James C. Capretta Articles

Be Prepared

How to respond if the Court ends Obamacare ­subsidies.
Mar 09, 2015


Few people expect much to happen on health care in the 114th Congress, certainly not President Obama. He plans to continue bending and twisting his interpretation of Obamacare’s many complex provisions as necessary to keep it afloat and to avoid dealing at all with opposition to the law among the public or the Republicans who now run Congress.

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Lessons from the 1995 Strategy

Tactics and an agenda for the new Congress.
Dec 01, 2014

The Republican victory in the midterm election was decisive. Now the victors must chart a sensible course for the next two years—one that demonstrates they can be trusted as America’s governing party and sets the table for 2016.

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Getting There

How to transition from Obamacare to real health care reform
Sep 22, 2014

Obamacare—or at least the version of it that the president and his advisers currently think they can get away with putting into place—has been upending arrangements and reshuffling the deck in the health system since the beginning of the year. That’s when the new insurance rules, subsidies, and optional state Medicaid expansions went into effect.

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The Reality Behind the Latest Pro-Obamacare Spin

3:44 PM, Sep 08, 2014

Obamacare’s defenders are busy declaring victory again.  Ezra Klein is touting a new survey of Obamacare benchmark premiums in some regions of the country as evidence that the law is defying the predictions of critics and working to cut costs rather than increase them.

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Hitting the Political Sweet Spot on an Obamacare Alternative

1:50 PM, Jun 05, 2014

Over at Forbes, Peter Ferrara has written an interesting assessment of the state of the debate among conservatives on how to advance an alternative to Obamacare that will lead to its repeal.  His analysis gets many things right.  Most especially, he is right that it will not be possible to move away from Obamacare without a viable plan to replace it — and not just any replacement plan will do the trick.  A politically viable alternative must substantially increase insurance coverage versus the pre-Obamacare status quo while also providing real solutions for persons with expensive pre-existing health conditions — doing so, of course, without the heavy-handed mandates and regulations of Obamacare.  Plans that fall short of these objectives will be successfully attacked as inadequate.  Most Americans rightly believe that a return to the pre-Obamacare status quo would not be satisfactory because health care in the United States desperately needs real reform.  What they don’t want is the massive government takeover of American medicine that Obamacare represents.

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The Obamacare Opportunity

An opening for a genuine alternative.
May 05, 2014

Obamacare’s defenders are doing their best to sustain a triumphant mood these days. In the wake of the late-March surge in exchange enrollment, many proponents of the law have insisted it can no longer be rolled back. As the president put it in his April 1 Mission Accomplished speech announcing the enrollment figures, “The Affordable Care Act is here to stay.”

But just as conservative assertions that the law would collapse of its own weight were premature, so too are today’s liberal proclamations that the debate is over.

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The Burr-Coburn-Hatch Proposal

8:40 PM, Jan 27, 2014

As Bill Kristol and Jeff Anderson noted earlier today, the introduction by Republican Senators Burr, Coburn, and Hatch of an Obamacare replacement plan is an important milestone in the health care debate. This is a serious and practical replacement proposal, offered by three prominent legislators. It could easily serve as the starting point for a legislative effort, perhaps even next year if Republicans regain control of the Senate, to undo Obamacare and replace it with something far better.

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Unwinding Obamacare

Jan 27, 2014

Obamacare is no longer a theoretical proposition. It is now being implemented, if with some notable exceptions for the portions of the law the Obama administration finds particularly inconvenient. Millions of Americans are experiencing its consequences directly, and millions more are forming their opinions of it based on what they are hearing of its effects. Those opinions are generally not positive. The fact that many of the law’s congressional supporters are now running scared for fear of voter backlash is a good indication of how poorly the rollout is going.

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Obamacare Is Falling Apart Before Our Eyes

Obamacare madness, Christmas edition.
4:31 PM, Dec 20, 2013

The wrecking ball swung again toward the crumbling Obamacare edifice yesterday. Ironically, it continues to be the Obama administration that is operating the heavy machinery.

Health and Human Services Secretary Kathleen Sebelius announced, in the form of a letter to Democratic senators, that Obamacare’s individual mandate tax will be waived in 2014 for persons who had their policies canceled in 2013 due to Obamacare.

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Another Broken Promise: Obamacare Is Driving Costs Up, Not Down

3:15 PM, Nov 26, 2013

The past two months have laid bare the emptiness of the president’s most prominent Obamacare promises.  Millions are losing the plans they have and like against their wishes, contrary to the president’s oft-repeated pledge.  And those being forced into Obamacare could lose access to the doctors and hospitals they trust, also contrary to assurances from the president.  The evidence demonstrating that these commitments cannot be met is so overwhelming that even the administration has abandoned defense of the president’s previous statements.

