The Last Senate Debate on Health Reform

With the Senate about to embark on a debate regarding health care legislation, it’s important to recall the last time the upper chamber considered health “reform.”  Contrary to some press reports, the Senate DID in fact debate health care legislation in 1994 – a proposal was introduced by then-Majority Leader Mitchell as S. 2357, which the Senate considered in August of that year without the debate coming to a conclusion or final vote.

The CBO analysis of the Mitchell bill from 1994 is available online here.  CBO estimated that the bill would cover 95% of the population and leave 14 million individuals uninsured.  By comparison, CBO’s analysis of the Reid bill found that the bill would cover 94% of legal American residents, leaving 16 million uninsured.  In other words, the Reid bill would leave more uninsured in both percentage and absolute terms than George Mitchell’s 1994 bill – even before accounting for the fact that CBO’s models at that time did not exclude the impact of undocumented immigrants when calculating the number of remaining uninsured.

For these reasons, it’s particularly interesting to note the reaction from Democrats to the Mitchell bill.  Haynes Johnson and David Broder write in The System that President Clinton’s statement to the National Governors Association outlining Mitchell’s strategy to cover “somewhere in the ballpark of 95%” of Americans sparked “pandemonium” and “chaos.”  AARP’s John Rother called the strategy “f—ing unbelievable.”  Pete Stark said that “If there is a bill without universal coverage, I would leave and a lot of liberal members would say no.”  Jim McDermott noted that Clinton “just put in jeopardy all the single-payer votes.”  Remember, this bill that caused so much liberal angst covered MORE people in both absolute and relative terms than the Reid bill being considered today.

Finally, Lawrence O’Donnell, then the Chief of Staff to Finance Chairman Moynihan, discussed the impending Senate debate on MSNBC last Tuesday; his comments can be found here.  It’s worth highlighting O’Donnell’s suggestion that the Senate should spend three months debating amendments to the health care bill – which would put a vote on cloture and final passage no sooner than the President’s Day recess.  It will be interesting to see whether Leader Reid will follow the words of wisdom of a prominent fellow Democrat in the way the debate is structured…

Legislative Bulletin: Second Motion to Recommit H.R. 3961, Medicare Physician Payment Reform Act

The second Republican motion to recommit would provide a two year “fix” to the Sustainable Growth Rate mechanism for Medicare physician payments, providing up to $22.3 billion.  The motion would include a finding that the Secretary of Health and Human Services should transfer a commensurate amount from the Medicare Improvement Fund to finance the cost of the SGR fix.

Legislative Bulletin: Motion to Recommit H.R. 3961, Medicare Physician Payment Reform Act

The Republican motion to recommit would provide a four year “fix” to the Sustainable Growth Rate mechanism for Medicare physician payments, providing 2 percent updates to physicians over each of the next four years.  The motion to recommit would be fully paid for by enacting reasonable limits on medical malpractice lawsuits, providing a path to approval for follow-on biologics, and enacting reforms that would simplify administrative inefficiencies in the insurance system.

Will $210 Billion in New Deficit Spending Kill American Jobs?

“It is important though to recognize if we keep on adding to the debt, even in the midst of this recovery, that at some point, people could lose confidence in the U.S. economy in a way that could actually lead to a double-dip recession.”

— President Barack Obama, interview quoted by Reuters, November 18, 2009

 

While some may attempt to assert that Speaker Pelosi’s government takeover of health care is fiscally responsible, even President Obama has finally recognized that its provisions could put the health of the American economy at risk:

