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The Future of the Affordable Care Act

October 11, 2017
Republicans elected to the House of Representative, Senate, and the Presidency from 2012 to 2016 ran on the promise to “repeal and replace” the Affordable Care Act signed into law by former President Obama.  The Affordable Care Act, otherwise known as Obamacare, revolutionized the healthcare market completely by leveling an individual mandate, offering subsidies to those who could not afford to buy health care, and bringing more people into the insurance market to offset costs. [1]

By Haley Boote

State-run websites were created for consumers to compare health insurance prices and purchase the most affordable option for them. The ACA also requires businesses with more than 50 employees to offer health insurance to their workers, a section of the bill that has received criticism from Republican lawmakers.  The most popular parts of the bill include the ban on insurance providers denying coverage based on a consumer’s pre-existing condition, the provision that allows people to stay on their parent’s health insurance until they are 26, and the option for states to increase their Medicaid programs.  The ACA is accredited with dropping the uninsured rate in the U.S. to only 8.8%, adding 20.4 million more people into the health insurance market since 2010. [2]

If Republicans had been successful in their attempt to repeal the ACA and implement their plan in late July, the CBO estimated that up to 16 million people would have lost their health insurance. [3] Many of these losses would come from the slashing of the Medicare expansion that the ACA provided.  President Trump was a main advocate for the repeal and replace bill, which would have cut Medicaid spending by about $800 billion over 10 years.   Medicaid provides public health insurance to low income individuals and families at no cost to them.  Currently, all adults earning up to 138 percent of the poverty line are eligible to apply for Medicaid. This rollback of Medicaid spending would have decimated the program by halting federal support of the ACA expansion in 2020, effectively taking away benefits from people already enrolled and creating stricter parameters to qualify for coverage.  Some people who qualified for Medicaid under the ACA would then lose their insurance, forcing them to go without or look for a private plan that would most likely be too costly for them to afford.  This would have increased the uninsured rate in the U.S. rapidly, moving further away from the ACA’s goal of having all Americans insured.

The Republican plan would have hurt people on Medicaid but also families paying for their own insurance and those with pre-existing conditions.  The “skinny bill,” which was the final attempt by Senate Republicans to replace the ACA, would have removed the individual mandate that incentivized people to purchase healthcare.  While this would increase an individual’s personal autonomy to choose if they want health care, it would have resulted in premiums increasing in the exchanges by about 20% according to the CBO report. [4] Because the mandate pulls in young, healthy people who would not otherwise buy health insurance, it reduces the premiums for everyone else in the market. This means that everyone else would be paying more for their health insurance without the ACA’s individual mandate. The people this would disproportionately affect would be low- to middle- income Americans and citizens with pre-existing conditions. [5] As healthier people stop buying health insurance, prices would climb rapidly for sicker people left in the market.  They would be left to pay skyrocketing, potentially devastating premiums.  If Republicans repealed the ACA in its entirety, including the stipulation that insurance providers must provide coverage for people with pre-existing conditions, some may not be able to buy health insurance at all.

Image: Protesters rallying against the GOP efforts to repeal the Affordable Care Act, 2017. Source: Flickr.

Image: Protesters rallying against the GOP efforts to repeal the Affordable Care Act, 2017. Source: Flickr.

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  • The views expressed on the Student Blog are the author’s opinions and don’t necessarily represent the Penn Wharton Public Policy Initiative’s strategies, recommendations, or opinions.

