Tags: Health Care

Jindal: ‘It’s a Mistake to Assume Democrats Will Never Vote for Repeal.’


More from my interview of Louisiana governor Bobby Jindal Wednesday, discussing his proposal to repeal and replace Obamacare:

Geraghty: How does your proposal differ from the repeal-and-replace proposal from the Republican Study Committee, or other plans and ideas from Republicans on Capitol Hill?

Jindal: There absolutely are proven concepts that are common in a lot of different conservative plans — lawsuit reform and other elements like that I think are very attractive. But I do think there are some things that are unique about this plan.

One, it’s comprehensive; it does include premium support in Medicare. It does include the global grants for Medicaid. It does include state reforms on certificates of need and provider scope to provide more supply-side competition. It includes the state grants — $100 billion to states — so there’s a strong federalism component.

With the tax equity, by doing the standard deduction, it drives more efficiency in health care.

I also think it’s a good thing that there are conservatives and Republicans talking about health care. I think there needs to be more of that. Unlike the Left, we don’t have to all march behind Obamacare or behind one plan. I think there’s a good thing there’s a competition and a bunch of different ideas. As somebody who spent much of my career in health-care policy, I hope more Republicans will talk about health-care policy.

We intend all of AmericaNext’s products to be “open source code” — we hope folks use it, there’s no pride of authorship. They can cut and paste it, they can borrow it, adapt it, put it in their plan. This is advancing the conservative debate. The president likes to say that there is no alternative to replace Obamacare with — he needs to stop saying that! The reality is there is an alternative. He can debate us on the merits, but there is a substantive, specific alternative.

Compared to Obamacare’s baseline, ours reduces premiums by $5,000. His actually took the previous marketplace and increased it by $2,100 for a family. The reality is, our plan, I believe, actually delivers what he promised back in 2008 better than his plan does. In 2008, he talked about the need to reduce health-care costs, he opposed the mandate when Senator Clinton proposed it, and since ‘08 he’s talked about the need to keep your plan and your doctor. His plan doesn’t do those things. Our plan actually does.

Geraghty: There are some elements of Obamacare that even the most staunch conservatives are wary about repealing entirely – lifetime limits, pre-existing conditions, or things like that. If there are some parts we don’t need to take away, do we really need to repeal the whole thing? Can you do partial repeal?

Jindal: No, we’ve got to repeal it. Take it out by its roots. The whole thing needs to go. This plan gets rid of the tax increases, Medicare cuts, and doesn’t replace those tax increases or Medicare cuts. When it comes to the insurance-market reforms, we give $100 billion to the states with very few strings, except we do tell them that they’ve got to guarantee they’ll provide coverage for those with pre-existing conditions. You can do that with high-risk pools, reinsurance, there are a lot of ways to do that. But secondly, we also tell them, you’ve got to use these dollars to lower premiums in their marketplace.

I think that one of the mistakes that the Left makes is that it doesn’t trust people. It doesn’t trust local government. The reality is, that if there are good insurance reforms, they’ll be adopted at the state level.

In Louisiana, it is state law, for example, that kids up to 24 can be carried on their parents’ plans. Not every state agrees with that. But the point is that states are in a better position to make these decisions.

[In 2011 Louisiana’s legislature passed, and Jindal signed into law, a bill that allows children to remain on their parents’ plans until age 21, or age 24 if the child is a full-time student, or continuously if the child is disabled.]

A lot of insurance companies said, before the Supreme Court case, that even if Obamacare were struck down, they weren’t going backwards on those provisions anyway. The Left doesn’t want individual consumers to select their own health-care plans; they don’t want states to make these decisions. I think one of the big mistakes of Obamacare is this one-size fits all benefits approach, regulatory approach from the federal government telling us how we buy health insurance.

One of the things that the cross-state sale of insurance will do under our plan is that as states consider these mandates, benefits, or other restrictions, it will force states to be more cognizant of what it does to the premiums. Now you’ll actually have real competition. The Founding Fathers intended for the states to be laboratories of experimentation. Let’s let that work.

Geraghty: So you’re fine with children staying on their parents’ plans until age 24 or 26?

Jindal: I’d say I’m fine with states being able to make that decision. I don’t think the federal government should dictate that decision. Now, different states can make different decisions. What’s happening right now is that states have been shielded from the consequences of their decisions. There isn’t that competitive pressure to reduce costs, reduce mandates or even examine if the costs outweigh the benefits.

