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.


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.

How Obamacare Is RAISING Premiums and Costs

The Administration has announced a conference call with press this afternoon, where Secretary Sebelius is expected to make announcements regarding Obamacare’s exchanges.  It is likely that the Administration will once again attempt to repeat the old saw that Exchanges will lower premiums.  Here’s what you need to remember about this bogus claim:

  1. Obamacare’s Exchanges will actually RAISE premiums, not lower them.  The Administration claim that Exchanges will lower premiums ignores the fact that Obamacare’s new benefit mandates will increase individual market insurance premiums overall – by an average of $2,100 per family, according to the Congressional Budget Office.  CBO also agrees that much of this increase in premiums will come from individuals being forced to buy richer coverage than they may need or want.  Politico summarized this HHS sleight-of-hand: “The Administration omits a part of CBO’s analysis.…[Obamacare] requires the purchase of benefit packages that are more comprehensive than what many Americans would otherwise buy.  These more generous benefit packages may mean higher premiums.”
  2. Candidate Obama repeatedly promised premiums would go down by $2,500 – and would go down that amount by this year.  For instance, in a speech on February 27, 2008, he said that “We’re going to work with you to lower your premiums by $2500 per family per year.  And we will not wait 20 years from now to do it or 10 years from now to do it.  We will do it by the end of my first term as President.”  Likewise, in July 2008, Jason Furman – who remains a senior economic advisor within the Administration – told the New York Times that “we think we could get to $2,500 in savings by the end of the first term, or be very close to it.”
  3. Secretary Sebelius has publicly admitted that candidate Obama’s goal of a $2,500 premium reduction will not be met.  In September 2010, she said that premium “rate increases are likely to continue to be somewhat substantial.”  And earlier this year, she conceded to questioners at both the House and Senate Appropriations Committees that premiums would not fall until at least 2014, when the Exchanges are first established.  Of course, the Exchanges actually won’t reduce premium costs, as noted in point #1 above.  Regardless, lower premiums in 2014 do NOT meet candidate Obama’s promise: he pledged premiums would go down by $2,500 “by the end of my first term as President.”
  4. Yet another survey issued this week illustrates how Obamacare is NOT controlling health costs or premium increases, both of which continue to skyrocket.  Actuaries at Milliman released their annual medical index yesterday, and it found that the total cost of health care for a family of four in a preferred provider organization rose by 6.9% this year – such that costs now exceed $20,000 for a family of four.  The record $1,335 increase in costs this year alone is far from the $2,500 cut candidate Obama promised back in 2008.

This afternoon’s call should not focus on Secretary Sebelius repeating the same old, tired, and debunked claims that Obamacare will lower premiums.  The real question is whether the Secretary will finally apologize on behalf of the entire Obama Administration for failing to deliver on its broken promise to lower health costs NOW for struggling middle-class families.

Health Provisions in Labor-HHS Appropriations Measure

As you are probably aware, the House introduced an omnibus appropriations bill early this morning; the Labor-HHS division of the bill can be found here.  A few policy points worth highlighting:

  • The bill includes a ban on HHS funding of needle exchange programs; according to the House Appropriations Committee, this provision had been included in the bill prior to Fiscal Year 2010.
  • The bill also includes a blanket ban on HHS funds being used “in whole or in part, to advocate or promote gun control.”  According to the House Appropriations Committee, this ban had previously been confined solely to Centers for Disease Control funds.
  • The bill rescinds $400 million from the co-operative grant program included in Section 1322 of Obamacare.  As you may recall, $2.2 billion of the original $6 billion in funding was rescinded in the six-month continuing resolution (P.L. 112-10).  This additional rescission means $3.4 billion in co-operative funding would remain available.
  • The bill rescinds $10 million of the $15 million in mandatory funding for the Independent Payment Advisory Board provided in Section 3403 of Obamacare.
  • The bill rescinds approximately $6.4 billion in performance bonuses created in the 2009 SCHIP reauthorization (P.L. 111-3).
  • The bill requires the Secretary to establish “a publicly accessible website to provide information” regarding funds spent in the Prevention and Public Health Fund created by Section 4002 of Obamacare.  Grants over $25,000 would have to be publicly identified within 5 days of award, and recipients would have to provide semi-annual reports on their activities.  Some Members have previously expressed concern first that this fund would be used to fund questionable projects like jungle gyms and bike paths, and second that this fund suffers from accountability problems due to the mandatory, auto-pilot nature of the spending.  The President’s September deficit submission proposed reducing spending on the Fund by $3.5 billion over ten years.
  • The bill also  contains several prohibitions on grant funding from the Prevention and Public Health Fund from being used “for publicity or propaganda purposes,” or to fund the salaries of lobbyists.  This section also includes a prohibition on Prevention Fund monies being used to promote tax increases or “the advocacy or promotion of gun control.”

