Will Democrats Shut Down the Government to Force Taxpayer Funding of Abortions?

Last week, the Hyde Amendment, which prohibits taxpayer funding of most abortions, became the focus of presidential politics. First Joe Biden said he still supported the amendment, then changed his position one day later, after tremendous political pressure from farther-left Democrats.

But the press should focus less on whether Democrats support taxpayer-funded abortion-on-demand. Virtually all Democrats running for president now support that position, as did the party’s 2016 national platform.

Democrats Don’t Want to Vote on Hyde

For all the focus last week on the Hyde Amendment, named after its prime advocate, the late Rep. Henry Hyde (R-IL), reporters have not focused on the Labor-Health and Human Services spending bill that the House of Representatives will consider this week. The committee-approved bill includes the following language:

SEC. 506. (a) None of the funds appropriated in this Act, and none of the funds in any trust fund to which funds are appropriated in this Act, shall be expended for any abortion.

In other words, an appropriations bill approved by the Democratic-run House Appropriations Committee still includes the Hyde Amendment language. (Subsequent sections exempt cases of rape, incest, or to save the life of the mother—the Hyde Amendment exceptions—from the funding ban.)

Yet the chairwoman of that Committee, Rep. Nita Lowey (D-NY), co-sponsored stand-alone legislation (H.R. 1692) repealing the Hyde Amendment protections that she included in her spending bill.

How Far Will They Go?

Even if Republicans did not control the Senate, 41 pro-life senators could filibuster any measure lacking Hyde Amendment protections, thus preventing the legislation from passing. And of course, President Trump can, and likely would, veto any appropriations bills that omitted pro-life protections on taxpayer funding of abortion.

The likelihood during this Congress of legislation passing that excludes the Hyde Amendment seems infinitesimal. Moreover, such legislation passing during the next Congress could well require 1) a Democrat to win the presidency, 2) Democrats to retake the Senate, and 3) Democrats to agree to end the legislative filibuster, which dozens of them claim they oppose.

This Is All Just Failure Theater

Events in the House this week show that liberal members of Congress are essentially “going through the motions” about repealing the Hyde Amendment. Several of them, led by Rep. Ayanna Pressley (D-MA), offered an amendment to strike Hyde from the spending bill. However, on Monday the House Rules Committee reported a rule for consideration of the underlying bill that did not make the amendment in order.

Likewise, Pressley could have omitted that authorizing language, and submitted a shorter amendment just striking the Hyde provisions. She did not—and that she did not strongly suggests that she and her colleagues wanted to give the House Rules Committee, and therefore Democratic leadership, an “out” to block consideration of her amendment.

Pressley’s office claimed “the Congresswoman believes that she and her colleagues must use every tool and tactic available to fight for reproductive justice.” But if she wanted to use “every tool and tactic,” she would have drafted an amendment without an obvious procedural flaw giving the leadership political cover to reject it. She and her liberal colleagues would also demand a vote on her amendment, and vote against the rule to consider the bill unless and until Democrats give them one.

Pressley didn’t do the former, and when the vote on the rule came on Tuesday, she and her colleagues didn’t do the latter either. Instead, she cut a deal with the leadership whereby everyone could “save face”—as evidenced by the fact that House Rules Committee Chairman Jim McGovern, on the same day he denied her amendment a vote, co-sponsored the stand-alone bill requiring taxpayer funding of abortions.

Flip-Flops Ahead

In the coming months, however, Moulton will face a flip-flop decision of his own, as will the many other Democratic presidential candidates currently serving in Congress. Will they vote for spending bills that include the Hyde Amendment—as any final appropriations package almost certainly must include its provisions to get enacted into law—even though they claim to support repealing the amendment?

On Sunday, Democratic presidential candidate Bernie Sanders (I-VT) laid the groundwork for just such a reversal. In an interview with CNN, he admitted that “sometimes in a large bill you have to vote for things you don’t like.” (That makes a good argument for Congress to stop passing massive spending bills that they don’t bother to read.)

Of course, if Democrats don’t want to flip-flop on taxpayer funding of abortion, they have another alternative: Refuse to pass any spending bills that include the Hyde Amendment provisions. If House Speaker Nancy Pelosi (D-CA) wants to shut the federal government down until Republican lawmakers approve taxpayer-funded abortion-on-demand, well, good luck with that. But if she and her Democratic colleagues don’t want to follow that strategy, then they should get ready to explain to their constituents why they voted for legislation that retained the Hyde Amendment after promising to abolish it.

