How will the new health care law affect those who must pay for it? This event held an in-depth discussion
Download Audio as MP3 of the costs and consequences of the health reform bill and its impact on U.S. economic growth, federal and state government budgets, labor-market decisions, and private health insurance coverage. Panelists also focused on the various implementation challenges and burdens faced by employers who account for the overwhelming share of private health coverage.
Over lunch, Indiana governor Mitchell E. Daniels Jr. discussed the impact of the new federal law on health care market reforms at the state level--where officials face severe fiscal pressures--including the management of the state's Medicaid program.
|9:00||Panel I: Costs and Consequences for Government Budgets, Labor Markets, and the U.S. Economy|
|Panelists:||Donald B. Marron, Urban-Brookings Tax Policy Center|
|Diana Furchtgott-Roth, Hudson Institute Center for Employment Policy|
|Scott D. Pattison, National Association of State Budget Officers|
|Moderator:||Thomas P. Miller, AEI|
|10:30||Panel II: Will Health Reform Work for Employers?|
|Panelists:||Robert F. Graboyes, National Federation of Independent Business|
|Neil Trautwein, National Retail Federation|
|Cori Uccello, American Academy of Actuaries|
|Tracy Watts, Mercer
|Moderator:||Joseph Antos, AEI|
|12:15 p.m.||Luncheon and Keynote Address: Will Health Reform Work for States?|
|Speaker:||Governor Mitchell E. Daniels Jr. (R-Ind.)
American Enterprise Institute
American Enterprise Institute
WASHINGTON, JUNE 15, 2010--With health reform legislation still in its early stages of implementation, an array of experts gathered at AEI to discuss its costs and consequences for those who will pay for it. The first panel assessed the budgetary and labor-market impacts of the law, observing that overstretched state resources and disincentives to hire low-skilled workers could limit access to care and dampen employment growth. The second panel noted that uncertainties in the rule-making process and the arbitrary nature of employer penalties could compromise the continuation of current employer-sponsored health coverage. The keynote speaker, Governor Mitchell E. Daniels Jr. of Indiana, presented a forecast of the substantial new costs to be imposed on his state in implementing Medicaid mandates and other likely burdens under the law. He observed that national health care policy had missed an opportunity to move toward a consumer-driven model of accountability in health care.
- "From my point of view as a budget geek, I have a long list in my mind . . . [of] the things I think we should do when we become serious about our budget situation. And I will plead that some of the things that are on my list are no longer available . . . and the reason why they are no longer available to deal with the long-run budget challenge is because they were used as pay-fors for the health care legislation. . . . And so, our quiver is somewhat empty. All else equal, I would argue that makes our long-run budget challenges different. . . . I would characterize this more generally as a problem with pay-go. Pay-go is a very useful budget construct to have Congress pay for things it wants to do. But if you're worried about the long-run budget challenge, and how we have this yawning gap in the future, then the reality is that pay-go isn't enough because pay-go often just means you're reaching over into the quiver of things you're saving for the future and using them now as pay-fors, and you're not really paying for things in . . . the larger budget perspective."
--Donald B. Marron, Director, Urban-Brookings Tax Policy Center
- "I think you'll see some reticence to hire at the margins [in regards to] entry-level employees. Not too long ago retail was celebrated for helping to support welfare reform and taking people who hadn't worked for a while into the labor force. And that capacity to absorb entry-level [employees] may be limited for fear of the unaffordability mandate. Many of the retailers I've talked to said they are thinking about moving toward a penalty-type approach and not increasing pay in partial compensation for that slice of the compensation pie. There is no free lunch when it comes to health care for all, and I think that is going to squeeze the labor force in many ways."
--Neil Trautwein, Vice President, National Retail Federation
- "I wish honestly that national health care policy had headed in some direction more like this [Indiana's model of consumerism in health care]. When people sometimes ask me what we ought to do or what my reaction to this whole bill is, I sometimes start by saying that 'in a dead end, full speed ahead is the worst option.' That's what I think we did. My own view is that we could hardly have built a health care system more guaranteed to produce excessive costs. . . . Whatever else you think or say about it, don't call this reform. It didn't reform anything. It took the form we had and blew it up to poster size. And I'm afraid by perpetuating the drivers of higher costs, it's setting us up for more disappointments in the future."
--Governor Mitchell E. Daniels Jr.
