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Think Tank 1010am Obamacare

Aug 18, 2016|

Is Obamacare in a death spiral?  Another major health provider is cutting the president’s plan?  The question is, who has a plan to replace Obamacare? This hours guest: Jim Capretta - Resident Fellow, American Enterprise Institute (Health Care Policy). He studies health care, entitlement, and US budgetary policy, as well as global trends in aging, health, and retirement programs Sally Pipes - President & CEO, Pacific Research Institute & contributing writer to Forbes.com

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Automatically Generated Transcript (may not be 100% accurate)

Twelve known knew that the intent will continue to bring you the latest on the greed load 2016. The aftermath. Of recovering. Which for our shoes are still floated in and I think 102. Or really concerned about Pak border coming up now. Days app of the regional here at. Also at 11 o'clock talked to via president of Louisiana business and industry. Tell you what businesses should apply for. When they go forward disaster relief from the bloated Koreans. We'll talk to Jim Dolan insurance commissioner wanted to give you advice on and on what you do won't be insurance side. We're gonna talk about Obama care of my question and seated in the of the players but it was a bomb in the deaths by a role. It's things like a broke about three major insurance companies. Cutting the president planned release coding big portions of which these serpent service. The question is. If if obamacare it's not going to work said he trump gets into all the agency. Republicans control congress from prison office and they bring down Obama care what do we grew to. And is always regarded the experts we have Jim compressor brands have been pro American Enterprise Institute. And expert in health care policy Jim I've appreciated time. Well thank you I'm glad to be richer social taught to do about the news is if I understand it correctly young people. Or or stay in the wave from the exchange. Coverage and invents. Primarily. The waltzes. I think it is driven a lot by younger people but also you know. Middle aged people who are healthier and others who are. You know not going to be high users of medical claims so what happened is that there would be a risk pools become tilted. Too much toured. Those who expected to use a lot of health services in their forty year and therefore eager to purchase coverage. Those who don't expect to use as many services. Are taking hard second looks at the prices and the coverages that are available on. And there are more skeptical about the value for themselves they're staying away. It has been skewed in that's very infer. Five losses across industries not just a few companies that think the entire industries losing. They lost a few billion dollars and 2014. And probably double that last year between fifteen and maybe triple Tony sixteen so. There's a lot of losses to be spread around. Would mandate requiring. Individuals to the by the health insurance and they're not they were fine didn't. Yes that are well. The under the Supreme Court decision point twelve the Chief Justice declared that attacks. So it's not a fine. And composer the tax system. And the idea people who do file their income taxes and they. Failed to check the box saying that they had it. Qualified coverage our their descent stage attacks. It is up to two and a half percent of earning commonplace sixteen. Above a certain exempt threshold. What's happening Millen there's people are weighing map packs that they might go against a premium that they have. Paying under the exchange offerings that are offered in the states. And they find the premiums are XTC the the tax penalty and so. You know from people are choosing to forgo coverage. Poem. Or there are companies. That are doing well. Is there anybody in any state. Running in exchange were dubbed the prompted two is within reason. Yeah okay. Yes there are few companies that are doing fairly well. I think it's because these are companies that tended to be. Are already in the business of providing health coverage. Two populations with lower income these are primarily companies have been participating has managed care companies and Medicaid. Which is a federal state program providing health coverage to. Couples with incomes below you know certain income threshold. And those companies of transition and now offering. Coverage also on the exchanges. And for for the most part the people buying coverage on the exchange is having considered just above the Medicaid eligibility levels. And so these are still relatively lower income. Households and visa insurers. Have built networks that. Have been in place for many years now that there have been using not just for Medicaid but also for the additional population these networks by the way. A physicians and hospitals are fairly narrow compared to commercial insurance. So that's why a lot of people who are. Are looking at what's being offered me a few exchanges are saying hey. It's a lot of money and by the way they don't current many doctors. And food. The and that's one reason why the there's a bit of division in terms of the popularity of the law. I think you've already mentioned that is. But I wondered airborne of descendants from reading from pure newsletter. Premiums are going up front ten to 20%. And most of the country and the only thing keeping the exchanges from collapsing. Of the federal subsidies. Yes for many many people. When they buy insurance on the exchanges. The premiums are so heavily subsidized by the federal government there aren't nearly free to being a role relieve. So for a lot of people buying. Coverage on the exchanges. Literally have to pay much and so the fact of the premium. Is going up and her 20%. I mean it's total premium doesn't affect them much because the entirety of that premium increase will be covered by the federal government. So the subsidies is really treated this sort of guaranteed. Market. On 8910. Million people. Of hope for home. The price of the enrollment is very very low and therefore they're not sensitive to it. It's only the people with slightly higher incomes where they have to pay the premium at least partially themselves. Where the sticker shock at the premium increases you're gonna have the fact that