ObamaCare’s Supreme Mistake

ObamaCare’s Supreme Mistake
By GRACE-MARIE TURNER
Last Updated: 12:29 AM, March 5, 2012
Posted: 11:17 PM, March 4, 2012

The US Supreme Court this month hears arguments on the constitutional challenges to the ObamaCare law — with the top challenge centering on the mandate that every American buy health insurance. Increasingly, and not just for constitutional reasons, that mandate looks to be the law’s downfall.

Princeton University’s Paul Starr, whose advice helped shape ObamaCare, recently admitted that the mandate was a big mistake.

“Democrats managed to get themselves the worst possible result: a law that enflames the opposition on the basis of overreaching federal power but may not work in practice because there is no real power behind it,” he wrote in a post for The New Republic. “Whether or not the court strikes it down, the individual mandate has been one of the most serious political and policy mistakes of recent decades.”

The American people are clear in their opinions. A poll from the AP-National Constitution Center found that a stunning 82 percent don’t think the federal government should be able to require them to buy health insurance or pay a fine if they don’t.

If the federal government, which constitutionally has “limited” and “enumerated” powers, can force private citizens to use their personal money to buy a private product, there is no end to what it could force citizens to do.

But even if the mandate survives the Supreme Court, it’s destined to fail, because (as Starr notes) it just can’t work as intended.

One mandate goal is to bring young and healthy people into the health-insurance market — people who, without the threat of a fine, are much less likely to buy costly health policies.

But this threat won’t do that. The law’s penalties are “toothless,” as the 11th Circuit Court of Appeals put it in August, in finding the mandate unconstitutional.

Under the law, the federal government is to fine individuals a maximum of $695 a year or 2.5 percent of their income — whichever is higher — for being uninsured. That’s too little to induce people to sign up for insurance that (according to the Congressional Budget Office) soon will cost more than $20,000 a year for a family. Millions will decide to pay the fine instead of buying coverage.

Of course, a big reason insurance will be so expensive is the rest of the ObamaCare law. Notably, it slaps insurers with strict rules on how they can price and sell their products — rules that have already sent premiums through the roof in such states as New York. These include “guaranteed issue,” which mandates the sale of policies to all comers, and “community rating,” which limits insurers’ ability to vary rates.

That means insurance companies will be forced to sell policies even to people who wait until they fall ill to sign up. And they’ll have to charge the same premiums as if the person had been insured all along.

Oh, and young people will be forced to pay more than their share for health insurance so that older people can pay less — ObamaCare’s version of fairness.

Will the federal government even have the political will to fine people? It’s difficult to imagine a policy more politically damaging than seeking out and financially punishing people who don’t buy insurance.

So, in all likelihood, millions of uninsured Americans will choose to wait, pay a fine — and buy insurance only when they need it.

This is precisely what’s been happening in Massachusetts under its 2006 health-reform law, which included an individual mandate. Ever more people are buying insurance just before incurring huge medical bills, then dropping it as soon as they’re treated.

ObamaCare backers are well aware their legislation fails without an effective individual mandate. Last year, Justice Department lawyers told federal Judge Roger Vinson more than a dozen times that the mandate is “essential” to the overall legislation.

Yet this mandate can’t work.

The Supreme Court would do the nation a great service by declaring the entire law unconstitutional and forcing Congress to go back and get reform right.

Grace-Marie Turner is president of the Galen Institute and a co-author of “Why ObamaCare Is Wrong for America.”

Read more: http://www.nypost.com/p/news/opinion/opedcolumnists/obamacare_supreme_mistake_RKmk2I5JwhWeT0zAzUbUuO#ixzz1oH7YMelW

Caution: Centralization Is Dangerous To Your Health

Caution: Centralization Is Dangerous To Your Health
By Grace-Marie Turner
4/8/2011

The agency that runs the Medicare program decided in late March that it will pay for patients to receive an advanced new treatment for prostate cancer called Provenge.

The decision was cheered by patient groups. The pressure was intense as they demanded that the Centers for Medicare and Medicaid Services (CMS) pay for the pioneering vaccine that already had been approved by the Food and Drug Administration. Early signals indicated the agency might deny payment because the drug is expensive.

But Provenge is expensive because it is expensive to make. The drug is created individually using each patient’s own cells and costs $93,000 for the required three treatments.

Patients with advance-stage breast cancer, however, are not cheering.

In December, the Food and Drug Administration revoked its earlier approval for Avastin, a cutting-edge biologic drug used to treat breast cancer that also is expensive. The agency decided the medicine's potential side effects were too great compared to its benefits. Many are still wondering if cost was part of the consideration.

Genentech, Avastin's manufacturer, has appealed the ruling. But if the FDA decision stands, thousands of women who wanted and needed the medication won’t be able to get it.

Both decisions symbolize one of the most pressing problems with our health sector -- government controls too many medical decisions.

People over 65 have virtually no choice but to use Medicare for their primary health coverage. So if Medicare declines to pay for a drug, seniors are, for all intents and purposes, denied access to it. Many private plans follow Medicare’s lead.

The treatments Medicare covers are determined by government officials. There are private plans within Medicare, but they’re highly regulated and limited in the coverage they can provide.

Provenge and Avastin are just two examples of many in which government officials will be deciding what treatments will or will not be available to us. Many of these decisions will be under the radar for patients and doctors, never knowing that government officials may well determine whether or not a doctor can prescribe an important, but possibly costly, drug for them.

Decisions from Washington could limit access to a wide range of novel drugs and biologics. And it’s going to get worse under agencies created by the new health law. The new Independent Payment Advisory Board, for example, will have sweeping authority over payments in Medicare, and these unelected board members are specifically charged with focusing on payments for prescription drugs. In other countries with government-run heath systems, bodies like IPAB lead to explicit rationing.

Washington control ultimately will dictate which drugs are developed – or not. This will certainly deter innovation and development of tomorrow’s new medicines. Firms generally avoid investing in treatments if there is a risk the big government programs won’t pay for them.

In the case of the Avastin ruling, Genentech is likely to take a huge financial hit. Medicare and Medicaid will probably stop paying for the drug for breast cancer, and the firm will lose a huge share of the market.

And this is happening even after the drug received FDA approval. Avastin was approved in 2008 when the FDA first considered it. So this new ruling adds yet another degree of uncertainty to the federal drug approval process, deterring future pharmaceutical development not just for Genentech, but for every pharmaceutical research company watching this play out.

We need to reform the FDA drug approval process to gather information more quickly and efficiently. And we definitely don’t want government to have the final say on whether these medicines will be available to us.

Physicians, hospitals, and health insurance companies all conduct their own effectiveness research into drugs, devices, and treatments. These entities are closer to the patient and better-positioned to make the call about which treatments are worth paying for.

The government now controls half of all health spending in this country. Putting so much of our health sector under government control distorts prices and restricts choice. Instead, we should empower patients to have more control over health insurance choices. Prices need to be more transparent. And it should be up to individual patients, doctors, and their insurer to determine if a new drug should be covered. These vital decisions shouldn't be left to a distant government bureaucrat sitting in an office in Washington DC.

Our centralized healthcare system is dangerous to health and must be watched carefully. When bureaucrats, distant from the actual delivery of care, decide what treatments are "worth it," patients suffer.
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What Does the FDA Avastin Decision Mean for Patients?
By Grace-Marie Turner
3/23/2011

The United States is the world’s leader in pharmaceutical innovation, especially in the newest form of drugs created through biomedical research. Made from living cells, biotech drugs can treat certain medical conditions for which no other medicines are available. These drugs are the cutting edge of 21st-century medicine, and the U.S. performs 80 percent of biotech research worldwide.

That could all change, though, because of a recent ruling from the Food and Drug Administration.

In December, the FDA announced it will revoke approval of the biotech drug Avastin to treat late-stage breast cancer. This decision could cause public insurance programs like Medicare, along with private insurers, to stop paying for Avastin treatment.

The ruling has been appealed by Avastin's manufacturer, Genentech, and the FDA will issue a final ruling this month. Unless the FDA reverses course, drug development and patient care in this country will be compromised.

Avastin slows the growth of cancer by cutting off the blood supply to tumors. The FDA approved the drug six years ago for the treatment of colon cancer, and the agency has since approved it to treat other cancers, including for lung, brain, and breast.

About 17,500 late-stage breast cancer patients are prescribed Avastin annually. The drug has improved the quality and length of life for thousands of women. One clinical trial found that patients given Avastin lived nearly twice as long as those not given the drug.

Last summer, the Oncologic Drugs Advisory Committee at the FDA recommended that approval for Avastin be rescinded, despite its proven benefits. Many observers speculated that the likely reason for the reversal was cost. Biologics -- the complex class of drugs Avastin falls under -- are expensive to develop and manufacture. Those expenses are reflected in the final product’s price: an individual Avastin regimen costs about $88,000 annually.

FDA agency officials have noted that doctors could still prescribe the drug “off-label.” But public and private insurers rarely covers off-label treatments. Patients would likely have to pay the whole cost of Avastin themselves. Very few can afford to do that. And so, for the vast majority of breast cancer patients, this drug effectively won’t be an option -- even though it might benefit them.

