Tag Archives: James Capretta

Health Policy Updates: June 10 2017

We’re back!

After a couple weeks away for travel, with a LOT that I’ve missed in the interim, here are some of the events and new ideas out over the last week.

First off, the Senate continues to deliberate on health care legislation, with varying degrees of confidence as to whether it will go anywhere. Conservative (though reality-based!) health policy wonks Lanhee Chen and James Capretta have continued to advocate for the incorporation of auto-enrollment into health care reform. This would present a way to “nudge” more healthy people into health insurance – a positive outcome – without the “big-government” personal mandates that Conservatives tend to bristle at.

“Even with the ACA’s penalties for going uninsured, large numbers of Americans are forgoing coverage and either paying additional tax penalties for doing so or applying for an exemption from the law’s individual mandate…If [the AHCA is] enacted, Congressional Budget Office forecasts there would be much lower take-up of insurance under the GOP’s plan than under the ACA…A well-designed automatic enrollment program can help boost enrollment into coverage whatever the design of the overall system.”

Continue reading Health Policy Updates: June 10 2017

Health Policy Updates: April 22 2017

Like a phoenix rising from its own ashes, Republican health care reform is alive again. Vox.com’s Sarah Kliff runs through some of the features of the new version of their bill:

“What we do know is that this latest proposal doesn’t do much at all to assuage concerns about the older proposals. While it meets many of the demands of the party’s far-right wing — namely, the deregulation of the individual insurance market — it does nothing to address concerns about massive coverage loss. Instead, it likely makes those problems worse…

…This GOP amendment to let states waive community rating would once again allow insurers to charge people based on their expected health care costs. Insurers would not be able to deny coverage to people with preexisting conditions, but they would have free rein to charge them especially high premiums.”

President Trump demonstrated his expertise in the complex details of health policy, with his analysis of the changes to this new version of the health care reform bill:

“‘The plan gets better and better and better, and it’s gotten really, really good, and a lot of people are liking it a lot,’ Mr. Trump said.”

Continue reading Health Policy Updates: April 22 2017

Health Policy Updates: January 7 2017

In the big health policy news of the week, the Republican-controlled congress has taken its first – expected – steps towards repealing the ACA/Obamacare by means of the budget reconciliation process.

“The concurrent resolution also establishes a “reserve fund for health care legislation,” which is intended to pocket any savings from repeal for subsequent replacement legislation, as well as a “deficit neutral reserve fund” to revise allocations within the budget resolution and adjustments to the pay-as-you-go ledger in the Senate to ensure that repeal legislation does not violate budget requirements. The reserve fund would allocate $2 billion of savings from the repeal toward reducing the deficit, but hold the rest for eventual replacement legislation.”


Meanwhile, away from the partisan circus of Congress, some leading conservative health policy thinkers are having serious concerns about the repeal-and-delay strategy:

“Antos and Capretta’s piece goes into much more detail on the technical problems of repeal and delay, and is worth reading in full. But they avoid the fundamental issue animating the whole strategy: Republicans don’t know how to replace Obamacare, and they don’t know how to force themselves to figure it out.”

Full details of Joseph Antos’ and James Capretta’s concerns about repeal-and-delay can be found here.

“We do not support this approach to repealing and replacing the ACA because it carries too much risk of unnecessary disruption to the existing insurance arrangements upon which many people are now relying to finance their health services, and because it is unlikely to produce a coherent reform of health care in the United States. The most likely end result of “repeal and delay” would be less secure insurance for many Americans, procrastination by political leaders who will delay taking any proactive steps as long as possible, and ultimately no discernible movement toward a real marketplace for either insurance or medical services.”


Meanwhile, with all the commotion about whether and how to dismantle the ACA, the law itself continue to truck along, providing insurance to some 20 million Americans. Sarah Kliff of Vox.com has some pretty charts showing this.

The uninsured rate is at an all-time low. The federal government announced in September that 8.6 percent of Americans lacked health insurance. That’s a big decline from 2010, when the health care law passed and the uninsured rate was 16 percent.”


In some local North Carolina health policy news, incoming governor Roy Cooper has announced plans to expand Medicaid in the state. Don Taylor of Duke shares his thoughts on how this may play out.


From Aaron Carroll at The Incidental Economist, in which the adjective “crazypants” is used to describe US health care spending.

“Between 1996 and 2013, more than $30 trillion was spent on personal health care. Let that sink in for a minute or two. Over that time period, spending increased between 3% and 4% annually for most age groups.”


The prices for drugs are going up. A lot. And not just in cancer, as I’ve written about many times, but for multiple sclerosis as well.


The 21st Century Cures act that President Obama just signed into law, which both funded the cancer “Moonshot” and weakened FDA regulatory power, is not universally loved. Drs. Aaron Kesselheim and Jerry Avorn share their thoughts in this JAMA commentary.

“Among the most concerning sections of the new law are components that address the types of data that manufacturers will be able to use to gain FDA approval of new products or additional indications for existing products…When biomarkers used as the basis for drug approval are not rigorously validated, they may not actually predict patient benefit, can mislead physicians about whether a drug works, and have the potential to expose patients to poorly effective treatments or unanticipated adverse effects.”