A primary argument made for passing the Affordable Care Act (ACA, or so-called “Obamacare”) was that only such an expansion of the federal role in healthcare could successfully slow the growth of national health costs and thereby avert fiscal disaster. During the first few years after the law’s enactment, many of its supporters contended it was already accomplishing this, which other analysts strongly disputed. But more recently a quiet consensus has overtaken the former controversy: thus far the ACA’s cost-containment mechanisms are failing, and the net effect of the law has been to make our national healthcare affordability problem worse than it was.
The ACA was complex legislation containing on the one hand several elements expected to increase healthcare spending, and on the other hand several it was hoped would reduce costs. On the cost-increasing side, the law significantly expanded federally-subsidized health insurance coverage, lowering millions of Americans’ out-of-pocket contributions to their own healthcare purchases. It is well documented that the greater the share of individuals’ healthcare financed by insurance, the more services they tend to use. The ACA’s coverage expansion, direct benefits, premium assistance and cost-sharing subsidies thus all increased healthcare demand, utilization and costs.[1]
At the same time, the ACA contained various provisions designed to slow healthcare spending growth. It established a new excise tax on high-premium employer-sponsored plans, the so-called “Cadillac plan tax,” intended to counter the cost-driving effects of the longstanding federal tax preference for employer-sponsored health insurance. The ACA also constrained Medicare provider payment growth, which it was hoped would have “spillover” effects of forcing efficiencies and generally lowering costs. The law also created a new Independent Payment Advisory Board (IPAB) with powerful authority to further constrain Medicare spending growth, while limiting lawmakers’ opportunities to override IPAB’s decisions. Also included in the ACA were various provisions designed to limit hospital readmissions, promote bundled payments, and move to value-based provider reimbursements.
Importantly, these provisions taken together were not projected to lower spending as much as the ACA’s subsidized coverage expansion would increase it. Specifically, the Centers for Medicare & Medicaid Services actuaries estimated the ACA would increase total health spending while assuming each of its cost-saving provisions would be fully implemented.
Unfortunately from a fiscal perspective, the ACA’s cost-increasing provisions took effect while many of its cost-saving provisions did not. The Cadillac plan tax was immediately postponed until 2018 in the reconciliation law amending the original ACA, and was more recently postponed to 2022 in the latest omnibus appropriations act. Some previously-planned Medicare Advantage cuts were scaled back, while the vast majority of the ACA’s scheduled Medicare payment reductions are only beginning to be implemented. IPAB was also repealed earlier this year. These events conformed to previous warnings that the proceeds of the ACA’s various savings provisions could not be safely spent until they had actually accrued.
National healthcare spending growth slowed significantly in the years leading up to and after the ACA was passed, tempting some to assert that the ACA itself was holding down cost growth. This was never a fully credible claim, not least because the spending slowdown was an international phenomenon and preceded the ACA’s 2010 enactment, but also because it long preceded 2014 when the ACA’s main coverage expansion provisions took effect. Subsequent evidence is that the ACA’s net effect has been to push healthcare spending higher.
Figure 1 shows historical and projected growth in National Health Expenditures (NHE) per capita. The graph suggests a trend. Annual percentage growth in NHE per capita was declining substantially before the ACA was enacted in 2010. In 2014, however, the ACA’s coverage expansion kicked in, and its effect of increasing national health spending was immediate. For the past few years NHE growth per capita has been elevated, a trend projected to continue in the near future.
Note that these raw per capita growth figures only tell part of the story, because NHE growth tends to rise and fall with broader economic growth. Figure 2 shows how historical and projected per capita GDP growth looks over the same time period. The trend in Figure 2 is partially, but not wholly, parallel with Figure 1; it shows faster growth after the ACA was enacted than before. With respect to GDP growth, this reflects the enactment of the ACA just after the Great Recession.
Figure 2 thus provides context for Figure 1, but neither figure tells the whole story. To reveal the healthcare spending growth trend, the critical factor to isolate is the difference between the two figures – that is, the difference between per capita NHE growth and per capita GDP growth, or in other words, “excess” NHE growth. Figure 3 shows the evolution of excess NHE growth.
Figure 3 shows that excess NHE growth spiked during the Great Recession: basically, the economy contracted but NHE did not, causing a substantial differential. During 2010-13 excess NHE growth effectively disappeared, as the economy recovered while health spending moderated. But then in 2014 the ACA’s coverage expansion began, which meant that despite our continuing economic recovery, the problem of excess NHE growth re-emerged.
While health economics is too complex for us to blame the ACA alone for the recent adverse trend, the evidence on balance points to the ACA increasing rather than decreasing health spending.
https://economics21.org/html/obamacare-failing-contain-healthcare-costs-3108.html
Once in a while you get shown the light, in the strangest of places if you look at it right.
Democrats dominated the Congress for 30 plus years. Republicans took over in 1995. After that, the Government experienced the first ever surplus. Deficits dropped significantly until they began seeing a surplus in 1998 as a result of the Contract with America, until after 9-11 and our subsequent invasions into Iraq and Afghanistan. Stop being a dishonest dumbfuck and pretending that there wasn't a reason the deficits began again. Find a single war that was ever fought with a surplus.
Deficits went up and down for thirty plus years dishonest dumbass. They didn't become a surplus until Republicans took over the Congress. Congress holds the purse strings.
