Christmas Eve Vote on Obamacare Showed Washington Still Has Shame

A decade ago this morning, 60 Senate Democrats cast their final votes approving the legislation that became Obamacare. The bill took a circuitous route to enactment after Scott Brown’s surprise victory in the Massachusetts Senate contest, which occurred a few weeks after the Senate vote, in January 2010.

Brown’s election meant Republicans gained a 41st Senate seat, giving them the necessary votes to filibuster a House-Senate conference report on Obamacare. Because Democrats lacked the 60 votes to overcome a filibuster, they eventually agreed to a process amending certain budgetary and fiscal elements of the Senate bill through the reconciliation process on a 51-vote threshold.

The grubby process leading up to Obamacare’s enactment, full of parochial politics and special interest pork, cost Democrats politically. But many Americans do not realize that such machinations occur all the time in Washington—indeed, occurred just last week. When one party participates in a corrupt process, it becomes a scandal; when both parties partake, few outside the Beltway bother to notice.

Backroom Deals

The process among Democrats leading up to the final health vote resembled an open market, with each Senator making “asks” of Majority Leader Harry Reid (D-NV). Reid needed all 60 Democrats to vote for Obamacare to break a Republican filibuster, and the parochial provisions included in the legislation showed the lengths he would go to enact it:

Cornhusker Kickback:” The most notorious of the backroom deals came after Sen. Ben Nelson (D-NE) requested a 100 percent Medicaid match rate for his home state of Nebraska. The final manager’s amendment introduced by Reid included this earmark—Nebraska would have its entire costs of Medicaid expansion paid for by the federal government forever. But the blowback from constituents and the press became so great that Nelson asked to have the provision removed; the reconciliation measure enacted in March 2010 gave Nebraska the same treatment as all other states.

Gator Aid:” This provision, inserted at the behest of Sen. Bill Nelson (D-FL), and later removed in the reconciliation bill, sought to exempt Florida seniors from much of the effects of the law’s Medicare Advantage cuts.

Louisiana Purchase:” This provision, included due to a request from Sen. Mary Landrieu (D-LA), adjusted the state’s Medicaid matching formula. Landrieu publicly defended the provision—which she said reflected the state’s circumstances after Hurricane Katrina—and it remained in law for several years, but was eventually phased out in legislation enacted February 2012.

While these three provisions captivated the public’s attention, other earmarks and pork provisions abounded inside Obamacare too—a Medicaid funding provision that helped Massachusetts; exemptions from the insurer tax for two Blue Cross carriers; a $100 million earmark for a Connecticut hospital, and health benefits for miners in Libby, Montana, courtesy of then-Senate Finance Committee Chairman Max Baucus (D-MT).

Not only did senators try to keep these corrupt deals in the legislation—notwithstanding the public outrage they engendered—but Reid defended both the earmarks and the horse-trading process that led to their inclusion:

I don’t know if there’s a senator who doesn’t have something in this bill that’s important to them. And if they don’t have something in it that’s important to them, then it doesn’t speak well for them.

It was a far cry from Barack Obama’s 2008 (broken) campaign promise to have all his health care negotiations televised on C-SPAN, “so we will know who is making arguments on behalf of their constituents, and who are making arguments on behalf of the drug companies or the insurance companies.” And it looked like Democrats didn’t really believe in the merits of the underlying legislation, but instead voted to restructure nearly one-fifth of the American economy because they got some comparatively minor pork project for their district back home.

Déjà Vu All Over Again

Democrats lost control of the House in the 2010 elections, and political scientists have attributed much of the loss to the impact of the Obamacare vote. One study found that Obamacare cost Democrats 6 percentage points of support in the 2010 midterm elections, and at least 13 seats in Congress.

But did the rebuke Democrats received for their behavior prompt them to change their ways? Only to the extent that, when they want to ram through a massive piece of legislation no one has bothered to read, they include Republicans in the taxpayer-funded largesse.

