The Commonwealth Fund has recently published its report on the impacts of the ACA on reducing the numbers of uninsured. The ACA increased coverage for the poor, the moderate income, the young, for whites, blacks and Latinos and for those working for small employers.

Joseph Stiglitz describes the changes in the rules undergirding the American economy over the past 40 years that have promoted short-term profit taking as opposed to long-term investments and their impacts in slowing the growth of the American economy.  http://rooseveltinstitute.org/rewriting-rules-report.

The average stock was held for seven years in 1940, for two years in 1987 and for seven months by 2007. Corporate CEO pay as compared to the average worker’s salary has grown from 20/1 in 1965 to 295/1 in 2013. Firms are not investing their capital in equipment needed and designed to increase worker productivity, but rather in stock buy-backs and shareholder dividends.

Ben Somers and colleagues compared changes under the ACA in Texas, Arkansas and Kentucky. The latter two adopted the Medicaid expansion under the ACA while Texas did not. The results between 2013 and 2015 were startling.

In Texas the uninsured rate for low income Texans fell from 39% to 32%. In Arkansas, it fell from over 40% to 14%; in Kentucky it fell from over 40% to 9%.

Nobel Prize winning economist Joseph Stiglitz’ report for the Roosevelt Institute entitled “Rewriting the Rules of the American Economy” notes the recurrent financial crises that plague our economic health and recommends ending “too big to fail”, regulating the shadow banking industry and off shore banking, transparency in all financial markets, reducing credit and debit card fees, stricter penalties for financial malfeasance, and reforming the rules of the Federal Reserve. http://rooseveltinstitute.org/rewriting-rules-report.

Fifteen years ago Joseph Stiglitz won the Nobel Prize for his research on information asymmetries and their impacts on free markets. In his report for the Roosevelt Institute entitled “Rewriting the Rules of the American Economy” he recommends a fresh look at anti-trust, at intellectual property rights, at global trade agreements and at government roles in negotiating health prices. http://rooseveltinstitute.org/rewriting-rules-report.

He points out that we have moved quite drastically from a manufacturing economy to a service and knowledge economy and that the 100 year old anti-trust rules from the turn of the 19th century into the 20th need to be updated to reflect a very different economy.

Health care is a classic case of market failure for several reasons: the asymmetric information about health care effectiveness between the patient and the providers, the third party payer role of the insurer or government, and the natural plan and provider monopolies in rural America and the oligopolies created by hospital system and health plan mergers.

I’ve been immersed in Nobel Prize winning economist Joseph Stiglitz' report for the Roosevelt Institute entitled “Rewriting the Rules of the American Economy”. http://rooseveltinstitute.org/rewriting-rules-report His perspective is that for the past thirty-five years or so we have been tilting the rules governing the American economy ever more towards the interests of the top 1%.  This is causing slow growth, endemic financial crises like the Great Recession, the wage-stagnant job recovery that has succeeded it under President Obama and the jobless recovery that preceded it under President Bush, the shrinking of the middle class, widening income inequality, stagnation of economic opportunities for the poor and the loss of American manufacturing jobs. He contends that a thorough going economic reform is necessary to restore economic equilibrium, redirect incentives and create the infrastructure of a healthy American economy. It is very provocative and deeply thoughtful.

His report (2015) predates the rise of Bernie Sanders and Donald Trump but presages their arguments about a “rigged” economic system. A number of his recommendations can now be found in the Democratic platform and in some of the policy recommendations from Secretary Clinton and Senator Sanders’ campaigns and in some of Donald Trump’s rhetoric as well (but no policy recommendations).

First a little background. Medicare is the primary program for seniors and the disabled. It is paid for by taxes on employers and employees and administered by the federal government.

Medicaid is the primary program for the poor. It is paid for by the federal and state governments with taxes. Each state runs its own program and decides who and what to cover within federal floors and ceilings; 20 states (primarily in the South) have not yet expanded their Medicaid programs to cover all the poor with the funding available under the ACA. 

About half of all Californians under 65 have employment-based coverage. The federal and state governments pay for about a third of the costs with a little understood mechanism known as pre-tax purchasing.

Individual coverage is partially paid for by the federal government with refundable tax credits and for the self employed with tax deductibility. The numbers of people with individual coverage have doubled due to the ACA.

The uninsured are people with none of the above coverage and no VA (Veterans Affairs) coverage. In California the numbers of uninsured have fallen very dramatically (more than half) due to the ACA. Undocumented Californians make up at least half of the remaining uninsured; they are not for the most part eligible for full scope Medicaid or for refundable tax credits.

After two years of 4% increases in health insurance premiums, Covered California premiums increased by 13.2% in 2017. Prices for the lowest cost bronze plans however increased only 3.9% (for a three-year average of 3.9%). Prices for the lowest cost silver plans increased 8.1% (for a three year average of 4.8%). Prices for the 2nd lowest cost silver plans (reference plans) increased 8.1% (for a three year average of 4.1%). Prices for the savvy comparison shoppers (i.e. those switching to the lowest priced plan in the metal tier they selected) declined -1.2%.

Clearly there will be lots of financial incentives for Covered CA customers to shop around in the coming year; this report will provide some information for those inclined to do so.

In a recent JAMA article, the President assesses the progress of health reform and makes his recommendations for next steps. http://jama.jamanetwork.com/article.aspx?articleid=2533698  The article includes some excellent graphs showing the improvements in coverage, cost, and quality.

The Committee for a Responsible Budget recently catalogued the campaign promises and their costs over the next decade from Prospective Presidential Nominees Donald Trump and Hillary Clinton. http://crfb.org/papers/promises-and-price-tags-fiscal-guide-2016-election

The chart below summarizes their most significant findings – important reading before the standard obfuscations of political conventions, debates and campaigns.