Where BillyBob Clinton gets credit is that unlike the Obama moron, he saw the American people's will and signed onto Newt Gingrich's agenda. Pretending it was a result of Clinton makes you look ignorant, dishonest and a partisan hack.
The deficit fell in 73 and 74, then increased again. The deficit fell in 79, then increased again. The deficit fell in 84, then increased again. The deficit fell in 87, then increased again. What does that say about your moronic hypothesis?
The Republican controlled Congress in the 90's had the first surplus since 1969. What does that do to your hypothesis. STFU, seriously. You look like a moron.
Yes, partisan hacks like you are quite full of excuses, moronic hypothesis and a lot of "IFs". Dunce.
You have it ass backwards. When Democrats took back control of the Congress for a very short four year term with Nancy Pelosi at the helm of the purse strings, deficits shot up to $1.4 trillion and we ended up with a massive and costly healthcare plan that never worked. Dunce.
You never had a track on it snowflake. Try re-thinking and this time use what little brain you have.
Blah, blah, blah, whine, Blah, blah, blah, whine, Blah, blah, blah, whine. STFU, seriously.
"When government fears the people, there is liberty. When the people fear the government, there is tyranny."
A lie doesn't become the truth, wrong doesn't become right, and evil doesn't become good just because it is accepted by a majority.
Author: Booker T. Washington
"When government fears the people, there is liberty. When the people fear the government, there is tyranny."
A lie doesn't become the truth, wrong doesn't become right, and evil doesn't become good just because it is accepted by a majority.
Author: Booker T. Washington
"When government fears the people, there is liberty. When the people fear the government, there is tyranny."
A lie doesn't become the truth, wrong doesn't become right, and evil doesn't become good just because it is accepted by a majority.
Author: Booker T. Washington
Once again, the American taxpayer hasn't saved anything no matter how many strawman claims you continue to construct scarecrow. When you add in the massive cost of subsidies the taxpayers have to come up with, they are in far worse shape than had NOTHING been done.
I would ask you to THINK, but you lack sufficient grey matter to comprehend the OBVIOUS.
"When government fears the people, there is liberty. When the people fear the government, there is tyranny."
A lie doesn't become the truth, wrong doesn't become right, and evil doesn't become good just because it is accepted by a majority.
Author: Booker T. Washington
It rose to $1.4 trillion, then $1.294 trillion, then $1.299 trillion, $1.087 trillion. There is nothing dramatic about it except for the massiveness of the numbers you willful idiot. Obama has the distinction of having amassed more deficit than the previous three Presidents combined.
Defenders of Obama's massive trillion dollar deficits have no room to whine about any Presidents spending......EVER. Unless, of course, you want to look like a brain dead, dishonest, clueless partisan hack moron on steroids. Right now you have that distinction.
"When government fears the people, there is liberty. When the people fear the government, there is tyranny."
A lie doesn't become the truth, wrong doesn't become right, and evil doesn't become good just because it is accepted by a majority.
Author: Booker T. Washington
Passing the Affordable Care Act was always much more about extending coverage than cutting costs. Still, as the landmark law faces one challenge after another, new data are giving a better picture of how the law has played out. That includes a new study that looks at how Obamacare affected household medical spending.
The short answer: On average, Obamacare did not affect household medical spending very much.
The study was looking for how Obamacare was affecting medical spending. As with everything with Obamacare, it's complicated. But here we go: In a nationally representative sample of over 80,000 adults, overall, in the first couple of years after Obamacare really kicked in — 2014 and '15 — out-of-pocket payments dropped by an average of $74.
Meanwhile, the insurance premiums that households paid rose by an average of $232. So it's a funny little coincidental parallel — out-of-pocket payments dropped by 12 percent, but premium payments rose by 12 percent.
The good news is that out-of-pocket, high-burden spending fell by 20 percent overall — and it especially dropped for poor people. The not-so-good news is that among middle-income households, there was a 28 percent increase in high-burden spending on premiums.
In the study's conclusions the authors write that without the individual mandate, the numbers of people without insurance will go back up again, as will out-of-pocket costs, and premiums will likely rise, too, because healthier people won't be buying insurance.
https://www.wbur.org/commonhealth/2018/01/23/obamacare-household-spending
"When government fears the people, there is liberty. When the people fear the government, there is tyranny."
A lie doesn't become the truth, wrong doesn't become right, and evil doesn't become good just because it is accepted by a majority.
Author: Booker T. Washington
Althea (12-18-2018)
Truth Detector (12-18-2018)
to be fair.....your level of sanity is a question of opinion........the provisions which impacted costs went into effect for self-employed people such as myself in 2014.....they went into effect for people who's employers paid their insurance in 2015........your posing is not successful........
Truth Detector (12-18-2018)
So you choose to ignore the explosive economic growth we had in the '80's because you don't like the letter of the party next to the President's name.
And you continue to spin the dot com bubble as if it is a figment of people's imagination and the Nasdaq crashing was as well.
And surpluses were projections. You understand what projections are right? The were projections if the bubble kept going, which it never was. I'll continue to repeat myself. You are creating a false economic narrative to match the political narrative you want to tell.
Truth Detector (12-18-2018)
they did not.......if you had bothered to read my post you would have already known that I was paying for it......and as I have already told you the price was exactly the same you're obviously an idiot for pretending it would have gone down.......as for my insurance.....when Obamacare went into effect for self-employed people in 2014, my premiums doubled......
Truth Detector (12-18-2018)
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