the heritage foundation and obamacare

News about Heritage Foundation, including commentary and archival spent almost seven years waging a battle to repeal the Affordable Care Act. Finally. Tom Price (R-Ga) is an orthopedic surgeon and a vocal critic of the Affordable Care Act. He's also President-elect Donald Trump's choice to head the. The New York Times Magazine recently looked at the prolonged fight against the Affordable Care Act (ACA) waged by Heritage Action for.

The heritage foundation and obamacare -

Heritage Foundation On Graham-Cassidy Health Care Bill

DAVID GREENE, HOST:

And the effort to kill the Affordable Care Act and replace it is certainly back to life. The Republican Party is taking another stab. And we're going to see what happens when the Senate votes next week on the latest bill to repeal Obamacare. The big question is, can it pass with Republican votes alone? Right now, at least one Republican senator, Rand Paul, is a solid no. According to the publication The Hill, there are at least 14 other Republicans who are undecided at this point.

And let's talk to Tommy Binion about this. He's congressional liaison with the Heritage Foundation, a conservative think tank in Washington. Hey, Tommy.

TOMMY BINION: Good morning.

GREENE: So you've been working with Republicans on the Hill. What's your sense here? Can this bill pass with all of these undecided members?

BINION: I think so. You've got the score correct. There is one Republican no vote, and they can sustain two. So right now, it is absolutely still a possibility. And I've got to say, this is really as close as they have been throughout this yearlong process and really seven-year-long process. So there are a lot of undecideds still to get to yes. But I think the more important score is that, at this moment, there is only one no. I think this is a real possibility this thing passes next week.

GREENE: OK. So this legislation - it's known as Graham-Cassidy for its sponsors. To summarize, I mean, it takes a lot of the funding for Obamacare, and it gives it to states as block grants to basically handle this. The undecided Republicans, they seem to divide into two camps. You've got some conservatives. You've got some moderates. Can you explain what those concerns are among those two camps?

BINION: Sure. The conservatives' concern, I think, is very important. And I do think it will be addressed by amendment over the weekend. Basically, the money that's going to the states can be spent in any way the states want, as long as it's spent on trying to bring down the cost of health care. Unfortunately, what that allows them to do is put all of the folks who are currently getting Obamacare subsidies on Medicaid or set up sort of a state-run single-payer program.

So what conservatives want to do is prohibit the states from doing that and sort of force them into providing market-based solutions. If they can't - if they put everybody on Medicaid or they set up single-payer run by the states, that will run into the same problems Obamacare did. So in order to make sure we're moving forward and getting better, we've got to tighten up those restrictions in the bill. I think that will happen.

On the moderate side, again, I think they'll come around. I think they're uneasy right now about Medicaid. But as we look into this, we'll see that Medicaid in this bill is really - it makes it more sustainable, and it focuses the resources on the most vulnerable population.

GREENE: OK. So one thing important to convince moderates is that Medicaid is not facing steep cuts, that, I mean, that program is going to survive, which is, according to many critics of the bill, not - certainly not a guarantee. Let me just ask you, though - looking forward, let's say this does pass by, like, one vote in the Senate. There's this deadline in September looming. And because of procedure in Congress, this would have to pass the House as is, no changes. Right? Is that likely to happen?

BINION: Yeah. So that's how it works. The deadline applies in the Senate. So if the House is working on the bill sometime after September 30, the Senate wouldn't be able to act on any changes the House made. So the House is going to be facing an up-or-down choice. And I think it will pass. Speaker Ryan thinks it will pass. Chairman Meadows, importantly of the House Freedom Caucus, thinks it will pass.

But the stakes couldn't be higher. They're going to get one chance at it. It's up or down. They won't be able to consider amendments. And if it goes down, so does, for now, the effort to repeal the Affordable Care Act. So it's going to be a really interesting scene in the House, sort of unprecedented.

GREENE: All right. Tommy Binion is congressional liaison with the Heritage Foundation. Tommy, we really appreciate your time, as always.

BINION: Thanks, David. Have a great morning. Transcript provided by NPR, Copyright NPR.

Источник: https://www.wksu.org/2017-09-22/heritage-foundation-on-graham-cassidy-health-care-bill

ObamaCare: 10 years of distress and disappointment

March 2020 marks the 10th anniversary of the passage of the Affordable Care Act, also known as ObamaCare. In its first decade, ObamaCare has failed to solve many of the health care problems it was supposed to address. Even worse, it has compounded many of the issues it was meant to fix — the law of unintended consequences in action.

First, then-candidate Barack Obama said his namesake act would “cut the cost of a typical family’s premiums by up to $2,500 a year.”

In reality, the opposite has occurred. According to the Department of Health and Human Services (HHS), “premiums have doubled for individual health insurance plans since 2013, the year before many of Obamacare’s regulations and mandates took effect.”

Even more shocking, HHS reports, “Average individual market premiums more than doubled from $2,784 per year in 2013 to $5,712 on Healthcare.gov in 2017—an increase of $2,928 or 105%.” Needless to say, ObamaCare has fallen woefully short in its grand ambition to slice health insurance premiums by $2,500 per year.

Second, ObamaCare supporters claimed it would drastically reduce the uninsured population. Unfortunately, this also has not happened. As of this writing, there are roughly 28 million Americans without health insurance. And the number of those without health insurance has increased in recent years. And now that the individual mandate (a dubious provision forcing Americans to purchase health insurance) has been repealed, this number is expected to rise even more.

Why is this happening? According to the Centers for Medicare and Medicaid Services (CMS), “Simply put, there are too many people without subsidies who cannot afford coverage under Obamacare.”

To exemplify why millions of Americans remain uninsured, CMS provides this personal account: “A 60-year old couple in Grand Island, Nebraska making $70,000 a year—which is just slightly too much to qualify for Obamacare’s premium subsidy—is faced with paying $38,000, over half of their yearly income, to buy a silver plan with an $11,100 annual maximum out-of-pocket limit.” No wonder 28 million Americans are uninsured.

CMS notes, “We should not be surprised if they make the tough decision to drop their coverage. With a similar cold reality facing millions of American families, it was inevitable that Obamacare’s affordability crisis would eventually show up in the rates of uninsured Americans.”

