Here’s How Trump Will Change Obamacare

Congress will take symbolic steps while states do the work.

Promises made by Donald Trump and Republicans in Congress to repeal and replace the Affordable Care Act are proving to be more complicated than they sounded on the campaign trail. With reality now setting in, what’s most likely to happen?

I expect to see Republicans stage a dramatic early vote to repeal, with legislation that includes only very modest steps toward replacement — and leave most of the work for later. Next, the new administration will aggressively issue waivers allowing states to experiment with different approaches, including changes to Medicaid and private insurance rules. At some point, then, the administration will declare that these state experiments have been so successful, Obamacare no longer exists.

In other words, the repeal vote will be just for show; the waivers will do most of the heavy lifting.

From Bloomberg View – Articles by Peter R. Orszag

 

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What Trump Needs to Learn About Planes, Trains and Automobiles

Splashy new projects get the attention, but the real problem is with boring upkeep and operations.

The tensions between President Donald Trump and House Republicans over whether to enact a massive infrastructure bill have slipped from the news a bit, but we should expect that debate to re-emerge this spring and summer. In the meanwhile, while the topic is temporarily off the front pages, we have time to examine what should and shouldn’t happen — which is why I’m excited to participate in a conference that the Hamilton Project is holding on infrastructure today in Washington.

From Bloomberg View – Articles by Peter R. Orszag

Congress Needs a Megadeal

One way to tackle the debt limit, the budget, military spending and health care — all in September.

As Congress returns to work this week, its agenda is crowded with must-pass legislation. To avoid shutting down the government, lawmakers will have to vote for new spending bills. To avoid a debt crisis, they will have to increase the debt limit. To avoid depriving millions of low-income children of health insurance, they will need to reauthorize funding for it. And since the Trump administration on its own seems unwilling to make the Obamacare health-insurance exchanges work more effectively, Congress will need to make some fixes.

From Bloomberg View – Articles by Peter R. Orszag

Republicans Will Find Corporate Tax Reform Isn’t That Easy

Legislating can be so much more challenging than it seems during an election campaign. That’s becoming increasingly clear about Republican promises to repeal and replace Obamacare. And it’s about to become clearer on corporate tax reform.

Tax reform is a relatively easy concept: Most people favor lowering the tax rate and closing loopholes. The difficulty is in the details.

From Bloomberg View – Articles by Peter R. Orszag

What’s Killing Low-Income Americans

Stress, I’ve long suspected, may explain why lifespans have been lengthening for high-income Americans but have remained the same or even shortened for low-income and middle-income people. A new analysis from the Hamilton Project released today adds important evidence: Biomarkers of stress have risen much more rapidly for low-income people than for high-income ones.

From Bloomberg View – Articles by Peter R. Orszag

Chicago’s Model Health-Care Fix

It may not seem obvious from news reports, but health-care costs in the U.S. have been growing remarkably slowly. Among the many forces that have caused the slowdown are efforts such as those by Chicago Mayor Rahm Emanuel to change how health-care dollars are spent — a strategy that other cities and states can learn from.

For the past five years, Chicago has kept its health-care bill for employees and retirees roughly flat, at about $450 million a year. And reflected in this success are reforms that hold much promise for the future.

From Bloomberg View – Articles by Peter R. Orszag

Another Piece of Obamacare That Trump Should Keep

To get a sense of the future of American health care, amidst the post-election uncertainty, watch what happens to the Center for Medicare and Medicaid Innovation. This agency, created as part of the Affordable Care Act, has attracted substantial opposition. A recent proposal to change reimbursement to doctors for administering certain drugs, in particular, has led to calls that it be abolished. But let’s hope the center survives, because it could prove crucial to any new effort to raise the value of health care in the U.S.

From Bloomberg View – Articles by Peter R. Orszag