In crass political terms, Biden didn’t help his candidacy by wavering over the Hyde Amendment last week. But even though they may not yet realize it, most of his fellow presidential candidates may soon have their own flip-flop moments on taxpayer funding for abortion.

This post was originally published at The Federalist.

What You Need to Know About Medicaid Crowd Out

A PDF version of this document is available on the Pelican Institute’s website

In recent weeks, lawmakers have focused on the tens of thousands of ineligible individuals who improperly received benefits under Louisiana’s Medicaid expansion. But fighting waste, fraud, and abuse in Medicaid should also include reforms to address another important issue—crowd out. The term refers to Louisiana residents who have dropped their existing coverage to enroll in Medicaid expansion—in other words, government programs “crowding out” private insurance. Here’s what you need to know about crowd out and Medicaid expansion:

Tens of Thousands of People Have Dropped Private Coverage to Enroll in Medicaid

Recently, the Pelican Institute filed a public records request to obtain internal Louisiana Department of Health (LDH) data showing that for much of 2016 and 2017, several thousand individuals dropped their existing health coverage to enroll in Medicaid expansion. With enrollment in Medicaid expansion averaging approximately 15,000 individuals per month in 2017, the data indicates a significant percentage of enrollees dropped their prior coverage to join Medicaid expansion.

Funding Benefits for People Who Previously Had Health Insurance Consumes Scarce Medicaid Resources

Crowd out populations pose big potential costs for Louisiana taxpayers. In 2015, the Legislative Fiscal Office assumed that if Louisiana expanded Medicaid, the state would spend between $900 million and $1.3 billion over five years providing Medicaid coverage to individuals with prior health coverage.

When testifying before the House Appropriations Committee on April 23, LDH staff indicated that, during the fiscal year ending this June 30, the average expansion enrollee cost Medicaid $523.85 per month, or $6,286.20 per year. Multiplying this average cost per enrollee by the number of individuals who dropped private coverage, according to last year’s LSU Health Insurance Survey, yields a potential cost to state and federal taxpayers of $461.6 million this fiscal year:

  • Dropped coverage from a current employer: 40,147; Potential cost to taxpayers: $252.4 million
  • Dropped coverage from a former employer: 23,086; Potential cost to taxpayers: $145.1 million
  • Dropped privately purchased coverage: 10,201; Potential cost to taxpayers: $64.1 million

Because the LSU researchers extrapolated the coverage numbers from survey responses, and because the survey responses varied only slightly from 2015 to 2017, the results for privately purchased coverage, and coverage from a former employer, might have occurred due to random chance, rather than any actual drop in coverage rates. Regardless, the decline in coverage from a former employer DID meet the tests of statistical significance; this crowd out is costing the Medicaid program on the order of $145.1 million per year. Moreover, the potential fiscal impact of the crowd out problem demonstrates the need for more accurate data on the issue.

Crowd Out Metrics

The March 2019 LSU report cites a seminal 1996 work from MIT Professor Jonathan Gruber to define crowd out—the decrease in private insurance divided by the change in public insurance. To put it simply, crowd out should quantify the percentage of Medicaid enrollees who dropped their private coverage to enroll in expansion. Unfortunately, LDH has used different—and inaccurate—metrics to define crowd out on several occasions in attempts to minimize its impact.

For instance, in August 2017, the Department counted 5,659 “Medicaid expansion members who have private insurance whose private insurance policies ended 0-60 days prior to Medicaid expansion enrollment”—4,957 whose coverage ended 0-30 days prior to enrollment in expansion, and another 702 whose coverage ended 31-60 days prior to enrollment. The Department’s internal spreadsheets calculated one crowd out rate of 1.3%, based on a total enrollment in expansion of 442,674.

But this calculation creates an inherently inaccurate result, because it divides the number of new enrollees who dropped coverage by the number of total enrollees in the program. An accurate crowd out rate would compare like with like—dividing the number of new enrollees who dropped private coverage in a given month by the overall number of new enrollees in that month. This metric would accurately determine what percentage of new enrollees are dropping coverage.

Using that rubric, Louisiana’s Medicaid expansion suffers from far higher crowd out rates. According to data provided by LDH in response to the Pelican Institute’s public records request, in August 2017 a total of 13,955 individuals enrolled in expansion—8,783 who had previously enrolled in Medicaid, and 5,172 who had never done so before. Dividing the number of new enrollees who dropped private coverage in the prior 30 days (4,957) by the number of new enrollees overall (13,955) yields a potential crowd out rate of 35.5%—far higher than the 1-2% figure cited in the internal LDH spreadsheets.

