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How are They Going to Attempt to Pass Health Reform

Editor’s note: The big fear of the House Democrats: if the Senate requires the original bill to be signed into law before it will vote on the side car, is it possible that the side car does not get passed — or it gets changed and sent to the House for another vote and it doesn’t agree, etc. and we end up with the original Senate Bill as the law of the land?

Here is an analysis by ERIC.


Advocating the Employee Benefit and Compensation Interests of America’s Major Employers

March 16, 2010

Healthcare reform is now in the root canal stage of the process, where pain and procedures seem to be dwarfing more substantive considerations.  At the moment, all eyes are focused on the House, where Speaker Nancy Pelosi (D-CA) must come up with 216 votes to approve the healthcare legislation passed by the Senate last December as well as a “sidecar” bill that would make enough changes to the Senate bill to assure an “aye” vote in the House for the legislative package as a whole. 

House action:  Yesterday the House Budget Committee got the ball rolling by approving a “placeholder” bill that has now been sent to the House Rules Committee.  The Rules Committee will substitute the “real” reform language for the fake language and then have a vote on a “rule” for the bill – i.e., how it will be packaged, how many amendments can be offered, how long debate can last, etc.; a vote in the Rules Committee could take place Wednesday or Thursday. 

If all goes as planned and the House Rules Committee reports out the legislation, a vote on the overall reform package in the House could occur Friday or, more likely, late Saturday afternoon.  At this point it is not entirely clear what this package will entail, i.e., if the Rules committee will keep the Senate legislation and a House sidecar bill separate or whether the two will be combined.  In the latter scenario, a vote to approve the sidecar would be “deemed” to also be a vote for the Senate bill.

One potential sticking point in all of this is that the Congressional Budget Office has still not released its final “score” on the legislative package; this score is important because a bill that bursts the $1 trillion optical ceiling for the cost of the legislation will have a harder time picking up stray votes in the House. 

Note:  the legislative language for the sidecar bill also has yet not been released.   

Senate action:  If the House summons 216 votes to approve this new healthcare reform package and avoids the numerous potholes that could cause its wheels to fall off, the last stage is consideration in the Senate.  At this point, the Senate bill will have been approved by both the House and the Senate and will have been sent to the president for his signature; although no definitive statement has been issued by the Senate parliamentarian, it appears that the president must sign the Senate bill into law before a reconciliation bill can amend it in the Senate.  What the Senate will consider and vote on is just the sidecar reconciliation bill

 As has been made much of lately, the Senate needs only a majority vote to approve the sidecar reconciliation bill and not the 60 votes to overcome a filibuster.  The trade-off, though, is that the reconciliation bill may not include any policy provisions that do not have a budgetary effect on the bill’s bottom line. (That is why Speaker Pelosi has been hamstrung in her ability to add a provision to the sidecar bar to appease anti-abortion House Democrats.)

 But here’s another rub:  the Senate may not necessarily want to approve the sidecar bill exactly as it was sent over by the House; the problem is that any changes to the sidecar would mean that the bill would need to go back to the House for another vote.  This would probably sound the death knell for healthcare reform legislation.


March 16, 2010 Posted by | Federal Government, healthcare | , , | Leave a comment

As a progressive, Obama hews to the Wilsonian tradition

Editor’s note: In interesting read of the ideological leanings of government leaders. By George F. Will

Thursday, March 11, 2010

Wilson, once a professor of political science, said that the Princeton he led as its president was dedicated to unbiased expertise, and he thought government could be “reduced to science.” Progressives are forever longing to replace the governance ofpeople by the administration of things. Because they are entirely public-spirited, progressives volunteer to be the administrators, and to be as disinterested as the dickens.

