Weekly Newsletter: July 21, 2008

Resolution Would Block SCHIP Funds from Being Targeted to Poor Children

Last week, a group of Senators introduced a Resolution of Disapproval (S. J. Res. 44) designed to nullify guidance put forward by the Administration regarding state efforts to expand government-funded health insurance coverage to higher-income children. The guidance, issued last August and revised this May, provides a list of steps states must take in order to expand coverage to children in families making over 250% of the federal poverty level (approximately $50,000 for a family of four), and to ensure that states do not encourage families to drop private insurance coverage in order to obtain coverage through a government program.

Many conservatives may be surprised and disappointed by this resolution, which if successful would effectively give states a disincentive to reach out and enroll poorer-income children if children from wealthier families can be more easily found and enrolled in government-funded coverage. Particularly as the Administration has issued clarifying guidance noting that no child need be dropped off the SCHIP rolls while states implement this new policy, some conservatives may question why Democrats would prefer to extend government-funded health insurance to families making $80,000 or more, while neglecting to ensure that poorer children receive first preference for SCHIP enrollment.

An RSC Policy Brief on the Administration’s SCHIP Guidance can be found here.

Medicaid Bailout for States Receives Committee Hearing

This week the House Energy and Commerce Committee will hold a Subcommittee hearing on legislation (H.R. 5268) designed to provide a temporary increase in the Medicaid matching rate provided to states. News reports suggest that the Democrat leadership may attempt to attach similar provisions to a second “stimulus” package being considered by the Congressional majority.

Some conservatives may be concerned that this legislation—which was proposed, and rejected, during negotiations over the first “stimulus” bill passed in January—would not provide any “stimulus” at all, instead substituting federal Medicaid spending for state dollars, at a significant cost to the federal budget deficit. Given an Urban Institute study suggesting that lost revenue—and not increases in Medicaid enrollment—generates a measurably larger impact on state budgets during economic downturns, some conservatives may view H.R. 5268 as providing a bailout to states, which did not engage in proper budgetary planning, that will only encourage “moral hazard” among states with flawed revenue projection models.

The legislation being considered also includes provisions designed to disregard “extraordinary pension contributions” for purposes of calculating each state’s Medicaid match rate. Because the Centers for Medicare and Medicaid Services has noted that Michigan—home to full Committee Chairman John Dingell—is the only state that would benefit from such a change, some conservatives may consider this provision an authorizing earmark and object to its inclusion.

An RSC Policy Brief on Medicaid matching formulae can be found here.

Documents of Note: Democrats Defend Entitlement Spending on the Wealthy

Last Wednesday, RSC Chairman Hensarling submitted an op-ed to the Washington Times discussing Medicare legislation recently enacted over the President’s veto. The article noted that the Democrat-constructed bill pits groups of low-income seniors against each other—by adding subsidies for some, while taking away access to Medicare Advantage for millions—all the while doing nothing to make billionaires like Warren Buffett and George Soros pay $2 per day more for prescription drug coverage.

Read the op-ed here.

And as Congress once again may consider SCHIP-related legislation, some conservatives may find the colloquy between Rep. Mike Burgess (R-TX) and House Energy and Commerce Chairman Dingell from last October enlightening. In it, Chairman Dingell admitted that states can choose to disregard tens of thousands of dollars of income from families applying for SCHIP—thus making families with six-figure incomes potentially subject to government-funded health insurance for “poor” children.

Rep. Hensarling Op-Ed: Democrat Medicare Bill Shortchanges Minorities

Over the last several weeks, I have heard from physicians rightly concerned that lawmakers had yet to pass legislation repealing a scheduled 10.6 percent reduction in their Medicare reimbursement rates. No doubt Congress should and will act soon, to preserve seniors’ access to physician care. This is critical for doctors, specifically primary care physicians, whom already face tremendously difficult challenges. But behind the scenes of the physician reimbursement debate lies an interesting paradox in the way Congressional Democrats protect wealthy seniors, while exposing large numbers of low-income beneficiaries whom the legislation purports to protect.

Nestled into the sprawling 278-page bill the House passed with limited debate are provisions that would expand eligibility for subsidy programs that aid low-income beneficiaries with Part B premium payments, deductibles, and co-insurance. Coupled with several proposals designed to increase outreach to low-income populations, the changes would cost hardworking Americans $7 billion over the next ten years.