In most ways, the new plan is same old, same old. It proposes block grants of the Medicaid program to the states, creates Medicare vouchers, adds in a Cadillac benefits tax for employer plans, repeals most but not all of the Obamacare consumer protections and payment reforms. It adds in a flat refundable tax credit for the uninsured. It keeps some consumer protections for those who maintain continuous and uninterrupted coverage and repeals them for most every one else.

Here are the summaries on the financing provisions. I would urge you to read the full 37 pages of text, so you are well-educated in these times of electoral confusion and potential tumult.

n most ways, the new plan is same old, same old. It proposes block grants of the Medicaid program to the states, creates Medicare vouchers, adds in a Cadillac benefits tax for employer plans, repeals most but not all of the Obamacare consumer protections and payment reforms. It adds in a flat refundable tax credit for the uninsured. It keeps some consumer protections for those who maintain continuous and uninterrupted coverage and repeals them for most every one else.

Here are the summaries on the employer and cost containment provisions. I would urge you to read the full 37 pages of text, so you are well-educated in these times of electoral confusion and potential tumult. I will follow up with a blog on the financing provisions in Part 4 of this series.

In most ways, the new plan is same old, same old. It proposes block grants of the Medicaid program to the states, creates Medicare vouchers, adds in a Cadillac benefits tax for employer plans, repeals most but not all of the Obamacare consumer protections and payment reforms. It adds in a flat refundable tax credit for the uninsured. It keeps some consumer protections for those who maintain continuous and uninterrupted coverage and repeals them for most every one else.

Here are the summaries on the Refundable Tax Credit and Consumer Protection provisions. I would urge you to read the full 37 pages of text, so you are well-educated in these times of electoral confusion and potential tumult. I will follow up with blogs on the cost containment and employer coverage provisions in Part 3 of this series.

In most ways, the new plan is same old, same old. It proposes block grants of the Medicaid program to the states, creates Medicare vouchers, adds in a Cadillac benefits tax for employer plans, repeals most but not all of the Obamacare consumer protections and payment reforms. It adds in a flat refundable tax credit for the uninsured. It keeps some consumer protections for those who maintain continuous and uninterrupted coverage and repeals them for most every one else.

Here are the summaries on the Medicaid and Medicare portions. I would urge you to read the full 37 pages of text, so you are well-educated in these times of electoral confusion and potential tumult. I will follow up with blogs on the refundable tax credits, the cost containment provisions and on the consumer protections.

Hillary Clinton’s tax proposal would raise taxes on the highest income individuals, repeal fossil fuel incentives, increase estate and gift taxes and create tax disincentives for corporations to shelter income overseas for tax avoidance purposes. Over the next 10 years, she would increase federal revenues by $1.1 trillion. Her proposals would decrease the federal debt by $1.2 trillion over the next decade and by $4.3 billion over the next 20 years.

Donald Trump proposes to cut taxes for businesses, individuals and heirs quite dramatically. He would decrease federal tax revenues by $9.5 trillion over the next 10 years. Over the following 10 years federal revenues would be cut by $15 trillion. He would increase the federal debt by $11 trillion over the next decade and by $34 billion over the following 10 years.

The general view of economists from both the left and right is that free trade is an excellent idea that benefits all nations. In other words, if the US is best at producing high quality low cost computers and worst at producing high quality, low cost clothes, the US should specialize in computer production and either leave clothes production to others who can do a better job or redesign its clothing design and manufacturing to make it competitive in world and domestic markets.

In general since the Second World War, the US has espoused and implemented free trade with world training partners, which worked well as long as the US was a manufacturing colossus during the 40s and 50s. However beginning in the 60s and 70s, the American competitive edge began to decline, and Germany and Japan rebuilding after World War Two proved able and often superior competitors in manufacturing. China and Mexico are currently perceived as competitive threats by some.

Donald J. Trump proposes mass deportation of 11 million Mexicans and wholesale exclusion of Muslim immigrants, tourists and visitors. His nativism has deep and disturbing roots in our nation’s past.

This is the title of an excellent article by Eduardo Porter on the business page of the New York Times today (June 8, 2016). http://www.nytimes.com/2016/06/08/business/economy/threatened-by-machines-a-once-stupid-concern-gains-respect.html It raises the questions of how society could evolve as computers and industrial robots displace more and more workers. Are human workers going the way of the working horses now thoroughly displaced by cars, trains, tractors and planes over the last century?

My old law school roommate, Dan Sullivan, has just self published a book, entitled Radical Change: the Death of the American Dream exploring in depth the same fascinating issues. http://www.amazon.com/Radical-Change-Death-American-Dream/dp/0692439145?ie=UTF8&keywords=death%20of%20the%20american%20dream&qid=1465439657&ref_=sr_1_3&sr=8-3

The Federal Reserve Bank of New York researchers recently looked at medical debt collection efforts in communities in those states that supported the Medicaid expansion of Obamacare. Medical debts fell like a rock between 2013 and 2015 in counties that previously had a high rate of uninsured. See http://www.bloomberg.com/news/articles/2016-06-07/u-s-states-that-embraced-healthcare-reform-are-seeing-less-debt-sent-to-collection-agencies

The Urban Institute looked at the rise in premiums of the lowest cost silver plans in the Exchanges. http://www.urban.org/research/publication/increases-2016-marketplace-nongroup-premiums-there-no-meaningful-national-average/view/full_report In California these premiums increased by 1.4% between 2015 and 2016.