Health Care

Health Care


James Bailey | Aug 01, 2016
Certificate-of-need (CON) laws are among the various experiments policymakers have conducted in an effort to curb the growth of healthcare spending. Currently in place in 35 states, these laws require new or expanding healthcare providers to prove to their state government that they are economically necessary and that they effectively limit the supply of healthcare services.
Brian Blase, Doug Badger, Edmund F. Haislmaier, Seth J. Chandler | Jun 28, 2016
The Affordable Care Act (ACA) significantly altered the rules governing health insurance, especially in the individual market. While the law has increased the number of people with health insurance, lower-than-expected enrollment in the new health insurance exchanges and significant insurer losses have resulted in substantial premium increases and insurer withdrawals from state markets. These negative outcomes cast increasing doubt on the ACA and its long-term sustainability.
Daniel Sutter | Jun 21, 2016
Medicaid was established in 1965 as a joint state and federal program to provide medical insurance to Americans who are poor and have disabilities, and it has grown from 1 percent to 3 percent of GDP. The source of Medicaid’s growth over the past 50 years must inform efforts to reform the program and slow spending. The literature on the political economy of Medicaid provides strong evidence of interest group and political ideological influence, enabled by the open-ended federal match for state spending.
Mark J. Warshawsky | Jun 10, 2016
Concern about income inequality has dramatically shifted public attitudes toward economic and fiscal policy, and the subject of inequality has increasingly dominated the political debate. But the discussion has focused almost exclusively on comparing the earnings of lower- and higher-paid workers, and on promoting redistributive policies aimed at “correcting” this disparity. New research finds, however, that both scholars and politicians have largely overlooked a key contributor to earnings inequality: the role of rapidly increasing healthcare costs.
Christopher Koopman, Thomas Stratmann, Scott Eastman | May 17, 2016
Certificate-of-need (CON) programs are state laws that require government permission for healthcare providers to open or expand a practice or to invest in certain devices or technology. These programs have been justified on the basis of achieving several public policy goals, including controlling costs and increasing access to healthcare services in rural areas. Little work has been done, however, to measure what effects CON programs have on access and distribution of healthcare services. Two recent studies that examined the relationship between a state’s CON program and access to care found that these laws failed to achieve their stated goals.
Brian Blase, Doug Badger, Edmund F. Haislmaier | Apr 22, 2016
This is the first in a series of papers in which we provide the most comprehensive analysis to date of the impact of the ACA on the individual and small group insurance market in 2014. In this overview, we provide information on how insurers fared in their first year selling QHPs—plans that satisfy all of the ACA’s requirements and are certified to be sold on exchanges—using a data set compiled from medical loss ratio form that insurers are required to file with the Department of Health and Human Services.

Testimony & Comments

Research Summaries & Toolkits

Expert Commentary

Aug 23, 2016

While the federal mandate was repealed, the laws had already been passed in nearly every state. And bad policy, especially one that creates the types of winners and losers that CON programs do, can be difficult to undo.
Aug 18, 2016

Outside the legal challenges it previously faced, the Affordable Care Act has never been as threatened as it is right now.
Aug 18, 2016

Now more than ever, we need to depoliticize health care and create transparent marketplaces where insurers heed the wishes of customers rather than government officials.
Aug 15, 2016

A study last year from economists at Harvard, Dartmouth, and MIT found that Medicaid enrollees value program benefits at only between 20 to 40 cents for each dollar of spending. That finding, coupled with the Medicaid expansion cost explosion, means that tens of billions of federal taxpayer dollars are being wasted while health-care interest groups gain excess profits.
Aug 09, 2016

Helping people purchase insurance through hidden corporate welfare is an idea of which people across a broad spectrum of political ideologies should be wary. Given the dysfunction in the ACA individual market, policymakers should instead seek to understand what’s gone wrong and fix those problems before spending billions propping up a program that appears to be failing. That requires a full understanding of all of the factors in play, precisely what our studies for the Mercatus Center have sought to provide.
Aug 04, 2016

Congress could do something about this new ACA scandal. The only acceptable solution would be to radically reform a program that — according to new research by academics Amy Finkelstein, Nathaniel Hendren and Erzo Luttmer — only returns 20 to 40 cents of value for each dollar spent on new enrollees and fails to demonstrate that it provides real health benefits to those enrolled.


Certificate-of-need (CON) laws in 21 states restrict acquisition of imaging equipment, including MRI, CT, and PET scans. These CON requirements effectively protect established hospitals from nonhospital competitors that provide medical imaging services, such as independently practicing physicians, group practices, and other ambulatory settings. In the process of protecting hospitals from these nonhospital providers, CON laws limit the imaging services available to patients.


Charles Blahous is the director of the Spending and Budget Initiative, a senior research fellow at the Mercatus Center at George Mason University and has served as a public trustee for Social Security and Medicare. He specializes in domestic economic policy and retirement security (with an emphasis on Social Security), as well as federal fiscal policy, entitlements, demographic change, and health-care reform.
Robert Graboyes is a Senior Research Fellow and Health Care Scholar with the Mercatus Center at George Mason University and is the author of the study “Fortress and Frontier in American Health Care.”…
Christopher J. Conover is a Senior Affiliated Scholar at the Mercatus Center at George Mason University and a research scholar at the Center for Health Policy & Inequalities Research at Duke University.
Jerry Ellig is a senior research fellow at the Mercatus Center at George Mason University and a former assistant professor of economics at George Mason University. He specializes in the federal regulatory process, economic regulation, and telecommunications regulation.
Jamil Khan is a program coordinator on health care policy for the Mercatus Center at George Mason University.


Brian Blase | August 18, 2016
Brian Blase discusses the impact of Aetna exiting the ACA exchanges with host Rob Schilling.

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| Sep 29, 2015
In a new set of essays commissioned by the Mercatus Center at George Mason University, seven leading policy experts share innovative ideas on how to solve the pre-existing condition challenge. While their approaches exhibit differences as well as similarities, they are unified in their pursuit of a humane, equitable, fiscally sustainable solution to a conundrum that has driven and strained the entire post–World War II healthcare debate.

Media Clippings

Casey B. Mulligan | Oct 09, 2014
This excerpt originally appeared in The Washington Times.
Robert Graboyes | Sep 25, 2014
This excerpt originally appeared in Reuters.
Charles Blahous | Jun 04, 2014
This excerpt originally appeared in CQ and also appeared Roll Call.
Robert Graboyes | Jan 29, 2014
Robert Graboyes cited at Star-Telegram.
Tyler Cowen | Oct 30, 2013
Tyler Cowen cited at The Washington Post.
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