Of course, budgetary rules require Congressional Democrats to pay for this expansion of the Medicare benefit. By listening to Senator Obama, you might assume that the likeliest culprit would be yet another tax on the wealthy. But that is far from it. The expanded subsidies for low-income individuals – as well as the physician reimbursement provisions and other related Medicare provisions – are paid for by cuts to Medicare Advantage plans that provide coverage to millions of seniors.

The paradox arrives in the discovery that Medicare Advantage plans disproportionately serve low-income and minority populations. Nearly half of all Medicare Advantage beneficiaries had incomes under $20,000; for Hispanic and African-American populations, that number rises to 70 percent. While policy-makers argue about “overpayments” to Medicare Advantage plans, many low-income seniors have come to appreciate – and rely on – the lower costs and increased benefits that these plans have provided. But as a result of the House-passed legislation, over 2 million seniors, including 1.8 million in private fee-for-service plans popular in rural areas with limited physician access, will lose their Medicare Advantage coverage.

To sum up: Congressional Democrats are cutting benefits for some low-income seniors – in order to extend benefits to other low-income seniors. All the while, proposals to increase Part D premiums for the wealthiest Medicare beneficiaries -think George Soros and Warren Buffett – languish in legislative purgatory.

There is a Machiavellian logic to Democrats’ apparent lack of appetite for Medicare means testing. If wealthier individuals become less dependent on the welfare state for their health benefits in retirement, political support for the popular program may wane. But when President Bush proposed to extend current means-testing of Part B premiums to the prescription drug plan as one way to alleviate Medicare’s funding woes, the New York Times considered this element of the President’s plan a “reasonable” proposal. If President Bush and the editorial board of the New York Times can both see the merits of this concept, there is little reason why Congress, in its infinite wisdom, should not see fit to include it in the Medicare bill.

Instead, the legislative product being considered constitutes, at best, an attempt at behavioral modification – forcing low-income beneficiaries away from plans run by “greedy” insurance companies – and at worst a perverse experiment in social Darwinism, pitting one group of vulnerable seniors against another in a competition for Medicare dollars. All this so Warren Buffett can avoid having his estimated $60 billion fortune decimated by paying an extra $2 per day for prescription drug coverage.

In March, the Medicare trustees issued their annual report, which noted that Medicare faces $86 trillion – yes, trillion – in unfunded obligations. The two best ways to stem this looming tide of debt are increased competition among private Medicare Advantage plans and proposals utilizing means-testing to dedicate scarce health care resources to the seniors who need them most. Yet the House bill undermines the former, while ignoring the latter.

While introducing Medicare legislation very similar to the bill the House passed, Senate Finance Committee Chairman Max Baucus decried efforts to “protect private insurance plans” that would “leave low-income beneficiaries behind,” arguing that his “balanced legislation” will prevent the latter while discouraging the former. I agree with Senator Baucus that his legislation is indeed balanced – it would ensure that a senior with $20,000 in income will continue to pay as much for prescription drugs as Ross Perot (or Senator Baucus himself). But in their ideological quest to undermine private insurance plans, Congressional Democrats are indeed leaving millions of beneficiaries on Medicare Advantage plans, many of them low-income, behind. Speaker Nancy Pelosi and House Democrats – Cutting coverage for beneficiaries while protecting billionaires.

This post was originally published at The Washington Times.

Weekly Newsletter: June 30, 2008

Senate Blocks Deep Cuts to Medicare Advantage…

Before recessing for the Independence Day recess, the House passed—and the Senate declined to limit debate on—legislation (H.R. 6331) addressing physician reimbursement levels under Medicare. The bill would prevent for 18 months a reduction in fee schedule levels scheduled to take effect on July 1, and would expand access to certain subsidy programs for low-income beneficiaries. These provisions would be offset largely by cuts to private Medicare Advantage plans, particularly private fee-for-service plans.

Some conservatives may be concerned that the House-passed bill’s significant cuts to Medicare Advantage would have the effect of driving beneficiaries away from a privately-run model of health insurance that has provided enhanced benefits and choice for millions of seniors, especially the 2.2 million beneficiaries in private fee-for-service plans. Some conservatives also may be concerned that the bill fails to address the long-term integrity of the Medicare program, relying on funding gimmicks and government-controlled price-fixing rather than undertaking comprehensive reform that would inject market forces into the program as a means to slow the growth of health care costs.

