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The Affordable Care Act: A Dire State of an Unstable Union

The Affordable Care Act: A Dire State of an Unstable Union. Tom Miller American Enterprise Institute January 25, 2012. Overview. It’s not dead yet (multiple threats ahead) Four main arenas The two halves of 2012 Rolling over, staying alive Run-up or run-down to 2014 and beyond.

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The Affordable Care Act: A Dire State of an Unstable Union

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  1. The Affordable Care Act:A Dire State of an Unstable Union Tom Miller American Enterprise Institute January 25, 2012

  2. Overview It’s not dead yet (multiple threats ahead) Four main arenas The two halves of 2012 Rolling over, staying alive Run-up or run-down to 2014 and beyond

  3. Diehard Defenders of ACA(The Dark Knight in Monty Python & the Holy Grail, 1975)

  4. It’s Only a Flesh Wound

  5. Getting More One-Sided asWounds Add Up

  6. Pitiful Desperation

  7. Four Main Battle Fronts Judicial (Supreme Court) Political (Congress, 2012 election) Administrative (statute vs. regs, states, clock) Economic

  8. Russian Roulette, with 4 Chambers Loaded

  9. Constitutional Challenges Individual mandate (no limiting principle) Medicaid coercion Anti-injunction act Severability Over-investment stifles political debate The day after decision day

  10. Political Hurdles First Half 2012: Recycle, oversight, stalemate (yawn) Second Half 2012 Response post-Supreme Court Reinforcing candidates Roiling passionate states of mind Reciprocal exaggerations Replace?

  11. Defense Mechanisms Stretching small accomplishments Roll over and play dead Regulatory rewrite Institutionalize until inevitable Rewrite, upgrade post-2012?

  12. Rope A Dope (II?)

  13. Narrator: Meanwhile a short distance away, Snidely Whiplash was up to his favorite pastime: tying women to railroad tracks. He soon had unexpected company!Snidely(spotting Dudley): A Mountie!Dudley(taking no notice of the situation): Correct! Pardon me, sir, but do you happen to know the way to the Royal Canadian Mountie camp?Snidely(politely): Why, yes, I do. ...Oh, this pesky knot! Could you give me a hand, or rather, finger, heh heh?Dudley: Always willing to help a citizen in need. (offering an index finger) There! Snidely immediately ties Dudley's finger into the knot.Snidely: Hah-hah-hah-haa! Dudley Do-Right of the Mounties! Get out of thaat if you can! Snidely exits. The blonde glares at Dudley as he realizes he's been tricked. Dudley: Oh, fudge.

  14. The Secret Plan for Health Delivery Reform & ACA Implementation

  15. Pre-2014 Warm Up Exchanges Premiums Employer option plays Medicare Advantage (slower meltdown) Consolidation, political competition

  16. Getting Past 2013 Solving simultaneous equations, w/ no proofs Delay Dollars Collisions at intersections

  17. Replacement? Defined contribution financing for taxpayer subsidies Retargeting subsidies (high-risk pools, Medicaid) Stop hiding the real price tags Maximizing value options for different levels of resources & preferences Usable “value” info beyond health insurance Back to basics insurance regulation (solvency, transparency, information, competition, contracts) State competition in ins reg (PASL plus)

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