Denying Avastin will also stunt U.S. drug innovation.

It costs about $1.3 billion, on average, to develop and tests a new biologic drug and bring it to market. Genentech spent $2.25 billion to develop Avastin.

Companies are less likely to make such a huge investment if the FDA can revoke coverage after a drug is approved and take away the opportunity to recoup its investment.

Unfortunately, the FDA's Avastin decision could be just the tip of the iceberg. The Obama administration is pursuing a government-centered model of medical care on multiple fronts. The new health law creates at least 159 new government boards and agencies that will sink roots into every aspect of the health sector. Some of these non-elected boards will have the power to cut costs and restrict choices for doctors and patients.

The new Independent Payment Advisory Board (IPAB), for example, has the authority to cut Medicare reimbursement rates for doctors. Such cuts will drive physicians out of the Medicare program, and with fewer doctors available, there will be longer waits for care.

And the economic stimulus bill created a federal office to study the “comparative effectiveness” of new drugs and medical treatments. In other countries, such research has been used by government officials to deny patients access to advanced medicines.

The comparative effectiveness body in the Britain, for instance, has routinely denied public coverage for new medicines that are widely available throughout the rest of the Western world. The result has been lower quality of medical care for the British people.

Indeed, a study published in the Lancet medical journal found that only 69 percent of British women survive at least five years after being diagnosed with breast cancer, but 84 percent of American women survive at least that long.

Medical decisions need to be left up to patients and their doctors – not distant bureaucrats. The FDA needs to reverse its Avastin decision. Otherwise, patients are going to lose a vital treatment option and we'll all lose out on investment in tomorrow’s new, life-saving drugs.

The Obamacare Legacy of Centralization and Bureaucracy

The Obamacare Legacy of Centralization and Bureaucracy
By Kevin Glass
3/21/2011

The monstrous Obamacare health law was passed by the House of Representatives on March 21, 2010 and signed into law by President Obama nine days later. Nancy Pelosi said that Congress had to pass the law to find out what was in it. Despite a lengthy debate, new details trickle out seemingly daily about the destructive impact of the law. One year later, a group of conservative health policy wonks have banded together to release a book that comes as close as possible to being the authoritative tome on the full impact of Obamacare.

Grace-Marie Turner, James Capretta, Thomas Miller and Robert Moffitt are co-authors of the new book Why Obamacare is Wrong For America. Turner, President of the Galen Institute (a health policy think tank) and frequent Townhall contributor, made time to talk with Townhall about her new book, Obamacare's continuing repercussions and what Americans can do to make sure their voices are heard.

Townhall: The title is blunt.

Grace-Marie Turner: It is, I know, there's not any question about where we stand on this.

TH: The book was written by you, James Capretta, Thomas Miller and Robert Moffitt, four of the biggest names in health care policy on the Right. How did this project come together?

Turner: You know, it was really clear to us that there needed to be one book that pulled together the key parts of Obamacare, and that we needed a book that really explained the impact of this awful new law. So rather than descriptions of the bill, which is important, we decided that we needed to do a book about the impact on young adults, on seniors, on patients and doctors, employers and employees, taxpayers and citizens whose constitutional rights are in jeopardy because of this legislation. So we offered this to several publishers, and Adam Bell, who's now our editor at HarperCollins, said "I believe we need this book." We produced it in unbelievable record time. We started it at Thanksgiving, and the manuscript was due at the end of December, so it's very, very current. We've continued to update it through January. Everything is in one place for what people need to know about this legislation and its impact on Americans.

TH: The book is perhaps the most comprehensive overview of what's in Obamacare. What would you say is the biggest impact of Obamacare that's still largely unknown by the public?

Turner: That's such a good question. We know it so well, but it's hard to know what other people know and don't know about it. I think the real risk is that people think that too many people are told that the law really is about some of the early provisions: keeping 26-year-olds on their parents' policies; "free" preventive care (we know there's no such thing as free preventive care); the high-risk pools for the uninsured; and they don't realize this unbelievable avalanche that is coming to take over one-sixth of our economy. It really is the totality: there's no one thing in it.

When you go through 2800 pages of legislation that's going to literally going to control one-sixth of our economy. The number of places in this legislation that give power to the [HHS] Secretary to decide how this is going to be done is totally unprecedented. We wanted to write about what we know already about this legislation and its impact, but also what's coming, and the projections by authoritative, independent experts, and pull it all together in one place. All of us, James Capretta, Tom Miller, Bob Moffitt and me, we write literally every day about this, as do all of our colleagues in the market-based policy community. But what people wanted is one place where they could get the best information about the impact of this law. And we have several hundred footnotes that tell people where to find this information. So even though the book is written for the average reader, it is very carefully documented and cited. This is not just our opinion. this is documented evidence of what the impact of this law is going to be.

TH: You just noted that the law is unprecedented in how it empowers the central government to make important healthcare decision, and that is probably the biggest underlying theme of the book: the trust in centralization and bureaucrats to make decisions about what will lead to healthier outcomes. Could you explain how this is a departure of what you phrase in the book to be "current medical trends towards more individualized and personalized care"?

Turner: Well, it is totally goes in the opposite direction of where the market in health care is going, and where science is taking us. We're moving toward ever more personlized care, where we can find out before somebody starts a round of chemotherapy, for example, whether or not that chemotherapy is going to work with them through genetic testing. That's where science is moving, to make sure that treatments are targeted toward what we can learn about that individual patient.

What this law does is really collectivize, and assumes that we need population medicine. The law claims that experts in Washington are going to figure out what is the right treatment, and what's going to be the protocols. Doctors are going to be judged based on how they follow those protocols whether or not it's the right thing for their patient. So doctors are put into a very difficult position, and one of the things that we talk about is the number of physicians who are seriously considering getting out of the practice of medicine as soon as they can.

The number of doctors who are thinking about retiring early, closing their practices and moving on to something else is astonishing. We are going to have a huge shortage of physicians if we try to put doctors in these boxes. They're saying, "I can't practice medicine according to Washington's rules. I know what's right for my patient." This law is going to absolutely interfere with that. It's astonishing: payment policies, fines on doctors, penalties, likely even lawsuits if they don't follow Washington's protocols.

TH: What really surprised me is the extent that Obamacare treats Medicare as a piggy bank to pay for all of this. The Republicans made a minor issue out of this, but do you think, if all the cuts that are planned go through, that Medicare can even continue to function as an effective program?

Turner: Oh, it absolutely can't. And Rick Foster, who's the chief actuary for Medicare, said that if the cuts in Medicare that are designed to pay for massive new entitlements, if these cuts were to go through, that it would decimate seniors' access to physicians. He says that, over the long term, as many as 40% of providers who treat Medicare patients would either have to stop seeing patients or go out of business. In addition to the doctors who are going to be leaving the practice of medicine so they don't have to follow Washington's protocols, we see that the payment policies are going to drive out a huge number of other providers like nursing homes.

Medicare will be paying less than Medicaid. And we already know that patients on Medicaid have a very difficult time finding a private physician to see them because Medicaid payment rates are so low. And so they wind up having to spend most of their time, if they want to see a physician, waiting for hours in a hospital emergency room, where they're required to be seen. It's just unacceptable that they'll do this to the Medicare program when there are other solutions out there.

TH: It's unclear if you could call it the "bright side," but you write in the book that it's pretty likely that a lot of these Medicare cuts won't actually happen.

Turner: Then you wind up with the impact on taxpayers. Douglas Holtz-Eakin, former director of the Congressional Budget Office, estimates that the number of people who will sign up for these new entitlement subsidies is much larger than the estimates by the current CBO. That's going to add at least a trillion dollars to the cost of this program. You add to that the likelihood that Congress will not allow these cuts to Medicare go into place, and the red ink from this law is absolutely unfathomable. The hypocrisy of this is that they would pretend that this law is designed to reduce the deficit. It will absolutely explode the deficit.

TH: It seems that the choices are destroy the program of Medicare or destroy the deficit.

Turner: Or, as we say in our final chapter when we talk about what we should do instead, figure out how we're going to redesign Medicare and give subsidies to people who need help with emergency health insurance. There's plenty of money in the existing system. But it has to be done in a market-based, competitive approach, rather than the centralized, top-down approach of Obamacare.

It's also going to bankrupt the states! When you go down the line of the implication of the people and taxpayers who are impacted by this law, it is completely unprecedented that we would do this much damage to so many people and such a big swathe of our economy with one piece of legislation.

TH: One of the biggest Medicare reforms in the law is the introduction of Accountable Care Organizations. And you note in the book that these could be used as an effective Medicare reform, but that Obamacare mangles that idea.

Turner: Mangles is really the right word. There is no question that one fo the solutions to the problems in our health care system is to have better coordinated care, particularly for people with significant health costs and multiple chronic illnesses. We need better coordinated care. Right now, the system tosses them around between Medicare and Medicaid, or they go uninsured and they don't get the care they need. The care is fragmented. One doctor doesn't know what the other doctor prescribes. We absolutely need to reform that system. But, once again, Obamacare does it with a Washington-knows-best rules-driven program.

