Second Opinion:
Where health care policy experts have their say


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November 11, 2010:
Post-Election Predictions for Obamacare

November 3, 2010 Republicans retook the House, in no small measure as a result of President Obama and a Democratic Congress over-reaching when they passed the Patient Protection and Affordable Care Act last March through a cynical legislative process and divisive partisan vote. The resulting legislation is extraordinarily expensive, and will do little to address that nation's underlying health care problems. While Republicans have promised to "repeal and replace" Obamacare, the road ahead will be difficult, given President Obama's veto power. At the same time, sustainable reform of the U.S.'s health care entitlements (Medicare and Medicaid) is a more pressing issue than ever. What can Republicans do to fulfill their pledge over the next two years and help create a truly competitive, affordable, and patient-centered U.S. health care system?

This edition of our expert panel includes:

  • Dr. David Gratzer, senior fellow at the Manhattan Institute
  • Thomas Miller, resident fellow at American Enterprise Institute
  • Sally Pipes, Taube Fellow in Health Care Studies, president and chief executive officer of the Pacific Research Institute
  • Peter Pitts, president and co-founder of the Center for Medicine in the Public Interest
  • Tevi Troy, visiting senior fellow at the Hudson Institute and senior fellow at the Potomac Institute
  • Grace Marie Turner, president of the Galen Institute

By David Gratzer

The Patient Protection and Affordable Care Act is decidedly unpopular. But, at the risk of stating the obvious, it’s also the law.

And laws are difficult to overturn. Presently Republicans lack a majority in the Senate. Even if they had scored wins in Nevada, Colorado, and a handful of other close races on November 2, they still wouldn’t have the votes to overturn a Presidential veto.

What’s then to be done? In the new Congress, Republicans and moderate Democrats should focus on three of the most significant – and controversial – aspects of the law: a tax on medical devices that will impede innovation; a new technocratic committee to “guide” health care spending that will undermine the doctor-patient relationship; health-insurance exchanges meant to spur competition that will instead strangle it with heavy regulations. For the tax and the committee, they should push for “micro-repeal.” In the case of the health-insurance exchanges, they should seek to expand and deregulate the exchanges, allowing interstate sales of insurance, for instance.

David Gratzer, a physician, is a senior fellow at the Manhattan Institute. His research interests include consumer-driven health care, Medicare and Medicaid, drug reimportation, and FDA reform.

* * *

By Thomas P. Miller

Beyond Repeal and Replace (this piece was adapted from an op-ed on

The key question for Republican leaders after Tuesday's election results is what can they do now to turn their opposition to ObamaCare into governing reality.

Hill Republicans should challenge the next Congressional Budget Office director to re-examine several of CBO's previous budgetary assumptions (particularly involving whether many employers will drop private coverage.) Smarter incentives to reward responsible behavior and better-targeted protections of the most vulnerable portions of the population are essential pillars of more vigorously competitive health insurance markets. Republicans should replace unpopular insurance coverage mandates with a pledge of protection against coverage exclusions for pre-existing health conditions that is limited to those who remain continuously insured over time. This approach needs to be bolstered with the backstop of a high-risk pool safety net that is subsidized sufficiently (though not lavishly) by taxpayers in an income-sensitive manner. Consumers failing to find coverage on the terms they want or can afford from traditional sources should be able to turn to information-heavy/regulation-light health exchanges that are organized by states in a more competitive, choice-expanding manner than ObamaCare would allow. Opening up sale and purchase of health insurance across state lines also would lower the regulation-added costs of health insurance to some extent (probably about ten to fifteen percent on average), as long as such competition among various state brands of regulation is driven by consumer choice and provides sufficient safeguards.

Tom Miller is a resident fellow at the American Enterprise Institute and a co-author of the forthcoming book What Will Happen to You Under ObamaCare?

* * *

By Sally Pipes

Last week, Americans broadcast their displeasure with Obamacare by relieving Democrats of control of the House of Representatives. The president's veto pen is primed to thwart Republican efforts to "repeal and replace" his signature health reform law. But lawmakers can start to advance real reform even with President Obama in the White House.

First, legislators should scrap the law's requirement that businesses file 1099 tax forms for each vendor with whom they do more than $600 in annual business. The provision will saddle 40 million businesses with huge new compliance costs.

President Obama may be on board. Last week, he said the rule "appears to be too burdensome for small businesses."

Congress can also starve the Obamacare beast by refusing to appropriate the $115 billion needed to fund the 160 boards, commissions, and agencies created by the law.

