Weekly Newsletter: March 30, 2009

Energy Tax Revenues Intended to Fund Health Reform

This past week, Democrat leaders in both the House and Senate advanced the idea of using climate change legislation as a means to finance health reform, including an expansion of federal entitlements.  On Wednesday, Senate Majority Leader Harry Reid (D-NV), noting that President Obama’s budget proposed raising $646 billion in revenue from a national energy tax, called the figure “exactly how much we need for the first phase of health reform.”  The next day, House Majority Leader Steny Hoyer (D-MD) “didn’t rule out using money from a potential cap-and-trade program…to make the necessary down payment” for health reform.

Some Members may be concerned by these developments, for several reasons.  First, a national energy tax would result in tax increases of up to $3,128 per family in higher energy costs, as well as up to 7 million job losses.  Congressional Budget Office Director Elmendorf further admitted on Thursday it is “unlikely” that such a tax would cause any goods not to rise in price—resulting in additional indirect tax increases on hard-working American families.  Just as important, some Members may believe that funding new health entitlements through tax increases may demonstrate a lack of focus on stringent efforts to make health care more affordable.

GAO Report Shows States Not Monitoring “Crowd-Out”

Last week the Government Accountability Office (GAO) publicly released a report requested by Senate Finance Committee Chairman Max Baucus (D-MT) regarding states’ efforts to study whether children enrolling in the State Children’s Health Insurance Program (SCHIP) were doing so after dropping private health insurance—a phenomenon known as “crowd-out.”  The report found many states were not properly monitoring the extent to which government-run health insurance was substituting for private health insurance—for instance, 19 states did not provide annual information to the Centers for Medicare and Medicaid Services (CMS), and fewer than half investigate whether applicants had access to private insurance, “which is key to understanding the extent to which crowd-out should be a concern.”

Some Members may be concerned about these developments, particularly as Congress recently enacted an SCHIP reauthorization measure (P.L. 111-3) that significantly expanded the program—without first finding out the extent to which government-run health insurance is substituting for private coverage.  With Medicare facing unfunded obligations of nearly $36 trillion, some Members may consider it unwise for Congress to have expanded SCHIP by more than $70 billion without first examining whether such a measure would increase access to coverage, or merely replace private spending with a new government entitlement.

Article of Note: Playing Monopoly

This past week, a University of Pennsylvania professor wrote an op-ed stating that Americans should not fear the creation of a government-run health program for the entire population.  The op-ed compared the competition from a government-run plan to American’s current options for mail delivery: “As with the competition between FedEx and the U.S. Postal Service, all Americans would have the option of purchasing public or private health insurance.”

Some Members would use the very same postal analogy to argue why “competition” with the federal government would never occur on a level playing field.  When it competes with the private sector, the Postal Service does so with a built-in monopoly—FedEx and other private carriers are prohibited by federal law from using residential mailboxes for deliveries.  Similarly, in health care, Medicare also holds a built-in monopoly—upon reaching retirement age, seniors are automatically enrolled in government-run Medicare, even if less-costly and higher-quality Medicare Advantage plans exist.  These and other examples caused the Director of the non-partisan Congressional Budget Office to state recently that it would be “extremely difficult” to have a government-run plan compete “on a level playing field”—precisely because the government would bias the rules in its own favor.

Independent estimates from the Lewin Group confirm that as many as 120 million Americans—including three out of every four with employer-sponsored health insurance—would lose their current coverage due to the creation of a government-run health plan.  In other words, the competition alluded to would be a virtual monopoly for government-run health care.

Read the article here:

http://www.philly.com/inquirer/opinion/41879122.html

A new Policy Brief outlining potential concerns with a government-run health plan can be found here.

 

Legislative Bulletin: H.R. 307, Christopher and Dana Reeve Paralysis Act

Floor Situation: H.R. 307 is being considered under suspension of the rules, requiring a two-thirds vote for passage. The legislation was introduced by Rep. Tammy Baldwin (D-WI) on January 8, 2009.

Summary: H.R. 307 would give the Director of the National Institutes of Health (NIH) the authority to coordinate research efforts regarding paralysis, and award grants to entities to support basic and clinical paralysis research through newly created Christopher and Dana Reeve Paralysis Research Consortia. The bill also would authorize grants related to clinical rehabilitation research related to care of paralysis, and a new program of grants to states to establish research databases of patients with paralysis and improve patients’ quality of life. The bill would authorize $25 million in annual appropriations for each of Fiscal Years 2010 through 2013.