Following the House vote, nearly six dozen House Members—including RSC Chairman Hensarling— weighed in asking the Senate to revive bipartisan compromise legislation, crafted by Finance Committee Chairman Baucus and Ranking Member Grassley, that would address physician reimbursements without damaging beneficiary access to Medicare Advantage plans.

The Legislative Bulletin on H.R. 6331 can be found here.

…While Democrat Political Gamesmanship Prevents Physician Fix

After the Senate vote to limit debate on physician payment legislation that included significant cuts to Medicare Advantage failed on Thursday, Senate Republican Leader Mitch McConnell attempted to pass by unanimous consent a 30-day extension of current reimbursement provisions. However, Majority Leader Reid objected, and in so doing referred to several House special election results while commenting that “I don’t know how many people are up here for re-election, but I am watching a few of them pretty closely.” Because Senate Democrats objected to Republicans’ unanimous consent requests to pass a “clean” physician payment bill, physicians will take a 10% cut in their reimbursement levels beginning today unless and until Congress passes a retroactive fix. However, today’s Politico reports that the Administration is considering ways to delay the impact of the reimbursement adjustment, pending efforts by Congress after the recess to address the matter.

Some conservatives may be concerned by the Senate Majority Leader’s actions blocking a “clean” extension of current-law policies on physician reimbursement. Some conservatives may also believe that the short-term nature of current physician reimbursement extensions, coupled with their potential to become entwined in unrelated disputes and/or “held hostage” due to various political considerations, makes a powerful argument for more comprehensive reforms to Medicare, including a long-term solution to physician reimbursement policy.

While it is currently unclear whether Democrats will continue to block Republican attempts to pass noncontroversial physician payment legislation, or what precise form a more bipartisan bill designed to address the reimbursement provisions will take, the RSC will weigh in with conservative concerns and updates on H.R. 6331 and any other physician payment legislation which may be introduced or considered following the recess.

There are additional RSC Policy Briefs on issues related to the Medicare bill: Physician Payments; Medicare Advantage; Bidding for Durable Medical Equipment; and the Medicare Trustees Report.

Report Could Presage Democrat Efforts at Insurer Price Controls

In a related development, Ways and Means Health Subcommittee Chairman Pete Stark released a Government Accountability Office (GAO) study on Tuesday, which noted that in 2005 Medicare Advantage plans had lower medical costs and higher profits than first projected when submitting their bids for that contract year. Although the Centers for Medicare and Medicaid Services (CMS) noted that the profit projections were made under a now-defunct bidding process that may have explained much of the disparity, Democrats may attempt to use the GAO study to revive provisions in legislation (H.R. 3162) the House passed last year imposing a minimum “medical loss ratio” that would require Medicare Advantage plans to spend at least 85% of their total revenues on health care expenses.

To the extent that the higher-than-expected profits highlighted in the report are derived from improved care models and administrative and related efficiencies, some conservatives may view these proceeds as consistent with the free-market principles that reward companies who take measures to streamline operations while improving quality of care. Conversely, some conservatives may also believe that efforts to restrict medical loss ratios constitute de facto price controls on the insurance industry that will prove ineffective at controlling the growth of health care costs and could lead to unintended and potentially adverse consequences for enrollees.

The RSC has prepared a Policy Brief on this issue, available here.

Article of Note: Public vs. Private Debate Revolves Around Taxes

A study released last week by researchers affiliated with the liberal Center for Budget and Policy Priorities, and published online by Health Affairs, studied the relative efficiencies of private and public health insurance models. The authors conclude that public coverage through government programs like Medicaid is more efficient than private insurance, largely because public programs feature less cost-sharing than private coverage.

Given that a similar study released in 2003 found that lower reimbursement rates to providers were the primary reason that public programs had lower medical costs than private insurance, some conservatives may take issue with the study’s findings. The authors admit that providers are paid less under Medicaid than most private payers, and advocate an increase in reimbursement rates that would “improve patients’ access to and quality of care.” Yet the study methodology fails to take into account that medical spending for Medicaid patients is lower than private insurance precisely because beneficiaries in public programs have poorer access to provider care—in other words, that costs for Medicaid patients could be lower because they have coverage they cannot as readily use.

