First Strategy: Dismantle ObamaCare

In a surprise pick, Pennsylvania Republican Rep. Joe Pitts was selected to chair the House Energy and Commerce Health Subcommittee, which, with the Ways and Means Health Subcommittee, will lead the charge against ObamaCare in the next Congress. Rep. Wally Herger of California is in line to head the Ways and Means Health Subcommittee.


John Reichard of Congressional Quarterly reports that Pitts said the first legislative priority will be wholesale repeal of the health law — “which will pass the House, I’m sure, but realistically won’t get past the Senate or the president.”

Then Mr. Pitts said he will move section by section through the health overhaul law to educate the public on just how bad it is. He plans to hold hearings on the individual mandate, the employer mandate, health insurance exchanges, and Medicare cuts. Other hearings will look at the Medicaid expansion under the law and treatment of health savings accounts.

Mr. Pitts added, “We want to bring in the governors of the states who have said that if we turn over Medicaid to the states and give them more flexibility they would be happy to take that, and they could actually run the program with less money.” Rhode Island is proof, with its remarkable success involving a block grant for Medicaid.

Rep. Pitts said he will pursue piecemeal repeal of the health care overhaul law while also rolling out market-based alternatives that he plans to move as a comprehensive piece of legislation.

Rep. Herger says that the dismantling already has begun with the Doc Fix bill that is paid for by increasing the penalty on people who get too much of a federal insurance subsidy. He sees it as “pulling at the thread that will begin to unravel Obamacare.”

“Let it be known on this day in the people’s House the dismantling of Obamacare begins,” Mr. Herger said. “Once the House passes this bill and the president signs it into law, we will have landed the first blow to the Democrats’ massive health care overhaul.”

As people talk about dismantling ObamaCare piece by piece, the reference I keep hearing is to the game called “Jenga.” Players build a tower out of wooden blocks. Each player pulls out a piece until the unfortunate last person pulls out the piece that causes the whole thing to come tumbling down.

Not a bad allusion.

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Doctors ready to quit: If we needed any more evidence that things are about to come tumbling down, a recent survey shows that many doctors are ready to quit medical practice altogether.

And it’s probably just a coincidence that doctors are thinking of leaving practice in about three years, which would be 2014?

Most physicians who actually see patients work in small private practices of 10 or fewer doctors. If even half of those contemplating leaving practice do so, it would have a serious impact on patients’ access to medical care.

Here are the findings by The Physicians Foundation of its survey of nearly 2,400 practicing physicians:


  • 40% of doctors plan to stop providing patient care within three years. They will retire, seek a non-clinical job within health care, or leave the health care field entirely.
  • 60% say reform will force them to close or restrict their practices to certain subgroups of patients. Of these, 93 percent say that decision would affect Medicaid patients, and 87 percent say they’d exclude some or all Medicare patients.
  • 59% believe that reform will cause them to spend less time with patients.
  • 74% will make significant changes in their practice in reaction to reform.
  • 68% think reform will reduce the viability of their practices, and a whopping 80% say that it will hurt private practice specifically.


Specialists, in particular, expect to lose income because of the payment changes under the health overhaul law, making finding a specialist especially difficult.

Our friend Dr. Richard Reece blogged that this wholesale rush from private practice would be a death knell for the health overhaul law. Politicians simply cannot risk imposing changes that will threaten access to care on anything like this scale.

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Galen contest: Last week we published a short paper about 8 things states can do to push back against ObamaCare. The paper has received a great deal of attention — further evidence that the states really are going to be on the front lines in this battle over the next two years.

John Vinci of Americans for Limited Government wrote to us suggesting that we really needed to include one more recommendation: States should refuse to take federal grants involving insurance rates. So we’ve updated the paper to include this ninth idea.

Nine is a good number, but 10 is better. Would you like to add to our list? Submit your 10th idea for the states to

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Beyond R&R: The American Enterprise Institute on Wednesday held a forum to present several major new papers in a series called “Beyond repeal and replace: Ideas for real health reform.” Here is the link to the papers and presentations with distinct and detailed proposals for reform.

AEI scholar Tom Miller is spearheading the project, which provides valuable and important policy recommendations. The publications released this week focused on informed competition, defined contribution financing, and new models for health information technologies, with more papers yet to come. This series provides specific ideas and a positive vision that puts patients, not bureaucrats, at the center of health care decision making and gets us off the path of crushing budget deficits driven by uncontrolled entitlement spending.

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Taking the long view: Speaking of AEI, Joe Antos has a thoughtful, 30,000-foot view of the health reform debate moving forward in the The New England Journal of Medicine.

He concludes:

“Will the President’s health care reform look burdensome and unworkable 2 years from now? Reform is no longer a 2000-page bill sitting on the desk of a senator or representative. The executive branch has been issuing guidance and regulations that are beginning to fill holes in the legislation and will change the way the law works in practice. Much to the chagrin of the legislation’s most ardent supporters, Secretary of Health and Human Services Kathleen Sebelius has been granting waivers when the rules don’t work for everyone, albeit on a selective basis designed to avoid the worst political heat. Although such decisions will soften the impact of reform, they neither alter the shift toward greater government control nor slow the growth of health care spending.

