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Obamacare’s forgotten OTHER subsidy

aca plan comparison laptop

Back in 2013, shortly before the first Affordable Care Act plans took effect, we wrote a post about what we called Obamacare’s “other” subsidy. In it, we explained how if your income is below 250% of the poverty line (currently $29,700 for a single adult), a provision called Cost Sharing Reduction (CSR) could dramatically lower your out-of-pocket costs if you buy a Silver level plan.

At the time, it seemed like hardly anyone knew this; while we’d seen plenty of articles mentioning the ACA’s help paying for premiums, CSR was largely ignored.

Unfortunately, over the past two and a half years, not much has changed. Even as high out-of-pocket costs have become a major campaign issue, Obamacare’s CSR has gotten little coverage, meaning many people who could benefit still have no idea it exists.   [click to continue…]



In our last post we talked about the wonky idea at the center of Martin O’Malley’s healthcare plan– an all payer system– and why both Hillary Clinton and Bernie Sanders should consider adopting it in their own plans.

But that’s not the only part of O’Malley’s plan that deserves a second look. In a piece for MedicareResources.org, Rob writes about his other good idea, which O’Malley calls Medicare Essential:

Originally proposed by researchers from John Hopkins University and the Commonwealth Fund, “Medicare Essential” could make Medicare simpler for enrollees, lower their premiums and out-of-pocket costs, and improve the quality of their care. It’s an idea that could strengthen Clinton’s “Medicare for More” plan or serve as a step toward Sanders’ “Medicare for All.” On top of that, it would cost the federal government nothing, making it hard for even a Republican Congress to vote no.

Go read the whole thing here!


martin o'malley doctors

Before you ask, yes we know Martin O’Malley dropped out of the 2016 presidential race months ago.

Here’s the thing: presidential campaigns in the U.S. are way too long. The UK’s most recent national election lasted 139 days, and the last Canadian election took just 11 weeks. Meanwhile, here in the U.S., the 2016 campaign began almost two years before election day, when Ted Cruz announced his candidacy. It’s a ridiculous amount of time to focus on an election, so aside from a quick post on the first Republican debate (which, like everyone else, we watched mostly just to see the Donald Trump circus) we decided not to cover the 2016 campaign until, well… 2016.

What that meant though is that by the time we started looking at candidates’ health plans, many of them had already dropped out. In the Republican race, this wasn’t a big deal since every GOP candidate promised basically the same thing on healthcare: to repeal the Affordable Care Act and replace it with some combination of catastrophic coverage, high risk pools, selling insurance over state lines, and block-granting Medicaid.

However, on the Democratic side Martin O’Malley had an interesting proposal that none of the other candidates touched on. Even though he’s out of the race, his ideas are still worth examining, because they could improve both Clinton’s plan, which builds on the ACA, and Sander’s single-payer approach– and possibly serve as a bridge between them.   [click to continue…]

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By far the most important change for pregnant women in the Affordable Care Act was the provision saying that all health plans have to include maternity coverage as an essential health benefit. (Before Obamacare, just 12% of plans on the individual market covered pregnancies.)  But the ACA didn’t stop there– it also provided pregnant women with more choices on how to give birth, by expanding access to midwives and birth centers.

In a piece for healthinsurance.org, Rob looks at why more women are choosing to give birth outside of hospitals, and how Obamacare has helped make that choice possible. Here’s a sample:

Elizabeth Criss knows all about the stigmas attached to giving birth outside of a hospital. “When I told my husband I was being interviewed about why we chose a birth center, he said I should just quote Jim Gaffigan: ‘We’re both lazy and the hospital was soooo far … the midwife was there because we believe in witchcraft.’”

In truth though, Criss did a lot of research into different birth options, and found that for low-risk pregnancies like hers, outcomes for babies are similar at birth centers and hospitals. Also, she had reservations about how quickly hospitals turn to medical and surgical interventions, which come with their own health risks; and she knew that if something happened, the midwives at her birth center, The Midwife Center in Pittsburgh, have admitting privileges at a nearby medical center. Plus, she’d been going there for well-woman visits for years before planning to become pregnant – the atmosphere was more homey and she felt more listened to than with past doctors.