frankly. It's gonna end up driving away many in the same people we were just talking about people that are working but don't happen to get coverage through their employer their younger their help here. They need to get insurance and they look on the exchanges may realize. Keyed that the coverages pretty narrow the deductibles are high and the premiums are high. Good we hear the figures ten million people we're eight million people are. Well we've we've got 300 billion plus people in this country. Ha many people were involved in obamacare is a day. Large fraction of the population. It's about eleven million people which is slightly less than. That would be a ballot. We know three or 4% of total US population right so it's not a huge number I mean there just about that many keep children on me. Program has created in the ninety's called the Children's Health Insurance Program that's. Other programs that are just as they get much bigger Medicaid of course has spots seventy million people on Medicare about sixty million. There's about a 160 million people on employer coverage. Got a lot of other things are bigger and the issue is exchanges. I'm having said that. The it is what happened really is that this market the exchanges really just place what was the older individual insurance market. And trying to make it better and more stable. In some way this offer coverage to people that have extensive health conditions that are it is better than what they used to have there's no doubt about that allowed it. Much easier access to insurance for many millions of people. So you know in some ways it met its mission and they in a certain sense but it stuck in a way that. Long term and even medium term might be too unstable to survive so. We'll have to wait and see what happens next but it's it's on shaky ground. Aren't jumps there would make regular quick break come and backward talking with Jim cobra. A resident fellow American enterprise institute for health care policy and we're talking about Obama care. Seems to be a more and more trouble though a little bit ago. They go about Obama and terrorism and asking you is that. Possibly. The death spiral. And another. Major. Oh adventurer amounts that was Monday. That is dropping Obama cure insurance we have Jim Crow pretty well that's. President total American Enterprise Institute hoped your policy expert. Jim as you mentioned. About 85%. Of Obama care plan members and receive tax credit substance. I'm sure at twelve noon. On and on load. Federal. Blood program subsidies. There wouldn't people were billion dollars in dead. And still. Insuring. Or it's subsidizing. A number of buyers around the country. Or there's subsidies for Obama care program or be in place or they run ended up blitzes that being funded. Well. It doesn't happen it doesn't have to could be. Funded foot in financing source says unlike the the flood insurance firm which has dedicated trust fund with premium payers and some of the position. That's supposedly going to. That no tracking of the subsidies. Coming from obamacare to the insurance plans. It's just a straight. Federal appropriation if you little to. Allow these subsidies to be paid to. Enrollees in these insurance plans. And there was. That did your overall bill paid for tax increases and spending cuts in Medicare but to no dedicated trust fund is trying to keep. A real time accounting for money coming in the money doing now so that means. That note is that rips it it's going to stop and anyway. Also read patients. Might lose what was it preferred doctors hospitals. In the in these sinopec plans that don't. Include providers I think in their network coverage. And I would assume people in rural areas would be most affected it is that correct. Yeah not a big problem with which was what happening on the planned pullout. They're gonna force you know tens of. Hundreds of thousands if not millions of people that switched their plans because they're gonna lose the character they have and sweet sixteen won't be available 2017. And I had to pick a new plan and when they do and so. These networks that they are offering through these plans can be pretty narrow and so the doctor that they saw on point sixteen may not be covered by their new planet when he seventeen which is caused. A lot of heartache and disruption in the last couple years already and could be even more so I think next year. There was still. Speculation. The the moves to the breach in insured to amounts have been dropping a bomb occurred at least. In the movie you there counties Aetna. Had done so because Obama administration. Had directed. Department of justices to block. A merger with evident that think it was two men who was 37 billion dollar merger. You think anything to that. Well. I think what happened here was the Justice Department sent a letter to witness sometime in June. And asking them to answer a number of questions. And had to respond to the latter in a forthright way basically saying. That if the murdered and go through it has some additional litigation cost that they really want the merger say that it's too soon abaco forward. And. I'd hit the way other way around government seems to stop and they have to defend that are. Their position the catalytic and forward. And you know as part of that litigation and incurred some expensive and so therefore have to back on businesses that are losing money man identified the exchanges as. Play for they have to roll back some business practices now. Some people are interpreting that as that's not true. Not so friendly and it's. Threat to the federal government I guess sites I see it more lights pagers answering a question that came from the Justice Department. And it was both via private letter by the way has gained ten and counsel be. It's not a piece of paper it's gonna get out yes anyway. You know. Adam I'm not sure what the make of it exactly myself I don't have any unity any inside information on where yeah but. I think it's. It's it is you know the federal government indices EPO organizational threat anyway it's not sure they would have tried. Let me you one away and scorched a pulled this from Kaiser landslide. Several major insurance companies merged Mercer chose. That it tends to lead to fewer chores from his higher premiums for the American public. Gives the company more leverage to pressure. All