Post on 13-Jun-2015
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After the Court & Election Decisions: What’s Next for Health Care?
Tom Miller
American Enterprise Institute
November 8, 2012
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
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
Primary ACA Political Equations:Blame Shifting
• States – branch offices, handle dirty work• Keep full costs off-budget
The Ordeal of Change:Politics vs. Markets
• Strategic & tactical repositioning• Getting beyond a common rhetoric• National goals, local trial & error• Scalability, replication, adaptation
Pilot Program Prototypes?
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Pilot Program Prototypes?
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Pilot Program Prototypes?
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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
Choke Points & Leverage
• Exchanges (state v. fed)• Medicaid expansion• Renegotiate & rewrite vs. repeal & replace
The Secret Plan for Health Delivery Reform,
ACA Implementation, & Affordable Entitlements
Predictive Modeling: Probabilities, Possibilies & Implausibilities
• Centripetal, not centrifugal, forces• But changing permanent law alters frame of reference• Accountability: to patients or politicians?• Macroeconomic overrides
Bonus Rounds
• Six Picks for Post-Election Health Policyhttp://www.realclearmarkets.com/articles/2012/11/07/six_picks_for_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