How a CBO Error Could Cost the Pharmaceutical Industry Billions

Government officials often attempt to bury bad news. Aaron Sorkin’s “The West Wing” even coined a term for it: “Take Out the Trash Day.” So it proved last week. A Congressional Budget Office (CBO) document released quietly on Thursday hinted at a major gaffe by the budget agency and its efforts to conceal that gaffe.

In a series of questions for the record submitted following Director Keith Hall’s April 11 hearing before the Senate Budget Committee, CBO admitted the following regarding a change to the Medicare Part D prescription drug program included in this past February’s budget agreement:

When the legislation was being considered, CBO estimated that provision would reduce net Medicare spending for Part D by $7.7 billion over the 2018-2027 period. CBO subsequently learned of a relevant analysis by the Centers for Medicare and Medicaid Services and incorporated that analysis in its projections for the April 2018 Medicare baseline. The current baseline incorporates an estimate that, compared with prior law, [the relevant provision] will reduce net Medicare spending for Part D by $11.8 billion over the 2018-2027 period.

As I wrote at the time, the provision attracted no small amount of controversy at its passage—or, for that matter, since. The provision accelerated the closing of the Part D “donut hole” faced by seniors with high prescription drug costs, but it did so by shifting costs away from the Part D program run by health insurers and on to drug companies.

The pharmaceutical industry was, and remains, livid at the change, which it did not expect, and tried to undo in the March omnibus spending bill. CBO didn’t just get its score wrong on a minor, non-controversial provision—it messed up on a major provision that will over the next decade affect both drug companies and health insurers.

Because the provision substitutes mandatory “discounts” by drug companies for government spending through the Part D program, it saves the government money through smaller Part D subsidies—at least on paper. (That said, the score doesn’t take into account whether drug manufacturers will raise prices in response to the change, which they could well do.) Because seniors actually spend more in the “donut hole” than CBO’s initial projections said, the provision will have a greater impact—i.e., cost the pharmaceutical industry billions more—than the February budget estimate says.

In its response last week, CBO tried to cover its tracks by claiming that “the $4 billion change…accounts for about 2 percent” of the total of $186 billion reduction in estimated Medicare spending over the coming decade due to technical changes incorporated into the revised baseline. But a $4.1 billion scoring error on a provision first projected to save $7.7 billion means CBO messed up its score by more than 53 percent of its original budgetary impact. That’s not exactly a small error.

Moreover, CBO didn’t come clean and publicly admit this error of its own volition. It did so only because Senate Budget Committee Chairman Mike Enzi (R-WY) forced the budget office to do so.

Enzi submitted a question noting that “CBO realized its estimate of a provision [in the budget agreement] was incorrect. Where is the correction featured in the new report?” CBO didn’t “feature” the correction in its April Budget and Economic Outlook report at all—it incorporated the change into the revised baseline without disclosing it, hoping to sneak it by without anyone calling the budget office out on its error.

Since that time, the purportedly “nonpartisan” organization realized it published an incorrect score—off by more than 50 percent—on a high-profile and controversial issue, changed its baseline to account for the scoring error, and said exactly nothing in a 166-page report on the federal budget about the change. If CBO won’t disclose this kind of major mistake on its own, then its “transparency efforts” seem like so much noise—a distraction designed to keep people preoccupied from focusing on errors like the Part D debacle.

To view it from another perspective: Any head of a private company whose analysis of a multi-billion-dollar transaction proved off by more than 50 percent, because his staff did not access relevant information available to them at the time of the analysis, would face major questions about his leadership, and could well lose his job. But judging from his desire to conceal this scoring mistake, the CBO director apparently feels no such sense of accountability.

Thankfully, however, members of Congress have tools available to fix the rot at CBO, up to and including replacing the director. Given the way CBO attempted to conceal the Part D scoring fiasco, they should start using them.

This post was originally published at The Federalist.