The economic implications of the proposed “skinny bill” are still being examined by analysts, academics, and policy makers.  By repealing the Medicaid expansion, the individual mandate, and protection for people with pre-existing conditions, health care would be out of reach for many families that are already struggling. Lower-income families may lose their Medicaid coverage and not be able to afford the increasing premiums of private insurance, and many families just above the limit for Medicaid would also lose health insurance because of increased costs. [6] Many constituents, realizing this, called their elected officials and protested ahead of the Senate vote. Daily Action, a progressive advocacy group, reported that over 200,000 calls were made to Republican Senators about the health care bill. [7] Senator Rob Portman, a Republican from Ohio, said “I think the concern of citizens generally has made an impact on me, yeah … those voices are heard, absolutely.” [8] A “repeal and replace” bill was passed in the Republican-majority House of Representatives, but the proposed “skinny bill” was voted down in the Senate by 48 Democrats and 3 Republicans. Key GOP Senators John McCain, Susan Collins, and Lisa Murkowski all voted against the bill, citing a lack of bipartisan support and increased costs to their constituents. Considering that virtually all congressional Republicans promised to “repeal and replace” the ACA during their elections, a bipartisan solution to their concerns will need to be drafted in order to pass in the Senate.

References

  [1] “Why is Obamacare so controversial?” BBC News, July 13, 2017. Accessed August 07, 2017, http://www.bbc.com/news/world-us-canada-24370967.

  [2] “Health Insurance Coverage: Early Release of Estimates From the National Health Interview Survey, Jan-Sept 2016” National Center for Health Statistics, February, 2017. Accessed August 07, 2017, https://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201702.pdf

  [3] “American Health Care Act Cost Estimate” Congressional Budget Office, March 13th, 2017. Accessed August 07, 2017,  https://www.cbo.gov/sites/default/files/115th-congress-2017-2018/costestimate/americanhealthcareact.pdf

  [4] “The Skinny Repeal Gets a Score” The Atlantic, July 27, 2017. Accessed August 07, 2017, https://www.theatlantic.com/politics/archive/2017/07/the-skinny-repeal-gets-a-score/535038/

  [5] Ibid.

  [6] “The Skinny Repeal Gets a Score” The Atlantic, July 27, 2017. Accessed August 07, 2017, https://www.theatlantic.com/politics/archive/2017/07/the-skinny-repeal-gets-a-score/535038/

  [7] “The health care resistance is working. Just ask a few Republican Senators.” Vox, July 20, 2017. Accessed August 07, 2017. https://www.vox.com/policy-and-politics/2017/7/20/16000752/health-resistance-gop-senators

  [8] Ibid.

  • (Image: Tissue donation in the United States is in need of a transparent national policy. Source: Health Matters.) April 12
    It is estimated that one individual organ, eye, and tissue donor can save up to 75 lives [1]. Currently an average of 22 individuals die each day waiting to be matched for a transplant [2]. Donated tissues and organs both have lifesaving potential, but unlike donated organs, donated tissue is also purchased by biotechnology and cosmetic companies for research purposes. Most donors, however, are not aware of the differences between organ and tissue donation, including how it is removed, used, and regulated [3]. Even fewer are aware that by registering for organ donation, they have become tissue donors by default and that their tissues can be sold for up to $80,000 to profitable companies [4]. In order to increase transparency and not lose informed consent of donors, registration for tissue donation and organ donation in the United States should be separate processes.
  • Image: The digital divide. Source: MIT Tech Review.  April 10

    Google, Facebook, Twitter, Snap, Amazon, Microsoft, Apple — these companies have become household names, and the world today heavily relies on their services. To many, the benefits of cheap and easy connection to information are obvious, ranging from increased educational and career opportunities to an increased rate of technological innovation. However, as the pace of this progress accelerates, two distinct issues have remained concerning: the use of these technologies and access to them. The topic of this article mostly focuses on how people still lack access to the Internet. This lack of access to and of use of the Internet is known as the “digital divide.”

  • Uber's app interface. April 3

    Leo drives a mid-2000s Acura TSX and arrives at the pickup point in front of a train station in Trenton, New Jersey. I’m headed home from New York City for the Thanksgiving holiday. Leo gives me a hand with my suitcase, and in under a minute, we’re off, driving Interstate 276 West most of the way there. The 26.66 mile trip takes 45 minutes. It costs me $34.68 on one of the most popular rideshare platforms, of which Leo receives about $25, minus the cost of gas, tolls, and vehicle mileage. Leo is a pretty talkative guy, and the subject turns to the various driving platforms, like Uber and Lyft. Leo is a young guy, and he tells me he’s one of the approximately 1 in 4 drivers who does not have health insurance.

