Monday, January 24, 2011

Douthat on Reforming PPACA

Cross-posted from The Agenda on National Review Online.

Ross Douthat has a useful piece out today on something I’ve been spending a lot of time on lately: what Republicans should do if and when their initial repeal effort fails. Here are some of his policy recommendations:
To address the first problem, Republicans should work to deregulate the new health care exchanges, so that high-deductible, catastrophic coverage can be purchased as easily as comprehensive plans. To address the second, they should propose capping the subsidies for the uninsured, so that they don’t dramatically exceed the value of the existing tax subsidy for employer-provided insurance.
Both of these are constructive ideas. House Republicans can ensure that high-deductible plans are not only eligible for the exchanges, but that the definition of HDHPs is broadened, such that individuals can put more money away in health savings accounts, and with more flexibility around out-of-pocket costs and deductible ceilings.

In addition, capping the dollar amount of subsidies in the exchanges could provide a backstop to the growth of subsidies, in case Republicans are ultimately unsuccessful in repealing PPACA.

Both of these efforts must be pursued with foremost consideration for how they would affect the CBO score of a repeal bill under reconciliation. As a reminder, Republicans will only be able to repeal PPACA via reconciliation if each provision of their repeal measure contributes to deficit reduction.

Ross goes on to endorse a limited enrollment period, something that we have advocated in this space:
The mandate is a harder puzzle, since it works in tandem with the requirement — popular enough to have many Republican supporters — that insurers cease denying coverage to customers with pre-existing conditions. If you repealed the mandate without repealing that requirement, people could simply wait until they were sick to buy insurance, driving everyone’s prices up.

But Republicans could propose dealing with the same problem in a less coercive way. One alternative would establish limited enrollment periods (every two years, for instance) when people with pre-existing conditions could buy into the new exchanges without being denied coverage. Anyone who failed to take advantage wouldn’t be able to get coverage for a pre-existing condition until the next enrollment period arrived. This would reduce the incentive to game the system, without directly penalizing Americans who decline to buy insurance.

Personally, I think two years is too short of an enrollment period: four-to-five years is better, as the German experience demonstrates. But the idea is sound.


  1. Fist of all congratulations for your recovery of loss . So whats the latest update about your band , when are you organizing the next show.

  2. This would reduce the incentive to game the system, without directly penalizing Americans who decline to buy insurance.
    Vimax Pills

  3. The Mondo film is an interesting cinematic curio. Purportedly documentaries on sensational themes, the films would often dramatize or fake incidents to heighten their topics. The success of MONDO CANE in 1962, with its Academy Award nominated theme song "More," opened the gates for a rash of similar offerings. Often foreign pick-ups, these movies were re-dubbed for American audiences, sometimes by celebrities on the decline like George Sanders or Boris Karloff. Something Weird Video has released two titles from this craze (which continues to this day in films like FACES OF DEATH), PRIMITIVE LOVE and MONDO BALORDO, on a double feature DVD that pays homage to this beloved genre. Though not a Mondo film proper, PRIMITIVE LOVE forgoes the usual unseen narrator technique and instead has Jayne Mansfield (THE GIRL CAN'T HELP IT) as herself spending an evening watching Super 8 films with an anthropologist in order to prove her point that men prefer "primitive love." Now as anybody who's seen THE WILD, WILD WORLD OF JAYNE MANSFIELD knows, this buxom blonde of bad taste was apparently possessed with quite the high IQ, so the idea of her actually engaging in intelligent conversation with an anthropologist is not that farfetched. Of course her methods of proving her point do degenerate into questionable tactics.

  4. I was very pleased to read your article very useful and add insight, excuse me permission to share articles herein may be useful to you in particular are looking for :
    cara mengobati sinusitis
    cara mengobati perlemakan hati
    cara mengobati infeksi saluran kencing

  5. I still liked this article, good, good content, and unique design.Thank you for sharing the article.
    cara alami menyembuhkan penyakit lupus

  6. I like viewing web sites which comprehend the price of delivering the excellent useful resource free of charge. I truly adored reading your posting. Thank you! Health

  7. During the summer months, there are a lot of great activities to be enjoyed. While at home or on vacation, there are several great lawn games that are quick to set up and easy to enjoy. From boules to quoits, there are ones that can be played by people of all ages. playstore games for mobile