Professor Obama, who will seek reelection on the 100th anniversary of Wilson’s 1912 election, understands, which makes him melancholy. Speaking to Katie Couric on Feb. 7, Obama said:

“I would have loved nothing better than to simply come up with some very elegant, academically approved approach to health care, and didn’t have any kinds of legislative fingerprints on it, and just go ahead and have that passed. But that’s not how it works in our democracy. Unfortunately, what we end up having to do is to do a lot of negotiations with a lot of different people.”

March 14, 2010 Posted by | Federal Government, healthcare | , , | 1 Comment

Boiling Down the Health Care Discussion

The health care debate is essentially about access and cost. The bills also include a significant language on quality. The quality agenda is highlighted by funding for the National Quality Forum and Health Information Technology. (ARRA also contains significant funding for Information Technology and the structures to support it.)

This post is about change and cost. There can be little doubt that there are significant issues for the uninsured, those that lose coverage between employers, pre-existing condition exclusions, those that can’t afford to pay for their coverage and other related issues. It is also true that we already pay a significant amount in our current premiums for indigent care. The question is, how much care can we afford for those not paying their own way.

That number is somewhere between ‘0’ and ‘100%’. It isn’t 100% since you need productive workers paying taxes to pay for the care of others unable to afford their own care. It is certainly more than ‘0’. Is it 10%, 20%, more?

Second, subject … liberalism vs. conservatism. The original definition of each goes something like this:

Liberals believe that where change is necessary, it should be done quickly. Conservatives believe that things should be changed incrementally to understand the impacts of the changes. If a liberal where in a room which quickly went dark they would be heard to say, ‘lets’ get the heck out of here.’ A conservative would methodically find their way out of the room.

So, how do these two subjects come together? Simply this, the debate currently underway is a ideological one. Should we go quickly or should we go incrementally and how much is affordable. If you can effectively answer those two questions …

March 14, 2010 Posted by | Cost, Federal Government, health information technology, healthcare | , , , , | Leave a comment

Declare Health Care Independence

Editor’s note: Link to the petition, below, and decide whether you support these several health care principles.

On Saturday, March 13 from 12:00 noon to 1:00 pm the Citizens Council on Health Care (CCHC) will be cosponsoring a rally in St. Paul, Minnesota. As part of that rally, CCHC head Twila Brase writes, “CCHC would like to present Congresswoman Michell Bachmann with the LARGEST stack of petitions imaginable against government-run health care!”

Twila asks that all friends of health care freedom join with her in signing the Declaration of Health Care Independence petition.

Please sign the petition and pass the link on to your friends and colleagues.

March 10, 2010 Posted by | Federal Government, healthcare | , , | Leave a comment

What if the Cost Projections Are Wrong?

Editor’s note: There appear to be no fail safe mechanisms in the new bill, in the event that the cost projections turn out to be wrong and it costs more. Even if there are fail-safe triggers, will a future Congress have the will to allow them to be triggered? See physician reimbursement under SGR (Sustainable Growth Rate) over the past 12 years. Does the phrase, “Not on My Watch” come to mind?

This from the NY Times:


But even some lawmakers who voted for the Senate bill have been calling in recent weeks for additional steps to be taken to guarantee that new spending will not spiral out of control. They also want to ensure that Congress will follow through on proposed cuts, especially reductions to slow the growth of Medicare.

Many experts have warned that members Congress may not have the stomach to carry out the proposed cuts in the future. In January, five Democratic senators, including Michael Bennet of Colorado and Mark Warner of Virginia, sent a letter to the Senate majority leader, Harry Reid of Nevada, urging him to include a “fail-safe” mechanism in the final bill that would result in cuts if spending were to exceed estimates.

Representative Chet Edwards, Democrat of Texas, noted the absence of such a fail-safe when he voted against the House bill in November.

“I am especially disappointed that the bill does not have a fiscal trigger in it to cut spending if actual costs of new programs turn out to be higher than projected,” Mr. Edwards said in a statement. “While the Congressional Budget Office predicts this bill is paid for over 10 years, there is no mechanism in the bill to force spending cuts if those complicated projections turn out to be wrong.”