Third, President ObamaBarack Hussein ObamaBiden on Bob Dole: 'among the greatest of the Greatest Generation'Moving beyond the era of American exceptionalismThe bully who pulls the levers of Trump's mind never learnsMORErepeatedly assured voters, “If you like your health care plan, you’ll be able to keep your health care plan, period.” After ObamaCare was enacted, millions of Americans were unable to keep their pre-ObamaCare health insurance plan.

According to a report by The Heritage Foundation, “Obamacare has significantly disrupted the market for those who buy coverage on their own by imposing new coverage and benefit mandates, causing a reported 4.7 million health insurance cancelations of an existing policy in 32 states.”

In other words, ObamaCare’s mandates and regulations have upended the health insurance market, causing millions to lose their pre-ObamaCare plans.

ObamaCare has been an abysmal failure when it comes to the integral promise of, “If you like your health care plan, you’ll be able to keep your health care plan, period.” Such is why President Obama’s pledge was named the Lie of the Year for 2013 by PolitiFact.

Fourth, President Obama also repeatedly guaranteed voters, “If you like your doctor, you will be able to keep your doctor, period.” As it turns out, this promise also fell by the wayside.

According to MarketWatch, “Various sources note that a common (and popular) way to reduce premium costs has been to reduce the number of doctors in the insurer’s network, which leads to a much greater likelihood of people losing their doctors than without the ACA.”

Even worse, “15% of plans offered on the exchanges exclude doctors from at least one kind of specialty” notes the National Institute of Health. Put another way, after ObamaCare took effect, millions of Americans lost access to their doctors.  

Sadly, since ObamaCare’s inception one decade ago, the vast majority of Americans are not better off in terms of their health insurance costs and health care access. ObamaCare has failed miserably because it lacks free-market principles and is a one-size-fits all, centrally planned boondoggle.

In the next decade, and for decades to come, the American health care system would function much more optimally if patients, not bureaucrats, were allowed to take control of their health care decisions.

Chris Talgois an editor at The Heartland Institute.

Источник: https://thehill.com/opinion/healthcare/486134-obamacare-10-years-of-distress-and-disappointment

Heritage Foundation Rally Cry: 'Defund Obamacare'

Opponents of the Affordable Care Act rallied hundreds of conservatives at a Tampa hotel Wednesday night with a call for the Republican House to strip funds for the law out of next year's budget.

The budget vote is scheduled for right after Labor Day, in time for the 2014 fiscal year, which begins Oct. 1.

"Can we defund Obamacare? Yes, we can!" declared Mike Needham, CEO of the host group Heritage Action for America. The crowd applauded heartily at his use of President Barack Obama's campaign slogan.

The town hall meeting in Tampa was heckle-free, unlike the one on Tuesday in Dallas. The host group, affiliated with the Heritage Foundation, is hopscotching across the South, firing up the anti-Obamacare troops during Congress' August recess.

Needham said that U.S. Rep. Gus Bilirakis, a Republican from Palm Harbor, has already pledged not to vote for the budget if it contains spending for implementation of the Affordable Care Act. Needham called on the crowd to pressure other members of Congress to follow Bilirakis' example.

The main speaker, former U.S. Sen. Jim DeMint, continued that theme, saying, "Politicians don't lead. ...they follow. They need to be forced to do the right thing."

DeMint, president of the Heritage Foundation, said President Obama wants to gain control over Americans, seize their assets and "redistribute" them. He said Obama is "tearing up our country" and that he will "betray the things we love."

The health law is not about compassion for the uninsured, DeMint said; "it's about control."

Credit Steve Newborn / WUSF

He also said Obamacare will turn American health care into a government-controlled system akin to that of Britain or Canada.  He did not explain; neutral observers have noted that the Affordable Care Act retains the employer-based system of coverage through private health plans.

PolitiFact's Angie Holan, who fact-checked DeMint's speech during the event, said her organization has examined this claim in the past and rated it "false." 

Another claim that DeMint made Wednesday night has also been rated "false" in the past. He said aid Obamacare "violates every American principle that we know: the concept of individual decision-making and individual responsibility, having your choices, having a relationship directly with your doctor, and your doctor and you deciding about your care." 

The law doesn't really talk about the doctor-patient relationship. DeMint did not explain what he meant, except for mentioning there will be many newly covered patients competing for doctors. The law offers primary care doctors a Medicaid pay raise, provides health-training scholarships and loans, and requires doctors to gradually shift from paper to electronic medical records.

DeMint said the Republicans in the House are well aware that their many votes to repeal the Affordable Care Act are meaningless, since the Democrats in control of the Senate will not consider it. But a vote for a budget that strips out health-law funds is a different matter, he said. The Senate and President will be forced to choose between accepting the budget without health-law funds or leaving the government without spending authority after Oct. 1.

"There are a lot of Republicans saying, 'We don't want to do that because that might risk us losing the House in 2014,'" DeMint said. "Since when do Americans not fight for what they believe in because they're afraid they might lose?"

There is no time to waste, he said. On Oct. 1, the online Marketplace is scheduled to open, where uninsured people can shop for a plan. On Jan. 1, the requirement that most Americans carry insurance or pay a penalty goes into effect.

"This might be that last off-ramp for us to stop Obamacare before it gets so enmeshed in our culture that it's impossible to change." -- Former Sen. Jim DeMint, Heritage Foundation president

"By this time next year,  tens of millions of Americans will have lost the insurance they had; they will be in these exchanges. It will be very, very difficult to unravel this thing. So this is the time. This might be that last off-ramp for us to stop Obamacare before it gets so enmeshed in our culture that it's impossible to change," DeMint said.

While the "defunders" of Obamacare were inside the Crowne Plaza, about a dozen of its defenders stood in the rain out front, carrying signs and waving to traffic on busy West Kennedy Boulevard.

Credit Steve Newborn / WUSF

Megan Milanese, a public health graduate student at University of South Florida, said she is standing up for the law "because it's important to me as a public-health student, as an individual, and as a young woman."

Karen Clay, 60, hasn't had health insurance since her marriage ended 12 years ago; when she gets sick, she has to go to the emergency room because doctors won't see her without insurance. She said she has to stay well to take care of her severely disabled son.

"I need a colonoscopy; I can't afford one," she said.

