Showing category "ACA" (Show all posts)

The Health Reform Catch-22

Posted by Timothy McBride on Tuesday, February 28, 2017, In : ACA 

Ever since the election, the President and members of his party in Congress have been focused on one of the central promises nearly all of them made in their campaigns, to “repeal” Obamacare and – perhaps – to “replace” it as well.

Repealing and replacing Obamacare has proved as difficult to accomplish as passage of health reform was in the first place.  After all, it took President Obama about 15 months to get the Affordable Care Act (ACA) through Congress, and sign it, and to acc...


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New estimates of uninsured to be released 9/13/16

Posted by Timothy McBride on Tuesday, September 13, 2016, In : ACA 
Another milestone in the release of federal data will come Tuesday, 9/13/16 and Thursday 9/15/16 when the U.S. Census Bureau releases results from two surveys that are widely used to estimate the number of people in the U.S. with and without health insurance.

The Bureau will release estimates from the Current Population Survey and the Annual Social and Economic Supplement (CPS/ASEC) and the American Community Survey (ACS).  The former survey provides national estimates of insurance coverage wi...

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Health Insurance Marketplaces: Premium Trends, 2014-16

Posted by Timothy McBride on Thursday, May 12, 2016, In : ACA 

There has been a great deal of attention recently to the premiums in the Health Insurance Marketplaces (HIMs), and the potential shape of the marketplaces in 2017. The recent announcements by some insurers that they may pull back from their role in the marketplaces authorized by the Patient Protection and Affordable Care Act (ACA) has fueled this interest, along with the annual period when insurers submit their preliminary bids for premiums in the marketplaces, with fears that the growth in p...


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IMPORTANT MILESTONE: Insurance, uninsurance estimates for 2014 to be released Wednesday 9/16

Posted by Timothy McBride on Tuesday, September 15, 2015, In : ACA 
A big milestone in the release of federal data will come on Wednesday when the U.S. Census Bureau releases results from two surveys that are widely used to estimate the number of people in the U.S. with and without health insurance.

The Bureau will release estimates from the Current Population Survey/Annual Social and Economic Supplement (CPS/ASEC) and the American Community Survey (ACS).  The former survey provides national estimates of insurance coverage with breakdowns by demographics, inco...
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Supreme Court upholds Obamacare again

Posted by Timothy McBride on Thursday, June 25, 2015, In : ACA 

The Supreme Court decided today on the “Obamacare” case, called “King v. Burwell” and ruled in a 6-3 decision to support the Administration’s position on the law, that subsidies should be allowable in federal marketplaces.  The Chief Justice Roberts and Justice Kennedy joined the four liberals (Breyer, Ginsburg, Kagan and Sotomayor) in the decision.  Find the decision here.

The decision is important for the continued implementation of the Affordable Care Act, and means that perhaps a...


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Awaiting SCOTUS case on subsidies: liberal justices on majority opinions all year

Posted by Timothy McBride on Tuesday, June 9, 2015, In : ACA 

Today I was looking at a New York Times article, which listed how the justices voted on "major" cases this session, and one thing struck me -- on each and every case all four so-called liberal Justices (Ginsburg, Breyer, Kagan and Sotomayor) voted in the MAJORITY on each and every case, sometimes joined (of course) by 1-5 other justices, most frequently Kennedy, Roberts.  The three most conservative justices (Thomas, Scalia, Alito) were least often on these cases.

This led me to think about th...
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Is the Sky Falling? Let's Wait

Posted by Timothy McBride on Wednesday, May 27, 2015, In : ACA 
So it's that time of the year on the calendar when private insurers who offer plans in the Health Insurance Marketplaces (HIMs) start to submit their "rate bids" for the next year, and some reporters have obtained information on these bids.  This is leading to some rather hyperbolic headlines, and reaction, about how the marketplaces may be falling apart under a cost explosion.  In fact, this is an annual experience that needs to be calmly understood, and we need more time -- and data -- to u...
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"Grubergate" (II): The contracts

Posted by Timothy McBride on Tuesday, November 18, 2014, In : ACA 

In the latest attempt to attack Obamacare, opponents think they have a juicy new target, Prof. Jonathan Gruber, from MIT.  In addition to pulling his quotes from academic musings out of context, the opponents have a new line of attack: that supposedly Gruber "netted" millions of dollars in contracts from the federal government (the Obama administration) to do his work.  The impression left, often said directly, is that Gruber himself was paid these dollars, or that the total dollars from the ...
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Grubergate

Posted by Timothy McBride on Tuesday, November 18, 2014, In : ACA 

In the last few days -- essentially since the election -- the Republicans have launched a new line of attack on Obamacare (the Affordable Care Act).  They are attacking what they call the "architect" of the ACA, who is quoted on video of making a handful of comments, which when they are heard out of context, seem quite damning. 

