State of The Union

Obamacare, Round 2?

Yesterday Mitch Daniels, Governor of Indiana and possible contender for the GOP 2012 Presidential nomination, along with 20 other Republican Governors, sent the following letter:

The Honorable Kathleen Sebelius
Secretary
U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Washington, DC 20201

Dear Secretary Sebelius;

Many of us believe the Patient Protection and Affordable Care Act (PPACA) should be repealed by Congress if the courts do not strike it down first.

But, with no assurance of either outcome, we face the decision of whether to participate in the bill by operating state exchanges, or to let the federal government take on that task, if the bill remains in effect in 2014.

In addition to its constitutional infringements, we believe the system proposed by the PPACA is seriously flawed, favors dependency over personal responsibility, and will ultimately destroy the private insurance market.

Because of this, we do not wish to be the federal government’s agents in this policy in its present form.

We wish states had been given more opportunity to provide input when the PPACA was being drafted. We believe in its current form the law will force our health care system down a path sure to lead to higher costs and the disruption or discontinuation of millions of American’s insurance plans.

Though we still have grave concerns with other provisions of the PPACA, we suggest the following improvements:

• Provide states with complete flexibility on operating the exchange, most importantly the freedom to decide which licensed insurers are permitted to offer their products

• Waive the bill’s costly mandates and grant states the authority to choose benefit rules that meet the specific needs of their citizens.

• Waive the provisions that discriminate against consumer-driven health plans, such as health savings accounts (HSA’s)

• Provide blanket discretion to individual states if they chose to move non-disabled Medicaid beneficiaries into the exchanges for their insurance coverage without the need of further HHS approval.

• Deliver a comprehensive plan for verifying incomes and subsidy amounts for exchange participants that is not an unfunded mandate but rather fully funded by the federal government and is certified as workable by an independent auditor.

• Commission a new and objective assessment of how many people will end up in the exchanges and on Medicaid in every state as a result of the legislation (including those “offloaded” by employers), and at what potential cost to state governments. The study must be conducted by a neutral third-party research organization agreed to by the states represented in this letter.

We hope the Administration will accommodate our states’ individual circumstances and needs, as we believe the PPACA in its current form threatens to destroy our budgets and perpetuate and magnify the most costly aspects of our health care system.

While we hope for your endorsement, if you do not agree, we will move forward with our own efforts regardless and HHS should begin making plans to run exchanges under its own auspices.

Sincerely,

Governor Robert J. Bentley
Alabama

Governor Nathan Deal
Georgia

Governor C.L. “Butch” Otter
Idaho

Governor Mitch Daniels
Indiana

Governor Terry E. Branstad
Iowa

Governor Sam Brownback
Kansas

Governor Bobby Jindal
Louisiana

Governor Paul R. LePage
Maine

Governor Haley Barbour
Mississippi

Governor David Heineman
Nebraska

Governor Brian Sandoval
Nevada

Governor Susana Martinez
New Mexico

Governor John R. Kasich
Ohio

Governor Mary Fallin
Oklahoma

Governor Tom Corbett
Pennsylvania

Governor Nikki Haley
South Carolina

Governor Dennis Daugaard
South Dakota

Governor Bill Haslam
Tennessee

Governor Rick Perry
Texas

Governor Gary R. Herbert
Utah

Governor Scott Walker
Wisconsin

Governor Daniels also penned an op-ed for the Wall Street Journal describing in more detail the fiscal dilemma the PPACA places on states, stating, in part:

“…the law expects to conscript the states as its agents in its takeover of health care. It assumes that we will set up and operate its new insurance “exchanges” for it, using our current welfare apparatuses to do the numbingly complex work of figuring out who is eligible for its subsidies, how much each person or family is eligible for, redetermining this eligibility regularly, and more. Then, we are supposed to oversee all the insurance plans in the exchanges for compliance with Washington’s dictates about terms and prices.”

In addition to the various and sundry lawsuits filed by state Attorney’s General, two of which have been decided in favor of the states (the recent Florida ruling involving 26 of our 50 states), two of which have been decided in favor of the Federal government, and all of which have been appealed and will likely end up in the Supreme court; in addition to a handful of states like Missouri passing legislation rejecting participation in some or all of the provisions of Obamacare, we now have 21 states recommending specific improvements to the legislation.  If the November 2010 elections did not send a message to Washington regarding public rejection of the PPACA and a desire for replacement of that heavy-handed legislation with something which deals with the real cost issues in our health care system, more recent events and the number of states involved should be getting their attention.  As Governor Daniels states in reference to the recommendations made to Secretary Sebelius:

