The Federal Regulatory Burden on American Health Care Soared Under Republican Rule

It is almost impossible to describe how bloated both the House and Senate bills have become.  Compare the 2,074 pages of the Senate bill to the 1965 Medicare and Medicaid law. The bill President Johnson signed was a mere 137 pages long!

This dramatic different in length motivated me to attempt a similar measurement of the federal regulatory burden on U.S. health care — by counting the pages dedicated to regulating health care in the Code of Federal Regulations (CFR) over the past decade. (I focused only on Medicare and Medicaid, regulation of private health insurance, and regulation of providers, ignoring the regulation of drugs or medical devices for safety and efficacy.) During most of this period, the federal government preached regulatory restraint.  Indeed, the major bill, the Medicare Modernization Act of 2003, was designed to reduce federal control over access to medical care via a privately run Medicare drug benefit and the introduction of Health Savings Accounts.

The result was surprising: Overall, the federal regulatory burden on American health care has increased by more than one-half in the last ten years (see the Table).

The greatest regulatory burden, perhaps unsurprisingly, is in Medicare and Medicaid. The October 2008 revision of the CFR included 2,688 pages of the Public Health Code dedicated to the Centers for Medicare & Medicaid Services. The October 1998 version had 1,881 pages. This is a 48 percent increase.

With respect to private health insurance, there are only 183 pages of regulations: the current Labor Code includes 75 pages of regulations, and the Public Welfare Code also contains 108 pages of regulations on group and individual coverage. This might not look like much, but 10 years earlier, the total was only 96: 36 in the Labor Code and 60 in the Public Welfare Code.

The Public Welfare Code contains 109 pages of rules governing providers. This includes rules governing the National Practitioners Database, HIPAA, as well as other administrative regulations. A mere 10 years earlier, the number of pages was only seven!

So, even during a period of self-proclaimed regulatory restraint, the regulatory burden on American health care soared. Since the current government has the opposite bias, the future regulatory burden will surely accelerate at breakneck speed.

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