The White House estimates that the President’s Proposal for health care reform would cost approximately $950 billion over a ten year window.  Here, James Capretta explains why this is unlikely to be the case and how President Obama’s plan would far exceed this cost estimate.

Read the summary here.

Read the President’s letter sent to Congressional leaders on March 2, 2010  here.

Click here to read Senate Republican Leader Mitch McConnell’s (R-KY) letter to President Obama regarding the White House Health Care Summit.

Ever since the U.S. Senate voted in December to provide new funding for Federally Qualified Health Centers in its version of health care reform, analysts have pointed out that these monies are not covered by the Hyde Amendment, the measure dating from 1976 that sharply limits federal financing of abortion. As a consequence, these new funds appropriated by the Senate bill, which is now being moved through the House of Representatives by an extraordinary legislative device, are available without statutory limit to underwrite elective abortions.

Yesterday the Obama Administration issued a internal memorandum from the Department of Health and Human Services (HHS) attempting to undercut this conclusion. The memo states that even in the absence of the statutory prohibition contained in the Hyde Amendment, longstanding regulations in place at HHS would “prohibit federal funds from being used for abortion services.” The memo notes that “[t]he president and Secretary [of HHS Kathleen] Sebelius have repeatedly stated their strong commitment to ensuring that health insurance reform does not change the status quo on abortion policy.”

The HHS memo has little or no status as a matter of law. It amounts to the issuance of another promise that legislators and citizens can evaluate on the merits. Because the regulations cited in the memo would be applied voluntarily by HHS to any funds not included in a future appropriations measure containing the Hyde Amendment (the FQHC funds appropriated by the Senate bill cover five full years of spending), HHS would not be obligated to apply the standards of the Hyde Amendment to these funds. The flexibility of federal agencies to expand or limit reasonable interpretations of the law has been demonstrated both in the context of abortion policy in federally funded family planning clinics and in the Obama administration’s rescission of conscience regulations last March.

The Obama administration’s argument also relies on a press release from the National Association of Community Health Centers, which asserted that these centers “do not plan to, nor are they seeking to, become providers of abortion.” While the release may have been issued in good faith, it has no policy force with respect to the nation’s 1,250 FQHCs. These centers, moreover, are under intense public scrutiny at a moment of decision on the President’s “signature” domestic policy issue. It is more instructive to look to their views when that scrutiny was largely absent.

In 2009 First Lady Michelle Obama paid her first visit to a nonprofit organization in the nation’s capital – choosing a clinic network called Mary’s Center. The Center is an FQHC and it focuses on promoting “healthy pregnancies, improv[ing] birth outcomes, and reduc[ing] infant mortality.” While Mary’s Center does not publicize a policy on providing abortion, its President/CEO Maria S. Gomez proudly lists on her official biography her receipt of the 2002 “Champions of Choice” Award from Planned Parenthood of Washington, D.C., a major area abortion provider. The award is given each year to an advocate of “choice,” a standard locution for abortion.

More significantly, key personnel from Mary’s Center were participants in a 2001 National Consortium convened by the National Abortion Federation. The Consortium issued a report titled “Increasing Access to Abortion for Women in Diverse Communities.” The report issued formal recommendations for policy changes. The singular domestic policy change: repeal of the Hyde Amendment. The report described this recommendation as “the universal consensus at the Consortium.” With passage of the Senate bill and signature by the President, the Consortium will be well on its way to that goal.

You can read Part One here.

But what about Al Gore’s Social Security “Lock Box?” Can’t we just spend that $2.5 trillion in the Social Security Trust Fund? As Heritage experts David John and Brian Reidl explain, since 1939 federal law has required Social Security to “invest” its extra money in Treasury bonds. Those bonds are really just IOUs from the government to the government. The feds already spent that $2.5 trillion long ago on programs such as education, foreign aid and defense. Add the $2.5 trillion Social Security obligation onto our other obligations and our current national debt stands at $12.5 trillion, or nearly $42,000 for every man, woman, and child in the country. And it will only get worse under President Barack Obama’s Budget. It would: 1) borrow 42 cents for each dollar spent in 2010; 2) leave permanent annual deficits that top $1 trillion as late as 2020; and 3) dump an additional $74,000 per household of debt into the laps of our children and grandchildren.