  • This week the House is expected to consider legislation providing for permanent increases in the Medicare Sustainable Growth Rate (SGR) mechanism for physician reimbursement. Because the Democrat bill is not paid for, CBO scores H.R. 3961 as increasing the deficit by at least $210 billion.
  • In the longer term, an independent analysis of official data conducted by former Medicare public trustee Tom Saving found that a permanent reversal of these current-law reductions, if not paid for by appropriate offsets in spending, could increase Medicare’s unfunded obligations by up to $1.9 trillion over a 75-year period.
  • Despite offering a “responsible” budget that would more than double the national debt to over $24 trillion, President Obama has finally recognized that further increasing federal deficits—as H.R. 3961 would do—could erode economic confidence, resulting in unemployment levels even higher than the current rate of 10.2 percent, a 26-year high.
  • America’s largest foreign creditor has already expressed strong concern about runaway federal spending and deficits. Treasury Secretary Geithner’s claims of the United States’ fiscal rectitude were publicly mocked by an audience during his visit to China earlier this year, and the New York Times ran a front-page article this Sunday noting significant Chinese skepticism about Democrats’ government takeover of health care, as “Chinese officials expect that they will help finance whatever Congress and the White House settle on.” Many may wonder the extent to which passing an unpaid-for “doc fix” adding up to $1.9 trillion in long-term obligations to the federal fisc will further undermine international confidence in the dollar—jeopardizing the American economy and jobs.
  • Many may also note that passage of stand-alone SGR legislation is intended to ease the passage of Democrats’ government takeover of health care—which itself contains job-killing tax increases that could choke any nascent economic recovery. According to a model developed by President Obama’s chief economic advisor, the tax increases in the Pelosi health care bill (H.R. 3962) would demolish or destroy up to 5 million jobs.

While many Members may support SGR reform that is fully paid for, many may also oppose any attempt to increase the deficit by hundreds of billions of dollars in a way that could jeopardize millions of American jobs as part of Democrats’ unpopular government takeover of health care.

