In a few recent editions, we’ve discussed the ramifications and possibilities of whether the next president, if a Republican, will engage the political capital necessary to “repeal and replace” President Barack Obama’s health care law. This week, Norm Coleman – the former senator from Minnesota and a prominent advisor for Mitt Romney – suggested that no matter who the Republican nominee is, he or she is unlikely to do so. Here’s a report on his remarks.
“You will not repeal the act in its entirety, but you will see major changes, particularly if there is a Republican president,” Coleman told BioCentury This Week television in an interview that aired on Sunday. “You can’t whole-cloth throw it out. But you can substantially change what’s been done.”
Coleman’s remarks are remarkable because every Republican candidate – including Romney – has vowed to make repealing the law a priority. Coleman is also the chairman of the American Action Network, which has urged the courts to strike down the law’s individual mandate and its Medicaid expansion.
The article doesn’t quote it, but Coleman also said: “We’re not going to do repeal. You’re not going to repeal Obamacare. … It’s not a total repeal. The Supreme Court first of all will have to deal with it. If you get rid of the individual mandate, then this whole thing may collapse.”
Asked by the moderator whether this means other provisions will go away as well, Coleman says: “I don’t think they will go away, because I don’t think the Act works financially, it simply doesn’t work, if you have severability. If you don’t have an individual mandate, your costs are going to go so far through the roof, that if you think those numbers are bad that you just saw now, wait til there’s … no individual mandate.” He maintains that Republicans still “need to do health care reform” and suggests he supports the approach put forward by Paul Ryan and Ron Wyden.
Here is a link to the full video interview.There are a number of takeaways from this, but this is a meaningful takeaway in large part because Coleman remains on the short list for a cabinet position in the next administration, and he’s almost assured a position there if he wants it (perhaps even at HHS). In other words, he’s not your average political pundit.
If Coleman is correct – and I think it’s possible he is – the next Republican president is likely to go through an experience along these lines: an attempt to repeal the whole bill will be made, passing the House but being filibustered in the Senate. Reconciliation can go only so far, and in the wake of a Supreme Court decision knocking down the individual mandate, the right’s political push to repeal the whole of Obamacare is likely to become less pressing (ironically, the Court’s getting rid of the worst part of the law from the public’s perspective may undercut these efforts). The Senate is likely to force instead a compromise position, in which Obamacare is “fixed,” not repealed – made “more market friendly”, as Coleman suggests.
This may be a good end result for many of the stakeholders and the politicians involved. As for the American people, well, that’s a different story.
— Benjamin Domenech
IN THIS ISSUE:
THE STATE OF STATE LEVEL HEALTH INSURANCE EXCHANGES
Nicole Fisher responds to the White House’s latest whitewash:
Last week the White House released a report on the progress of state-level health insurance exchanges. The report took an exceptionally favorable view of the headway being made by states creating their online insurance marketplaces, and, in truth, was a bit misleading. The Administration claimed that there are currently 28 states making great progress in establishing an exchange. Even if that were true, it still indicates that 22 states, or about 40 percent, are not complying with the Patient Protection and Affordable Care Act (PPACA).
Although the report does not specifically lie, it also does not quite paint an accurate picture. The Administration chose to favorably count any state that falls into a grey area as making progress. Many states have refrained from any legislative activity or the state legislature has merely set up a committee to “study options.” What this really indicates is that many states are purposefully not complying with PPACA, but managing not to violate it either, at least until the January 2014 deadline.
Additionally, as the economic crisis continues, unemployment remains high and PPACA is about to be heard by the Supreme Court, the number of states rejecting the idea of setting up an exchange continues to grow. Just last week, Governor Scott Walker of Wisconsin announced that his state would be joining the likes of Louisiana, Kansas and Florida in refusing to set up an exchange. He further said that Wisconsin would be giving back the $1 million Early Innovator Grant the federal government had given.
Regardless, whether states are stalling on setting up state-level exchanges, “studying” alternative options and costs, or flat out rejecting the idea, it’s safe to say that the optimism shown by the White House report is not an accurate portrait of the state of state-level health insurance exchanges.
The White House’s report is here. An Urban Institute report follows up on the same issue as the above item.
SOURCE: American Action Forum
THE NUMBER OF UNINSURED AMERICANS RISES
Politico reports on the latest study from Gallup.
In December 2011, the monthly percentage of uninsured adults increased to 17.7 percent, the highest on record, reports Gallup.
Since 2008, the rise in the number of adults who lack insurance is most pronounced among Asians (4.2 percent), those who makes less than $36,000 (4.1 percent), those ages 26–64 (3.8 percent) and Hispanics (3.7 percent).
