About the Author

James C. Capretta

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: jcapretta@aei.org.


James C. Caprettaís 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)


 More on James C. Capretta

Text Patterns - by Alan JacobsFuturisms - Critiquing the project to reengineer humanity

Thursday, April 4, 2013

Itís Time to Delay Obamacare 

Over at the AEI Ideas blog my colleague Yuval Levin and I make the case that both supporters and opponents of Obamacare should agree to delay the implementation of the major provisions of the law that are now scheduled for 2014.

Everyone should now understand that, if there is not a delay, next year will be the scene of an epic disaster for American health care. The trouble started, as it often does, at the top. The president insisted on passing a reform with only Democratic support. That guaranteed large-scale public opposition, which has persisted. It also left the nation’s Republican governors less than enthusiastic about becoming the law’s enablers.

The president compounded the problem by stalling on key implementation decisions in 2011 and 2012 to avoid controversy before the election. States could not get answers to basic questions about what the law’s “exchanges” would involve or what their options were for Medicaid. And insurers even now remain unclear about the regulatory environment they will confront. With so much uncertainty, states, employers, and insurers all delayed their decision-making as long as possible too. The result is that implementation of the largest social-welfare policy change in a generation is far behind schedule.

The rest of the post is online at the AEI Ideas blog here.

posted by James C. Capretta | 1:53 pm
Tags: Yuval Levin, Obamacare
File As: Health Care

Wednesday, March 27, 2013

Recasting Conservative Economics 

In the Spring issue of National Affairs I have an essay on what Republicans need to say about the economic issues that matter most to American voters.

Normally, political candidates and parties are far better off looking forward, not backward. But the two cannot really be separated, and Republicans need to improve their economic message by looking forward and backward at once. The prevailing understanding of what caused the economic collapse of 2007-2009 — and of how best to respond to such events — is so distorted and so damaging to the advancement of conservative economic principles that it can no longer be ignored. It has not only saddled Republicans with the blame for a terrible economic crisis, but has also made it difficult for them to explain the elements of their economic agenda in the aftermath of the crisis.

Before they can regain their footing in presidential politics, therefore, Republicans will need to recast and revitalize their basic economic message — helping voters see what conservative economics has and has not involved in the past, and what it can offer them in the future.

Those interested can read the rest of the article here.

posted by James C. Capretta | 2:30 pm
Tags: recession, stimulus, economic philosophy
File As: Politics, U.S.

Monday, March 25, 2013

End Medicaidís Crony Federalism 

Over at National Review Online I have a column on why Republican governors should resist the Obama administration’s Medicaid expansion, and instead seek real legislative Medicaid reform.

The GOP governors engaged in these direct negotiations with the White House are playing a loser’s game, and throwing away a historic opportunity to secure fundamental and lasting reform of the Medicaid program. Even if individual states are able to secure concessions from HHS and the White House, the “deals” they strike will be in the form of temporary and inconsequential “waivers” (the terms of which will always be subject to administration amendment and revision, too). What’s worse, these deals are no way to run a national program. Why should one state receive more favorable treatment than others? And why should the administration be allowed to “buy off” states with federal taxpayer funds in the first place?

Instead, GOP governors should withdraw from this White House game of “let’s make a deal” and instead decide, as a group, what kind of Medicaid reform to demand in return for considering broader insurance coverage. Importantly, the reforms they seek should be in the form of legislative revisions of Medicaid, not temporary “waivers.” By pursuing a legislative approach, the GOP governors could join forces with House speaker John Boehner and Energy and Commerce Committee chairman Fred Upton, who have made serious Medicaid reform one of their top priorities this year.

You can read the rest of the article online here.

posted by James C. Capretta | 1:01 pm
Tags: Medicaid reform
File As: Health Care

Thursday, March 21, 2013

More on Medicaid Reform in Texas 

In December last year, the Texas Public Policy Foundation released a report that I co-authored with colleagues from Leavitt Partners.  The report focused on how the state of Texas should reform the long-term care components of the program to stay within the confines of a fixed Medicaid budget, such as would be the case with a block grant.

This week, TPPF released a follow-on report outlining the broader reform strategy for the Medicaid program.  The report describes in some detail the provisions which should be included in federal legislation to convert Medicaid into a block grant.  It then also describes what the state of Texas should do once it gets a block grant to provide more cost-effective services to its citizens.  In short, the report provides a roadmap for making a Medicaid block grant work at both the federal and state levels of government and should be of interest to state policymakers in all fifty states.