Consider last week’s $1.4 trillion spending package: Two bills totaling more than 2,300 pages, which lawmakers introduced on Monday and voted on in the House 24 hours later. Democrats wanted to repeal one set of Obamacare taxes—and in exchange, they agreed to repeal another set of taxes that Republicans (and their K Street lobbying friends) wanted gone. The Obamacare taxes went away, but the Obamacare spending remained, thus increasing the deficit by nearly $400 billion.

And both sides agreed to increase spending in defense and non-defense categories alike. Therein lies the true definition of bipartisanship in Washington: An agreement in which both sides get what they want—courtesy of taxpayers in the next generation, who get stuck with the bill.

It remains a sad commentary on the state of affairs in the nation’s capital that the Obamacare debacle remains an anomaly—the one time when the glare of the spotlight so seared Members seeking pork projects that they dared consider forsaking their ill-gotten gains. To paraphrase the axiom about casinos, in Washington, The Swamp (almost) always wins.

What Exactly Is in the Obamacare “Stability” Deal?

Memo to Rand Paul: It’s time to fire up the copier again.

On Tuesday, the simmering controversy over Obamacare “stability” legislation came to the boil, as conservatives increasingly voiced objections at bailing out Obamacare and giving tens of billions of taxpayer dollars to fund abortion coverage in the process. But the controversy centers around a “deal” of which the precise contents remain a closely guarded secret.

But at least Democrats (eventually) made the text of the Cornhusker Kickback, Louisiana Purchase, Gator Aid, and other provisions public. For the Obamacare “stability” bill, Senate Republican leaders have yet to indicate exactly what legislation they wish to pass.

Substance and Process Unclear

As I noted last week, while Sen. Lamar Alexander (R-TN) recently claimed in an op-ed that the “stability” legislation would appropriate $10 billion in reinsurance funds for insurers, the public version of legislation to which he referred—a bill introduced by Sens. Susan Collins (R-ME) and Bill Nelson (D-FL)—appropriated “only” $4.5 billion in funds to health insurers. Collins and Alexander are apparently engaging in a bidding war with themselves about how many billions worth of taxpayer dollars they wish to spend on corporate welfare payments to insurance companies.

On the policy substance, Senate leadership has refused to disclose exactly what provisions comprise the “deal” Collins supposedly cut with Senate leadership. Did they promise $4.5 billion in reinsurance funding, $10 billion, or more than $10 billion? What other promises did they make in exchange for Collins’ support for repealing the individual mandate in the tax bill?

Did Republican leaders pledge merely to support an open process and a vote on the “stability” measure—as Senate Republican Conference Chairman John Thune (R-SD) implied on Tuesday—or its enactment into law? How exactly could they promise the latter, when any such bill would require 60 votes to break a potential Senate filibuster—a number that Senate Republican leaders do not have, even if they could persuade their entire conference to support bailing out Obamacare?

Then and Now

As noted above, we’ve seen this play before, when Democrats rammed through Obamacare through a series of backroom deals cobbled together behind closed doors, notwithstanding then-candidate Obama’s pledge to televise all health-care negotiations on C-SPAN. Here’s what McConnell had to say about that lack of transparency in a December 2009 floor speech:

Americans are right to be stunned because this bill is a mess. And so was the process that was used to get it over the finish line.

Americans are outraged by the last-minute, closed-door, sweetheart deals that were made to gain the slimmest margin for passage of a bill that is all about their health care. Once the Sun came up, Americans could see all the deals that were tucked inside this grab bag, and they do not like what they are finding. After all, common sense dictates that anytime Congress rushes, Congress stumbles. It is whether Senator so-and-so got a sweet enough deal to sign off on it. Well, Senator so-and-so might have gotten his deal, but the American people have not signed off.

Public opinion is clear. What have we become as a body if we are not even listening to the people we serve? What have we become if we are more concerned about a political victory or some hollow call to history than we are about actually solving the problems the American people sent us here to address?