At the April 23 House Appropriations Committee hearing, Medicaid director Jen Steele cited data from the LSU Health Insurance Survey to estimate a crowd out rate of 2.4%. But that survey data expressed coverage changes as a percentage of the overall low-income population, not based as a percentage of Medicaid enrollees—making it another inaccurate metric.

Based on LDH’s own internal data, that rate more likely approaches 30-40%.

Need for Better Program Integrity

The debate regarding crowd out comes on the heels of the Medicaid eligibility situation, in which LDH acknowledged that 1,672 individuals with six-figure incomes—including at least one individual reporting a higher income than Gov. John Bel Edwards’ annual salary—enrolled in Medicaid expansion. LDH’s failure to address the crowd out problem, and at the same time, the expansion enrollment of individuals with six-figure incomes suggests the need for fundamental reform to Louisiana’s Medicaid program. Government officials at all levels must serve as smart stewards of scarce taxpayer dollars, and a growing number of signs raise questions about LDH’s fulfillment of this critical role.

Conclusion

Solutions to mitigate crowd out should focus on using scarce government resources wisely, while promoting independence and self-sufficiency amongst beneficiaries. For instance, Indiana recently proposed a waiver that would allow beneficiaries transitioning off of Medicaid to keep a portion of their Medicaid dollars. Those retained dollars could fund co-payments on their new private insurance, whether purchased through an employer or individually. These and similar innovative concepts would encourage beneficiaries to transition off of government assistance and into private coverage.

Pediatric Research Bill: Obamacare’s Road to Rationing?

A PDF of this Issue Brief is available on the Heritage Foundation website.

Later this month, the House of Representatives could consider legislation regarding pediatric research.[1] Legislation regarding this issue (H.R. 1724) was first introduced in April, and a new version of the bill (H.R. 2019) was introduced in May.

Although largely similar, H.R. 1724 would require the director of the National Institutes of Health (NIH) to provide a justification for any existing grants studying health economics, and would prohibit new grants until “a federal law has been enacted authorizing the National Institutes of Health to use funding specifically for health economics research.”[2] Press reports indicate that H.R. 2019 excludes the restrictions included in H.R. 1724 “in order to please Democrats who favor the research.”[3]

This is a mistake. The House should ensure that H.R. 1724’s proposed restrictions on health economics research remain in any NIH-related legislation that comes to the House floor. To do otherwise would provide tacit approval to Obamacare’s road to government-rationed health care.

Proposed Restriction a Necessary Protection

The provision omitted from H.R. 2019 would have instituted an important and necessary protection on taxpayer-funded research on cost-effectiveness in health care. In recent years, the federal government has funded numerous such studies. For instance, a June 2011 Government Accountability Office report examining projects funded by the “stimulus” highlighted NIH grants studying the cost-effectiveness of various medical treatments, including:

  • “A Comprehensive Model to Assess the Cost-Effectiveness of Patient Navigation,”
  • “Cost-Effectiveness of Hormonal Therapy for Clinically Localized Prostate Cancer;”
  • “Clinical and Cost-Effectiveness of Biologics in Rheumatoid Arthritis,” and
  • “Cost-Effectiveness of HIV-Related Mental Health Interventions.”[4]

Liberals Favor Cost-Effectiveness Research

Setting aside the wisdom of using taxpayer funds to examine the cost-effectiveness of various treatments, such research could eventually be used to deny patients access to certain kinds of care. Quotes from key policymakers reveal how some would use cost-effectiveness research as a way for government bureaucrats to block access to treatments that are deemed too costly:

  • Former Senator Tom Daschle (D–SD), President Obama’s first choice for Secretary of Health and Human Services, wrote in 2008 that “we won’t be able to make a significant dent in health-care spending without getting into the nitty-gritty of which treatments are the most clinically valuable and cost effective. That means taking a harder look at the real costs and benefits of new drugs and procedures.”[5]
  • In a 2009 interview with The New York Times, President Obama argued that “the chronically ill and those toward the end of their lives are accounting for potentially 80 percent of the total health care bill out here.… There is going to have to be a very difficult democratic conversation that takes place.”[6]
  • Former Medicare Administrator Dr. Donald Berwick, in his infamous 2009 interview, strongly argued in favor of taxpayer-funded cost-effectiveness research when stating that “the decision is not whether or not we will ration care—the decision is whether we will ration with our eyes open.”[7]

Lawmakers have already expressed their desire to use cost-effectiveness research to restrict access to certain treatments. A report prepared by the House Appropriations Committee in 2009, discussing “stimulus” funding for the types of projects highlighted above, noted that thanks to the research funding, “those items, procedures, and interventions that are most effective to prevent, control, and treat health conditions will be utilized, while those that are found to be less effective and in some cases more expensive will no longer be prescribed.”[8]

Road to Rationing

Although research comparing the relative merits and costs of medical treatments may sound appealing, past experience has demonstrated that such research can, and often is, used as a blunt tool by governments to restrict access to certain kinds of care. At a time when genetic advances have opened the door to personalized medical treatments, Obamacare has moved health policy in the opposite direction, expanding the federal bureaucracy in an attempt to micromanage the health care system.[9]

Imposing the restrictions on cost-effectiveness research included in H.R. 1724 would represent a good first step in restoring the balance between federal bureaucrats and patients.