Responding to such unsustainable borrowing, Moody’s rating agency announced Monday that the United States needs to make deep spending cuts or risk losing its AAA credit rating. From the report: “growth alone will not resolve an increasingly complicated debt equation. Preserving debt affordability at levels consistent with AAA ratings will invariably require fiscal adjustments of a magnitude that, in some cases, will test social cohesion.”

Losing our AAA rating would send interest rates higher, increase our borrowing costs, and send the percentage of GDP we spend servicing our debt sky rocketing. Bloomberg adds: “the U.S. will spend more on debt service as a percentage of revenue this year than any other top-rated country except the U.K., and will be the biggest spender from 2011 to 2013.” The message from Moody’s was clear: the U.S. federal government must change direction on spending or face economic disaster.

The leftist majorities in Congress and the White House are not listening. Instead of reining in federal spending and tackling our existing Entitlement crisis, they are locked in an all out push to create a brand new $2.5 trillion health care entitlement. The President may say his plan is deficit neutral, but the American people do not believe him. And they are wise not to. The President tries to pay for his plan with over half a trillion dollars in Medicare cuts over the next decade. The president’s own Centers for Medicare and Medicaid Services reports that these cuts would cause one-fifth of all health care providers to go bankrupt. Congress would never allow those hospitals to go out of business. Congress will never actually make those Medicare cuts. So already Obamacare is half a trillion dollars in the red, and we haven’t even tacked on the hundreds of billion of dollars the doc fix adds on.

Reducing our entitlement obligations is the only way to prevent our nation from becoming another Greece. We need to: 1) to show these programs’ long-term obligations in the budget; target these programs to only who that need them; and strengthen personal responsibility by making it easier for people to build personal retirement savings and use health care savings accounts. But first we must avoid the fiscal insanity that is Obamacare.

“Deeming” and “reconciliation” are hardly household words, but for the next week Americans will come to know them as key procedural maneuvers that could push Obamacare across the finish line. But while they might deliver a bill to President Obama’s desk, they will also make it easier to repeal the measure, says former White House deputy chief of staff Karl Rove.

On the road for his “Courage and Consequence” book tour, Rove chatted with The Heritage Foundation about Obamacare, his defense of President George W. Bush’s conservatism, the growth of Tea Parties and anger toward government spending.

Listen to the full 30-minute interview.

Rove, who joined Heritage for the launch of our San Francisco Community Committee last September, recalled how even in the heart of Speaker Nancy Pelosi’s (D-CA) district, conservatives were teeming with energy and enthusiasm. Rove will appear at a Heritage Foundation community committee event in Naples, FL, next week.

During the interview, he did not hold back his criticism of conservatives, particularly those who took issue with Bush’s support of No Child Left Behind, the Medicare prescription drug benefit and TARP. He also singled out conservatives, in addition to congressional Democrats, for the failure of Social Security reform in 2005.

Rove, however, has a positive vibe about the future of conservatism, particularly leaders such as Reps. Paul Ryan (R-WI) and Kevin McCarthy (R-CA); Sens. Richard Burr (R-NC), Lamar Alexander (R-TN) and Jon Kyl (R-AZ); and Govs. Tim Pawlenty (R-WI), Mitch Daniels (R-IN) and Bobby Jindal (R-LA).

What follows is a partial transcript of the interview.

This is crunch time in Congress for Obamacare, and Rove said he was surprised at the procedural tactics Democrats are willing to use:

“They’re going to use every tool at their disposal, no matter how weird and perverted its use will be. This idea that they’re going to take a major piece of legislation and use in the House what’s called deeming … is pretty extraordinary. And then for the Senate to use budget reconciliation—not to adjust the dials on spending and tax rates on existing law, but in essence to create new law—is an enormous perversion of the system.”

“If they pass this bill using these procedures, they will come to regret that because the procedures used to pass it may also be used to repeal it. And if they use 51 votes in the Senate to make a major substantive change in legislation, that’s going to be a problem.”