What You Need to Know About Budget Reconciliation in the Senate

After last week’s House passage of the American Health Care Act, the Senate has begun sorting through various policy options for health care legislation. But looming over the policy discussions are procedural concerns unique to the Senate. Herewith a primer on the process under which the upper chamber will consider an Obamacare “repeal-and-replace” bill.

How Will the Bill Come to the Senate Floor?

The bill that passed the House was drafted as a budget reconciliation bill. The phrase “budget reconciliation” refers to a process established by the Congressional Budget Act of 1974, in which congressional committees reconcile spending in programs within their jurisdiction to the budget blueprint passed by Congress. In this case, Congress passed a budget in January that required health-care committees to report legislation reducing the deficit by $1 billion—the intended vehicle for an Obamacare “repeal-and-replace” bill.

What’s So Important about Budget Reconciliation?

Under most circumstances, the Senate can only limit debate and amendments by invoking cloture, which requires the approval of three-fifths of all senators sworn (i.e., 60 votes). Because the reconciliation process prohibits filibusters and unlimited debate, it allows the Senate to pass reconciliation bills with a simple majority (i.e., 51-vote) threshold.

Why Does the ‘Byrd Rule’ Exist as part of Budget Reconciliation?

Named for former Senate Majority Leader Robert Byrd (D-WV), the rule intends to protect the integrity of the legislative filibuster. By allowing only matters integral to the budget reconciliation to pass the Senate with a simple majority (as opposed to the 60-vote threshold), the rule seeks to keep the body’s tradition of extended debate.

What Is the ‘Byrd Rule’?

Simply put, the rule prohibits “extraneous” material from intruding in budget reconciliation legislation. However, the term “Byrd rule” is technically a misnomer in two respects. First, the “Byrd rule” is more than just a longstanding practice of the Senate. After several years of operation as a Senate rule, it was codified into law beginning in 1985, and can be found at 2 U.S.C. 644. Second, the rule consists of not just one test to define whether material is “extraneous,” but six.

What Are the Six Different Types of Extraneous Material?

So the Various Types of ‘Byrd Rule’ Violations Are Not Necessarily Equivalent?

Correct. While most reporters focus on the fourth test—when a legislative provision has a budgetary impact merely incidental to the provision’s policy change—that is not the only type of rule violation. Nor in many respects is it the most significant.

While violations of the fourth test are fatal to the provision—the extraneous material is stricken from the underlying legislation—violations of the third (material outside the jurisdiction of committees charged with reporting reconciliation legislation) and sixth (changes to Title II of the Social Security Act) tests are fatal to the entire bill.

Who Determines Whether a Provision Qualifies as ‘Extraneous’ Under the ‘Byrd Rule’?

How Does One Determine Whether a Provision Qualifies as ‘Extraneous’ under the ‘Byrd Rule’?

In some cases, determining compliance with the rule is relatively straight-forward. A provision dealing with veterans’ benefits (within the jurisdiction of the Veterans Affairs Committee) would clearly fail the third test in a tax reconciliation bill, as tax matters lie within the Finance Committee’s jurisdiction.

However, other cases require a more nuanced, textual analysis by the parliamentarian. Such an analysis might examine Congressional Budget Office (CBO) and other outside scores, to assess the provision’s fiscal impact (or lack thereof), the statute the reconciliation bill seeks to amend, other statutes cross-referenced in the legislation (to assess the impact of the programmatic changes the provision would make), and prior precedent on related matters.

When Does the Senate Assess Whether a Provision Qualifies as ‘Extraneous’?

In some respects, assessing compliance is an iterative process. Often, the Senate parliamentarian will provide informal advice to majority staff as they begin to write reconciliation legislation. While these informal conversations help to guide bill writers during the drafting process, the parliamentarian normally notes that these discussions do not constitute a formal advisory opinion; minority party staff and other interested persons are not privy to the ex parte conversations, and could in time bring her new information that could cause her to change her opinion.

Do Debates about the ‘Byrd Rule’ Take Place on the Senate Floor?

