CSA Health Care Interview Series: Interview with Manhattan Institute Senior Fellow Avik Roy

Posted by Blake Wright on December 02, 2014 at 9:54 AM

As the American health care sector rapidly changes with the implementation of the Affordable Care Act, CSA’s Director of Policy Andrew Smith conducted a series of interviews with health care experts in order to better understand the future of the health care sector and its impact on American Millennials. Featuring diverse perspectives on these dynamic issues from both sides of the aisle,  Andrew interviewed Manhattan Institute Senior Fellow Avik Roy, Third Way Senior Fellow David Kendall, and Center for American Progress Health Policy Director Maura Calsyn in order to capture some conservative, centrist, and liberal perspectives on the rapidly changing health care sector. Read Andrew’s interview with Mr. Roy below or his interviews with Mr. Kendall and Ms. Calsyn on CSA’s policy blog.

Mr. Smith: You’re a conservative. But you’ve recently proposed a plan to reform Obamacare instead of repealing it, as almost every Republican to date has argued for. Can you give us a brief synopsis of your plan and explain why it may be a better course than either the ACA or outright repeal?

Mr. Roy: Not sure if I would agree with the “but” there.  Conservatism is, by definition, cautious about disruption and turbulence.  In health care, that’s especially important.  When it comes to people’s health insurance and thereby the security of their finances and health care, it’s important to look for modest, gradual reforms. The ACA disrupted health coverage for millions of Americans, and drove up costs for millions more.  Simply repealing the ACA and going back to the status quo ante would also disrupt coverage, and the status quo ante was not so great to begin with.  If we really want to get to a better health care system, we need to take the system as a whole today — Obamacare, along with everything that preceded Obamacare — and gradually reform it.

Mr. Smith: Folks like Jim Capretta have proposed Obamacare replacement plans that rely on similar principles as what you believe will fix our health care system. Is the chief virtue of your approach over theirs that reforming Obamacare is more politically plausible than repeal and replace?


Mr. Roy: The principal virtue of my approach over the type of approach favored by Jim is that it’s less disruptive.  Less disruption is a virtue in and of itself — but because most Americans are skeptical about disruption, it also ends up being a more politically plausible approach.


Mr. Smith: Moving back to the actual law, what is the aspect of the ACA that you find most attractive and hope to build on? On the other side, what’s the single biggest flaw that you would hope to change in your reform plan? 


Mr. Roy: The opportunity that comes out of the ACA, for all its flaws, is the idea that people ought to shop for coverage on their own, while getting premium assistance if they are low-income, on a means-tested sliding scale (higher subsidies for poorer people, modest subsidies for lower-middle-class individuals).  An expansion of that idea could do a lot to improve our health care system.  What’s the biggest flaw?  Two: (1) That the ACA expanded Medicaid, a broken and dysfunctional program that doesn’t help the poor achieve better health outcomes. (2) That the program increases US health spending, rather than tackling the fundamental problem of high U.S. health care prices, driven especially by hospital consolidation. 


Mr. Smith: Have conservatives been merited in their negativity surrounding the law, in your view? What would it take for more Republicans to start thinking productively, like you have, instead of just criticizing the law?


Mr. Roy: Yes, they have been right to be critical of the law.  I think that there is increasing eagerness among Republicans to offer a productive alternative — I think that will be especially evident in the 2016 presidential contest.


Mr. Smith: Why should college students prefer your approach to the ACA?


Mr. Roy: If there’s anyone more screwed over by the ACA than college students, I don’t know who it is.  College students can’t find work in the Obama economy, because the ACA’s tax increases and labor regulations depress hiring.  Then, the ACA dramatically drives up the cost of insurance for young people, especially those who can’t get coverage from their parents.  Finally, it’s college people who will bear the brunt of the costs of the $100 trillion in unfunded liabilities from Medicaid and Medicare, liabilities that the ACA further entrenches. 


Avik Roy is a Senior Fellow at the Manhattan Institute and the Opinion Editor at Forbes. In 2012, Roy served as a health care policy adviser to Mitt Romney. NBC’s Chuck Todd, on Meet the Press, described Roy as one “of the most thoughtful guys that [has] been debating” health care reform. He is the author of Transcending Obamacare: A Patient-Centered Plan for Near-Universal Coverage and Permanent Fiscal Solvency. Roy is also principal author of The Apothecary, the influential Forbes blog on health care policy and entitlement reform. In addition, Roy writes regularly for National Review Online on politics and policy. He is a frequent guest on television news programs, including appearances on Fox News, Fox Business, NBC, MSNBC, CNBC, Bloomberg, PBS, and HBO. His work has also appeared in The Atlantic, USA Today, National Affairs, and The American Spectator, among other publications. At the Manhattan Institute, Roy's research interests include the Affordable Care Act, universal coverage, entitlement reform, international health systems, and FDA policy. Roy is the founder of Roy Healthcare Research, an investment research firm in New York. Previously, he served as an analyst and portfolio manager at Bain Capital, J.P. Morgan, and other firms.