So far, there is no indication from the White House or Democratic Congressional leaders that they would include such a mechanism in the legislation. One Senate leadership aide dismissed the idea as a “second tier” issue at a time when officials are focused on how they can make final changes to the core components of the health care legislation through the budget reconciliation process.

After the health care summit meeting last week, Mr. Altmire said the legislation still seemed “weak” on cost containment.

Representative Lincoln Davis, Democrat of Tennessee, who voted against the House bill in November, raised similar concerns after the summit meeting last week.

“America has the best health care system in the world, but we need to work on reducing its costs,” Mr. Davis said in a statement. “Folks in my district could care less about the partisan gamesmanship that is being waged by ideologues who are only interested in scoring political points, they want affordable and accessible care, and they want an honest discussion on workable solutions.”

March 6, 2010 Posted by | Cost, Federal Government, healthcare | , , , | Leave a comment

The Bay State Experiment is Failing


In defending his decision to go nuclear (i.e., using reconciliation to pass his unpopular health care bill), President Obama talked Tuesday about insurance company “abuses.”  He talked about premium hikes in California.  He talked about a sick mom in Wisconsin.  He even talked (in extremely modest ways) about Republican ideas like tort reform and fighting Medicare fraud.

What Obama didn’t mention was Massachusetts or bringing the benefits of Bay State reform to all America.  Quite simply, he avoided mentioning the Bay State’s attempt at government-run health care because it has been a debacle in Massachusetts, says columnist Michael Graham, of the Boston Herald.

Here are a few “highlights” of the current status of the Obamacare experiment in Massachusetts:

  • The Bay State’s “universal” health insurance scheme is already $47 million over budget for 2010; “Romneycare,” or “Obamacare Beta” as some are calling it, will cost taxpayers more than $900 million next year alone.
  • Average premiums are the highest in the nation and rising.
  • The state also spends 27 percent more on health care services, per capita, than the national average; those costs, contrary to what we were promised, have been going up faster here than nearly everywhere else.
  • It’s creating bizarre marketplace mutations; in Massachusetts, Obamacare 1.0 is such a mess the governor is talking about imposing draconian price controls.
  • Gov. Deval Patrick (D) has even suggested going to “capitation,” a system where doctors get a fixed amount of money per patient — and then that’s it; which means it would become in your doctor’s financial interest never to see you again.

All this damage to the taxpayers, the insured and the responsible business owners . . . and for what?  The percentage of uninsured Bay State residents has gone from around 6 percent to around 3 percent.  In other words, it’s a dud, says Graham.

The damage Obamacare would do to the current health care system — where 85 percent of Americans are happy with their health care, by the way — could be so great, the only institution big enough to repair it would be the government.  The fact that the government inflicted that damage would be a moot point, says Graham.

Source: Michael Graham, “Romneycare model a dud,” Boston Herald, March 4, 2010.

For text:

March 6, 2010 Posted by | Cost, Federal Government, healthcare | , , | 1 Comment

The Feds Propose to Oversee State Insurance Rates

This from Greg Scandlen — a little clarity, thank you. Anyone for the expansion, once again, of the Commerce Clause?

Federal Rate Review?

This ignorance  is underscored by Obama’s sudden interest in having federal oversight of health insurance premiums. Once again, these people do not have the slightest idea of what they are doing. One company (WellPoint) issues rates that Obama thinks are too high. But his reaction is based on nothing. He has no idea if the rates are too high, too low, or just right. It is a political temper tantrum — period.

So he wants federal oversight and looks for excuses to justify his position. One reason cited by Kaiser Health News is that, “more than half the states allow insurers to implement rate increases without first obtaining state approval.”  Well, yes they do. But that doesn’t mean there is no oversight. There are two approaches to rate regulation. One is “Prior Approval,” whereby the regulator has to approve the new rate ahead of time. The other is “File and Use,” whereby the rate goes into effect UNLESS it is denied by the regulator. In either case the regulator has the power to deny a rate increase. The only difference is what happens if the regulator takes no action. In one case it defaults to denial and in the other case it defaults to approval.