Some conservatives may believe that the authors’ admission that public programs reimburse providers at lower levels highlights the double taxation associated with expansions of Medicaid or the State Children’s Health Insurance Program (SCHIP). In addition to the amounts government spends to cover individuals in a public program, the cost-shifting that results from unrealistically low government reimbursement rates represents secondary taxes throughout the economy—on individuals with private insurance who pay more to subsidize health care costs the government will not pay; on Medicaid beneficiaries with reduced access to care; and on providers who are forced to work longer hours, or shorten the amount of time spent with each patient, in order to compensate for costs the government will not pay. For these reasons, many conservatives may believe that market-based reforms to the health care sector represent a far more preferable way to improve the quality of care while controlling the growth of health care costs.

Weekly Newsletter: March 10, 2008

Democrat Budget Fails to Address Medicare’s Woes…

The concurrent budget resolution (H. Con. Res. 312), which Democrats will bring to the House floor this week, does not include provisions providing comprehensive Medicare reform. The budget includes reconciliation provisions instructing the Ways and Means Committee to reduce spending on mandatory programs within their jurisdiction—but by only $750 million over the next five years. An amendment offered during last week’s Budget Committee markup by RSC Chairman Hensarling, which offered reconciliation instructions to ensure that Congress addresses the funding warning issued by the Medicare trustees last year, was defeated on a party-line vote.

Many conservatives will be concerned that, with the Medicare trust funds projected to be exhausted in little more than a decade, the Democrats’ budget will make no substantive effort to address Medicare’s $74 trillion in unfunded liabilities. In addition, some conservatives may be concerned by press reports indicating that the Democrat leadership will use the reconciliation process to justify new spending proposals for health care, rather than using all savings achieved to reduce the deficit and improve Medicare’s long-term viability.

More information on the Medicare trigger—and the President’s proposals for entitlement reform—can be found here.

…And Increases Spending on SCHIP

The Democrat budget also includes a proposed $50 billion reserve fund to finance an expansion of the State Children’s Health Insurance Program (SCHIP). This reserve fund would be consistent with a bill (H.R. 3162) considered by the House last July, under which nearly two and a half million children would drop private health insurance coverage in order to join a government-financed program—including children in families with incomes of more than $80,000.

Most conservatives support the enrollment and funding of the SCHIP program for the populations for whom it was created. However, continued efforts to extend this government-financed program to wealthier children and families may give some conservatives concern. If Democrats wish to look out for America’s children, some conservatives might argue that the better way to help is to reform Medicare and Medicaid so that future generations will not be saddled with trillions of dollars of debt, not to work to expand public programs for wealthier families.

An RSC Policy Brief discussing Administration proposals on SCHIP can be found here.

Mental Health Parity Bill Passes House

A Top Ten list of conservative concerns about H.R. 1424 can be found here.

Votes on the motion to recommit and final passage can be found here: Motion to Recommit Final Passage

Article of Note: Silence on Medicare Reform

Last week, the New York Times highlighted the absence of plans by Sen. Hillary Clinton or Sen. Barack Obama to confront the fiscal entitlement crisis our country faces in the coming decade. Although a report issued last month by the Centers for Medicare and Medicaid Services estimated that federal spending on health care will increase by 7.3% annually for the next decade, neither Democrat candidate has provided details on how to address the trillions of dollars of debt this additional spending will create.

The Times article notes that much of Medicare’s fiscal problem stems from the overall growth in health care costs. Several reports released in recent weeks have highlighted the need for measures to examine, and ultimately slow, excess cost growth within the health sphere. The RSC is preparing a policy brief summarizing these reports and offering some principles for controlling health costs using conservative, free-market solutions. By contrast, proposals by Sens. Clinton and Obama to control health costs contain a heavy emphasis on government-imposed price controls on insurance and pharmaceutical companies.

With the first Baby Boomer scheduled to become eligible for Medicare in fewer than three years, and the winner in November’s election likely to seek re-election, any potential President will have to address this crucial entitlement reform at some point during his (or her) intended term of office. Moreover, the $2 trillion added to America’s collective entitlement obligations every year that Congress and the President fail to take action provides a strong justification for immediate reform. Hopefully the Democratic contenders will embrace the opportunity to propose real, market-oriented solutions that control health care costs, or otherwise, as Robert Reischauer of the Urban Institute notes, “it will be difficult for Senator Clinton and Senator Obama to retain popular support for their plans once the details are supplied.”

