Our Health Policy Matters

As the December 14 th and February 14 th dates draw near for states to say whether they will create Affordable Care Act health insurance exchanges and what they will look like, the world seems upside down. Traditional “states’ rights” advocates such as South Carolina, Georgia, Alabama, Louisiana, and Texas all say they will let the federal government set up their exchange.  Historically “strong federal government” allies like Connecticut, Massachusetts, California, New York, and the District of Columbia are setting up their own exchanges. In all, sixteen states so far have said they want the federal government to set up their exchange, while eighteen states and the District of Columbia have decided to run their own .  The rest are either undecided or looking to partner with the federal government.  No states are considering a multi-state exchange – so much for “selling insurance across state lines.” The states that are deferring to the federal government cite a number

A person who was unhappy with the outcome of the election suggested that the voters gave President Obama a “Mulligan” on election day – a second chance to do things right.  That’s one way to look at it. But if you belief that, then you also have to say the same thing about the divided Congress – it, too, was being given at least one more chance to get things right. That means agreeing to the surprisingly little compromise on which the future of Medicare will depend. It’s hard to understand how two sides looking at the same reality and sharing the same goals could be so far apart in coming to an agreement about what to do.  Nowhere is this more evident than in the Medicare program debate. Both sides acknowledge that Medicare is as popular as any entitlement, is as well run as any health insurance program, and addresses a need that is only going to grow in the coming years. They also agree on certain facts.  The first is that Medicare hasn’t yet contributed to our

It took Super Storm Sandy to remind us how much we need our government. And how rarely we see government leaders truly cooperate. Cooperation has been a dirty word in politics for close to two decades.  But in responding to the crisis caused by Sandy, President Obama and Governor Christie showed us that political adversaries are at their best when they work together to meet our needs. It took an environmental holocaust for this to happen.  But as the pictures of destruction in state after state circulated throughout the media, no one talked about privatizing FEMA.  No one complained that the government was spending too many taxpayer dollars rescuing people from death.  It was a fine way for the President to end his first term in office – one that may ultimately have won him his re-election.  And also won him a new opportunity to collaborate with the states. In the storm’s aftermath, we understand that one of the prices of having the freedom to live where we desire –

Newly re-elected President Barack Obama may now have a new road to health policy-making after three years of defending the Affordable Care Act.  And even if the Congress does nothing to help in the months to come, his road may be a whole lot easier than it has been. Even with the Affordable Care Act in place, our health policy debate has been dominated by the belief that health care Armageddon is just around the corner. But some recent data suggest that Armageddon may still be down the road. Just how far may well determine how our health policy debate shakes out over the next two years. First, let's look at the Armageddon scenario. The candidates accepted the scenario that health care costs are out of control when they made the future of Medicare and Medicaid a centerpiece of the campaign.  Governor Romney’s proposed solution was to clamp down on federal funding for these programs.  President Obama advocated managing state and local costs by expanding the