They can, and they have, but relatively rarely. As James Wallner, an expert in Senate parliamentary procedure, notes, over the last three decades, the Senate has formally adjudicated only ten instances of the fourth test—whether a provision’s fiscal impacts are merely incidental to its proposed policy changes.

Because most determinations of “Byrd rule” compliance (or non-compliance) have been made through informal, closed-door “Byrd bath” discussions in the Senate parliamentarian’s office, there are few formal precedents—either rulings from the chair or votes by the Senate itself—regarding specific examples of “extraneous” material. As a result, the Senate—whether the parliamentarian, the presiding officer, or the body itself—has significant latitude to interpret the statutory tests about what qualifies as “extraneous.”

Can the Senate Overrule the Parliamentarian about What Qualifies as ‘Extraneous’ Under the ‘Byrd Rule’?

Yes, in two respects. The presiding officer—whether the vice president as president of the Senate, the president pro tempore (currently Sen. Orrin Hatch, R-UT), or another senator—can disregard the parliamentarian’s guidance and issue his or her own ruling. Alternatively, a senator could appeal the chair’s decision, and a simple majority of the body could overrule that decision. There is a long history of senators doing just that.

As a practical matter, however, such a scenario appears unlikely during the Obamacare debate, for two reasons. First, some senators may view such a move as akin to the “nuclear option,” undermining the legislative filibuster by a simple majority vote. The recent letter signed by 61 senators pledging to uphold the legislative filibuster indicates that at least some senators in both parties want to preserve the usual 60-vote margin for passing legislation, and therefore may not wish to set a precedent of allowing potentially “extraneous” material on to a budget reconciliation bill through a simple majority.

Second, if the Senate did overrule the parliamentarian on a procedural matter related to budget reconciliation, a conservative senator would likely introduce a simple, one-line Obamacare repeal bill and ask the Senate to overrule the parliamentarian to allow it to qualify as a reconciliation matter. Since many members of the Senate, like the House, do not actually wish to repeal Obamacare, they would likely decline to head down the road of overruling the parliamentarian, for fear it may head in this direction.

Can the Senate Waive the ‘Byrd Rule’?

Yes—provided three-fifths of senators sworn (i.e., 60 senators) agree. In the past, many budget reconciliation bills—like the Balanced Budget Act of 1997—passed with far more than 60 Senate votes, which made waiving the rule easier.

However, Republicans did not agree to waive the rule for extraneous material included in Senate Democrats’ Obamacare “fix” bill in March 2010. That material was stricken from the legislation and did not make it into law. For this and other reasons, it seems unlikely that eight or more Senate Democrats would vote to waive the rule for an Obamacare “repeal-and-replace” bill.

Didn’t Democrats Pass Obamacare through Budget Reconciliation?

Yes and no. They fixed portions of Obamacare—for instance, the notorious “Cornhusker Kickback”—through a budget reconciliation measure that passed through both houses of Congress in March 2010. But the larger, 2,400-page measure that passed the Senate on Christmas Eve 2009 was enacted into law first.

Once Scott Brown’s election to the Senate in January 2010 gave Republicans 41 votes, Democrats knew they could not go through the usual process of convening a House-Senate conference committee to consider the differences between each chamber’s legislation. A conference report is subject to a filibuster, and Republicans had the votes to sustain that filibuster.

Instead, House Democrats agreed to pass the Senate version of the legislation—the version that passed with 60 votes on Christmas Eve 2009—then have both chambers use a separate budget reconciliation bill—one that could pass the Senate with a 51-vote majority—to make changes to the bill they had just enacted.

This post was originally published at The Federalist.

One More Way Obamacare Is Hurting Families and Children

In case you hadn’t seen it, Sen. Enzi’s staff earlier today released a report outlining how Obamacare has reduced access to insurance coverage for children across the country.  Specifically, the onerous mandates imposed in Obamacare – coupled with the inept way the Administration has implemented the law – has resulted in 17 states not having access to child-only insurance policiesIn a total of 39 states, at least one insurance company has exited the child-only insurance marketplace.