Under the Affordable Care Act, she will finally be able to get the test. When Oct. 1 comes, she said, "I will be the first one to sign up."

--Health News Florida is part of WUSF Public Media. Contact Carol Gentry at 813-974-8629 (desk) or e-mail at [email protected] For more health news, visit HealthNewsFlorida.org.

Источник: https://wusfnews.wusf.usf.edu/health-news-florida/2013-08-22/heritage-foundation-rally-cry-defund-obamacare

No, Obamacare Wasn't a "Republican" Proposal

The filmmaker Michael Moore has, through his fine documentary Sicko and other public arguments, done a great deal to bring attention to the deficiencies of the American health-care system. His New York Timesop-ed on the occasion of the first day of the Affordable Care Act's exchanges repeats some of these important points. However, his essay also repeats a pernicious lie: the idea that the Affordable Care Act is essentially a Republican plan based on a Heritage Foundation blueprint. This argument is very wrong. It is both unfair to the ACA and far too fair to American conservatives.

Before explaining why a central premise of Moore's argument is wrong, let me emphasize our points of agreement. It is true that the health-care system established by the ACA remains inequitable and extremely inefficient compared to the health-care systems of every other comparable liberal democracy. Moore, unlike some critics of the ACA from the left, is also careful to note that the ACA is a substantial improvement on the status quo ante: if it's "awful" compared to the French or Canadian or British models, it's a "godsend" for many Americans. Moore also has some sensible suggestions for improving the ACA in the short term-most notably, a public option and state-level experiments in more public health care where it's politically viable.

Where Moore goes wrong is in this paragraph:

What we now call Obamacare was conceived at the Heritage Foundation, a conservative think tank, and birthed in Massachusetts by Mitt Romney, then the governor. The president took Romneycare, a program designed to keep the private insurance industry intact, and just improved some of its provisions. In effect, the president was simply trying to put lipstick on the dog in the carrier on top of Mitt Romney's car. And we knew it.

The assertion that the ACA was "conceived" at the Heritage Foundation is simply false. I say this with no little humility-since Republicans at the national level have never actually favored any significant plan for health-care reform, I thought the content of the Heritage Plan was irrelevant, but didn't think to question claims that it was fundamentally similar to the ACA. When I actually took the time to read the Heritage plan, what I found was a proposal that was radically dissimilar to the Affordable Care Act. Had Obama proposed anything like the Heritage Plan, Moore would have been leading daily marches against it in front of the White House-and I would have been right there with him.

The argument for the similarity between the two plans depends on their one shared attribute: both contained a "mandate" requiring people to carry insurance coverage. But this basic recognition of the free-rider problem does not establish a fundamental similarity between the two plans. Compulsory insurance coverage as a way of preventing a death spiral in the insurance market when regulations compel companies to issue insurance to all applicants is hardly an invention of the Heritage Foundation. Several other countries (including Switzerland, the Netherlands, and Germany) have compulsory insurance requirements without single-payer or socialized systems. Not only are these not "Republican" models of health insurance, given the institutional realities of American politics they represent more politically viable models for future reform than the British or Canadian models.

The presence of a mandate is where the similarities between the ACA and the Heritage Plan end, and the massive remaining differences reveal the disagreement between Democrats and Republicans about the importance of access to health care for the nonaffluent. The ACA substantially tightens regulations on the health-care industry and requires that plans provide medical service while limiting out-of-pocket expenses. The Heritage Plan mandated only catastrophic plans that wouldn't cover basic medical treatment and would still entail huge expenditures for people afflicted by a medical emergency. The Affordable Care Act contained a historic expansion of Medicaid that will extend medical coverage to millions (and would have covered much more were it not for the Supreme Court), while the Heritage Plan would have diminished the federal role in Medicaid. The ACA preserves Medicare; the Heritage Plan, like the Paul Ryan plan favored by House Republicans, would have destroyed Medicare by replacing it with a voucher system.

The Affordable Care Act was not "conceived" by the Heritage Foundation: the plans are different not in degree but in kind.

Because the Heritage Foundation plan and the ACA are so different, to make his case that the ACA is fundamental plan Moore pulls a subtle bait-and-switch, comparing the ACA not only to the Heritage Plan but to the health-care reform plan passed in Massachusetts. Unlike the Heritage plan, the Massachusetts law is quite similar to the ACA, but as an argument against the ACA from the left this is neither here nor there. The problem with the comparison is the argument that the Massachusetts law was "birthed" by Mitt Romney. What has retrospectively been described as "Romneycare" is much more accurately described as a health-care plan passed by massive supermajorities of liberal Massachusetts Democrats over eight Mitt Romney vetoes (every one of which was ultimately overridden by the legislature.) Mitt Romney's strident opposition to the Affordable Care Act as the Republican candidate for president is far more representative of Republican attitudes toward health care than Romney acquiescing to health-care legislation developed in close collaboration with Ted Kennedy when he had essentially no choice.

In fairness, many liberals repeating the dishonest spin that the ACA was conceived by the Heritage Foundation have good intentions. Some, like Moore, want to emphasize the extent to which American health-care policy remain suboptimal. Some wanted to attack the ad hoc constitutional arguments developed against the individual mandate by noting that conservatives never noticed that the mandate was the greatest threat to human liberty ever conceived when the nominally favored it. But, especially with the constitutional challenge to the mandate having been resolved, the argument that the ACA is the "Heritage Plan" is not only wrong but deeply pernicious. It understates the extent to which the ACA extends access to medical care, including through single-payer insurance where it's politically viable. And it gives Republicans far, far too much credit. The Republican offer to the uninsured isn't anything like the ACA. It's "nothing." And the Republican offer to Medicare and Medicaid recipients is to deny many of them access to health care that they now receive. Progressive frustration with the ACA is understandable, but let's not pretend that anything about the law reflects the priorities of actually existing American conservatives.

Источник: https://prospect.org/power/no-obamacare-republican-proposal/

Today, another lesson in why you should never take anything Rush Limbaugh says at face value without first doing your homework. On his radio program, Rush called President Obama a liar for making claims that the health care law contains numerous Republican ideas--including the idea of the insurance exchanges, which Obama says came from The Heritage Foundation, but which Rush says is "Total BS."