We don't even know the rules, by the way, that the Accountable Care Organizations are going to have to follow. But you know that all of the other regulations so far from Health Secretary Sebelius is that this is a top-down program that will absolutely suffocate the innovation that would be the solution to the problems of fragmentation, lack of coordinated care and waste and inefficiency in our health sector.

TH: There's a lot written in the book about goverment's research into effective spending control measures like the Federal Coordinated Council for Comparative Effectiveness Research and PCORI, the Patient-Centered Outcomes Research Institute. Considering, even without Obamacare, the massive involvement that the government has in paying for health care services, couldn't these be seen as good ideas?

Turner: Well I'd add to that list the Independent Payment Advisory Board. It's this independent board that, without any oversight whatsoever, will have control over payment policies for Medicare. These are centralized agencies. It's important to understand the basic philosophy of the people who wrote this legislation: that they feel like it's really kind of awful for anyone to make a profit in the delivery of health care services. so when you look at this from that perspective, they really want to drive out that competition.

They want to have Washington tell physicians, "this is the way you're going to practice, we're going to set up all these institutions," like the three that we just mentioned. That's only three of 159, at least, that the Congressional Research Sevice says will be created by this legislation.

Absolutely, we agree with the goals: greater efficiency, having physicians know more about what the treatments should be, but that is again something that can be driven by an information age economy, and better incentives for physicians. More transparency, so that the patients know which doctors and hospitals perform best, have the best track record. Instead, this is going to be Washington telling physicians and hospitals, "follow our rules or else."

TH: Something else that was striking in the book was your description of some of the ways that President Obama and the Democrats co-opted what could be promising health care reforms. Like we talked about Accountable Care Organizations, and you go over high-risk pools and the pre-existing condition insurance plan, and say that those could be promising, but that Obama has set them up to fail.

Turner: And that's one of the things they say. They say, "we took your ideas for high risk pools, we took your ideas for refundable tax credits to help people purchase health insurance," but they mangled them beyond recognition. These are not the policies and proposals that we had recommended. Because we believe that doctors and patients should be in charge of decisions. We trust them and the competitive market to figure out how to get better care faster and more efficiently to patients. They simply don't believe in that philosophy.

So there's an underlying philosophy in Obamacare that Washington knows best. And we believe that patients and doctors know best. That fundamental divide has led them to this legislation. It is just completely out of sync with the rest of the economy. And it is a reason that people were literally marching in the streets against it. When Congress was getting ready the last few days of the session to vote on this law a year ago, Congress was getting 100,000 calls per hour. For a switchboard that's only able to handle 50,000 calls an hour, so it was a meltdown. And the great majority were telling their members, please vote against this legislation. There were vigils outside the Capitol literally until the vote was taken, with people saying, "please don't vote for this. Listen to us." And they did it anyway.

It's that philosophy that we're going to completely disregard the American people, that "we're going to do what we know is best for them." And I know I think the American people know what's best for them. That's why they need to know what's in this law. A number of states that have filed for appeals. The House has voted to repeal it. Several courts have declared it unconstitutional. Americans need to know this law is fully in force, and is absolutely coming at us like a steamroller. We're marching toward 2014, when the full impact of this law will be in place.

We have a chapter in the book that tells pepole what they can do to fight back. Many people write to me and ask, "what can we do? This has been passed. And my member of Congress, they're not listening for me." And we have a whole chapter on things that people can do to make sure their voices can be heard. I really hope that, if nothing else, people read the book for that. but I also hope that they really find that the book is important in helping educate them about the details of what's in this law in a way that makes it relevant and accessible to them.

TH: And what do you think the chances are for some kind of repeal or replace of Obamacare, either through the legislature or through the courts?

Turner: This is a multi-front battle at this point. There are now 30 states that are in one way or another challenging this legislation. They know they'll go bankrupt, and they want to protect their citizens from these Washington mandates. The new House is doing a fabulous job with oversight, both bringing Administration officials up to talk about it and business leaders to discuss the law's impact on them.

The political debate continues to rage about this, and you've got Congress trying to take this apart. They've held a vote to repeal one of the most egregious parts of the legislation: the requirement that all businesses file 1099 reporting forms on all purchases over $600. That would have buried over 40 million businesses in paperwork, including mine. And that's gonna go. So you're starting to see the dismantling.

It's hard for me to know, and I don't think anybody has a crystal ball to see, how the Supreme Court is going to come down on this. The political process is continuing to judge this. Back in November, it was a huge, huge motivator for people to go to the polls and vote against anybody who voted for this legislation. Pat Caddell has said, "this is not over." I think the American people's voices will be heard eventually. I don't know how it's going to happen, but I think that they will make sure that this legislation is delayed, postponed and hopefully repealed. But it's going to take a new President to repeal it. That's why the 2012 elections are so consequential.
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To read another article by Kevin Glass about ObamaCare, click here.

Romney's Best Defense: The Truth About Romneycare

Romney's Best Defense: The Truth About Romneycare
By Grace-Marie Turner on 3.6.12 @ 6:09AM

Voters need to hear it from him -- and he has to be straight with them.

Even though Mitt Romney has had a string of primary wins, support for his presidential bid still is tepid among Republican voters nervous about Romneycare. He could calm them if he were to more fully explain the difference between his vision for reform and the law that ultimately was enacted in Massachusetts.

Gov. Romney gets big applause when he pledges to repeal Obamacare, but he faces silence when he tries to defend Romneycare. He insists, for example, that his individual mandate only impacted the 8 percent of residents who were uninsured (the mandate covers everyone), that he didn't cut Medicare (states have no authority over Medicare), and that he would issue a waiver to the states to implement Obamacare their way (a president can't undo an Act of Congress with a waiver).

The voters are not reassured. Gov. Romney can get off the defensive and change the subject by explaining that the Massachusetts law which was passed by the overwhelmingly Democratic legislature diverged significantly from his vision for reform, and then describe what his reform plan would be as president.

During the presidential debate in Jacksonville, Florida, in late January, Romney took a small step in this direction when he acknowledged that his successor, Gov. Deval Patrick, has taken a much more liberal track in implementing Romneycare. "If I were governor," Romney said, "it would work a heck of a lot better." Indeed, when it passed the law, the legislature was counting on a Democrat governor to succeed Romney to put the real regulatory thumb screws in place.

The Massachusetts law is different in important ways from the plan that Romney pushed as governor. Few voters know, for example, that Romney strongly opposed the employer mandate and wanted an escape from the individual mandate -- allowing people to instead be able to post a bond if they were uninsured and had big medical bills. When Romney signed the law, he believed it contained the escape hatch, but legislators removed it before final passage.

Romney vetoed eight provisions of the Massachusetts bill, and every one of his vetoes was overridden by the legislature. Should Romney have known this was likely? Yes. Should he have known exactly what he was signing? Absolutely. But voters may be more forgiving if he tells them he wanted to give citizens and employers a way out.

Why did he push Romneycare? The state was at risk of losing $385 million in federal Medicaid money, and the Bush administration insisted Massachusetts make changes to get more residents covered and keep the money flowing.

Romney also wanted to find a way to make it easier for small businesses and individuals to get insurance that would be portable from job to job. To get around federal tax law restrictions and to make health insurance portable, he adopted the Heritage Foundation's proposal to create exchanges that would allow individuals to have portable insurance and pay premiums with pre-tax dollars.

TODAY ROMNEY SAYS, "The market can work to solve our health care needs." The policy recommendations on his campaign website back up his perspective on patient-centered reform. But primary voters aren't. He needs to get off the defensive and take charge of this issue.

Here's a three-step plan:

Step 1: Focus on Repeal of Obamacare.

Gov. Romney needs to get his message straight, or he will be hammered in the general election over false promises. He calls for repeal of Obamacare while saying he would immediately issue an executive order to give flexibility to the states to implement the law their way. That sets the stage to massively confuse the political agenda: He would be sending the states off to begin to implement Obamacare while Congress works in Washington to repeal it.

Further, the Congressional Research Service issued a report that said Obamacare's major provisions are Acts of Congress, and they simply cannot be changed through an executive order.

His focus should be on repeal. Waivers to the states from Obamacare are not a solution and, in fact, might well detract from the ultimate goal of repealing the law and replacing it with a genuine free market alternative. If Gov. Romney is serious about repealing Obamacare, he will have to devote all of his energies to doing that as soon as possible.

The House of Representatives passed a repeal bill a few weeks after Republicans took control last year. In the Senate, many parts of Obamacare could be repealed through reconciliation with only 51 votes should Republicans take control there, allowing them to enact legislation repealing the spending provisions that are the biggest threat to the economy and to the federal deficit.

He also could calm voters by emphasizing that a federal mandate to purchase health insurance is unconstitutional and detail more reasons why Obamacare's government-centric approach is wrong.

Step 2: Explain what really happened with passage of Romneycare.