- "A model like the one we just discussed [consumerism in health care] is more respectful of human dignity and human autonomy. Most [people] probably think of themselves as pretty savvy, self-reliant people. The premise of the bill we got is, you're too dumb to do that. We're going to do it for you, and you're certainly not capable of making the admittedly difficult rational decisions that will always be there as long as an infinite want--immortality--collides with a finite resource--money."
--Governor Mitchell E. Daniels Jr.
Joseph Antos is the Wilson H. Taylor Scholar in Health Care and Retirement Policy at AEI. He is also a commissioner of the Maryland Health Services Cost Review Commission, a health adviser to the Congressional Budget Office, and an adjunct professor at the Gillings School of Global Public Health at the University of North Carolina at Chapel Hill. Before joining AEI, Mr. Antos was assistant director for Health and Human Resources at the Congressional Budget Office. At AEI, Mr. Antos's research focuses on the economics of health policy, including Medicare reform, health insurance regulation, and the uninsured. He has written and spoken extensively on the Medicare drug benefit and has led a team of experienced independent actuaries and cost estimators in a study to evaluate various proposals to extend health coverage to the uninsured. Mr. Antos also writes for AEI's Health Policy Outlook series.
Governor Mitchell E. Daniels Jr. was elected as the forty-ninth governor of Indiana in 2004. He came from a successful career in business and government, holding top management positions at the Hudson Institute and Eli Lilly and Company, and served as chief of staff to Senator Richard Lugar (R-Ind.), senior adviser to President Ronald Reagan, and director of the Office of Management and Budget under President George W. Bush. During his tenure as governor, Mr. Daniels has made restoring the state's fiscal integrity and job creation his top priorities. The state has seen record job growth and investment, experienced its first honestly balanced budget in eight years, and remains the only state in the nation with a funded infrastructure plan, all without raising taxes. Mr. Daniels was reelected in 2008 and received more votes than any candidate for public office in the state's history. He and his wife, Cheri, have four daughters.
Diana Furchtgott-Roth is a senior fellow at the Hudson Institute, where she directs the Center for Employment Policy. Her areas of expertise include employment, health, taxation, education, pensions, unionization, and immigration. Prior to joining Hudson, Ms. Furchtgott-Roth was chief economist of the U.S. Department of Labor. From 2001 to 2002, she served as chief of staff of the President's Council of Economic Advisers under President George W. Bush. Ms. Furchtgott-Roth served as deputy executive director of the Domestic Policy Council and associate director of the Office of Policy Planning in the White House under President George H. W. Bush from 1991 to 1993, and she was an economist on the staff of President Ronald Reagan's Council of Economic Advisers from 1986 to 1987. She is the editor of Overcoming Barriers to Entrepreneurship in the United States (Rowman and Littlefield, 2008) and the coauthor of The Feminist Dilemma: When Success Is Not Enough (AEI Press, 2001) and Women's Figures: An Illustrated Guide to the Economics of Women in America (AEI Press, 1999). Ms. Furchtgott-Roth was assistant to the president and resident fellow at AEI from 1993 to 2001. From 1987 to 1991, she was an economist at the American Petroleum Institute, where she authored papers on energy and taxation.
Robert F. Graboyes is senior health care adviser at the National Federation of Independent Business. A frequent public speaker, interviewee, and blogger, Mr. Graboyes is intimately involved in federal and state health care reform. He also teaches health economics in master's and doctoral programs at Virginia Commonwealth University, the University of Virginia, and George Mason University. Previously, he was Chase Manhattan Bank's economist for sub-Saharan Africa and, later, an economist at the Federal Reserve Bank of Richmond. He visited Kazakhstan twice to teach economics to public health officials, and he chaired the Health Economics Roundtable for the National Association for Business Economics.
Donald B. Marron is the director of the Urban-Brookings Tax Policy Center and a visiting professor at the Georgetown Public Policy Institute. He also writes about economics, finance, and life at dmarron.com. Mr. Marron previously served as a member of the President's Council of Economic Advisers, as acting director of the Congressional Budget Office, and as executive director of Congress's Joint Economic Committee. Before his government service, he taught economics and finance at the University of Chicago Graduate School of Business, consulted on antitrust matters, and served as chief financial officer of a health care software start-up.
