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Baker Institute Update: How might Obamacare change in 2017?

June 15, 2016: In this edition
How might Obamacare change in 2017?
The Affordable Care Act could expand or be abolished next year depending on who is elected president in November, but either change will likely increase the federal budget, Center for Health and Biosciences Director Vivian Ho said during a recent health policy luncheon at the institute.
Ho, the James A. Baker III Chair in Health Economics, examined the health care platforms of presumptive presidential nominees Donald Trump and Hillary Clinton earlier this month during her annual health care briefing with Health Policy Forum members.
Her presentation concluded that the proposals offered thus far by Trump and Clinton would each raise federal spending. However, Trump’s plan, which centers on repealing Obamacare, would lower access to health care, while Clinton’s plan to expand the program would increase the number of insured individuals in the U.S.
Ho has extensively studied the Affordable Care Act and is the co-author of a series of issue briefs analyzing the program’s impact in Texas.
Ho said while Trump’s pledge to repeal Obamacare would initially reduce the federal deficit, his overall proposal would actually cost an additional $490 billion net over the next 10 years, according to analysis by the Committee for Responsible Federal Budget. Trump’s proposal would also cause the number of uninsured to rise to 50 million by 2025.
Obamacare spending will cost $42 billion in 2016 to cover premium tax credits, cost-sharing subsidies and basic administration expenses. There are currently about 30 million uninsured Americans.
“What people don’t realize is that in order to get the (ACA) legislation passed, the administration made everybody at the table pay in,” Ho said. “There are taxes on health insurance policies that get passed on to you and me, taxes on prescription drugs and taxes on medical devices, plus savings to Medicare built in.”
“If you repeal the legislation  wholesale, you get rid of all of those things as well, and there are some problems with that.”
In addition, Ho said premiums would rise if the ACA is repealed, since the provision requiring all residents to obtain health insurance would be eliminated, likely leading younger and healthier residents to opt out of coverage and resulting in health insurance providers contending with a higher-risk pool of individuals.
In analyzing Clinton’s health care proposals, Ho said the Democratic candidate would aim to expand and tweak Obamacare through various measures, such as making so-called “bronze” or baseline health care insurance packages more affordable, lowering out-of-pocket maximums, and further incentivizing states to expand Medicaid.
While doing so would increase access to health care, it would also expand the financial burden on the federal government, Ho said. Obamacare currently costs the federal government about $4,420 per insured person.
“It sounds like a great deal, but remember, this is taxpayer money,” Ho said. “How much more is the country willing to pay? That’s up to each particular voter to decide, and it has to do with a broader debate we’re having on health and income inequality in this country.”

Click here to watch a video of her full remarks.
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CHB receives $667K grant for physician-hospital integration study

Coordinated health care is often proposed as a strategy to improve patient outcomes while slowing growth costs; yet, no data exists to prove it works. Vivian Ho, chair in health economics at the Baker Institute, is launching a first-of-its-kind study to quantify the impact of physician-hospital integration on the quality and price of health care.
Ho and co-investigator Marah Short, associate director of the Center for Health and Biosciences (CHB), were recently awarded a three-year, $667,000 grant from the federal Agency for Healthcare Research and Quality to begin the project.
“The project will provide valuable information to physicians, hospitals and consumers about the effects of physician-hospital integration,” said Ho, who is also director of the CHB. “In addition, analysis results could lead to policy recommendations about the optimal level of integration needed to meet the goals of increased quality and controlled costs — and in turn prices — which were set by the Affordable Care Act (ACA).”
The ACA encourages the integration of physicians and hospitals through accountable care organizations (ACOs) and medical homes. ACOs incentivize a team of health care providers — primary care physicians, hospitals, specialists and public or private health payers — to deliver coordinated patient care that yields continuity across time and visits. Though this method should mean better care for patients, integration could also enable hospitals to raise prices, Ho and Short said.
The investigators will examine both price and quality of care using data from the American Hospital Association Annual Survey, Medicare Hospital Compare database and multiple state databases that collect detailed hospital-level financial reports. The Medicare Hospital Compare database provides a novel opportunity to determine quality of care measured by timeliness and effectiveness of care for specific conditions, readmission rates and patient experience, according to Ho and Short.