Gov. Romney's support for states' rights is important, saying the law worked for Massachusetts but that other states need their own solutions in our diverse and complex country. But conservatives would feel better knowing what he initially proposed in the Bay State. For example:

• Mandate escape. Few voters know that Romney wanted an escape from the individual mandate. Voters may be more forgiving if he were to tell them he wanted to give citizens a way out and that he strongly opposed the employer mandate.

• Real insurance. Romney wanted people to be able to purchase real health insurance that would have covered catastrophic events. Instead, the legislature insisted on including all of the 50-plus health insurance mandates already on the books. The legislature allowed the high-deductible plans only for some young people aged 18-26.
After the Massachusetts law was passed by the legislature, Romney continued to try to reshape it with his line-item veto. For example:

• Employer mandate: Vetoed. The bill called for a mandate on employers with 11 or more workers to provide health coverage or pay an annual fee of $295 per worker. Overridden.

• Covering certain immigrants: Vetoed. The bill included a provision that would allow some non-citizens to qualify for coverage under the new health plan. Overridden.

• New bureaucracy: Vetoed. The bill created a powerful new bureaucracy, called the Public Health Council. Overridden.

• Limiting improvements to Medicaid: Vetoed. The bill restricted changes to Medicaid to make the program more efficient. Overridden.

Gov. Romney must clarify that in working with a Republican Congress on a new health reform agenda, he would start with a very different vision than Romneycare and work much harder to make sure the consumer-friendly structure is what becomes law.

Step 3: Emphasize his vision for market-based health reform, with a much clearer description of what a President Romney's plan would look like.

He needs to talk about what he would do so he can stop having to defend Romneycare. A handful of specifics would do, many of which are included on his campaign website:

1) Help states set up functional pools so people with pre-existing conditions are protected.

2) Provide new subsidies for the uninsured to purchase the coverage of their choice.

3) Encourage the states to set up marketplaces for people to buy insurance and allow policies to be purchased across state lines.

4) Boost insurance rules to guarantee that if people have coverage, they can keep it and their premiums won't skyrocket if they get sick, etc.

5) Move toward a system of tax credits and deductions to allow individuals to buy and own portable health insurance.

And regarding the "free-rider" problem Romney says that the Massachusetts law was designed to stop: This can be addressed without a mandate and in a way that is likely to be much more effective. For example, if people don't buy coverage with the credit, then the credit could be used to automatically enroll them in a private plan that would cover their major medical bills. Properly structured incentives would be more effective than a mandate in expanding coverage.

The health reform plan Gov. Romney pushed in Massachusetts was different in key respects from the model that became Obamacare but few people know the truth about Romneycare.

Unless Gov. Romney takes steps to clarify and remedy his position, he will continue to have trouble convincing Republican voters he is serious about repeal and will have an even harder time mapping a clear plan on health reform should he be elected president.
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To read another article by Grace-Marie Turner, click here.

Mitt Romney's Achilles' Heel

Mitt Romney's Achilles' Heel
By Grace-Marie Turner on 1.6.12 @ 6:09AM

He simply has to come clean on Romneycare.

Former Massachusetts Gov. Mitt Romney's narrow win in the Iowa caucuses and his lead in the New Hampshire primary could catapult him to the GOP presidential nomination, but if he is to have any hope of gaining favor with conservative voters to get elected in November, he must escape the chains of Romneycare.

Romney has been unwilling to repudiate the health reform he signed into law in 2006, complete with the hugely unpopular individual mandate. The latest Associated Press-GfK poll shows only 15 percent of the American people think the government should have the power to require citizens to purchase health insurance or pay a fine.

That's what Obamacare will do -- barring a Supreme Court repudiation -- and that's what Romneycare already does.

In a November interview on Fox News, Romney got testy when anchor Bret Baier asked him, "Do you think a mandate, mandating people to buy insurance, is the right tool?" Romney replied, impatiently, "What we did in Massachusetts was right for Massachusetts. I've said that time and time again.… This is not a federal plan, it's a state plan."

Romney is stubbornly defensive about his universal coverage law, poking a finger in the eye of Republican voters who rightly see it as the platform for President Obama's takeover of health care. John McDonough, who helped design both Romneycare and then Obamacare, said the federal law is "Massachusetts with three more zeros."

Democratic pollster Patrick Caddell is among those insisting the health law will continue to be a huge issue in the 2012 election. Romney's defenses just aren't convincing, and as a result, voters distrust him on what he would do next in this crucial area. There is a way out of this box for Romney, but first, let's look at some examples of his current strategy and why it isn't working:

• Repeal and Replace -- with Romneycare? In the October 11, 2011 debate, Romney said: "…we all agree about repeal and replace. And I'm proud of the fact that I've put together a plan that says what I'm going to replace it with."

He says he wants to repeal and replace Obamacare, but then he says what he would replace it with is Romneycare! No wonder voters are worried. Does he really mean that he wants to use Massachusetts as a model for his "replacement" plan?

• Waivers for the states. Romney has said repeatedly that one of his first acts as president would be to "put out an executive order granting a waiver from Obamacare to all 50 states."

But Romney can't use an executive order to wipe out a massive new federal entitlement program and its huge taxpayer subsidies for health insurance, a vast expansion of Medicaid coverage, the Medicare rationing board, $550 billion in new and higher taxes, $575 billion in cuts to Medicare, and federal mandates on individuals, businesses, and the states to comply with the law. These are all part of the federal health overhaul law and simply cannot be waived by executive order.

The Congressional Research Service sent a letter to Sen. Coburn in November confirming this. "A President would not appear to be able to issue an executive order halting statutorily-required programs or mandatory appropriations… [or blocking] an agency from promulgating a rule that is statutorily required by PPACA," the CRS concluded.

So Romney's campaign slogan is calling for an action that simply would not be legal. Waivers are not a solution and, in fact, might well detract from the ultimate goal of repealing Obamacare and replacing it with a genuine free market alternative.

• Mimicking Obama. When Romney says he wants to give states more discretion in implementing Obamacare, there is very little daylight between his position and President Obama's.

The president has said Congress should pass legislation to accelerate the provision in the law that would allow states more flexibility in implementing the health law starting in 2017, arguing Congress should move the date forward to 2014. That is precisely Romney's position. Not much room for debate there.

• Individual mandate affects everyone. Romney seems especially proud of the individual mandate requiring all residents to have health insurance as "the ultimate conservative idea."

When asked about the despised issue, Romney says: "Our bill dealt with eight percent of our population, the people who aren't insured and said to them, if you can pay, don't count on the government, take personal responsibility."

But the mandate applies to everyone, not just to the eight percent who were uninsured.

• Romneycare and taxes. He also defends Romneycare by saying that Massachusetts didn't raise taxes to finance his plan. That's because Massachusetts simply passed a big share of its costs along to federal taxpayers. Massachusetts relied on previously enacted health insurance taxes and an infusion of federal Medicaid money to finance its coverage expansion.

Washington didn't have any higher government authority to draw from so it had to raise taxes to finance Obamacare. The fact that a significant part of Massachusetts' coverage expansion relied on federal Medicaid money defies Romney's position that the Bay State's reform was a state solution.

• Medicare cuts. Romney also boasts, accurately, "We didn't cut Medicare." This is a bogus boast, however, since states have no authority over spending in the federal Medicare program, and cutting Medicare therefore never was an option with Romneycare.

• The speed of repeal. Romney pledges to pursue the ultimate goal of repealing Obamacare and replacing it with "free-market reforms that promote competition and lower health-care costs. But since an outright repeal would take time, an executive order is the first step in returning power to the states," he wrote earlier this year.

Actually, it wouldn't. Romney's cautious step-by-step approach overlooks the fact that the Republican House passed a repeal bill within a few weeks of taking power. If there were a majority in the Senate supporting repeal, then a new president could have a repeal bill to sign on his desk within a month or two of taking office.

Why on earth would a President Mitt Romney want to send states on a wild chase to start implementing Obamacare in a different way when, as he himself observes, the ultimate goal must be total repeal?

ROMNEY'S ATTEMPT TO DISTANCE himself from the despised health care law isn't working. He is simply not able to talk his way around it. A video has surfaced recently of a 2010 appearance by Romney that is causing new alarms in which he says of Obamacare, he would "repeal the bad and keep the good."

There is a way out, however: Romney needs to take a bolder step and say that the law he passed in Massachusetts never would work for our diverse and complex country, that he shouldn't have tried to do so much all at once, and that he should have put health costs, not universal coverage, at the top of his priority list. He needs to emphasize as strongly as he can that a federal mandate to purchase health insurance is unconstitutional and that he wants to sign a bill fully repealing Obamacare. And he needs to explain what really happened in the passage of Romneycare.

The health reform plan he pushed in Massachusetts was different in key respects from the one that became law -- and which became the model for Obamacare.

Few voters know that Romney wanted an escape from the individual mandate, by allowing people to instead be able to post a bond in case they were uninsured and had big medical bills.

When Romney signed the law, he believed it contained the bond escape hatch, but legislators took it out at the last minute.

Romney also objected to the employer mandate and vetoed the provision that requires employers with 11 or more workers to provide health coverage or pay an annual fee of $295 per worker.