Legislative Bulletin: H.R. 3961, Medicare Physician Payment Reform Act

Order of Business: H.R. 3961 is being considered under a closed rule.  The rule provides that following its passage, the Clerk will be directed to append the text of H.R. 2920, the Statutory PAYGO bill that passed the House on July 22, 2009, to the legislation before sending it to the Senate.  The legislation was introduced by Rep. John Dingell (D-MI) on October 29, 2009.
Summary: H.R. 3961 provides for an increase in Medicare physician reimbursements for 2010 equal to the increase in medical inflation, and recalibrates the Sustainable Growth Rate (SGR) mechanism such that year 2009 physician expenditures shall be used as the new baseline for computing whether total physician payments exceed the SGR targets.  The bill establishes two separate conversion factors—one for evaluation and management services, including primary care and preventive services, and one for all other services provided.  Thus evaluation and management services and all other specialist services would receive different annual payment rates, based on the growth of each service over time; the former would also receive a higher conversion factor under the bill—GDP growth plus two percent for evaluation and management services, as opposed to GDP growth plus one percent for all other services.  Finally, the bill allows accountable care organizations established to opt-out of the national expenditure targets created in the bill and establish their own organization-specific targets.
Background: As part of spending reforms included in the Balanced Budget Act of 1997, Congress enacted a sustainable growth rate (SGR) mechanism for Medicare physician payment levels.  The SGR mechanism is designed to balance the previous year’s increase in physician spending with a decrease in the next year, in order to maintain aggregate growth targets.  In light of increased Medicare spending in recent years, the statutory formula has resulted in negative annual updates.  While an imperfect formula, the SGR was designed as a cost-containment mechanism to help deal with Medicare’s exploding costs.
While Democrats claim Speaker Pelosi’s 1,990-page health “reform” bill (H.R. 3962) is “deficit-neutral,” the hundreds of billions of dollars in new spending in H.R. 3961 is not paid for.  While Members may support reform of the SGR mechanism, many may oppose what amounts to an obvious attempt to hide the apparent cost of health “reform” by introducing separate legislation to repeal the SGR mechanism without paying for this more than $200 billion increase in federal spending in its first ten years.  Moreover, H.R. 3961 would permanently alter the SGR mechanism, and an independent analysis of official data conducted by former Medicare public trustee Tom Saving found that a permanent reversal of these current-law reductions, if not paid for by appropriate offsets in spending, would increase Medicare’s unfunded obligations by nearly $2 trillion over a 75-year period.
Due to these significant concerns about rising deficits and higher federal spending, a bipartisan majority in the Senate recently rejected similar legislation (S. 1776) designed to increase physician payments over the next 10 years that did not include any offsetting spending reductions.
Press reports indicate that the Democrat majority desires to pass a stand-alone “doc fix” bill in order to help facilitate passage of its broader health “reform” initiative.  A CQ Today article noted that omitting an SGR “fix” from the Democrat health “reform” legislation “could free up billions of dollars that Democratic leaders could apply to make other changes in a health care plan”—making it easier for the majority to pass its government takeover of health care.  Therefore, some may view a vote for H.R. 3961 that is not paid for through appropriate spending reductions as helping to facilitate a government takeover of health care, with all its flaws: More than $700 billion in job-killing new taxes, regulations that will raise premiums for millions of Americans, and creation of a government-run health plan causing as many as 114 million Americans to lose their current coverage.
In its rollout of the Pelosi bill, the Democrat majority released a one-page document claiming that “a previous Congress established the policy for paying Medicare doctors, so the update for 2010 is not a new policy to be paid for.”  By this logic, future Congresses will not have to pay for any increases in federal deficits and spending associated with the Pelosi health “reform” bill—directly contradicting President Obama’s pledge that his bill would not increase the federal deficit by one dime.  Regardless, many may note that adding hundreds of billions in new spending will be paid for—by America’s children and grandchildren, through mountains of new federal debt.
Cost: The Congressional Budget Office earlier this year estimated that a full SGR repeal would cost $285 billion over ten years.  However, the Administration has already begun the process of “reforming” the SGR by hiding approximately $80 billion of a repeal’s cost (the amount of the SGR attributed to physician-administered drugs) into the budgetary baseline as “current law”—even though some have questioned the Administration’s authority to do so.  Therefore, CBO scores H.R. 3961 as increasing the deficit by nearly $210 billion, though as stated earlier, the full impact of a long-term SGR “fix” approaches nearly $300 billion.
Members may particularly note that because seniors pay for one-quarter of total physician spending through their Medicare Part B premiums, CBO also notes that H.R. 3961 would raise seniors’ Medicare premiums by nearly $50 billion over ten years.   These premium increases would be on top of the 20 percent increase in Part D prescription drug premiums as a result of the Pelosi health care bill.
Moreover, today the Congressional Budget Office released a report finding that enactment of H.R. 3961, when coupled with the spending provisions in the Pelosi bill (H.R. 3962), would increase federal deficits by $89 billion in the 2010-2019 period.  CBO further found that enactment of both provisions would increase deficits by $23 billion in 2019, and “those increments would grow during the following decade.”  CBO concluded:  “If both H.R. 3961 and H.R. 3962 were enacted, CBO expects that federal budget deficits during the decade following the 10-year budget window would increase relative to those projected under current law—with a total effect during that decade that is in a broad range between zero and one quarter percent of GDP.” [Emphasis original]

Democrats’ Health Care “Ponzi Schemes”

Senate Moderates Call Out One Entitlement Gimmick—

But What About the “Medicare Savings?”

 

“We have grave concerns that the real effect of the provisions would be to create a new federal entitlement program with large, long-term spending increases that far exceed revenues. This is especially the case if savings from the first decade of the program are spent on other health reform priorities.”

— Letter by seven Democratic Senators to Majority Leader Reid, October 23, 2009

 

While the majority may attempt to assert that Speaker Pelosi’s government takeover of health care is fiscally responsible, even Democrats themselves doubt the Speaker’s assertions:

