June 10, 2013 | Issue Brief on Health Care
As the case against Obamacare continues to mount, states should be ready to act. Despite the President’s professions of confidence, recent concerns voiced by Members of Congress—added to lackluster support for and understanding of the law by the public—have further exposed Obamacare’s real and practical vulnerabilities.
In preparation for the likely collapse of Obamacare, states should advance their own patient-centered, market-based solutions that stimulate more affordable coverage, better access, and superior quality and innovation.
President Obama recently tried to downplay the law’s implementation problems and their impact on everyday Americans. The reality, however, is that the massive disruption caused by this health care law has already started—and the worst is still to come. For instance, in the near future, Americans will see higher taxes, new penalties, and skyrocketing premiums; millions will be displaced from their current coverage, and millions will remain without health insurance.
Even among supporters of the law in Congress, there is growing concern and discontent. At a recent hearing with a top Department of Health and Human Services (HHS) official, Senator Jay Rockefeller (D–WV) warned that the implementation is “so complicated and if it isn’t done right the first time, it will just simply get worse.” At a hearing with HHS Secretary Kathleen Sebelius, Senate Finance Committee chairman Max Baucus (D–MT) expressed similar concerns:
I am very concerned that not enough is being done so far—very concerned. When I’m home, small businesses have no idea what to do, what to expect, they don’t know what affordability rules are, they don’t know what penalties may apply.…
A lot of people have no idea about all of this.… I just see a huge train wreck coming down, and you and I have discussed this many times and I don’t see any results yet.
The American people remain skeptical and confused. According to a new Kaiser Family Foundation Tracking Poll, 40 percent of Americans have an unfavorable view of the law. Moreover, 42 percent believe incorrectly that the law has been repealed or overturned by the Supreme Court or do not know.
The dismissiveness of the Administration, the lack of confidence in Congress, and the continued lack of public support and understanding of the law itself all add to the unavoidable structural challenges facing the law.
Obamacare remains an obstacle to states advancing real health care reform. But states should be ready to act on the inevitable collapse of Obamacare and its full repeal. The following are a few among many state policy ideas that states could pursue and put them ahead of the reform curve:
The future of Obamacare remains uncertain. Higher premiums, exploding costs, and deteriorating coverage could ultimately lead to its downfall. Its repeal would pave the way for patient-centered, market-based reforms, and states should be ready to lead the way.
—Nina Owcharenko is Director of the Center for Health Policy Studies and Preston A. Wells Jr. Fellow at The Heritage Foundation.
Robert E. Moffit, “The Prospects for Ending Obamacare: Learning from Health Policy History,” Heritage Foundation Backgrounder No. 2424, June 21, 2010, http://www.heritage.org/research/reports/2010/06/the-prospects-for-ending-obamacare-learning-from-health-policy-history. See also The Heritage Foundation, “The Case Against Obamacare,” http://www.heritage.org/research/projects/the-case-against-obamacare.
Paul Bedard, “Obamacare Architect Rockefeller: It’s ‘Beyond Comprehension,’” Washington Examiner, April 11, 2013, http://washingtonexaminer.com/obamacare-architect-rockefeller-its-beyond-comprehension/article/2526681 (accessed June 8, 2013).
Alyene Senger, “Democratic Senator: Obamacare a ‘Train Wreck Coming,’” Heritage Foundation, The Foundry, April 18, 2013, http://blog.heritage.org/2013/04/18/dem-senator-obamacare-a-train-wreck-coming/.
Leigh Wachenheim and Hans Leida, “The Impact of Guaranteed Issue and Community Rating Reforms on States’ Individual Insurance Markets,” Milliman, March 2012, http://ahipcoverage.com/wp-content/uploads/2012/03/Updated-Milliman-Report.pdf (accessed June 8, 2013).
Council for Affordable Health Insurance, “CAHI Identifies 2,271 State Health Insurance Mandates,” April 9, 2013,
For a discussion of this issue, see Edmund F. Haislmaier, “Saving the American Dream: The U.S. Needs Commonsense Health Insurance Reforms,” Heritage Foundation Backgrounder No. 2703, June 22, 2012, http://www.heritage.org/research/reports/2012/06/saving-the-american-dream-the-us-needs-commonsense-health-insurance-reforms; and Tom Miller and James Capretta, “How to Cover Pre-Existing Conditions,” National Affairs, Summer 2010, http://www.nationalaffairs.com/publications/detail/how-to-cover-pre-existing-conditions (accessed June 10, 2013).
Florida, for example, has recently received approval to expand its two-county Medicaid demonstration project statewide. See Tarren Bragdon, “Florida’s Medicaid Reform Shows the Way to Improve Health, Increase Satisfaction, and Control Costs,” Heritage Foundation Backgrounder No. 2620, November 9, 2011, http://www.heritage.org/research/reports/2011/11/floridas-medicaid-reform-shows-the-way-to-improve-health-increase-satisfaction-and-control-costs.
For a discussion of the issue and options, see Randolph W. Pate and Derek Hunter, “Code Blue: The Case for Serious State Medical Liability Reform,” Heritage Foundation Backgrounder No. 1908, January 17, 2006, http://www.heritage.org/research/reports/2006/01/code-blue-the-case-for-serious-state-medical-liability-reform.
U.S. Federal Trade Commission and the U.S. Department of Justice, “Improving Health Care: A Dose of Competition,” July 2004, p. 22,