  • (Image: Farm scene with city of Philadelphia in the background. Source:  Yipa.org)  March 23
    Many young Americans leave home and never return. In particular, this trend can be seen in rural America. 1,350 counties “non-metro” counties have lost population since 2010.[1] Since the mid 1990s, rural population growth has been significantly lower than urban areas.[2] The movement of people has resulted in national economic growth, but there are consequences. Behind these numbers lie worrisome consequences.
  • (Image: Coffee cups floating in front of an image of the globe, alluding to the Boston Tea Party and Br... March 21
    Caffeine has been heralded as the world’s most popular drug. However, as more people want their coffees to go, the industry has failed to confront the waste from single-use cups. In the last two decades, the United Kingdom has seen a 400% increase in the number of coffee shops. The sheer volume of waste affects both the environment and the country’s waste management infrastructure [1][2]. In the UK alone, people throw away 2.5 billion disposable coffee cups a year [3]. The scope of this problem is magnified by the difficulty of recycling wax-lined paper (the most common material for coffee cups), with only 0.25% of these cups being reprocessed [4]. In order to combat the growing practical and environmental effects of throwing away single-use cups, UK lawmakers have stepped in, and are considering instituting a “latte levy,” a new tax to influence on-the-go coffee drinkers.
  • (Image: Pharmaceutical drug price hikes are now commonplace in American news. Source: Pixabay.) March 16
    Pharmaceutical drug price hikes have now become a common feature in American news. From Martin Shkreli’s infamous Daraprim price hike that saw a $737 increase to the chemotherapy drug Cosmogen that currently sells for $1,400 in the U.S. compared to $20-30 overseas, the problem is clearly systemic [1]. Many important cancer drugs, including Gilead’s Sovaldi, Merck’s Keytruda, and Vertex’ Kalydeco all cost over $80,000 for a course of treatment [2]. Often prices increase are unrelated to any new research and development done. There is a clear need to address such drastic drug price increases in order to prevent these dramatic hikes and create a more stable biopharmaceutical market.
  • (Image: Construction on the Tappan Zee Bridge in New York, the result of a public-private partnership, has generated over ... February 28

    The state of American infrastructure figures prominently in current national policy discussion, prompted by poor report cards, energized political campaigns, and recent executive initiatives. Severe underfunding of needed infrastructure projects has prompted proposals from both sides of the political aisle, with public-private partnerships (P3s) featuring prominently. This article evaluates and offers perspective on different types of P3s, examining their benefits and costs and the Trump administration’s plans.

  • (Image: The Fukushima Daiichi nuclear disaster of 2011. Source:  NYTimes) February 1

    Nuclear energy has the potential to assist nations in tackling climate change and sustain a rapidly growing world population. In the first part of this series on nuclear energy, I analyzed why nuclear energy is superior to other energy sources in achieving this end but also why current market forces prevent its growth. However, even if US legislators decided to pass legislation that aggressively expanded the country’s nuclear infrastructure, there are three primary non-market challenges with current U.S. policy, or lack thereof: a hostile public, the absence of a centralized nuclear waste disposal site, and concerns with proliferation and the imperilment of U.S. national security objectives. In order to responsibly expand nuclear energy capacities and prevent proliferation to hostile states, policy-makers have an obligation to address these issues. Not doing so may bear worse consequences than wantonly enlarging the United States’ atomic sector.

  • (Image: U.S. one dollar bill. Source: NeONBRAND on Unsplash) January 30
    In 2015, Seattle legislators signed a bill to gradually increase the city’s minimum wage to $15 an hour over several years. Businesses with fewer than 500 employees will still have until January of 2024 to deal with the full ramifications of the act. However, businesses that do not provide medical benefits and employ over 500 people were forced to pay their workers $15 dollars an hour starting this past January [1]. Since then, two major studies have been published on the effects of the act, one concluding that it has had a positive effect on economic activity and employment and the other stating that it has made the labor market far too rigid.
  • (Image: A hallway of jail cells. Source: Penn Criminology) January 25
    Today private prisons house about 126,000 federal and state inmates [1]. Orders issued under the Obama Administration to phase out the use of private prisons are now being reversed under the Trump Administration, which has caused some debates over the efficacy of private prisons to resurface. Chiefly, this reversal has sparked controversy over the economic benefits of private prisons in America, as the most avid dissidents highlight problems with the economic argument for private prisons and even moderate objectors point to inconclusive data as a poor indicator of their advantages.