the players in the industries hawks that moves like cost them students at their prices. And there's even some evidence. That consolidation. Could even reduce the quality of health services that Americans receive your thoughts. Well I think there's two different kind of consolidation we need to think about there there are. Confront this consolidation among hospitals which is actually happened a lot in the last fifteen years. And there's evidence that that has driven up costs for sure. Hospitals get together. And Forman a. Paid large bloc in certain large market they're able then say to those who are buying services from them happy. Here's my price take it or leave it. So the supplier of hospital services have been able to consolidate and drive up prices I do believe it. Uninsured I think there may be some evidence that and it did well. On the other hand I think limiting it to keep in mind there are lots and insurers offering lots of different products a lot of different markets today and Medicaid Medicare and exchanges. The corporate sector of the employer sector. And so there's no shortage of really an insurance competitors at the moment what's happen. Now shortage to living shortage in the exchanges and at what caused the problem. All right well thank you so much appreciated your calling in and your vehicle back here in the time we'd love to continued compensation. Okay you you had to do. RA and it is news time and spend box. A good thing good about obamacare once again in the end can it survive another. Major insurance company is pulling out this time of not. Rivera and I think at least two of the major wounds number of other. Meet you saw its have also dropped out of the market. Of selling bribes was it presidency you'll Pacific grocers institute contributing writer at Forbes dot com. So we welcome back to the show is reaching. Thank you gone for having me on its. I pulled juror you're across finger majority corn sports and abuse said. Obama cares only going to functions bed and opened the looming collapse of goods exchanges prompting called free even more government involvement in health care even. Is single Payer system. Yes exactly well. I don't PP. I definitely couldn't Boyd following the news than your previous speaker as well I mean Aetna has announced that they are going to only to provide exchange. Plant in force state next year they blocked our imported thirty million to 2014 and exchanges came into being. On on on the an exchange under obamacare. UnitedHealth is only going to be in three markets next year they used to be in 34 states. Humana has that they're getting out of the number of market. So obamacare is definitely imploding. And as you've probably also been calling upon Garland that's the the president. And mrs. Clinton the democratic nominee for president have now been pushing for that public option which would be a public. A government insurance plan to compete against private insurers and the exchanges so. They know regional they won't admit it that obamacare is on a plaque on a path to implosion. And and would that proposal. These similar to single Payer system. A new United Kingdom Canada launched reviewed Taiwan. All had that quote single Payer system but they all have slightly different sids it's kind of vote. A cold mean lingo private and government. Right now. Of course in the regional and legislation that passed the house they had a public option which would be you know a government insurance plan in the exchanges when the bill went to the senate. In December after a 2009. The senate felt that they could not. Get the bill passed through the senate with the public option and it will be pulled it but what they did do it at Indy car lot. The consumer oriented and operated exchanges. Which would be which was to BD. Alternative to the public option and you know it's amazing that only that. Sixteen after the 23 original collapse have now failed. I'm affecting about a million. The people with plans in the in this in this country so that they they collapsed because I believe they couldn't sustain the financial losses felt. You know we've seen. The cola. Failings in the exchange is now sitting with people as an insurance companies getting out. And then Hillary and Obama calling for the public option which in my mind if it comes in that will be a further push. For the private insurers get out of the market. And we will be in this country on the path to let Bernie Sanders ultimately want it I think why Hillary moved to the left and included the public option. Is he single Payer government run plan in Canada is one of the few countries. About at three countries in the world that actually is that true single Payer health consistently to outlaw private. It would delay and scripts bigger Obama cures as some. Cupboards about eleven million people out of the 300 million polish people that we have in this country. Is it only eleven million dead that are unable to food to death. Health insurance on their own without subsidies. Or is it only eleven million or funded that. I get confused by the figure. Well I'd like to say who wrote a car on that. Understanding healthcare it's similar to unraveling an and in many layers. And many tearful moment it is that it is I think that the reason that a number of politicians don't like to discuss health care obamacare because it's so confusing. But the revised number for that from the and center for Medicare and Medicaid services and health and human services. If that eleven point one million people this year have been ruled on exchanges out of over 300 million of those eleven point 1000082%. Of them are receiving subsidies. Come from the federal government be original number that came out earlier this year that twelve point eight million people had signed up. On the exchanges but that number had to be downgraded. Because. Some people did not. Paid premiums so they were off the insurance plan and second and number of people couldn't prove that they were Americans and therefore. They lost their coverage to. But the net is really a very small number. Of people you know are actually. I'm being covered and the problem is that the young invincible the eighteen to 34 year old site left that age bracket. Pat the eighteen to 34 year old in order to make. Obamacare work should it signed up at about 40%. And the fact only 28%. Of the