FixHealthCarePolicy

Think Medicaid Expansion is a Good Idea? Think Again.

Most everyone agrees that decreasing the number of the uninsured is an important goal of health care legislation. What is not agreed upon is the best way to achieve that goal. Obama’s health care plan depends on expanding the number of Americans enrolled in Medicaid – the government-run program for the poor and disabled. The Congressional Budget Office (CBO) estimates the Senate bill would account for about 50 percent of the reduction in the uninsured population at a cost of $395 billion over 10 years.

New research by Heritage’s health fellow Brian Blase presents evidence suggesting that Medicaid expansion would be both costly and do little to improve the health of the uninsured. Blase examines the “TennCare” program, a Tennessee public program enacted in 1994 that dramatically increased the expansion of Medicaid to Tennessee’s uninsured population. The TennCare program quickly added over half a million individuals to Medicaid, enrolling one-fourth of the entire state. And costs also skyrocketed. Per-capita Medicaid spending from 1994-2004 increased by 146 percent in Tennessee, which was over double the national average increase of 71 percent.

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Tags: CBO, Medicaid Expansion, ObamaCare, President's proposal, TennCare

The President’s Health Plan Won’t Cut the Budget Deficit

One of the central arguments President Barack Obama has made on behalf of the health care plan he wants Congress to approve in coming weeks is that it would begin to address the problem of rising costs and thus also begin to bring down future federal budget deficits.

But will it?

The president’s plan has not yet been assessed by the Congressional Budget Office. But CBO has provided a cost estimate for the Senate-passed bill, upon which the president’s proposal is built. That estimate shows the Senate bill would reduce the budget deficit by $132 billion through 2019. CBO also says that the Senate bill would likely reduce projected deficits even more during the second decade of implementation.

But, as Republican Rep. Paul Ryan of Wisconsin noted at last week’s Blair House meeting, there are a number of reasons to be skeptical about this claim.

For starters, the Senate bill omits the president’s proposal to permanently restore a 21 percent reduction in Medicare’s fees for physician services, now in effect as of March 1. The administration estimates that overriding this cut will cost $371 billion through 2020. (more…)

Tags: CBO, doc fix, federal deficit, Medicaid Expansion, Medicare cuts, ObamaCare, President's proposal

Morning Bell: Obamacare’s Kabuki End Game

The doctors in lab coats surrounding President Barack Obama as he gave his latest health care speech yesterday were not there to give the President a physical; that happened Sunday. No, these doctors were props, dressed to impress for what the White House claims is their “final push” for the President’s government take-over of the health care industry. The President again repeated the same old tired claims he has been making for months: “The proposal I’ve put forward gives Americans more control over their health care,” “our proposal is paid for,” and “my proposal would bring down the cost of health care for millions.” We, and plenty of others, have refuted all these claims before, but this time they are particularly easy to expose as patently false. President Obama gave away the game when he said:

“Our cost-cutting measures mirror most of the proposals in the current Senate bill, which reduces most people’s premiums and brings down our deficit by up to $1 trillion over the next two decades. And those aren’t my numbers – they are the savings determined by the CBO, which is the Washington acronym for the nonpartisan, independent referee of Congress.”

But there is one huge difference between the Senate bill and what the President kept referring to as my/our proposal: the Senate bill actually exists. For all the talk in Washington about Democrats in the Senate using reconciliation to pass a final version of Obamacare, one key fact has been overlooked: no reconciliation bill exists. Not in the House. Not in the Senate. Nowhere. It simply has not yet been written, and there are plenty of reasons to believe it never will. (more…)

Tags: CBO, final push, House Speaker Nancy Pelosi, ObamaCare, President Barack Obama, reconciliation, White House speech

Morning Bell: Can They Make Obamacare Worse? Yes They Can!

Flacking for President Barack Obama’s “new” health care plan, White House Press Secretary Robert Gibbs told reporters assembled for yesterday’s press briefing: “The president posted ideas of his on the White House website today. We hope Republicans will post their ideas either on their website, or we’d be happy to post them on ours, so that the American people could come to one location and find out the parameters of what will largely be discussed on Thursday.” And this might have been a small bit of successful Obama administration gamesmanship on health care and transparency in government except for one small problem: reality. Not only do House Republicans already have their own health care plan, not only is it already available online, but the White House’s own website already links to it!

And speaking of the President’s behind-closed-doors plan, don’t believe any of those headlines showing a $950 billion price tag. That is an Obama administration-created number that should not be afforded any more credibility than Gibbs’ grasp of the contents of his own website. In fact, the independent Congressional Budget Office (CBO) published this about the President’s new plan yesterday:

“Preparing a cost estimate requires very detailed specifications of numerous provisions, and the materials that were released this morning do not provide sufficient detail on all of the provisions. Therefore, CBO cannot provide a cost estimate for the proposal without additional detail, and, even if such detail were provided, analyzing the proposal would be a time-consuming process that could not be completed this week.”