Rove also debunked claims by liberals about reconciliation, specifically its use during the 2001 tax cut legislation signed by Bush:

“We used reconciliation on the passage of the tax cuts in 2001. Well, guess what? One-quarter of Democrats in the Senate were supportive of the tax cuts, so there was bipartisanship. Reconciliation is generally used as a way to smooth the consideration of budget and tax measures that are changes in existing law. It was not designed and was never intended to be used to pass major, dramatic, big, huge, economy-affecting policy that the Democrats are trying to do in this instance.”

Rove also spoke at length about Bush’s conservatism, specifically programs such as No Child Left Behind, the Medicare prescription drug benefit and TARP, which have raised questions about his fiscal conservatism.

His defense of No Child Left Behind:

“[Rep.] John Boehner and [Sen.] Judd Gregg were the two Republicans who worked with [then-Sen.] Ted Kennedy and [Rep.] George Miller and the administration to put No Child Left Behind into place. I believe it is conservative legislation. It says states are in charge. If you get federal money, a state has to have standards. We don’t care what those standards are; you just have to have standards.”

“The education oligopoly doesn’t like to be held to account. And having standards—expectations about what children are expected to learn and when they’re expected to learn it—is a conservative principle. …”

“What’s so odd to me is that a lot of conservatives have come to join with the teacher unions in objecting to children being tested. … Conservatives should not get in bed with the teacher unions and give them what they want, which is weakening or an end to a tool that gives parents and communities a chance to demand success and to blow the whistle on failure.”

His defense of the Medicare prescription drug benefit:

“We had two competing plans: We had an $800 billion Democratic plan that was government-run. The government set the formulary. It decided what drugs you got and set their prices. And it was not paid for. The Republican plan was free-market oriented and was scored by the CBO at $450 billion, and included other reforms of Medicare and the creation of health savings accounts.”

“Because it was based on free-market principles, in which private companies competed to deliver the benefit, guess what? The program is costing one-third less than what CBO anticipated. … Why? Because it’s based around markets and markets have a wonderful way of lowering prices and increasing benefit. …”

“It’s the only government-sponsored health program in the history of the country which has come in under its original estimates. …”

“I understand if a conservative says to me, ‘I think we ought to repeal Medicare and it ought to be gone. And I, therefore, object to a Medicare prescription drug benefit.’ I salute them as being consistent. But if Medicare is going to exist, then we need to have Medicare driven by market forces and we need to have it as modern as possible. …”

“It was a wise decision for conservatives to say, while we have this moment—a Republican President, a Republican House, a Republican Senate—let us pass a conservative, market-oriented version of this benefit, rather than allowing them to pass a much more expensive, much larger, big government, price-fixing form of service.”

On the use of TARP I, supported by Bush, and TARP II, supported by Obama:

“The difference between those two are clear: We have one where a Republican, conservative president said, I don’t like doing this, but if we’re going to have to do this to save the economy, we better make certain the taxpayer is protected and at the end of the day we get made whole and we make money. And we have a Democrat president who says, I’ve got a big pot of money, let me use it to reward my friends, punish my enemies and engage in industrial policy.”

What went wrong in the Social Security reform debate of 2005:

“When it came to Social Security reform, we had problems on the left and the right. The political left in Congress was not the same as thoughtful liberals like [the late Sen.] Daniel Patrick Moynihan, who said we better repair the safety net before it breaks. We had no political support among Democrats. …”

“Let’s be candid about this. Republicans applauded when Bush talked about this in the 2000 and 2004 campaigns, and there were a lot of reformers like [Sens.] Elizabeth Dole, John Sununu and Jim DeMint who got elected to the Congress by talking about this. But when it came time for the rubber to meet the road in 2005, there was little enthusiasm among Republicans for taking this up, and particularly striking among some conservative leaders whom you would’ve thought would’ve understood the special moment we had and the responsibility we had to save this program, who said, nope, sorry, not going to do it.”

The role of Tea Party groups:

“I don’t want them to become an adjunct of the Republican Party. I think they are far more powerful and influential if they remain as they are today, which is a movement that holds the feet of elected officials in both parties to account for what they do on spending, deficits, debt and powers of government.”