young invincible and actually. Bought coverage the majorities in the course thing we're young we're healthy you know we want to take our chance. And pain and we will pay that. Tax penalty on the under the individual mandate which is at this year's 695 dollars or two. And a half percent of income whichever is greater but for young healthy person 695 dollars or 2.5 percent of the income is nothing compared to that. You know close to 400 dollars a month that they would have to pay to get coverage on the exchange. Are actually would leave where the finger and about Obama Kara another. Major insurance company pulled out of obamacare that's three major ones and number of small ones. The question we're asking trying to better understand is obamacare on the verge of imploding and it so. What do we replace it with. And who's got that plan. WWL questions comments we have the experts deli products. Presidency you'll Pacific group search institute. Terms and 0187. Regular about obamacare another. Three major old insurance companies. Or dropping oil bond care. The leaders is at nine. We have selling pipe with the trojans CU who's a big surge institute's only I'm about to be eleven million number. Of people dead Cairo all on Obama care with the but the country of 300 million plots. We viewed in the end I think a cores so one of the richest countries in the world how is that we we can't give people that can afford insurance insurance it's. When it's off for actions of the population. Well about the very good point Carlin but the issue is so eleven point one million signed up on the exchanges that they had 82% of getting subsidies. Which means there for people earning between 138. And 400% of the federal poverty level we have another probably. Nine million people who bought private insurance plans whether from at an error he manner. Amp than the napping that's twenty million then we have in this country now. 76. Million people are on. Medicaid the program for people earning below 133%. At the federal poverty level so. When under the law. They were encouraged to take funding from the federal government to expand their Medicaid program. So now we have. As a patent six million people on Medicaid. Now we're finding out that a lot of these people. Cannot find doctors because doctors are picking Medicaid patients because of the low reimbursement rates lower than what they can get for treating Medicare. Patient and then a lot in many cases the doctors are taking that they put these people on the long waiting list so we've seen emergency room use. Five point 6% because of obamacare so you know by expanding Medicaid under the Affordable Care Act it's really hurt have the people who were originally. On Medicaid and the state. You know of course mini state I'm 32 state but the District of Columbia took that federal fund a 100% for the expansion of the Medicaid president tells. You know it really when you look at that say eleven million who signed up on the exchanges its really a very excited and we've gone we have. Obamacare at the individual mandate employer mandate on these. Mandate. That does have to it is insurance companies have to provide we would be able with a lot of people would buy coverage because they could get the kind of plan. With the type of premium they pay that deductible that is there any. Final quotient. Everything breed no broad a couple of boats on the news. Wind when the culture of ranking of the country is with the best insurance for the people. It's France it Singapore many beat England in their clothes. And every one of them. Or adding deficits in the billions of dollars every year end. Subtracting. Services. From that single Payer system. Would would look back and said. Where he is the program. The second row please obamacare. That doesn't run deficits in the same thing the best in the world Hillary experience. Well and me because after we took a look at Canada the efforts we continue primary care doc. Getting treatment by a specialist is now over reform on all of these countries Great Britain cute line the line for care rationed care people dying you know. We're we're constantly and also Brantley is that the. The plan is. What is in my latest book out of my calendar probably out of obamacare. Looking at the leveling a tax treatment so individuals could write up a cockpit there. On health insurance in the same way that those people who have the 155 million Americans that employer sponsored coverage. Getting rid of the individual mandate getting greeted the employer mandate. Setting up each based refundable tax credits which could be based on your age not on your income making changes to. The medical malpractice laws. So that. You know doctors wouldn't be practicing. Defensive medicine to the extent they do today. Allowing Medicare to become. But I have have a voucher premium support for Medicare people who are over the age of 65. All of those things are in my book the way out of obamacare. But ultimately the past. Republicans. Are talking about they have a leaves they bare bones plan. Doesn't reflect what Jews suggest we do we won't government. Yes absolutely I'm Paul Ryan's plan that he helped plan they introduced just before the election is called a better way it's actually a blueprint. White paper it doesn't actually a dollar amount covered with a cut and included in that it's not legislation but his plan better ways very similar to mine I think. And I think the Republican plan is the GOP plan is slightly different but we're all there is the plan out there that would. So I'll butcher book worded people get it. It's on Amazon.com. The way of obamacare. And encounter book. So they always pleasure have a good day in thing to do. All right governor acknowledged we're gonna talk applauding we're gonna have the insurance committee sure going to be. President of business interest read talk about all the ways to help you. In this nightmare. I just sold were payment said the words disasters. And send the government of all right. Now we're coming back to Steve will this. We got Jim Dolan coming up insurance measured tone of Cuba and all of that damage it's rigged new logged. As always brought to is still bringing to us. And we'll talk to be your president Louisiana business industry talk to you business. Owners. Sustained damage from the plugs and ports they would lose dub audio.