Does financial burden outweigh benefits? – The Register-Guard

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President Trump has called the Affordable Care Act “a total disaster.” He and national Republican leaders are taking steps to try to repeal the act and replace it with something they view as more affordable to patients and less costly to government.

After initially promising to make changes swiftly, the Trump administration has stalled on the ACA. It is unclear when changes might be unveiled. Congressional Republicans have not yet agreed on a replacement plan.

But Republicans have said they want to scrap the ­unpopular income tax penalties the ACA slaps on people who don’t have insurance through their employer or a government-funded program, and fail to buy a private policy.

Critics also fault the online health insurance exchange created by the ACA, where people who lack employer or government health insurance are supposed to buy their own policies. Nationwide, some insurers have dropped from the exchange, and some that have remained have increased the premiums they charge. For example, only two ­insurers offer policies on the exchange to Lane County residents, and some area consumers reported that their premiums had jumped as much as 40 percent from 2016 to 2017.

Some Republican proposals also want to do away with the exchange’s federal subsidies that help lower-income people — those who don’t qualify for government-funded health insurance — pay their monthly insurance premiums.
Republicans say they want to increase competition and drive down costs among health insurers to induce more of them to offer plans. One GOP idea: let ­insurers sell policies across state lines.

They also say they want to expand use of health savings accounts, which let people set aside money before taxes to pay for certain medical costs, if they have a high-deductible health insurance plan.

And Republicans want to change how the federal government funds Medicaid to curb the growth of the federal deficit. The federal government pays the bulk of Medicaid costs, which have zoomed ­upward with the ACA expansion of who is eligible to receive Medicaid.

In Oregon, the state government pays about 20 percent of the $6.6 billion in annual Medicaid costs for the nearly 1.1 million residents now on the program, with the federal government picking up the rest. About 436,000 of those residents were added to Medicaid under the ACA.

Economist Eric Fruits, adjunct professor of economics at Portland State ­University, argues that state taxpayers can’t afford the added cost of the greatly ­expanded Medicaid rolls.

If Congress doesn’t repeal outright the Medicaid expansion under the Affordable Care Act, it should consider halting new enrollments and letting people already in the program stay until their income climbs and they’re no longer eligible, Fruits wrote in an opinion piece for Cascade Policy Institute, a Libertarian policy research group based in Portland.

“Rejecting the health care law’s expansion is the clearest path to fiscal solvency and financial responsibility,” Fruits wrote.

Follow Sherri on Twitter @sburimcdonald . Email sherri@registerguard.com .

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Affordable care act by the numbers

The Affordable Care Act ushered in sweeping reforms, including requirements for employers with more than 50 full-time employees to provide health insurance for employees; tax penalties on people who weren’t insured through their job, a government plan or a private policy; and more federal money for states that wanted to expand Medicaid to more residents.

Lane County residents without insurance pre-Affordable Care Act: 15 percent

Lane County residents without insurance post-Affordable Care Act: 6 percent

Lane County Medicaid patients: 111,008

Lane County Medicaid spending: $632 million for fiscal year ended June 30

Lane County residents in 2016 covered by the Affordable Care Act’s expanded Medicaid eligibility standards: 45,033

Lane County residents who bought private 2017 health plans on the online exchange created by the Affordable Care Act: 12,543

Value of federal subsidies to help the 9,523 qualifying Lane County residents buy health plans on the exchange: $43.74 million per year; average $4,593 per year per purchaser

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