  • In order to achieve deficit neutrality, the Pelosi bill (H.R. 3962) relies on more than $70 billion in revenue from a new program for long-term care services. As the long-term care program requires individuals to pay premiums for five years before becoming eligible for benefits, the Pelosi bill diverts this initial program revenue to finance a government takeover of health care.
  • As noted above, moderate Democrats wrote to Majority Leader Reid objecting to this new entitlement’s inclusion in the health care legislation he continues to write behind closed doors. Senate Budget Committee Chairman Kent Conrad (D-ND) went further, calling the program a “Ponzi scheme of the first order, the kind of thing Bernie Madoff would have been proud of.”
  • In the letter quoted above, Democrats opposed the concept of using revenues from the long-term care program in order to finance a government takeover of health care—as doing so would be fiscally unsustainable. By their own logic, these same Democrats should oppose using $400-500 billion in Medicare savings to create a new health care entitlement.
  • Speaker Pelosi’s government takeover of health care would lead to exactly the type of “large, long-term spending increases” the moderate Democrat senators most fear. The Congressional Budget Office has already confirmed that the Pelosi bill would increase the federal budgetary commitment to health care by $598 billion in its first decade alone—and by greater sums in the years following 2019.

While many may welcome moderate Democrats’ fiscal rectitude with respect to the long-term care entitlement, many may similarly question why these same Democrats refuse to question the bigger “Ponzi scheme”—diverting hundreds of billions of dollars in Medicare savings to finance Speaker Pelosi’s $1.3 trillion government takeover of health care.

What Every Member Needs to Know about a Long-Term “Doc Fix”

Background:

As part of spending reforms included in the Balanced Budget Act of 1997, Congress enacted a sustainable growth rate (SGR) mechanism for Medicare physician payment levels. The SGR mechanism is designed to maintain aggregate growth targets in physician spending. Thus, in light of increased Medicare spending in recent years, the statutory formula has resulted in negative annual updates. While an imperfect formula, the SGR was designed as a cost-containment mechanism to help deal with Medicare’s exploding costs, forcing offsets in some years. This week the Democrat majority will bring to the floor stand-alone legislation that is not paid for (H.R. 3691) to permanently re-set the SGR formula at higher 2009 spending levels.

The Cost:

Due to significant concerns about rising deficits and higher federal spending, a bipartisan majority in the Senate recently rejected similar legislation (S. 1776) designed to increase physician payments over the next 10 years that did not include any offsetting spending reductions—meaning any House-passed legislation likely will not advance without curbs on spending.

The Congressional Budget Office earlier this year estimated that a full SGR “fix” would cost $285 billion over ten years. However, the Administration has already begun the process of “reforming” the SGR by hiding approximately $80 billion of that cost into the budgetary baseline as “current law”—even though some have questioned the Administration’s authority to do so. Therefore, CBO scores H.R. 3691 as increasing the deficit by nearly $210 billion, though as stated earlier, the full impact of a long-term SGR “fix” approaches nearly $300 billion.

Members may note that because seniors pay for one-quarter of total physician spending through Medicare Part B premiums, passing H.R. 3691 would raise seniors’ Medicare premiums by nearly $50 billion over ten years—on top of the up to 20 percent increase in Part D prescription drug premiums in the Pelosi bill (H.R. 3692) proper.

The Strategy:

Press reports indicate that the Democrat majority intends to pass H.R. 3691 as a stand-alone bill in order to help facilitate passage of its broader health “reform” initiative. A CQ Today article noted that omitting an SGR “fix” from the larger legislation “could free up billions of dollars that Democratic leaders could apply to make other changes in a health care plan.” Therefore, some may view a vote for H.R. 3691 as paving the way for enactment of a government takeover of health care, with all its flaws: More than $700 billion in job-killing new taxes, regulations that will raise premiums for millions of Americans, and creation of a government-run health plan causing as many as 114 million Americans to lose their current coverage.

True Reform Instead:

Many Members may support legislation to address potential future SGR shortfalls, provided the legislation is fully paid for. For instance, a recent Congressional Budget Office report found that enactment of liability reform provisions—another top priority of physician groups—would reduce mandatory spending on Medicare and other federal entitlements by $41 billion over ten years. These changes would represent sound fiscal policy and true entitlement reform. Members may also note that the Administration has already proposed nearly $600 billion in savings from Medicare alone, and that less than half of this supposed “waste, fraud, and abuse” would easily finance SGR reform—if Democrats were not insistent that this money should be re-directed to fund its government takeover of health care.