These are but the first steps to implementing patient-driven health reform in the United States. Voters will have the opportunity to finish the job in 2012 by ushering President Obama out of office and sending another round of fresh lawmakers to Congress.

If last week's election results are any indication, Obamacare may soon be history.

Sally Pipes is Taube Fellow in Health Care Studies, president and chief executive officer of the Pacific Research Institute.

* * *

By Peter Pitts

When it comes to healthcare reform will the 112th be sanguine or sanguinary? Or is there a third way – of bipartisanship? Considering the role that healthcare reform played in the midterms, we can expect all three.

We can expect a series of hearings on the many aspects of the Patient Protection and Affordable Care Act. And many will center on the contentious philosophical notion of a government-run cost-centric design versus a free-market patient centric system.

Hearings are likely to focus on cost– and there’s plenty of grist for the mill. Remember all that money that healthcare reform was going to save us? Well former OMB chief Peter Orszag put that shibboleth to bed.

Hearings on this topic will be closely watched as a bell-weather for significant ObamaCare reform. Congressional Budget Office re-scoring will be at the top of the card.

Will the 112th Congress usher in a new spirit of bipartisanship on healthcare reform? That’s the difference between addressing policy concerns and playing politics. Winners and losers (not to mention “enemies”) aside, we’ve got an opportunity to fiercely fix ObamaCare.

It’s time for pragmatism -- or we can all go down with the (partisan) ship.

Peter Pitts is President and co-founder of the Center for Medicine in the Public Interest and Partner/Director Global Healthcare, Porter Novelli.

* * *

By Tevi Troy

Despite their historic victory, it will be tough for Republicans to transform our health care system over the next two years because they lack a majority in the Senate, let alone a filibuster-proof majority, and President Obama still has the veto pen. This means that repeal, which is the stated goal of the new GOP House majority, is simply not going to happen in the next session in Congress. Given this situation, I expect Republicans to spend the next two years highlighting the law’s most unpopular and unworkable provisions, by working to defund aspects of the new law's implementation, holding hearings to force Obama administration personnel to defend their activities, and using the majority’s investigative tools to shed light on the law's deficiencies. We may also see Republicans try to tweak or fix some of the law’s most egregious provisions, such as the 1099 reporting requirements that will saddle businesses with huge paperwork requirements, but the focus will be on building the case for repealing the current law and replacing it with a more efficient, market-friendly, value-driven health care system after the 2012 elections.

Tevi Troy is a Visiting Senior Fellow at the Hudson Institute, a Senior Fellow at the Potomac Institute, and a writer and consultant on health care and domestic policy.

* * *

By Grace-Marie Turner

While the White House and Democratic leaders in Congress try to pretend otherwise, a vote for the health law was a death knell for Democratic candidates in the Nov. 2 elections.

All five of the House Democrats who flipped from voting "no" to "yes" on final passage lost their seats. Seniors voted overwhelmingly against candidates who supported passage and defeated many of them. The two Democrats who actively defended their votes for ObamaCare – Sen. Russ Feingold (D., Wis.) and Rep. Earl Pomeroy (D., N.D.) – both lost.

Even Democratic pollster Pat Caddell said health care was key to his party’s loss of at least 60 seats in the House. He told Fox News: “The economy, as important as it was, was not the decisive factor this election. Health care was,” he said.

“It care [that] killed them,” Caddell continued. “The American people found this a crime against democracy... they want it repealed, and this issue is gonna go on and on.”

Even if substantive changes to the law could get through the Democratic Senate, President Obama will resist – and veto – any effort to make major changes to his signature legislation. Consequently, the House is likely to push for measures that delay, defund, and begin to dismantle the legislation.

As Republicans try to stall implementation of the law, they must simultaneously articulate their own solutions to the very real problems in our health care sector. They have signaled they plan to take a step-by-step approach to reform.

They will target the most unpopular parts of the law for immediate repeal and will try to enlist conservative Democrats who survived the election to elp override a likely presidential veto.

Congress also will be getting a great deal of pressure from a large number of new Republican governors disinclined to go along with the avalanche of requirements to comply with the new law. They will want flexibility, for example, to redefine an acceptable structure for a Health Insurance Exchange and relief from the dramatic and costly expansion of Medicaid.

Because President Obama and Democrats in Congress don’t appear to be listening to the American people’s serious concerns about the health care overhaul law, the battles will continue at least through 2012 when voters get another chance to get their attention in the voting booth.

Grace-Marie Turner is president of the Galen Institute, a public policy research organization that she founded in 1995 to promote an informed debate over free-market ideas for health reform.

* * *




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