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Health Reform After SCOTUS Nelson Mullins LLP July 20, 2012 Joseph R. Antos, Ph.D. Wilson H. Taylor Scholar in Health Care and Retirement Policy and Retirement.

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Presentation on theme: "Health Reform After SCOTUS Nelson Mullins LLP July 20, 2012 Joseph R. Antos, Ph.D. Wilson H. Taylor Scholar in Health Care and Retirement Policy and Retirement."— Presentation transcript:

1 Health Reform After SCOTUS Nelson Mullins LLP July 20, 2012 Joseph R. Antos, Ph.D. Wilson H. Taylor Scholar in Health Care and Retirement Policy and Retirement Policy American Enterprise Institute

2 Do we really have to eat it? …and does it matter?

3 AEI  Guaranteed issue, community rating without ~full participation → selection spiral  IRS authority limited by ACA  Behavioral economics vs. simple arithmetic  Subsidized premiums = 2% to 9.5% of income (plus inflation plus “excess” premium growth in 2019+) 3 Year“Tax” 2014$95/1% of income 2015$325/2% of income 2016$695/2.5% of income rate + inflation

4 A moot point? Can the federal exchange distribute subsidies? Will the federal exchange provide “1-stop shopping”? Is it a state exchange managed by the feds?

5 Medicaid typo?  Exchange subsidies for % FPL? ◦ Premium = 2% of income ◦ Cost-sharing credits = 94% of plan value ◦ State cost = $0 ◦ Medicaid: State cost = 5% in 2017 → 10% in 2020+

6 AEI  Lame duck, lamer than usual  Romney: Repeal and replace? ◦ Reconciliation ◦ What goes, what stays under a new name? ◦ How much has already changed? ◦ Put health subsidies on a real budget  Obama: The economy is in charge, not him ◦ Replay of Budget Control Act, but with teeth  Major spending cuts—including Medicare, Medicaid, exchanges  Reality that ACA is not ready for 2014 prime time  Devolution to the States ◦ Difficult balance with short-term “stimulus” 6

7 7 Don’t worry… …Congress will work it out


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