“Further investigation will be needed to determine the net effect on consumer welfare, but this project would be an important step toward determining the effect on consumers and a building block for future research on the effects of the ACA,” Ho said.
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Ambassador Djerejian recognized for humanitarian diplomacy

Ambassador Edward P. Djerejian, director of the Baker Institute, received The Award for Humanitarian Diplomacy at the S. Daniel Abraham Center for Strategic Studies at Netanya College on June 8 in Israel. The award recognized the Ambassador’s career achievements in promoting conflict resolution in the Middle East, and specifically his work to secure increased travel rights for Syrian Jews during his time as U.S. Ambassador to Syria from 1988-1991.

At the time of his appointment to Damascus, tensions in Syria were high and Syria’s Jewish community faced severe travel and property restrictions. Previous U.S. attempts to ease the restrictions had failed. During his acceptance speech, Ambassador Djerejian noted that, on raising the issue directly with Syrian President Hafez Assad, Assad finally indicated that he had no problem with Syrian Jews going to “this place you call Brooklyn,” but that he would reverse his decision if he saw that Syrian Jews were leaving for Israel.

In 1989, after sustained negotiations, Assad agreed to grant 500 exit visas to Syrian Jews on the condition they not go to Israel. “While I was there, I do know that at least a few ended up in that ‘place called Brooklyn,’ and some finally ended up here in Israel,” Ambassador Djerejian said.  

The awards ceremony took place during a conference commemorating the career of Israeli Prime Minister Yitzak Shamir, who Djerejian noted for his pragmatism in pursuing Israel’s policy goals: “He did a number of things that he, personally, did not want to do, but did so because it was in Israel’s longer-term interest. Today, that kind of approach seems an increasingly rare trait.”

Prime Minister Shamir was a key interlocutor during the 1991 Gulf War and 1993 Madrid Peace Conference, which Ambassador Djerejian was involved in under the leadership of President George H.W. Bush and Secretary of State James A. Baker, III. At the request of the United States, Shamir acted with great restraint in not retaliating militarily when Saddam Hussein launched scud missile attacks over Israel, lest such action break up the Arab coalition the U.S. had successfully put together. And at Madrid, Shamir had many reservations about negotiations with Israel’s Arab neighbors, but he accepted the United States’ assurances and went.

“Many say that we exerted hard pressure on either side to get them to come to the table, but it wasn’t so much pressure as it was assertive diplomacy with a coherent strategy behind it,” Djerejian said. “We crafted the peace conference by creating a diplomatic and political landscape where it was difficult for both the Arabs and Israelis to say no. That is something I feel is largely missing from the U.S. approach to the complex issues of the Middle East today.”

Click here to read his full acceptance speech.

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Upcoming Events
  • Mexico in 2016: What's at Stake? The Council of the Americas and the Baker Institute Mexico Center at Rice University will co-host a two-panel discussion at the Carnegie Endowment for International Peace in Washington, D.C. Panelists will examine Mexico’s economic trajectory, the relationship between the rule of law and economic development, and the important implications of both for the United States. 9:00 am June 23
  • 50 Years of Human Spaceflight. Almost 50 years after the first U.S. moon landing, America’s space program faces an uncertain future. Join the Baker Institute Roundtable Young Professionals for a look at what’s ahead for NASA with senior space policy fellow George Abbey, former director of the Johnson Space Center, and former astronauts Leroy Chiao (space shuttle commander) and Fred Haise (Apollo 13). 6:00 pm June 27
  • The 2016 Battle for Control of the White House: National Trends and Consequences for Texas. At this Roundtable Young Professionals event, political science fellow Mark Jones will offer a nonpartisan take on the presidential election and how it will shape Texas’ future. 6:30 pm August 23
  • Stem Cell Tourism Near and Far: Achieving a Compromise for the Patient. Panelists will examine the FDA’s efforts to combat stem cell tourism in the U.S. and why the clinical trial process is the gold standard for understanding the impact of therapeutic interventions. The dialogue also will highlight options for better cooperation and collaboration between scientists, clinicians and the FDA to expedite proven therapies. 8:00 am September 22

For a complete list, visit our event page.

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