Robert F. Graboyes, MSHA, PhD

Health Economist | rfgraboyes@gmail.com | www.robertgraboyes.com


Writing 2007-date


Introduction to a study that I envisioned, commissioned, and managed


·       Health Insurance Reform in an Experimental Market, by Stephen Rassenti and Carl Johnston, foreword by Vernon L. Smith (January 2009): In the Foreword, Vernon Smith (2002 Nobel laureate) wrote, “This is a path-breaking, sophisticated study of healthcare reform proposals in a controlled setting. It measures and evaluates the effect of nine policy treatments on the payoff-motivated choices made by subjects. In turn, it measures and evaluates how those choices impact the costs and earnings of employees and employers (differing in size and profit margins), premiums paid, benefits received, and level of subsidies incurred.”  


NFIB Healthcare Bulletin: Periodic email blasts (all in one document)


·        Aggregation Aggravation (6/27/13): Thanks to ERISA’s “aggregation” rules, many businesses with fewer than 50 employees will be swept into PPACA’s employer mandate.

·        SHOP Chopped: Opt Dropped: (4/22/13): In 2014, the SHOP exchanges will be largely dysfunctional, with no capacity for employers to offer employees choices.

·        End the Employer Mandate Now: (2/21/13): Congress should repeal the employer mandate, currently PPACA’s most corrosive mechanism.

·        Will PPACA Self-Repeal?: (12/20/12): Is PPACA’s structure so unstable that the law will bring itself down?

·        PPACA for Employees: The Good, the Bad, and the Ugly: (10/16/12): PPACA hands employees a long list of pros and cons.

·        Small Business under PPACA: Behind the Eight-ball: (8/22/12): PPACA’s uncertainties make it impossible for small business to plan.

·        The Day After: Health Care Reform after NFIB v Sebelius: (6/20/12): Real reform should begin the day after the Supreme Court rules.

·        Self-insurance and Small Business: (5/31/12): Some are trying to deny small business the ability to self-insure.

·        Cashews on the Hindenburg: (2/24/12): PPACA’s small business health insurance tax credit has yielded underwhelming results.

·        PPACA’s Pyroclastic Plume: (11/28/11): PPACA is in trouble (legally and structurally), costs jobs, and can be replaced with a better law.

·        PPACA: Five Layers of Uncertainty (9/28/11): PPACA creates uncertainty over costs, regulations, enforcement, responses, and logistics.

·        PPACA and the Jobless Recovery (8/9/11): An NFIB survey suggests that PPACA is a significant factor in the lack of job creation in the current

·        The HIT Hit: PPACA's Health Insurance Tax (6/14/11): PPACA imposes a heavy tax on small business insurance policies.

·        Essential Health Benefits: The Secretary’s Joystick (5/3/11): The Secretary of HHS gains unilateral power to impose costly benefit mandates.

·        The Incredible Shrinking Small Business Tax Credit (4/3/11): PPACA’s small business health insurance tax credit is complex, narrowly-focused.

·        Small Business in Waiver World (3/9/11): Mini-med waivers are vaguely explained, poorly advertised, and inscrutably administered.

·        Caught in the Middle (Douglas Holtz-Eakin, co-author, 1/6/11): PPACA’s illogical “Medicare” tax hits middle-earners hardest.

·        No sales tax on home sales, BUT ... (10/20/10): There’s no 3.8% sales tax on homes in PPACA, despite a grain of truth to the claim.

·        Costs and The Law that Shall Not Be Named (10/4/10): Claims that PPACA will contain costs were and are patently false.

·        1099 Collation Calamity (8/31/10): Before its repeal, the IRS Form 1099 provision would have drowned small business in a sea of red tape.

·        The Healthcare Law: Pulling the Plug on Grandfather (6/29/10): Liking your current health insurance plan doesn’t mean you can keep it.

·        Premium Credits + Free Rider Provision = Mystery Tax (6/7/10): PPACA exposes employers’ income to private affairs of employees' families.

·        Healthcare Law vs. Employee Privacy (5/25/10): PPACA compromises the privacy of employees and their families.

·        Small Business Tax Credit: Less Than Meets the Eye (5/13/10): The small business tax credit provides little incentive to offer insurance.

·        The Majestic Equality of the Healthcare Law (4/19/10): The 1099 provision’s special burdens on small business.

·        To Congress: Three Proverbs for Healthcare Reform (3/18/10): “The road to ruin” and more.

·        Health Insurance Exchanges (10/15/09): Airline and ticket-scalping reforms suggest potential health insurance reforms.

·        Healthcare Reform and Wages (8/19/09): Unless healthcare cost increases slow, wages could stagnate or decline for decades.

