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.


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James C. Capretta’s 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

Friday, September 28, 2012

The Candidates' Positions on Medicare Advantage 

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

Friday, September 21, 2012

Building Upon Medicare Advantage 

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

Monday, September 10, 2012

Curing the Pre-Existing Conditions of Obamacare 

Tom Miller and I have a column in AEI’s The American on why Obamacare is the wrong way to cover pre-existing conditions.

The starting point for addressing the problem of pre-existing conditions is a proper perspective on its size. The claim that tens of millions of Americans are at risk of losing coverage defies common sense. ObamaCare included $5 billion in new funding to subsidize insurance for the millions who were supposedly sick and without options. Far from the alleged 65 million people,only 77,877 had signed up for the subsidized Pre-Existing Condition Insurance Plan by June 30 of this year. The truth is that most Americans with health problems are protected by rules passed years ago by Congress and state legislatures that prohibit discrimination against them in job-based insurance. Not surprisingly, those employer plans pay for hundreds of billions of dollars of claims each year—from workers with “pre-existing” health conditions.

But don’t get us wrong. The problem of gaps in coverage for pre-existing conditions is real and needs to be addressed. It affects several million Americans, and that’s far too many.

The fundamental cause of gaps in coverage is a lack of portable health insurance, not the likelihood that almost everyone will eventually suffer from some spells of poor health. Health problems are an inevitable pre-existing condition of life, especially as we live longer. Lack of access to health insurance, however, is largely due to two particular public policies that unfairly penalize individuals and families seeking coverage on their own, rather than through their employer’s group coverage.

You can read the rest of the column here.

posted by James C. Capretta | 11:28 am
Tags: Obamacare, pre-existing conditions
File As: Health Care

Monday, September 10, 2012

The Medicare Distortions 

I have a column up at National Review Online about the dishonest attacks over Medicare on the Romney-Ryan campaign by the Obama campaign and its apologists.  

To begin with, those attacking Ryan have resorted to silly name-calling (“VoucherCare,” “CouponCare”) in an attempt to discredit the idea of Medicare premium support. But premium support — which, by the way, has a long bipartisan history, including support from Democratic senator Ron Wyden — cannot be considered a “voucher” program any more than the prescription-drug benefit in Medicare is a voucher program. Under the drug benefit, the federal government accepts bids from private insurers wishing to offer coverage to the beneficiaries. The government’s contribution toward coverage is based on the weighted average of those bids. Every beneficiary in a given market area is entitled to the same level of governmental support. The government provides an organized format to assist the beneficiaries in their choice of plans. And once a beneficiary decides on a plan, the government’s contribution is sent directly to the insurer. No voucher is ever issued. That’s exactly how a Wyden-Ryan premium-support plan would work in the rest of Medicare.

You can read the rest of the article here.

posted by James C. Capretta | 11:25 am
Tags: 2012 election, Medicare
File As: Health Care

Thursday, August 30, 2012

Ryan and His Panicky Critics 

I have a column up at National Review Online responding to the criticisms of Paul Ryan’s nomination acceptance speech made by some of his liberal detractors.

Ryan’s critics are beside themselves that the Romney campaign has effectively pinned $716 billion in Medicare cuts on the Obama administration. Two arguments are made to defend the president. First, it is said that Ryan’s own budget cut Medicare by the same amount. But the Ryan budget not only repealed all of Obamacare’s spending, it also doesn’t specify the kinds of Medicare cuts Obamacare does: It calls for the same level of savings but doesn’t spend the money elsewhere and leaves room for Congress to pursue those savings in ways that don’t rely on price controls and the elimination of benefits. Moreover, both Romney and Ryan have said that they, in a Romney administration, would meet their budgetary goals without Obamacare’s Medicare cuts by trimming elsewhere in the budget. And it is certainly the case that Romney and Ryan will have much greater flexibility than Ryan did as House Budget Committee chairman to make cuts wherever they can find them.

Ryan’s critics also take exception to the implication that the Medicare “cuts” will do any harm to the health care provided to seniors, arguing that the savings come from “targeted cuts to providers,” not seniors. This is utter nonsense. Among the cuts in Obamacare is a deep and permanent reduction in payments to Medicare Advantage plans. According to the Medicare trustees, that cut will force 4 million seniors out of their Medicare Advantage plans. There is no question that these seniors will lose thousands of dollars per year in health benefits because of these cuts. Moreover, the chief actuary for the Medicare program has projected that, by the end of this decade, 15 percent of facilities will have to stop taking Medicare patients because of Obamacare’s cuts. That will directly impair access to care for millions of seniors, and the percentage of hospitals and nursing homes dropping out of Medicare will grow to 25 percent by 2030.

You can read the rest of the column here.

posted by James C. Capretta | 4:57 pm
Tags: Paul Ryan, mediscare
File As: Health Care

Thursday, August 30, 2012

What to Say about Health Care 

I have a column in the latest issue of National Review (payment required to view online) on how the Romney-Ryan campaign can offer Americans a compelling alternative to Obama’s health care plan.

