Health Care

The GOP’s Payroll Tax Opportunity

December 4, 2012

My EPPC colleague Yuval Levin and I have a piece in The Weekly Standard on how congressional Republicans can appeal to middle class voters by taking a stand against increasing Social Security and Medicare payroll taxes.

For households squarely in the middle class, income taxes are less of a burden today than payroll taxes, because a variety of deductions, credits, and exclusions either exempt most of these households from any income tax liability at all, or leave them paying very little.

Not so with the Social Security and Medicare payroll taxes. Prior to 2011, the combined Social Security and Medicare payroll tax was 15.3 percent for households with incomes up to about $100,000, with half paid by the employer and half paid by the worker. For a family making $50,000 per year, that’s a tax liability of $7,650. According to the Tax Policy Center, households in the middle quintile of the income distribution pay an effective payroll-tax rate that is, on average, nearly three times what they pay in income taxes.

For these households, the 2 percent increase in the payroll tax that would result from a failure to renew today’s rates would be significant—a worker earning the median income would see his tax bill rise by $1,000 a year, which would be more than enough to make him take notice. The message for the GOP should be obvious: The party of low taxation must apply that broad principle not just to income taxes but to payroll taxes too.

You can read the rest of the article here.

posted by James C. Capretta | 3:22 pm
Tags: payroll tax, fiscal cliff
File As: Health Care

How to Approach the ‘Fiscal Cliff’

November 27, 2012

Today at National Review Online I have a column on how congressional Republicans should negotiate with the White House over the impending fiscal cliff, and why reforming entitlements, including Obamacare, needs to be high on their agenda.

The hardest part of these negotiations will be the battle over entitlement reform. The bottom line for the GOP should be this: There should be no deal on long-term taxes without far-reaching reforms to health-entitlement programs. And what’s far-reaching? For starters, the entirety of Obamacare should be on the table for revision and retrenchment. The law sets in motion the largest entitlement expansion in a generation. It’s far better to scale the program back now before it gets started than to wait and hope it can be scaled back later.

Republican governors have substantial leverage in these negotiations because they can opt out of the Medicaid expansion in Obamacare, thanks to the Supreme Court. If 25 or so Republican governors refuse to put more people into an unreformed Medicaid program, it will put tremendous pressure on the Obama administration, which is desperate to see the Medicaid expansion occur during the president’s second term.

You can read the rest of the article here.

posted by James C. Capretta | 2:45 pm
File As: Health Care

Why Obamacare Is Still No Sure Thing

November 19, 2012

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

Health Policy After The Election

November 9, 2012

I have a post on the Health Affairs blog today about what the results of the election will mean for the policy debates over American health care.

No one should underestimate the difficulty of bridging the deep divide between the parties on health care, which is mainly a disagreement over how best to slow the pace of rising costs.  One side favors empowering the federal government to impose more cost controls, while the other side wants to put consumers in functioning marketplaces in the driver’s seat.  In deliberations over restraining projected federal budget deficits, these different visions are sure to collide.

This does not mean that bipartisan agreement is beyond reach.  It isn’t.  Indeed, if ever there were a moment for bipartisan accord, this is certainly it.  There are big problems that must be confronted — problems that are difficult if not impossible for one party to ever fix by itself.  The president, with re-election behind him, will have every reason to make 2013 a highly productive legislative year because his power will only diminish with time.  And House Republicans want to demonstrate to voters that they are as interested in governing as in checking the excesses of the administration.  So it would not at all be surprising to see both sides show more flexibility in the coming year than they have shown in the past.

The rest of the column is online at the Health Affairs blog.

posted by James C. Capretta | 6:40 pm
Tags: 2012 election
File As: Health Care

Obamacare’s Heavy Toll on Middle Class Americans

October 19, 2012

My AEI colleague Tom Miller and I have an article at e21 today on how Obamacare will lead to a massive redistribution of wealth away from the middle class.

In broad terms, the amount of redistribution is easily ascertained form the aggregate expenditures and taxes contained in ObamaCare. According to the Congressional Budget Office (CBO), in 2020, ObamaCare will spend $229 billion on a Medicaid expansion and a new subsidy program for health insurance. These expenditures will primarily benefit 29 million people newly enrolled in Medicaid and the insurance subsidy program. That works out to nearly $8,000 for every newly insured American, or about $21,000 per newly insured household.

Much of the rest of the legislation is devoted to extracting these resources from everyone else in the country — about 290 million people — who won’t benefit from the new spending programs, and doing so in way that obscures what’s taking place. For these Americans who already have insurance, the law contains nothing but new financial burdens, in the form of higher taxes, higher premiums for their existing plans, and lower benefits, particularly for those on Medicare.

Read more here.

posted by James C. Capretta | 10:23 am
Tags: Obamacare, taxes
File As: Health Care

Kaiser’s Faux ‘Study’ of Premium Support

October 17, 2012

I have a column today at National Review Online on the flaws of the latest “studies” of the Ryan-Wyden Medicare plan.