PENN WHARTON PPI
RESOURCE SPOTLIGHT:

  • <h3>USDA Nutrition Assistance Data</h3><p><img width="180" height="124" alt="" src="/live/image/gid/4/width/180/height/124/485_usda_logo.rev.1407789238.jpg" class="lw_image lw_image485 lw_align_right" srcset="/live/image/scale/2x/gid/4/width/180/height/124/485_usda_logo.rev.1407789238.jpg 2x, /live/image/scale/3x/gid/4/width/180/height/124/485_usda_logo.rev.1407789238.jpg 3x" data-max-w="1233" data-max-h="850"/>Data and research regarding the following <strong>USDA Nutrition Assistance</strong> programs are available through this site:</p><ul><li>Supplemental Nutrition Assistance Program (SNAP) </li><li>Food Distribution Programs </li><li>School Meals </li><li>Women, Infants and Children </li></ul><p> Quick link: <a href="http://www.fns.usda.gov/data-and-statistics" target="_blank">http://www.fns.usda.gov/data-and-statistics</a></p><p>See all <a href="/data-resources/">data and resources</a> »</p>
  • <h3>The World Bank Data (U.S.)</h3><p><img width="130" height="118" alt="" src="/live/image/gid/4/width/130/height/118/484_world-bank-logo.rev.1407788945.jpg" class="lw_image lw_image484 lw_align_left" srcset="/live/image/scale/2x/gid/4/width/130/height/118/484_world-bank-logo.rev.1407788945.jpg 2x, /live/image/scale/3x/gid/4/width/130/height/118/484_world-bank-logo.rev.1407788945.jpg 3x" data-max-w="1406" data-max-h="1275"/>The <strong>World Bank</strong> provides World Development Indicators, Surveys, and data on Finances and Climate Change.</p><p> Quick link: <a href="http://data.worldbank.org/country/united-states" target="_blank">http://data.worldbank.org/country/united-states</a></p><p>See all <a href="/data-resources/">data and resources</a> »</p>
  • <h3>NOAA National Climatic Data Center</h3><p><img width="200" height="198" alt="" src="/live/image/gid/4/width/200/height/198/483_noaa_logo.rev.1407788692.jpg" class="lw_image lw_image483 lw_align_left" srcset="/live/image/scale/2x/gid/4/width/200/height/198/483_noaa_logo.rev.1407788692.jpg 2x, /live/image/scale/3x/gid/4/width/200/height/198/483_noaa_logo.rev.1407788692.jpg 3x" data-max-w="954" data-max-h="945"/>NOAA’s National Climatic Data Center (NCDC) is responsible for preserving, monitoring, assessing, and providing public access to the Nation’s treasure of <strong>climate and historical weather data and information</strong>.</p><p> Quick link to home page: <a href="http://www.ncdc.noaa.gov/" target="_blank">http://www.ncdc.noaa.gov/</a></p><p> Quick link to NCDC’s climate and weather datasets, products, and various web pages and resources: <a href="http://www.ncdc.noaa.gov/data-access/quick-links" target="_blank">http://www.ncdc.noaa.gov/data-access/quick-links</a></p><p> Quick link to Text & Map Search: <a href="http://www.ncdc.noaa.gov/cdo-web/" target="_blank">http://www.ncdc.noaa.gov/cdo-web/</a></p><p>See all <a href="/data-resources/">data and resources</a> »</p>
  • <h3>Federal Aviation Administration: Accident & Incident Data</h3><p><img width="100" height="100" alt="" src="/live/image/gid/4/width/100/height/100/80_faa-logo.rev.1402681347.jpg" class="lw_image lw_image80 lw_align_left" srcset="/live/image/scale/2x/gid/4/width/100/height/100/80_faa-logo.rev.1402681347.jpg 2x, /live/image/scale/3x/gid/4/width/100/height/100/80_faa-logo.rev.1402681347.jpg 3x" data-max-w="550" data-max-h="550"/>The NTSB issues an accident report following each investigation. These reports are available online for reports issued since 1996, with older reports coming online soon. The reports listing is sortable by the event date, report date, city, and state.</p><p> Quick link: <a href="http://www.faa.gov/data_research/accident_incident/" target="_blank">http://www.faa.gov/data_research/accident_incident/</a></p><p>See all <a href="/data-resources/">data and resources</a> »</p>