“Most fundamentally, the system we are proposing requires Washington to abandon most of the command-and-control aspects of the law as written. It steers away from nanny-state paternalism by assuming, recognizing and reinforcing the dignity of all our citizens and their right to make health care’s highly personal decisions for themselves. ”

It seems the Obama administration has a number of options available at this point:

• allow the various lawsuits to play out in the courts according to the routine appeals process, which could well move any Supreme Court action into the 2012 election season
• push for an accelerated appeals process, which could move the decision into the high court within the next few months
• consider recommendations made by the governors, as well as amending legislation being developed by both House and Senate Republicans designed to remove the more onerous provisions of Obamacare and enhance cost reform efforts
• support an outright repeal and rewrite of the legislation, which appears to be the option favored by most Americans.

An accelerated court solution could be the most expeditious route, but would also involve the greatest political risk to the administration, as a Supreme Court opinion in support of the Vinson ruling would invalidate the PPACA in its entirety.  On the other hand, a legislative solution that returns power and authority to the states, while quite possibly the solution most Americans would prefer – elected officials working together to arrive at a truly bipartisan answer, would likely extend the ongoing health care and insurance debate into the 2012 election season and quite possibly beyond, setting up a race to the finish line between the legislative and judicial branches.  Could the governors’ recommendations help to bring about an end to the debate, or only add fuel to the fire? 

“If there’s to be a train wreck, we governors would rather be spectators than conductors. But if the federal government is willing to reroute the train to a different, more productive track, we are here to help.”

Virginia Ruling - Moon 

Michigan Ruling

Virginia Ruling - Hudson

Florida Ruling

Where Do We Go From Here?

Sunday night, 219 House Democrats voted to approved the Patient Protection and Affordable Care Act that has been the subject of contentious political debate since the beginning of the Obama presidency, despite bipartisan efforts to kill the legislation.   House Speaker Nancy Pelosi ( D-CA) proclaimed the legislation an historic victory 

“on a par with passing Social Security and Medicare“

while  President Obama stated that

“this government — a government of the people and by the people — still works for the people.”  

Yet support for this legislation by the people was sorely lacking, and states are lining up to file lawsuits challenging the legislation before the President’s signature is dry.  Officials in at least eleven states already have plans to challenge the constitutionality of mandating that all Americans have some form of health insurance, including Virginia, Texas, Alabama, Florida, South Carolina, Nebraska, North and South Dakota, Pennsylvania, Utah and Washington.  These state sovereignty claims will be met with Commerce Clause assertions by supporters of the legislation, though one has to wonder what interstate commerce is being conducted by those citizens who choose not to purchase health insurance.  In addition, at least three dozen state legislatures are weighing possible challenges to the legislation, changes to state law and amendments to their constitutions. 

Florida Attorney General Bill McCollum said  

“The health care reform legislation passed by the U.S. House of Representatives this last night clearly violates the U.S. Constitution and infringes on each state’s sovereignty.” 

Nebraska Attorney General Jon Bruning said the measure 

“tramples on individual liberty and dumps on the states the burden of an unfunded mandate that taxpayers cannot afford.” 

So now we turn to the courts.  Will the legislation survive state challenges, which are certain to increase over the coming weeks and months.  While legal challenges are heard, will the courts stay implementation of the Act?  How will states already on the verge of bankruptcy pay for the increase in their share of Medicare?  And what will be the impact on the House and Senate come November?  Will the American people soon forget those in Washington who chose to ignore them for the sake of another “We Won” moment?

Health Care: Which Path Shall We Take?

I’ve always loved the holiday season. Thanksgiving, Christmas and New Year’s are truly some of my favorite times of the year, but they bring about a curious blend of emotions. Whether it’s being thankful for what I have, the joy of sharing my good fortune with those less fortunate, the reflection on the past or the hope of the future, this season uniquely awakens my soul!

This year is unique for the country in many ways, as we haven’t been challenged like this for quite some time. (more…)

Connecting the Dots on Health Care

Marsha Blackburn, US Congressman representing the 7th District in Tennessee and current Deputy Whip for the 111th Congress, has done a bit of homework on mammograms and H.R. 3692:

This week, the U.S. Preventive Services Task Force, an agency within the Department of Health and Human Services, published a study recommending that women under 50 do not need to receive annual mammograms. The study created an uproar in Washington while angering and confusing women across America.

 

Setting the scientific evidence in the study, its methodology, and the troubling implications for women’s health aside, I’d like to show how the Democrat health care bill, H.R 3962 (Full Text Linked Here) will give this troubling study the force of law and result in limited access to mammograms for women enrolled in a health insurance exchange plan or the public option. In short, connecting the dots through H.R. 3962 will illustrate how these regulations place us all on the slippery slope to health care rationing.

