Dissecting Trump’s latest Obamacare tweet

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I'll be honest: I did not spend a lot of time thinking about health care over the Thanksgiving break.

Our president, however, seems to have had a slightly different experience. Around 5:18 pm on Thanksgiving — right when I and many others were sitting down to dinner — here's what he tweeted:

Now that we've fully digested our Thanksgiving meal, I thought it was time to digest what is happening in this tweet — which gets a little bit right but a lot more wrong about the current state of the Affordable Care Act.

Trump is right that "ObamaCare premiums are going up, up, up" this year — but experts pretty roundly agree that most of the price hike is due to actions taken by the Trump administration itself.

We covered this a lot a few months ago in VoxCare, but the main cause of big Obamacare rate hikes is the Trump administration's decision to stop paying cost-sharing reduction (CSR) subsidies. These payments went to health insurance plans to subsidize the copayments and deductibles for low-income health law enrollees.

When the Trump administration made this decision a few months ago, insurance plans responded by raising their premiums. If one source of income was going away, they reasoned, they needed another. This turned many single-digit rate hikes into double-digit rate hikes, as you can see in this brief from the Kaiser Family Foundation.

They find that insurance plans added 7 to 38 percentage point rate hikes to respond to the lack of CSR subsidies for 2018.

Then, there is the idea that "Obamacare is OWNED by the Democrats." Most voters disagree with this point — they think that the Trump administration now owns the future of the Affordable Care Act. We know this because the Kaiser Family Foundation monthly tracking poll asked a question about this in August. It found that 60 percent of voters think Trump and congressional Republicans are responsible for "any problems with [Obamacare] going forward."

Thirty-six percent of Republicans agreed with this statement, too.

Kaiser Family Foundation

Chart of the Day: Insured patients with severe injuries less likely to be transferred to trauma centers

Journal of the American Medical Association

A downside to having insurance? R. Adams Dudley, director of the UCSF Center for Health Care Value, flags a fascinating study from the Journal of the American Medical Association, which finds that severely injured patients with coverage are slightly less likely to be transferred to trauma centers.

"Our findings demonstrating disparities in transfer patterns of severely injured patients by insurance status who are initially seen at non-trauma center EDs," the authors write, "are even more concerning because these hospitals do not have the critical care trauma resources that level III trauma centers have."

Kliff’s Notes

Today's top news

• “States prepare to shut down children’s health programs if Congress doesn’t act”: “Officials in nearly a dozen states are preparing to notify families that a crucial health insurance program for low-income children is running out of money for the first time since its creation two decades ago, putting coverage for many at risk by the end of the year.” —Colby Itkowitz and Sandhya Somashekhar, Washington Post
• “Groups make year-end push to delay ObamaCare taxes”: “Industry groups are gearing up for a final push to repeal or delay taxes in ObamaCare before the end of the year. Stalling the taxes on medical devices and health insurance, which were included in the health-care law to help pay for its coverage expansion, has been a rare area of some bipartisan cooperation on ObamaCare.” —Peter Sullivan, the Hill
• “Patent ‘Death Squad’ Pitting Tech and Pharma Heads to Supreme Court”: “'The pendulum has recently swung against patent owners at the Supreme Court,' said Christopher Loh, a patent lawyer with Fitzpatrick, Cella, Harper & Scinto who often represents drugmakers. 'There’s growing sentiment that the uncertainty in the patent world is leading to a global lack of competitiveness.'” —Susan Decker, Bloomberg

Analysis and longer reads

• “As Health Care Changes, Insurers, Hospitals and Drugstores Team Up”: “Given the uncertainty over the Affordable Care Act and the potentially limited appeal of the core insurance business, insurers are looking to follow the strategy pursued by UnitedHealth Group. The big insurer, which acquired a chain of outpatient surgery centers earlier this year, has a wide array of profitable health care businesses like its own pharmacy benefit manager and various consulting arms through its Optum unit.” - Ree—Abelson, New York Times
• “Republicans' latest plan to repeal Obamacare's insurance requirement could wreak havoc in some very red states”: “The Senate Republican plan to use tax legislation to repeal the federal requirement that Americans have health coverage threatens to derail insurance markets in conservative, rural swaths of the country, according to a Los Angeles Times data analysis.” —Noam N. Levey, Los Angeles Times
• “Taken For A Ride? Ambulances Stick Patients With Surprise Bills”: “Public outrage has erupted over surprise medical bills — generally out-of-network charges that a patient did not expect or could not control — prompting 21 states to pass laws protecting consumers in some situations. But these laws largely ignore ground ambulance rides, which can leave patients stuck with hundreds or even thousands of dollars in bills, with few options for recourse, finds a Kaiser Health News review of 350 consumer complaints in 32 states.” —Melissa Bailey, Kaiser Health News

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