A full summary featuring several top-line spending numbers for the Labor-HHS bill can be found on the appropriations website here.  One particular note of caution if you’re trying to analyze the bill itself:  The last section of the bill includes an across-the-board rescission of 0.189 percent, so the actual spending levels under the bill would be lower than the bill’s plain text.

GAO Study Exposes Questionable “Stimulus” Funding for Questionable PR Campaigns and Comparative Effectiveness Research

The Government Accountability Office released the second of four reports required by the continuing resolution today, this one covering comparative effectiveness research funded in the “stimulus.”  On this list of projects funded by the “stimulus,” several questionable studies stand out:

  • Two separate grants of $8.6 million and $18 million to Ogilvy Public Relations – the former with no description attached, the latter described as funding a “Publicity Center.”  (No word as to whether or not Andy Griffith will be included in this publicity campaign.)
  • A total of eight separate grants with “cost-effectiveness” in the title, including one examining the cost effectiveness of hormonal therapy for prostate cancer.  (Other grants could also incorporate cost-effectiveness research without incorporating the term into their titles.)  Many have previously raised concerns that cost-effectiveness research will be used by federal bureaucrats to deny treatment options the government deems too expensive.  As a reminder, the initial House Appropriations Committee report on the “stimulus” stated that treatments “that are found to be…more expensive will no longer be prescribed” as a result of the effectiveness research funding.
  • A grant of nearly $2.8 million awarded by the HHS Office of the Secretary to the Institute for Healthcare Improvement, the organization that CMS Administrator Donald Berwick formerly led.  The grant was awarded last September 20 (i.e., after Dr. Berwick had taken office at CMS), raising questions about how this grant was processed and whether Dr. Berwick had any input in a grant application involving his former employer.

At a time when the federal government is running trillion-dollar deficits, many may question the point of granting over $26 million to PR firms for a “Publicity Center” – and spending taxpayer dollars on research that could be used to deny vulnerable patients care.

Is Secretary Sebelius Hiding Information on CLASS?

Several senators this afternoon sent a letter to Secretary Sebelius asking that her Department provide information on the participation and premium modeling conducted by the Administration on the CLASS Act prior to the enactment of the health care law.  In exchanges with Senator Thune at recent Finance Committee hearings, the Secretary admitted that the program is “totally unsustainable” as written in the law – and she pledged to disclose to Congress the information that was available to HHS prior to the law’s enactment.  However, several months later, she has failed to provide that information to the Senate – and also failed to disclose the same information to House Labor-HHS Subcommittee Chairman Rehberg, who requested similar documents from HHS nearly a month ago.

The participation models are important because, as Secretary Sebelius herself testified last month, if only the disabled community enrolls in the CLASS Act, “this program is immediately insolvent.”  It’s entirely possible that HHS knew through participation analyses that the program would be “totally unsustainable” and BEFORE the bill became law – yet did not publicly alert Members of Congress to the fact that they were passing a fiscally unsound and “immediately insolvent” new entitlement.

Multiple Members of Congress have requested these documents – and the President said as recently as this morning that he’s interested in engaging in bipartisan discussions around entitlement reform.  In that case, why haven’t the documents been released?  What exactly does HHS not want to disclose?

Health Provisions in Six-Month Continuing Resolution

As you will be aware, the House Appropriations Committee filed the six-month continuing resolution (through September 30) early this morning.  Text is available here, and a list of discretionary program reductions outlined by the Appropriations Committee is available here. (The Rules Committee also posted the text of two separate enrolling resolutions related to health care; summaries of those provisions will be sent under separate cover.)  House floor action is expected as soon as tomorrow, with the Senate expected to follow thereafter.

Unfortunately, CBO scoring estimates, including “runs” providing budget authority figures, are not yet available (other than the list of program reductions provided by the Appropriations Committee, and linked to above).  Below is a summary of the health care policy-related changes included in the CR.

Provisions related to the Department of Health and Human Services can be found on pages 311-324 and 337-342 of the text posted online.  (As usual, Food and Drug Administration funding is included in the Agriculture Department appropriations title, pages 191-95, and Indian Health Service funding is included in the Interior appropriations title, page 300.)  However, a BIG caveat for those reading through the CR text itself: Section 1119 provides for a 0.2 percent across-the-board rescission of budget authority for ALL discretionary appropriations, applying to “each discretionary account” and “each program, project, and activity.”  In other words, the discretionary account figures included in the text of the Labor-HHS title do NOT represent the final budgetary authority given – so don’t forget to read the bill with that in mind.

We will have more information on both policy and process as it becomes available.


Prevention “Slush Fund”:  Section 1855 requires that all money transferred from the Prevention and Public Health Fund established in the Patient Protection and Affordable Care Act (PPACA) to discretionary accounts (e.g., Centers for Disease Control, HRSA, etc.) comply with Section 503 of Division D of P.L. 111-117, which prohibits funds from being used “for publicity or propaganda purposes.”