This latest line of attack on the ACA is rather bizarre in many ways.  Why? Here is why:

  • Everyone who closely followed the development and then passage of the ACA knows...

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SCOTUS (III): Smoking gun (CBO score) proves plaintiffs case has no merit

Posted by Timothy McBride on Monday, November 10, 2014, In : ACA 

As I mentioned in two previous posts, the Supreme Court (SCOTUS) this past week decided to take the case of an appeal of a ruling by the 4th Circuit US federal court of appeals (King v. Burwell), in a case where the plaintiffs allege the Affordable Care Act (ACA) is ambiguous or conflicted on whether subsidies can be offered to lower-income persons who obtain coverage through Marketplaces established and run by the federal government.

Earlier I pointed out two huge flaws in the argument of the...
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SCOTUS (II): Legislative intent of ACA always clear, key Senate-House chairs say

Posted by Timothy McBride on Sunday, November 9, 2014, In : ACA 
As I noted earlier, the Supreme Court (SCOTUS) this past week decided to take the case of an appeal of a ruling by the 4th Circuit US federal court of appeals (King v. Burwell), in a case where the plaintiffs allege the Affordable Care Act (ACA) is ambiguous or conflicted on whether subsidies can be offered to lower-income persons who obtain coverage through Marketplaces established and run by the federal government.

My earlier post pointed to some fatal flaws in the arguments of the plaintiff...
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SCOTUS (I): Why the case against the ACA at Supreme Court has no merit

Posted by Timothy McBride on Sunday, November 9, 2014, In : ACA 

The Supreme Court has decided to take a case, ruling on another aspect of the legality of a key provision of the Affordable Care Act (ACA), whether it is legal for the federal government to provide subsidies for insurance coverage under the federal Marketplaces.  Though nearly every scholar has cast serious doubt on the logic of the case made by the plaintiffs, the Court has decided to take the case, likely because at least four Justices have certainly expressed their strong skepticism on the...


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Missouri shows very small change in uninsured rate in latest Gallup survey

Posted by Timothy McBride on Wednesday, August 6, 2014, In : ACA 

Gallup has released its latest results from its survey of how the Affordable Care Act (ACA) is faring nationwide, and it shows rather stunning (though in most cases likely unsurprising to health policy analysts) results of how this grand policy change is rolling out state by state.  Their main finding is that in states that implemented most of the features of the ACA the drop in the uninsured rate (which was already lower in the states that chose to implement the core mechanisms of the ACA) w...
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Here is something about the response to the Health Reform (the Affordable Care Act) I don't get...

Posted by Timothy McBride on Saturday, June 28, 2014, In : ACA 
So here is something that has perplexed me for a long time, watching the (largely successful) rollout of health reform (the Affordable Care Act).

For months now, many very bright people (pundits, reporters, Legislators) have been fixated on one part of the Affordable Care Act (ACA)'s rollout and using it as a ruler to measure the law's success: the number of people enrolled in the MARKETPLACES -- whether the law would reach the target of roughly 8 million people enrolled in the "Marketplaces" ...
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UPDATE: Layoffs continue in Missouri-near 1,000 layoffs in health sector since April 2013?

Posted by Timothy McBride on Friday, June 27, 2014, In : ACA 
In an earlier post, I laid out data I have been accumulating from press reports on job layoffs in the health care sector, mostly affecting hospitals and health systems.  Today (6/27), 60 more layoffs were announced in Springfield (MO) by Ozarks Community Hospital.  

Thus I am updating the table I presented earlier (attached here), which shows almost 1,000 jobs affected in Missouri 
(including layoffs, jobs eliminated that are vacant but will not be refilled, and jobs where hours will be reduced...
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Does the new GDP report pass the smell test?