He also vetoed several other provisions, and every one of his vetoes was overridden by the overwhelmingly Democratic legislature. Should Romney have known this was likely? Yes. Should he have known exactly what he was signing? Absolutely. But voters may be more forgiving if he tells them he wanted to give citizens and employers a way out.

If Gov. Romney is serious about repealing Obamacare, he will have to devote all of his energies to doing that as soon as possible.

As primary voters continue their serial search for the non-Romney candidate, Romneycare remains his Achilles' heel. Granting waivers would simply allow Obamacare to sink its roots even deeper into our economy and health sector and would send a mixed message to the Congress, to the states, and to the American people about what he would do.

Unless he takes steps to remedy his position, he will have trouble convincing Republican voters he is serious about repeal and will have an even harder time mapping a clear plan on health reform should he be elected president.
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To read another article by Grace-Marie Turner, click here.

Major corporations may dump health insurance, pay penalties instead

Shocker: Major corporations may dump health insurance, pay penalties instead

posted at 11:37 am on May 6, 2010 by Ed Morrissey

Well, well, well. Remember when Barack Obama said that under ObamaCare, people would keep their existing health plans and doctors? Remember when any suggestion that companies would find it a lot less expensive to dump employer-based health care and pay the penalties instead were cast as “myths” and “scare tactics,” even though the math was extremely easy to see? Welcome to Hope and Change:

The great mystery surrounding the historic health care bill is how the corporations that provide coverage for most Americans — coverage they know and prize — will react to the new law’s radically different regime of subsidies, penalties, and taxes. Now, we’re getting a remarkable inside look at the options AT&T, Deere, and other big companies are weighing to deal with the new legislation.

Internal documents recently reviewed by Fortune, originally requested by Congress, show what the bill’s critics predicted, and what its champions dreaded: many large companies are examining a course that was heretofore unthinkable, dumping the health care coverage they provide to their workers in exchange for paying penalty fees to the government.

Remember Henry Waxman’s threat to subpoena CEOs over their writedowns on the tax credit that disappeared in ObamaCare? Fortune now reveals why those hearings got canceled:

Waxman didn’t simply request documents related to the write down issue. He wanted every document the companies created that discussed what the bill would do to their most uncontrollable expense: healthcare costs.

The request yielded 1,100 pages of documents from four major employers: AT&T, Verizon, Caterpillar and Deere (DE, Fortune 500). No sooner did the Democrats on the Energy Committee read them than they abruptly cancelled the hearings. On April 14, the Committee’s majority staff issued a memo stating that the write downs were “proper and in accordance with SEC rules.” The committee also stated that the memos took a generally sunny view of the new legislation. The documents, said the Democrats’ memo, show that “the overall impact of health reform on large employers could be beneficial.”

Nowhere in the five-page report did the majority staff mention that not one, but all four companies, were weighing the costs and benefits of dropping their coverage.
It’s not just the calculus of mandates and penalties that has employers considering the option of dumping health care and paying more in salaries instead. The mandate to keep “children” on plans until the age of 26 has employers seeing a steep cost curve. For Caterpillar alone, the 26-year-old mandate will cost over $20 million a year. Under those conditions, the penalties look pretty good. Add on the “Cadillac tax” on some health plans and the expected jump in medical costs from providers dealing with their own set of mandates, and health insurance looks like a very bad risk.

What will it cost the government to provide subsidies for tens of millions of Americans who used to get health insurance through their employers? No one really knows for sure, but Fortune takes a stab at it:

What does it mean for health care reform if the employer-sponsored regime collapses? By Fortune’s reckoning, each person who’s dropped would cost the government an average of around $2,100 after deducting the extra taxes collected on their additional pay. So if 50% of people covered by company plans get dumped, federal health care costs will rise by $160 billion a year in 2016, in addition to the $93 billion in subsidies already forecast by the CBO. Of course, as we’ve seen throughout the health care reform process, it’s impossible to know for certain what the unintended consequences of these actions will be.

But some of us predicted that the numbers used by Democrats pushing ObamaCare bore little connection to reality — and that it would incentivize employers to destroy the net of employer-based health insurance. It looks like that day is fast approaching, and that’s no myth. It’s a reality that Henry Waxman tried hard to hide from the American public.
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Medicare Report Shows ObamaCare’s Harmful Budgetary Impact
Grace-Marie Turner
Thursday, May 06, 2010

Many Americans wondered why Congress was in such a rush to take the final vote on ObamaCare at midnight on a Sunday night when most of its major programs don’t begin until 2014. It’s now clear that Democratic leaders feared their members might balk if they saw the objective analysis that was being prepared showing the overhaul law’s true costs.

Their concerns were validated when a respected, non-partisan analyst issued a report one month after the law was enacted. The chief actuary for Medicare, Richard Foster, found that under ObamaCare, health spending and health costs will rise, businesses and families will face higher premiums, millions of people will lose their current coverage, and seniors will have trouble accessing care.

The analysis by the administration’s own actuary confirms why a majority of Americans opposed the legislation and why House Republicans want Foster to testify about his findings.

Foster’s analysis already has had an impact on decisions regarding one of the first programs launched under ObamaCare – the new temporary high-risk pools for the uninsured. Congress allocated $5 billion to fund the pools until 2014 when enrollees would be transferred into new health insurance exchanges.

But Foster found that the $5 billion “would be expended during the first 1 to 3 calendar years of operation.” That means states could have to fill the funding void. Nineteen states told HHS Secretary Kathleen Sebelius, “No thanks” when she asked if they planned to run these new programs.

The states don’t want to be responsible for the added cost of the federal high-risk program and wisely chose to protect their taxpayers from yet another unfunded liability. As a result, HHS will now be responsible for creating and operating risk programs in these 19 states.

They wisely told Sebelius who is in charge and that they will not be subservient to Washington.

Now that Foster’s report is out, the White House spin can’t hide the fact that ObamaCare is an abject failure at achieving its number one goal: reducing health care costs. Foster’s analysis estimates that total national health spending will increase by $311 billion as a result of ObamaCare, thereby bending the cost curve up.

He also predicts higher health insurance premiums for individuals and businesses because billions of dollars in new fees and excise taxes will “generally be passed through to health consumers in the form of higher drug and devices prices and higher premiums."

Foster warns that the cost of the health overhaul law may be much greater than advertised. It relies on more than $500 billion in Medicare cuts to help pay for the new entitlement spending. But these cuts “may not be fully achievable” because “Medicare productivity adjustments could become unsustainable even within the next ten years,” Foster wrote. Given Congress’s inability to address Medicare’s exploding costs thus far, Foster’s skepticism is justified.

The report also highlights the shaky financial footing of the new long-term care insurance program – the CLASS Act, which Sen. Kent Conrad (D-ND) has described as “a Ponzi scheme of the first order.” Foster agrees the program faces “a significant risk of failure,” resulting in “a very serious risk that the problem of adverse selection will make the CLASS program unsustainable.” At a time of ballooning deficits and record debt, he finds the program will result “in a net Federal cost in the long-term.”

Concerned you’ll be kicked off your health insurance plans due to ObamaCare? Foster’s report shows that millions of Americans will suffer just this fate. He estimates that 14 million people will lose their employer coverage by 2019 as smaller employers terminate their plans and as workers who currently have employer plans enroll in taxpayer-subsidized coverage.

For seniors, Foster estimates that more than seven million will lose their current Medicare Advantage plans and that the “new provisions will … result in less generous benefit packages.” Recipients on traditional Medicare also will have trouble accessing care: Fifteen percent of all hospitals, nursing homes and other providers treating Medicare recipients could be operating at a loss by 2019 and “possibly jeopardize access to care for beneficiaries.”

He also warns that there simply is not enough capacity in the system, especially at government payment rates, to provide actual medical care for the newly insured: “The additional demand for health services could be difficult to meet initially with existing health provider resources and could lead to price increases, cost-shifting, and/or changes in providers’ willingness to treat patients with low-reimbursement health coverage.”

Unfortunately, the White House and congressional leaders are unlikely to address the damaging findings in Foster’s analysis. When Americans begin to feel the impact, they will see there was independent evidence of the false promises proponents made to gain votes to enact this unpopular legislation.

Obama's Strategy of Silence

Obama's Strategy of Silence
By Grace-Marie Turner from the September 2011 issue

The president is trying to hide from his "signature achievement."

The White House is quietly implementing a shrewd new strategy of silence on Obamacare. Its goal: making sure the revolt against the unpopular health care overhaul that swept Republicans into power across the country in November 2010 isn't repeated in 2012.

After two years of nonstop focus on health care, the president has stopped talking about the law's far-reaching effects. Now he is concentrating on a few micro changes. Meanwhile the administration is working hard to dampen controversy by handing out buckets of waivers and attacking Republicans over Medicare.

Bringing Obama around to this new course wasn't easy for his advisors. The day after last November's elections, the president belligerently refused to acknowledge that the results were a referendum on his unpopular policies or that Obamacare had hurt Democratic candidates. His health policy agenda was correct and possibly only needed a bit of "tweaking," he insisted.

