Chris Pope
@CPopeHC
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Senior Fellow, Manhattan Institute. Opinions my own.
Joined July 2017
I don't think there's good reason to expand subsidies <400%FPL as he suggests. But joined to an expansion of robust non-ACA plans, those two elements could be part of a decent bipartisan compromise.
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The combination of ending silver-loading to offset the cost of a smoother phase-out of ACA subsidies >400% FPL in @SenJonHusted's bill hasn't received much attention, but it's a smart way to fix the biggest flaw in subsidies without increasing cost overall
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My comments focus on Medicare Advantage's five main purposes: 1) Addressing Medicare's volume/value problem. 2) Modernizing the benefit package. 3) Depoliticizing provider payment. 4) Integrating new technology. 5) Reining in program costs with defined contribution.
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Great discussion of the purpose of Medicare Advantage and how to improve it on Capitol Hill last week hosted by @CAHPR_BrownSPH @Brown_SPH:
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...and the extent of age-based redistribution apparently has little to do with democracy: https://t.co/wKAxORMqi0
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It's amusing to think of the intensity of 19th century fights over democracy, which so many thought made massive class-based redistribution inevitable -- and then we mostly ended up with massive age-based redistribution.
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A good reminder that any discussion of redistribution is overwhelmingly a question about financing retirement benefits.
IMMIGRATION FISCAL/ECONOMIC IMPACT MEGATHREAD First, the average immigrant contributes less on net to the U.S. treasury than the average native-born American throughout their working years. However, this doesn't account for emigration.
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The House GOP healthcare bill reduces insurance coverage by 100k, i.e. 0.03%. It's hard to understand why Rs didn't tweak the coverage-expanding and coverage-reducing provisions to make the net effect positive.
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Good chart of how prevalence of prior authorization varies across medical specialties. It's concentrated where there are extremely costly drugs and diagnostics of debatable marginal value. https://t.co/ytlqsFCB8T
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This gives employers an incentive to eliminate health benefits for all. Firms can make sure every worker profits from the switch by giving high earners a wage increase.
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Original ACA subsidies paid the bulk of health insurance costs for the poor, but little for the rich. Expanded ACA subsidies are a generous entitlement, which greatly exceeds the value of the ESI tax exemption for all but a few. https://t.co/lptTmAfX7v
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When people think of ACA subsidy beneficiaries, they often have in mind young low-income single people. The biggest beneficiaries of the *expansion* of ACA subsidies (shaded area) are older high-income larger households.
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The way to eliminate the ACA subsidy cliff without causing federal spending to surge is to better harmonize ACA subsidies with the ESI tax exemption.
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A great flaw of the ACA framework is that attempting to impose guaranteed issue and community rating without adverse selection effectively requires uniformity in the scope of benefit packages.
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Decoupling insurance from employment would be a good idea: https://t.co/AZ6lWgNGcG Fixing hospital fees for private insurers by regulation would not:
manhattan.institute
A number of Medicare-for-All proposals point to Maryland’s all-payer system as an example of how government regulation of hospital prices can reduce health care costs. MI senior fellow Chris Pope...
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That said, systematizing the way we pay for emergency care for the uninsured might be a good place to start:
manhattan.institute
In order to fund emergency health care for indigent patients, the U.S. provides billions of dollars in subsidies to hospitals. But these subsidies allocate aid to facilities that need it least, fail...
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Many economists have advocated "very basic universal insurance" -- but the hard part is coming up with a robust definition that falls between just stabilization in emergencies and comprehensive medical benefits, without sliding to either extreme.
Great piece from @zackcooperYale The high cost of health care isn't an ACA problem. It's an American health care problem. Requires a bigger, tougher conversation, though there are chances for some easy bipartisan wins. (Meantime, extend the subsidies.)
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The evidence suggests the opposite. ERISA (i.e. large employer) plans tend to impose lower deductibles on workers, despite similar premiums. AHPs allow small employers to provide this same coverage to their staff. https://t.co/Ws1QmMCNRb
Cheap AHPs would provide less-than-robust coverage, & would appeal only to healthy enrollees. AHPs would not have the incentives to provide robust coverage that employers have. This would NOT be a way for self-employed people to get cheap coverage that matches current ESI plans.
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Senate Dems *could* put ACA reforms on the table, which would make conservatives agree to spend more money. But Ds clearly seem to prioritize having an issue that helps them win back the House, over negotiating policy for substantive reasons.
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This is an astonishing amount of money to just be spent on research.
The WHO's and big public health's movement on the "social determinants of health" has always been about socialism and wealth redistribution Between 2020-24, the NIH spent billions of dollars on this politicised area of research The Nuzzo Letter report: https://t.co/FiMjZEp8S7
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