If you adopted these reforms, and you empowered individuals to buy their own health care and made it more affordable, it might cause a lot of states to reexamine whether they needed these restrictions and regulations.

Geraghty: President Obama is going to be sitting in the Oval Office until January 2017. As far as he’s concerned, Obamacare is working fine. Occasionally he’ll say he’s willing to listen to ideas to reform Obamacare, but he never gets all that specific about what he wants to reform. Is it realistic to think that anything in your plan can end up on his desk, or that any of it can be signed into law by President Obama? Or is it really just setting up a blueprint for what Republicans could do in 2017?

Jindal: One, I do think you’ve got to win the debate first. We’ve got to have this debate. We have to go out and show that there is a good alternative. But absolutely there are things that can be done. We don’t need to forget that this president forced this bill through with parliamentary maneuvers and on a party-line vote. There’s a lot that can be done. The reality is you’re seeing more and more Democrats running away from this law, especially those facing their own reelections.

I think it’s a mistake to assume Democrats will never vote for repeal, and that Democrats will never vote for different provisions. I think the reality is they’re about to pay a pretty big political price for supporting this bill. You’re going to see more and more Democrats open to this — as they see the bill isn’t doing what they promised it was going to do.

It’s odd to have a president say it’s a good thing to have over two million fewer Americans in the work force. It’s odd for a president to say, “You know what, you’re not going to be able to keep your doctor. Maybe I shouldn’t have said you were going to keep your health care plan.” It’s odd when the president said, very specifically, not vaguely, “I’m going to cut your premiums $2,500″ and the CBO says they’re going to go up $2,100.

I wouldn’t underestimate how many Democrats will start running from this law and looking for opportunities to repeal and replace. I wouldn’t want to negotiate with ourselves and say, “No, we can’t get this done.” But even before we pass this law, we’ve got to win the debate. We’ve got to persuade folks and show them there’s a better way.

Geraghty: Periodically, conservatives will say we really have to separate the employer from health insurance. That way it will be more portable, and easier for people to take their health insurance from one job to another job. It seems that one of the experiences of Obamacare is that people don’t always like having choices, and that in fact a lot of people don’t like to think about health insurance any more than they have to. Your plan pushes in the direction of separating health insurance from employment. Are Republicans ready for a backlash on that aspect?

Jindal: My takeaway from Obamacare is that people do like choices, but they don’t like to be forced to do things they don’t want to do. We do ease away from that job lock by giving people the ability to have a portable deduction. We also do through association plans that can be sold across state lines with ERISA protections to give them more choices. We do make it easier for people to buy their health care through the individual and other marketplaces.

We’re very explicit about this: This is going to be a voluntary and gradual transition. This is not going to be an overnight, dramatic, and forced transition from employer-provided health care. The reality is, folks can continue to get their health care through their employers. This is one of the benefits of making it a standard deduction, as opposed to some of the other alternatives that are out there. You can still get your health care through your employer, and most people probably still will, in the short term. That doesn’t change overnight. But what you have is a gradual transition where now if people change jobs, they can go to the individual market without exhausting COBRA. If they want to buy through their churches or unions or their social membership multi-state clubs, they can do that and get those ERISA protections.

It’ll be easier to buy [Health Savings Accounts], it’s be easier to bring those tax-advantaged accounts with you from place to place.

It’s also going to be easier for employers to provide health care – because now they can contribute to a wellness account on a tax-advantaged basis or an HSA with varying deductibles, or they can allow you to use your savings in your HSA to pay your premiums, which they couldn’t do before.

I think it actually makes it easier for employers who want to continue to provide the health care, but it also makes it easier for folks that are changing jobs or changing states that don’t want to be job-locked.

You may have seen that new study out today from larger employers talking about the thousands of dollars per employee that Obamacare is going to cost them over the next several years. So it’s not just small employers, but big employers are waking up to these costs, too.

Geraghty: I notice you used the term “job lock” twice. I presume you mean staying in a job because you need the health insurance. But I presume you recall Nancy Pelosi lamenting how terrible it was that people getting locked into jobs . . . 