In other words, even with over a year to prepare for the moment they would finally release their own plan, the White House could only manage to obtain an “incomplete” grade from the official budget scorekeeper in Washington. So every time you hear the President say “my plan is paid for” or “my plan reduces the deficit,” just remember you are going to have to take his word for it.

And where the President’s plan is more firm than fuzzy, it only makes the scheme worse: (more…)

Tags: CBO, Cornhusker Kickback, Medicaid, Medicare, ObamaCare, President's proposal, price controls

An Entitlement Certain to Grow

One of the main arguments President Barack Obama and other Democrats have made on behalf of the health care bills that have passed the House and the Senate is that they would reduce the federal budget deficit in the coming decade and in the years following as well. Their claim is backed up by the official cost estimates provided by the Congressional Budget Office that show modest improvements in the budget outlook through 2019 if the bills become law. But there are important reasons to be very skeptical that a final health care bill will improve the nation’s budget outlook, both in the short and the long term.

For starters, neither bill addresses the impending cut in the fees paid to physicians under the Medicare program. There is bipartisan opposition to these cuts, but the cost of fixing the problem would exceed $200 billion over 10 years. Consequently, congressional Democrats aren’t providing a permanent solution in the health care bills; they are in effect understating the cost of the reform program they have promised to deliver. If the so-called “doc fix” were included in the accounting, the health care reform effort would no longer be a deficit reducer at all. (more…)

Tags: CBO, doc fix, entitlement, Medicaid Expansion, ObamaCare

Reid 2.0: It’s Still a Budget Buster

The Obama White House and its congressional allies have tried all year to push their various bills through to passage by truncating the time between introduction and a decisive vote to the bare minimum. They figure the only way to get something passed is to minimize public review and scrutiny of whatever their latest idea is to engineer American health care from Washington, D.C.

To date, that tactic hasn’t worked out so well. In July, House Democrats tried to unveil a bill on the 14th for a planned vote on the 31st. A firestorm erupted, however, pushing back the vote into November. In the Senate, meanwhile, a series of self-imposed deadlines have been missed as Democratic pronouncements of inevitability have bumped up against the reality of steadfast and growing public opposition.

Nonetheless, Senate Majority Leader Harry Reid is running the same play again today, and very possibly with different results. He unveiled the latest version of his reform legislation this morning, filled to the brim with outrageous payoffs to buy the votes of holdout Senators. Virtually no one else has seen the bill before today, much less had a chance to give it the scrutiny it deserves. And certainly the public has not had a chance to weigh in. No matter. Senator Reid has simultaneously set in motion the procedures necessary to force a vote on his new health-care plan in a matter of hours, not weeks. (more…)

Tags: CBO, Medicaid, Medicare, Obama Health Care Plan, Sen. Harry Reid

The Reid Amendment: Sweetheart Deals and Interstate Warfare

Christmas is coming early for a few lucky states including Hawaii, Massachusetts, Nebraska and Vermont. But their good fortune will come at the expense of other states. Overall, the government health care plan is still alive and well in Majority Leader Harry Reid’s (D-NV) manager’s amendment released this morning, hiding in the form of expanding Medicaid eligibility and inserting State Children’s Health Insurance Plan (SCHIP) rules into the Exchange.

First, the winning states. Nebraska and Hawaii are easily identifiable because the Reid amendment specifies their sweetheart deals by name. While all the other states will lose the extra federal financing for new Medicaid eligibles after 2017, full federal financing will continue for Nebraska. Hawaii gets funding for Disproportionate Share Hospital (DSH) payments that it gave up years ago to expand Medicaid eligibility. Ironically, $18.5 billion in cuts to the DSH program in all the other states help finance the rest of the health care legislation. (more…)

Tags: CBO, manager's amendment, Medicaid Expansion, schip, Sen. Harry Reid

Morning Bell: Obamacare is Seriously Unconstitutional

On October 23rd, a reporter asked Speaker Nancy Pelosi (D-CA): “Madam Speaker, where specifically does the Constitution grant Congress the authority to enact an individual health insurance mandate?” Speaker Pelosi shook her head and before moving on to another question replied: “Are you serious? Are you serious??” Pressed for a more substantive response later, Pelosi’s press spokesman admonished the reporter: “You can put this on the record. That is not a serious question. That is not a serious question.”