Some may argue that passing “stability” legislation bears little comparison to home-state earmarks like the Cornhusker Kickback that plagued the Obamacare bill the Senate passed on Christmas Eve 2009. But when Alexander remains adamant about passing “stability” legislation about which senators of both parties now seem ambivalent at best, one must ask whether his insistence stems from the fact that it would provide a significant financial windfall to his biggest campaign contributor—making it a “sweet enough deal” for him too.

The fact that no Senate leaders will dare explain publicly what they have promised privately should tell the public everything they need to know about the merits of this secretive backroom deal. As McConnell might say, it’s “kind of [a] smelly proposition.”

This post was originally published at The Federalist.

Big Hospitals’ Obamacare Hypocrisy

As Republicans prepare legislation to repeal Obamacare, the health care industrial complex has raised a host of concerns. Notably, two hospital associations recently released a report highlighting the supposed negative implications of the reconciliation bill Congress passed, and President Obama vetoed, late last year.

While the hospitals allege that repealing Obamacare would decimate their industry, their report cleverly omits four inconvenient truths.

1. They Pushed Bad Ideas Because They Expect Bailouts

Kahn gave a simple, yet cynical, reply: “You could say, did you make a bad deal, and fortunately, I don’t think I’ll probably be working after 2020 [Laughter.]….I’m glad my contract only goes another six years. [Laughter.]”

Fast-forward those six years to earlier this fall, when the Congressional Budget Office (CBO) analyzed the effects of various Obamacare provisions on hospital margins. The report concluded that even under the best-case scenario—in which hospitals achieve a level of efficiency non-partisan experts doubt they can reach—the revenue from Obamacare’s coverage expansions will barely offset the negative effects of the productivity adjustments. Under the worst-case scenario, more than half of hospitals could become unprofitable by 2025, and the entire industry could face negative profit margins.

Kahn knew full well in August 2010 that Obamacare would eventually decimate his industry, through the cumulative effect of year-over-year reductions in Medicare payments. The laughter during his comments demonstrates Kahn thought it was one big joke. He and his colleagues cynically calculated first that they wouldn’t be around when those payment reductions really started to bite; and second that Congress would bail the hospitals out of their own bad deal—essentially, that hospitals are “too big to fail.”

2. Hospitals Supported Raiding Medicare to Pay for Obamacare

Last year’s reconciliation bill essentially undid the fiscal legerdemain that allowed Obamacare to pass in the first place. In the original 2010 legislation, Democrats used savings from Medicare both to improve the solvency of Medicare (at least on paper) and to fund the new entitlements.

The reconciliation bill would have repealed the new entitlements, and—in a truly novel concept—used Obamacare’s Medicare savings to…save Medicare. Instead, the hospital industry wants to continue the budget gimmickry that allows Medicare money to be spent twice and used for other projects.

3. Hospitals Believe Entitlements Are for Them, Not You

In theory, individuals receiving cash contributions in lieu of Medicaid coverage could improve their health in all sorts of ways—buy healthier food, obtain transportation to a higher-paying job, move to a better apartment closer to parks and recreation. But who would object to giving patients cash to improve their health instead of insurance? You guessed it: Hospitals.

Hospitals view Medicaid as their entitlement, not their patients’. That’s why hospitals have worked so hard for Obamacare’s Medicaid expansion. It’s also why they wouldn’t support diverting money from coverage into other programs (e.g., education, housing, nutrition, etc.) that could actually improve patients’ health more than insurance, which has been demonstrated not to improve physical health outcomes.

4. Insisting Health Care Is Their Personal Jobs Program

Hospitals will claim that repealing Obamacare will cost industry jobs, just as they pushed for states to expand Medicaid as a way to create jobs. But economic experts on both sides of the aisle find this argument frivolous at best. As Zeke Emanuel, a former Obama administration official, has noted: “Health care is about keeping people healthy or fixing them up when they get sick. It is not a jobs program.”

