After The Court And Election Decisions: What's Next For Healthcare?
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After The Court And Election Decisions: What's Next For Healthcare?

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Presentation by Tom Miller, from Reporting on Health's "From the White House to Community Clinics: What Happens Next for Healthcare Reform" webinar 11/8/2012.

Presentation by Tom Miller, from Reporting on Health's "From the White House to Community Clinics: What Happens Next for Healthcare Reform" webinar 11/8/2012.

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  • Thank you’sTwo years of waiting for courtObamaCare and health policy problems didn’t stopVoters in Nov 2010 sent a message, but it has not gotten throughUnusual law in many ways ---- contorted process, but also a very slow-developing implementationIt takes a while to takeover the private health care system,while trying to hide all the costs, impacts, and long-term goals with false promises, budgeting accounting fictions, political scapegoating, and “whatever it takes” rulemaking --- and get all the rewiring done so it doesn’t compeltely collapseThis issue matters a lot It’s a big one, not just for the near term but how it will shape our future --- our politics, the role of govt, our economy and, oh yes, our health.
  • Consumer demand within a budget constraintPublic vs. private money
  • This morning, I’m going to cover the ground quickly, and hit the highlightsWhere are we? BulletsUrgency to stop before institutionallizatoin and capitulationSlower health spending ----- what a great solution ---- slow eco growth
  • This morning, I’m going to cover the ground quickly, and hit the highlightsWhere are we? BulletsUrgency to stop before institutionallizatoin and capitulationSlower health spending ----- what a great solution ---- slow eco growth
  • Pay or play No LEGAL COMPULSION to actually buy the insurance Before 2014, and after link to state-run exchange?Trying to go below March 2010 level, or at least below 138% FPL laterStates may try tto make BETTER deals Leverage ---- for participation and market share Watch Maine case (just lost yesterday?)CBO – only modest adjustments in enrollment and budget costs forecast guessing at Medicare state takeupFed tax credits for fed exchanges Possible litigatoinMain delivery vehiicle, w/ Medicaid partly stalledMid-Nov implementation ready deadine? Fed-facilitated overrideRuling impact depends on what feds attempt next, to stretch out compuulsion somewhere else Politics was stalled and frozen while waiting for Court Industry -- it’s just business
  • Pay or play No LEGAL COMPULSION to actually buy the insurance Before 2014, and after link to state-run exchange?Trying to go below March 2010 level, or at least below 138% FPL laterStates may try tto make BETTER deals Leverage ---- for participation and market share Watch Maine case (just lost yesterday?)CBO – only modest adjustments in enrollment and budget costs forecast guessing at Medicare state takeupFed tax credits for fed exchanges Possible litigatoinMain delivery vehiicle, w/ Medicaid partly stalledMid-Nov implementation ready deadine? Fed-facilitated overrideRuling impact depends on what feds attempt next, to stretch out compuulsion somewhere else Politics was stalled and frozen while waiting for Court Industry -- it’s just business
  • Pay or play No LEGAL COMPULSION to actually buy the insurance Before 2014, and after link to state-run exchange?Trying to go below March 2010 level, or at least below 138% FPL laterStates may try tto make BETTER deals Leverage ---- for participation and market share Watch Maine case (just lost yesterday?)CBO – only modest adjustments in enrollment and budget costs forecast guessing at Medicare state takeupFed tax credits for fed exchanges Possible litigatoinMain delivery vehiicle, w/ Medicaid partly stalledMid-Nov implementation ready deadine? Fed-facilitated overrideRuling impact depends on what feds attempt next, to stretch out compuulsion somewhere else Politics was stalled and frozen while waiting for Court Industry -- it’s just business
  • Pay or play No LEGAL COMPULSION to actually buy the insurance Before 2014, and after link to state-run exchange?Trying to go below March 2010 level, or at least below 138% FPL laterStates may try tto make BETTER deals Leverage ---- for participation and market share Watch Maine case (just lost yesterday?)CBO – only modest adjustments in enrollment and budget costs forecast guessing at Medicare state takeupFed tax credits for fed exchanges Possible litigatoinMain delivery vehiicle, w/ Medicaid partly stalledMid-Nov implementation ready deadine? Fed-facilitated overrideRuling impact depends on what feds attempt next, to stretch out compuulsion somewhere else Politics was stalled and frozen while waiting for Court Industry -- it’s just business
  • Pay or play No LEGAL COMPULSION to actually buy the insurance Before 2014, and after link to state-run exchange?Trying to go below March 2010 level, or at least below 138% FPL laterStates may try tto make BETTER deals Leverage ---- for participation and market share Watch Maine case (just lost yesterday?)CBO – only modest adjustments in enrollment and budget costs forecast guessing at Medicare state takeupFed tax credits for fed exchanges Possible litigatoinMain delivery vehiicle, w/ Medicaid partly stalledMid-Nov implementation ready deadine? Fed-facilitated overrideRuling impact depends on what feds attempt next, to stretch out compuulsion somewhere else Politics was stalled and frozen while waiting for Court Industry -- it’s just business
  • g fieldOther legal challenges (fed exchange, MOE,Statutory vs reg conflict Employer mandate, state sovereingty Negotiate for big structural M waiversCritical mass?Reconciliation ---- debone and filet mostFirst day vs. first yearNew rulemaking, limited waivers What’s short-term popular Irreversible changes in markets?Avoiding biggest disasters Tactical vs. strategic Customization/standardization continuum
  • It could crash, if not delayed and rewritten for reality
  • Fiscal cliffRebid for more, better careInstalled base, population health
  • Fiscal cliffRebid for more, better careInstalled base, population health