These difficulties come because the Administration, in implementing the law, required insurance companies to accept ALL applicants for child-only insurance, regardless of health status.  Many companies, fearing (rightly) that they would be deluged with applications from individuals with costly medical conditions, decided to limit their involvement and/or exit the child-only insurance market entirely.  Now, thanks to these misguided policies under Obamacare, millions of Americans have no easy options to obtain health insurance coverage for their children.

Former Speaker Pelosi famously said we had to pass the bill to find out what’s in it.  Unfortunately, millions of American families seeking to obtain insurance coverage for their children are finding out that a provision designed to increase access to insurance coverage, particularly for children with pre-existing conditions, has in reality only served to decrease access.  And if this child-only insurance debacle portends similar problems as Obamacare gets rolled out fully in 2014, millions more Americans may find out the unexpected consequences of the 2,700 page health care law three years from now.

How Can You Implement a Law If You Can’t Deliver a Letter?

The Daily Caller reports today on a letter sent by HELP Committee Ranking Member Enzi to Vice President Biden, noting that the Vice President’s office has thus far failed to provide official transmittal of the Administration’s Medical Loss Ratio regulation to the Senate.  HHS has confirmed it sent the rule to the Vice President’s office, but the Vice President never delivered the rule to the Senate Parliamentarian.  And because the Vice President’s office has not done so, the Senate cannot debate or vote on legislation seeking to modify this new Obamacare mandate.

As a reminder, candidate Obama repeatedly pledged to televise all health care negotiations on C-SPAN – yet the Administration cannot deliver a letter to the Senate allowing an open debate on one of Obamacare’s regulations to occur.  More broadly, it’s worth asking:  How can this Administration implement a 2700 page law if it can’t deliver a simple letter…?

Non-Transparency During Sunshine Week

During his opening remarks at the Finance Committee hearing this morning, Senator Hatch referred to the letter he and Senator Enzi wrote to Secretary Sebelius calling for more openness in the Department’s dealings regarding health care reform.  Among the excerpts:

We remain disappointed that many of our requests for information are not receiving timely responses.  Your Department has failed to schedule regular briefings with the Committees of jurisdiction regarding ongoing implementation activities.  While the Department frequently makes HHS senior staff available to brief the media on new Administration regulations and reports, the Department has ignored multiple requests for Congressional briefings on the same topic.  The Department has also failed to provide any responses to Member questions that were submitted for the record at both HELP and Finance Committee hearings that were held in January and February.

As a reminder, President Obama promised “an unmatched level of transparency, participation, and accountability across the entire Administration.”  The Enzi-Hatch letter to the Secretary asks for a return to the President’s promises, as opposed to current practice, which some might argue resembles “government by press release.”

More Misinformation on Pre-Existing Conditions

In case you hadn’t seen it, the new website healthcareandyou.org launched on Tuesday.  Organized by several activist groups that support the law (e.g., the American Nurses Association), the website intends to provide “easy to understand information” about its contents.  Unfortunately, however, some of its statements are far from complete.  For instance, the video on the site’s homepage advertises “No Denials for Kids with Pre-existing Conditions.”  What it doesn’t mention however is the fact that, as Sen. Enzi’s HELP Committee staff discovered, families in 20 states are now unable to buy child-only insurance policies thanks to the new mandates imposed by the statute – meaning the promise of coverage for children with pre-existing conditions may turn out to be a hollow one.

Then there’s this apparently universal claim the website makes regarding pre-existing conditions:

No Denials Because of Pre-existing Conditions

Starting January 1, 2014, health insurance companies will no longer be able to refuse coverage or charge you a higher premium because of a pre-existing condition, including a disability.  A pre-existing condition is a health problem, disease or disability that an individual developed before they applied for health coverage.  Insurers will also no longer be able to base premium prices on gender or health status in the individual and small group markets.  Individuals who buy their coverage straight from insurance companies purchase coverage on the individual market. Small businesses that purchase health insurance for their employees buy it on the small group market.

