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Whither Obamacare Now That Its the Law of the Land
While a roll-back of Obamacare now is about as likely as spotting gargoyle statuettes among the DMCB spouses holiday decor, a recent New England Journal article points out that the Affordable Care Act (ACA) - even if it is the law of the land - still has a very bumpy road ahead.
Thats because of four key issues:
1. The States can still knot things up by forcing Washington DC to run the Health Insurance Exchanges (HIEs). Its very possible that Uncle Sam wont pull them off on time and, whats more, theres a credible Supreme Court challenge looming over Obamacares potential lapse in extending tax credits to the federally-run HIEs.
2. States can use the Medicaid expansion. While their statewide hospital associations are very unhappy about that, Governors are either ideologically opposed or just plain wary of additional downstream costs. This could result in additional millions of uninsured, especially in the conservative "red" states.
3. Health care cost inflation is likely continue its upward spiral. Congress, no matter how CMS payment innovations turn out and no matter how much it wants to curtail costs, is unlikely to withstand the lobbying from all corners of medical-industrial complex involving thousands of pages of rules and regulations.
4. Deep public ambivalence about the law will continue. That means that as Congress and the President look for ways to control the Federal deficit, Obamacare is especially vulnerable. Unlike Social Security or Medicare, the ACAs "patchwork" of insurance orms is headed toward the fiscal cliff without a strong supportive constituency. Before Congress even touches Medicare, its far more likely to cut Obamacare. The first hit could be those insurance tax subsidies mentioned above.
Whither Obamacare Now That Its the Law of the Land
Tuesday, February 11, 2014
While a roll-back of Obamacare now is about as likely as spotting gargoyle statuettes among the DMCB spouses holiday decor, a recent New England Journal article points out that the Affordable Care Act (ACA) - even if it is the law of the land - still has a very bumpy road ahead.Thats because of four key issues:
1. The States can still knot things up by forcing Washington DC to run the Health Insurance Exchanges (HIEs). Its very possible that Uncle Sam wont pull them off on time and, whats more, theres a credible Supreme Court challenge looming over Obamacares potential lapse in extending tax credits to the federally-run HIEs.
2. States can use the Medicaid expansion. While their statewide hospital associations are very unhappy about that, Governors are either ideologically opposed or just plain wary of additional downstream costs. This could result in additional millions of uninsured, especially in the conservative "red" states.
3. Health care cost inflation is likely continue its upward spiral. Congress, no matter how CMS payment innovations turn out and no matter how much it wants to curtail costs, is unlikely to withstand the lobbying from all corners of medical-industrial complex involving thousands of pages of rules and regulations.
4. Deep public ambivalence about the law will continue. That means that as Congress and the President look for ways to control the Federal deficit, Obamacare is especially vulnerable. Unlike Social Security or Medicare, the ACAs "patchwork" of insurance orms is headed toward the fiscal cliff without a strong supportive constituency. Before Congress even touches Medicare, its far more likely to cut Obamacare. The first hit could be those insurance tax subsidies mentioned above.
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