 

 STEP 1: Provider Networks And Essential Benefits

Going back to the text of H.R. 3962; on page 1329, line 21 the bill goes into more detail about the Task Force’s recommendations.  It says “all recommendations of the Preventive Services Task Force [the panel that issued this week's mammogram recommendation]… as in existence on the day before the date of the enactment of this Act shall be considered to be recommendations of the Task Force on Clinical Preventive Services…”  It goes on to say, and I find this remarkable, that the Preventive Services Task Force automatically becomes the Task Force on Clinical Preventive Services.

Lets start with the full text of H.R. 3962 as finally passed by the House this month. Page 106 of the bill, starting at line 7, sets forth guidelines that all health insurance plans and the public option must comply with. Page 107  goes on to define these plans as “provider networks.”

Jumping a few pages ahead, to page 110, we see on line 3 that the bill lays out precisely what essential health care benefits must be in these approved plans. Those services begin to be outlined on page 111, line 8 . Service 8 (number “8” on line 1 of page 112) says that “preventive services, including those services with a grade of A or B by the Task Force on Clinical Preventive Services” must be covered.

STEP 2: The Task Force

Who is this Task Force on Clinical Preventive Services? Well, their authority begins to be laid out in Section 2301 of the bill, starting at line 18 of page 1296. Their specific authority begins to be spelled out on page 1301 at line 15. The bill says that The Task Force will identify clinical preventive services for review.” The Task Force will “review the scientific evidence related to the benefits, effectiveness, appropriateness, and costs of clinical preventive services.” (page 1302 lines 1-3) The Task Force will then, “determine whether subsidies and rewards meet The Task Force’s standards for a grade of A or B.” (page 1302 lines 14-16)

STEP 3: Services Graded And Provided

On page 1317 at line 21 the bill reiterates that the Secretary of Health and Human Services must include those A and B graded services among essential benefits that all health care plans must include.

Here is where we have to inject a little common sense into H.R. 3962. The bill mandates that all Americans must be able to purchase plans in the exchange and be provided these essential benefits; in this case, preventative care ranked with a grade of A or B. This will be enormously expensive for private plans and for the Federal Government under the pubic option since everyone must be covered. 

Because there is no mandate or incentive in the bill to provide coverage for services graded as C or below, it is reasonable to conclude that costs will keep health care plans from providing these services.

STEP 4: What This Means For Mammograms

The very mammogram study that we heard so much about this week, the one conducted by the Preventive Services Task Force, will automatically be the guideline for determining what grade mammograms for women under 50 receive.  As you can see here  the study recommended a grade of “C” for that service.  This all means that getting a mammogram under the age of 50 is not considered an “essential benefit” and will not be covered under the new health care regime.  

You are welcome to argue with the conclusions reached by Congressman Blackburn, but by following the convoluted trail created by H.R. 3962 she has demonstrated just one of the ways in which the current healthcare bills under debate will negatively impact both choice and the long-term health of Americans.  If more of our elected representatives would follow Congressman Blackburn’s example and take the time to read and follow the bills, you can be sure many other examples would be found and discussed.  Please contact your Senators and Congressmen and demand that they do so, for the health of America. 

Congressman Blackburn’s Web Site

Your Rights, Trampled by … the Commerce Clause?

Whether you like the man or not, Judge Andrew Napolitano hits the nail on the head as he describes how government is trampling your rights under the guise of the Constitution’s commerce clause.

(more…)

More Inconvenient Truth

“You Lie!”

That unscripted remark by South Carolina GOP Representative Joe Wilson during President Obama’s healthcare address to Congress last month was a prime example of the level of dissent and anger which has surrounded the healthcare debate.  There is significant disagreement as to not only the nature and extent of the problem with the American healthcare system, but also as to the solution.  The misrepresentations and distortions have reached historic levels, and gutter-level political discourse has at times reached epic proportions.  No tax increases on the middle class.  Death squads.  No coverage for abortions.  Kill Grandma.  No coverage for illegal aliens.  Increase competition with a public option.  The list of talking points heard nearly every day across the country is long and at times ugly. (more…)

T. Lee Mac: The Health Care Scam – Their REAL Agenda

Soon after a maverick inland hurricane destroyed our home and one-third of our storage units, we rented a building down town that had formerly been used as a health clinic. We put our office in the front and the several examination rooms and closets we turned into storage units to make up for some of those lost in the storm. While working on this conversion, I went next door to the local hardware store and made a certain purchase, I don’t recall the exact expenditure but it was around $40 and I remember the disgust I felt at having just spent $40 for something I absolutely did not want and did not need.