In fairness, before you read this post any further, why don't you go ahead and confirm Limbaugh's remarks for yourself by reading or listening to the segment. Okay. Now that you've done that, can we agree that I've accurately captured Limbaugh's remarks? Good. Time to debunk them.

For starters, ObamaCare is nearly identical to RomneyCare (the Massachusetts reforms) in many respects, and Heritage took credit for the RomneyCare ideas. So, to the extent that RomneyCare and ObamaCare are similar, Heritage has every right to take credit for the ideas in ObamaCare. The fact that they don't want to is another story.

Better yet, Stuart Butler wrote a piece on the "Exchange We Can Believe In" in which he leads off by saying: "The president-elect didn't invent the idea of a health exchange. He came up with his own version of an idea that's been refined by people like us at the Heritage Foundation and already field tested. Frankly, we prefer the original." He didn't say that the idea originated with Heritage, but he certainly seems to suggest that Heritage bought into and further developed the idea well before Obama or the Democrats in Congress took a shine to it. Butler continues "It's better to have exchanges operate at the state level. This assures that an exchange can be adapted to the local insurance market. Massachusetts' could continue to be the Connector, say, while Virginia's might be based on the FEHBP. But a federal-level exchange run by Congress would likely lead to a homogenous, one-size-fits-all system. Sure, general goals could be set at the national level, but if state health experts can figure a better way to reach those goals, let them try."

Guess what? The health insurance exchanges that Congress just passed into law? Yeah, they're implemented at the state level. So, once again, Heritage has every right to take credit for the ideas in ObamaCare. They just don't want to. That doesn't seem to me to be the workings of a "nonpartisan" think-tank. It's fine to be a conservative think-tank. Just don't try to have it both ways, because when you do, you lose your objectivity and your credibility won't be far behind.

For the best overview of this whole Heritage Foundation flip-flop, you need to read Timothy Noah's piece at Slate.

If you read what I write here 3 times a week, you really ought to consider reading my daily blog. That means you should subscribe to Wright on Health and tell your friends and family to do the same. I'm counting on you to spread the word! You can also contact me here.

Источник: https://www.huffpost.com/entry/did-the-heritage-foundati_b_551804

Top 5 Reasons to Repeal Obamacare

The Washington-based Heritage Foundation has published a brief “Top 5 Reasons to Repeal Obamacare.” Here are its headlines, which are arranged in reverse order:

 

5. To stop adding to the U.S. deficit and debt.
4. To help stop Taxmageddon.
3. To preserve freedom, including religious freedom, for all Americans.
2. To keep health care decisions where they belong—with patients and their doctors.
1. To make way for real, patient-centered, market-based health care reform.

 

Each of these comes with a brief explanation including some facts and figures – read the whole thing here. 


Permission to reprint this blog post in whole or in part is hereby granted, provided that the author (or authors) and the Mackinac Center for Public Policy are properly cited. Permission to reprint any comments below is granted only for those comments written by Mackinac Center policy staff.

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Источник: https://www.mackinac.org/17220

Heritage Foundation Rally Cry: 'Defund Obamacare'

Opponents of the Affordable Care Act rallied hundreds of conservatives at a Tampa hotel Wednesday night with a call for the Republican House to strip funds for the law out of next year's budget.

The budget vote is scheduled for right after Labor Day, in time for the 2014 fiscal year, which begins Oct. 1.

"Can we defund Obamacare? Yes, we can!" declared Mike Needham, CEO of the host group Heritage Action for America. The crowd applauded heartily at his use of The heritage foundation and obamacare Barack Obama's campaign slogan.

The town hall meeting in Tampa was heckle-free, unlike the one on Tuesday in Dallas. The host group, affiliated with the Heritage Foundation, is hopscotching across the South, firing up the anti-Obamacare troops during Congress' August recess.

Needham said that U.S. Rep. Gus Bilirakis, a Republican from Palm Harbor, has already pledged not to vote for the budget if it contains spending for implementation of the Affordable Care Act. Needham called on the crowd to pressure other members of Congress to follow Bilirakis' example.

The main speaker, former U.S. Sen. Jim DeMint, continued that theme, saying, "Politicians don't lead. .they follow. They need to be forced to do the right thing."

DeMint, president of the Heritage Foundation, said President Obama wants to gain control over Americans, seize their assets and "redistribute" them. He said Obama is "tearing up our country" and that he will "betray the things we love."

The health law is not about compassion for the uninsured, DeMint said; "it's about control."

Credit Steve Newborn / WUSF

He also said Obamacare will turn American health care into a government-controlled system akin to that of Britain or Canada.  He did not explain; neutral observers have noted that the Affordable Care Act retains the employer-based system of coverage through private health plans.

PolitiFact's Angie Holan, who fact-checked DeMint's speech during the event, said her organization has examined this claim in the past and rated it "false." 

Another claim that DeMint made Wednesday night has also been rated "false" in the past. He said aid Obamacare "violates every American principle that we know: the concept of individual decision-making and individual responsibility, having your choices, having a relationship directly with your doctor, and your doctor and you deciding about your care." 

The law doesn't really talk about the doctor-patient relationship. DeMint did not explain what he meant, except for mentioning there will be many newly covered patients competing for doctors. The law offers primary care doctors a Medicaid pay raise, provides health-training scholarships and loans, and requires doctors to gradually shift from paper to electronic medical records.

DeMint said the Republicans in the House are well aware that their many votes to repeal the Affordable Care Act are meaningless, since the Democrats in control of the Senate will not consider it. But a vote for a budget that strips out health-law funds is a different matter, he said. The Senate and President will be forced to choose between accepting the budget without health-law funds or leaving the government without spending authority after Oct. 1.

"There are a lot of Republicans saying, 'We don't want to do that because that might risk us losing the House in 2014,'" DeMint said. "Since when do Americans not fight for what they believe in because they're afraid they might lose?"

There is no time to waste, he said. On Oct. 1, the online Marketplace is scheduled to open, where uninsured people can shop for a plan. On Jan. 1, the requirement that most Americans carry insurance or pay a penalty goes into effect.

"This might be that last off-ramp for us to stop Obamacare before it gets so enmeshed in our culture that it's impossible to change." -- Former Sen. Jim DeMint, Heritage Foundation president

"By this time next year,  tens of millions of Americans will have lost the insurance they had; they will be in these exchanges. It will be very, very difficult to unravel this thing. So this is the time. This might be that last off-ramp for us to stop Obamacare before it gets so enmeshed in our culture that it's impossible to change," DeMint said.