  • <h3>Internal Revenue Service: Tax Statistics</h3><p><img width="155" height="200" alt="" src="/live/image/gid/4/width/155/height/200/486_irs_logo.rev.1407789424.jpg" class="lw_image lw_image486 lw_align_left" srcset="/live/image/scale/2x/gid/4/width/155/height/200/486_irs_logo.rev.1407789424.jpg 2x" data-max-w="463" data-max-h="596"/>Find statistics on business tax, individual tax, charitable and exempt organizations, IRS operations and budget, and income (SOI), as well as statistics by form, products, publications, papers, and other IRS data.</p><p> Quick link to <strong>Tax Statistics, where you will find a wide range of tables, articles, and data</strong> that describe and measure elements of the U.S. tax system: <a href="http://www.irs.gov/uac/Tax-Stats-2" target="_blank">http://www.irs.gov/uac/Tax-Stats-2</a></p><p>See all <a href="/data-resources/">data and resources</a> »</p>
  • <h3>National Center for Education Statistics</h3><p><strong><img width="400" height="80" alt="" src="/live/image/gid/4/width/400/height/80/479_nces.rev.1407787656.jpg" class="lw_image lw_image479 lw_align_right" data-max-w="400" data-max-h="80"/>The National Center for Education Statistics (NCES) is the primary federal entity for collecting and analyzing data related to education in the U.S. and other nations.</strong> NCES is located within the U.S. Department of Education and the Institute of Education Sciences. NCES has an extensive Statistical Standards Program that consults and advises on methodological and statistical aspects involved in the design, collection, and analysis of data collections in the Center. To learn more about the NCES, <a href="http://nces.ed.gov/about/" target="_blank">click here</a>.</p><p> Quick link to NCES Data Tools: <a href="http://nces.ed.gov/datatools/index.asp?DataToolSectionID=4" target="_blank">http://nces.ed.gov/datatools/index.asp?DataToolSectionID=4</a></p><p> Quick link to Quick Tables and Figures: <a href="http://nces.ed.gov/quicktables/" target="_blank">http://nces.ed.gov/quicktables/</a></p><p> Quick link to NCES Fast Facts (Note: The primary purpose of the Fast Facts website is to provide users with concise information on a range of educational issues, from early childhood to adult learning.): <a href="http://nces.ed.gov/fastfacts/" target="_blank">http://nces.ed.gov/fastfacts/#</a></p><p>See all <a href="/data-resources/">data and resources</a> »</p>
  • <h3>Federal Reserve Economic Data (FRED®)</h3><p><strong><img width="180" height="79" alt="" src="/live/image/gid/4/width/180/height/79/481_fred-logo.rev.1407788243.jpg" class="lw_image lw_image481 lw_align_right" data-max-w="222" data-max-h="97"/>An online database consisting of more than 72,000 economic data time series from 54 national, international, public, and private sources.</strong> FRED®, created and maintained by Research Department at the Federal Reserve Bank of St. Louis, goes far beyond simply providing data: It combines data with a powerful mix of tools that help the user understand, interact with, display, and disseminate the data.</p><p> Quick link to data page: <a href="http://research.stlouisfed.org/fred2/tags/series" target="_blank">http://research.stlouisfed.org/fred2/tags/series</a></p><p>See all <a href="/data-resources/">data and resources</a> »</p>
  • <h3>The Penn World Table</h3><p> The Penn World Table provides purchasing power parity and national income accounts converted to international prices for 189 countries/territories for some or all of the years 1950-2010.</p><p><a href="https://pwt.sas.upenn.edu/php_site/pwt71/pwt71_form.php" target="_blank">Quick link.</a> </p><p>See all <a href="/data-resources/">data and resources</a> »</p>
