Jonathan Cohn: Romneycare Offers Significant Clues to What Obamacare Would Do

Jonathan Cohn at The New Republic has a great article up today focusing on some conclusions we can make about Obamacare's implementation, namely to use what has happened in Massachusetts since Mitt Romney passed Romneycare (the blueprint of Obamacare). You can read the entire article here.

"But we can imagine what the world would be like if the new law were already in place. One way is to go back through the data, and figure out what would have happened over the last decade if the Affordable Care Act, or something like it, had been in place. Steven Hill, a senior economist at the Agency for Healthcare Research and Quality, did just that. And he's published his findings in Health Affairs:"

If adults who had individual insurance during 2001–08 had instead had benefits similar to those under the Affordable Care Act, their average annual out-of-pocket spending on medical care and drugs might have been $280 less. The near-elderly and people with low incomes might have saved $589 and $535, respectively. An important improvement would have been the reduced probability of incurring very high out-of-pocket spending. The likelihood of having out-of-pocket expenditures on care exceeding $6,000 would have been reduced for all adults with individual insurance, and the likelihood of having expenditures exceeding $4,000 would have been reduced for many.

This part is also good: "The usual rap on the Massachusetts health reforms is that they haven’t controlled medical costs. And it’s true: Romneycare hasn’t slowed the growth in health care spending. But that was never its goal. The idea was to expand coverage and then, hopefully, address costs later. This is precisely what the state is doing right now: Lawmakers and stakeholders are hammering out a law that, they hope, will blaze a trail for cost containment just as the previous reforms blazed a trail for coverage expansion. (For more on these efforts, see this great primer from Sarah Kliff of the Washington Post.)"

Jonathan Cohn Worried in the Supreme Court

Jonathan Cohn, one of the leading voices covering the Health Care Reform debate, expresses his trepidation Wednesday afternoon after hearing the final arguments in the Affordable Care Act case before the Supreme Court.

"If there was one thing of which I was certain going into this week’s Supreme Court hearings, it was that, at worst, the justices would strike down the individual mandate and related coverage positions. In other words, they’d get rid of requirements that insurers cover everybody at a uniform price, on the theory those reforms don’t work without the mandate. But the other major pieces of the law – the expansion of Medicaid to cover 15 million people, the changes to the way Medicare pays hospitals, and so on – would stay..." continue readin here.

Obamacare in Trouble

Jonathan Cohn is nervous that after today, Day Two of arguments before the Supreme Court in the case against the Affordable Care Act, the individual mandate will be struck down and very likely the entire law will fall with it.

"My first impression from day two at the Supreme Court: I was more confident yesterday than I am today. With the caveat that I know health policy a lot better than I know law, I can still imagine the justices upholding the individual mandate. But, at this point, I can just as easily imagine them striking it down.

"Tuesday's hearing was energized and contentious, from start to finish. But while the justices hammered lawyers from both sides with difficult questions, Solicitor General Don Verrilli seemed to struggle more than Paul Clement, attorney for the states. And although the liberal justices were able, more or less, to carry the case on their own, there are only four of them – and the conservatives number five..." continue reading here.

Medicare and Obamacare

The New Republic's Jonathan Cohn last week questioned the notion put forth by the opposition to the President Obama's Affordable Care Act that the 'individual mandate' is an "unprecedented" over-reach of congressional power. Cohn argues that if Medicare is okay as law, the individual mandate must also be upheld in the Court.

"I’m speaking, of course, about Social Security and Medicare. Each program is a form of “social insurance” and each serves the same basic function: To protect us from financial shocks that we cannot anticipate or avoid. With Social Security, the shock is reaching retirement without enough income. With Medicare, the shock is high medical bills during old age. During our working years, we pay into these programs by handing over portions of our incomes, in the form of payroll taxes. And we don't have a choice about it, unless we want to start evading taxes..." continue reading here.