·        The Problem with Prevention (7/24/09): Preventive care may be good for health, but it generally pushes costs up, not down.

·        Healthcare lesson from Massachusetts: Deal with costs from Day One (7/14/09): What Massachusetts should have taught the country.


Altarum Blogs: Columns written for the Altarum Institute’s Health Policy Forum. (all in one document)


·        SHOP Chopped: Opt Dropped [link] (4/22/13): In 2014, the SHOP exchanges will be largely dysfunctional, with no capacity for employers to offer employees choices.

·        End the Employer Mandate Now [link] (2/21/13): Congress should repeal the employer mandate, currently PPACA’s most corrosive mechanism.

·        Will PPACA Self-Repeal? [link] (12/20/12): Is PPACA’s structure so unstable that the law will bring itself down?

·        PPACA for Employees: The Good, the Bad, and the Ugly [link] (10/16/12): PPACA hands employees a long list of pros and cons.

·        Small Business Under PPACA: Behind the Eight-ball [link] (8/21/12): Thirteen currently unanswerable questions about PPACA discourage job creation. (Republished under NFIB Healthcare Bulletin above.)

·        The Day After: Health Care Reform After NFIB v Sebelius [link] (6/19/12): The long process of health care reform will begin the day after the U.S. Supreme Court rules in the case of NFIB v Sebelius. (Republished under NFIB Healthcare Bulletin above.)

·        Health Care Law Blues: They Hear That Train a-Comin’ [link] (4/3/12): For small business, PPACA means higher costs, more red-tape and fewer choices. (Republished under NFIB Healthcare Bulletin above.)

·        Cashews on the Hindenburg [link] (2/16/12): PPACA has a thousand pages of moving parts, and the relatively few that have rolled out are shedding sprockets across the landscape. (Republished under NFIB Healthcare Bulletin above.)

·        Small Business and Exchanges: SHOP Till You Drop [link] (12/20/11): PPACA’s SHOP exchanges create mechanisms for small-group survival, but also powerful incentives for their dissolution.

·        Health Care Law Subsidies: A Tale of Two Cities  [link] (10/11/11): PPACA will conjure up a strange brew of inequities as it comes to a boil in 2014. The mechanistic, one-size-fits-all health insurance subsidies, for example, will generate serious questions about the law’s fairness.

·        PPACA and the Jobless Recovery [link] (8/9/11): Small-business owners are deeply concerned that PPACA will prolong what has been described as America’s “jobless recovery.” (Republished under NFIB Healthcare Bulletin above.)

·        HIT Hit: (PPACA’s Health Insurance Tax) [link] (6/14/11): PPACA hits small business with a barrage of inequities. Among the most egregious is the health insurance tax (HIT) launched by the law’s Section 9010. (Republished under NFIB Healthcare Bulletin above.)

·        Essential Health Benefits: The Secretary’s Joystick [link] (5/3/11): Beginning in 2014, PPACA hands the Secretary of Health and Human Services a joystick – the Essential Health Benefits package – with the potential to rocket small-business health insurance premiums skyward. (Republished under NFIB Healthcare Bulletin above.)

·        Small Business Health Care Wish List: Repeal and Replace [link] (2/8/11): Here’s the small business position on healthcare: The past was awful, the present lies somewhere between no-better and much-worse, and the future can be bright if sensible replace follows blessed repeal.

·        Health Reform - New Burdens for Small Business [link] (4/27/10): If the healthcare law stands without major revision, only time will tell how it ultimately affects health care costs, coverage, and quality. I have my own thoughts, but opinion and forecast must give way to reality.


Miscellaneous writings, speeches, long interviews (all in one document)


·        CoBank Interview [link] (cobank.com, 2/12)  

·        Job Stagnation: Lost Years’ Legacy Urban Institute speech (Urban Institute speech, 12/1/10)

·        Healthcare Reform and Small Business (National Conference of State Legislatures speech, 7/20/09)

·        Healthcare and Small Business: Problems and Fixes (National Economists Club speech, 6/23/09)

·        Small Business and Healthcare Reform (American Benefits Council speech, 5/28/09)

·        Easing the Healthcare Burden on Small Businesses (interview with Dr. Janet Wright, ReachMD, XMRadio)

·        Robb Mandelbaum interview (inc.com, late 07-early 2008)


Washington Post Healthcare Rx: Panelist for the Washington Post’s 2009-2010 healthcare reform blog (all in one document)


·        Not an ending, only a beginning (3/31/10): PPACA begins a long struggle against cost increases, uncertainty and perverse incentives.

·        It will ravage small business (3/19/10): PPACA will wreck small business – ironic, since reform was supposed to be for small business.

·        The cash cows' beef (3/11/10): The insurance industry may soon look back and realize that it was its own worst enemy.

