ObamaCare


The 2009–2010 Slowdown in Health Spending

I have a new post up at The Corner on new estimates showing that 2009 and 2010 had the slowest growth rates in health spending in five decades. The obvious cause is the recession. But:

it would appear that these economic factors alone don’t fully explain the drop in spending growth, so the search is on for additional causes.

Here’s one thing we can rule out: Obamacare.

Some of the law’s advocates are trying to take credit for the slowdown in spending, claiming that the debate over Obamacare and the prospect of its “cost control” efforts becoming law were enough to force anticipatory actions that have rooted out waste and inefficiency.

This is nonsense.

Details here.

posted by James C. Capretta | 1:26 pm
Tags: Obamacare, health spending
File As: Health Care

Obamacare’s Creation of Instability in Insurance Subsidies

I have a new column up at e21 on the recent CBO study that shows the strange inequalities that will result in the health insurance options for certain families:

CBO’s analysis confirms a crucial point about ObamaCare which remains poorly understood, which is that the law creates a massive inequity in insurance subsidies for working families with low wages.... The problem is that the subsidies inside the exchanges will far exceed the tax subsidy for employer-paid premiums at the lower end of the wage scale.

However:

CBO believes that other preexisting labor laws will make it very difficult for employers to selectively dump their workers into the exchanges.... But what if CBO is wrong and employers are able to find ways around the existing rules to create a two-pronged approach to coverage, with high-wage workers staying in tax-preferred employer plans and low-wage workers migrating to the exchanges?

You can read the rest of the article here.

posted by James C. Capretta | 10:40 am
Tags: Obamacare, health exchanges, CBO
File As: Health Care

How to Replace Obamacare

I have an article in the new issue of National Affairs on “How to Replace Obamacare”:

...repeal will not be enough, for a simple reason: Although Obamacare would worsen many of the problems with our system of health-care financing, that system clearly does call out for serious reform. Despite the widespread public antipathy toward the new health-care law, simply reverting to the pre-Obamacare status quo would be viewed by many Americans, perhaps even most, as unacceptable. After all, a repeal-only approach would leave many of the most grievous flaws in our system of financing health care unaddressed. Chief among them would be steadily rising health-care costs, driven by the same misguided government policies that so evidently demand reform.

If the problems that are today obvious to the public had been addressed by market-oriented policies over the past few decades, there would have been no political opening through which to ram Obamacare. Instead, these problems were allowed to fester; by 2009, they had become so acute that there was strong sentiment, even among some business-oriented conservatives, that "something had to be done." And as the 2010 congressional debate over Obamacare reached its climax, this sentiment — that some action, even an imperfect one, would be better than nothing — likely played a large role in enabling the health-care law to pass.

This history suggests that, now that Obamacare is with us, the law cannot be reversed without a credible proposal for what should take its place. Those reforms must account for both the strengths and the weaknesses of our health-care system, and must solve the problems that contributed to the demand for Obamacare in the first place. There is room for debate about the particulars of these reforms, and different components of our health-care system will call for different kinds of fixes. What any effective solution must involve, however, is the creation of a true market in health coverage — one that drives efficiency through competition, and places health-care decisions in the hands of consumers and taxpayers, where they belong.

The entire article is available online here.

posted by James C. Capretta | 12:49 pm
Tags: Obamacare, repeal and replace
File As: Health Care

Bunting on Contraception

I have a new post up at The Corner on the Obama administration’s latest announcement, release late Friday afternoon, about the HHS mandate, which they’re now proposing not to issue final regulations on until far after this year’s elections:

In the ANPRM, the administration said it is seeking input and comments on the so-called “accommodation” that the president announced on February 10. But the ANPRM also makes it clear that this process of getting input and issuing new rules will be very long and drawn out — so much so that the administration doesn’t expect to issue final regulations until August 1, 2013....

Still, despite the transparent stalling tactics, it is abundantly clear from the text of the ANPRM that this process is essentially a waste of time. The administration is seeking comment only on its dead-end “accommodation” proposal that doesn’t come close to satisfying legitimate religious-liberty interests, including those expressed yet again by the nation’s Catholic bishops this week in their latest statement on the matter.

You can read the whole post here.

posted by James C. Capretta | 6:38 pm
Tags: religious exemption, Obamacare, contraception
File As: Health Care

The ‘Accommodation’ That Isn’t

I have a new column up at National Review Online on the latest negotiations between Catholic leaders and the White House about the contraception mandate, and on why last month’s “accommodation” is anything but:

Unfortunately, until it is widely understood that the president’s accommodation is actually no such thing, confusion will continue to reign. Therefore, it is critical for those trying to defend religious liberty against the administration’s aggressive moves to expose the accommodation as the deception that it is, as quickly as possible.

Here, it’s worth repeating some of the basic facts. On February 10, on the same day that the administration announced it wanted to craft the so-called accommodation, it finalized the rule that had been previously issued with no change. That rule includes the infamous four-part test by which HHS bureaucrats will determine which houses of worship are pure enough to warrant a full exemption from the mandatory coverage of abortion-inducing drugs, sterilization procedures, and contraception. It is also the same rule that provides no exemption from the mandate for religious employers that provide services to the general public. So, as matters stand today, the Obama administration has implemented rules that even it concedes infringe on the traditional rights of religious employers.

