exchanges


Keeping the Pressure on Obamacare

The disastrous implementation of the Obamacare health insurance exchanges on October 1 has left the left health care law more vulnerable than ever. As I argue in a column at National Review Online, Republicans need to continue to push back against the most problematic and unpopular elements of the legislation to both protect Americans losing their insurance because of Obamacare, and to hasten the eventual repeal and replacement of the law with a better alternative.

The first order of business remains thinking through what to do about canceled individual-market policies. Prior to last week, it would have been unthinkable that the White House would unilaterally adopt a policy allowing millions of people to stay in their individual-insurance plans in 2014. After all, notwithstanding that famous presidential pledge, a major focus of Obamacare is the termination of the individual insurance market and the shifting of that market’s participants into the Obamacare exchanges in 2014. An escape route that allows large numbers of current individual-insurance enrollees to avoid the exchanges in 2014 (even one with its own set of traps) raises the very real possibility that the exchanges will falter before they ever get started.

This does not mean that the GOP should be applauding the White House’s supposed “fix.” For starters, the administration’s plan is completely lawless, as many others have noted. The president has not altered any regulations or asked Congress to provide a carve-out for the 2013 insurance plans. He instead announced he would not enforce the law for a year, which the administration claims should be enough for state regulators and the insurance industry to reopen the canceled plans.

Of course, this is not the way to run the government. In the near term, it’s not at all clear that states and insurers aren’t still exposed legally. What if an insurance enrollee sues an insurer for not providing an Obamacare-required benefit? Would that have standing in court? Who knows?

You can read the rest of the column here.





 


posted by James C. Capretta | 11:33 am
Tags: individual market, individual mandate, exchanges, Fred Upton
File As: Health Care

Obamacare's Unlikely Coverage Goal

In the midst of the troubled launch of Obamacare's health insurance exchanges, it is looking less and less likely that the law will lead to the net increase of insured Americans that the administration has promised, as I explain in a column at National Review Online.

At the time of enactment, CBO estimated that the net effect of the various Obamacare provisions would be 10 million new enrollees in Medicaid in 2014, 8 million enrollees in plans offered on the exchanges, 4 million new enrollees in plans sponsored by employers, and a reduction of 2 million people in the non-exchange individual insurance market. The net effect was an estimated reduction in the ranks of the uninsured of 19 million in 2014.

The Obama administration relied heavily on this CBO cost estimate to argue that the law would dramatically expand insurance coverage even as it also reduced projected federal budget deficits, in the short and long term. The CBO estimate was also instrumental in rounding up the final votes in favor of passage of the legislation in Congress. A strong case can be made that the numbers in the CBO cost estimate were what was promised to the American people, and therefore represent the benchmark against which Obamacare should be assessed.

The likelihood that such a sizeable reduction in the uninsured can be achieved in 2014 is slim. To date, far more people have learned that they are losing their plans next year than have signed up for new coverage in the exchanges. Moreover, even though Medicaid enrollments are running above those in the exchange plans, they are still not nearly on pace to reach the levels promised at enactment.

You can read the rest of the column here.

posted by James C. Capretta | 5:58 pm
Tags: exchanges, CBO
File As: Health Care

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.

You can read the rest of my written remarks here, or watch video of the entire hearing here.

posted by James C. Capretta | 6:47 pm
Tags: Obamacare, employer mandate, exchanges
File As: Health Care

The Fiasco That Is Obamacare

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.

posted by James C. Capretta | 10:46 am
Tags: Obamacare, exchanges
File As: Health Care

Why Obamacare Is Still No Sure Thing

My Ethics and Public Policy Center colleague Yuval Levin and I co-authored an op-ed for the Wall Street Journal this weekend on what state governments can do to resist the implementation of Obamacare.

Talk of the law's inevitability is intended to pressure these governors into implementing it on the administration's behalf. But states still have two key choices to make that together will put them in the driver's seat: whether to create state health-insurance exchanges, and whether to expand Medicaid. They should say "no" to both.

At its core, ObamaCare is a massive entitlement expansion. Between vastly increased Medicaid eligibility and new premium subsidies, it is expected to bring 30 million more people onto the federal government's entitlement rolls. The law anticipates that the states will take on the burden of implementing the expansions, but states can opt out of both.

You can read the rest of the column online here.

posted by James C. Capretta | 11:17 am
Tags: Obamacare, Yuval Levin, exchanges
File As: Health Care

The Private Insurance Boogeymen

I have a new article at Kaiser Health News on the efforts of Kathleen Sebelius and the Obama administration to shift attention in the health care debate to private insurance companies as antagonists:

On Sept. 9, [Health and Human Services Secretary Kathleen Sebelius] sent a letter to the trade group representing the nation’s health insurers expressing her displeasure with stories in the press that quoted insurers that blame a portion of their looming premium increases on the mandates in the new health law....

[T]o apparently show how serious she is about getting the industry to toe the line, the secretary’s letter issued a plainly stated threat: Any insurer that dared to utter the truth about why premiums are rising might be banned from the government-managed "exchanges" through which the administration hopes most individual and small-group purchasers of insurance will eventually get their coverage. For many insurers, if the law gets implemented as planned, banishment from these exchanges could very well mean going out of business....

It is not every day that a cabinet secretary issues a threat aimed at controlling the speech of an entire industry for plainly political reasons.

But it does fit a pattern. For more than a year, the administration has sought to frame the health care debate as primarily a fight between advocates for consumers and the private health insurance industry, and Secretary Sebelius has been leading the way in this regard.

Read the whole article here.

posted by James C. Capretta | 5:53 pm
Tags: Kathleen Sebelius, exchanges
File As: Health Care