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The Upton Bill Is No Small Matter

5:52 PM, Nov 13, 2013

The full reality of what Obamacare will mean for average Americans is only now becoming clear as the crisis over cancelled insurance plans in the individual market has steadily unfolded in recent days.

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Obamacare’s Mugged by Reality Moment

Nov 04, 2013

As  metaphors go, “train wreck” turned out to be pretty apt. That’s how retiring Democratic senator Max Baucus described his expectations for the implementation of Obamacare at a hearing last April. If anything, he could be accused of soft pedaling the fiasco that has been on full display since the beginning of October.

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Win the Argument: How the GOP Can Get the Upper Hand

11:00 PM, Oct 01, 2013

The congressional GOP has finally taken a position in its budget struggle with the Obama administration that maximizes its chances for a decent outcome.  Unfortunately, it only got there after going through several other steps first, a process that may have jeopardized the advantage they should be now enjoying.

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The Play Should Be Delay

11:50 AM, Sep 16, 2013

Between now and the end of the calendar year, congressional Republicans and the Obama White House will engage in a protracted struggle over fiscal matters. The pile-up of must-do budgetary items now on the agenda makes that certain, starting with the need for stop-gap funding before October 1 to keep the government open and running.

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The Soft Underbelly of Obama­care

Aug 12, 2013

For opponents of Obamacare, it almost seems like the law offers too many targets to choose from. Its effects on premiums and costs look to be highly unpopular, its perverse incentives are already harming employment, its state exchanges will hand out costly subsidies without the necessary checks against fraud, the promises of its champions—from keeping costs down to keeping the coverage and doctors you have—are proving empty, its lawless implementation is anathema to our system of government, and on and on.

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The Significance of the Missing Employer Mandate

9:02 PM, Jul 30, 2013

After getting over the shock of the Obama administration’s unilateral decision to delay the employer mandate for a year, supporters of the law have taken to downplaying the significance of the step. Jonathan Chait and Ezra Klein, among others, have said it is just not that big of a deal to delay a provision that they claim affects so few employers. After all, they argue, most employers offer coverage today without the mandate, so it can’t be true that imposing the mandate is essential to making the rest of the law work well. Klein goes even further and

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The Fiasco That Is Obamacare

12:50 PM, Jul 08, 2013

On Friday, the Obama administration dropped another health care implementation bombshell.

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The White House’s Peculiar Obamacare Delay

7:15 AM, Jul 03, 2013

The Obama administration must have been hearing some awfully threatening noises from the business community lately, because its unilateral delay of Obamacare’s employer mandate, from 2014 to 2015, is otherwise very difficult to explain. The delay is an embarrassing move for the White House and will create some serious new headaches for Obamacare’s defenders.

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Delay, Repeal, Replace

The Obamacare fight has just begun
Feb 04, 2013

More Mediscare

Aug 20, 2012

The oddly convenient academic study has long been a weapon in the Democratic party’s arsenal of election-season demagoguery. Do you need to say that conservative policies would sink the republic? Here’s a paper by scholars from a respected university, published in a respected journal, and released just as your campaign was turning to the issue in question, which happens to say just what you had in mind. It might all fall apart on closer inspection, but in the heat of a campaign it’s a perfect fit.

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The Medicare Trustees’ Report and the $8.1 Trillion Double Count

9:10 AM, Apr 24, 2012

The 2012 Medicare and Social Security trustees’ reports have been released (see here and here). The headline is that the Medicare Hospital Insurance (HI) trust fund will have insufficient reserves to pay full benefits beginning in 2024 (the same year that was projected in last year’s report).

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CLASS Dismissed

Oct 31, 2011

As the debate on Obamacare reached a crescendo in late 2009 and 2010, no question was more hotly contested than whether the plan would narrow or widen future federal budget deficits. This issue was particularly sensitive among the handful of wavering Democrats from conservative-leaning districts and states. Their constituents were dubious of the budgetary wisdom of the entire Obama-care exercise, but the bill couldn’t pass without their votes.

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Don’t Forget Obamacare

Sep 26, 2011

Obamacare’s individual mandate—requiring that all Americans purchase government-approved health insurance beginning in 2014—has always been the law’s most vulnerable provision. It is incredibly unpopular, and not just among conservatives. Polls consistently show that a large majority of the electorate opposes it, including a good portion of registered Democrats.

It is not hard to see why.

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The Central Front

Why health care is the essential issue for 2012.
Apr 04, 2011

Even as they engage in heated battles over the budget and try to define a new agenda from their perch in the House of Representatives, conservatives clearly understand that the key to turning things around​—​to averting a debt crisis and defending the ideal of limited government​—​is winning the 2012 election. Only with a new president can they halt and reverse the leftward leaps of the past few years and address the increasingly dire consequences of six decades of welfare-state expansion.

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