New Federal Bureaucracies Created in the Pelosi Health Care Bill

The House Republican Conference has compiled a list of all the 120 new boards, bureaucracies, commissions, and programs created in H.R. 3962, Speaker Pelosi’s government takeover of health care:

  1. Retiree Reserve Trust Fund (Section 111(d), p. 61)
  2. Grant program for wellness programs to small employers (Section 112, p. 62)
  3. Grant program for State health access programs (Section 114, p. 72)
  4. Program of administrative simplification (Section 115, p. 76)
  5. Health Benefits Advisory Committee (Section 223, p. 111)
  6. Health Choices Administration (Section 241, p. 131)
  7. Qualified Health Benefits Plan Ombudsman (Section 244, p. 138)
  8. Health Insurance Exchange (Section 201, p. 155)
  9. Program for technical assistance to employees of small businesses buying Exchange coverage (Section 305(h), p. 191)
  10. Mechanism for insurance risk pooling to be established by Health Choices Commissioner (Section 306(b), p. 194)
  11. Health Insurance Exchange Trust Fund (Section 307, p. 195)
  12. State-based Health Insurance Exchanges (Section 308, p. 197)
  13. Grant program for health insurance cooperatives (Section 310, p. 206)
  14. “Public Health Insurance Option” (Section 321, p. 211)
  15. Ombudsman for “Public Health Insurance Option” (Section 321(d), p. 213)
  16. Account for receipts and disbursements for “Public Health Insurance Option” (Section 322(b), p. 215)
  17. Telehealth Advisory Committee (Section 1191 (b), p. 589)
  18. Demonstration program providing reimbursement for “culturally and linguistically appropriate services” (Section 1222, p. 617)
  19. Demonstration program for shared decision making using patient decision aids (Section 1236, p. 648)
  20. Accountable Care Organization pilot program under Medicare (Section 1301, p. 653)
  21. Independent patient-centered medical home pilot program under Medicare (Section 1302, p. 672)
  22. Community-based medical home pilot program under Medicare (Section 1302(d), p. 681)
  23. Independence at home demonstration program (Section 1312, p. 718)
  24. Center for Comparative Effectiveness Research (Section 1401(a), p. 734)
  25. Comparative Effectiveness Research Commission (Section 1401(a), p. 738)
  26. Patient ombudsman for comparative effectiveness research (Section 1401(a), p. 753)
  27. Quality assurance and performance improvement program for skilled nursing facilities (Section 1412(b)(1), p. 784)
  28. Quality assurance and performance improvement program for nursing facilities (Section 1412 (b)(2), p. 786)
  29. Special focus facility program for skilled nursing facilities (Section 1413(a)(3), p. 796)
  30. Special focus facility program for nursing facilities (Section 1413(b)(3), p. 804)
  31. National independent monitor pilot program for skilled nursing facilities and nursing facilities (Section 1422, p. 859)
  32. Demonstration program for approved teaching health centers with respect to Medicare GME (Section 1502(d), p. 933)
  33. Pilot program to develop anti-fraud compliance systems for Medicare providers (Section 1635, p. 978)
  34. Special Inspector General for the Health Insurance Exchange (Section 1647, p. 1000)
  35. Medical home pilot program under Medicaid (Section 1722, p. 1058)
  36. Accountable Care Organization pilot program under Medicaid (Section 1730A, p. 1073)
  37. Nursing facility supplemental payment program (Section 1745, p. 1106)
  38. Demonstration program for Medicaid coverage to stabilize emergency medical conditions in institutions for mental diseases (Section 1787, p. 1149)
  39. Comparative Effectiveness Research Trust Fund (Section 1802, p. 1162)
