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Saturday, October 16, 2021

Can Clinton save Obamacare?

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FILE - In this May 2, 2016 file photo, 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. 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. (AP Photo/Paul Sancya)
Democratic presidential candidate Hillary Clinton listens to Dr. Christopher Beckett, CEO of Williamson Health and Wellness Center during a tour in Williamson, W.Va. (AP Photo/Paul Sancya)

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 only have one 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.

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SWEETENING SUBDIDIES

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.

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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.

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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.”

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Copyright © 2016 Capitol Hill Blue

Copyright  © 2016 The Associated Press. All Rights Reserved

7 thoughts on “Can Clinton save Obamacare?”

  1. The damn thing is a Rube Goldberg monstrosity. If it fails it will because at it’s core is an idea incompatible with Health Care PROFIT. The Dems. don’t understand that any better then the Reukes. When most of the BIG Ins. Corps. who wrote most of the law can’t make enough money from it they’ll lobby Clinton and the Corp. Dems. and Corp. Reukes to make it even sweeter for the BIG Corps. thinking if only we feed the beast it won’t eat it’s customers. WRONG! It will eat them and then throw their bones on the rubbish heap. This is a BAD law and it doesn’t deserve to survive. Eventually, some form of Single Payer or extended Medicare is going to have to replace it.

  2. Health Insurance companies are needless parasitic middlemen that the government is subsidizing anyway!

    “The invisible hand of the marketplace” solution is a fiction that implies ruthless, for profit mercenaries – that could care less weather you live or die – should be monopolizing life or death, suffering or “the liberty to pursue happiness”, but still be subsidized by our taxes!

    Their excuse for fighting a public option is they “can’t compete”? ? ? ?

    What happened to “The invisible hand of the marketplace” solution?

    Republicans fought tooth and nail against the automobile. They said it scared horses and would put Blacksmiths, delivery wagons, etc. out of work.

    Instead of standing up to the Axis, republicans lauded the Fascist philosophy. They claimed the words “Work shall set you free” (as memorialized above the gates of Dachau) and Mussolini’s achievement of, “At least he made the trains run on time”, was just the ticket.

    They fought and stopped the President from interfering with their Nazi Businessman friend’s death dealing machinations at every turn … then came Pearl Harbor and they had no political survival choice but to grudgingly give in to the forceful preservation of good, verses evil.

    The party of big business cannot be trusted to do anything except preserve the status quo monopolizing and making a buck. They don’t care about OUR costs, only their profits.

    Instead of the Government subsidizing insurance companies: Government insurance. Doctors deal direct.

    • Thank you Paul. May I use some of your observations in my arguments with ignorant Republican voters? Of course, those who vote Republican not only don’t know their history, but are susceptible to believing the rw media’s warped interpretation, which causes them to vote against their interests. Time and time again.

  3. We would be throwing a lot of people under the bus if ACA was killed. I think some people would get upset enough to take 2nd Amendment remedies, if you know what I mean. When some politician murders your kid, some folks don’t take that lying down.

    • Quite accurate. There has never been a violent revolution until people had to put their crying, sick children to be hungry.
      Accurately, it can also be said: Communism has always come from roughshod capitalism.
      Never has one country on earth evolved from a Socialist Democracy to Communism. It has always been the result of “the invisible hand of the free market” run amok.
      Only a Lunatic can on the one hand despise, but on the other quote and believe Marx. Communism is not and cannot be the evolution of Socialism.

    • “When some politician murders your kid, some folks don’t take that lying down.”

      What are you even talking about here? It has nothing to do with the ACA.

  4. The collapse of Obamacare would be the Republican’s dream come true. Make sure everything was just as it was before the ACA. And let “the invisible hand of the market” do it’s magic just like it did before. We may want to take a lesson from Germany.

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