The best reporter to cover the Bush White House:

“I hate to sound like I’m flacking for my friends at Fox, but the Fox reporters were always good in that they were tough but fair. I thought also, surprising enough, that Jake Tapper, who is an ABC reporter, who is a lefty, was nonetheless reasonably fair and tough. You could count on him to ask you tough questions.”

Rove’s thoughts on those who call Obama a “socialist”:

“We’ve got to be very careful about our language in order not to give our adversaries cheap shots to make at us, while at the same time making the case against President Obama and liberal policies. …”

“President Obama wants things to remain in the hands of private owners and operators. It’s just that he wants them to be subjected to a level of regulation, scrutiny and restraint by government that would be stifling.”

“We have to remember our target: It’s not our fellow conservatives. Our object here is to say things and make the case to people whose ears and eyes are open, but who don’t necessarily view themselves as conservatives.”

How technology is changing politics:

“We need to as a movement avail ourselves of all these channels because they are ways to reach people, particularly younger people who are otherwise not available to us. Just remember this, 2008 in the presidential election, it’s the first election in history that more people said they got their information about the election from the Internet than from local newspapers.”

As written, the current health care bill before Congress already is guaranteed to face serious constitutional challenges on enumerated powers, 5th Amendment, racial discrimination, and unequal state treatment. Now the White House seems determined to add a whole new reason courts will throw out Obamacare on sight. Director of the Stanford Constitutional Law Center at Stanford Law School and former-federal judge Michael McConnell explains:

“To become law—hence eligible for amendment via reconciliation—the Senate health-care bill must actually be signed into law. The Constitution speaks directly to how that is done. According to Article I, Section 7, in order for a ‘Bill’ to ‘become a Law,’ it ’shall have passed the House of Representatives and the Senate’ and be ‘presented to the President of the United States’ for signature or veto. Unless a bill actually has ‘passed’ both Houses, it cannot be presented to the president and cannot become a law.”

“To be sure, each House of Congress has power to ‘determine the Rules of its Proceedings.’ Each house can thus determine how much debate to permit, whether to allow amendments from the floor, and even to require supermajority votes for some types of proceeding. But House and Senate rules cannot dispense with the bare-bones requirements of the Constitution. Under Article I, Section 7, passage of one bill cannot be deemed to be enactment of another.”

“The Slaughter solution attempts to allow the House to pass the Senate bill, plus a bill amending it, with a single vote. The senators would then vote only on the amendatory bill. But this means that no single bill will have passed both houses in the same form. As the Supreme Court wrote in Clinton v. City of New York (1998), a bill containing the ‘exact text’ must be approved by one house; the other house must approve ‘precisely the same text.’”

“These constitutional rules set forth in Article I are not mere exercises in formalism. They ensure the democratic accountability of our representatives. Under Section 7, no bill can become law unless it is put up for public vote by both houses of Congress, and under Section 5 ‘the Yeas and Nays of the Members of either House on any question . . . shall be entered on the Journal.’ These requirements enable the people to evaluate whether their representatives are promoting their interests and the public good. Democratic leaders have not announced whether they will pursue the Slaughter solution. But the very purpose of it is to enable members of the House to vote for something without appearing to do so. The Constitution was drafted to prevent that.”

Congressional liberals are working overtime. In case you missed it, hidden behind the non-stop news coverage of the health care debate, the Senate-passed extenders bill includes several health care provisions that follow the same flawed policies of the big Stimulus Bill. Once again, these provisions move the health care system in the wrong direction.

– COBRA or Nothing. The bill would give premium relief only to those unemployed workers who opt for COBRA coverage. It is well documented that COBRA coverage is one of the most expensive options available to those who lose their jobs. Workers would be better served if they were able to decide whether to use this temporary assistance on COBRA or another more affordable option, including policies available in the individual market.

– Another Medicaid Bailout. The bill would continue to use federal taxpayer funds to bailout state Medicaid programs. While state budgets are crippled by Medicaid, the solution is not to transfer the cost on the federal taxpayers. Instead, Congress should get serious about Medicaid reform and grant states the flexibility they need to fix the program.