You can read the whole column here.

posted by James C. Capretta | 4:16 pm
Tags: religious exemption, Obamacare, contraception
File As: Health Care

On the Contraceptives Controversy

I spoke on a panel yesterday at the Catholic Information Center in Washington, D.C., about the controversy brewing over the Obama administration’s requirement that church employers cover contraception (among other services deemed preventive) in the health care plans they provide to their employees. The video of that event is available from C-SPAN here.

posted by James C. Capretta | 5:11 pm
Tags: religious exemption, Obamacare, contraception
File As: Health Care

A Clash of Conscience

I have a new column up at National Review Online on the Obama administration’s recent refusal to grant a religious exemption for institutions that wish not to be required to pay for contraception and abortifacients:

The central purpose of Obamacare — and the reason it was and is so strenuously opposed by so many Americans — is to transfer all of the critical decisions about how American health care operates to the federal government. Despite what the president contends, it is a federal takeover. The federal bureaucracy is now in the driver’s seat.

And, with the federal government now calling all of the shots, it is a foregone conclusion that a decidedly secularist and utilitarian point of view will be pervasive in everything that is done. It is simply beyond the capacity of the modern federal government to even consider arguments questioning the wisdom of governmental policies promoting free and abundant contraception. Indeed, it is an article of faith in the modern bureaucratic context that pushing such “prevention” measures onto the American public is one more step on the long march to a more just and humane society.

This is the environment in which we live. The hard truth is that the federal government cannot be trusted today with these kinds of decisions, and there’s no prospect of that changing anytime soon. That’s a big reason why Obamacare should never have been allowed to pass in the first place. Just the sight of Catholic leaders’ being forced to go begging before federal officials ought to be enough to convince most Americans that handing over so much power over such sensitive matters to the federal government was a terrible, terrible mistake.

Read more here.

posted by James C. Capretta | 11:24 am
Tags: religious exemption, Obamacare
File As: Health Care

Inside the Obamacare Spin Zone

Over at National Review Online, I have a new column up looking inside the Obama administration’s claims about progress at the state level implementing the “health exchanges” meant to form much of the new health care system:

According to the administration’s spin, some 28 states are “on their way” toward establishing the exchanges, so everything is apparently well under control. In other words, nothing to worry about here. Full speed ahead! 

But is that really what’s going on here?

Because, even if one were to accept the White House’s accounting (which one shouldn’t), that would mean that 22 states — roughly 40 percent of the country — are not “on their way” toward erecting the Obamacare exchanges. Isn’t that a problem? Further, upon closer inspection, it’s clear that many of the 28 states that are supposedly “on their way” really aren’t “on their way.”

You can read the full column here.

posted by James C. Capretta | 6:43 pm
Tags: Obamacare, health exchanges
File As: Health Care

The Reconciliation Option

Over at National Review Online, I have a new column up on a special budgetary procedure known as “reconciliation,” which was mentioned by Mitt Romney and Rick Santorum at last Tuesday’s Republican presidential debate as an option for repealing Obamacare:

If, in the 2012 election, Republicans are able to maintain control of the House, pick up the majority in the Senate (a real possibility) but not a 60-vote supermajority, and win the White House (looking more possible by the day), the GOP would be in position to set in motion a reconciliation bill to repeal and replace Obamacare — and they wouldn’t need any Democratic cooperation to make it happen. The fact that leading Republican presidential candidates have now said that reconciliation is an option is a big deal, as it makes it very clear to all concerned that there is a clear path to victory for Obamacare opponents.

Seeing the threat that the reconciliation option could pose, Obamacare’s apologists have responded by suggesting it would be the height of cynical partisanship for Republicans to undo Obamacare in this fashion, since reconciliation supposedly played only a minor role in the enactment of Obamacare. Obamacare’s defenders also claim that, in any event, the GOP may not be able to pull it off because some aspects of Obamacare are non-budgetary and therefore aren’t eligible for repeal in a reconciliation measure, which is supposed to deal exclusively with budgetary matters. Sen. Kent Conrad, the Democratic chairman of the Senate Budget Committee, took the argument further and said that using reconciliation for repeal would be inappropriate because reconciliation is supposed to be used fordeficit-cutting efforts — and Obamacare’s full repeal would increase the deficit, according to the Congressional Budget Office (CBO).

As usual, there’s a lot of smoke and misdirection in these arguments, and not much clarity....

You can read the whole column here.

posted by James C. Capretta | 1:01 pm
Tags: Obamacare, repeal and replace, reconciliation
File As: Health Care

On Political Expediency and Health Care Reform

In a new column for Kaiser Health News, I point out a strange turn that our debates over health care have taken:

Once upon a time, President Barack Obama and many others who championed his health care plan actually professed faith in the power of a functioning health care marketplace. That now seems like a distant memory, given the demonization campaign that the president and his allies have launched against House Budget Committee Chairman Paul Ryan's plan to inject consumer choice and competition into Medicare. But there's no doubt that while the health law was under consideration in Congress, the president and his team wanted to leave the impression with voters that the plan they were pushing would rely mainly on market signals, not heavy-handed government control....

Meanwhile, now that their plan is law, the tune has changed. The enthusiasm for premium credits, consumer choice of private health plans and decoupling of credits from health costs seems to have waned. Indeed, it's waned to such an extent that these are now not just bad ideas but ideas that would destroy America as we know it! ... Those who previously stressed that the new health law would have a strong component of consumer choice and competition are now saying that a functioning marketplace will never work.
 
You can read the whole thing here.

posted by James C. Capretta | 10:59 am
Tags: Obamacare, Ryan plan, Peter Orszag
File As: Health Care

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