Background: On October 15, 2007 the House passed a similar bill (H.R. 1727) by voice vote. The Senate never considered the legislation.

Cost: According to the Congressional Budget Office, implementation of H.R. 307 would increase spending subject to appropriations by $10 million in Fiscal 2010 and $95 million over the 2010-2014 period.

Legislative Bulletin: H.R. 914, Physician Workforce Enhancement Act

Floor Situation: H.R. 914 is being considered under suspension of the rules, requiring a two-thirds vote for passage. The legislation was introduced by Rep. Michael Burgess (R-TX) on February 9, 2009.

Summary: H.R. 914 would amend the Public Health Service Act to create a new loan program for hospitals to create residency training programs. Hospitals located in rural areas or outside major cities would receive priority in applying for the interest-free loans of up to $1 million, which would be repayable over a 24-month period. The bill authorizes a total of $25 million in appropriations.

Background: On September 23, 2008 the House passed a similar bill (H.R. 2583) by voice vote. The Senate never considered the legislation.

Cost: A Congressional Budget Office score was not available.

Legislative Bulletin: H.R. 577, Vision Care for Kids Act

Floor Situation: H.R. 577 is being considered under suspension of the rules, requiring a two-thirds vote for passage. The legislation was introduced by Rep. Gene Green (D-TX) on January 15, 2009.

Summary: H.R. 577 would amend the Public Health Service Act to authorize the Department of Health and Human Services to provide new grants to states to support efforts providing eye examinations for low-income children (as defined by the state) identified as needing such services. The bill authorizes $10 million in appropriations for Fiscal Year 2010, and a total of $65 million over five years.

Background: On October 15, 2007, the House passed a similar bill (H.R. 507) by voice vote. The Senate never considered the legislation.

Cost: According to the Congressional Budget Office, implementation of H.R. 577 would increase spending subject to appropriations by $4 million in Fiscal 2010 and $54 million over five years.

Legislative Bulletin: H.Con.Res. 60, Supporting the Observance of Colorectal Cancer Awareness Month

Floor Situation: H.Con.Res. 60 is being considered under suspension of the rules, requiring a two-thirds vote for passage. The legislation was introduced by Rep. Kay Granger (R-TX) on February 25, 2009.

Summary: H.Con.Res. 60 would resolve that Congress:

  • “Supports the observance of Colorectal Cancer Awareness Month in order to provide a special opportunity to offer education on the importance of early detection and screening;
  • “Recognizes and applauds the national and community organizations for their work in promoting awareness about colorectal cancer, providing information on the importance of prevention and early detection through regular screening, and facilitating access to treatment for its sufferers; and
  • “Urges organizations and health practitioners to ‘earn a Blue Star’ by using this opportunity to promote awareness about colorectal cancer and to support early identification and removal of pre-cancerous polyps, detectable only through colorectal cancer screenings.”

Background: According to the resolution’s findings, more than 148,000 Americans are diagnosed with, and nearly 50,000 Americans die from, colon cancer every year. The findings also note that colon cancer is treatable when detected early, but only 39 percent of Americans have their colon cancer detected at an early stage due to lack of preventive screening and detection.

Cost: The resolution does not authorize expenditures.

Legislative Bulletin: H.R. 1259, Dextromethorhan Distribution Act

Floor Situation: H.R. 1259 is being considered under suspension of the rules, requiring a two-thirds vote for passage. The legislation was introduced by Rep. Fred Upton (R-MI) on March 3, 2009.

Summary: H.R. 1259 would amend the Food, Drug, and Cosmetic Act to prohibit the possession or distribution of unfinished (i.e. “not contained in a drug that is in finished dosage form”) dextromorphan outside of licensed pharmacies, drug manufacturers, and shipping entities.

Background: On October 15, 2007, the House passed a similar bill (H.R. 970) by voice vote. The Senate never considered the legislation.