– More Delay on the Doctor Fix. The bill would delay automatic Medicare reimbursement cuts to doctors. Cleverly, Congressional leaders removed this costly fix from their health care overhaul and instead have kicked the can down the road one more time. This will enable them to say that the health care legislation is deficit neutral. Senate Congressional leaders should get serious about a permanent fix of the Medicare reimbursement for doctors once and for all, and find some way to offset its cost, rather than adding the additional costs to the deficit.

This bill is a good reminder that even if the massive health care overhaul fails, health care is not dead. Ill-advised health care proposals gain support in different forms, and can be enacted in bite-sized bits.

In 2009, Democrats chose to proceed with a health-care bill under the regular order – that is, they sought to pass the legislation under normal House and Senate rules. They did not put together a budget reconciliation bill with health care in it, something that could have passed the Senate with a simple majority vote. They conceded that such an approach would likely produce a flawed product, as many non-budgetary provisions in a health-care plan would not survive the reconciliation process. And so they decided to try and pass a bill without resorting to reconciliation, even though they knew they would need sixty votes in the Senate to succeed. It worked. They passed a bill in the House in November, and a somewhat different version in the Senate in December.

Then came Scott Brown. His stunning election to the Senate on January 19 upended the Democrats’ end-game. They were going to work out the differences between the House and Senate-passed bills in January and proceed to pass an agreed-upon version in both chambers as expeditiously as possible. But that plan was contingent on getting sixty votes again in the Senate. With Brown’s election, Senate Republicans increased their numbers from forty to forty-one, thus forcing Democrats to find at least one Republican Senator to support their final bill.

For the past two months, the White House and Democrats in Congress have been weaving ever-more complicated legislative webs all with the express intent of avoiding at all costs any need to negotiate with the now slightly enlarged Senate minority. In effect, what Democratic leaders want to do is – at the very end of the legislative process – switch from regular order to a reconciliation process in order to avoid having to deal seriously with any elected Republicans.

But it’s become increasingly clear that the Democratic scheming and maneuvering necessary to pull off such a high-wire act has created a web of entanglements that could very well doom passage of the entire effort.

In particular, there now appear to be two huge hurdles standing directly in the way of a plan to jam a bill through in the coming days.

First, there is the matter of the liberal abortion provisions in the Senate bill. As the Catholic Bishops conference has noted the Senate-passed bill includes several provisions that would allow taxpayer funding of elective abortions. Consequently, the Bishops opposed passage of that bill when it was considered in the Senate, and now oppose its passage by the House. The problem for House Democrats is that every version of the end-game they are now considering is predicated on having the House take up the Senate bill and pass it unchanged for presidential signature.

That is entirely unacceptable to the Catholic Bishops. They oppose House passage of the Senate’s pro-abortion health bill. Period. And their opposition hasn’t come with procedural loopholes that would let members off the hook if they promised to pass a fix separately. That would be fool’s bargain, and the Bishops know it. So pro-life House Democrats, led by Congressman Bart Stupak, really have no choice here. They can’t support the Senate bill unless they want to be known for supporting the most pro-abortion bill ever considered in Congress. Their only real option is to force House leaders to amend the Senate bill before passing it to include strong restrictions on funding of abortion. Yes, that would mean the bill would have to go back through the Senate again before going to the president, but so be it. That’s not the Bishops’ problem. It would mean the president and the Democrats would have to really negotiate to get some Republican support, which is of course the norm for sweeping and important legislation.

This post originally appeared at National Review Online.

In the face of declining polling numbers, daily Democratic defections, and unfavorable rulings from the Senate Parliamentarian, the White House has devolved into all out panic mode. Politico reports:

“President Barack Obama is delaying his trip to Indonesia and Australia by three days in hopes of finalizing a health care deal — and will scrap plans to bring along First Lady Michelle Obama and his two daughters, according to senior administration officials.”
…
“By postponing his trip, Obama effectively gives the House some breathing room, preserving the hope that members will be able to depart the Capitol for their Easter break two weeks from today with a deal in their pockets.”