Now, just what does this have to do with providing quality health care to the 50 million odd people in America (allegedly) who have no access (allegedly) to such a vital necessity? Well, nothing, really. And that’s the first point I want to make. While my story above has absolutely nothing to do with providing health care to those in need, it has just as much to do with providing that quality health care to needy people as does the current legislation being pushed in Washington. (more…)

The Death of Rational Discussion

Franking is a process by which Congress, the President and some cabinet members correspond with the public using their signature on the envelope instead of a stamp.  These mailings to constituents are limited by budget allotment and of course are paid for with taxpayer dollars.  The Franking Commission approves the content of materials to prevent abuse of the privilege. 

Rep. Ken Calvert (R-Calif.) sends a regular newsletter to his constituents.  When he recently attempted to mail a newsletter to his district regarding healthcare, he was forced to remove the following language before Democrats on the commission would approve payment: 

“The below quote is from President Obama at a recent town hall on health care, responding to a question on possible medical treatment for an elderly woman who had heart problems and received a pacemaker:

‘Look, the first thing for all of us to understand that is we actually have some — some choices to make about how we want to deal with our own end-of-life care… we as a culture and as a society [can start] to make better decisions within our own families and for ourselves…at least we can let doctors know and your mom know that, you know what? Maybe this isn’t going to help. Maybe you’re better off not having the surgery, but taking the painkiller.’

(more…)

Hank: An Affordable Path to Health Care Reform

As we move forward with the health care debate, we’re bombarded by a constant rhetoric stream, and it appears we’re in a headlong rush to do something, simply for the sake of doing it! So let’s slow down and find a no-nonsense approach to the problem.

First of all, let’s start with the numbers. We continually hear the 47 million number thrown around. When we take out those who earn more than $50,000, unenrolled Medicaid-eligibles, illegal aliens, and the short term uninsured (4 months or less), that number drops down to somewhere around 7-8 million. We can argue about the specific number all day long, but that would be like teaching the proverbial pig to sing. The fact remains there are millions of Americans chronically uninsured. So how do we fix it? (more…)

Who Will Pay for Health Care Overhaul?

The House Democrats released their anxiously-awaited health care bill yesterday with proclamations of coverage for all Americans, cost reductions and efficiency improvements.  Those with expectations of tax increases to fund the $1.0 trillion bill were not disappointed, as funding provisions bill included:

• A tax on individuals who opt out of health care insurance, equal to the lesser of 2.5% of adjusted gross income (AGI) or the average individual premium amount.
• A tax on employers who do not provide a health care plan, equal to 8% of payroll for companies with payrolls exceeding $400,000 annually, with lower rates applying to employers with smaller payrolls.  This, on top of the current 15.3% payroll tax for Social Security and Medicare, brings the total entitlement tax to a whopping 23.3%.
• A new excise tax on health insurance plans at a rate yet to be determined.
• A new “surtax” on the AGI of small businesses and other high income earners:

              -  1% on AGI of $350,000 to $500,000
              -  1.5% on AGI of $500,000 to $1,000,000
              -  5.4% on AGI over $1,000,000

This last, on top of allowing the Bush tax cuts to expire, will result in a top marginal tax rate of 45% and a capital gains rate of over 25%.   The fact that the surtax is applied against AGI rather than taxable income (meaning that it is applied before deductions such as mortgage interest, property taxes and medical expenses) will push the top rate, including state taxes, over 50% and the capital gains rate over 30%.

These punitive income tax rates alone will be a huge impediment to business, particularly small and medium sized businesses responsible for the vast majority of job creation.  Additional corporate tax provisions contained in the bill, designed to close “loopholes”, reduce the use of offshore tax havens and accelerate the double taxation of foreign earnings, will further add to the corporate tax burden.  These additional costs not only provide businesses further incentive to move to a more friendly environment, but will ultimately be borne by the consumer (taxpayer), again flying in the face of Obama’s vow not to raise taxes on families earning under $250,000.

Proponents of massive health care reform are once again playing the crisis card to accelerate approval of this bill.  We are far from a health care crisis in this country.   Collapse of the entire health care system is not imminent.  Despite misleading statistics published on a daily basis by those complicit in the charade, the numbers of chronically uninsured Americans are relatively small.  Improvements certainly need to be made, but taking the time to explore options, gather real facts and make intelligent decisions will ultimately result in a solution that makes more sense and has a far greater chance of actually working.  This high cost, ill-conceived bureaucratic nightmare is not the answer.