James C. Capretta
New Atlantis Contributing Editor James C. Capretta is an expert on health care and entitlement policy, with years of experience in both the executive and legislative branches of government. E-mail: firstname.lastname@example.org.
James C. Capretta’s Latest New Atlantis Articles
“Health Care with a Conscience” (Fall 2008)
“Health Care 2008: A Political Primer” (Spring 2008)
“The Clipboard of the Future” (Winter 2008)
Wednesday, 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.
Wednesday, July 10, 2013
Ways and Means Health Subcommittee Hearing: “The Obama Administration’s Delay of the Employer Mandate”
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.
Tuesday, 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.
Wednesday, 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.
Wednesday, July 3, 2013
On Tuesday, the Obama administration announced that they would be delaying the implementation of the employer mandate provisions of Obamacare from 2014 to 2015. Over at the Weekly Standard, I explain how this strange decision highlights the underlying weaknesses of the entire health care law:
For starters, the delay confirms precisely what the critics have been saying all along: That Obamacare is a huge burden on the economy that will reduce employment and stifle wages. By delaying enforcement of the mandate, and citing complaints from employers as the reason, the Obama administration is essentially conceding this point. How do Democrats defend the law now that the administration has admitted it has the potential to harm business vitality and job growth?
The rest of the post can be read here.
Tuesday, June 25, 2013
There has been considerable debate among conservative opponents of Obamacare over proposed federal legislation that would fund high-risk pools for people with expensive pre-existing health conditions. In a column at e21 I explain why and how the federal government should help protect people with pre-existing conditions by funding high-risk pools.
Some opponents of this legislation have in mind the possibility that the problem of pre-existing conditions can be resolved with deregulation and a more functioning marketplace for health insurance. And it is certainly true that the problem is caused — in part — by the favorable tax treatment granted to employer-paid insurance premiums. This encourages heavy reliance on job-based insurance that is not owned or controlled by the workers, and can’t be taken with them when they leave their jobs. The discontinuity in insurance coverage that therefore occurs in the United States compels a regulatory solution to ensure that workers who switch insurance do so without incurring significant financial risks. We would be far better off if the market for private health insurance had developed differently, with individuals purchasing and owning their coverage more, as they do with most other insurance products.
But there’s no sense in ignoring reality. Today, about 160 million Americans are enrolled in job-based insurance plans, and mainly they are satisfied with what they have. If Obamacare is repealed, there’s little prospect of wholesale change to this insurance system. Therefore, opponents of Obamacare need to promote solutions for pre-existing conditions that presume the continuation of job-based insurance as the dominant form of coverage.
You can read the rest of the column here.
Wednesday, June 19, 2013
Obamacare apologists have been touting last month’s news from California about the effect that the law will have on insurance premiums, but, as I explain in a column on National Review Online, the law’s critics have been right to point out how Obamacare will increase rates in the individual insurance market.
Obamacare is imposing a minimum benefit for insurance that is in excess of what many consumers purchase on their own today. And the law is imposing many new rules on what insurance companies may and may not take into account when setting premiums. There is no experience anywhere indicating that these kinds of changes will lower premiums. And there’s an abundance of evidence from state experiments indicating that these changes will increase premiums, and probably quite substantially.
So Roy and the others were rightly suspicious of the spin coming out of California and decided to take a look themselves. What they found is that California officials were comparing the Obamacare exchange premiums with small-employer plans, not the existing individual market in the state. This was a completely inappropriate comparison. It is the enrollees in the individual-insurance market who will have little choice but to get their coverage from the exchange next year. Employees of small businesses can still get their insurance outside of the exchange, and do so on a self-insured basis to avoid getting pooled with insurance enrollees outside their firms. But for people in the individual market, there’s no getting around Obamacare.
You can read the rest of the piece here.
Friday, June 14, 2013
This week, the U.S. News “Debate Club” blog posed the question of whether the federal government’s short term deficit has been reduced enough, following the less dismal than usual projections in last month’s Congressional Budget Office report. I weighed in on the debate, arguing that the United States still faces serious fiscal challenges, especially the challenge of controlling the long-term growth of entitlement spending.
But the core fiscal challenge for the country, which remains unaddressed, is the unrelenting growth of entitlement spending -- a problem that will become acute in the next twenty years. Between 1973 and 2012, entitlement spending rose from 7.4 percent of GDP to 13.1 percent of GDP. By 2035, spending on Social Security, Medicare, Medicaid and the health care law's new entitlements is expected to add another 5.4 percent of GDP to the spending side of the federal ledger. Absent serious reform, the budgetary pressures created by this entitlement spending surge will either force massive cuts in the rest of the budget or very large tax increases, or perhaps trigger a debt crisis.
You can read (and vote for!) the rest of my post here.
Thursday, June 6, 2013
The prospects for a “grand bargain” on the budget finally seem dead, and as I explain at National Review Online, the fault lies with tactical blunders made by President Obama.
There was a period when the prospects for a “grand bargain” were on the rise — right after President Obama’s reelection in November 2012. The president was riding high and had campaigned on a “balanced approach” to deficit reduction, by which he meant any deal to reform entitlements and cut spending must also increase taxes, especially on the rich. In the weeks after his reelection, the president might have been able to press a demoralized congressional GOP into agreeing to a large, multiyear budget framework along these lines.
That certainly would have been in his interests. Based on where things now stand, his presidency will be defined in part by the $7 trillion in debt he will run up during his time in office. A “grand bargain” on the budget at the beginning of his second term could have fundamentally altered the legacy of his budgetary performance in office, turning what is sure to be viewed as a rather large failure into perhaps a modest achievement. Moreover, a multiyear budget deal would have taken fiscal issues, including the sequester the administration despises, off the table for the remaining years of the president’s time in office, freeing up his administration to press for agenda items he clearly is more passionate about.
But for some unfathomable reason, the president decided to pursue a different strategic approach. Instead of moving quickly to do what was necessary to create the conditions for a budget deal, he chose instead to pursue a two-part strategy on taxes and spending. That was a huge mistake.
You can read the rest of the column here.
Tuesday, June 4, 2013
Last Friday, the Medicare trustees released their annual report on the state of Medicare’s finances. And, yesterday, the American Enterprise Institute held its annual event on the report, moderated by AEI’s Joe Antos. The session always features a presentation on the report’s main findings by a representative from the office of the actuary that prepares the report. For many years, that task fell to long-serving chief actuary Richard Foster, but Mr. Foster retired earlier this year after a distinguished career. So, yesterday, Paul Spitalnic, the acting chief actuary for Medicare, performed the duty for the first time, and did so admirably.
The rest of the session featured comments on the state of health care costs and Medicare by Mark Pauly of the University of Pennsylvania, Chapin White of the Center for Studying Health System Change, and myself, followed by a question and answer session with the audience.