GAO and Related Audits:  Section 1856 calls for several audits related to provisions included in PPACA:

  • A GAO report listing contracts, outside firms, and consultants used to implement new authorities provided by PPACA, due within 90 days of enactment;
  • A GAO report auditing “requests for administrative waiver of the annual limit requirements” under PPACA, including “an analysis of the number of approvals and denials of such requests and the reasons for such approval or denial,” due within 60 days of enactment;
  • A report by the Medicare actuary, due within 90 days of enactment, containing “an estimate of the impact of the guaranteed issue, guaranteed renewal, and community rating requirements…on premiums for individuals and families with employer-sponsored health insurance.  Such estimate shall cover the 10-year period beginning with 2014 and shall include an estimate of the number of such individuals and families who will experience a premium increase as a result of such requirements and the number of such individuals and families who will experience a premium decrease as a result of such requirements.”
  • A GAO report “that includes the results of an audit of expenditures made for comparative effectiveness research funds” in the “stimulus” or PPACA, due within 60 days of enactment.

Co-Op Rescission:  Section 1857 rescinds $2.2 billion of the $6 billion in start-up funding provided for the Consumer Operated and Oriented Plan (Co-Op) program created under Section 1322 of PPACA.

Free Choice Program:  Section 1858 repeals Section 10108 of PPACA, which provided for “free choice” vouchers for workers whose employer-provided health insurance premiums cost between 8 percent and 9.8 percent of family income.

Performance Bonuses:  Section 1859 rescinds $3.5 billion in performance bonus payments authorized in the 2009 SCHIP reauthorization (P.L. 111-3).  The program provides for bonuses for states that increase their Medicaid enrollment above threshold levels while engaging in at least five enrollment and retention provisions specified in the statute.  In 2009, the Congressional Budget Office scored the performance bonus provisions as costing $4.4 billion over the 2009-2019 budget window in its estimate of the SCHIP legislation as enacted.

Pelosi Advisor Admits: Comparative Effectiveness Research a “Cost Control Method”

Earlier today, Wendell Primus – a “liberal lion,” and Speaker Pelosi’s chief health care advisor – spoke on a panel about the health care outlook for the 112th Congress.  At the bottom of one page of his Powerpoint slideshow is a list of “Cost Control Mechanisms” in the health care bill, the first of which is “comparative effectiveness research.”

It is perhaps unsurprising that one of Speaker Pelosi’s closest policy advisors would make such a statement, as Democrats have a long history of making statements in support of cost-based rationing of health care resources:

A draft House Appropriations Committee report on last year’s “stimulus,” discussing the impact of comparative effectiveness research:  “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.”

Former Senate Majority Leader Tom Daschle, writing in his book Critical:  “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….The federal government could exert tremendous leverage with its decisions.”

President Obama, in a New York Times interview last year:   “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 conversation that is guided by doctors, scientists, ethicists.  And then there is going to have to be a very difficult democratic conversation that takes place.”

Medicare Administrator Donald Berwick, in a 2009 magazine piece:  “The decision is not whether or not we will ration care—the decision is whether we will ration with our eyes open.”

The first page of slides includes the following so-called “Republican provisions” in Obamacare, the fifth of which is that it “Must reduce [the] deficit.” (Emphasis mine.)  If Speaker Pelosi’s office believes the bill “MUST” reduce the deficit, does that mean that she will support repealing the legislation if it does not accomplish that objective?  The non-partisan Congressional Budget Office categorized most of the major savings provisions in the health care law as “widely expected” to change, or “difficult to sustain for a long period” – meaning that under a more realistic scenario (as opposed to the rosy scenarios painted by Democrats), the law will likely increase, rather than decrease, federal budget deficits.

It may be difficult to reconcile the statement that the health care law “must” reduce the deficit with non-partisan opinions raising significant questions about the accuracy of that assertion.  Then again, if Speaker Pelosi and Democrats plan to use comparative effectiveness research as a “cost control mechanism” by denying patients access to expensive treatments, the law may in fact reduce the deficit – at an extraordinarily high price to American patients.

Bioterror Cuts in House Supplemental Bill

Wanted to pass along this LA Times article on a proposed $2 billion cut to the Project BioShield program, which House Appropriations Committee Chairman Obey included in the House-passed supplemental as part of a package of offsets to fund a $10 billion education “slush fund.”  Of particular note are the comments by former Florida Democrat – and co-chair of the WMD Commission – Sen. Bob Graham, who said the proposed cut is “an extremely negative development in our overall efforts to prepare not only for bioterrorism but for other biological events from nature.”

The final disposition of the supplemental in the Senate remains unclear; however, Chairman Harkin indicated yesterday that action is not likely either this week or next week – meaning action may be postponed until the week of July 26, the last week the House is scheduled to be in session prior to the August recess.