• Healthcare Triage: How We Pay for Obamacare

    This week’s episode of Healthcare Triage is an explanation of the fiscal workings of Obamacare. We’ve done this on the blog, but now you have somewhere to send your family and friends for an easier explanation:

    After we posted our video on “How Obamacare works” tons of commenters asked how Obamacare is paid for. Often, the question was NSFW. But you ask, we answer.
    In this episode, we will explain how much Obamacare costs, and what spending cuts and revenue increases (ie taxes) were passed to pay for it. You’ll get to see why it really is “deficit reducing”.

    Please watch and share! We need support in terms of subscribers and viewers to keep this going!


    • I know you’re being brief, but I wish you wouldn’t describe Medicare DSH as “no longer needed”. That ignores the many, many remaining uninsured (in the best case, all the undocumented), and gives people the impression the program was eliminated, not cut — or that if not eliminated, it should be. The Medicare and Medicaid DSH cuts may in fact be excessive considering trajectory of takeup and all the states opting out of Medicaid (although certainly that’s a tricky issue as we may not want to financially reward that decision). For both, long-term cuts are less than 50% of baseline.

      Similarly, the summary at the end also says “Removal of disproportionate hospital share payment regulation”.

      “Changes in how payments to corporations are reported” – was this the 1099 thing that was later repealed?

      • Yes to your last comment.

        As for DSH payments, I was describing the intent, not how I feel. With many states refusing the Medicaid expansion, DSH payments are more important than ever!

        • Good, but I still think people will get the wrong impression about the intent and content of the change. Your words are “Medicare also used to pay what’s called a disproportionate hospital share payment to providers who take care of the uninsured, but Obamacare’s going to reduce the number of uninsured. Those DSH payments are no longer needed.” I’m sure you intended otherwise, but the wording makes it sound very much like the elimination is to the whole program (“used to pay”; “those payments are no longer needed”, without any “as much” or “in the same amount”).

          • I understand your concern, but this was a video about the intent of the law. That was the thinking of those who passed it. I disagree with various aspects of it, but it wasn’t about me.

    • Has the CBO released projections based on the states no longer needing to expand Medicaid? On one hand that means fewer people are going to be put on Medicaid (which saves money), but on the other it means more people will probably remain uninsured (which could end up costing more money)

    • Thanks for this clear description of a complicated subject.

    • There are two slides near the end of the video that itemize the ACA savings and revenues and the net effect on the budget. Would you post those two slides as still graphics or PDFs, please?

    • Excellent video, Aaron. Some of the ACA savings/taxes started in 2011, but the majority of the spending for healthcare expansion doesn’t begin until 2014-16. The first 3-4 years of ACA will have generated meaningful revenue, offset by very minimal spending. Are you comparing 10 years worth of taxes (>$1.0 trillion) with 7 years worth of spending ($980 billion)?