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NEW YORK, March 23 U.S. President Donald Trump
and fellow Republicans in the House of Representatives have
proposed a healthcare law to kick off their promise to repeal
and replace Obamacare.
Following are some questions and answers about healthcare
spending and health insurance coverage in the United States as
Republicans try to throw out President Barack Obama's signature
piece of domestic policy, the 2010 Affordable Care Act.
Who is covered by what insurance?
The majority of America’s 323 million people are covered by
either government or private insurance. Less than half of U.S.
spending on healthcare is publicly financed, a contrast to the
72 percent average among member countries of the Organisation
for Economic Co-operation and Development. A core goal of
Obamacare was to cut into the numbers of uninsured and some 20
million people gained coverage under the law.
- 155 million people are covered by employer-based health
- 70 million people are in the publicly funded Medicaid
program for the poor, including 32 million children
- 56 million older or disabled people receive Medicare
- 15 million people are covered by military healthcare
- 12 million people buy individual insurance on the online
shopping exchanges created by Obamacare
- 9 million people purchase unsubsidized health insurance
- 6 million people are covered by the Indian Health Service,
student health plans and other sources
- About 28 million Americans remain uninsured
The figures are government estimates. They do not add up to
a total of 323 million because some people have more than one
type of coverage.
How much does the country spend?
Spending on healthcare in the United States is about $3.5
trillion a year, representing about 18 percent of U.S. gross
domestic product. Current U.S. government estimates are for that
spending to outpace economic growth and rise to 20 percent of
GDP by 2025. Healthcare spending has been rising faster than
inflation. The government estimated it to have risen 4.8 percent
in 2016 and that it will increase at an average rate of 5.6
percent through 2025.
What does America get for its money?
While U.S. healthcare spending as a percentage of GDP ranks
higher than for any other OECD country, Americans’ life
expectancy is near the bottom in a ranking of other OECD
countries, behind countries such as France, Germany and Britain.
The country's obesity rate is the highest.
What was the impact of Obamacare?
As the Affordable Care Act was implemented over the past six
years, it made sweeping changes to the health insurance system
and implemented new taxes, so gutting the law will affect most
Americans at some point.
The law set a series of minimum standards. It introduced
free preventive care coverage, mandated most employers to offer
insurance and individuals to buy it, expanded the Medicaid
program to include people with higher incomes and created
income-based subsidies for individuals to draw them into buying
insurance. It prevented insurers from denying coverage to people
based on their health status and allowed young adults to stay on
their parents' health insurance policies.
What sectors are feeling the impact now?
Republicans will tackle repealing Obamacare in multiple
steps because while they control both chambers in Congress, they
do not have the 60 seats in the 100-seat Senate needed to simply
undo the law.
The first step focuses on insurance sold to individuals and
the Medicaid expansion, which could mean diminished payments to
hospitals and doctors who benefited from the 20 million people
covered by the ACA. They now face uncertain revenues and the
possibility of increased bad debt as they lose paying patients.
The impact on insurers is twofold: uncertainty over who will
buy insurance could lead to them mispricing insurance plans and
suffering financially as soon as this year. In the longer term,
the retrenchment is changing the outlook for the growth rate of
publicly backed healthcare.
Which publicly traded companies does this affect?
There are only a handful of publicly traded hospital
companies, and the biggest one, HCA Holdings Inc, is not
focused on states where Medicaid expanded, so it tends not to be
involved. Tenet Healthcare Corp and Community Health
Systems Inc are smaller hospital chains with high debt
loads and their shares do tend to be affected by news about
potential cuts to the numbers of Americans with publicly funded
The insurers that specialize in Medicaid and government
healthcare such as WellCare Health Plans, Molina
Healthcare Inc and Centene Corp are small but
tend to move on news that the Medicaid expansion may be repealed
and on proposed changes in how the federal government pays its
share of all Medicaid costs to the states. Anthem Inc is
one of the biggest insurers selling plans on the individual
exchanges and may see shares affected by news of rules that
could affect who enrolls in insurance.
Sources - Congressional Budget Office, U.S. Census Bureau,
Centers for Medicare and Medicaid Services
(Reporting by Caroline Humer; Editing by Frances Kerry and Bill