Jindal: I think she was talking about them going and becoming artists or whatever and not working. What I’m saying is that when you change jobs, or move jobs, you should be able to take your health care with you.

Geraghty: Who advised you on this?

Jindal: Chris [Jacobs, policy director for America Next]. A lot of people. We’ve talked with a number of folks — conservative governors and lawmakers and health-care-policy folks. This is something we’ve been working on for a while. But it also comes from my career of thinking about and writing health-care policy. Premium support, for example, goes back to my year on the Medicare commission in the 1990s. I like to remind folks, we’re the ones who came up with the idea of applying premium support to Medicare, and the [center-left think tank Democratic Leadership Council] endorsed it that year. Now the Left likes to call it this radical, fringe idea, but the reality is that this has been something that has been around for several years, and the [American Medical Association], the Mayo Clinic, the Wall Street Journal — several mainstream folks endorsed this concept way back when.

The global grant on Medicaid reform is something I’ve been talking about with governors for quite some time. It’s not just Republican governors, Democratic governors are very frustrated with what they see coming out of [the Center Medicaid Services] and HHS in D.C. When you look at the market reforms, I’ve been talking to folks in the industry, patient-advocacy groups, and asking, “All right, if we were do these things differently, how should we do these things?”

Tags: Bobby Jindal , Obamacare , Senate Democrats , Health Care

45 States Still Haven’t Hit 10 Percent of Enrollment Goals for Obamacare


Check out that runaway Obamacare enrollment over on!

In Arkansas, its up to 1,404! Well along the way to the state’s goal of 51,000 paid enrollees by the end of March.

In Delaware, it’s up to 793! The state’s goal is 35,000.

In New Hampshire, they hit 1,569. Getting close to that goal of 19,000!

In West Virginia, it’s up to 775! They’ll hit their goal of 24,000 in no time!

In Hawaii, all the way up to 444! That goal of 9,000 is in sight!

In Colorado they’re up to 9,980 . . . with a goal of 92,000.

We can skip the scoffing over Oregon and Washington exchanges, as their ludicrously embarrassing failures have been extensively discussed. Oregon’s at 44, with a state goal of 237,000; Washington’s at 17,780 . . . with a goal of 340,000.

Illinois, the president’s home state! Surely they’re ahead of the curve in getting folks enrolled and paid, right? They’re at 7,043 . . . out of a goal of 143,000.

Even Kentucky, often cited as one of Obamacare’s shining success stories, is at 20,951 . . . about 10 percent of the way to their goal of 220,000 enrolled.

All of those “M” states with their own state exchanges, ambitious Democratic governors and deep-blue state legislatures — surely, they must be enrolling at a better pace, right?

Eh, not really. Maryland’s at 3,758, with the goal of 150,000 far from sight.

Massachusetts is at 1,700, even further from their state goal of 250,000 paid enrollees.

Minnesota has hit 4,478 . . . out of a goal of 67,000. Still trying to hit 10 percent.

Note that all of the above states have Democratic governors. The Obamacare fan’s usual dodge or whine that the rollout is impeded by uncooperative Republican governors does not apply in any of those states; the difficulties in these states indicate that the problems with the program do not stem from insufficient enthusiasm from GOP lawmakers.

The one state making serious progress is Connecticut; they’re up to 11,631 out of a goal of 33,000. Rhode Island has 2,669, but that state’s goal is only 12,000, one of the lowest in the country. (One health official in the state “predicts that 70,000 to 100,000 will enroll on the exchange by the end of next year.”)

Some states have hit more than five digits. In New York, they’re at 50,119; a pretty solid chunk of their goal of 218,000.

In California, they’re up to 159,004. That sounds pretty good, until you realize they were aiming for 1.3 million.

States with Republican governors are faring no better, of course.

In Iowa, they’re at 757! Nice number for a plane, but well short of the goal of 41,000 enrolled.

In Maine, they’re up to 1,747. Closing in on that goal of 23,000!

An overwhelming 398 in Alaska! Look out, enrollment goal of 20,000!

Let’s make this simpler. The only states that have reached 10 percent of their enrollment goals are California, Colorado, Connecticut, New York and Rhode Island; Kentucky is close.

Tags: Obamacare , Barack Obama , Health Care

Attack Obamacare, but Talk Growth Too


There’s no question that the catastrophic debut of Obamacare — including the website breakdown and the millions of pink-slip cancellations — will be a great card for Republicans to play on the way to the 2014 midterm elections. No question.