Read the article here: New York Times: “About Those Health Care Plans by the Democrats…

Weekly Newsletter: February 25, 2008

Mental Health Parity Bill Headed for Floor

With the House scheduled to return from its President’s Day recess today, the period between now and the Easter recess may include action on a mental health bill (H.R. 1424) sponsored by Rep. Patrick Kennedy (D-RI). Among other provisions, the bill would impose a federal mandate that group health insurance plans offered by employers provide insurance coverage for a broad array of mental and substance abuse disorders, impose a federal scope of benefits for mental health coverage, and permit states to enact laws with more stringent consumer protections, potentially creating a patchwork of regulations to which large employers will be forced to comply.

Some conservatives may have strong concerns about both the principle behind the legislation—a costly federal mandate that will raise the health insurance premiums and increase the number of uninsured Americans—as well as the way in which the expansive House language would mandate coverage for “mental disorders” such as caffeine addiction and jet leg. The RSC will be monitoring this legislation as it makes its way to the House floor, and will be weighing in during the process to express conservatives’ concerns.

SCHIP Hearing Scheduled

Tomorrow the Health Subcommittee of the House Energy and Commerce Committee has scheduled a hearing around the State Children’s Health Insurance Program (SCHIP). This hearing will center around the guidance letter the Centers for Medicare and Medicaid Services (CMS) issued in August 2007 requiring states to take steps that ensure that SCHIP funds are targeted toward low-income children before states spend money to expand coverage to wealthier populations.

Most conservatives support enrollment and funding of the SCHIP program for the populations for whom the SCHIP program was created. That is why in December the House passed, by a 411—3 vote, legislation reauthorizing and extending the SCHIP program through March 2009. That legislation included an additional $800 million in funding for states to ensure that all currently eligible children will continue to have access to state-based SCHIP coverage. However, many conservatives also express strong reservations about further expansions of government-funded health insurance, particularly when those expansions would displace private insurance coverage held by wealthier families and children.

Interestingly enough, the Subcommittee hearing comes just over a week after full Committee Chairman John Dingell (D-MI) called the President’s Medicare trigger proposal “little more than a scare tactic.” With the size of America’s unfunded obligations rising by $2 trillion every year that Congress takes no action to reform entitlement spending, some conservatives might argue that the better way to help America’s children is to reform Medicare and Medicaid so that future generations will not be saddled with trillions of dollars of debt, not work to expand public programs for wealthier children.

Chairman Hensarling Op-Ed on Medicare Trigger Legislation

Last Friday, RSC Chairman Jeb Hensarling placed an op-ed article in The Washington Times discussing President Bush’s submissions to Congress regarding the state of Medicare—both the package of reimbursement adjustments proposed in the Fiscal Year 2009 budget, and the additional reforms proposed as part of the White House’s response to the “trigger” issued as a result of the Medicare trustees’ funding warning.

Chairman Hensarling’s article reflects the views of many conservatives that the “trigger” represents a critical opportunity to enact fundamental reform of the Medicare program that should ensure the program’s long-term sustainability and reduce its cost growth. In the coming months, RSC members will explore and advocate for market-based approaches intended to alleviate the fiscal crisis that will loom large in the absence of comprehensive entitlement reform.

Read the article here. To learn more about the Medicare trigger, read the RSC policy briefs on this issue.

Article of Note: “Lone Star Showdown”

With the Presidential primary campaign moving to the key states of Texas and Ohio, the Hudson Institute’s Betsy McCaughey examines the way in which the Democratic candidates’ proposals might affect the Lone Star State. Her op-ed piece in the Wall Street Journal posed questions to Sens. Hillary Rodham Clinton (D-NY) and Barack Obama (D-IL) that illustrated the logistical and philosophical objections many conservatives find with their health platforms:

  • Would illegal immigrants receive federal subsidies for health insurance?
  • How would a mandate for all individuals to have health insurance—or, in the case of Sen. Obama’s plan, requiring all parents to buy coverage for their children—be enforced?
  • How are guaranteed issue and community rating policies—which prohibit insurance carriers from varying premiums based on age or health status—fair to the younger workers who will pay more to subsidize older and less healthy—but presumably richer—individuals?
  • How are dozens of costly state benefit mandates consistent with “affordable” health insurance coverage?
  • Will promises that individuals will be able to keep coverage they like extend to persons with high-deductible health plans and/or Health Savings Accounts, or will they be forced to convert to more expensive coverage they may not want?
  • Is attempting to regulate the profits of insurance companies a wise role for government to be playing in health care—or in any industry, for that matter?McCaughey’s article uses examples derived from Texas, but the concerns she raises could be cited by conservatives in all states as they weigh the import of the proposals put forward by the Presidential contenders.