“Despite the talk of repeal, Congress will not pass any major health legislation over the next 2 years, and the health sector and private employers will be hard at work preparing for 2014, when many ACA provisions take effect. That does not make health care reform a fait accompli. Absent a miracle, the country will still face crushing budget deficits when the next president takes office. A Republican president, backed by a Republican Congress, would be wise to delay enrollment in the health insurance exchanges, using the time and money to develop a more targeted plan that closes off open-ended subsidies for health insurance and gets the economic incentives right. A Democratic president would do the same thing out of necessity — but it would take longer.”


Joe gets the last word.


Grace-Marie Turner on AdviserTV

Following the forum “Challenges and Changes: The Next Chapter in the Health Reform Debate,” Grace-Marie was interviewed by Elizabeth Galentine of Employee Benefit Adviser on how the next Congress could improve health reform.
Watch now >>


Also, here is the full-length video from last week’s conference, “Challenges and Changes: The Next Chapter in the Health Reform Debate.”
Watch now >>

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When A Major Medical Financing Study Gets It Wrong

Grace-Marie Turner, Galen Institute
Forbes, 12/10/10

A study issued by the group ProPublica claiming that many doctors are being corrupted by payments from the pharmaceutical industry is seriously flawed, Turner writes. “Dollars for Docs” compiled a database of $257.8 million in payments to 17,700 doctors by seven drug companies. But there are important distinctions in the kinds of payments made to doctors that the study ignores. The ProPublica report does not distinguish between rare private payments for genuinely pernicious activities — like payola, which is already a serious crime — and those that finance crucial activities, like education and laboratory work. The result of ProPublica’s demonizing report is to undermine a vital doctor-industry relationship that facilitates drug innovation and the creation of new cures and treatments.
Read More »

9 Things States Can Do To Push Back Against ObamaCare

Grace-Marie Turner
Galen Institute, 12/08/10

Turner outlines nine things legislators can do to protect states against the destructive health overhaul law: set up only a minimal health exchange, using Utah as a model; request a block grant for Medicaid; join the Florida lawsuit; pass the Freedom of Choice Act; request MLR waivers; get business waivers; hold hearings; and refuse to take federal grants involving insurance rates.
Read More »

Would you like to add to our list? Submit your 10th idea for states to


The Defined Contribution Route to Health Care Choice and Competition
James C. Capretta and Thomas P. Miller, American Enterprise Institute, 12/07/10

Regime Change for Health Insurance Regulation: Rethinking Rate Review, Medical Loss Ratios, and Informed Competition
Scott E. Harrington, American Enterprise Institute, 12/08/10

Harnessing Health Information in Real Time: Back to the Future for a More Practical and Effective Infrastructure
Stephen T. Parente, American Enterprise Institute, 12/08/10

Reforming Health Care Reform in the 112th Congress
Joseph Antos, The New England Journal of Medicine, 12/08/10

The Future of Health Care Reform: Paul Ryan’s “Roadmap” and Its Critics
Robert Moffit, Ph.D., and Kathryn Nix, The Heritage Foundation, 12/03/10

More Health Waivers
Jamie Dupree, The Atlanta Journal-Constitution: Washington Insider, 12/07/10

The Debt Commission’s Most Radical Proposal
Merrill Matthews, Forbes: Right Directions, 12/06/10


Children’s Hospitals Lose Some Drug Discounts
Robert Pear, The New York Times, 12/07/10
(Note that Congress included a patch to this problem in the Doc Fix legislation it passed this week.)


Waiting Your Turn: Wait Times for Health Care in Canada 2010 Report
Bacchus Barua, Mark Rovere, and Brett J. Skinner, Fraser Institute, 12/06/10


Findings From the 2010 EBRI/MGA Consumer Engagement in Health Care Survey
Paul Fronstin, Employee Benefit Research Institute, 12/10

An Analysis of Health Savings Account Balances, Contributions, and Withdrawals in 2009
Hannah Yoo, Christelle Chen, Karen Heath, and Kelly Buck, AHIP’s Center for Policy and Research, 12/10


The Independent Payment Advisory Board
David Newman and Christopher M. Davis, Congressional Research Service, 11/30/10


Washington Needs Medicaid Flexibility
Roger Stark, MD, FACS, and Jason Mercier, Washington Policy Center, 12/10

No Takers for Health Insurance Program
Sean P. Murphy, The Boston Globe, 12/04/10

Making States Responsible
Merrill Matthews, The New York Times: Room for Debate, 12/05/10

Health Costs Sap State Aid for Schools
Michael Levenson, The Boston Globe, 12/09/10


Innovations in Primary Care: What’s in the ACA?
Alliance for Health Reform Briefing
Monday, December 13, 2010
12:15pm – 2:00pm
Washington, DC

Innovations in Health Care Delivery
Health Affairs Conference
Thursday, December 16, 2010
8:30am – 3:00pm
Washington, DC