The Contraception Non-Compromise

As I’ve predicted in the past, Kasich did not hold:

[A]n estimated 366,000 Ohioans will now be covered by health-care insurance as the Kasich administration agrees to enact an extension of the federal-state Medicaid program. The administration is emphasizing how the federal government will pick up the bulk of the tab until 2020, but say if that changes Kasich’s plan will include a “trigger” allowing Ohio to drop the expansion, which is part of “Obamacare.”

The young and healthy are hardest hit:

The forecasts in the study are higher than most so far by allies and foes of the Affordable Care Act. But it is likely that some in the group will face increases. That’s because the same new insurance market rules that will make coverage more affordable for older and sicker people will make insurance for young and healthier people more expensive.

Most other studies have tried to estimate average premium increases, which have ranged anywhere from negligible to 85 percent and higher. This survey looks at individual examples in specific markets to show the itemized impact of the major Obamacare reforms.

The insurers estimated that a healthy 27-year-old man in Austin, Texas, who pays $54 a month for insurance this year would have a $153 premium if Obamacare’s market regulations were in effect.

The pressure would be the opposite but more modest for top-tier plans covering an older, unhealthy woman in Austin. Her premium would drop by 40 percent, they estimated.

But the sharp increase for some is going to make it “hard to declare victory,” said Douglas Holtz-Eakin, president of the American Action Forum and a persistent critic of the health law.

The Obama administration should “be very, very, very afraid,” he said. The country was “told it was going to make health care cheaper.”

The survey asked insurers how the market reforms would affect policies for specific individuals and small groups in Chicago, Phoenix, Atlanta, Austin, Milwaukee and Albany.

The Goldwater Institute raises a significant point:

In a letter sent to Idaho legislators today, Goldwater Institute attorney Christina Sandefur explains, “establishing a PPACA state health insurance exchange in Idaho would conflict with the state’s Health Care Freedom Act.” Idaho’s Health Care Freedom Act protects the “right of all persons residing in the state of Idaho in choosing the mode of securing heatlh care services free from the imposition of penalties” including “any civil or criminal fine, tax, salary or wage withholding, surcharge, fee or any other imposed consequence.” Sandefur explains (as I have explained elsewhere), “State exchanges that conform to PPACA are inconsistent with this safeguard because they are the key vehicles for implementing the individual mandate tax,” as well as the penalties ObamaCare levies on employers under the employer mandate. Idaho’s Health Care Freedom Act forbids state officials or state-created non-profits from doing anything that helps to enforce such penalties: “No public official, employee, or agent of the state of Idaho or any of its political subdivisions, shall act to impose, collect, enforce, or effectuate any penalty in the state of Idaho that violates the public policy set forth in [this Act].” As a result, Sandefur writes, “Idaho public officials who operate exchanges would be violating state law,” and “the Attorney General is charged with taking legal action against those who do so.”

Otter himself signed the Health Care Freedom Act into law in 2010, and was the first governor in the nation to do so. The purpose of that Act was to prevent state officials from doing what Otter is now trying to do. “What the Idaho Health Freedom Act says,” Otter boasted at the time, “is that the citizens of our state won’t be subject to another federal mandate or turn over another part of their life to government control.” Yet he is now trying to subject Idaho residents to those mandates, and violating his own law to help the federal government implement ObamaCare. The best spin I can put on this is that Otter is getting some very, very bad advice about the Health Care Freedom Act and ObamaCare’s Exchanges.

The situation in Idaho is a replay of Arizona, which enshrined a similar Health Care Freedom Act in its Constitution. As Arizona officials were wrestling with whether to establish an Exchange, Sandefur and her Goldwater Institute colleagues threatened legal action if Arizona did so. That threat was likely a major factor in Gov. Jan Brewer’s (R) decision to oppose an Exchange.

An interesting point by John C. Goodman and Devon Herrick:

True reform falls into four basic categories: freeing the patient, freeing the doctor, freeing the market and freeing the insurer.