  40. “Identifiable office or program” within CMS to “provide for improved coordination between Medicare and Medicaid in the case of dual eligibles” (Section 1905, p. 1191)
  41. Center for Medicare and Medicaid Innovation (Section 1907, p. 1198)
  42. Public Health Investment Fund (Section 2002, p. 1214)
  43. Scholarships for service in health professional needs areas (Section 2211, p. 1224)
  44. Program for training medical residents in community-based settings (Section 2214, p. 1236)
  45. Grant program for training in dentistry programs (Section 2215, p. 1240)
  46. Public Health Workforce Corps (Section 2231, p. 1253)
  47. Public health workforce scholarship program (Section 2231, p. 1254)
  48. Public health workforce loan forgiveness program (Section 2231, p. 1258)
  49. Grant program for innovations in interdisciplinary care (Section 2252, p. 1272)
  50. Advisory Committee on Health Workforce Evaluation and Assessment (Section 2261, p. 1275)
  51. Prevention and Wellness Trust (Section 2301, p. 1286)
  52. Clinical Prevention Stakeholders Board (Section 2301, p. 1295)
  53. Community Prevention Stakeholders Board (Section 2301, p. 1301)
  54. Grant program for community prevention and wellness research (Section 2301, p. 1305)
  55. Grant program for research and demonstration projects related to wellness incentives (Section 2301, p. 1305)
  56. Grant program for community prevention and wellness services (Section 2301, p. 1308)
  57. Grant program for public health infrastructure (Section 2301, p. 1313)
  58. Center for Quality Improvement (Section 2401, p. 1322)
  59. Assistant Secretary for Health Information (Section 2402, p. 1330)
  60. Grant program to support the operation of school-based health clinics (Section 2511, p. 1352)
  61. Grant program for nurse-managed health centers (Section 2512, p. 1361)
  62. Grants for labor-management programs for nursing training (Section 2521, p. 1372)
  63. Grant program for interdisciplinary mental and behavioral health training (Section 2522, p. 1382)
  64. “No Child Left Unimmunized Against Influenza” demonstration grant program (Section 2524, p. 1391)
  65. Healthy Teen Initiative grant program regarding teen pregnancy (Section 2526, p. 1398)
  66. Grant program for interdisciplinary training, education, and services for individuals with autism (Section 2527(a), p. 1402)
  67. University centers for excellence in developmental disabilities education (Section 2527(b), p. 1410)
  68. Grant program to implement medication therapy management services (Section 2528, p. 1412)
  69. Grant program to promote positive health behaviors in underserved communities (Section 2530, p. 1422)
  70. Grant program for State alternative medical liability laws (Section 2531, p. 1431)
  71. Grant program to develop infant mortality programs (Section 2532, p. 1433)
  72. Grant program to prepare secondary school students for careers in health professions (Section 2533, p. 1437)
  73. Grant program for community-based collaborative care (Section 2534, p. 1440)
  74. Grant program for community-based overweight and obesity prevention (Section 2535, p. 1457)
  75. Grant program for reducing the student-to-school nurse ratio in primary and secondary schools (Section 2536, p. 1462)
  76. Demonstration project of grants to medical-legal partnerships (Section 2537, p. 1464)
  77. Center for Emergency Care under the Assistant Secretary for Preparedness and Response (Section 2552, p. 1478)
  78. Council for Emergency Care (Section 2552, p 1479)
  79. Grant program to support demonstration programs that design and implement regionalized emergency care systems (Section 2553, p. 1480)
  80. Grant program to assist veterans who wish to become emergency medical technicians upon discharge (Section 2554, p. 1487)