Hispanics remained, in each of the four years polled, the group least likely to have health insurance.
Those groups that saw an increase in coverage over the past four years were those ages 18–25 (2.7 percent), those making $90,000 or more (0.4 percent) and those age 65 and older (0.2 percent).
A STRATEGY SHIFT IN THE STATE OF THE UNION?
Tuesday’s State of the Union may bring a strategy shift from the president on health care:
President Obama, who offered to work with Republicans last year to revamp the healthcare reform law, is expected to adopt a much different tone in Tuesday’s State of the Union address.
Bruised from the huge GOP electoral gains in 2010, Obama said he wanted to work in a bipartisan fashion on healthcare in last year’s speech. Republicans scoffed at what was called an olive branch, and worked to repeal the entire law. While the GOP-led House passed such a measure, the legislation was defeated in the Democratic-controlled Senate.
The battle lines this year are even more sharply drawn ahead of the Supreme Court’s ruling on the law’s constitutionality, which is expected months before the election. Both sides are dug in, hoping the high court’s ruling will give them momentum this fall.
It is unclear how much Obama will address healthcare reform in what Republicans hope will be his last State of the Union. Polls show that the health law is unpopular, and Democrats have acknowledged that the GOP has beat them on the intense message war over the merits of the reforms enacted in 2010.
I’d expect a strong defense of the act, but also a re-framed olive branch on improvement, in order to project bipartisanship.
SOURCE: The Hill
THE COSTS TO STATES OF NON-COMPLIANCE WITH OBAMACARE’S MEDICAID EXPANSION
A worthwhile report from Ed Haislmaier:
The steadily increasing fiscal burden that Medicaid imposes on state budgets is already a major problem for state lawmakers, and the PPACA’s Medicaid expansion will only make that problem worse in 2014. States argue that they cannot afford their current Medicaid programs, much less the scheduled expansion.
Indeed, earlier versions of the PPACA raised the possibility that states might be able (after January 1, 2014) to dump their Medicaid programs and redirect most beneficiaries into new, federally subsidized exchange coverage – a rational response by states. However, the final legislation largely foreclosed that possibility by stipulating that the new federal subsidies would not be available to individuals with incomes below 100 percent of the federal poverty level.
Thus, it is not surprising that states feel that the federal government is coercing them into accepting an unaffordable Medicaid expansion under the PPACA. Rather than enacting structural reforms in Medicaid, Congress expanded Medicaid in the PPACA. Congress also wrote the legislation to provide that a state refusing to comply would need to replace federal funding with additional state funds or disrupt the existing health care coverage of its poorest residents. Regardless of how the Supreme Court eventually rules on the constitutional issue, this case should serve as an object lesson for states on the dangers of becoming too dependent on federal funding.
SOURCE: The Heritage Foundation
CANADIAN DOCTORS, AMERICAN PATIENTS
Don Boudreaux spots this interesting quote from a recent American Enterprise Institute report:
In a recent paper, Phillips and others examine administrative data from the American Medical Association, the Canadian Medical Association, and other sources to document the extent to which Canadian-educated physicians are working in the United States and U.S.-educated physicians are working in Canada. They find that while only 408 U.S.-educated physicians were working in direct patient care in Canada in 2004, 8,162 Canadian-educated physicians were working in direct patient care in the United States in 2006, and close to 70 percent of these physicians were specialists. Canadian-educated specialists in the United States represent 19 percent of the Canadian specialist workforce, while Canadian-educated primary-care physicians in the United States represent 8 percent of the Canadian general-practitioner workforce.
Overall, one in nine Canadian-educated physicians are practicing in the United States; after excluding U.S.-born physicians educated in Canada, still one in twelve are practicing in the United States. They conclude that physician emigration to the United States is in fact an important contributing factor to the shortage of physicians in Canada.
SOURCE: Café Hayek
EVENT AT HERITAGE: BEYOND THE INDIVIDUAL MANDATE
If you’re in Washington DC on Thursday, this event is worth attending or streaming online:
With the Supreme Court set to hear challenges to the federal health care law, much attention is rightly focused on the constitutionality of the individual mandate. But there is much more to be concerned about in the massive health care overhaul law. The law creates a maze of bureaucratic regulation, will burden taxpayers and businesses with unknown costs, and impacts every aspect of the health care economy. Join us as three noted health reform authorities examine the continuing debate on ObamaCare, the impact and consequences of these policies, and an alternative path to improve health care for America.
Featuring Sally Pipes, Grace-Marie Turner, and Michael Tanner.
SOURCE: The Heritage Foundation