October 2, 2013 • In a column at The Weekly Standard, I argue that Republicans should use the budget debates over the government shutdown as a chance to argue for a delay of the Affordable Care Act's individual mandate.
You can read the rest of the article here.
The political and substantive case for a delay in the individual mandate is compelling. On a political level, what politician wants to defend giving a one-year break to corporate America but not to the little guy? That’s exactly the position Democrats are now in, and the GOP can swing public opinion their way by making this the central theme of their public case. In the coming days and weeks, there will be no shortage of opportunities for GOP members and Senators to go on TV, and they should use every chance they get to pound the message home with voters that the Democrats are the ones protecting businesses but not workers.
Substantively, the case is just as strong. The administration has delayed enforcement of the employer mandate for a year, which means some workers will not get an offer of coverage at their place of work. Because the individual mandate is still in place, they will have to go into the exchanges to get insurance or pay the uninsured tax. In two states, New Hampshire and West Virginia, there’s only one plan being offered in the exchanges. In other states, there are very few choices. Is it really fair to force American to buy insurance from one insurance carrier, or limit their choices to even two or three plans? The administration says it will start enforcing the employer mandate in 2015, which means many workers who were forced into the exchanges in 2014 will be forced out of them in 2015 when they get offered employer plans. Does disrupting insurance like this make any sense? The GOP should make these points to show that a delay of the employer mandate necessitates a commensurate delay of the individual requirement.
September 20, 2013 •
Medicare premium support, the entitlement reform plan that has been part of budgets passed by the House Republicans in 2011, 2012, and 2013, was harshly criticized during the last election, with the president repeatedly, and falsely, claiming that the plan would “end Medicare as we know it.” But, as I explain in a column at National Review Online, a new report from the Congressional Budget Office shows that premium support would not undermine Medicare benefits, even though it would be effective at cutting costs.
The CBO’s new analysis concludes that, depending on the specifics of the reform, it would indeed be possible to build a program that moderates federal costs and eases premiums for beneficiaries. For instance, under a premium-support model that used the average of premium bids by region (weighted by the size of the insurer’s beneficiary enrollment) to determine the government’s contribution, federal spending would drop by 4 percent relative to current law and beneficiary premiums would fall by 6 percent.
The key change in the CBO’s assessment: They forecast that intense price competition would cause the private insurance plans to submit bids that are 4 percent below the bids they would submit under today’s Medicare Advantage program. That’s a big difference, given that Medicare’s total per capita costs are expected to approach $12,500 in 2020. This assumed reduction in costs from private insurers would mean an even wider cost gap than the one that already exists between today’s Medicare Advantage plans and the traditional fee-for-service (FFS) program. CBO’s assessment leaves no doubt that private plans, properly run, can deliver Medicare benefits at far lower cost than the existing fee-for-service plans in most regions of the country.
You can read the rest of the column here.
September 19, 2013 •
Contrary to the expectations of its early critics, the Medicare prescription drug benefit has been very successful at using market forces and consumer preferences to keep the cost of drug coverage down over the past decade. In a column at e21 I argue that, instead of bringing more government regulation to the drug benefit program, as the Obama administration is planning, the market-based model of the program should be used as a model for how to reform the rest of Medicare.
A new paper from Doug Holtz-Eakin and Robert Book of the American Action Forum documents the compelling record of the drug benefit. For starters, the primary objective of those who authored and pushed for the enactment of the program has been met, which is ensuring access to prescription drugs for America’s seniors. About 90 percent of the Medicare population is now enrolled in a drug plan of some sort. Most beneficiaries get their coverage through one of the private plans competing directly for enrollment within Medicare, but a sizeable portion of Medicare enrollees also get good coverage outside of Medicare through retiree benefit plans. The law facilitated the continuation of these plans.