While the "defunders" of Obamacare were inside the Crowne Plaza, about a dozen of its defenders stood in the rain out front, carrying signs and waving to traffic on busy West Kennedy Boulevard.

Credit Steve Newborn / WUSF

Megan Milanese, a public health graduate student at University of South Florida, said she is standing up for the law "because it's important to me as a public-health student, as an individual, and as a young woman."

Karen Clay, 60, hasn't had health insurance since her marriage ended 12 years ago; when she gets sick, she has to go to the emergency room because doctors won't see her without insurance. She said she has to stay well to take care of her severely disabled son.

"I need a colonoscopy; I can't afford one," she said.

Under the Affordable Care Act, she will finally be able to get the test. When Oct. 1 comes, she said, "I will be the first one to sign up."

--Health News Florida is part of WUSF Public Media. Contact Carol Gentry at 813-974-8629 (desk) or e-mail at [email protected] For more health news, visit HealthNewsFlorida.org.

Источник: https://wusfnews.wusf.usf.edu/health-news-florida/2013-08-22/heritage-foundation-rally-cry-defund-obamacare
Epstein) on health law and policy, we will be watching the Supreme Court’s oral arguments on the ACA. If the court strikes it down, we expect that it will force Congress to someday enact a single-payer system, which will be legally invincible. Let us explain.

A bipartisan consensus

In 1986 President Ronald Reagan signed a law called EMTALA – the Emergency Treatment and Active Labor Act – recognizing that uninsured Americans would get sick and would show up at emergency rooms needing health care.
Reagan and his Republican Senate majority, led by Bob Dole, agreed with their Democratic colleagues in the House that, as a society, we simply cannot turn away fellow Americans to die on the streets. So, to this day, EMTALA requires hospitals to provide emergency health care. But it provides no funding mechanism to do it. Hospitals can try to shift those costs to other payers, or try to go after the patients themselves, who often have no alternative but bankruptcy.

With EMTALA in place, conservatives began to embrace the goal of getting everyone into the insurance system. Conservatives viewed having insurance as a matter of personal responsibility, to avoid passing health care costs on to others.

Conservatives also turned to the Gingrich model, because they long feared the alternative of a single-payer system. What we now call Medicare for All would leave out insurance companies and instead rely on the federal government as the single insurer. Indeed, Reagan got his start in national politics during the 1960s campaigning against the enactment of Medicare. He claimed it would lead to a socialist dictatorship that would “invade every area of freedom we have known in this country.” So, with single-payer off the table, an individual mandate for private health insurance was the conservative solution.

Ronald Reagan in the Oval Office.

The debate over preexisting conditions

Today, our society has made another moral commitment that insurers cannot turn away the sick. But the market cannot let people wait until they are sick to buy insurance. That would be like buying homeowners insurance when your house is already on fire. If insurers insured only sick people, premiums would have to be exorbitantly high. Rather, insurers must be able to spread the risk of any of us getting sick over a large base of healthy subscribers.

Accordingly, when Republican Mitt Romney was the governor of Massachusetts, he spearheaded a landmark reform that protected patients with preexisting conditions. He also recognized the need to pay for it. Through bipartisan legislative debate and bargaining emerged the individual mandate – a way to encourage people to buy insurance, even when they were healthy.

When Barack Obama was elected president, he initially resisted the idea of an individual mandate. But he lacked the votes for a single-payer approach. In the ACA, he settled on a weak mandate with a low monetary penalty for failure to comply, an expansion of Medicaid through the states, and subsidies so everyone could afford coverage on the private market, just as Newt Gingrich proposed so many years ago.

The right wing pivots

One might have imagined a round of conservative applause, but instead Republicans pivoted to attack mode. Even Gingrich started arguing that the individual mandate was “clearly unconstitutional.” The law ultimately passed with no Republican votes.

The first challenge to the ACA that reached the Supreme Court was in 2012, NFIB v. Sebelius. The issues were the constitutionality of the mandate that people buy insurance or face a penalty, and congressional expansion of state Medicaid coverage for poorer patients.

On the first point, conservative Supreme Court justices decided that Congress lacked the power under the Constitution’s commerce clause to enact the mandate. Although conservative justices normally look to the “original intent” of the founders, the five conservatives ignored the fact that in 1790 and 1798, George Washington and John Adams each signed laws requiring the purchase of health insurance by ship owners and sailors.

Still, Chief Justice Roberts saved the ACA’s mandate, finding it a legitimate exercise of the Constitution’s taxing power; he was joined by the four more liberal justices.

Another key conservative principle is federalism – to retain a central role for the states. The ACA carved out an important role for the states in expanding the state-administered Medicaid program to provide health care for poor Americans. But in the NFIB case, the Court conservatives the heritage foundation and obamacare that states be allowed to opt out.

While on the surface this position seemed like a vindication of states’ rights, in our view, the message to Congress was simple: Don’t involve the states at all. To achieve universal coverage, the federal government needs to do it alone, with a simple federal entitlement, like Medicare.

The 2012 ACA case therefore set a strange precedent. The result is a lopsided reading of constitutional authority. The federal government has a weakened power to work with private businesses and with states to achieve universal coverage. Meanwhile, the federal government has a nearly invincible power to itself tax and spend.

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A blank slate?

The battle was not yet over. In 2019, President Donald Trump and congressional Republicans eliminated the tax penalty for going without insurance. A judge in Texas then held that in doing so, Congress inadvertently repealed the entire ACA, including its subsidies, protections for the heritage foundation and obamacare conditions and expansion of Medicaid. The judge theorized that a tax of zero is not a legal nullity, but rather an unconstitutional and fatal flaw that brings down the entire bill.

That case is the one now in the Supreme Court. The legal arguments are convoluted, depending on whether one part of the Affordable Care Act can be “severed” from the nullified tax. Some conservative legal scholars have panned the challenge.

The conservatives who now control the Supreme Court face an odd dilemma. In the short run, they may strike down the ACA, causing chaos that Congress and the president may not be able fix, given the politics. However, as long as American law reflects the moral commitments to people with emergency health care needs and preexisting conditions, then someday Congress will have to find a way to pay for it.