The health-care sector seems to believe they have a God-given right to consume at least one-sixth of the economy (and growing). Rebutting hospitals’ argument—that they, and only they, can create jobs—might represent the first step in lowering health costs, which would help non-health sectors of the economy grow more quickly.

This post was originally published at The Federalist.

Repealing “Son of Obamacare”

The election of Donald Trump brings conservatives an opportunity to repeal a misguided piece of health care legislation that cost hundreds of billions of dollars, will blow a major whole in our deficit, has led to thousands of pages of regulations, and will further undermine the integrity of the doctor-patient relationship.

Think I’m talking about Obamacare?

I am — but I’m not just talking about Obamacare.

I’m also talking about the Medicare and CHIP Reauthorization Act (MACRA), which passed last year (with a surprising level of Republican support) and contains many of the same flaws as Obamacare itself.

Just as Republicans are preparing legislation to repeal and replace Obamacare, they also need to figure out how to undo MACRA.

Last month, the Obama administration released a 2,398-page final regulation — let me say that again: a 2,398-page regulation — implementing MACRA’s physician reimbursement regime.

In the new Congress, Republicans can and should use the Congressional Review Act to pass a resolution of disapproval revoking this massive new regulation. They can then set about making the changes to Medicare that both Paul Ryan and Donald Trump have discussed: getting government out of the business of 1) fixing prices and 2) micro-managing the practice of medicine.

MACRA’S FUNDAMENTALLY FLAWED, STATIST APPROACH

Since the administration released its physician-payment regulations — nearly as long as Obamacare itself – some commentary has emphasized (rightly) the burdensome nature of the new federal regulations and mandates.

But the more fundamental point, rarely made, is that we need more than mere tweaks to free doctors from an ever-tightening grip exercised by federal overseers. After more than a half century of failed attempts at government price-setting and micro-management of medical practice, it’s time to get Washington out of the business of playing “Dr. Sam” once and for all.

In fact, even liberals tend to acknowledge this occasionally. In a May 2011 C-SPAN interview, Noam Levey of the Los Angeles Times asked then-administrator of the Centers for Medicare and Medicaid Services Donald Berwick why he thought the federal government could use Medicare as it exists to reform the health-care system:

In nearly half a century of federal-government oversight, the federal government hasn’t succeeded in two really important things: Number one, Medicare costs are still growing substantially more quickly than the economy; and number two, that fragmented [health care] system . . . has persisted in Medicare for 46 years now. . . . Why should the public, when it hears you, when it hears the President say, “Don’t worry, this time we’re going to make it better, we’re going to give you a more efficient, higher-quality health care system,” why should they believe that the federal government can do now what it essentially hasn’t really been able to do for close to half a century? [Emphasis added] 

Dr. Berwick didn’t really answer the question: He claimed that fragmented care issues “are not Medicare problems — they’re health system problems.” But in reality, liberal organizations like the Commonwealth Fund often argue Medicare can be leveraged as a model to reform the entire health care system — and that is exactly what MACRA, in defiance of historical precedent, tries to do.

When a 2012 Congressional Budget Office report examined the history of various Medicare payment demonstrations, it concluded that most had not saved money. A seminal study undertaken by MIT’s Amy Finkelstein concluded that the introduction of Medicare, and specifically its method of third-party payment, was one of the primary drivers of the growth in health-care spending during the second half of the 20th century.

After five decades of failed government control and rising costs driven by the existing Medicare program, the solution lies not in more tweaks and changes to the same program.

The answer lies in replacing that program with a system of premium support that gets the federal government out of the price-fixing business entirely.

The notion that the federal government can know the right price for inhalation therapy in Birmingham or the appropriate reimbursement for a wart removal in Boise is a fundamentally flawed and arrogant premise — one that conservatives should whole-heartedly reject.

