Why the Utah Health Exchange is No Model for Health Reform

The Utah Health Exchange is the model some conservatives believe can be used to push back against Obamacare. Witness the Wall Street Journal (July 16) soundly rejecting regulatory guidance on what the Administration is now calling "Affordable Insurance Exchanges," but encouraging governors to get on the exchange bandwagon, in the hope they can build free-market exchanges that will blunt Obamacare's worst effects.

Capped Federal Matching Funds: Washington State's Bipartisan Medicaid Reform

It’s a short law with big potential: SB 5596, signed by governor Christine Gregoire at the end of May, is only three pages long. Nevertheless it puts Washington State on a path to Medicaid solvency and sets an example for California and the nation.

Remarkably, the law, sponsored by conservative Republican senator, Linda Evans Parlette, passed with unanimous support in the state Senate and Assembly. Needless to say, the state’s Democratic legislators and liberal governor took some political risks in endorsing it. But we have to be careful in describing what SB 5596 achieves.

Why Medicaid Should Be Easier to Fix Than Entitlements

Congress remains gridlocked on many important issues but not every politician is afraid to challenge the unsustainable growth of Medicaid. Consider S. 1031, by U.S. Senator Tom Coburn.

This measure would increase local control over Medicaid spending and improve the incentives that have led politicians to trap ever more low-income citizens in poverty and the poor access to care that characterizes this top-heavy system.

Medicaid is often described as an “entitlement,” but that is wrongheaded. Medicaid is welfare, targeted at low-income Americans. And Medicaid should be easier to fix, politically, than two other troublesome programs.

Shooting the Messenger: California’s Proposal to Control Health Plans’ Rate Increases

California legislators are considering a bill, AB 52, that would give the executive branch the power to decide whether health plans should be allowed to increase their premiums at rates that keep pace with medical costs. Health plans may be a politically attractive target, but giving politicians the power to approve premiums causes other problems — and doesn't even hold down rate increases.

Rhode Island's Medicaid Waiver Survives Scrutiny

Rhode Island, the smallest state, is wielding big influence against federal control of health care. Other states would do well to take notice.

Federal taxpayers pay about 53 percent of Rhode Island’s Medicaid costs. This has created a perverse incentive for state politicians to increase dependency on Medicaid in order to capture more federal funds. A solution is to convert the funding formula, known as FMAP (Federal Medical Assistance Percentages), to a per-head block grant to the states. Unfortunately, under the Obama administration, things have moved in the wrong direction.

The “stimulus” bill of February 2009, increased Rhode Island’s match to about 64 percent. Originally a short-term measure, this excessive leverage was extended through this June. Fortunately, Rhode Island succeeded in crafting a mechanism to restrain out-of-control Medicaid growth. In August 2008, Governor Carcieri tasked his Secretary of Health and Human Services, Gary Alexander, to apply for a “Global Consumer Choice Compact Waiver” from the federal government.

Fight Against Obamacare = Fight Against Government-Run Health Care?

The previous congressional majority managed to jam Obamacare down the throats of an increasingly resistant nation. Now the fight against Obamacare may have delivered a shock to the system that goes beyond the battle cry of “repeal and replace.” Serious health care reformers, however, still face some unpleasant realities.

Defeating Obamacare: Governors Respond to Judge Vinson's Decision

This month's Capital Ideas column, which focuses especially on the responses from Florida governor Scott and Georgia governor Deal.

Read the article here.

The End of the Individual Mandate is Not the End of Obamacare

Last month Virginia attorney general Ken Cuccinelli successfully argued that the so-called “individual mandate” in Obamacare was outside congressional competence. Advocates of individual choice in health care cheered a significant victory, but this is not the final judicial word on Obamacare.

Are Your State Politicians Serious About Defeating Obamacare? A "Litmus Test"

Last month’s elections demonstrated convincingly that the American people are already fed up with Obamacare, the March legislation that gives the federal government control over our access to medical services. Anti-Obamacare Republicans took the majority in the House of Representatives and increased their numbers in the U.S. Senate.

Most people believe that President Obama will not listen to the American people and repeal his own legislation. This makes final defeat of Obamacare unlikely before a future president takes office in January 2013, at the earliest. The federal government, however, relies on states to do Obamacare’s dirty work.

Election Gives States Momentum to Defeat Obamacare

Yesterday’s election resulted in a resounding setback for Obamacare. The federal government takeover of Americans’ access to medical services will suffer significant setbacks in the new Congress. While Congress works towards repeal, states have to choose whether to enable or obstruct Obamacare, which will further pummel states’ fiscal situations.

Governor Schwarzenegger Should Veto the Health-Insurance Exchange Bills

This month's Capital Ideas column explains how the legislation proposing ObamaCare's exchanges for California would reduce choice and increase costs, urging governor Schwarzenegger to veto it by September 30.  It's a beefier version of my San Francisco Examiner op-ed from a few days ago.

Read more here.

Whis is More Obese, San Francisco's Kids, or its Government?

Imagine this scene a year or two in our future: An inspector from the San Francisco Department of Public Health spots something shiny behind a restaurant freezer. He pulls out a plastic Iron Man™ action figure, which the manager claims belongs to his son. No dice – they haul him downtown for using toys to lure kids into his restaurant.

If Supervisors Eric Mar, David Campos, and David Chiu have their way, this embarrassing spectacle of political overreach will become reality. Their stated goal is to reduce childhood obesity, but will it work?

Read more in this month's Capital Ideas.

Should the State Decide How Many Nurses Hospitals Must Hire

Yes, if you want a major nurses' union to have its way. No, if you want patient-centered health care. This month's Capital Ideas.

Cops Bust Hamburglar! Santa Clara County's Toy Ban

This month's Capital Ideas column, addressing Santa Clara County's banning toys with Happy Meals.

We Don’t Call People on Welfare “Employed”; So Why Call People on Medicaid “Insured”?

My latest entry at John Goodman's Health Blog (similar to PRI's latest Capital Ideas).

Did You Hear About Blue Cross Cutting Rates 20%?

Probably not, but it's just as true as the headlines that scream about the 39% increase. Government discrimination against individual ownership of health insurance is the real cause of volatile changes in premium: This month's Capital Ideas.

California's New HMO Regulations

It's a supreme irony that California has just imposed HMO regs that its Medi-Cal program could never achieve, and a state senator re-introduces a single-payer bill!

The "Public Option" Is Nothing Like Medicaid Managed Care

Despite Professor Romer's claims: The latest Capital Ideas.

Nurses Beware! Don't Let Your Union Win Health Care

This month's Capital Ideas.

San Francisco's Employer Health Tax: Change We Can Do Without

San Francisco's job-killing tax on employers to fund the public-health bureaucracy has garnered some scholarly support, which I rouse myself to challenge in this month's Capital Ideas.