If conservatives keep killing conservative reforms like the individual mandate and expanding Medicaid through the heritage foundation and obamacare states, the only alternative left will be a single-payer system, like Medicare for All. Ironically, the Supreme Court has made eminently clear that such a midland states bank routing number rockford il tax-and-spend approach is constitutionally invincible.

Источник: https://theconversation.com/conservatives-backed-the-ideas-behind-obamacare-so-how-did-they-come-to-hate-it-149698

ObamaCare: 10 years of distress and disappointment

March 2020 marks the 10th anniversary of the passage of the Affordable Care Act, also known as ObamaCare. In its first decade, ObamaCare has failed to solve many of the health care problems it was supposed to address. Even worse, it has compounded many of the issues it was meant to fix — the law of unintended consequences in action.

First, then-candidate Barack Obama said his namesake act would “cut the cost of a typical family’s premiums by up to $2,500 a year.”

In reality, the opposite has occurred. According to the Department of Health and Human Services (HHS), “premiums have doubled for individual health insurance plans since 2013, the year before many of Obamacare’s regulations and mandates took effect.”

Even more shocking, HHS reports, “Average individual market premiums more than doubled from $2,784 per year in 2013 to $5,712 on Healthcare.gov in 2017—an increase of $2,928 or 105%.” Needless to say, ObamaCare has fallen woefully short in its grand ambition to slice health insurance premiums by $2,500 per year.

Second, ObamaCare supporters claimed it would drastically reduce the uninsured population. Unfortunately, this also has not happened. As of this writing, there are roughly 28 million Americans without health insurance. And the number of those without health insurance has increased in recent years. And now that the individual mandate (a dubious the heritage foundation and obamacare forcing Americans to purchase health insurance) has been repealed, this number is expected to rise even more.

Why is this happening? According to the Centers for Medicare and Medicaid Services (CMS), “Simply put, there are too many people without subsidies who cannot afford coverage under Obamacare.”

To exemplify why millions of Americans remain uninsured, CMS provides this personal account: “A 60-year old couple in Grand Island, Nebraska making $70,000 a year—which is just slightly too much to qualify for Obamacare’s premium subsidy—is faced with paying $38,000, over half of their yearly income, to buy a silver plan with an $11,100 annual maximum out-of-pocket limit.” No wonder 28 million Americans are uninsured.

CMS notes, “We should not be surprised if they make the tough decision to drop their coverage. With a similar cold reality facing millions of American families, it was inevitable that Obamacare’s affordability crisis would eventually show up in the rates of uninsured Americans.”

Third, President ObamaBarack Hussein ObamaBiden on Bob Dole: 'among the greatest of the Greatest Generation'Moving beyond the era of American exceptionalismThe bully who pulls the levers of Trump's mind never learnsMORErepeatedly assured voters, “If you like your health care plan, you’ll be able to keep your health care plan, period.” After ObamaCare was enacted, millions of Americans were unable to keep best mortgage refinance rates in texas pre-ObamaCare health insurance plan.

According to a report by The Heritage Foundation, “Obamacare has significantly disrupted the market for those who buy coverage on their own by imposing new coverage and benefit mandates, causing a reported 4.7 million health insurance cancelations of an existing policy in 32 states.”

In other words, ObamaCare’s mandates and regulations have upended the health insurance market, causing millions to lose their pre-ObamaCare plans.

ObamaCare has been an abysmal failure when it comes to the integral promise of, “If you like your health care plan, you’ll be able to keep your health care plan, period.” Such is why President Obama’s pledge was named the Lie of the Year for 2013 by PolitiFact.

Fourth, President Obama also repeatedly guaranteed voters, “If you like your doctor, you will be able to keep your doctor, period.” As it turns out, this promise also fell by the wayside.

According to MarketWatch, “Various sources note that a common (and popular) way to reduce premium costs has been to reduce the number of doctors in the insurer’s network, which leads to a much greater likelihood of people losing their doctors than without the ACA.”

Even worse, “15% of plans offered on the exchanges exclude doctors from at least one kind of specialty” notes the National Institute of Health. Put another way, after ObamaCare took effect, millions of Americans lost access to their doctors.  

Sadly, since ObamaCare’s inception one decade ago, the vast majority of Americans are not better off in terms of their health insurance costs and health care access. ObamaCare has failed miserably because it lacks free-market principles and is a one-size-fits all, centrally planned boondoggle.

In the next decade, and for decades to come, the American health care system would function much more the heritage foundation and obamacare if patients, not bureaucrats, were allowed to take control of their health care decisions.

Chris Talgois an editor at The Heartland Institute.

Источник: https://thehill.com/opinion/healthcare/486134-obamacare-10-years-of-distress-and-disappointment

WASHINGTON -- Health and Human Services (HHS) Secretary Alex Azar, JD, described the free-market principles driving the Trump Administration's approach to healthcare policy at a briefing hosted by the Heritage Foundation on Wednesday.

Specifically, Azar celebrated the expansion of alternatives to Obamacare, such as association health plans; doubled down on the administration's commitment to work requirements -- the heritage foundation and obamacare despite a federal court decision rejecting the idea -- and plugged the administration's new blueprint for lowering drug prices.

Azar likened President Trump's economic philosophy to that of former President Ronald Reagan, who summed up the failures of the big government approach to the economy this way: "If it moves, tax it. If it keeps moving, regulate it. And if it stops moving, subsidize it."

"When things don't work the way they should . often the culprit is government action," Azar said, citing the lack of digitization in the healthcare field as one example.

"The Trump administration's first instincts are the opposite of the big government nightmare that President Reagan described."

Azar noted that, in some cases, the government must intervene to correct past wrong-headed approaches.

"Always, however, our actions will be aimed at building markets and competition restoring price signals and incentives and empowering consumers through choice, rather than having government decide what is best for the individual," he said.

He went on to list a handful of health policy priority areas where he felt these free-market principles were most relevant: reforming the individual insurance market, curbing high drug costs, and rethinking the Medicaid expansion.

Obamacare's Flaws

In speaking about the individual insurance market, Azar blasted the Affordable Care Act, for "creat[ing] a thicket of subsidies, regulations, and taxes," while failing to expand private coverage and to lower costs. From 2013 to 2017, individual premiums more than doubled in 39 states, he said.

