The Leaflet – Health Care Law Implementation Changes

Published July 11, 2013

Health Care Law Implementation Changes


In the latest setback for the implementation of President Barack Obama’s health care law, the U.S. Department of Health and Human Services has formally delayed the small business health insurance exchange originally set to begin enrollment in October. Small businesses will be able to buy coverage only from a single insurance provider for all their employees, eliminating any choice within the marketplace for at least the first year.

In addition to delaying the small business health insurance exchange for a year, the Obama administration announced last week that it would considerably scale back the health law’s requirements that new insurance marketplaces verify consumers’ income and health insurance status. Instead the federal government will rely more heavily on consumer’s self-reported evidence until 2015, when it plans to have robust verification systems in place.

In addition to federal setbacks and the growing uncertainty surrounding the viability of many parts of the health care law, states continue to debate whether to expand their Medicaid programs. Currently 26 states and the District of Columbia have expanded, whereas 13 states have decided not to do so. The remaining 11 states are still debating or have ended their legislative sessions without a vote. The most recent states to take action have been Florida, which despite advocacy from Gov. Rick Scott ended its legislative term with no action on the expansion, and New Hampshire, which has launched a study commission that will begin meeting this month to consider the implications of expansion.

Many changes have surfaced recently under the health care law, and many more will surface in the coming months. With so many questions regarding the law, The Heartland Institute – which publishes Health Care News and other publications you may recognize – is happy to send an expert to your state to testify or brief your caucus, help organize an event in your state, or provide research and commentary on the issue.

This week’s edition of The Leaflet features research and commentary addressing New Hampshire Medicaid expansion, state incentives for electric vehicles, Wisconsin’s Act 10, Ohio tax reform, a win for property owners, and arbitrary spectrum policy.


John Nothdurft
Director of Government Relations
The Heartland Institute


Research & Commentary: New Hampshire Medicaid Expansion
Health Care

States across the country, including New Hampshire, are currently debating whether to expand their Medicaid programs under the Patient Protection and Affordable Care Act (PPACA). A New Hampshire study commission will begin meeting this month to consider the implications of expansion.

If New Hampshire expands its Medicaid program to individuals at 100 to 138 percent of the federal poverty level, the federal government will pay 100 percent of the cost of newly entitled Medicaid beneficiaries for the first three years beginning in January 2014. The federal government’s subsidy will decrease thereafter. Supporters of expansion argue it would be ill-advised to reject this “free money,” and they say expansion will give insurance coverage to more of New Hampshire’s neediest residents.

If expansion is implemented, most states, including New Hampshire, will find costs exceed savings as the federal match rate drops. In 2010, New Hampshire spent $1.3 billion on Medicaid with a population of only 1.3 million people. A study conducted by The Heritage Foundation and Urban Institute found Medicaid expansion in New Hampshire would cause a swift surge in spending beginning in 2017, rapidly exceeding any modest savings from cutbacks in state expenditures to providers for uncompensated care. The expansion is estimated to cost New Hampshire taxpayers a total of $126 million through 2022.

There are also no assurances the federal government won’t lower the Medicaid matching rate. Avik Roy of the Manhattan Institute notes, “During the ‘supercommittee’ deficit-reduction talks last year, President Obama proposed reducing federal funding for the Medicaid expansion by $100 billion over ten years, with states picking up the difference.”

The Josiah Bartlett Center for Public Policy found that in states that have previously expanded Medicaid, such as Oregon, “Medicaid coverage generated no significant improvements in measured physical health outcomes in the first two years.” Bartlett Center scholar Charlie Arlinghaus asked, “Is it a good public policy to adopt a program we can tell from experience will largely just shift people from private insurance to Medicaid?”

Instead of expanding a Medicaid program that already delivers inadequate health care access to New Hampshire citizens and guarantees higher costs to taxpayers, New Hampshire lawmakers should focus on employing alternate ways to increase health care access.




Research & Commentary: State Incentives for Electric Vehicles

According to the National Conference of State Legislatures, 27 states and the District of Columbia have electric vehicle incentives for individuals, and 13 states currently have pending legislation regarding them. These incentives include allowing EVs to use high-occupancy-vehicle (carpool) lanes no matter the number of passengers they’re carrying, plus tax exemptions, registration fee reductions, emission test exemptions, and parking incentives.

Policy Analyst Taylor Smith says, “Such government subsidies and incentives make for poor public policy because they encourage rent-seeking, subvert the market’s natural mechanism for matching supply with demand at the correct price, and clash with other government incentives, all of which creates adverse fiscal consequences while providing negligible environmental benefits.”

Podcast: Christian D’Andrea: How Wisconsin’s Union Limits Are Helping Schools


People who pay attention to the news will certainly remember the mobs thronging Wisconsin’s capitol in 2011 and the recall election that quickly followed, all over a bill and then law that restricted teachers unions. Now the mobs have gone home, Gov. Scott Walker won the recall, and Act 10 is in effect in Wisconsin. How is that measure affecting school districts?

Christian D’Andrea, an education policy analyst at Madison’s MacIver Institute, recently wrote about just that for the journal Education Next. He joins the podcast to discuss what Act 10 has meant for schools, the future of the law, and what other states can learn from Wisconsin.

Research & Commentary: Tax Reform in Ohio
Budget & Tax


The Ohio General Assembly has considered several major tax reform proposals during the current legislative session. The proposal currently being considered contains several positive tax reforms, but it would not achieve the comprehensive reform Ohio needs.

In this Research & Commentary, Senior Policy Analyst Matthew Glans contends Ohio consumers and the economy are likely to be made worse off by the tax bill. The haphazardly constructed plan seems to contradict itself in several ways. The income tax changes would leave more money in taxpayers’ pockets, but the CAT increases the cost of goods and thus limits the tax cut’s effect. And although the pass-through deduction is designed to help small businesses grow, the plan increases the number of small businesses affected by the CAT.

Huge Supreme Court Win for Property Owners
Finance, Insurance and Real Estate

In this Heartlander digital magazine article, Research Fellow Steve Stanek discusses what he argues may be one of the most important rulings of the recently completed session of the U.S. Supreme Court. Under the decision, property owners needing government permits to develop their vacant land or improve existing structures now have improved protections from abusive federal, state, and local governments. The case, Koontz v. St. Johns River Water Management District, declared government demands for money, land, or other concessions may be subject to heightened judicial review.

“Now, governments have got to demonstrate a connection – a very close connection – between what they’re asking for in money or fees and the impact of your project. Whereas before, there really was no federal standard, and governments could sort of willy-nilly impose whatever they wanted and expect to get deference from the courts,” said Paul Beard, an attorney with the Pacific Legal Foundation, who argued the case on behalf of the family of Coy Koontz, Jr. of Orange County, Florida.

Arbitrary Spectrum Policy

In this article from the Heartlander digital magazine, originally published in the Daily Caller, Scott Cleland argues against the Federal Communications Commission’s recent arbitrary approach to wireless spectrum policy. Cleland points out how the FCC has not consistently applied its spectrum screen/cap policy when approving or disapproving spectrum transactions. He argues the U.S. wireless market is succeeding on its own and does not need FCC micromanagement.

“The growing arbitrariness of the Government’s approach to spectrum policy and regulation has become exceptionally troubling and profoundly counterproductive,” Cleland writes. “If the government is not careful, and respectful of the rule of law and due process, the government could quickly and severely screw up a critical and successful American industry – for no good reason.”