Posted by Timothy McBride on Thursday, June 26, 2014, In : ACA 
After sleeping on it, I have to wonder whether the third revision of the 1st Quarter GDP report actually passes the smell test any more than the first one did.  When the first one came out -- and it said that health utilization grew by 9.9% at an annual rate (even when GDP was growing just 0.1%) many of us did not believe this passed the smell test.  We subsequently learned that the Commerce department did not have real use numbers to back this up, but it was based on projections.  And even i...
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Understanding what is driving the downward trends in GDP in 2014 and what is going on in the health sector

Posted by Timothy McBride on Wednesday, June 25, 2014, In : ACA 
Today the third revision of the first quarter GDP report was released and it shows a rather remarkable downward slide in the health care sector's share of GDP, according to the Commerce Department that counts this up.  As I discussed in my previous blog report and is shown here in a good post on the Council of Economic Advisors web site, the revision has overall health utilization down -1.4% (on an annual rate), prices up only a very slow 0.5% (on an annual rate), so overall health care fell ...
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Is the Health Care Cost Curve Being Bent? Third Revision of GDP

Posted by Timothy McBride on Wednesday, June 25, 2014, In : ACA 
As I discussed earlier, I did not believe the first report for the first quarter quarter of 2014 for GDP, which showed a whopping increase of 9.9% annual growth in health use, attributed all to the ACA (see my previous blog posts on that).  We later learned that this was all based on projections and not on any real data.  Most of my health economics friends expected this to be revised downward.

Well it has been, twice.  The third revision of the GDP was announced today (June 25, 2014), and it ...
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Job Layoffs in Health Care Sector Continue to Plague Missouri

Posted by Timothy McBride on Sunday, June 22, 2014, In : ACA 
Missouri continues to be plagued by job layoffs in the health care sector.  Though it is admittedly hard to track these job layoffs specifically without exact details (reports I have on these are based on press reports which are notoriously lacking in detail, for good reasons) -- and it could be that some of the job layoffs have not been reported at all publicly, this post will be based on what I have been able to find in the news over the period April 2013 to June 2014.

Over that period as th...
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Health Spending, the GDP Report, An Update

Posted by Timothy McBride on Saturday, May 10, 2014, In : ACA 

Since the GDP report came out for First Quarter 2014 and there was much attention to this from many quarters, including in the press (see column by Los Angeles Times columnist Michael Hiltzik and column by Peter Orszag, to cite a couple examples).

In the last week or so, a couple more pieces have come out to weigh in on this.  For example:

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Health Use up 9.9% in Early 2014: What does this mean? Was this Expected?

Posted by Timothy McBride on Thursday, May 1, 2014, In : ACA 

[UPDATED 630 am Central, 5/1; updated May 2, 3 pm to include link to new Altarum report]

The first quarter 2014, gross domestic product (GDP) numbers were released Wednesday April 30, and other than the report gaining headlines for being so dismal (largely attributed to the terrible winter weather), the other big headlines were for the large increase in medical care utilization (9.9% annual rate, even when medical inflation rose only 0.1%).

Certainly it WAS EXPECTED that the total health spendi...
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New Gallup results: most encouraging yet to set aside concerns about adverse selection?

Posted by Timothy McBride on Friday, April 18, 2014, In : ACA 

First, the caveat: at this very early stage in the implementation, and more to the point, the rollout of the data on the Affordable Care Act (ACA), we should all proceed with caution.  That is especially true when we get several studies, or surveys from different sources, with different samples, using different methods, and in particular using samples that are in general relatively small in comparison to social scientists and health researchers are used to seeing in doing health policy analys...
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The politics of the ACA is widely misunderstood

Posted by Timothy McBride on Saturday, April 12, 2014, In : ACA 
It has become widely accepted, it seems, in the popular press, and in Washington, for a long time that the Affordable Care Act (ACA) is unpopular and will hurt the Democrats in the midterm elections in November 2014. My belief is that this stems from at least a couple misunderstandings of the polls.

First, most polls ask a lead question about the ACA, simply asking a question about whether people favor or oppose the ACA.  For a long time a plurality has been more against the ACA than in favor ...
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Three surveys show uninsured dropping rapidly since ACA open enrollment period started

Posted by Timothy McBride on Friday, April 11, 2014, In : ACA 

Three surveys recently released are now showing significant increases in the number of people insured in just the last six months (September 2013 to March 2014), roughly showing the same effect:


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Uninsured in States with State-Based Marketplaces Twice as Likely to Obtain Coverage

Posted by Timothy McBride on Thursday, March 20, 2014, In : ACA 

·  ·    The ACA left the important decision of whether to create a state-based marketplace or not up to the states, and the Supreme Court gave states the option to expand Medicaid or not.  

