The best part of the plan is the fixed tax credit. This is an idea proposed by Mark Pauly and me in Health Affairs almost 20 years ago and virtually all economists favor it. It contrasts with tax deductions and exclusions employer payments that are not counted in the employee’s taxable income. These unbounded tax subsidies encourage over-insurance because we can all lower our taxes by buying more expensive insurance. The fixed sum tax credit, by contrast, pays for the first dollars of coverage but beyond some point all remaining premium payments are made with after-tax dollars. This means that individuals won’t buy another dollar of insurance unless they get a dollar’s worth of value.Another good feature of the Capretta plan is that the tax credit is independent of income. It is universal, at least for people who buy insurance on their own. This contrasts with the Burr/Coburn/Hatch proposal, with which Capretta is associated and which he curiously promotes in the same chapter where he describes his own plan – even implying that the two plans are essentially the same. They’re not.
Savvy primary voters understood that all GOP candidates would criticize the detested Obamacare law, but they were looking for candidates committed to actually working towards repealing and replacing it. The Repeal Pledge was established in the summer of 2010 for just that purpose. It is designed to attest to the seriousness of the signer’s understanding that the Affordable Care Act is so fundamentally and structurally flawed that it cannot be fixed. Instead, it needs to be delayed, defunded, and prevented from metastasizing until it can be repealed and replaced with positive, patient-centered reforms.
Capretta’s tax on employer provided health insurance in practice turns out to apply to the top 35% of employer health plans, as reflected in the bill proposed by Senators Coburn R-OK, Burr R-NC and Hatch R-UT. That is a tax assessed against the covered workers, which means roughly 35% of workers not necessarily wealthier than middle income could be expected to bear that tax.Moreover, about 97% of voters have health insurance. So the plan is to raise taxes on about 35% of those who vote, to help finance insurance for those who don’t vote. Unions will be more worried about this new tax on their workers than about losing employer provided health insurance for their workers.
John Goodman, until recently the president of the National Center for Policy Analysis, has a post at Forbes attempting to defend Dr. Monica Wehby’s proposed “fixes” to Obamacare from my charge that her plan won’t work. In the process, though, it becomes clear that what he’s really saying is that Wehby’s plan would need substantial changes to work — which is to say, he agrees with me that as presented it won’t. The Wehby campaign nonetheless promoted Goodman’s article on her twitter account.
The bad news for Democrats trying to ride the “fix it” wave is that their actions betray their words. The Senate has refused to allow even committee consideration of about 40 House-passed bills fixing the worst elements of the law. The Senate has passed zero health care bills of its own. Even the handful of Democratic senators who have introduced “fix it” bills have exerted no pressure on their party’s leadership to schedule floor consideration. And their most specific proposal—adding a “copper plan” with an identical benefit package and network to existing Obamacare plans but with even higher deductibles—shows a lack of understanding of the problems millions of Americans are suffering.
Obamacare’s employer mandate is under attack from both sides. Will it survive? – The Washington PostJune 10, 2014
Critics of the health care law, including many business owners, have long bemoaned a provision that requires employers to provide health coverage to their workers.Now, some of the law’s supporters are starting to call for the rule’s elimination, too.“Repeal of the employer mandate might, in fact, not be such a bad idea,” Timothy Jost, a law professor at Washington and Lee University and vocal supporter of the Affordable Care Act, wrote this week in a column for Health Affairs.
It doesn’t have to be this way. If plans could compete on the basis of the therapies they cover, consumers could decide what they wish to pay for. This sounds complicated, but it need not be.Health plans could define themselves at least in part by the value of technologies they cover, an idea proposed by Professor Russell Korobkin of the U.C.L.A. School of Law. For example, a bronze plan could cover hospitalizations and visits to doctors for emergencies and accidents; genetic diseases; and prescription drugs that keep people out of hospitals. A silver plan could cover what bronze plans do but also include treatments a large majority of physicians find useful. A gold plan could be more inclusive still, adding coverage, for instance, for every cancer therapy shown to improve patient outcomes no matter the cost as long as it was delivered at a leading cancer center. Finally, a platinum plan could cover experimental and unproven cancer therapies, including, for example, that proton beam.
From a strictly strategic point of view, it is also true that if the adherents of the “pure” goal do not state that goal and hold it aloft, no one will do so, and the goal therefore will never be attained. Furthermore, since most people and most politicians will hold to the “middle” of whatever “road” may be offered them, the “extremist,” by constantly raising the ante, and by holding the pure or “extreme” goal aloft, will move the extremes further over, and will therefore pull the “middle” further over in his extreme direction. Hence, raising the ante by pulling the middle further in his direction will, in the ordinary pulling and hauling of the political process, accomplish more for that goal, even in the day-by-day short run, than any opportunistic surrender of the ultimate principle.
Tom Miller is a resident fellow at the American Enterprise Institute (AEI). He spoke at the Pioneer Institute’s 2014 Hewitt Health Care Lecture: “What Just Happened and What’s Ahead for the Affordable Care Act,” May 6, 2014.
Serious health reform packages have been introduced by, among others, Congressmen Phil Roe (R-TN), Tom Price (R-GA), and Paul Broun (R-GA). All three are physicians, and I think all three would describe themselves as “strict constructionists.”
In their respective state-lines bills, which incidentally run to nearly 30 pages, all use basically the same language: they authorize private insurance companies to offer contracts in any state, so long as they inform their out-of-state customers that the contract will be governed by the laws of the company’s home state (the “primary” state) and not those of the customer’s state (the “secondary” state). Pretty simple.
But where does Congress get the power to do this? The Commerce Clause? Insurance is a contract, not commerce. It’s certainly not commerce in the sense of “physical exchange of goods.” If it is commerce, it’s intrastate (remember Geico of Virginia). And while, yes, the New Deal Supreme Court decided that insurance is interstate commerce, and also redefined such commerce to include virtually all human activity, that doesn’t mean Congress must exercise such an expansive power.
And yet the doctors’ bills all do. They’re all based on a Rooseveltian, New Deal reading of the Commerce Clause, the same reading that every self-respecting originalist and five sitting members of the Supreme Court reject when it comes to Obamacare.