·        Peggy Lee sings health care (2/24/10). The President's Proposal is like Peggy Lee’s “Is That All There Is to a Fire?”

·        Retreat, rethink, return to principles (1/21/10): After Scott Brown’s election, time to return to cost, coverage, and quality.

·        Beware. Destination unknown (1/14/10): Healthcare bills are costly, massive, incoherent, and internally inconsistent, and unpredictable.

·        A kick in the teeth (1/7/10): Congress punished small business while rewarding unions, big business, trial attorneys, insurers, hospitals, etc.

·        Disaster turns to disgrace (12/21/09): Small business was forgotten as the law evolved.

·        Doughnuts in the parking lot (12/15/09): The proposed Medicare buy-in is indefensible.

·        With a huge pen and sharp scissors (11/30/09): The House bill is unsalvageable. The Senate bill is problematic but still has a chance.

·        Not Lucy Ricardo, but not Godot (11/18/09): Congress is moving too quickly on healthcare legislation, but it shouldn’t move too slowly.

·        Start with a smaller burger (11/3/09): Individuals, not governments, can improve health fast.

·        Not enough, and yet too much (10/29/09): Proposed legislation would push costs up, not down.

·        Westminster health-care show (10/22/09): Frequently quoted international healthcare comparisons are nonsense.

·        Killer Tax on Low-Income Workers? No! (10/7/09): An employer mandate harms vulnerable firms and low-wage employees.

·        Malpractice Matters (9/17/09): Malpractice law needs reform, and current proposals ignore it.

·        Umpire or Play Ball, Not Both (8/7/09): A “public option” plan won’t level the playing field.

·        Amending Marshal Lyautey (7/29/09): Delaying the House vote till after recess is a good thing.

·        Rein Costs In or They'll Rein Us In (7/24/09): If we don't rein in costs, costs will rein us in.

·        Only If You Like Killing Jobs (7/16/09): Tax increases on the so-called “wealthy” can wreck healthcare reform and the economy.

·        Innovation, Timeliness, Choice, Quality (7/2/09): Despite its problems, there’s much to admire about America’s healthcare.

·        Message to Obama from Small Businesses (6/16/09): Erratic, unrelenting rise in health-care costs threatens small firms' viability.


Tools and primers


·        Small Business Health Insurance Tax Credit Calculator


NFIB CribSheets


·        Fiscal Cliff 2013 (after the deal) (13-1)

·        PPACA: A Healthcare Law Guide for Employees (12-17)

·        Small Business Tax Rates and Tax Complexity (12-16)

·        PPACA: Medicare Wage/Salary & Investment Taxes (12-15)

·        Healthcare Solutions: Interstate Insurance Markets (12-14)

·        Healthcare Solutions: Portability (12-13)

·        Healthcare Solutions: Tax Parity for Insurance (12-12)

·        Healthcare Solutions: Defined Contribution Plans (12-11)

·        Healthcare Solutions: Malpractice Reform (12-10)

·        Fiscal Cliff 2013 (before the deal) (12-9)

·        PPACA Timeline (12-8)

·        PPACA: Employer Mandate Penalty Calculations (12-7)

·        NFIB Healthcare Solutions (12-6)

·        IRS Form 1099 Reporting Requirements (12-5)

·        PPACA: Problems for Small Business (12-4)

·        PPACA: Health Insurance Tax (HIT) (12-3)

·        PPACA: The Individual Mandate Tax (12-2)

·        EPA Lead Renovation, Repair and Painting (LRRP) Program (12-1)

·        PPACA: Small Business Health Insurance Tax Credit (11-2)

·        PPACA: Employer Mandate Penalties (11-1)

·        All PPACA CribSheets (includes 12-4, 12-17, 12-8, 12-2, 11-1, 12-7, 12-3, 12-15, 11-2)

·        All Healthcare-Solutions CribSheets (includes 12-6, 12-10, 12-11, 12-12, 12-13, 12-14)


Blog Comments


·         "Sorting Through Small Business Polling" (John Tozzi, BusinessWeek.com) and my response (7/29/09)

·        “Business Crunches the Health Care Numbers” (Catherine Arnst & John Tozzi, Businessweek.com) and my response (7/17/09)

·        Response to “Pragmatism and Cooptation” (Jeff Cornwall/The Entrepreneurial Mind) (7/17/09)

·        Response to "NFIB Healthcare Principles" (Inc.com/The Entrepreneurial Agenda) 1/2/08

·        Response to "Health Insurance Followup: I Told You So" (Jeff Cornwall/The Entrepreneurial Mind) 12/14/07

·        Comments from NFIB (Jeff Cornwall/The Entrepreneurial Mind) 12/18/07 and  response from Jeff Cornwall