“When you’re pregnant, there’s a lot going on physically and otherwise,” says Criss. “I liked that the care was more comprehensive and whole-person centered, and they don’t treat it like you’re just a uterus.”

Criss says she was happy with her experience at The Midwife Center, and she’s glad she had that option. Now, thanks to Obamacare, it’s a choice available to more women.

Go read the whole thing over at healthinsurance.org!


trump pumpkin american flag

[This post is part of a series looking at the health plans of the presidential candidates. You can read about Bernie Sanders’ health plan here, and Hillary Clinton’s plan here and here.]

Honestly, we’re not sure what to do with Donald Trump’s health plan. On the one hand, he is the leading Republican candidate for president, and he does have an actual plan up on his website that’s about as detailed as anything Marco Rubio or John Kasich (the GOP’s “serious” candidates) have put forward.

On the other hand, Trump seems to be making up his policy positions as he goes, so who knows what the plan will look like tomorrow. Health care experts have questioned how much effort, if any, he put into it, since he doesn’t appear to have a single health policy adviser, with some of the harshest criticism coming from conservatives. For example, Michael Cannon, director of health policy studies at the libertarian Cato Institute writes:

This isn’t a health reform plan. It’s a campaign operative copying and pasting a bunch of stuff from the around the web, without knowing what it means or even realizing that he’s describing current law. It shows Trump is as unserious about reforming health care as ever. He doesn’t have a plan. He has paroxysms.

Yet for all the complaints from conservative health experts, what’s most striking about Trump’s plan/paroxysms is how similar it is to other Republican candidates’. This is a guy who told 60 Minutes, “Everybody’s got to be covered. This is an un-Republican thing for me to say… I am going to take care of everybody.” But his actual plan simply repeals Obamacare– leaving tens of millions more Americans uninsured– replacing it with almost nothing.  [click to continue…]


hillary clinton health rally

In our look at Hillary Clinton’s health plan yesterday, we pointed out that of seven big problems that Obamacare didn’t fix, she had ignored perhaps the biggest. Despite saying that she shared Bernie Sanders’ goal of universal coverage, she hadn’t actually proposed a plan to get there. At the end of the post we said that we hoped she’d put out something more ambitious.

Well that didn’t take long. Less than hour after the post went up, we discovered that within the past day or two, Clinton has added a bunch more proposals to her campaign website, all with an eye toward expanding coverage to more of the uninsured. (For comparison, here’s what the healthcare section of her site looked like a week ago.) In addition to the things we mentioned in our last post, Clinton now says she would:

  • Enhance the premium tax credits on the ACA’s exchanges;
  • Fix the law’s “family glitch”;
  • Support new incentives to encourage all states to expand Medicaid;
  • Invest in navigators, advertising and other outreach activities to make enrollment easier;
  • Expand access to affordable health care to families regardless of immigration status; and
  • Continue to support a “public option”.

These new proposals would in fact expand coverage to more people, moving us closer to universal coverage. But how close would they actually get us?   [click to continue…]


hillary clinton

[This is the second post in a series on the health plans of the 2016 presidential candidates. Part 1, which looked at Bernie Sanders’ health plan, is here.]

Here’s what the 2016 Democratic candidates for president agree on: They agree that healthcare in America is better since the Affordable Care Act. They also agree that there are still problems that need to be fixed, and they mostly agree on what those problems are– a list that looks pretty similar to one we made a while back:

  1. We still don’t have universal coverage;
  2. Unaffordable out-of-pocket costs;
  3. Buying and using insurance is incredibly confusing;
  4. Narrow provider networks;
  5. Price-gouging by providers;
  6. Lack of dental coverage; and
  7. Drug discrimination by insurers.