The president lied about his lies about keeping your health plans and doctors. And when he did finally apologize, he didn’t really say he was sorry. It’s also possible that we’ll see 10 million more insurance cancellations, leading to much higher premiums, bigger deductibilities, and more cutoffs between patients and their doctors. And employer-based cancellations will compound this disaster, with the whole process stretching across most of next year. It will be a killer for the Obama Democrats.

But while my conservative-pundit colleagues are out thrashing Obamacare, I want to raise a critical point: Don’t forget economic growth.

Read my full column here

Tags: Health Care , The Economy

The Liberal Entitlement-State Dream Is Crumbling


May I ask this question? Why is it that Americans don’t have the freedom to choose their own health insurance? I just don’t get it. Why must the liberal nanny state make decisions for us? We can make them ourselves, thank you very much. It’s like choosing a car, buying a home, or investing in a stock. We can handle it.

So why must the government tell me and everyone else what we can and cannot buy?

Charles Krauthammer and the Wall Street Journal’s Dan Henninger noted in excellent recent columns that this whole Obamacare business represents the greatest-ever expansion of the liberal entitlement-state dream. But I don’t want that dream. And you shouldn’t either.

Here’s what else I don’t want: As a 60-something, relatively healthy person, I don’t want lactation and maternity services, abortion services, speech therapy, mammograms, fertility treatments, or Viagra. I don’t want it. So why should I have to tear up my existing health-care plan, and then buy a plan with far more expensive premiums and deductibilities and with services I don’t need or want?

Why? Because Team Obama says I have to. And that’s not much of a reason. It’s not freedom.

Read my full column here.

Tags: Health Care

Ryan: Obamacare’s Foundation ‘Not Workable’


House Budget Committee chairman Paul Ryan says Obamacare’s glitches are here to stay. In an exclusive interview set to air on tonight’s Kudlow Report, Ryan said the problems with the Affordable Care Act extend far beyond website malfunctions.

“It’s more than the website,” Ryan said. “It’s because this law itself is built from an architecture, a foundation, that’s just not workable.”

Ryan said he sat through several House Committee Oversight meetings in which the administration failed to answer fundamental questions on the rollout of the Affordable Care Act. “The point is, they said, ‘Everything is fine, the law is going to be okay. We are ready to roll it out. We won’t have any problems.’” But House Republicans knew better, Ryan said.

“People should know that we tried to prevent this from happening in the first place by fighting a law we did not intend,” Ryan said, referring to the Republican-led House’s 46 attempts to repeal the law. “Then we tried giving people relief from the law by delaying it until 2013. That was rejected and now we are living with this law.”

Frustrated with the Senate’s rejection of attempts to defund and delay the law, Ryan shifted to the GOP’s most plausible tactic to end the Affordable Care Act: winning elections.

“We owe the American people an alternative,” Ryan said. “We want to win elections by saying this is not working for you and there are better ways in keeping with the country’s principles that puts you in charge of your heath-care future.”

Ryan dismissed criticism that the Republican party is in a “civil war” following failed attempts to delay Obamacare as part of the government shutdown and debt-ceiling negotiations. “We’ve had disagreements with each other on tactics,” he said. “These aren’t principles. I don’t know a Republican that doesn’t support comprehensive reforms to replace Obamacare with patient-centered health care.”

The Wisconsin congressman said the GOP will have a chance to showcase its common principles in budget negotiations set to begin Wednesday. He rejected hopes for a “grand bargain” deal, which he said would include pro-growth tax reform, a balanced budget, and entitlement reform.

“I don’t think we’ll get a grand bargain, and we’re not talking about getting a grand bargain,” he said. “Because then, one party will require that the other compromise their core principles, and we won’t get anything done.”

The GOP’s key bargaining chip, Ryan said, is the sequestration, the automatic spending cuts Democrats are seeking to repeal. “If we can’t get anything better than the sequester, then we’ll keep the sequester,” Ryan said. “That’s our base case to begin with.”

Ryan insisted that increased tax revenue was out of the question, calling Keynesian stimulus programs “sugar-high economics.” He said, “We’re not in this business to raise taxes. We’ll take the spending cuts we have and work with those.”