The problem is, under Ryan-Wyden, no current seniors would be placed into a premium-support program. They would all be exempt, as would everyone age 55 and older but not yet on Medicare. So this hypothetical premium jump for current Medicare beneficiaries has no connection to reality.

Moreover, under Ryan-Wyden, future enrollees into the program — those who have not yet enrolled in any Medicare option — would be guaranteed at least two options that would cost no more than what current Medicare would require. So, under Ryan-Wyden, no senior — present or in the future — would ever have to pay more than they do today for Medicare. Period.

You can read the rest of the article here.

posted by James C. Capretta | 10:43 am
Tags: Ryan plan, Medicare
File As: Health Care

Debating Pre-Existing Conditions

October 8, 2012

I have a column today at National Review Online about how Romney's health care plan will help people with pre-existing conditions find insurance.

Under current law, the Health Insurance Portability and Accountability Act of 1996 (HIPAA) ensures that workers can easily move from one employer plan to another without fear that their new coverage will exclude a pre-existing condition or that their new plan will increase premiums based on their elevated health risks. However, HIPAA does not provide solid protection for people who move from employer coverage to an individually owned insurance plan. In theory, HIPAA required states to set up options for those people with continuous insurance coverage and a pre-existing condition who want to move into the individual market from group insurance. In practice, those options do not prohibit insurers from charging much higher premiums based on the elevated risks of the enrollees; and, in any event, the law requires people who might enroll in such plans to first exhaust their COBRA rights with their previous employer plan. (COBRA is a program through which former employees pay premiums into their former employer’s health plan for up to 18 months after being separated from the firm.) The upshot is that HIPAA’s protections simply do not work in the individual-insurance market, and that is a big, not a small, problem.

Romney’s plan would fix this and extend to the entire health system, including the individual market, the HIPAA protections that work well today in the group market. This would allow millions of people to move seamlessly from group to individual coverage, and back again, so long as they stay continuously insured. That alone will dramatically reduce gaps in coverage that are so frequent today.

You can read the rest of the column here.

posted by James C. Capretta | 10:36 am
Tags: pre-existing conditions, 2012 election
File As: Health Care

A Fantasy-Based Case for Obamacare

October 1, 2012

I have a column up at National Review Online on how J. D. Kleinke is mistaken about there being a “conservative case for Obamacare.”

Does the 2010 law move us closer to an effectively functioning marketplace, as Kleinke claims? Or is it a significant and possibly irreversible step toward establishing federal-government control over the health-care system, as most conservatives contend?

One clue can be found in the views of those who were and are Obamacare’s strongest supporters, such as Peter Orszag, the president’s first director of the Office of Management and Budget. Orszag, along with just about every other left-leaning economist and health-policy analyst, has been spending much of his time lately attacking the notion that market-based reforms could work to control Medicare costs. In his view, the only solution is for the federal government to impose cost-control schemes. Of course, in the Medicare program, the government already has the power to impose such controls, which is why Orszag and others are so adamantly opposed to converting Medicare to a system built on true consumer choice.

Are these the views of someone who wants to see “conservative economic principles” reign supreme, as Kleinke asserts will occur under Obamacare? Of course not.

You can read the rest of the article here.

posted by James C. Capretta | 11:16 am
Tags: Obamacare
File As: Health Care

The Candidates' Positions on Medicare Advantage

September 28, 2012

I have a post at The Hill’s Congress blog explaining what the Obama administration’s cuts to Medicare Advantage will mean for seniors, and why Governor Romney’s proposal will build on the success of Medicare Advantage rather than undermine it.  

The president targeted Medicare Advantage for big cuts in the 2010 health care law to partially pay for the large entitlement spending also provided in the law. Over the next ten years, these cuts will reach $308 billion, according to the Congressional Budget Office. That these cuts will affect Medicare beneficiaries is indisputable. According to the most recent Medicare Trustees’ Report, enrollment in Medicare Advantage will peak in 2013 at 13.7 million people and then fall to 9.7 million in 2017. Four million seniors will thus get pushed out of the Medicare Advantage plan they prefer as a direct consequence of the Obamacare cuts.

You can read the rest of the post here.

posted by James C. Capretta | 12:50 pm
Tags: Medicare Advantage, 2012 election
File As: Health Care

Building Upon Medicare Advantage

September 21, 2012 • This morning, I testified before the House Committee on Ways and Means on the subject of the Medicare Advantage program. As I explained in my testimony, the Medicare Advantage program allows for innovations and flexibility that greatly improve on the delivery of benefits under Medicare’s traditional "fee-for-service" payment structures. My written testimony is available here, and you can see video of my testimony, courtesy of C-SPAN, by clicking here or clicking play below.

posted by James C. Capretta | 2:48 pm
Tags: Medicare Advantage, testimony, Ways and Means
File As: Health Care

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