Unfortunately, most critics of MACRA have not fully grasped this. A law that prompts the federal bureaucracy to issue a sprawling regulation of nearly 2,400 pages cannot on any level be considered conceptually sound.

Believing otherwise echoes Margaret Thatcher’s famous maxim about consensus politicians and conviction politicians: Some analysts, seeking a consensus among their fellow technocrats, push for changes to make the 2,400-page rule more palatable. But our convictions should have us automatically reject any regulation with this level of micro-management and government-enforced minutiae.

THE NEED FOR COMPREHENSIVE REFORM

It bears worth repeating that, in addition to perpetuating the statist nature of Medicare, MACRA raised the deficit by over $100 billion in its first ten years — and more thereafter — while not fundamentally solving the long-term problem of Medicare physician-payment levels.

More than a decade ago, after President Bush and a Republican Congress passed the costly Medicare Modernization Act (MMA), creating the Part D prescription-drug entitlement, conservatives argued even after the law’s passage that the new entitlement should not take effect. If the MMA was “no Medicare reform” for including only a premium-support demonstration project, conservatives should likewise reject MACRA, which includes nothing – not even a demonstration project — to advance the premium-support reform Medicare truly needs.

Any efforts focused on building a slightly better government health-care mousetrap distract from the ultimate goal: removing the mousetrap entirely. In his 1964 speech A Time for Choosing, Reagan rejected the idea “that a little intellectual elite in a far distant capital can plan our lives for us better than we can plan them ourselves” — and Republicans should do the same today.

In the context of health care, this means not debating the details of MACRA but replacing it, sending power back to where it belongs — with the people themselves.

Last week’s election results give the new Congress an opportunity to do just that, by disapproving the MACRA rule and moving to enact comprehensive Medicare reform in its place. After more than five decades of the same statist health care policies, it’s finally time for a new approach. Here’s hoping Congress agrees.

This post was originally published at National Review.

Gov. Jindal Op-Ed: On Obamacare, Better Late than Never

Little wonder why President Obama decided not to put all those health care negotiations on C-SPAN. In recent weeks, several videos have emerged featuring Jonathan Gruber—who famously received nearly $400,000 in contracts from the Department of Health and Human Services as a technical adviser on Obamacare—revealing inconvenient truths about the way the law was enacted.

In talking about “the stupidity of the American voter,” Gruber admitted several deceptions used to sell Obamacare. In discussing the individual mandate—which Barack Obama famously said was “absolutely” not a tax increase—Gruber said that if Democrats had called the mandate a tax increase in 2010, “the bill dies.” He admitted that Obamacare will substantially raise premiums on younger Americans, in a massive redistribution of wealth. And he argued that “basic exploitation of the lack of economic misunderstanding of the American voter” allowed Democrats to pass a massive tax increase on the middle class—even though candidate Obama in 2008 made a “firm pledge” that “no family making less than $250,000 a year” would see “any form of tax increase.”

Of course, President Obama broke many other promises to ram his unpopular law through Congress. Last year this time, millions of people found the lie in “If you like your plan, you can keep it,” receiving cancellation notices in the mail. Many other Americans have found they can’t keep their doctor—or that, if they can keep their doctor, it will cost them much more, because Obamacare’s new coverage requirements have forced insurance companies to narrow their doctor networks in a vain attempt to minimize premium increases. And of course, the “most transparent” Administration utterly failed to keep candidate Obama’s repeated pledge to negotiate the bill in the public eye, rather than in backroom dealings with Washington special interests.

But the biggest broken promise of all was the promise that Obamacare would reduce health care costs. President Obama promised repeatedly that his plan would lower premiums by $2,500 for the average family—and do so within his first four years. He hasn’t come close. Premiums for employer provided coverage have risen by an average of $4,154 per family since President Obama was first elected. Overall, American families have faced a 33 percent increase in their premiums, from $12,680 to $16,834, because premiums and health costs have risen, not fallen, under Obamacare. And things will only get worse; the law itself will raise health spending by $621 billion in the coming decade, according to the Administration’s own actuaries.