But his advisers pored over the election results and reached an inescapable conclusion. "The economy, as important as it was, was not the decisive factor this election. Health care was," Democratic pollster Pat Caddell said just after the election. "It is…health care [that] killed them," Caddell said of the 63 defeated House Democrats. "The American people found this a crime against democracy…they want it repealed, and this issue is gonna go on and on." Now the White House's strategy has the president talking as little as possible about Obamacare.

We haven't intercepted their memo to the Oval Office, but we can extrapolate from recent White House tactics what his advisers have recommended Obama must do:

1. Stop talking about it. Every time you talk about the sweeping overhaul of health care, your poll numbers go down. People know you can't spend $1 trillion and pretend to reduce the deficit. Or take more than $575 billion out of Medicare and make it stronger. Anyway, it is now the law of the land and the wheels of bureaucracy are grinding to make sure it takes effect in 2014. Your only job right now is to get reelected to veto any reform bills passed by the next Congress.

2. Focus on the small stuff. People don't know what is in this law, as Republicans so annoyingly continue to remind us with Nancy Pelosi's unfortunate quote -- "We have to pass the bill so you can find out what's in it." We can calm the opposition if the public is convinced that it's only about putting 26-year-olds on their parents' health insurance, free preventive care, risk pools for preexisting conditions, and some new insurance regulations. We should call attention to those who have already benefited from the law's early provisions. If people believe it is only about small changes, they will wonder what all the fuss was about.

3. Attack Republicans. Health care is a Democratic issue and always will be. So go after Republicans for their ridiculous ideas about "private competition" and "putting consumers in charge of decisions." Paul Ryan has given you a golden opportunity to target Republicans for trying to destroy Medicare and forcing seniors to pay thousands of dollars more for health care. Hammer away at him.

4. Calm the opposition. The most important thing is to keep opponents quiet. Health Secretary Kathleen Sebelius is a key ally here since the health law gives her so much power over how it is implemented. Focus on the governors. Sebelius should find ways to give them temporary relief from Medicaid costs. She also should issue waivers to states, companies, and anyone else who complains the new law is hurting them.

THE NEW OBAMACARE strategy is working smoothly except for tactic number 4. The waiver tactic backfired, as it became clear that waivers from the law's early provisions were needed and were being granted disproportionately to politically favored groups (restaurants and spas in San Francisco and hundreds of labor unions, for example). To calm the negative press, the administration now says waivers will be good through 2013, and it will stop granting new ones as of September 22, 2011.

But the rest of the strategy clearly is in place. Since the elections, the president has not given a single speech on the major changes coming from his health law. His main focus has been on tactic number 3--attacking Republicans at every opportunity and claiming that he is the protector of Medicare because he won't "ask our seniors to pay more for health care."

So far, it seems to be working. Obamacare has evaporated as a major issue. The House of Representatives voted overwhelmingly to repeal the law in January and, according to a CBS News poll, about half of those asked think it has been repealed or aren't sure. The confusion suits the White House just fine. Republicans are working to defund the law, delay its implementation, investigate the avalanche of regulations that have already been issued, and examine the impact the law is having on health costs and the ballooning deficit, but their efforts didn't make the front page.

It is difficult to overestimate the sweeping impact that Obamacare will have on our health sector, our economy, and our freedom. (My co-authors and I have highlighted in our book Why ObamaCare Is Wrong for America [Broadside/HarperCollins, 2011] the devastating impact it will have on seniors, families, young people, taxpayers, employers and employees, doctors and patients).

WILL THE SUPREMES rescue us? While many hope Congress will repeal the law, others believe there is a good chance its key provision--that all citizens purchase federally approved health insurance--will be declared unconstitutional by the Supreme Court. That is a big gamble.

The Sixth Circuit was the first of several appeals courts to rule on the validity of Obamacare's mandate; conservatives were disappointed about its decision in late June to uphold it. At least two other appeals courts will issue decisions over the next several months, with a likely U.S. Supreme Court hearing next year and a decision by June 2012.

Scholars expect a 5–4 decision, with Justice Anthony Kennedy the deciding vote. Courts are reluctant to overturn major legislation enacted by Congress. The Supremes will likely look at public opinion in weighing their decision. If the law is still unpopular, it will be much easier for them to decide (correctly) that the individual mandate is unconstitutional. But if the country seems to have settled into acceptance, they could do the easy thing and let the legislation stand.

That's yet another reason the White House is doing everything it can to calm opposition and convince the public that the law is beneficial. The Supreme Court verdict could depend upon its strategy of silence.

THIS STATE OF AFFAIRS won't last forever, though. If the president were to be reelected and Obamacare therefore left in place, the American people will have a shocking awakening in 2014…

…when they are facing a mandate to purchase health insurance policies that will be one of the most expensive items in their family budget.

…when job creation continues to stall because employers are reluctant to hire workers due to federal mandates, fines, and even higher health costs.

…when businesses have to find out their employees' household income so they can avoid $3,000 per-employee annual fines.

…when states find that adequately funding schools, roads, and police protection is almost impossible because dramatically expanded Medicaid costs are crushing their budgets.

…when hospital emergency rooms are still flooded with patients but funds for this "uncompensated care" are vanishing.

…when tens of millions more line up for subsidized health insurance, adding $1 trillion or more to the cost of the law.

…and taxpayers realize that estimates of the cost of Obamacare were dramatically understated, with more and more deficit-financed dollars poured into an unreformed health care system.

In the face of this tsunami of change, it's crucial to direct the conversation back to the health care law's defects. There are two hot-button issues that will surely force Obamacare back into the center of the political debate: employment-based health insurance and Medicare--both of which affect two huge constituencies with health coverage that is threatened by Obamacare.

Start with employer-based health insurance. The White House knew that providing security to those with coverage was a key selling point for passing legislation designed to provide insurance to an estimated 32 million more Americans. Hence the mantra: "If you like your health insurance, you can keep your health insurance." But a recent survey of employers conducted by the consulting group McKinsey & Company found that up to 50 percent say they will definitely or probably pursue alternatives to their current health insurance plan after Obamacare takes effect in 2014. That means as many as 78 million Americans could be forced to find other sources of coverage--half of the 156 million working Americans who get health insurance through employers.

This also has huge implications for the deficit. This new entitlement program will exacerbate the extraordinarily difficult task of controlling federal spending. Before the health law passed, the Congressional Budget Office estimated that only 9 million to 10 million people, or about 7 percent of employees who currently get health insurance at work, would switch to government-subsidized insurance. But the McKinsey survey of 1,300 employers across industries, geographies, and employer sizes found "that reform will provoke a much greater response." It concludes that the new law will lead to a "radical restructuring" of job-based health coverage.

Another McKinsey analyst, Alissa Meade, told a meeting of health insurance executives soon after the November elections that "something in the range of 80 million to 100 million individuals are going
to change coverage categories in the two years" after the insurance mandates take effect in 2014. Many employees who will need to seek another source of coverage will take advantage of the health insurance subsidies for families making as much as $89,000 a year included in the health care law. This will drive up the cost of Obamacare by $1 trillion or more, according to Douglas Holtz-Eakin, a former director of the Congressional Budget Office.

The cost of Obamacare will also soar due to what liberals call "a glitch" in the law: employees can obtain subsidized health insurance if their employer plan is "unaffordable," meaning it costs more than 9.5 percent of their income. Let's take an employee who now has a family health plan through his job. Congressional analysts assumed that as long as the employer's coverage for the individual worker cost less than the 9.5 percent trigger, he wouldn't be eligible for subsidies even if the Obamacare-mandated family plan cost 20 percent of his income. Liberal advocates are worried about the impact of this budget gimmick. As one admits, "We're going to have middle-class families extremely unhappy with health reform in 2014, because they'll basically be facing financial penalties for not buying coverage when they don't have access to any affordable options."

The other unpopular aspect of Obamacare is its treatment of Medicare, which is being used as a budgetary piggy bank by Democrats. They count on using $575 billion in future payment cuts to finance creation of the two massive new entitlement programs in Obamacare. And the president has proposed taking another $480 billion out of the program to lower the deficit.

Under Obamacare, payments to providers would be cut so deeply that seniors will find it harder and harder to get care. Doctors would stop taking Medicare or go bankrupt, according to Medicare actuaries. A whopping 87 percent of doctors say they will stop seeing or will restrict the number of Medicare patients they see, further limiting access to care. Seniors also fear the powerful, 15-member Independent Payment Advisory Board (IPAB) that will use price controls to meet ever-elusive spending targets. Rationing is inevitable, especially of newer medicines and technologies.

Medicare is $38 trillion in the red, and it accelerated five years toward insolvency in just the last year, according to the Medicare Trustees' latest report. Sen. Marco Rubio captures it best in a new video, saying, "Anyone who is in favor of doing nothing to deal with this fact is in favor of bankrupting it."