Fifteen states (representing about one-third of the uninsured in the U.S.) have chosen to create state-based marketplaces, 10 states are using the federally-facilitated marketplaces (FFM) but are expanding Medicaid, while the remaining 26 states have chosen to use the federally-facilitated marketplace and...


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Additional comment on Patrick Ishmael's commentary

Posted by Timothy McBride on Saturday, March 8, 2014, In : ACA 

Earlier I commented on Patrick Ishmael's comments on Medicaid in Missouri posted on Forbes website.  In my previous comments I dealt with several of the issues he raises in that commentary, except the last one.  At the end of his piece he makes this comment:

"Keep in mind that this enrollment conversation doesn’t even touch on the abysmal Medicaid health outcome record that Avik Roy, Michael Cannon and others have talked about for years. That’s no small matter. Combine the outcomes problem...


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Where is Paul Ryan?

Posted by Timothy McBride on Thursday, December 5, 2013, In : ACA 
It has occurred to me that in all the news reports I have seen, with many Republicans out front and center attacking the rollout of the Affordable Care Act (ACA), one person I have not seen speaking about it is Paul Ryan.  I wonder why this is the case.  But I have a hypothesis.

Ryan made a Medicare Exchange the centerpiece of his policy changes to Medicare in his proposal outlined in "Path to Prosperity" (see pages 39-40 of the document at the link).

It has been pointed out before, most notabl...
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A Tale of Three Markets: How ACA implementation by state is affecting the uninsured's ability to obtain coverage

Posted by Timothy McBride on Monday, December 2, 2013, In : ACA 

After passage of the ACA, and the decision by the Supreme Court, states have faced important implementation decisions that will profoundly affect the effectiveness of health reform in reaching the previously uninsured.   As the Affordable Care Act (ACA) is being implemented, it is becoming clear that the experience for those trying to obtain health insurance coverage is influenced by two major decisions made by the states: whether the state chose to operate their own state-based marketplace, ...


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Media narrative on the ACA: is it over the top?

Posted by Timothy McBride on Saturday, November 30, 2013, In : ACA 
It seems we cannot open up a newspaper, or listen to a newscast these days without hearing reference to how troubled the "rollout" of "Obamacare" is.  This seems a dominant media narrative, deserved or not.  

Just for kicks, I did a quick and (I am sure not exhaustive) search on "Lexis/Nexis" to see how many references I could come up with to this.  Using just the parts of the database limited to "all news (English)" and "broadcast transcripts" and limiting the search to articles posted on Oct...
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Interesting preliminary data on age distribution of ACA enrollees

Posted by Timothy McBride on Friday, November 29, 2013, In : ACA 
A Reuters report (link sent to me by Chris Conover; thanks Chris) reports that in four states where they have reports about 20% of new enrollees are 18-34 years old (ranging from 19% in KY to 27% in MD). The report indicates that "The Obama administration is aiming to enroll about 2.7 million 18-to-35 year olds in the exchanges by the end of March, out of 7 million total, or about 38 percent."

The age distribution seems actually better than I might have expected at this early stage.  Many repo...

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Why is media minimizing impact of ACA?

Posted by Timothy McBride on Friday, November 29, 2013, In : ACA 
Persistent reports on the impact of the rollout of the new insurance options for 2014 under the Affordable Care Act (ACA) have fixated on the enrollments in the new Marketplaces, where private plans are being offered. 

Why is it that the media is not reporting widely the TOTAL number of previously uninsured who are obtaining coverage through all sources, including the marketplace plans as well as Medicaid coverage?

The recent updates from Kaiser show that over 741,000 people are now enrolled, a...
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What if all states had adopted State-Based Exchanges?

Posted by Timothy McBride on Thursday, November 21, 2013, In : ACA 
In the many things to dissect about the Affordable Care Act (ACA), one thing we will study is the decisions by states not to operate their own Marketplaces, and states not adopting Medicaid expansion. 

Given the problems to date with the federal website, it is notable that this likely has hampered many people in the 36 states not operating a state marketplace.  One measure of this is that of the 993,635 people who applied for coverage in the state marketplaces, only 21% were enrolled in market...
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Enrollment in ACA starting to accelerate?

