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Articles by Galen Institute

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Jeryl Bier: 27.49% of Everyone’s Tax Bill Is Spent on Health Care April 16, 2015

By Jeryl Bier

The Weekly Standard, April 16, 2015

Every year since 2011, the White House has used tax time to post a “Federal Taxpayer Receipt” showing taxpayers how their federal tax dollars are being spent. President Obama introduced the concept in his 2011 State of the Union address, and Wednesday the White House posted the fifth installment so taxpayers can see how “tax dollars are being spent on priorities like education, veterans benefits, and health care.”

While users can punch in their own tax liability and see dollar amounts assigned to each category, the figures are based on percentages from the prior fiscal year budget. Comparing those percentages from year to year, taxpayers can see that from 2012 to 2014, the percentage of their taxes going towards federal healthcare expenses has jumped 22 percent.

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Louise Radnofsky: Health-Care Law Trips Up Some at Tax Time April 16, 2015

By Louise Radnofsky:

The Wall Street Journal, April 14, 2015

The tax filing season has uncovered lingering wrinkles in the 2010 health-care law that have caused headaches for consumers who incorrectly estimated their income, didn’t use a government exchange to buy an insurance plan or changed coverage during the year.

Marta Chapman saw her anticipated $850 federal refund wiped out because she received too much in advance tax credits in 2014 to pay her insurance premiums under the Affordable Care Act. That prompted her to drop her plan for this year.

“I canceled because I was very upset. To me it was kind of a trick,” said the 48-year-old personal-care aide in Aztec, N.M. “If I knew that, I wouldn’t have got the insurance.”

Federal officials said they have been working hard to help people get used to the law’s system of financial help to pay health premiums, and will continue to try to make it easier for them. They said the Treasury Department had estimated the vast majority of people who got tax credits would still have some tax refund, on net.

“This is the first year that health insurance and taxes intersect,” said Aaron Albright, a spokesman for the Centers for Medicare and Medicaid Services. “Their tax credit may end up being bigger or smaller than expected, depending on what the person’s income was, but in every case, it is a tax credit from the federal government to lower the cost of their health care. We’re committed to listening and learning along the way so that we can improve.”

The law’s architects wanted the system to be fair, precise and well regulated. They tailored premium subsidies to the cost of insurance for people based on their age, local area and their household income for the year they have the insurance plan.

Continued at The Wall Street Journal

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Ryan Ellis: A Bill That Actually Reforms Medicare April 13, 2015

By Ryan Ellis

National Review, April 13, 2015

Over the long term, the savings from MACRA are enormous.

Tomorrow, the Senate will consider H.R. 2, a Medicare-reform bill that has already acquired a classic Beltway acronym, MACRA. Conservatives should give their full support: According to a report released last week, MACRA not only would pay for itself but would result in large net savings to the Medicare program over time, reducing unfunded liabilities and preventing massive new debt.

To oversimplify it, MACRA does two things to Medicare. First, it replaces a 21 percent planned payment cut to doctors — known as the “sustainable growth rate” or SGR — with a more durable payment system. (This is the devastating cut that has been repeatedly delayed with the “doc fix.”) Second, the bill strengthens means testing in Medicare and requires “Medigap” plans — which cover expenses Medicare does not, encouraging overuse — to expose patients to more costs when they seek treatment.

Some senators have expressed concerns with the bill related to its cost. The Congressional Budget Office projects that MACRA will spend more in the first decade than it saves – $141 billion. This was confirmed by the Center for Medicare Services (CMS) report last week. However, that same report confirms what conservative supporters of MACRA have been saying all along: Over the long term, the new payment regime will cost no more than current law — which assumes the 21 percent SGR cut — and yields even greater savings to the Medicare system.

Continued at National Review

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Dave Gram: Auditor: Little monitoring of Medicaid spending April 13, 2015

By Dave Gram

Burlington Free Press, March 31, 2015

During the past decade, Vermont has spent $675 million setting up Medicaid managed-care programs but has done such a spotty job monitoring them that they can’t even be audited.

That’s the upshot from a letter state Auditor of Accounts Douglas Hoffer sent to lawmakers last week. It followed up on an internal report in January by the Agency of Human Services detailing gaps in answers to this question: Have the state and federal governments — and taxpayers — been getting their two-thirds of a billion dollars’ worth?

Nearly every Vermonter is touched, or knows someone who is, by the wide range of programs in question, Hoffer said in an interview.

“People with developmental disabilities, mental health issues, poor people who need some assistance, schools — these are programs reaching an awful lot of Vermonters,” Hoffer said.

Vermont entered a unique arrangement with the federal government in 2006 called “global commitment,” in which as long as it stayed under projected spending caps, the state would be allowed unusual flexibility in how it spent federal Medicaid dollars.

It was an ideal arrangement for a state where many politicians and activists wanted to expand health coverage to the uninsured while holding down costs — Vermont would become a laboratory for health reform.

While those efforts have unfolded, there has been an increasing focus on government accountability — checking up on programs to be sure the money being spent on them is bringing the desired result. The latest such effort was a “results-based accountability” law passed last year.

Last summer, then-Human Services Secretary Doug Racine decided to focus on the state’s unique role as a Medicaid managed care organization.

Racine left his job in August, but the review he launched resulted in the internal January report, which was obtained by The Associated Press, showing many instances in which the tools of government accountability — performance benchmarks and data on whether they were being reached — did not exist.

Continued on Burlington Free Press

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Clark Neily and Evan Bernick: Supreme Court must decide law, not popularity: Column April 6, 2015

USA Today, April 3, 2015

It’s spring in Washington, and time to resume one of the capital’s favorite sports. No, not baseball, but throwing mud at the Supreme Court. Pending cases include the legal status of same-sex marriage and whether the IRS can provide billions of dollars in Obamacare subsidies without explicit congressional authorization. Partisans have launched a preemptive bid to undermine the legitimacy of the forthcoming decisions by accusing the court of “activism” for involving itself at all.

These increasingly transparent attempts to discredit the court should be rejected.Every case involving plausible abuses of power requires judicial engagement — conscientious, impartial truth-seeking, grounded in evidence — rather than reflexive deference to the political branches.

Take the Obamacare case. At issue in King v. Burwell is a section of the Affordable Care Act concerning tax credits for buying health insurance from government-operated healthcare exchanges. Congress wanted states to set up their own exchanges, but it lacks constitutional authority to force them. So Congress opted for a stick-and-carrot approach, authorizing tax credits for insurance policies purchased “through an Exchange established by the State.” As a backup, the ACA directed federal bureaucrats to set up federally operated exchanges in states that declined to set up their own.

The question before the court is whether it was legal for the IRS to provide subsidies for policies purchased on federal exchanges, despite the lack of explicit statutory authorization. According to some critics, only a politically motivated court could answer no. But the language of the ACA is clear: “‘State’ means each of the 50 States and the District of Columbia.” As Justice Kagan put it recently in another case, the court “has no roving license, in even ordinary cases of statutory interpretation, to disregard clear language.” If the court disregards this maxim when deciding King, it will replace the rule of law with the rule of impatient executives and unelected bureaucrats.

Continued on USA Today…