And the beneficiaries like what they are getting. Surveys of beneficiaries since the program was implemented have consistently shown high consumer satisfaction with the drug benefit plans offered through the program. The most recent survey indicates that 92 percent of Medicare beneficiaries enrolled in a drug plan are satisfied with their coverage, with 58 percent indicating they are “very satisfied” with their current plan.
You can read the rest of the column here.
September 16, 2013 •
While there is widespread recognition among conservatives that the Affordable Care Act should be their chief target in the fiscal debates between now and the end of the year, there is some disagreement about whether Republicans in the House should seek to delay or defund the health care law. In a piece in The Weekly Standard, Jeffrey Anderson and I argue that, for both political and substantive reasons, delaying rather than defunding Obamacare is a wiser strategy.
A push for a full-year delay of other major provisions is thus seen not as an unusual and politicized concept but rather as a reasonable response to the reality on the ground. A recent Kaiser poll asked whether Obamacare’s opponents “should continue trying to change or stop it, so it has less impact on taxpayers, employers, and health care providers,” or “should accept that it is now the law of the land and stop trying to block the law’s implementation.” By a 20-point margin—53 to 33 percent—respondents said that Obamacare’s opponents should keep trying to impede its implementation. In other words, Americans don’t think Republicans should just sit by and watch Obamacare go into effect.
The notion of defunding Obamacare gets a very different public reaction. While essentially every poll taken over the past three-and-a-half years has shown that Americans want to see Obamacare repealed, they don’t want to see it defunded. Rather, polls show that Americans oppose defunding Obamacare by large margins—ranging from about 20 to 30 percentage points. Over the past two-and-a-half years, Kaiser has taken eight polls on defunding. On average, those 8 polls have shown 29-point opposition to defunding—61 to 32 percent. A CBS News poll that showed 18-point opposition to Obamacare (51 to 33 percent) showed 20-point opposition to defunding it (55 to 35 percent).
You can read the rest of the article at the Weekly Standard’s website here.
August 26, 2013 •
One of the core provisions for “bending the cost curve down” contained in the Patient Protection and Affordable Care Act (PPACA) are the Medicare accountable care organizations (ACO), which are intended to serve as integrated health plans that will be able to deliver health care more efficiently than the current Medicare fee for service model. But, as I argue in a new AEI research paper, these ACOs do not allow for genuine consumer choice, and because they continue to rely on the fee for service payment model, they are unlikely to deliver on the health care savings that they are supposed to provide.
Private-sector efforts to build high-performing health systems around the country are making real progress in some cases and should be given the room they need to succeed. But this is not the same as saying the ACO program under the PPACA is a success or that it will be successful down the road, which is very unlikely to be the case.
Fortunately, the shortcomings of the ACO model in the PPACA need not be the end of the story. It remains important to encourage the development of more integrated and cost-effective care within Medicare. And that goal can be achieved by replacing the flawed ACO model of the PPACA with a more workable approach based on incentivizing the formation of high-quality plans and on allowing the beneficiaries to share in the cost savings such plans would produce.
The rest of the paper can be read online here.
August 5, 2013 •
One of the challenges facing opponents of Obamacare has been that there is so much wrong with the law, it can be difficult to choose a single target to focus on. But as Yuval Levin and I explain in an article in The Weekly Standard, the individual mandate, one of law’s most important provisions is also one of its most problematic and unpopular.
The law’s champions have always considered the individual mandate to be the indispensable provision. It is what allows them to make the only boast they really care to make, which is that the law—in their estimation—will deliver on the long-sought goal of “universal coverage” (which now appears to mean covering all but 30 million people in our country). And it is what allows them to attempt to transform the purchase of government-sanctioned health insurance from just another consumer choice into a social obligation, if not a legal decree.
Of course, the mandate has already ceased to be the obligation that Obamacare’s architects wanted it to be. In his landmark ruling in NFIB v. Sebelius last summer, Chief Justice John Roberts found that Congress did not have the authority under the commerce clause to make the purchase of health insurance obligatory. The only way the “personal responsibility” requirement was found constitutional was as a tax on the uninsured: Citizens can either purchase insurance or pay that tax. Both options are perfectly permissible under the law. Indeed, the Roberts decision suggests that Congress could never raise the tax very much because that would tip the balance away from providing a genuine choice to imposing a de facto obligation to buy coverage.
