The case for competition, choice, and a healthy federalism

Chapter 1 of The Great Experiment

The case for competition, choice and a healthy federalism

 

Chapter 1 of The Great Experiment

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Are We All Federalists Now?

  • The excessive claims and ambiguities of the Affordable Care Act have opened important opportunities to reassert state-level leadership and innovation in health policy
  • Facilitating greater jurisdictional competition among states to provide and regulate health care should be designed to limit each state’s current monopoly-like political powers based on geographic factors alone.
  • States can test and demonstrate new models of policy reform until their broader adoption reaches a critical tipping point for more of a national policy consensus.
  • States still face longstanding institutional constraints (a fractured regulatory system, dependence on federal financial subsidy rules, their underlying resource base, and an uncertain but unfriendly federal policy climate) that limit how much health reform they can achieve on their own.
  • Nevertheless, states should take a more assertive role in ensuring access to individuals with serious pre-existing health conditions, expanding choices in health insurance regulation, restructuring their Medicaid programs, and developing actionable information for better health care decisions.        
  • Real health reform is needed at both the state and federal levels. It will take a few more shovels first to bury most, if not all, of the Affordable Care Act and then to dig a way out to a market-based solution that relies on state-level policy innovation in key areas.  
More information about The Great Experiment is available here

 

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About the Author

 

Thomas P.
Miller
  • Thomas Miller is a former senior health economist for the Joint Economic Committee (JEC). He studies health care policy and regulation. A former trial attorney, journalist, and sports broadcaster, Mr. Miller is the co-author of Why ObamaCare Is Wrong For America (HarperCollins 2011) and heads AEI's "Beyond Repeal & Replace" health reform project. He has testified before Congress on issues including the uninsured, health care costs, Medicare prescription drug benefits, health insurance tax credits, genetic information, Social Security, and federal reinsurance of catastrophic events. While at the JEC, he organized a number of hearings that focused on reforms in private health care markets, such as information transparency and consumer-driven health care.
  • Phone: 202-862-5886
    Email: tmiller@aei.org
  • Assistant Info

    Name: Neil McCray
    Phone: 202-862-5826
    Email: Neil.McCray@aei.org

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Getting it right: A better strategy to defeat al Qaeda

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Obamacare’s rocky start and uncertain future

During this event, experts with many different views on the ACA will offer their predictions for the future.   

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