Mr. Gruber and the other know-it-alls designed Obamacare as a top down government centered approach where costs are high, and Washington bureaucrats are driving the train and making decisions about our health care. It was always meant to be a closed system that puts bureaucrats in the waiting room with you and your doctor. The Left’s mindset on expanding Medicaid was a terrible totally misguided idea, putting quantity over quality.

Expanding Medicaid represents government doubling down on a program whose health outcomes range from marginal to horrendous. Medicaid was set up by Congress in order to provide a safety net for the disabled and truly needy, yet this President has turned it into yet another massive entitlement program, while we can’t pay for our existing programs.  It is the absolute height of irresponsibility.

Real healthcare outcomes stem from patients and their doctors working together in an open health care system. Decisions about our health care should not be made top-down, politically.

Better late than never for President Obama himself to embrace reforms that can reduce costs, not raise them. As a Christian, I firmly believe in the redemptive power of second chances. Here’s hoping that the new Congress and those in Washington take the opportunity fully within their grasp.

This post was originally published at the Bossier Press.

Donald Berwick’s Rationed Transparency

Dr. Donald Berwick is back in the public eye. The former administrator of the Centers for Medicare and Medicaid Services (CMS) has announced he will run for governor in Massachusetts.

Berwick first entered the public spotlight in April 2010, when President Obama nominated him for the CMS post. But Berwick never went through the regular confirmation process. Instead, the president granted him a surprise recess appointment that July.

The president renominated him in January 2011, but it became apparent that he could not garner enough votes for Senate confirmation. That December, Berwick resigned. Now, he is pursuing office as an elected, rather than an appointed, official.

Berwick’s short tenure at CMS was defined by a series of controversial statements he made before his appointment. He defended both Britain’s National Health Service and government rationing of health care. Most famously, in a June 2009 interview, he stated that “the decision is not whether or not we will ration care — the decision is whether we will ration with our eyes open.”

After leaving CMS, Berwick said his comments were merely an attempt to argue for greater transparency in decision-making. “Someone, like your health-insurance company, is going to limit what you can get. That’s the way it’s set up,” he told the New York Times. “The government, unlike many private health-insurance plans, is working in the daylight,” he insisted. “That’s a strength.”

Unfortunately, Berwick himself, while head of CMS, went to great lengths to avoid transparency. He ducked reporters, in one instance even “exit[ing] behind a stage” to avoid press queries. Another time he went so far as to request a “security escort” to avoid questions.

Today, Berwick concedes his lack of transparency. According to a Politico report, he now “regrets listening to White House orders to avoid reaching out to congressional Republicans.”

The lack of transparency is endemic in the Obama administration. Case in point: the enactment of Obamacare. During his 2008 campaign, Barack Obama promised health-care negotiations televised on C-SPAN. Instead, we got a series of notorious backroom deals: the Cornhusker Kickback, the Louisiana Purchase, the Gator Aid.

“It’s an ugly process, and it looks like there are a bunch of backroom deals,” Obama feebly admitted in January 2010 — only to retreat again to the smoke-filled rooms two months later, where he cut the final deals to ram the legislation through Congress.

Obamacare is premised on the belief that government knows best. And those who share that belief all too often regard transparency and public accountability as inconveniences.

Consider the administration’s approach to regulating the proposed health-insurance “exchanges.” Obamacare requires state-based exchanges to “hold public meetings and input sessions,” but it fails to apply these same transparency standards to the federally run exchanges Washington will create in 33 states. The result: Many key questions remain unanswered.

Thus a law written in secret is being implemented in secret, with a maximum of opacity and a minimum of accountability from the administration.

This post was originally published at National Review.

Does Obamacare Cover “Obamnesia?”

