have imposed so substantial a condition in such an oblique and circuitous manner.”
“The simple truth is that Appellants’ incentive story [see below] is a fiction, a post hoc narrative concocted to provide a colorable explanation for the otherwise risible notion that Congress would have wanted insurance markets to collapse in States that elected not to create their own Exchanges.”
“If an HHS-created Exchange does not count as established by the State it is in, there would be no individuals ‘qualified’ to purchase coverage in the 34 States with HHS-created Exchanges. This would make little sense.”
“The record indicates that, when the ACA was enacted, no State even considered the possibility that its taxpayers would be denied subsidies if the State opted to allow HHS to establish an Exchange on its behalf. Not one.”
“The IRS’s and HHS’s constructions of the statute are perfectly consistent with the statute’s text, structure, and purpose.”

The Supreme Court Is Now a Death Panel
(The New Republic) The contested text could be fixed with a comically simple technical corrections bill, which Democrats would happily support. If Republicans were to sit on their hands, or use the ensuing chaos as leverage to extract unrelated concessions, it will cost people their lives. That is a cardinal reality facing justices, and the people soliciting their conservative activism.

6 November
McConnell and Boehner Announce Plan to Take Health Insurance Away From 1 Million Americans
Mitch McConnell and John Boehner have announced that one of the first things that the new Republican controlled Congress will do is take away health insurance from 1 million Americans.
In their Wall Street Journal op-ed McConnell and Boehner wrote:

We’ll also consider legislation to help protect and expand America’s emerging energy boom and to support innovative charter schools around the country.These bills include measures authorizing the construction of the Keystone XL pipeline, which will mean lower energy costs for families and more jobs for American workers; the Hire More Heroes Act, legislation encouraging employers to hire more of our nation’s veterans; and a proposal to restore the traditional 40-hour definition of full-time employment, removing an arbitrary and destructive government barrier to more hours and better pay created by the Affordable Care Act of 2010.

A return to tradition sounds nice, until one understands what that means. Republicans are trying to take private employer based health insurance away from one million Americans. House Republicans tried this same move in February 2014, and the impact on healthcare was spelled out by the CBO.

22 July
Two Republican Judges Gut Obamacare, Threatening Health Care For Millions
Two Republican judges on the D.C. Circuit Court have ruled that the equivalent of a typo is enough to strip health care subsidies from up to 5 million people, dealing what would be a death blow to the Affordable Care Act if the decision is allowed to stand. The one Democrat on the panel dissented.
The three-judge panel ruled in Halbig v. Burwell that people in the 36 states that use the federal health insurance exchange are ineligible for subsidized insurance. The decision would also affect those who purchased insurance through the exchange but don’t receive subsidies, as reneging on the payments would lead to a rapid increase in insurance rates for everyone.
The White House said Tuesday the decision will be appealed to the entire D.C. circuit court — what’s known as an en banc review — where Democrats hold a majority that is nearly certain to overturn the GOP judges’ aggressive move. The next step could be the Supreme Court, which already upheld the Affordable Care Act in a separate case two years ago. Separate U.S. Appeals Court Upholds Subsidies Under Obama Health Law

5 June
Latest Gallup Numbers Confirm 10-12 Million Newly Insured Under Obamacare
(Mother Jones) Gallup’s latest poll number for the uninsured is out, and it’s stabilized now that the open enrollment period for Obamacare has ended. It was 13.4 percent in April and it’s 13.4 percent in May
This is a drop of about 4 percentage points from the 2011-12 baseline, and represents about 10 million newly insured—a figure that’s been confirmed elsewhere and now seems like a pretty good estimate. Add to this the number of children and sub-26ers who are newly insured, and you’re probably up to 12-13 million who are newly insured under Obamacare. Some of this comes from people buying insurance through the exchanges; some comes from Medicaid signups; and some comes from people signing up for insurance at work thanks to the individual mandate. (HuffPost) Obamacare Has Drastically Cut The Uninsured Rate For Blacks, Hispanics

10 April
Kathleen Sebelius to step down as HHS secretary; OMB director will take her place
(WaPost) Health and Human Services Secretary Kathleen Sebelius is resigning, ending a tumultuous tenure as the public face of the Affordable Care Act. President Obama will nominate his budget director on Friday as her successor, according to White House officials.
Sebelius entered the Cabinet in 2009, three months into Obama’s presidency, as a well-regarded former governor of conservative Kansas. She is leaving after months of intense criticism over the botched rollout in the fall of the insurance marketplace.
During the firestorm, Obama made clear to his aides that he would not seek the resignation of his health secretary, and her departure is timed to brighter news for the White House as enrollment soared late last month.
According to White House officials, Obama will nominate Office of Management and Budget Director Sylvia Mathews Burwell to take Sebelius’s place. Although Burwell does not have an extensive background in health-care policy, she is known for her strong management skills and has experience in issues of poverty and global health issues from her time at the Bill and Melinda Gates Foundation.

2013

The Khan Academy presents a brilliant, simple explanation, “not taking political sides, but shedding light on what people are debating”

White House website on Health Reform
Washington Post — Obamacare: Understanding the Affordable Care Act
To help readers understand and maneuver through Obamacare — the Affordable Care Act — the Washington Post has published a variety of consumer stories, FAQs, online chats and video segments, linked below. Check back for regular updates.

Affordable Care Act
Attention, consumers! If you are a consumer and have specific questions about the Affordable Care Act, please visit www.healthcare.gov, the official Affordable Care Act website, for more information. In March 2010, President Obama signed comprehensive health reform, the Patient Protection and Affordable Care Act (ACA), into law. The law makes preventive care—including family planning and related services—more accessible and affordable for many Americans.  While some provisions of the law have already taken effect, many more provisions will be implemented in the coming years. Get Ready for ACA Enrollment which Begins October 1, 2013 for coverage beginning January 1, 2014
Up-to-date information about enrollment and implementation can be found at http://www.healthcare.gov/
View video about the new Health Care Marketplaces which will be going live October 1, 2013
Look up your state’s plan on state-by-state fact sheets
Top ten things to know about the health care law for special populations such as women, clinicians, small businesses, others
Sign up for text and email updates about your state’s ACA implementation