 



[1]Daniel Newhauser, “Mindful of Previous Defeat, Cantor Pushes Bill to Increase Pediatric Research,” Roll Call, June 10, 2011, http://www.rollcall.com/news/mindful_of_previous_defeat_cantor_pushes_bill_to_increase_pediatric-225436-1.html?zkPrintable=true (accessed June 13, 2013).

[2]The Kids First Research Act of 2013, H.R. 1724, § 4.

[3]Newhauser, “Mindful of Previous Defeat.”

[4]U.S. Government Accountability Office, HHS Research Awards: Use of Recovery Act and Patient Protection and Affordable Care Act Funds for Comparative Effectiveness Research, GAO-11-712R, June 14, 2011, http://www.gao.gov/new.items/d11712r.pdf (accessed June 13, 2013).

[5]Tom Daschle, Scott Greenberger, and Jeanne Lambrew, Critical: What We Can Do about the Health Care Crisis (New York: Thomas Dunne Books, 2008), pp. 172–173.

[6]David Leonhardt, “After the Great Recession,” The New York Times, April 28, 2009, http://www.nytimes.com/2009/05/03/magazine/03Obama-t.html (accessed June 13, 2013).

[7]Biotechnology Healthcare, “Rethinking Comparative Effectiveness Research,” June 2009, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2799075/pdf/bth06_2p035.pdf (accessed June 13, 2013).

[8]Helen Evans, “Comparative Effectiveness in Health Care Reform: Lessons from Abroad,” Heritage Foundation Backgrounder No. 2239, February 4, 2009, note 3, http://www.heritage.org/research/reports/2009/02/comparative-effectiveness-in-health-care-reform-lessons-from-abroad.

[9]Kathryn Nix, “Comparative Effectiveness Research Under Obamacare: A Slippery Slope to Health Care Rationing,” Heritage Foundation Backgrounder No. 2679, April 12, 2012, http://www.heritage.org/research/reports/2012/04/comparative-effectiveness-research-under-obamacare-a-slippery-slope-to-health-care-rationing.

Questions for House Democrats on the Medicare Trigger

  • Ways and Means Health Subcommittee Chairman Pete Stark has publicly stated that “Medicare is not in crisis.” Yet the Medicare program faces unfunded liabilities of $86 trillion—more than 70 times the total anticipated losses from subprime mortgages worldwide.  Why do House Democrats believe that a $1.2 trillion “crisis” requires the creation of massive new government programs to help borrowers, while $86 trillion in debt from an existing government program warrants no action at all?
  • Democrats have complained that the trigger is an “arbitrary” calculation of the health of the Medicare program. Since they find Medicare’s $86 trillion in unfunded obligations an “arbitrary” figure too low to prompt any concern, how high will Medicare’s expected losses have to rise before Democrats will take action?  $100 trillion?  $200 trillion?
  • “Fixing” the Medicare trigger this year requires finding less than $2 billion in savings during Fiscal Year 2013—this for a program projected to grow over the next five years from $454 billion to $636 billion in spending. Do Democrats really believe that nothing can be done to reduce Medicare’s growth in spending from $182 billion to a mere $180 billion over the next five years?
  • At a recent House Appropriations Committee markup, attempts to attach language creating a bipartisan commission to examine entitlement spending and make recommendations to Congress was defeated on a largely party-line vote. Why do most House Democrats oppose even creating a commission to study the nation’s impending fiscal crisis due to unsustainable entitlement spending?
  • Why do House Democrats believe that wealthy seniors—including billionaires like Warren Buffett and George Soros—should not be asked to pay $2 per day more in premiums for their prescription drug coverage to help improve the solvency of the Medicare program?
  • A House Democratic aide recently said that the party’s advice to frustrated families dealing with high gas prices consisted of “Drive small cars and wait for the wind.” What will Democrats tell seniors and those individuals looking to retire when the Medicare Hospital Trust Fund goes broke just over a decade from now?