Posted by Timothy McBride on Wednesday, November 20, 2013, In : ACA 
As is being reported in some media outlets, in November the enrollment in the Affordable Care Act (ACA) may be accelerating.  

This is being shown by preliminary data reported by the Kaiser Family Foundation, which is tracking state enrollment where it can get regular updates from the states.

In the three states where Kaiser has new updates since the administration released the nationwide report (of enrollment through November 2), there is a 28% increase in enrollment of 36,641 persons.  It bre...
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About 75% of new Medicaid enrollment in states expanding Medicaid

Posted by Timothy McBride on Tuesday, November 19, 2013, In : ACA 
Based on the report published last week, about three-quarters (74.2%, or 293,984 people) of the new enrollment in Medicaid (from October 1 to November 2) occurred in the 26 states (including D.C.).  This means that the remaining increase in enrollment -- 25.8%, or 102,277 people -- has occurred in the 25 states that have not expanded Medicaid so far.

This may not seem like a surprise, because perhaps some might ask: of course the new enrollment is occurring mostly in the states that expanded M...
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State Based Marketplaces Much More Successful in Enrolling People under ACA

Posted by Timothy McBride on Monday, November 18, 2013, In : ACA 
Last week the administration released data on the number of people who have applied for, and been enrolled in, insurance through the Affordable Care Act (ACA).  As has been widely reported, 106,185 people enrolled in the state and federal Marketplaces, and 396,291 enrolled in Medicaid plans, for a total of 502,446 enrolled.

How well are these state-based and federal Marketplaces doing in enrolling people, especially relative to the number of uninsured in the states?  Some overall impressions, ...
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Making sense of Enrollment reports: State Based Marketplaces

Posted by Timothy McBride on Wednesday, November 13, 2013, In : ACA 
There are now several places tracking and reporting numbers enrolled in the state-based Marketplaces.  For example, the New York Times this morning reported on what is happening in the state-based Marketplaces which are generally working better than the much-maligned federal Marketplace (healthcare.gov).  

I have put together a table to compare the estimates from the New York Times, Avalere, and Advisroy Board, all that are reporting numbers on a semi-regular basis.  Just to be clear, not all ...
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Get ready for a wild ready on enrollment numbers

Posted by Timothy McBride on Tuesday, November 12, 2013, In : ACA 
We are starting to see early reports on "enrollment" numbers in the Affordable Care Act (ACA) Marketplaces in various places.  It could be a real wild ride, and as in any reports on data, it could get very confusing.  And, unfortunately, when numbers are confusing, and all over the place, that could lead to a situation where pundits or politicians pick and choose the numbers they want to choose to make the numbers look bad, or good, depending on their point of view.

Officially the federal gove...
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The Health Reform Have- and Have-Not States

Posted by Timothy McBride on Monday, November 11, 2013, In : ACA 
As the press and pundits rush to judgment (apparently) on deciding how "Obamacare" is going they ought to actually stop to ponder that the Affordable Care Act is not just one program, not a federal program, rolling out the same in every part of the country.  In fact, what we are witnessing is essentially 51 different health reforms being rolled out in the 50 states and D.C., and taking on different forms everywhere.

One way to characterize the way this is rolling out is on two major dimensions...
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Politics will leave some uninsured

Posted by Timothy McBride on Monday, November 11, 2013, In : ACA 
It is worth remembering that because of policy and political decisions many of the uninsured will not have access to the options for coverage available under the Affordable Coverage Act (ACA).  At least two major groups are important:

Thus about 14 million (see Table here) are not ev...

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Press is missing the boat on ACA by not covering State-Based Marketplaces?

Posted by Timothy McBride on Sunday, November 10, 2013, In : ACA 
There has been much hyperbole in the press about the "failure" of "Obamacare" because of the problems with the federal healthcare.gov website.  The focus on this website and perhaps few enrollments through this website and many mentions of this seems odd given that in 17 states individuals will enroll through state-based Marketplaces.

The Kaiser Foundation is reporting preliminary data on these state-based Marketplaces on their website, at least for 15 of these states.  They report that 227,81...
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About Me


Timothy McBride Timothy D. McBride, Ph.D. is a Professor at the Brown School, Washington University in St. Louis. Here you can find musings on health policy and other issues. Opinions are my own, and not those of my employer. Contact: mcbridetd@gmail.com