But that is indeed the president's strategy. He repeatedly hammers House Budget chairman Paul Ryan for his plan to begin modernizing the program starting in 10 years. Ryan wants to give baby boomers the option of private coverage much like the plan members of Congress have today. Access to coverage would be guaranteed, and payments would be tailored to meet a person's age, health, and income level. Meanwhile, the president's plan would tighten the tourniquet on Medicare with price controls that will make it more and more difficult for seniors to find a provider. This will inevitably lead to government rationing of care.

SO HOW is this issue going to play in the 2012 elections? There is legitimate concern about former Massachusetts governor Mitt Romney as the Republican nominee. The president appears to relish opportunities to remind people that he used Romneycare, the state health care program Romney signed into law, as the model for his own plan.

His plan is an easy target for Democrats. Both Romneycare and Obamacare require residents to have health insurance or pay a penalty. Both force most businesses to participate or pay a fine. Both expand coverage through Medicaid and government-controlled insurance exchanges. Both subsidize highly prescriptive (and costly) insurance policies. And both require an expanded government bureaucracy to manage the whole Rube Goldberg contraption.

While Romney insists Obamacare must be repealed, it will be very difficult for him to put much daylight between his plan and the president's. Romney still is trying to defend his position that his plan was right for Massachusetts, but that he wouldn't impose it on the rest of the country.

Romney's plan for his first 100 days as president also is troublesome. First, he says he would begin to undo Obamacare with an executive order: "If I were president, on Day One I would issue an executive order paving the way for Obamacare waivers to all 50 states," he claims. "The executive order would direct the Secretary of Health and Human Services and all relevant federal officials to return the maximum possible authority to the states to innovate and design health care solutions that work best for them."

But Gov. Romney must know he can't use an executive order to wipe out two massive new entitlement programs, $550 billion in new and higher taxes, vast Medicaid expansion, and mandates on individuals, businesses, and the states to comply with the Patient Protection and Affordable Care Act. Waivers are not a solution.

Second, he says: "Of course, the ultimate goal is to repeal Obamacare and replace it with free-market reforms that promote competition and lower health care costs. But since an outright repeal would take time, an executive order is the first step in returning power to the states." Take time? The Republican House passed a repeal bill within a few weeks of taking power. If there were a majority in the Senate supporting repeal, they could repeal virtually all of its massive spending provisions with 51 votes, using the reconciliation process that allowed Obamacare to pass. Then a new president could have a bill to sign on his desk within a month or two of taking office.

FOR NOW, expect the administration to continue to play down Obamacare's changes and show flexibility at every turn.

For instance, there is the substantive concession that the president has made by quietly repealing the burdensome 1099 provision that would have required small businesses to track and report all transactions with vendors totaling $600 in a year. And last spring, the administration manipulated formulas to allow a small increase in the Medicare Advantage payments that were cut by the law. This avoided a firestorm among seniors who would otherwise lose their popular plans. But it means putting off the larger cuts that the law requires until after the presidential election.

Secretary Sebelius has said she now realizes changes need to be made to the law's long-term care program--another new entitlement which even the Democratic chairman of the Senate Budget Committee, Kent Conrad, called "a Ponzi scheme of the first order." And in July, she testified before two House committees that the dreaded IPAB won't be needed if Congress does its job in cutting Medicare payments to meet strict targets.

Tactic number 3--attack Republicans--is in full gear. Sebelius said in congressional testimony recently that the Republican Medicare plan could cause people to "die sooner." When challenged at a later hearing to defend the statement, she took the offense to criticize the Ryan Medicare plan. Clearly, it is imperative that conservatives prevent Sebelius and Obama from defining the issue on such distorted terms. It would be disastrous to allow the president to try to hide from his "signature achievement," or distract the public by demonizing Paul Ryan and his Medicare plan.

Our country's future will be determined by what happens in 2012. The American people tried to tell Washington in every way they could that they strongly opposed Obamacare--from town hall meetings, marches on Washington, and electing Republicans to office in very blue states, to creation of an entirely new political movement. Washington didn't listen. Now the White House hopes we will forget.

That's why it is so crucially important that Obamacare not slip to a second-tier issue in the political debate. The threats to our liberty, our economy, and our future prosperity could not be greater.

6 big ideas for Obamacare repeal and replace

6 big ideas for Obamacare repeal and replace
By: Cathy Taylor
7/1/2012 06:56 AM

House Republicans soon will vote to repeal the heath care law that the Supreme Court just upheld. The November election may bring a new president and a Senate majority that will carry out the mission to replace the Affordable Care Act, known as Obamacare. Democrats charge that those who oppose Obamacare have no ideas or alternative plans, but that is simply not true.

There is not only a different way to deliver health care, there is a better way to achieve better outcomes. Americans want less government in their health care decisions, not more. They seek the kinds of reforms that wrench the system away from government control and toward free markets, flexibility for states to address their particular concerns, choice for patients, competition among providers and toward structures that put decision making in the hands of those closest to the condition—doctors and patients. And, they want effective ways to control costs.

The Editors of Human Events did not have to look far to find free market health care concepts that are already in place and succeeding in various states and among private companies. Some initiatives are as modest as a private exchange in Utah serving a few thousand people, or as large as Medicaid reform in Florida. Thirty-five states have launched high risk pools, with varying degrees of accomplishment, but with plenty of track record to learn from.

The point is, Republicans have a lot to recommend, and they should pursue “repeal and embrace,” as one of our Special Focus: Health Care writers put it, in the Legislature. The Republican Study Committee last week released a 27-page document that lists more than 200 pieces of health care-related legislation introduced by members of the committee in the last 18 months.

For this Special Focus, we identified health care initiatives that are already succeeding and we asked people involved in those initiatives to write about them. Here’s what they had to say.

No. 1: A ‘defined contribution’ model is a key building block for free market plans
by Grace-Marie Turner

There are structural elements common to virtually all market-oriented health reform proposals to give consumers in both public and private plans more control and ownership over health care arrangements.

No. 2: How to save Medicare
Exclusive Q&A with House Budget Committee Chairman Rep. Paul Ryan of Wisconsin.

No. 3: Florida’s pro-taxpayer cure for Medicaid
by Tarren Bragdon

States seeking to improve patient health and save taxpayer dollars should look at Florida’s Medicaid Cure program.

No. 4: Exchange expanded coverage to small businesses in Utah
by Cheryl Smith

The Utah Health Exchange is not a regulatory entity, did not result in the establishment of a new state agency, and did not require any new mandates or taxes.

No. 5: ‘Account-based’ plans are bending the health care cost curve down
by Roy Ramthun

These insurance plans come with higher deductibles than most traditional plans and are paired with tax-preferred accounts, such as a health savings account or a health reimbursement account.

No. 6: High risk pools are workable alternative to costly pre-existing condition mandate
by Merrill Matthews

High risk pools, which charge a higher premium to those with pre-existing conditions, keep private health insurance pools large and more affordable.
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To read another article about Obamacare, click here.

Coulter Care

Coulter Care
By Peter Ferrara on 2.8.12 @ 6:10AM

Schooling Ann Coulter on the individual mandate.

Sorry, Ann. I have adored you as a commentator, as you know, and appreciate your kind words about me in the past. But in discussing the individual mandate in your piece last week, "Three Cheers for RomneyCare," you honestly don't know what you are talking about. In the process, you are transgressing on my own work and past policy achievements, and grossly undermining the policy and political case against Obamacare. Read on, and I will explain in full.

It was me, working for and with conservative health policy guru John Goodman, who first rang the alarm bell for conservatives over the individual mandate in the early 1990s. As I explained recently in this space, it was we who led the fight to kill the Heritage Foundation health bill at that time.

That bill had been introduced by Sen. Don Nickles (R-OK) because he thought it was the conservative alternative to HillaryCare. Leaving Heritage over the matter and working for Goodman's National Center for Policy Analysis, I went through the bill line by line and wrote up all the conservative objections, which primarily stemmed from the individual mandate. I then got my critique signed by 37 major conservative leaders.

It was the only time you could find Phyllis Schlafly and Ed Crane signing on to the same document. Others who signed included Paul Weyrich, David Keene, and Grover Norquist. It was a Who's Who of conservative leaders.

When I delivered the document to Nickles' office, he had the good sense to pull the bill. Stuart Butler was furious with me, and it has ruined our previously close friendship to this day. I received awards for this work from the American Conservative Union and the Eagle Forum. That is because the Heritage health plan with its individual mandate was detested throughout the conservative movement, and there was broad approbation for my work in practically figuring out how to pull them back.

Why the Individual Mandate Equals Socialized Medicine

Here is why the individual mandate inevitably leads to full-blown socialized medicine, as it has with Obamacare: When the government mandates that you have to buy health insurance, then it has to specify what health insurance is required to satisfy the mandate. This means politics is involved in deciding what must be included and covered by that insurance.

And once politics is involved, that means you can't leave anything out, as that would be taken as an offense and a slight to both the consumers and the providers of the excluded service. Mental health benefits and counseling, drug rehab, maternity benefits (even for men and seniors), abortion -- everything must be covered. We will see that when the final regulations are issued for Obamacare by the Supreme Dictator, Kathleen Sebelius (who looks and acts the part of a villain from an Ayn Rand novel). We are already seeing that the mandated services must include sterilization and "morning after" pills, which even Catholic institutions will have to pay for in regard to their own employees.