Instead, he said he was willing to negotiate on the “smarter” cuts to replace sequestration. “If we get a down payment on this debt and deficit in exchange for short-term relief, we’ll take it,” he said. “But it has to be on net a positive, meaning we will take the spending cuts right now.”

Ryan said substituting entitlement reform in place of broad spending cuts under sequestration would enable long-term growth in the U.S. economy. “If smart entitlement reforms could replace this crude across-the-board sequester, it would do a couple things,” Ryan said. “It would show the world that America is getting ahead of its problems. We’re not just going to be victims of circumstances. We’re not just going to fall into a debt crisis like Europe, but we’re going to get out of it.”

Entitlement should be at the top of the budget agenda, Ryan said.

“The question is not if we deal with entitlements,” Ryan said. “The question is if we are going to do it before the debt crisis or after the debt crisis. We would like to do it before so that we can shape events in this country instead of having events shape us.”

The congressman said that, ultimately, his job is to find common ground in budget negotiations among Republicans and Democrats. “I would argue that in this very difficult time that we are in, wouldn’t it be nice to show that this American divided government can at least govern?”

Watch the interview here:

– Elizabeth Schulze is a CNBC producer.

Tags: Health Care

Sell the Individual-Mandate Delay


The defeat of Senator Ted Cruz’s defunding strategy may not be the end of the fight to overturn Obamacare. In some sense, for free-market conservatives who want consumer choice and private-sector competition, this whole debate is about good versus evil. It’s a point that the brave and courageous Cruz grasps all too well. If Obamacare becomes permanent, it will crowd out the private health-care sector, including insurers and providers, and over time will create a single-payer, government-statist health-care sector.

Stopping this will be hard. But Senator Joe Manchin, Democrat from West Virginia, has given conservatives a ray of hope. Manchin is prepared to vote for a one-year delay of the individual mandate, the very heart of Obamacare. That means the GOP would need only four more votes to get that delay. Maybe red-state Democratic senators like Mary Landrieu (Louisiana), Mark Begich (Alaska), Kay Hagan (North Carolina), and Mark Pryor (Arkansas) will join 46 Republicans and vote for delay.

Read my full column here.

Tags: Health Care

Gallup: 6 Percent Say Health Care Most Important Problem in U.S.



Although the Affordable Care Act of 2010 has dominated the news recently, with coverage exploding Thursday as the Supreme Court ruled to uphold the law, few Americans so far in 2012 mention healthcare when asked to identify the most important problem facing the country. Six percent say healthcare is the top problem in June, behind mentions of the economy, jobs, the deficit, and problems in government. The current 6% who mention healthcare is slightly below the average of 8% of Americans who since January 2001 have mentioned healthcare as the nation’s top problem.

They point out that this number increases dramatically when there is public debate about legislation on the issue, mostly in the first two years of Bill Clinton’s and Barack Obama’s presidencies. Of course, when the perception that health care is a “problem” spikes, the question doesn’t differentiate between those who think it’s a problem that requires the legislation being debated and those who think the legislation itself is the problem.

Tags: Gallup , Health Care , Obamacare , Polling

‘Barack did the stimulus, and he thought he checked the box and moved on.’


Do not forget this anecdote from New York magazine, November 29, 2009:

But the most damaging consequence of all may have been inside the White House, where bullishness about how rapidly the stimulus would kick in led to foolish projections that unemployment would peak at 8 percent—and where the bill’s passage bred a certain cockiness and complacency about the need to drive a sustained economic message in the months thereafter. “I recently talked to a very senior friend of mine in the White House, and I said, ‘How did we not spend a year talking about the economy?’ ” a Democratic think-tank maven recalls. “And he said, ‘Look, I think Barack did the stimulus and he thought he checked the box and he moved on.’ I said, ‘That’s not governing, dude. That’s some other thing.’ ”

“Barack did the stimulus, and he thought he checked the box and moved on.” Of course, unemployment remained high, and the economy continued to struggle through this year. Obama moved on, of course, to Obamacare, phenomenally unpopular legislation that may very well be found unconstitutional by the Supreme Court.

It would be bad enough for a president to presume that economic recovery was “done” and to move on to another agenda item. But to do so for legislation struck down about two years later…

Tags: Barack Obama , Health Care , Stimulus

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