Cost: According to the Congressional Budget Office, implementation of H.R. 1259 would increase spending subject to annual appropriations by $1 million in Fiscal Year 2010 and $11 million over five years. The CBO score also notes that the bill would impose an unfunded mandate on the private sector, by requiring sellers of unfinished dextromorphan to verify their buyers are properly registered and licensed; however, CBO does not believe these mandates exceed the thresholds specified in the Unfunded Mandates Reform Act (UMRA).

Legislative Bulletin: H.R. 1253, Health Insurance Restrictions and Limitations Clarification Act

Floor Situation: H.R. 1253 is being considered under suspension of the rules, requiring a two-thirds vote for passage. The legislation was introduced by Rep. Michael Burgess (R-TX) on March 3, 2009.

Summary: H.R. 1253 would amend the Employee Retirement Income Security Act, the Internal Revenue Code, and the Public Health Service Act to require group health insurance sponsors (i.e. employers) and issuers (i.e. insurance carriers) to disclose plan restrictions and limitations in an easily understandable format prior to enrollment.

Background: On September 23, 2008, the House passed a similar bill (H.R. 6908) by voice vote. The Senate never considered the legislation.

Cost: According to the Congressional Budget Office, implementation of H.R. 1253 would have no significant impact on the federal budget. The CBO score also notes that the bill would impose an unfunded mandate on the private sector, by requiring insurers to disclose limitations and restrictions on health insurance coverage; however, CBO does not believe these mandates exceed the thresholds specified in the Unfunded Mandates Reform Act (UMRA).

Legislative Bulletin: H.R. 479, Wakefield Act

Floor Situation: H.R. 479 is being considered under suspension of the rules, requiring a two-thirds vote for passage. The legislation was introduced by Rep. Jim Matheson (D-UT) on January 13, 2009.

Summary: H.R. 479 would amend the Public Health Service Act to reauthorize the emergency medical services for children program, under which the Department of Health and Human Services provides grants to states to support projects expanding or improving access to emergency medical services for children. The bill would authorize $25 million in appropriations for Fiscal Year 2010, and $138 million over five years.

Background: On April 8, 2008, the House passed a similar bill (H.R. 2464) by a 390-1 vote. The Senate never considered the legislation.

Cost: According to the Congressional Budget Office, implementation of H.R. 479 would increase spending subject to appropriations by $4 million in Fiscal 2010 and $96 million over five years.

Legislative Bulletin: H.R. 20, Melanie Blocker Stokes Mom’s Opportunity to Access Health, Education, Research, and Support for Postpartum Depression (MOTHERS) Act

Floor Situation: H.R. 20 is being considered under suspension of the rules, requiring a two-thirds vote for passage. The legislation was introduced by Rep. Bobby Rush (D-IL) on January 6, 2009.

Summary: H.R. 20 would encourage the Secretary of Health and Human Services to continue basic and clinical research, as well as informational and educational activities, related to postpartum depression. The bill also authorizes a new program of grants to eligible entities (including state and local governments and non-profit organizations) to foster the establishment of systems to deliver services to individuals and families with postpartum depression. The bill authorizes $3 million in Fiscal Year 2009, and “such sums” as necessary in Fiscal 2010 and 2011.

Background: On October 15, 2007, the House passed a similar bill (H.R. 20) by a 382-3 vote. The Senate never considered the legislation.

Cost: According to the Congressional Budget Office, implementation of H.R. 20 would cost less than $500,000 in Fiscal 2009, and $9 million over five years.

Legislative Bulletin: H.R. 756, National Pain Care Policy Act

Floor Situation: H.R. 756 is being considered under suspension of the rules, requiring a two-thirds vote for passage. The legislation was introduced by Rep. Lois Capps (D-CA) on January 28, 2009.

Summary: H.R. 756 would amend the Public Health Service Act to establish a national conference on pain, as well as an interagency committee to coordinate pain research. The bill also authorizes $5 million per year in grants for health professions schools and other entities regarding pain care training, as well as a national pain education outreach and awareness campaign on pain management. The bill would authorize a total of $36 million in appropriations over five years.

Background: On September 23, 2008, the House passed a similar bill (H.R. 2994) by voice vote. The Senate never considered the legislation.

Cost: According to the Congressional Budget Office, implementation of H.R. 756 would increase spending subject to appropriations by $3 million in Fiscal 2010 and $33 million over five years.