The Congressional Budget Office (CBO) disagrees. In 1994, the CBO said of an individual mandate to buy health insurance:

“A mandate requiring all individuals to purchase health insurance would be an unprecedented form of federal action. The government has never required people to buy any good or service as a condition of lawful residence in the United States. An individual mandate would have two features that, in combination, would make it unique. First, it would impose a duty on individuals as members of society. Second, it would require people to purchase a specific service that would be heavily regulated by the federal government.”

As much as Speaker Pelosi may wish otherwise, the CBO is dead on: the Supreme Court has never validated a federal power as intrusive as forcing all Americans to purchase a service due to their very existence. Sure, the Supreme Court has said that Congress may regulate a farmer’s production of wheat even if he never plans to distribute it off of his farm, and the Supreme Court has said Congress may ban the possession of Marijuana even if it is for personal use, but never before has the Supreme Court said the power to regulate commerce enabled Congress to force an individual to do something just because he existed.

In fact, the Supreme Court has always been clear that the Commerce clause must have some limits. In United States v. Lopez (1995), the Court struck down the Gun-Free School Zones Act, which attempted to reach the activity of possessing a gun within a thousand feet of a school. In United States v. Morrison, it invalidated part of the Violence Against Women Act, which regulated gender-motivated violence. In both cases, the Court found the regulated activity in each case to be noneconomic; it was outside the reach of Congress’s Commerce power, regardless of its effect on interstate commerce. The case for the constitutionality of the individual mandate is far weaker than either of these two cases. Congress was at least trying to regulate an individual’s activity in the cases above. But the mandate does not purport to regulate or prohibit activity of any kind, whether economic or noneconomic. To the contrary, it purports to “regulate” inactivity.

If the individual mandate is Constitutional, then Congress could do anything. They could: require us to buy a new Chevy Impala each year to support the government-supported auto industry; require us to buy war bonds to pay for the Iraq and Afghan wars; require us to grow wheat (10 bushels each), or pay someone else to grow your share; require us to buy whatever they want.

Many on the left immediately point to state mandates that drivers purchase car insurance as proof of a mandate that all Americans buy health insurance is not new. But car insurance mandates are distinguishable in at least four ways: 1) they are state requirements and states have broader constitutional authority than the federal government; 2) they apply to drivers only, not all Americans (e.g. passengers are not required to carry insurance); 3) drivers use public roads; 4) states only require drivers to insure against injury to other drivers, not to insure themselves against personal injury.

Yesterday The Heritage Foundation’s Center for Legal and Judicial Studies released a Legal Memorandum written in conjunction with Georgetown University Law Center Professor Randy Barnett and Nathaniel Stewart explaining: Why the Personal Mandate to Buy Health Insurance Is Unprecedented and Unconstitutional. Introducing the paper, Sen. Orrin Hatch noted:

“James Madison said that if men were angels, no government would be necessary and if angels governed men, no limits on government would be necessary. Because neither men nor the governments they create are angelic, government and limits on government are both necessary for ordered liberty. Politics may tell us what we want to do, but the Constitution tells us what we may do and we must keep those separate. The ends do not justify the means for one simple reason – liberty. Liberty requires limits on government power, it always has and it always will.”

Someone needs to explain this concept to Speaker Pelosi. Seriously.

Tags: CBO, Constitution, fines, House Speaker Nancy Pelosi, individual mandates, jail times

Morning Bell: The Pelosi Blueprint for Government Run Health Care

The new House health care bill (H.R. 3962) unveiled by Speaker Nancy Pelosi (D-CA) yesterday clocks in at 1,990 pages and about 400,000 words. As written, the bill purports to cost only $1.05 trillion over the first ten years and is paid for by over $700 billion in tax increases and cuts to Medicare Advantage and Medicare prescription drug payments. But as troubling as those numbers are, the scariest thing about the bill is the solid foundation it lays for a complete government take over of the health care sector of our economy.

The Washington Post describes the bill as “creating an expensive new entitlement program (subsidies to purchase health insurance) and dramatically expanding an existing one (Medicaid).” This is true by itself, but the Post later dismissively adds: “If you’ve noticed that we haven’t talked about the public option in the House bill, that’s not an oversight. For all the fury over the issue, it doesn’t matter that much; the CBO estimates that the government-run plan would actually have slightly higher premiums.” This is a breathtakingly naive statement by the Post and demonstrates that they have not yet fully grasped how all the different elements of the bill are designed to interact to produce President Barack Obama’s desired outcome. (more…)

Tags: 3962, Barack Obama, CBO, debt, deficit, entitlement, government takeover, Medicaid, Medicare, Medicare Advantage, Nancy Pelosi, Obama Health Care Plan, tax increases