Azar also took aim at the ACA's age-rating mechanism -- currently, older Americans can be charged only three times what a younger American can for premiums -- saying it forces young people to foot the bill for older adults.

"Congress created this broken system, and it's going to take an act of Congress to fix it," he said.

In continuing the theme of bashing Obamacare, Azar also slammed the Medicaid expansion and extolled the promise of community engagement.

Azar also spoke of Medicaid expansion extending health insurance to "able-bodied adults."

Under the ACA, the the heritage foundation and obamacare pays more to ensure healthcare coverage for these newly covered individuals than for the "traditional, vulnerable, Medicaid populations" -- e.g. low-income mothers, children, and the disabled.

"Supporting legislation to undo those perverse incentives is a priority for this administration," he said.

In the meantime, HHS has encouraged states to pursue work requirements or "community engagement activities" -- provisions requiring that "able-bodied" adults, with some exceptions, demonstrate that they are working, in school, engaged in child care, or volunteering in order to enroll in Medicaid.

In June, a federal judge blocked work requirements sought by Kentucky's Medicaid program.

"We suffered one blow. We are undeterred," Azar said of the judge's decision and HHS's commitment to work-requirement provisions.

More than a dozen states have applied for Medicaid waivers to enact such changes.

Alternatives to ACA Plans

In spaces where HHS can independently intervene to reshape the individual market unilaterally, it has, he noted.

Azar also touted the Trump administration's proposed rules to expand access to short-term health insurance policies that cost one-third of Affordable Care Act plans. Critics view such insurance as "junk plans" and argue that making them more available would bifurcate the health insurance market, making premiums unaffordable for older and sicker patients who need conventional full-coverage plans.

Azar also praised the Department of Labor for increasing access to association health plans, intended to help small businesses to buy group health insurance.

He touched briefly on the president's 2019 budget, which continues to call for ACA repeal and for replacing all of the Obamacare subsidies and the Medicaid expansion with block grants.

This idea and its variations, while trumpeted by many conservative think tanks -- including the Heritage Foundation -- has so far failed to win a majority in Congress.

Curbing Drug Prices

Looking beyond the individual market, Azar turned his eye to drug prices, claiming there is no "real market" for prescription drugs in the U.S. because of the maze of relationships between drugmakers, insurers, and pharmacy benefit managers that seek to squelch price-based competition.

Azar said that HHS has the authority to right this flawed system by closing regulatory loopholes.

Lastly, the Secretary highlighted his decision last week to direct the FDA to establish a working group that would explore the idea of importing drugs from other countries to address "patient access problems caused by spikes in drug prices."

The announcement, he noted, "took some by surprise." (Azar had previously criticized the the heritage foundation and obamacare of drug importation as a "gimmick.")

But he stressed that he and the president had been clear in launching their blueprint to curb drug costs: "We are open to all solutions that put American patients first -- meaning [ideas that] are safe, effective, and respectful of patient choice and the incentives that drive American innovation."

Источник: https://www.medpagetoday.com/publichealthpolicy/healthpolicy/74263

The Heritage Foundation disowns its baby

The Heritage Foundation is desperate for Congress to strangle Obamacare in the crib. Prevent the program’s major provisions from taking effect on Oct.1, the conservative Washington research foundation advises, by threatening to shut down the government. Heritage President Jim DeMint just launched a nine-city “Defund Obamacare” tour, sponsored by Heritage’s advocacy arm, Heritage Action. It’s all very scholarly.

Obamacare must be stopped, according to Heritage, because it’s expensive, imposes new taxes, and tramples on individual liberty.

But the heritage foundation and obamacare punchline is that Obamacare is largely Heritage’s own invention.

It may not be news that a conservative Washington think tank is going to great lengths to defeat a Democratic policy proposal. But this may be the first instance where the policy being opposed was incubated at the very same think tank. Look out, donors: the policies you pay Heritage to develop today may be policies you pay Heritage to defeat tomorrow. It's like Victor Frankenstein stumbling over the frozen tundra to defeat the creation he was so proud of but now despises.

In this instance Dr. Frankenstein is Stuart Butler, then director of domestic policy research at Heritage and, since 2010, director of Heritage’s Center For Policy Innovation. (No, they didn’t fire him.) Butler’s greatest claim to fame is that he developed the idea of “enterprise zones,” i.e., lowering taxes in certain the heritage foundation and obamacare areas to promote economic development. But his greater accomplishment—shhhh!—is that he developed two central ideas in Obamacare: an individual mandate requiring everyone to purchase health insurance, and expansion of How to get my amazon login id coverage to the working poor.

Butler wrote a 1989 pamphlet titled A National Health System For America in collaboration with Edmund Haislmaier (then a health care policy analyst at Heritage and now a senior research fellow there—no, they didn’t fire him, either). The pamphlet is not currently available on Heritage’s Web site (it can be purchased online), but a 1989 lecture by Butler (“Assuring Affordable Healthcare For All Americans”) is, and a more readable version is available on the Web site HealthCareReform.ProCon.org.

In the lecture, Butler said:

 Many states now require passengers in automobiles to wear seatbelts for their own protection. Many others require anybody driving a car to have liability insurance. But neither the federal government nor any state requires all households to protect themselves from the potentially catastrophic costs of a serious accident or illness. Under the Heritage plan, there would be such a requirement.

That’s the individual mandate. Butler didn’t invent the idea—it was, according to Butler’s assistant, also promoted three years earlier in a paper by Randall R. Bovbjerg and William G. Kopit—but that doesn’t get Butler off the hook. Bovbjerg was then (and remains) a scholar at the Urban Institute, a mildly liberal Washington think tank. (In fairness to Butler, something like an individual mandate was also favored by the conservative economist Milton Friedman. Conservatism has shifted dramatically rightward during the past two decades.)

In the 1989 lecture, Butler also said

a new index of eligibility would be developed to link Medicaid coverage to poverty instead of welfare. This is an important distinction, because many poor families struggling to keep off welfare currently risk enormous and uncovered medical bills because they are not eligible, or do not seek, to go on to the welfare rolls.