It has also helped the Romney campaign tremendously that Ryan is carrying much of the load. He knows these issues cold, because he is a prominent budget expert, and health care in general, and Medicare specifically, are central to the nation’s long-term budgetary troubles. Ryan’s adeptness in debating the topic was on full display at the February 2010 White House “summit” on health care, during which Ryan dismantled the phony deficit-reduction claims the president and congressional Democrats were making about Obamacare.

The challenge for the Romney-Ryan ticket is to channel the political momentum generated by this early Medicare counterattack into a larger conversation about broad visions for health care. Although Obamacare remains unpopular, it will be difficult to uproot it without articulating a compelling replacement strategy that can solve the problems in the health-care sector without Obamacare’s massive expense and heavy-handed government coercion. Here again, Ryan will be indispensable, because he has become one of the party’s most articulate and persuasive advocates of a patient-driven health-care system.

You can find the rest of the article here.

posted by James C. Capretta | 2:02 pm
Tags: 2012 election
File As: Health Care

Wednesday, August 22, 2012

Paul Ryan's Medicare Plan Harnesses Consumer Power in Healthcare 

Last Friday I contributed to a debate on the Ryan Medicare plan at the U.S. News & World Report “Debate Club.”

There are two basic choices for slowing the pace of rising costs in Medicare. The first option—the one embraced by the Obama administration—is to rely on the federal government to impose price controls and otherwise try to micromanage how healthcare is delivered to patients. This approach has been tried for the past four decades in Medicare, and hasn't worked.

The alternative is to harness the power of consumer choice in Medicare. The proposal would be phased in gradually. Current beneficiaries and those age 55 and older would see no changes in the way the program works for them. Future entrants, however, would be entitled to a premium support payment which they would direct to the plan of their choice.

You can read the rest of my post here.

posted by James C. Capretta | 3:27 pm
Tags: Ryan plan, Medicare
File As: Health Care

Wednesday, August 15, 2012

President Obama’s $700 Billion Medicare Problem 

I have a new article at National Review Online on how the Romney campaign can and should go on the offensive against Obama for his cuts to Medicare.

The selection of Ryan has also been a revealing moment for the mainstream media. In these first days after the announcement, the media have largely played along with the Democratic story line that the selection of Ryan will put the Republicans on the defensive over Medicare in the run-up to November. They have told this story by repeating over and over completely inaccurate descriptions of the policy positions of the candidates.

A fair reading of the facts shows that the Romney-Ryan campaign has every reason to believe that they can put the Obama-Biden ticket on the defensive over Medicare. The most salient fact is that, to pass Obamacare, the president cut Medicare by more than $700 billion over the coming decade, according to the Congressional Budget Office (CBO). And these cuts are of the worst kind. They are arbitrary and across the board. They reduce reimbursement rates for all who provide services to Medicare patients, regardless of how well or badly they treat their patients. Among the cuts is a $156 billion reduction in payments to Medicare Advantage plans over ten years. These cuts will force seniors to pay $3,700 more for their health care by 2017, according to a study I co-authored with Robert Book (for those who might be interested, the cuts are distributed by congressional district here). The Medicare trustees project that the cuts will drive some 4 million seniors out of Medicare Advantage plans between 2012 and 2018.

You can read the rest of the article here.

posted by James C. Capretta | 10:19 am
Tags: Medicare cuts
File As: Health Care

Tuesday, August 14, 2012

More Mediscare 

My colleague Yuval Levin and I have a column in The Weekly Standard about how a recent study of Medicare reform in the Journal of American Medical Association distorts its own findings in an attempt to discredit premium support proposals like the Wyden-Ryan plan:

For starters, the Wyden-Ryan plan would apply only to entrants into the program after 2023. No current senior, and no one under 55 today, would be affected by it. So there is no way for the reform to increase the premiums of any current beneficiaries.

Moreover, even the Harvard scholars’ own analysis shows that no senior would necessarily pay any more for Medicare coverage under the proposed reform. The point of premium support is to bring more efficiency into the program. If competition introduced new ways of providing and structuring coverage and care that significantly reduced costs, presumably the fee-for-service Medicare plan (which would remain an option under Ryan’s proposal) would learn from some of these and reduce its own costs too. If it didn’t, it would lose customers, and it would deserve to.

You can read the rest of the article here.

posted by James C. Capretta | 10:57 am
Tags: Yuval Levin, premium support
File As: Health Care

Friday, August 3, 2012

Obamacare Remains a Budgetary and Policy Disaster 

I have a new issue brief at the Heritage Foundation on the CBO’s updated cost estimate for Obamacare after the recent Supreme Court decision, and what CBO’s assessment leaves out.

CBO now projects that Obamacare’s Medicare and Medicaid cuts will reduce federal spending by over $700 billion over the coming decade. (Most of the cuts come from Medicare, although CBO did not break the estimate down by program.) However, these cuts are being double-counted. The cuts are being used to replenish the Medicare trust fund for hospital and other institutional care and pay future Medicare claims. Over the next 75 years, this will add about $8 trillion to the government’s unfunded liabilities. Over the next decade, when the double-counted cuts are taken out of the equation, Obamacare adds at least $340 billion to projected budget deficits.

You can read the rest of the brief here.

posted by James C. Capretta | 12:27 pm
Tags: CBO, double count

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