Two things to remember about this latest development:

1) This just proves, again, how desperate the White House is for the House of Representatives to pass the Senate health care bill before the Easter recess. The Obama administration knows the American people hate Obamacare and that after a week listening to their constituents back home, there is no way the House will take up the Senate bill again.

2) President Obama has made many other attempts at influencing outcomes with his presence. He went to Copenhagen in November to lobby for the 2016 Olympics to come to Chicago, returning there again a month later to obtain a global climate treaty. The President also campaigned for Creigh Deeds to be governor of Virginia, Jon Corzine in New Jersey and for Martha Coakley’s campaign to become junior senator from Massachusetts. We fail to see why he believes his presence at the health care negotiations might have a different impact.

This Tuesday, Gallup released its latest poll showing that by a 48%-45% margin Americans would tell their representative in Congress to vote against President Obama’s health plan. Compare that to the last time Gallup asked the question in January, Americans supported the President’s plan 49%-46%. That’s a net six point loss in support for the President’s plan since the State of the Union. That is momentum. Against Obamacare.

And Gallup isn’t alone. The Associated Press released a poll this week showing that 68% of Americans believe the President and Congressional Democrats shouldn’t pass their health care plan without Republican support. “Nothing has been more disconcerting than to watch Democratic politicians and their media supporters deceive themselves into believing that the public favors the Democrats’ current health-care plan,” Democratic pollsters Pat Caddell and Doug Schoen add in today’s Washington Post, “A solid majority of Americans opposes the massive health-reform plan.”

Yesterday was particularly tough for the President’s plan. First, the White House underwhelmed the Democratic Caucus in a presentation of the new (still unwritten) reconciliation bill. Then, the Senate Parliamentarian killed the Democrats favored procedural path for passage by signaling he would rule that President Obama must sign the original Senate bill into law before the Senate could act on the President’s new reconciliation package. Finally, the Associated Press reported that House leaders have abandoned all hope of finding language to satisfy Rep. Bart Stupak’s (D-MI) concerns that the Senate bill funds abortion. By the end of the day, the leftist firedoglake site had dropped its count of committed House Democrats for passage to 189 (Speaker Pelosi needs 216 for passage).

With the loss of Stupak and his 7-12 member caucus opposed to taxpayer-funded-abortions, Speaker Pelosi will have to find the remaining dozen plus votes from the ranks of cost conscious Blue Dog Democrats. For example, Rep. Suzanne Kosmas (D-FL) who voted against the House bill in the fall explained at the time: “According to the Congressional Budget Office, the House health care bill will actually increase federal health care spending over the long term, while proposals being considered by the Senate would have a net decrease.” But according to a new CBO score of the Senate bill passed on Christmas Eve (the one with the Cornhusker Kickback), it actually increases health care spending. And the reconciliation bill only make things worse, since, among other increased spending measures, President Obama “fixed” the Cornhusker Kickback not by eliminating the new spending, but by extending it to all 50 states.

With no votes piling up, and “yes” votes materializing, the Democratic plans to shove Obamacare down the throats of the American people are becoming more and more desperate. This Monday, the House Budget Committee will begin markup on the new reconciliation bill even though actual legislative text does not exist for it yet. The Democrats plan to pass a shell of a bill through the appropriate committees so that the Rules Committee can then substitute the bill that is being drafted completely behind closed doors by the White House and Senate and Democrat leaders.

Politico reports that despite the Parliamentarian’s initial verbal ruling, they will press on with their Slaughter Rule plan to pass the Senate bill without voting on it. NRO’s Yuval Levin quips: “Democratic leaders should be asking themselves just how they have gotten to the point that their strategy is to amend a law that doesn’t exist yet by passing a bill without voting on it.”

But President Obama’s progressive base is way past rational thought when it comes to health care. They want it passed at any cost. And as George Will pointed out yesterday, the very essence of progressivism sublimates the democratic process to the rule of experts in Washington. No one can say if this bill will finally pass, but if it does, it is abundantly clear that our republican form of government will be permanently damaged by it.