Freeing the Patient. Instead of treating beneficiaries as passive recipients of government largess, it is time to treat them as partners in the enterprise. This requires making health care more like other consumer markets. In health care, however, prices are difficult to obtain and often meaningless when they are disclosed. The reason: patients rarely pay their own bills.

The first step to freeing the patient is to make individuals responsible for managing at least some of the money. They would benefit from prudent decisions and be penalized by bad ones.

In addition, under a market-based approach, providers find it in their self-interest to solve other people’s problems. The more problems they solve and the more thoroughly they solve them, the more take-home pay they realize. Without in any way discouraging altruism, a market-based approach harnesses the pursuit of financial self-interest in the course of lower-cost, higher-quality, more accessible care.

Free the Doctor. Importantly, in a real market it is the suppliers (in this case health care providers) who come up with the innovations. They develop a new idea and see if anyone wants to buy it. There are many services physicians and other providers would like to offer their patients, but the current system of bureaucratic payments prohibits it, as Medicare has strict rules about how tasks can be combined and reimbursed. The solution is to allow any Medicare provider to propose and obtain a different reimbursement arrangement, provided that: (1) the total cost to government does not increase, (2) patient quality of care does not decrease and (3) the doctor proposes a method of measuring and assuring that conditions (1) and (2) have been satisfied.

Free the Market. Medical fees should be determined the way prices are determined everywhere else in the economy – in the marketplace. However, normal market forces in medical care have been suppressed, making it difficult to determine the actual market price. Furthermore, many economists believe that Medicare uses its purchasing power as the single largest buyer of health care services to push provider fees below market levels.

Who cares about dark money now?

The challenge is real: The White House has not been able to penetrate the confusion and skepticism about the law in the nearly three years since its passage. Numerous polls have shown that people still don’t know what’s in the law, or how it could benefit them.

So it is both fitting and ironic that – for perhaps the most significant battle in the war over Obamacare – the president’s allies are completely setting aside their qualms about the unlimited cash they once railed against. They plan to use it to unleash the 20 million-address strong email list of Organizing for Action, to hire up to 100 people at Enroll America and to flood television, radio and social media with ads this fall. They even hope to go door to door, walking people through the sign-up process.

“This is going to be run like a political campaign,” said Families USA Executive Director Ron Pollack, who helped conceive and fund Enroll America in 2010 and is chairman of the board.

It’s clear Enroll America is a priority for Team Obama. The group received a blessing from Organizing for Action at a private gathering of Democratic donors during Inauguration weekend. Its new president, Anne Filipic, just resigned as the deputy director of the White House Office of Public Engagement, where she had worked under Organizing for Action’s director Jon Carson. Its new managing director, Chris Wyant, led the ground game in Ohio for Obama’s reelection campaign.

The private effort is relying on many of the tools, donors and operatives that were pivotal to Obama’s reelection, but also streams of cash – including secret and corporate money – that Obama once eschewed.

IPAB is turning out to be difficult to staff.

Jonathan Gruber was one of the Obama administration’s key advisers during the health-care reform debate. As the economist who conceived the ideas at the heart of the Massachusetts health-care law, he is arguably the intellectual godfather of the Affordable Care Act.

All of which would make him a natural fit for the Independent Payment Advisory Board, the new, 15-member panel that has the authority to reduce Medicare doctors’ reimbursements and pilot new ways to deliver high quality care for less. There’s just one tiny problem: Gruber has absolutely no interest in serving on the panel. “No way,” he says without pause. “Maybe if it was a part-time gig. But full time? I can’t see it.”

It’s not just Gruber. Obama’s former health policy advisers worry that other top health economists, those in hot demand in academia and in the industry, won’t be interested in a federal job where the compensation is low, the political controversy high and the ultimate payoff unclear.

“It is supposed to be 15 members, with limited salaries who can’t do any outside work,” says Peter Orszag, the former director of the Office of Budget and Management under Obama who was a key proponent of IPAB. “It will be challenging to find top 15 health-care experts are who would want that job.”

“You’re joining an organization that has uncertain authority with the certainty of being deeply political and widely criticized,” says Bob Kocher, a former Obama health policy adviser. “It doesn’t make sense for current thought leaders in American health care to want this.”