Yesterday two researchers at the Brookings Institution released an article claiming that “people are getting more for less” in the individual market under Obamacare. The piece claims that people are getting “better” coverage, so I asked one of the authors on Twitter: What proof do you have that the coverage is better? Do people like PPACA plans more than their prior coverage? Are these new plans leading to better health outcomes for patients?
In an exchange of tweets, Brookings’ Loren Adler said that surveys show people are satisfied with their PPACA coverage — a nice point, but one that doesn’t prove people think it’s “better” than what they had before. And he admitted that studying the trade-offs PPACA created — in which generally plans have a higher actuarial value, but smaller doctor and hospital networks — “wasn’t the focus of the research piece.” All well and good, but if that’s the case, why go out on a limb and make an unsubstantiated claim that PPACA coverage is “better?”
He didn’t have a good answer. He tweeted that the claim of “better” coverage “has nothing to do with the analysis itself of premium comparison,” and that “the wording used in the intro/conclusion has nothing to do w/ analysis itself.”
Think about those words for a second. Is that the standard we want for research — that people can reach “conclusions” that have “nothing to do with the analysis itself?” On that basis, I wrote an e-mail to Brookings (pasted below) requesting a retraction or clarification on the specific point that coverage is “better” and people are getting “more” under PPACA.
As I pointed out last night, the Brookings researchers MADE the nature of PPACA coverage a focal point of the analysis, by including unsubstantiated claims to fit a political talking point: “You’re getting more/better coverage for less!” Having been called out on it, they should prove the claim, or withdraw it.
Folks on the Left complain frequently about a supposed “wonk gap” among conservatives. I’d be VERY interested to hear from Paul Krugman, or any other observer, who would defend a researcher who makes conclusions that — by his own admission — have “nothing to do with the analysis itself.”
The platform approved Monday at the Republican National Convention suggests that a future Republican administration could dismantle Obamacare using regulatory authority. A Republican president could not waive portions of the law, but he could act to stop controversial payments that are being made to insurers.
In its section on health care, the platform pledged of Obamacare: “a Republican president, on the first day in office, will use legitimate waiver authority under the law to halt its advance and then, with the unanimous support of Congressional Republicans, will sign its repeal.” The waiver concept echoes language used by 2012 Republican nominee Mitt Romney, who pledged that “If I were president, on Day One I would issue an executive order paving the way for Obamacare waivers to all 50 states.”
The “legitimate waiver authority” provided under the law is unlikely to grant the type of relief the Republican delegates or Mr. Romney envisioned. Language in section 1332 of the Affordable Care Act addresses the waiver of some provisions of the law. The waivers, however, apply only to states, not to individuals. They also apply only to a few delineated sections of the law, including the individual and employer mandates.
As I wrote last July, the waiver authority in the law allows changes in just one direction. States can cover more people or provide more generous insurance coverage than Obamacare does, but they cannot make changes that deviate from the law’s objectives—such as implementing health savings accounts or consumer-directed health plans. This amounts to the administration and Obamacare offering little flexibility to states whose leaders’ philosophical objectives differ from their own. A Republican administration is likely to bring in regulators with a different philosophy, but the statutory strictures would not change unless and until Congress acted.
It’s worth noting, however, that the Obama administration has made several unilateral decisions about a series of supplemental payments to insurers—regarding reinsurance, risk corridors, and cost-sharing subsidies. Because these payments were provided without the usual notice-and-comment period in rule-making, a Republican administration could take its own steps to end the billions of dollars in payments to insurers. If a future president wants to “waive” portions of Obamacare on Day One, these controversial payments would be the most feasible objective.
This post was originally published at the Wall Street Journal Think Tank blog.