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.
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After The Court And Election Decisions: What's Next For Healthcare?
- 1. After the Court & Election Decisions: What’s Next for Health Care? Tom Miller American Enterprise Institute November 8, 2012
- 2. 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
- 3. 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
- 4. Primary ACA Political Equations: Blame Shifting • States – branch offices, handle dirty work • Keep full costs off-budget
- 5. The Ordeal of Change: Politics vs. Markets • Strategic & tactical repositioning • Getting beyond a common rhetoric • National goals, local trial & error • Scalability, replication, adaptation
- 9. 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
- 10. Choke Points & Leverage • Exchanges (state v. fed) • Medicaid expansion • Renegotiate & rewrite vs. repeal & replace
- 11. The Secret Plan for Health Delivery Reform, ACA Implementation, & Affordable Entitlements
- 12. Predictive Modeling: Probabilities, Possibilies & Implausibilities • Centripetal, not centrifugal, forces • But changing permanent law alters frame of reference • Accountability: to patients or politicians? • Macroeconomic overrides
- 13. Bonus Rounds • Six Picks for Post-Election Health Policy http://www.realclearmarkets.com/articles/2012/11/07/six_picks_f or_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
Hinweis der Redaktion
- 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