costs


About Those Presidential Promises...

From my latest column today in Kaiser Health News:

Over the past three years, President Barack Obama made many promises to the American people about his health care plan. Among other things, he said it would reduce the federal budget deficit in coming years, promote better quality care and improve access to physicians.

But two promises stood out in the sales pitch because they were aimed at assuaging the deepest fears of a broad cross-section of the electorate: those who already have good health insurance today.

First, during the presidential campaign, Obama promised on numerous occasions that families with existing coverage would see their annual premiums fall, on average, by $2,500 per household. Jason Furman, an adviser to candidate Obama and now an economic aide in the White House, even said that the Obama campaign team believed this level of premium savings could be fully achieved, or nearly so, by the end of an Obama first term.

Second, throughout the campaign and many times since taking office, the president has promised to let Americans stay with the health insurance plans they are enrolled in today if they want to. In other words, the changes he favors in health care arrangements would not force anyone out of something they find entirely satisfactory.

The rest of the piece looks at how those two promises have been panning out. Short version: not all that well. Read the whole thing here.

posted by James C. Capretta | 2:24 pm
Tags: broken promises, costs, coverage
File As: Health Care

Where’s the Administration’s Cost Estimate?

The latest numbers from the Medicare actuary puncture the health care spin

Yesterday, the chief actuary for Medicare released a memorandum providing cost estimates for the final health legislation passed by Congress and signed by the president.

Amazingly, the HHS Secretary tried to suggest that the memo confirms that the legislation will produce the favorable results that the legislation’s backers have touted for months.

That’s nothing but spin. In truth, the memo is another devastating indictment of the bill. It contradicts several key assertions by made by the bill’s proponents, including the president.

For starters, the actuary says that the legislation will increase health care costs, not reduce them — by about $300 billion over a decade. Yes, that’s over a very large base of spending (more than $35 trillion). But the president and his team have talked incessantly of painlessly cutting $700 billion or more of wasteful spending. Nothing in the bill comes close to making that happen. Overall health spending will continue to rise very rapidly after the bill is implemented.

The actuary also says that the financial incentives in the bill will lead many employers to stop offering coverage altogether. That means about 14 million people with job-based insurance today will lose it. Moreover, he estimates that the cuts in Medicare Advantage will reduce enrollment by 7 million people. So much for keeping the Democrats’ other mantra of “keeping the coverage you have today.”

The memo says the Medicare cuts will total nearly $600 billion through 2019, and that they will almost certainly jeopardize access to care for seniors by driving scores of institutions into financial distress.

Employers will pay taxes totaling $87 billion over a decade for not offering qualified coverage, and individuals who don’t sign up with approved insurance will pay another $33 billion in fines over the same period.

The various taxes and fees on insurers and producers of drugs and devices will largely get passed on to consumers, says the memo. In other words, these taxes will hit the middle class hard and drive their premiums up, not down.

The actuary says the new long-term care insurance program created in the bill faces “a significant risk of failure” due to adverse selection — meaning that the program will attract the kind of enrollment that will require higher costs than can be covered by the premiums collected. That, however, did not stop the Democrats from double-counting the program’s $70 billion in premiums as an offset for the massive health entitlement program. So not only did the bill use a budget gimmick to hide the costs of the health expansion, it also set taxpayers up for another bailout when the long-term care program runs aground.

By longstanding practice, the administration uses the health care cost estimates produced by the chief actuary when putting together the president’s annual budget submission in February and an update in mid-summer.

But the estimates that the actuary has produced for the health bill so clearly contradict what the president has said the bill will do that the administration is in an awkward position, to say the least. So awkward in fact that the administration has stamped every memo put out by the actuary during the entire health debate with this disclaimer: “The statements, estimates, and other information provided in this memorandum are those of the Office of the Actuary and do not represent an official position of the Department of Health and Human Services or the Administration.”

Which raises the question: If the actuary isn’t producing the administration’s health care cost projections, who is?

posted by James C. Capretta | 8:00 pm
Tags: chief actuary, costs, adverse selection, spin
File As: Health Care

Lessons of the Massachusetts Experiment

In a new column for Kaiser Health News, I ask what the Massachusetts health reforms of 2007 might warn us about what to expect from the new national reform:

The president himself has said that the national plan contains many of the features of the Massachusetts program, now operating in its third year. He is right. There are striking similarities between the reform plans, which is why what’s happening in Massachusetts today is very instructive....

After three years, no real progress has been made on rising costs. The program remains well over budget, with no end in sight. Further, state residents who now must buy state-sanctioned coverage are bristling at their rising premiums and the inability to find coverage which covers less and thus costs less.

State politicians are responding to the cost crisis the only way they know how: by promising to impose arbitrary caps on premiums and price controls for medical services. The governor and state regulators have disallowed 90 percent of the premium increases insurers — all of whom are not-for-profit — submitted for their enrollees for the upcoming plan year. The state says premium increases above eight percent are too high and unacceptable, though they themselves don’t have a plan to make health care more efficient in Massachusetts. They just want lower premiums. The insurers have responded by refusing to sell any coverage at the rates the state wants to impose.

The way out of this stand-off is predictable: more price controls. To hold premiums down, Massachusetts officials are already laying the groundwork to impose government-set payment rate schedules for services beyond the realm of public insurance.

The risk of cost overruns is even higher at the federal level than in Massachusetts....

You can read the whole thing here.

posted by James C. Capretta | 10:54 am
Tags: Massachusetts, costs, price controls
File As: Health Care