  81. Interagency Pain Research Coordinating Committee (Section 2562, p. 1494)
  82. National Medical Device Registry (Section 2571, p. 1501)
  83. CLASS Independence Fund (Section 2581, p. 1597)
  84. CLASS Independence Fund Board of Trustees (Section 2581, p. 1598)
  85. CLASS Independence Advisory Council (Section 2581, p. 1602)
  86. Health and Human Services Coordinating Committee on Women’s Health (Section 2588, p. 1610)
  87. National Women’s Health Information Center (Section 2588, p. 1611)
  88. Centers for Disease Control Office of Women’s Health (Section 2588, p. 1614)
  89. Agency for Healthcare Research and Quality Office of Women’s Health and Gender-Based Research (Section 2588, p. 1617)
  90. Health Resources and Services Administration Office of Women’s Health (Section 2588, p. 1618)
  91. Food and Drug Administration Office of Women’s Health (Section 2588, p. 1621)
  92. Personal Care Attendant Workforce Advisory Panel (Section 2589(a)(2), p. 1624)
  93. Grant program for national health workforce online training (Section 2591, p. 1629)
  94. Grant program to disseminate best practices on implementing health workforce investment programs (Section 2591, p. 1632)
  95. Demonstration program for chronic shortages of health professionals (Section 3101, p. 1717)
  96. Demonstration program for substance abuse counselor educational curricula (Section 3101, p. 1719)
  97. Program of Indian community education on mental illness (Section 3101, p. 1722)
  98. Intergovernmental Task Force on Indian environmental and nuclear hazards (Section 3101, p. 1754)
  99. Office of Indian Men’s Health (Section 3101, p. 1765)
  100. Indian Health facilities appropriation advisory board (Section 3101, p. 1774)
  101. Indian Health facilities needs assessment workgroup (Section 3101, p. 1775)
  102. Indian Health Service tribal facilities joint venture demonstration projects (Section 3101, p. 1809)
  103. Urban youth treatment center demonstration project (Section 3101, p. 1873)
  104. Grants to Urban Indian Organizations for diabetes prevention (Section 3101, p. 1874)
  105. Grants to Urban Indian Organizations for health IT adoption (Section 3101, p. 1877)
  106. Mental health technician training program (Section 3101, p. 1898)
  107. Indian youth telemental health demonstration project (Section 3101, p. 1909)
  108. Program for treatment of child sexual abuse victims and perpetrators (Section 3101, p. 1925)
  109. Program for treatment of domestic violence and sexual abuse (Section 3101, p. 1927)
  110. Native American Health and Wellness Foundation (Section 3103, p. 1966)
  111. Committee for the Establishment of the Native American Health and Wellness Foundation (Section 3103, p. 1968)
  112. Grant program for mental health and substance abuse screening (Manager’s Amendment, p. 31)
  113. Centers for Disease Control Office of Minority Health (Manager’s Amendment, p. 35)
  114. Substance Abuse and Mental Health Services Administration Office of Minority Health (Manager’s Amendment, p. 35)
  115. Agency for Healthcare Research and Quality Office of Minority Health (Manager’s Amendment, p. 36)
  116. Health Resources and Services Administration Office of Minority Health (Manager’s Amendment, p. 36)
  117. Food and Drug Administration Office of Minority Health (Manager’s Amendment, p. 36)
  118. Outreach program to increase awareness of diabetes screening benefits (Manager’s Amendment, p. 39)
  119. Grant program to develop medical schools in shortage areas (Manager’s Amendment modification, p. 2)
  120. Demonstration program of incentive payments for National Health Service Corps (Manager’s Amendment modification, p. 4)