Where they differ is on how to fix them. Bernie Sanders proposes a totally new system: one single-payer plan covering everyone. As we’ve said before, it could be a great idea, potentially solving every problem on that list (and then some) all at once. Still, single-payer doesn’t automatically mean that people would be better off. For example, if we simply moved everyone into traditional Medicare, which is a single-payer plan, most people would end up with higher out-of-pocket costs, and its low reimbursement rates could force providers out of businesses. To judge any plan– single-payer or otherwise– you have to look at how it balances benefits and costs; and in Sanders’ plan those key details are a mess.

Hillary Clinton’s approach on the other hand is to build on the ACA. Clinton doesn’t provide detailed cost estimates for her proposals, but they’re all small enough changes that it’s easy to imagine how they might be paid for. In a way though, this also highlights a problem: even if all of her proposals were in place, the major issues with our health system would still remain. In other words, unlike Sanders’ plan, the numbers add up– but they don’t add up to nearly enough. [click to continue…]


The fuzzy math behind Bernie Sanders health plan

bernie sanders

[This is the first post in a series on the health plans of the 2016 presidential candidates.] 

Even before they released specific plans, it was obvious that Bernie Sanders and Hillary Clinton had very different philosophies for improving our health system. Clinton promised an incremental approach: new regulations and funding to fix issues that Obamacare missed, but otherwise keeping the current system. Sanders proposed something much more radical: eliminating private insurance entirely, and covering everyone under one single-payer system.

It’s a great idea in theory: everyone gets an insurance card that they can take to any doctor or hospital in the country. No more worrying about whether you have insurance, whether a provider is in-network, or whether your claim will be denied. Single-payer also saves money thanks to lower administrative costs– hospitals don’t have to bill hundreds of different insurance plans, each with their own rules– and by negotiating for better prices from drug companies. Canada and a few other countries have shown that a national single-payer plan can work; they spend much less per person on care than us while covering everyone.

The hard part is figuring out how to get there from our current system. To switch to single payer you need to (1) figure out what services will be covered for every single American, keeping in mind that every benefit makes the plan more expensive; (2) set taxes and out-of-pocket costs so they’re affordable for every family; and (3) decide what to pay providers (set prices too high and the system is too expensive to sustain, set them too low and you force some doctors and hospitals out of business). Balancing all these variables is tricky, especially since the numbers are enormous. Over the next ten years we’re expected to spend over $40 trillion on health care, so a few percentage points here or there can mean the difference between a working system and an economic crisis.   [click to continue…]


The Health of the Union 2016

obama state of the union 2016

For his final state of the union, President Obama said he’d go easy on the traditional list of proposals for the year ahead. Instead, he said, he wanted to talk about “the next five years, the next ten years, and beyond.”  And so, while he talked about the programs enacted during his time in office– including, of course, Obamacare– and the issues he’ll work on during his last year, but he didn’t lay out much in the way of specific plans. Still though, the health issues he talked about were telling, and there were some surprises.

Here, for the last time under an Obama White House, is our annual look at healthcare in the State of the Union.   [click to continue…]


john bel edwards

If you really think about it, the politics surrounding the Affordable Care Act have always been weird. The ACA was modeled on Massachusetts’ health reform, which was signed into law by future Republican presidential candidate Mitt Romney and supported by conservative think tanks like the Heritage Foundation. It’s also very similar to a plan proposed by Republican senators as an alternative to President Clinton’s health reform efforts in the early ‘90’s. So in theory, Republicans should have had no problem with Obamacare. Instead, Romney, the Heritage Foundation, and every other Republican in Congress came out against it.

But lately the politics of the ACA have gotten even stranger.

There are basically two parts to Obamacare’s coverage expansion: (1) Medicaid for those with incomes below 138% of the federal poverty line, and (2) exchanges where anyone who isn’t covered by an employer or government program like Medicare can purchase private insurance. Of the two parts, you’d think that Republicans would want to see more people enrolled in private insurance and fewer people enrolled in a big government health plan like Medicaid.

Yet, over the past month, we’ve seen Republicans across the country push to expand Medicaid, while their colleagues in Congress work to blow up the ACA’s private insurance expansion.   [click to continue…]