As I said, this is public policy driven solely by crass politics. The Kaiser story says, “In the past two weeks, Obama administration officials have tried to build public outrage over recent insurance rate hikes in the individual health insurance market, especially a 39 percent increase sought by Anthem Blue Cross of California, the largest for-profit health insurer in that state.” They have no interest in why these rates went up 39%, they just want to use it to inflame public opinion.

The New York Times reports, “Mr. Obama is seizing on outrage over recent premium increases of up to 39 percent.” So, Kaiser says Obama has “tried to build public outrage,” and then the NY Times says he is “seizing” on the outrage he has built.  The Times goes on to explain, “The president’s bill would grant the federal health and human services secretary new authority to review, and to block, premium increases by private insurers, potentially superseding state insurance regulators. Officials said they envisioned the provision taking effect immediately after the health care bill is signed into law.”

Also in the New York Times, WellPoint CEO Angela Braly explains that “higher premiums were justified by soaring medical costs and added that health care providers were charging more to the private sector, “including our members,” because payments from Medicare and Medicaid did not fully cover providers’ costs.” She also explained that many younger and healthier enrollees have dropped their coverage because of the recession. They have higher priorities when finances are tight.

Importantly, she noted that premiums in New York are double what they are in California because of New York’s guaranteed issue and community rating requirements – which Congress wants to apply to the entire country.

And John Graham of the Pacific Research Institute notes that while some people in California are getting a 39% premium increase others are getting a 20% cut. It is curious how we hear about one but not the other.

Look, folks, this is all about as dumb as can be. The fact is that insurance companies set rates based on what they pay out. There is no other way to do it. Sure administrative costs may be too high and that is part of the reason to support HSAs – it is far more efficient to minimize the amount of services that go through an insurance mechanism. But even if admin costs could somehow be slashed to zero, the rate increases from underlying costs would still be substantial.

Adding federal oversight is nothing but a political stunt. How is the Secretary of HHS supposed to know anything at all about local market conditions in San Bernardino, California? If she denies a rate increase and the company goes out of business as a result, who will suffer? Not her. It will be the policyholders.

When you add in the McCarran-Ferguson repeal, things get really wacky. Currently the states have very elaborate and time-tested ways to deal with insolvent insurance companies. They go onto receivorship and the state guaranty fund kicks in to cushion the blow for policyholders. If we have federal regulation of insurance companies an insolvent company will be able to file for bankruptcy in federal court (they cannot do that currently.) That means the policyholders will get no relief whatsoever.

The gross incompetence coming out of Washington these days is simply stunning.


Kaiser Health News
New York Times
Braley in NY Times
John Graham

March 4, 2010 Posted by | Federal Government, healthcare, insurance | , , | Leave a comment

Paul Ryan of Wisconsin on Health Care

Health care reform gets messier with every iteration. One week it is bigger than it was before. The next week they are talking about a scaled down version. One week the talk is all about using reconciliation. The next week Harry Reid says nobody is talking about reconciliation.  One week Rahm Emmanuel is the  muscle behind the push. The next week Washington is abuzz with talk about how the Obama White House pays no attention to Rahm.  YIKES!

The star of the big day-long summit at the Blair House was Paul Ryan of Wisconsin. He provided clarity where everyone else was, well blowing the same old smoke. It was a treat to watch him in action. Here is a transcript and video of his remarks.