Thomas P. Miller is a resident fellow at AEI, where he focuses on health policy with a particular emphasis on information transparency, health insurance regulation, and consumer-driven health care. He was a member of the National Advisory Council for the Agency for Healthcare Research and Quality from 2007 to 2009. Before joining AEI, Mr. Miller served for three years as a senior health economist for the Joint Economic Committee, where he organized a series of hearings focusing on promising reforms in private health care markets. He also has been director of health policy studies at the Cato Institute and director of economic policy studies at the Competitive Enterprise Institute. Mr. Miller's writing has appeared in publications such as Health Affairs, the Wall Street Journal, the New York Times, the Washington Post, the Los Angeles Times, Reader's Digest, National Review, the Journal of Law and Contemporary Problems, Regulation, and Cato Journal. Before coming to Washington to work on public policy, he was a trial attorney, a journalist, and a radio broadcaster.
Scott D. Pattison serves as the executive director of the National Association of State Budget Officers (NASBO) located in Washington, D.C. Prior to accepting the position with NASBO, Mr. Pattison served for four years as the state budget director of Virginia after heading the Regulatory and Economic Analysis section of the Virginia Department of Planning and Budget. Mr. Pattison held a variety of posts in the Office of the Attorney General of Virginia, including that of counsel. Mr. Pattison has served on several boards in Virginia, including the Debt Capacity Advisory Board, the College Building Authority, and the Performance Management Advisory Committee. He has been an adjunct faculty member at the University of Richmond and has served on the board of Old Dominion University in Norfolk, Virginia. He is a fellow with the National Academy of Public Administration. Mr. Pattison's career includes service with the federal government as an attorney-adviser with the U.S. Federal Trade Commission in Washington, D.C. He also operated a small nonprofit focusing on consumer-protection issues.
Neil Trautwein joined the National Retail Foundation (NRF) in 2006 as vice president and employee benefits policy counsel. As such, Mr. Trautwein heads NRF's work on health care reform and other benefits-related legislation and regulatory issues, developing both short-term tactics and long-term strategy aimed at helping retailers provide workers with competitive benefits while controlling costs. Mr. Trautwein is one of the most prominent health care lobbyists in Washington, serving in a leadership role in a wide variety of key health policy positions and coalitions over the past two decades. He also publishes a popular e-mail newsletter that is widely read among congressional staff, industry allies, media, and health policy experts across the nation. Mr. Trautwein is an NRF spokesperson on health care issues and is often quoted in print and broadcast media. He came to NRF from the National Association of Manufacturers (NAM), where he was assistant vice president for human resources policy. Before joining NAM, he served as manager of health care policy at the U.S. Chamber of Commerce, as director of governmental affairs at the National Association of Health Underwriters, and as a legislative assistant handling health policy and other issues for Senator Mitch McConnell (R-Ky.).
Cori Uccello is an actuary and the senior health fellow at the American Academy of Actuaries. She serves as the actuarial profession's chief public policy liaison on health care issues. In this role, she promotes the formulation of sound health policy by providing nonpartisan technical assistance to federal and state policymakers. These efforts include the development of the Academy's Critical Issues in Health Reform series. She is currently involved in the Academy's efforts to provide guidance to state and federal regulators regarding the implementation of various health reform provisions. She has been cited in numerous media outlets, including the New York Times, the Washington Post, and the Wall Street Journal, and has appeared on National Public Radio, the PBS Nightly Business Report, and Fox Business News. Ms. Uccello was appointed to the Medicare Payment Advisory Commission in May 2010.
Tracy Watts is a partner in Mercer's Washington, D.C., office. A consultant with Mercer for over twenty years, she leads Mercer's health care and group benefits consulting segment activity (large market) for three geographies: the Mid-Atlantic, Southeast, and Southwest. She also leads Mercer's health care reform efforts for consulting segment (large market) clients. Ms. Watts specializes in health care cost management, assisting employers in the design, evaluation, and ongoing management of health and group benefit plans for active and retired employees. She is on Mercer's national steering committee that supports client initiatives in the area of consumerism and account-based plans and on the advisory group responsible for Mercer's HealthOnline decision-support tool. Ms. Watts is a member of the National Business Group on Health National Leadership Committee on Consumerism and Engagement. She coauthored a chapter titled "Employer Coverage Trends" in Rise to Prominence—The PPO Story (American Association of Preferred Provider Organizations, 2000). She served on the Standards Committee for URAC/American Accreditation HealthCare Commission and on an advisory board for an online education program developed by the American Association of Preferred Provider Organizations.