But their proposal is not a serious attempt to deal with the complex provider payment issues associated with Medicaid expansion, and merely establishes an open-ended grant of power and resources for the secretary of Health and Human Services to figure things out. Section of the ARP Act had increased federal assistance for states to provide services to low-income individuals who need help with basic activities of daily living such as bathing, walking or preparing food.
Unmet long-term care needs are concentrated among Americans who are already eligible for Medicaid, and those individuals typically face substantial waiting lists to receive assistance in their homes. Congressional Democrats are considering an extension of the payment increase for such home- and community-based services. By contrast, the proposed expansion of the basic Medicare benefit package to cover dental, hearing and vision benefits is far less justified.
It is unnecessary, because beneficiaries already can choose Medicare Advantage plans covering them at no extra cost. Adding extra money to American health care is likely to be less politically risky than structural reform for congressional Democrats. But given that high costs are the main challenge facing American health care, throwing money at the problem is unlikely to be a lasting solution.
Chris Pope is a senior fellow at the Manhattan Institute. View the discussion thread. At the end of the first open enrollment period in March , enrollment figures from the U. Department of Health and Human Services showed that 28 percent of enrollees were between the ages of , while 48 percent were 45 or older. In addition, the spending data used as input to COMPARE suggest that, for most enrollees of all ages, premium payments exceed health care spending.
To encourage enrollment in the new individual insurance exchanges, the ACA offers tax credits to help lower-income individuals and families buy coverage. These tax credits have faced multiple court challenges. In late , the U. Supreme Court agreed to hear King v Burwell , a case that challenges the legality of government subsidies that help low- and moderate-income people buy health insurance in marketplaces operated by the federal government.
The legal challenge to these subsidies rests on the grounds that the wording of the law allows such aid only to people who buy policies through state-run marketplaces. They estimated that eliminating subsidies for low- and moderate-income people who purchase ACA-compliant plans would reduce enrollment in those 34 states from Of these, 8 million would be left uninsured. This analysis was widely cited in the debate in the run-up to the case in amicus briefs submitted to the Court before it heard oral arguments in March, Another unanticipated swerve along the path to implementation took place in , when the Supreme Court ruled that the federal government could not require states to expand Medicaid.
The ruling thus left expansion up to the states. In the wake of this decision, roughly half of the states have expanded Medicaid and half have not. RAND analysis found that Medicaid expansion is a boon for states: it boosts state economies and benefits the poorest residents by expanding their access to coverage and care and reducing their health spending and exposure to catastrophic medical costs.
As of late , momentum seemed to be swinging toward expansion. Additional states had either come around to expanding Medicaid Pennsylvania or were reconsidering their earlier decision not to expand Wyoming.
This mandate, aimed at larger firms those with 50 or more employees , requires that firms offer coverage to employees who work at least 30 hours per week. RAND analysis estimated that the effect would be the opposite: that the number of workers receiving employer offers of coverage would actually increase.
Early enrollment numbers from confirmed that most of the newly insured in the U. During the initial rollout in , political pressure and angst in the business community led the Obama administration to delay enforcement of the employer mandate for a year and then extend the delay for some firms an additional year, until Yet another controversy—this one self-inflicted by the Obama Administration—emerged when millions of Americans began receiving notices that their pre-ACA health policies had been canceled.
This contradicted the promise made earlier by President Obama that Americans would be able to keep their existing health care plans. RAND estimates found that, of the 52 million who would have been uninsured without the ACA, approximately 33 million will become eligible for coverage through Medicaid or the individual marketplace after the major provisions of the ACA take full effect.
Some of these individuals will choose not to enroll in coverage. An estimated 19 million uninsured Americans will remain ineligible for Medicare or subsidies, and are 'left behind' by the ACA.
A RAND survey found that in a nationally representative sample, roughly half of respondents lacked sufficient understanding of insurance or the law to navigate the exchanges. In other words, affordable employee-only coverage can disqualify the rest of the family for a subsidy in the ACA Marketplace. The subsidy amount is determined based on the cost of a benchmark plan, but the Marketplace allows the participant to use their subsidy to purchase any plan available. The ACA has now been integrated into the broader review of federal government spending on healthcare, so there are no longer dedicated budget estimates of the ACA.
The CBO uses a year economic-impact cost basis. The ACA expanded coverage to approximately 20 million people. The largest source of funding for the ACA was from Medicare. The combination of Medicare provider reimbursement reductions and the Medicare taxes provided Medicare with a temporary reprieve from its ominous financial position. This temporary reduction in the Medicare shortfall provided budget room to add new programs.
Medicare is going to need all the revenue and savings it can get. How can the new ACA programs get their funding from Medicare? Although the original ACA scoring gave the ACA the dollars from Medicare savings, the programs are now financed separately, and there really are no Medicare savings available to fund ACA coverage expansion. The second area of funding was new industry fees charged to the pharmaceutical, medical device, health insurance, and tanning booth industries.
They are referred to as fees, rather than taxes, because the fees are not linked to or contingent upon profit. They are applied based on market share. These industry fees have created significant pushback from the industries impacted, who say that the fees simply increase the cost for consumers. With annual moratoriums, the industry fees have been sporadically applied.
The third area of funding was related to mandates and penalties. Large employers, defined as having at least 50 full-time employees, were required to offer health insurance to their full-time employees or to make a shared-responsibility payment for not offering coverage.
In a similar fashion, every American is required by the ACA to have health insurance coverage. Those who chose to not have coverage were subject to a shared-responsibility payment. The shared-responsibility payment for individuals was lowered to zero by the Trump administration and Republican Congress.
The law still requires every American to have health insurance, but there is no financial penalty for noncompliance. The large-employer, shared-responsibility payment implementation was delayed but is still in place. Two major funding sources have never been implemented.
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