Paul Ryan

March 4, 2010 Posted by | Federal Government, healthcare | , , | Leave a comment

Extension of the Medicare Physician Payment Update

President Signs Into Law Temporary Extension of COBRA Premium Subsidy, Unemployment Insurance, and Medicare Physician Payment Update

President Obama signed into law on March 2, 2010 a bill to temporarily extend emergency unemployment benefits, the COBRA premium subsidy program, and a Medicare physician payment update, along with other programs, all of which had expired on February 28. The “Temporary Extension Act of 2010” (H.R. 4691), which was passed by the Senate on March 2 and the House on February 25, continues the emergency unemployment compensation program through April 5, 2010. It also extends the 65% COBRA premium subsidy included in the American Recovery and Reinvestment Act (ARRA) (P.L. 111-5) through March 31, 2010. In addition, the law expands eligibility for the COBRA premium subsidy to certain individuals who are involuntarily terminated after they experience a qualifying event of reduction in hours. Also included in the law is an extension of the Medicare physician payment update, which sustains current Medicare payment rates for physicians (preventing a 21% payment reduction) through March 31, 2010.

The full text of H.R. 4691 is available here.

March 3, 2010 Posted by | Federal Government, healthcare, Medicare, physicians | , , , , , | Leave a comment

In A Letter to the President, McConnell Calls for ‘Better Way’ on Health Reform

‘The American people are asking us for step-by-step reforms that target cost and expand access, not a couple of commonsense ideas layered over a rewrite of one-sixth of the economy, a massive expansion of the federal government’s role in their daily lives, and higher taxes and cuts to Medicare to pay for it. The virtue of the ideas we all agreed upon at the summit is that they would lower costs and expand access without requiring these things. That’s the kind of reform Americans will support’

WASHINGTON, D.C. – U.S. Senate Republican Leader Mitch McConnell sent the following letter to President Obama regarding the White House Health Care Summit. The text of the letter appears below

Mr. President,

Thank you for your letter. Republicans also believe that last week’s health care summit at Blair House was productive. It provided a forum for the kind of open and broad-based discussion of ideas that our constituents have been demanding for months. It should be clear by now that most Americans oppose the massive health spending bills that Democrats in Washington have been attempting to push through Congress. Last week’s summit gave us an opportunity to show our constituents that there is a better way to proceed with the kind reforms they truly want.

Particularly encouraging was your apparent support at the summit for a number of commonsense ideas that Republicans have long promoted as a way of targeting the high cost of health care. All of us agree that cost is the core problem, and following last week’s summit many of us were hopeful that these proposals could form the basis for a health care bill that Americans would actually embrace. Indeed, that’s what many of us thought the summit was all about: finding areas of agreement upon which we could build a new bill, since Americans clearly oppose the old ones.

It was with this in mind that we were surprised and disappointed with your latest proposal to simply paper a few of these commonsense proposals over an unsalvageable bill. The American people are asking us for step-by-step reforms that target cost and expand access, not a couple of commonsense ideas layered over a rewrite of one-sixth of the economy, a massive expansion of the federal government’s role in their daily lives, and higher taxes and cuts to Medicare to pay for it. The virtue of the ideas we all agreed upon at the summit is that they would lower costs and expand access without requiring these things. That’s the kind of reform Americans will support.

We respectfully encourage you to consider a new approach to reform, one that does not cut Medicare to fund a trillion dollar takeover of the health care system or impose job-killing taxes in the middle of a recession. We encourage you to join with Democrats and Republicans in Congress in listening to what the American people have been telling us for more than a year now. Americans are telling us quite plainly that in order to reform health care, we should scrap the bills they have already rejected and start over with commonsense, step-by-step reforms we can all agree on.

We would also ask you to encourage Democrats in Congress to scrap something else; namely, their last-ditch plan to jam some version of their original bill through Congress and past the American people by way of the highly partisan process known as Reconciliation. It should be clear by now how Americans feel about forcing massive policy changes through Congress with a back room deal. The fact that Democrats in Congress still seem intent on this approach suggests that they are completely out of step with the public. Now is not the time to repeat the same mistakes that brought us here. It’s time to listen to the people, and start over with reforms that lower costs.


Mitch McConnell

March 3, 2010 Posted by | Federal Government, healthcare | , , | Leave a comment