Health Reform After SCOTUS Nelson Mullins LLP July 20, 2012 Joseph R. Antos, Ph.D.
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Health Reform After SCOTUS
Nelson Mullins LLPJuly 20, 2012
Joseph R. Antos, Ph.D.Wilson H. Taylor Scholar in Health Care and Retirement PolicyAmerican Enterprise Institute
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Do we really have to eat it?
…and does it matter?
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AEI
Guaranteed issue, community rating without ~full participation → selection spiral
IRS authority limited by ACA Behavioral economics vs. simple arithmetic
Subsidized premiums = 2% to 9.5% of income (plus inflation plus “excess” premium growth in 2019+)
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Mandate penalty/tax remains weak
Year “Tax”2014 $95/1% of income2015 $325/2% of income2016 $695/2.5% of income
2017+ 2016 rate + inflation
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A moot point?
Can the federal exchange distribute subsidies?Will the federal exchange provide “1-stop shopping”?Is it a state exchange managed by the feds?
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Medicaid typo? Exchange subsidies for 100-133% FPL?
◦ Premium = 2% of income◦ Cost-sharing credits = 94% of plan value◦ State cost = $0◦ Medicaid: State cost = 5% in 2017 → 10% in 2020+
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AEI
Lame duck, lamer than usual Romney: Repeal and replace?
◦ Reconciliation◦ What goes, what stays under a new name?◦ How much has already changed?◦ Put health subsidies on a real budget
Obama: The economy is in charge, not him◦ Replay of Budget Control Act, but with teeth
Major spending cuts—including Medicare, Medicaid, exchanges
Reality that ACA is not ready for 2014 prime time Devolution to the States
◦ Difficult balance with short-term “stimulus”
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What happens next?
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Don’t worry……Congress will work it out