That means the mandated health insurance will inevitably be extremely expensive, as we are just starting to see with Obamacare. To make such a mandated expense politically palatable, the government must provide extensive welfare subsidies well into the middle class and beyond, again as we see with Obamacare. The biggest expense there is not the explosion of Medicaid, as bad as that is. It is the entirely new entitlement program providing benefits (subsidies) for the purchase of the mandated insurance for families making up to $88,000 a year to start, indexed to grow to over $100,000 in the near future.

But there is still another shoe to drop. As the costs to the government, taxpayers, and others for this mandated health insurance skyrocket, the government will decide it must step in to control costs. That means more than just price controls on health insurance, which can't repeal the mathematics of needing enough revenue to pay for the covered benefits. It means the government deciding what health care will be paid for and for whom, and what will not. In other words, rationing. After all, if the government is ultimately paying, then just being careful stewards of public funds means the government must ultimately decide what health care gets paid for, and what doesn't. This reasoning is how the public comes to accept such health care rationing in the countries with socialized medicine.

And so starting with the individual mandate, we inevitably get to full blown socialized medicine, with the government and swarms of new bureaucracies to control health insurance and health care, including Sarah Palin's death panel. This is why even the Heritage Foundation finally realized its error years ago, and has now turned around to oppose the individual mandate, even filing Supreme Court briefs against it.

And this is why all the leading conservative health care experts have so vociferously opposed the Obamacare individual mandate, from John Goodman, to Betsy McCaughey, to Grace Marie Turner, to Sally Pipes, to myself.

Coulter's Fallacies

Now, Ann, don't get mad at me because I have to extend this analysis to explain in particular your fallacious reasoning. Perhaps if you had called one of the above leading experts to do basic research beforehand, you would have written a better piece. And I am sorry, but it is not my fault that you didn't.

Coulter writes, "The only reason the 'individual mandate' has become a malediction is because the legal argument against Obamacare is that Congress has no constitutional authority to force citizens to buy a particular product... The hyperventilating over government-mandated health insurance confuses a legal argument with a policy objection."

But the above discussion shows that this is not only wrong, but uninformed and even unreasoned. I have been hyperventilating over government-mandated health insurance for 20 years, ever since I was inspired to kill the Heritage health plan. That was never about a legal objection, but about a policy objection -- that the individual mandate inevitably leads to full-blown socialized medicine.

Coulter writes further, "But because both Obamacare and Romneycare concern the same general topic area -- health care -- and can be nicknamed (politician's name plus 'care'), Romney's health care bill is suddenly perceived as virtually the same thing as the widely detested Obamacare."

No, Ann, it's a lot more than that. Where did you get that excessively speculative rationalization? Romney's health care bill is perceived as virtually the same thing as the widely detested Obamacare because it is virtually the same thing as the widely detested Obamacare.

Both Romneycare and Obamacare include the individual mandate. Both Romneycare and Obamacare include sharp increases in Medicaid. Both Romneycare and Obamacare include guaranteed issue and community rating (like requiring fire insurers to insure homes that have already caught fire, and at the same standard rates as for everyone else). Both Romneycare and Obamacare include welfare subsidies for the purchase of health insurance well into the middle class. And both Romneycare and Obamacare include the latent government power for price controls on health insurance and rationing of health care.

No, Ann, this is not "like saying state school choice plans are 'the same idea' as the Department of Education."

But Coulter continues,

States have been forcing people to do things from the beginning of the of the republic: drilling for the militia, taking blood tests before marriage, paying for public schools, registering property titles and waiting in line for six hours at the Department of Motor Vehicles in order to drive. There's no obvious constitutional difference between a state forcing militia age males to equip themselves with guns and a state forcing adults in today's world to equip themselves with health insurance.

That is true but irrelevant. States have the admitted constitutional power under the federal Constitution to adopt an individual mandate if they want to do so.

What is relevant is that there is no important difference between state-run socialized medicine and federally run socialized medicine. Ronald Reagan would have fought against each just as fiercely. That is why, if he were alive today, he would be just as strongly opposed to Romneycare as Obamacare.

But Coulter imparts to us her health care policy insight that the only thing wrong with Romneycare is Democrats: "First, the overwhelmingly Democratic legislature set the threshold for receiving a subsidy so that it included people making just below the median income in the United States, a policy known as 'redistribution of income.'" But as explained above, this policy is the inevitable result of an individual mandate. If the government is going to force people to buy the most expensive health insurance possible, the government is going to come under irresistible pressure to help even middle income people and above pay for that mandate.

Coulter further explains the role of those dastardly Democrats: "Then, liberals destroyed the group rate, 'no frills' private insurance plans allowed under Romneycare ... by adding dozens of state mandates, including requiring insurers to cover chiropractors and in vitro fertilization -- a policy known as 'pandering to lobbyists.'" But again, as explained above, this was only the natural, predictable, indeed inevitable result of the individual mandate. Once the government has to specify the health insurance plan the mandate requires everyone to buy, no one can be left out in our democratic system.

Coulter explains that all of this is necessary because of the "free rider problem" that results when people decide not to buy insurance, incur health costs, and then don't pay, shifting those costs to the rest of us. But such uncompensated care for the uninsured is just 2 percent of total health costs, which amounts to a weak excuse, not a justification, for socialized medicine.

The government's free-rider problem, from failing to pay market rates to doctors and hospitals under Medicare and Medicaid, is estimated to produce twice as much cost shifting to the rest of us. Obamacare makes that much worse by greatly expanding Medicaid and sharply slashing payments to doctors and hospitals under Medicare, which shows that such cost shifting is not remotely what these folks are concerned about.

Romney's Corruption of the Reagan Coalition

This episode perfectly illustrates the problem with the lifelong liberal Mitt Romney, coming from a liberal heritage going back to his father, now stepping forward to lead Republicans against the Marxist infiltrator Barack Obama. Inevitably, Romney will pull the Republican Party to the left and crack up the Reagan coalition which has dominated the party since 1980.

And it's not just the Republican Party, but the conservative movement as well, as we see when a formerly firebreathing leader like Ann Coulter caves in an unquestioning fashion to Romney's embrace of the individual mandate. Conservative leaders were uniformly appalled by the Heritage health plan and its mandate rolling downhill to socialized medicine. Coulter cites it as a reason to support Mitt Romney.

Last week came further troubling confirmation of the rapidly developing disaster. As soon as Romney got himself in trouble due to his unfamiliarity with conservative doctrine on welfare policy and the poor, he suddenly veered left to bail himself out. He is now to the left of Barack Obama and Nancy Pelosi on the minimum wage, endorsing an automatic increase that even Obama and an overwhelming Democrat Congress didn't support. Somebody buy the man a Charles Murray anthology, and a compilation of Jack Kemp's speeches.

When the government raises the cost of hiring low-skill workers by raising the minimum wage, naturally employers hire fewer of them at the higher cost. That leaves more of the least skilled without work and consigned to poverty. The new Democrat Congress in 2007 enacted a sharp minimum wage increase in three steps. Unemployment for minorities jumped from under 9 percent to almost 16 percent. For teenagers, the rate jumped from under 15 percent to over 23 percent. And for black teenagers, unemployment soared to over 40 percent. How high will unemployment among the disadvantaged go under Romney's thoughtless policies?

The government should not be setting wage rates. That should be left to the market. That is why Ronald Reagan, soon after he was nominated in 1980, called for the abolition of the minimum wage law. As Milton Friedman explained, that law is expressly designed by union operatives to suppress competition from lesser skilled and lower cost workers, propping up above-market union wage scales. That, of course, comes at the expense and suffering of the low-skilled poor, who are then excluded from the entry-level positions that would help them build skills and climb the ladder.

This just demonstrates Romney's basic political instincts to pander to the liberal media, which he exhibited throughout his career in Massachusetts politics. Coulter excuses him, saying he had to go liberal to succeed in liberal Massachusetts. But liberal political expediency has never before been considered a qualification for presidential support from conservatives. What other liberal/left sellouts can we expect from Romney once he gets the nomination? Or worse, if he is elected? Check out the complete list of Romney advisors for a clue.

Everything about Romney screams "Country Club Republican." This is not a man who will inspire the conservative grassroots to come out in maximum force, carrying Republicans with him to victory in the Senate, as Reagan -- and later Gingrich -- did. Instead, Romney is the perfect foil and caricature for Obama's political strategy this year, a perfect example of the problem, according to Obama's narrative. Perhaps Ann is spooked by the need to liberate the country from Obama's Marxists, thinking we must embrace the safest, most electable candidate. But that prevent-defense thinking is a prescription for failure, if not disaster, if Romney is elected and turns out to govern as a Massachusetts liberal after all.

Tea Party Republicans are not going to sit still for another round of George H.W. Bush, which is what Romney is offering us. They will bolt, resulting in the breakup of the Republican party. That is the fire we are playing with in Mitt Romney.
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To read another article by Peter Ferrera, click here.