 

AARP: On the Wrong Side of History–Again

What Happened the Last Time the Organization Put Its Own Interests Before Seniors’

 

 

Even as Speaker Pelosi and President Obama attempt to trump the endorsement of purported seniors’ advocacy organization AARP for the Pelosi health care bill as a monumental achievement, a look at past health care bill shows the AARP’s “seal of approval” has often functioned as the “kiss of death” for proposals unpopular with the American people. Just as disturbing lies the fact that AARP’s endorsements of legislation often coincides with special favors being bestowed in those very bills:

  • In 1988, AARP endorsed the Medicare Catastrophic Coverage Act (P.L. 100-360)—so unpopular that it was repealed the following year. As Haynes Johnson and David Broder write in their analysis of the Clinton health care debate, The System, “AARP had been badly burned by the failure of the Medicare catastrophic insurance legislation…It endorsed that bill early, saw it become law, and then watched rival organizations of senior citizens lead the battle to have it repealed.”
  • What Johnson and Broder refer to as the Medicare catastrophic “fiasco” occurred as the bill fell “victim [to] a loud protest from the very people it was supposed to help.” While AARP claimed the catastrophic bill would help seniors—just as AARP alleges the Pelosi bill will provide untold benefits to Medicare beneficiaries—its own members did not agree. Perhaps most worrisome for Democrats, the bill’s higher taxes began immediately, while the benefits did not take effect for several years—prompting rapid outcries from seniors that led to the bill’s repeal. The exact same scenario faces the Pelosi health care bill.
  • The Medicare catastrophic debacle contains other parallels to the Pelosi bill 20 years later—out-of-touch politicians being accosted by angry constituents seeking to hold Members accountable for not representing their interests. Most famously, then-House Ways and Means Committee Chairman Dan Rostenkowski (D-IL) was—despite his protests to the contrary—chased out of a meeting by angry seniors, who promptly surrounded his car as he attempted to escape. The contrast between Rostenkowski and his constituents was stark; the latter shouted, “He’s supposed to represent the people—not himself!” while the Chairman alleged, “I don’t think they understand what the government’s trying to do for them…
  • Despite the cautionary tale of the Medicare catastrophic debacle, five years later Democrats waded back into health care, with another scheme to expand government-run insurance—this time to all Americans as part of President Clinton’s “reform” effort. Despite the fact that the proposed new entitlement to government-run health care was financed by reductions in seniors’ Medicare benefits—as is the case today—AARP endorsed legislation written by then-Senate Majority Leader George Mitchell (D-ME).
  • The AARP-endorsed legislation also happened to contain provisions benefiting the organization. For instance, one news article from 1994—headlined “AARP Endorsement of Reform May Be Financially Motivated”—pointed out that the Mitchell bill exempted mail-order pharmaceuticals from price controls imposed on Medicare prescription drugs—and “not coincidentally, AARP currently owns a stake in one of America’s oldest and largest mail-order prescription drug companies.” As the article noted, “If the Mitchell bill becomes law, this clause could mean extra wealth for what’s already become a cash cow for America’s largest advocacy group.”
  • Similarly, passing the Pelosi health care bill would likely provide a significant benefit to AARP’s financial interests. The Pelosi bill contains strict restrictions on all other forms of health insurance—banning pre-existing condition exclusions and limiting “excessive” price increases—except Medigap supplemental insurance plans purchased by seniors. Perhaps not coincidentally, AARP plans dominate the Medigap market—meaning that under the Pelosi bill, AARP could continue its current practice of denying access to individuals with pre-existing conditions in order to increase its own “royalty fees.” Indeed, AARP could benefit further from the Pelosi bill, by obtaining new Medigap customers when the legislation’s cuts to Medicare Advantage cause millions of seniors to lose their current coverage.

Even as the month of August demonstrated seniors’ concern about the impact of the Pelosi health care bill on them, AARP officials showed the same kind of disdain for their members’ concerns that Chairman Rostenkowski demonstrated to his constituents twenty years ago—attempting to quiet its members by telling them, “You are not running the meeting,” then running out of the meeting when members continued to raise concerns about Democrats’ government takeover of health care. Both the organization’s past history and its present behavior raise questions about the entity’s very character and nature: How many more times will AARP need to support failed health care legislation before understanding that its members do not support a government takeover of health care? And when will the organization stop endorsing legislation that benefits its financial interests rather than those of seniors?

Legislative Bulletin: Motion to Recommit H.R. 3962, Pelosi Health Care Bill

The Republican motion to recommit H.R. 3962 would add common-sense medical liability reforms, imposing caps on non-economic damages of $250,000, caps on punitive damages, restrictions on attorney contingency fees, and restrictions on the liability statute of limitations and collateral source damages.  The savings from enactment of those liability reforms—which would lower health costs by eliminating defensive medicine practices—would be directed into a new Seniors Protection and Medicare Regional Payment Equity Fund in order to correct payment inequities and preserve seniors’ choice and access.