During a campaign speech on Friday, President Obama went on a riff about “Romnesia,” which according to the President is a disease symptomized by frequent reversals of position.  Of course, that diagnosis comes from someone particularly expert at switching positions when it comes to health care.  As the saying goes, let’s go to the videotape:

Barack Obama, February 5, 2008: “If a mandate was the solution, we could try that to solve homelessness by mandating everyone buy a house.”

Barack Obama, January 31, 2008: “I think that it is important for us to recognize that if in fact you’re going to mandate the purchase of insurance and it’s not affordable, then there’s going to have to be some enforcement mechanism that the government uses.   And they may charge people who already don’t have health care fines, or have to take it out of their paychecks.  And that I don’t think is helping those without health insurance.”

Barack Obama, September 20, 2009: “For us to say that you’ve got to take a responsibility to get health insurance is absolutely not a tax increase….The fact that you looked up Merriam’s Dictionary, the definition of tax increase, indicates to me that you’re stretching a little bit right now.”

Barack Obama, September 12, 2008: “I can make a firm pledge: Under my plan, no family making less than $250,000 a year will see any form of tax increase.  Not your income tax, not your payroll tax, not your capital gains taxes, not any of your taxes.”

Obama 2008 campaign ad: “[Senator] McCain would make you pay income tax on your health insurance benefits – taxing health benefits for the first time ever….Taxing health care instead of fixing it?  We can’t afford John McCain.”

Barack Obama, September 3, 2007: “It’s a plan that will cover every American and cut the cost of a typical family’s premiums by $2,500 a year.”

Barack Obama, July 21, 2008: “What we will do is, we’ll have the [health care] negotiations televised on C-SPAN, so that people can see who is making arguments on behalf of their constituents, and who are making arguments on behalf of the drug companies or the insurance companies.”

Obama 2008 campaign ad: “And that tax credit?  [Senator] McCain’s own website says it would go straight to the insurance companies – not to you.”

The President claimed that Obamacare covers pre-existing conditions like “Romnesia.”  But before making those comments, the President first should have declared his own interest.  Because based on the above, it looks for all the world that President Obama wanted to ram through Obamacare so that his own “Obamnesia” would be covered.

What Are Obama’s Secret Post-Election Plans?

Two articles in today’s Wall Street Journal illustrate how President Obama is putting politics before policy – deliberately failing to lead on tough fiscal choices to score cheap political points.  One news article notes that the White House has put together a secret deficit reduction plan, which it refuses to release to the American people:

President Barack Obama’s most recent budget…[did not] detail how to slow the growth of spending on Medicare or Social Security.  Nor has Mr. Obama made public the details of proposals he made in unsuccessful talks with House Speaker John Boehner (R., Ohio) last summer, such as raising the eligibility age for Medicare from 65 to 67, a notion both Mr. Romney and Mr. Ryan have endorsed.

Administration officials are preparing new deficit-reduction proposals to be released if Mr. Obama is re-elected, but see no political advantage in previewing them now, people familiar with the process said.

Likewise, an excellent editorial in this morning’s Journal about the Administration’s plans for top-down government health “reform” notes that the White House has refused to name individuals to Obamacare’s Independent Payment Advisory Board “until after the election.”

So we’ve gone from a world in which candidate Obama repeatedly promised that he would hold all the negotiations on C-SPAN to one in which tough choices are deliberately being withheld from the American people for political reasons, and a world in which the President’s pledge that “we are implementing” Obamacare right now doesn’t apply to the supposed centerpiece of its attempt to control costs – because of the backlash that exposing the law’s coercive nature would generate.  Hope and change indeed.

Get Ready for the NEXT Obamacare Mandate

Politico Pro reports this afternoon (subscription required) that the Administration and outside groups have begun a series of backroom discussions regarding long-term care and the CLASS Act.  Among the topics being discussed – how to enact something similar to a participation mandate.  One participant said “there have been discussions about incentivizing enrollment in ways that would ‘come close enough to mimicking a mandate.’”  One way could involve taxing all Americans who do not participate in CLASS – a policy the Supreme Court upheld as constitutional not two months ago.