The rest of the piece can be read online here.
July 31, 2013 •
Apologists for Obamacare have been scrambling to defend the administration's decision to delay the implementation of the employer mandate by claiming that the mandate is not actually an important part of the law. But as I explain in a post at The Weekly Standard, delaying the mandate has serious implications for how much Obamacare will add to the federal deficit over the next ten years.
CBO’s estimates make clear how important the employer mandate is to Obamacare. Today, the agency provided updated projections of what the administration’s one-year delay (as well as related changes in the administrative process for adjudicating claims for federal subsidies) would mean for costs and coverage in coming years. CBO concluded that the administration’s decisions will increase the federal budget deficit over the coming decade by $12 billion. (Incidentally, the blog post from the Treasury Department announcing the mandate delay contained 478 words, so that’s about $25 million per word.) CBO also says the delay and related actions will mean one million people won’t get employer-sponsored health insurance in 2014, and about half of them will be left uninsured as a result. Even by Obamacare standards, these are not minor consequences unless one cares nothing about federal deficits or how many people don’t have health insurance.
You can read the rest of the post here.
Ways and Means Health Subcommittee Hearing: “The Obama Administration’s Delay of the Employer Mandate”July 10, 2013 •
Today, the House Ways and Means Health Subcommittee held a hearing on the Obama administration’s decision to delay enforcement of the employer mandate, where I gave testimony on the implications of both the delay in the employer mandate as well as the administration’s recent decision to abandon income verification for applicants to state insurance exchanges.
The decisions to abandon the employer mandate for 2014 and to allow applicant attestations in some instances were announced only last week; it will take some additional time before the full implications are known and understood. Nonetheless, in my testimony, I will provide some initial observations about what they mean for employers and the federal budget, and for broader implementation of the 2010 health care law. I also offer my recommendations to the committee and to Congress regarding what I believe would be an appropriate legislative response to the administration’s recent announcements.
July 9, 2013 •
Following close on last week’s announcement that the employer mandate provisions of Obamacare will be delayed by a year, the administration just announced another problem in the law’s implementation.
In a 606-page regulation, issued the Friday after July 4, the administration announced that income and employment verification in the state-run exchanges in 2014 will be based on the “honor system.” That is, the state exchanges will not be required to secure independent verification of the household incomes of the applicants, nor will they have to track down whether or not applicants were offered qualified coverage by their employers. On both counts, the state exchanges can simply accept whatever is claimed by the applicants as accurate, and then pay out subsidies accordingly.
This announcement is another indicator—as if we needed one—of the complete fiasco that is Obamacare implementation.
You can read the rest of my post on the fiasco that is Obamacare on the Weekly Standard blog, and listen to this episode of the Weekly Standard podcast, where I spoke with Michael Graham about Obamacare’s sloppy and irresponsible implementation.
July 3, 2013 •
The Obama administration’s “HHS mandate”, which requires that all employers provide free contraception, sterilization procedures, and abortifacients in their health-insurance plans for their workers has met with stern resistance from both the religious employers who are forced to choose between obeying their consciences and the law under this mandate, and from defenders of religious liberty from all faiths. And as I explain in a column at National Review Online, the administration’s so-called “accommodation” for religious employers has never been anything but a fraud.
Of course, it was never going to be possible to square this circle; something would have to give. The administration could either do what previous administrations would have done, which is to recognize the importance of providing ample space for those with religious sensibilities to follow their consciences without running afoul of the government’s laws and regulations, or it could ignore our nation’s history of religious tolerance and impose an inviolate “right to contraception” on every employer, religious objections notwithstanding.
You can read the rest of the article here.Previous Next