That’s the Medicaid expansion—though, to be fair, Butler wasn’t the only person then calling for loosened Medicaid eligibility requirements. Many conservatives at that time were looking for ways to reward the working (“deserving”) poor as distinct from the welfare-dependent poor—a concern that faded after the 1996 welfare-reform bill eliminated long-term dependence on cash payments, making many more of the poor “deserving.”

One significant departure Butler makes from Obamacare is that he does not (at least in the 1989 lecture) favor “community rating,” i.e., a requirement that insurers take all comers regardless of pre-existing conditions and charge them approximately the same premium. But this is not a difference Heritage is likely to advertise now, because community rating is the one part of Obamacare so popular that most conservatives dare not openly oppose it.

In the lecture, Butler repeatedly called his proposal “the Heritage plan”-- not “my plan.” He elaborated these ideas in a 1990 backgrounder and in a 1993 paper titled “Why Conservatives Need A National Health Plan.”

In none of these writings did Butler make explicit mention of government-run insurance exchanges. But Butler favored severing health insurance entirely from the workplace—a good idea that was too far left for Obama to favor—by eliminating the tax deduction that employers receive for it.

Under Butler’s (whoops, make that Heritage’s) scheme, everyone would have to purchase his or her own health insurance. Butler proposed a consumer-choice system in which the government “set broad rules of the ‘game,’” and the context strongly suggested that by “government” Butler meant “federal government.”

That sounds an awful lot like insurance exchanges, which President Obama has used similar language to describe. Butler also mentioned as one model the Federal Health Employee Benefits Program, which was one model for Obamacare. A decade later, when Massachusetts Gov. Mitt Romney was putting together a state-level health reform plan that was another model for Obamacare, Heritage “helped us construct an exchange,” according to Romney’s 2010 book, No Apology.

In a 2012 op-ed, Butler emphasized some hair-splitting differences on the individual mandate (his was motivated by a desire not to protect the policyholder but to “protect others”) and added for good measure that he’s since changed his mind. Meanwhile, Heritage, in a 2011 amicus curiae brief submitted in support of the legal challenge to Obamacare, stated, “Heritage has stopped supporting any insurance mandate.” Heritage also said it had come to believe the individual mandate was unconstitutional—an interpretation later rejected, of course, by the Supreme Court.

Mainly, though, Heritage denies that it ever favored a health plan that remotely resembled Obamacare. Conceding this point too conspicuously would compromise its splashy campaign to defeat Obamacare by any means necessary. How can Obamacare be the work of the devil if much of that work was done at Heritage? A subject, perhaps, for future scholarly inquiry.

Источник: https://www.msnbc.com/msnbc/the-heritage-foundation-disowns-its-baby-msna153581

Repealing Obamacare with no replacement could be a 'recipe for disaster'

— -- President Trump this morning flipped on his previous strategy for accomplishing health care reform.

“If Republican Senators are unable to pass what they are working on now, they should immediately REPEAL, and then REPLACE at a later date!” he said in a tweet.

The president's new strategy was actually the preferred plan of attack for many top Republican lawmakers during the campaign.

Last November, just days after winning the election, Trump promised to repeal and replace the law concurrently.

“We’re going to do it simultaneously … we’re not going to have, like, a two-day period and we’re not going to have a two-year period where there’s nothing. It will be repealed and replaced,” he said during an interview with CBS.

Simply repealing parts of the law could leave insurance markets spinning, experts and some Republicans have warned.

Even The Heritage Foundation, a solidly right think-tank, cautioned in a February report that parts of the Affordable Care Act should be repealed gradually.

“Congress must replace Obamacare through a careful transition process that establishes everyone on more solid ground,” the report said. “Timing and sequencing of these efforts are complex, and proper execution is critical. Congress, the Trump Administration, and the states should work together both to ensure a smooth transition for the repeal of Obamacare.”

The Heritage Foundation, like other conservative groups, recommends an immediate repeal of the individual and employer insurance mandates. But it argued that rolling back the Medicaid expansion and government subsidies to help people buy individual insurance should take place a few years after any repeal legislation is passed.

Matthew Fiedler, a health policy fellow at the in Brookings Institution, argued that repealing the mandate alone, without a replacement plan, could have a big impact on prices and that lawmakers just threatening to do so has impacted the market.

“A lot insurers who have been filing for 2018 have already been building in a margin to say, ‘We think there might not be an individual mandate, so we are going to have a sicker pool, so we need to charge much higher premiums,'” Fiedler told ABC News. “In the ‘repeal and delay’ construct you could very well have insurers say, ‘Why am I going to deal with the chaos next year if I don’t even know if there is a business opportunity here in the long run and so I am going to pull up stakes and leave.’”

While the open enrollment period to buy individual insurance on state exchanges does not start until November, insurance companies are far along in their process of designing and submitting preliminary plans and pricing to states. Even if a repeal bill temporarily preserved some part of the law, like the cost-sharing subsides for people purchasing their own insurance for another year or two, experts say repealing the insurance mandates could lead insurance companies to raise prices or leave individual markets immediately.

In January, the Congressional Budget Office published a report analyzing a previous iteration of a repeal-only bill that would have removed the individual mandate immediately and then later eliminated the federal subsidies of individual insurance and the Medicaid expansion two years later. The CBO estimated that within the first year of enactment, 18 million more Americans would become insured because of the mandates repeal. Premiums in the non-group sector would increase by 20 to 25 percent in the first year, according to the report, as compared to projections under current health care legislation.

When cuts to Medicaid and the end of cost-sharing subsidies for individual insurance go into effect, the CBO estimated the number of uninsured Americans would grow by 32 million by 2026.

“If Republicans have been unhappy with the coverage estimates they have been getting so far, I can’t see how a repeal and delay strategy would solve the problem,” Fiedler said.

He went on, the heritage foundation and obamacare of the major challenges and one of the reasons Republicans on the Hill moved away from [repeal and delay] six months ago is that upending the whole health care system and then giving insurers no certainty on what would come after is a recipe for disaster. One of the things we have seen is that the insurance industry just does not deal very well with uncertainty … If the last six months have demonstrated nothing else it is that coming to an agreement on health care reform is hard.”

Источник: https://abcnews.go.com/Politics/repealing-obamacare-replacement-recipe-disaster/story?id=48379606