This movement towards a de facto CLASS mandate is entirely predictable – in fact, was predicted – once HHS admitted the program could not be made solvent without a mandate.  After all, Peter Orszag, the former Obama Administration budget director, first referenced the idea of mandatory participation in CLASS last summer; other liberal bloggers have agreed.  The Justice Department likewise conceded in a Pennsylvania courtroom that mandatory long-term care insurance would be constitutional.  And now, mere months after the Supreme Court upheld Obamacare’s individual mandate as a tax – forcing all Americans to purchase a product for the first time ever – the Obama Administration is already wondering how close it can come to enacting yet another purchase mandate on the American people.

It’s also worth noting the “closely guarded” nature of these secret negotiations, and the fact that most participants won’t even say who’s in the (back)room:

Participants wouldn’t discuss which federal officials have attended the meetings.  HHS did not respond to a request for comment by deadline….[One participant] declined to say whether federal officials have joined in the discussions.  Other group members POLITICO spoke with also declined to say who’s participating, citing directions…

Negotiations on C-SPAN, it ain’t, that’s for sure.  But one thing is fairly certain: If HHS is conducting secret backroom discussions, and not telling Republicans, let alone the public, about them, you can practically bet the policy the Administration will try to ram down Congress’ throats – or implement unilaterally – will be government-centered, and far from bipartisan.

Obamacare: Written in Secret, Implemented in Secret

A feature article in yesterday’s New York Times profiled Obama Administration efforts to create a federal Obamacare exchange.  The article explores the massive secrecy behind the federal Exchange, and contrasts the transparency requirements imposed on state-based Exchanges with the non-transparency of HHS officials creating a federal Exchange:

Mr. Hash, the director of the federal Office of Health Reform, said the federal exchanges “will operate essentially in the same manner as the state-based exchanges.”  However, they differ in a significant way.  States have done their work in public, but planning for the federal exchanges has been done almost entirely behind closed doors….

The 2010 health care law says that if a state runs its own exchange, it must “consult with stakeholders,” including consumers and small businesses.  Subsequent rules go further, requiring states to consult health care providers, insurers, agents and brokers.  Kathleen Sebelius, the secretary of health and human services, has repeatedly emphasized that “states have to meet a standard of transparency and accountability.”  A state exchange must have “a clearly defined governing board,” and the board must hold regular public meetings.

States as diverse as California, Minnesota, Mississippi and Nevada have Web sites where they post documents laying the groundwork for exchanges.  The documents include minutes of public meetings, cost estimates and information about contracts for goods and services.

By contrast, federal officials have disclosed little about their plans, are vague about the financing of the federal exchanges and have refused even to divulge the “request for proposals” circulated to advertising agencies.  The federal government requires a state exchange to develop a budget, with “expected operating costs, revenues and expenditures.”  States must explain how the revenue will be generated and how the exchange will address “any financial deficits.”  Administration officials have not set forth a budget for the federal exchanges.  They said they intended to charge “user fees” to the participating health insurance plans, but it is unclear whether the fees are subject to approval by Congress or whether insurers could pass the costs on to consumers.

Because the Obama Administration is once again using a “Do as I Say, Not as I Do” mentality with respect to transparency – imposing requirements on states that the federal government itself refuses to follow – business owners told the Times that “nobody has any idea what the federal exchange will look like.”  This lack of transparency increases uncertainty for businesses, states, and individuals, which will only make the law that much less effective.

Candidate Obama said he would televise all health care negotiations on C-SPAN, but the process leading up to Obamacare was plagued with notorious backroom deals.  Unfortunately, yesterday’s New York Times story highlights how, after using backroom deals to create Obamacare, the Administration is once again retreating behind closed doors to implement the 2700-page law.