After The Court And Election Decisions: What's Next For Healthcare? After The Court And Election Decisions: What's Next For Healthcare? Presentation Transcript

  • After the Court & Election Decisions: What’s Next for Health Care? Tom Miller American Enterprise Institute November 8, 2012
  • Story Lines to Pursue• Cross-pressures on exchanges• Recalibrating Medicaid expansion Metabolic disorder or fiscal bulimia?• State-level politics• Setting the table for the 2014 “stress test”• Transparency without real prices
  • Primary Political Scenarios: Ratification, Rejection, or Equivocation?Post-November playing field scenarios• Re-election w/o full congressional control From “rope a dope” to “survive & advance” Reality-based revision or fuller strength dosage? Pottery barn rules
  • Primary ACA Political Equations: Blame Shifting• States – branch offices, handle dirty work• Keep full costs off-budget
  • The Ordeal of Change: Politics vs. Markets• Strategic & tactical repositioning• Getting beyond a common rhetoric• National goals, local trial & error• Scalability, replication, adaptation
  • Pilot Program Prototypes?•
  • Pilot Program Prototypes?•
  • Pilot Program Prototypes?•
  • Don’t Just Look under the Street Light for Lost Keys• Social determinants of health• Broader portfolio of investments• Scope of practice• Competition policy• Telemedicine• Broader use of self-insurance
  • Choke Points & Leverage• Exchanges (state v. fed)• Medicaid expansion• Renegotiate & rewrite vs. repeal & replace
  • The Secret Plan for Health Delivery Reform,ACA Implementation, & Affordable Entitlements
  • Predictive Modeling:Probabilities, Possibilies & Implausibilities• Centripetal, not centrifugal, forces• But changing permanent law alters frame of reference• Accountability: to patients or politicians?• Macroeconomic overrides
  • Bonus Rounds• Six Picks for Post-Election Health Policyhttp://www.realclearmarkets.com/articles/2012/11/07/six_picks_for_post-election_health_policy_99976.html• When Obamacare Fails: The Playbook for Market-Based Reform (AEI, November 2012)• Beyond Repeal and Replace (AEI project)•http://www.aei.org/issue/health/healthcare-reform/beyond-repeal-and-replace-series