  • <h3>MapStats</h3><p> A feature of FedStats, MapStats allows users to search for <strong>state, county, city, congressional district, or Federal judicial district data</strong> (demographic, economic, and geographic).</p><p> Quick link: <a href="http://www.fedstats.gov/mapstats/" target="_blank">http://www.fedstats.gov/mapstats/</a></p><p>See all <a href="/data-resources/">data and resources</a> »</p>
  • <h3>National Bureau of Economic Research (Public Use Data Archive)</h3><p><img width="180" height="43" alt="" src="/live/image/gid/4/width/180/height/43/478_nber.rev.1407530465.jpg" class="lw_image lw_image478 lw_align_right" data-max-w="329" data-max-h="79"/>Founded in 1920, the <strong>National Bureau of Economic Research</strong> is a private, nonprofit, nonpartisan research organization dedicated to promoting a greater understanding of how the economy works. The NBER is committed to undertaking and disseminating unbiased economic research among public policymakers, business professionals, and the academic community.</p><p> Quick Link to <strong>Public Use Data Archive</strong>: <a href="http://www.nber.org/data/" target="_blank">http://www.nber.org/data/</a></p><p>See all <a href="/data-resources/">data and resources</a> »</p>
  • <h3>HUD State of the Cities Data Systems</h3><p><strong><img width="200" height="200" alt="" src="/live/image/gid/4/width/200/height/200/482_hud_logo.rev.1407788472.jpg" class="lw_image lw_image482 lw_align_left" srcset="/live/image/scale/2x/gid/4/width/200/height/200/482_hud_logo.rev.1407788472.jpg 2x, /live/image/scale/3x/gid/4/width/200/height/200/482_hud_logo.rev.1407788472.jpg 3x" data-max-w="612" data-max-h="613"/>The SOCDS provides data for individual Metropolitan Areas, Central Cities, and Suburbs.</strong> It is a portal for non-national data made available through a number of outside institutions (e.g. Census, BLS, FBI and others).</p><p> Quick link: <a href="http://www.huduser.org/portal/datasets/socds.html" target="_blank">http://www.huduser.org/portal/datasets/socds.html</a></p><p>See all <a href="/data-resources/">data and resources</a> »</p>
  • <h3>Congressional Budget Office</h3><p><img width="180" height="180" alt="" src="/live/image/gid/4/width/180/height/180/380_cbo-logo.rev.1406822035.jpg" class="lw_image lw_image380 lw_align_right" data-max-w="180" data-max-h="180"/>Since its founding in 1974, the Congressional Budget Office (CBO) has produced independent analyses of budgetary and economic issues to support the Congressional budget process.</p><p> The agency is strictly nonpartisan and conducts objective, impartial analysis, which is evident in each of the dozens of reports and hundreds of cost estimates that its economists and policy analysts produce each year. CBO does not make policy recommendations, and each report and cost estimate discloses the agency’s assumptions and methodologies. <strong>CBO provides budgetary and economic information in a variety of ways and at various points in the legislative process.</strong> Products include baseline budget projections and economic forecasts, analysis of the President’s budget, cost estimates, analysis of federal mandates, working papers, and more.</p><p> Quick link to Products page: <a href="http://www.cbo.gov/about/our-products" target="_blank">http://www.cbo.gov/about/our-products</a></p><p> Quick link to Topics: <a href="http://www.cbo.gov/topics" target="_blank">http://www.cbo.gov/topics</a></p><p>See all <a href="/data-resources/">data and resources</a> »</p>