Read the article here: The Wall Street Journal: “Health Questions for the Candidates” (subscription required)

Rep. Hensarling Op-Ed: Medicare and Entitlements

It’s become an annual ritual — almost as much a herald of springtime in Washington as the cherry blossoms along the Potomac: President Bush advances a plan for entitlement reform, and Democrats in Congress proclaim it “dead on arrival.” It happened with Social Security reform three years ago, it happened with the president’s proposed savings from Medicare last year, and now it’s about to happen again with the new and enhanced Medicare proposals that the White House has delivered to Capitol Hill. But things are a bit different this time — for better and for worse.

The worsening news comes from the Medicare trustees themselves, whose latest report details the precarious financial situation of the trust funds that finance Medicare expenditures. The trustees warn that Medicare faces collective unfunded obligations of more than $74 trillion — more than six times the current size of the American economy. And those obligations are not getting smaller; they keep increasing. The Government Accountability Office estimates that for each year that Medicare and Social Security entitlements go unreformed, their projected shortfall grows by an additional $2 trillion.

The implications of these warnings from the trustees could not be more stark to the 200 million Americans under age 54 — who, according to the latest trustees’ report, will not be able to retire with full Medicare benefits. The Medicare Part A trust fund is scheduled to be “exhausted” — in plain English, flat broke — in 2019. This means that tens of millions of Baby Boomers face an uncertain retirement rife with questions about the future of health care.

If there is a silver lining to be found amid the darkening fiscal clouds, it lies in statutory provisions that ensure that proposals to curb Medicare spending will live to see the light of a fair vote in Congress. Fortunately, my Republican Study Committee colleagues and I added a little-known provision into the Medicare Modernization Act of 2003 — the overarching law that added prescription drug benefits to Medicare — that requires the independent Medicare trustees to issue a funding warning if Medicare expenditures are projected to grow to levels that will take away from other important national priorities. The president has now responded to that warning by submitting proposals that will help save the Medicare system by slowing its growth and empowering concerned Americans to demand comprehensive entitlement reform.

The president’s budget constituted a good first step toward Medicare reform, proposing to slow the growth of Medicare by nearly $178 billion over the next five years. Contrary to the mythical rhetoric of congressional Democratic leaders, the president’s budget proposal would not “cut” Medicare. Instead, his proposal allows Medicare to grow by 5 percent, instead of the 7.2 percent currently projected. Since most providers would continue to receive increased reimbursements from the federal government, the level, number and intensity of services provided would still continue to grow. And therein lies one of the keys to true Medicare reform: ensuring that budgetary savings derive from wise choices by patients and doctors about the most cost-effective treatment options.

In addition to the White House budget proposals, there are additional, more comprehensive solutions that have the potential to yield greater savings and slow the growth of the health costs that threaten to cripple our future. Solutions that would restructure Medicare cost-sharing and increase means-testing for wealthy beneficiaries would ensure the program’s sustainability by making beneficiaries more cost-conscious. Solutions like medical liability reform that would reduce providers’ costs associated with legal claims, saving money for Medicare and the general public. Solutions that would transform Medicare into a health care system similar to that which members of Congress have so that all seniors receive better care at a lower cost.

The president’s proposals have advanced the discussion of Medicare reform, and the trigger mechanism which we instituted five years ago provides Congress with a golden opportunity to conduct a thorough, stem-to-stern review of the way seniors receive health care and ensure that we can maintain our promises to baby boomers and future retirees alike.

The current race for the White House is teaching us many things about the American people. They are clamoring for change and yearn for leaders who will not only speak the truth about the problems facing our nation but work to provide solutions to them. Congress has an opportunity to do just that without waiting for a new president.

We have 2 trillion — that’s 2,000,000,000,000 — reasons to act on comprehensive entitlement reform, and to act this year. The American people expect no less.

This post was originally published in The Washington Times.