The full report is available online here, and the pdf version is available here.

posted by James C. Capretta | 12:04 pm
Tags: Medicaid reform
File As: Health Care

Wednesday, March 20, 2013

Saving Seniors and Our Most Vulnerable Citizens from an Entitlement Crisis 

Earlier this week I was invited to give testimony before a House Energy and Commerce Health Subcommittee hearing on “Saving Seniors and Our Most Vulnerable Citizens from an Entitlement Crisis.” A video of the entire hearing is available here (with my testimony beginning around at around 20:30), and you can read my written statement here.

posted by James C. Capretta | 12:30 pm
Tags: medicare, entitlement reform
File As: Health Care

Tuesday, March 12, 2013

To Save Medicare, Change the Model 

 I have a column in USA Today on Paul Ryan’s plan to reform Medicare on the model of the Medicare prescription drug plan.

Without reform, the Medicare Hospital Insurance trust fund will be depleted of reserves in 2024. An insolvent Medicare is unfair to younger Americans who will need the program just as much as their parents and grandparents.

The solution can be found within Medicare itself. The drug benefit, enacted in 2003, is built on consumer choice and competition among private drug plans. This approach has worked well to provide access to drugs at an affordable price.

You can read the rest of the column here.

posted by James C. Capretta | 11:06 am
Tags: Medicare

Wednesday, February 27, 2013

Obamaís Sequester Scare Tactics 

Tevi Troy and I have a new column at National Review Online on how President Obama has ignored sensible strategies for limiting the impact of the budget sequestration, opting instead to create a politically advantageous panic over the impending cuts.

It seems clear that the administration has the capacity to make sequestration’s impact excessively unpleasant, and these statements could make one wonder whether the administration is determined to do so. But does a sequester have to be disastrous? Could the White House wield the scheduled cuts in such a way as to minimize the impact felt by the American people? Our experience inside the executive branch suggests that this is indeed the case: The administration could have prepared for the sequester in ways that would steer cuts toward less sensitive programs and activities. In fact, it still has the capacity to adjust some, although certainly not all, of the ways in which the sequester is applied.

You can read the rest of the column here.

posted by James C. Capretta | 12:42 pm
Tags: sequestration
File As: Politics, U.S.

Wednesday, February 20, 2013

The Top Ten Health-Care Bills for 2013 

Over at National Review Online I outline ten health care bills that could receive bipartisan support in Congress and would limit the worst aspects of Obamacare.

The Obama administration chose to delay many of the most controversial implementing rules of Obamacare during 2012 to avoid stirring up opposition to the president during the election year. That decision has now put everything behind schedule. Moreover, a majority of states have decided (as was their right) not to build the state exchanges envisioned in the law, leaving the task to the federal government. And there’s no direct appropriation available to the federal government for this task. So it’s quite clear that implementing the law by January 2014 will create significant and unnecessary chaos in the insurance marketplace. Republicans should seize the opportunity this state of affairs provides and push for a delay of the law’s implementation. The administration will of course vigorously oppose any suggestion of delay, but many employers, states, and health-sector participants would welcome it.

You can read the other nine proposals here.

posted by James C. Capretta | 11:33 am
Tags: Obamacare
File As: Health Care

Friday, February 15, 2013

The Incredible Lowering of the Medicare Drug Benefit Baseline 

Over at e21 I have a short article on how the restrained growth of Medicare spending owes more to the market-oriented reforms in the Medicare drug benefit program enacted in 2003 than to the supposed cost-restraining features of Obamacare.

The talk of the supposed cost-restraining features of Obamacare has also distracted attention away from an actual trend in health spending that is worth noting. Last week, the Congressional Budget Office (CBO) released its annual updated projections for the entire federal budget, including health programs. And, in those projections, CBO dropped the projected ten-year cost for Medicare quite substantially—by $137 billion. The reason? Buried deep in the CBO report there’s this explanation: “the largest downward revision in the current baseline is for spending for Medicare’s Part D (prescription drugs).”

That’s an understatement. Of the $137 billion drop in the Medicare baseline, $104 billion—or 75 percent—was due to the drop in expected Medicare drug benefit spending. This is truly remarkable because CBO had already lowered the drug benefit baseline several times in the preceding years. With this latest revision, CBO’s part D projections bear almost no resemblance to what was expected to occur when the law was enacted in 2003.

You can read the rest of the column here.

posted by James C. Capretta | 11:32 am
Tags: Medicare Part D
File As: Health Care

Wednesday, February 13, 2013

The Presidentís State of the Union Address 

Earlier today I participated in a short video produced by the American Enterprise Institute with reactions from scholars and fellows to some of the statements made by the president in his State of the Union Address.  The full video is available here. I also have a brief post up at National Review Online with some of my thoughts on the president’s (predictably) disappointing speech.

He said we can never pull back on promises made in the form of entitlement commitments — without ever mentioning that those promises have never been fully funded and will lead, at some point, to a fiscal and economic crisis. There’s nothing more fiscally irresponsible than to suggest that entitlement commitments can never be revised — but that’s essentially what the president said in his speech tonight.

You can read the rest of the post here.

posted by James C. Capretta | 2:59 pm
Tags: State of the union
File As: Politics, U.S.

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