Even one of the site’s sponsors, AARP, previously admitted that the blanket claims made on the website are FALSE:  Pre-existing condition protections do NOT extend to Medigap plans.  Yet the AARP-sponsored website doesn’t include a single mention that the law allows companies offering Medigap plans to continue imposing waiting periods on seniors with pre-existing conditions.  Funny that.

You may recall that Secretary Sebelius previously wrote she would not tolerate any “misinformation” regarding the health care law from entities offering health insurance products.  I’m sure that means her letter to the sponsors of the Health Care and You website is in the mail.

At Least 20 States Not Selling Child-Only Policies

Sen. Enzi’s staff have compiled a report finding that children in at least 20 states are unable to obtain child-only health insurance, thanks to the clumsy way the law’s ban on pre-existing condition exclusions has taken effect.  In other words, in many cases, the individuals targeted by the law for assistance are some of the ones directly suffering as a result of its many flaws. That report can be found here.

It’s also worth noting that in a Politico story on the matter, advocates claim “that the damage could have actually been a lot worse, had [states] not taken aggressive action to intervene.”  It’s interesting first that having “only” 20 states not selling child-only policies is being claimed by some as progress, and second that the apparent “solution” to government intervention (i.e., a bad law passed by Congress) is yet more government intervention, in the form of “aggressive action” by state governments and regulators.  It’s enough to bring to mind the famous quote that “The nine most terrifying words in the English language are, ‘I’m from the government and I’m here to help.”

Also, the Ways and Means Committee has posted video of Rep. Tiberi’s exchange yesterday with Council of Economic Advisers Chairman Austan Goolsbee, in which Mr. Goolsbee claimed it is “not accurate” to describe the individual mandate as a tax.  That video can be found here.

Enzi Resolution of Disapproval on Grandfathered Plan Regulation

As previously reported, Sen. Enzi’s resolution (S.J.Res. 39) disapproving of the Administration’s rules on grandfathered plans will be debated this morning, beginning at 10 AM. There will be two hours of debate (equally divided) on the motion to proceed, followed by a vote on proceeding to the resolution at about noon. If the motion to proceed is successful, we expect a further hour of debate on the resolution itself, followed by a vote on passage. (Both votes would have majority, 51-vote thresholds.)

Further information about the grandfathered plan regulations can be found in previous one-pagers available here and here.  We’ve also compiled a list of Barack Obama quotes over the past three years promising that Americans would be able to keep their own plan, which are listed below. (Special thanks to researcher Shane Scanlon for his help in compiling the Obama quotes.)

UPDATE: In case you missed it, the Senate just voted not to proceed to consider the Enzi resolution of disapproval (S.J.Res. 39).  The vote was 40-59.  A final tally of the results will be online here shortly.

 

 

 

 

Remarks by the President on Health Insurance Reform in Portland, Maine

Portland Expo, Portland, Maine

April 01, 2010

http://www.whitehouse.gov/the-press-office/remarks-president-health-insurance-reform-portland-maine

“They’ll have to finally acknowledge that this isn’t a government takeover of our health care system.  They’ll see that if Americans like their doctor, they will keep their doctor.  And if you like your insurance plan, you will keep it.  No one will be able to take that away from you.  It hasn’t happened yet.  It won’t happen in the future.

Remarks by the President on Health Insurance Reform s

University of Iowa Field House, Iowa City, Iowa.

March 25, 2010

http://www.whitehouse.gov/the-press-office/remarks-president-health-insurance-reform-university-iowa-field-house-iowa-city-iow

“From this day forward, all of the cynics, all the naysayers — they’re going to have to confront the reality of what this reform is and what it isn’t.  They’ll have to finally acknowledge this isn’t a government takeover of our health care system.  They’ll see that if Americans like their doctor, they’ll be keeping their doctor.  You like your plan?  You’ll be keeping your plan.  No one is taking that away from you.  Three months from now, six months from now you’re going to look around.  You’re going to be sitting in a doctor’s office reading through the old People magazines.  (Laughter.)  And you’ll say, hey, this is the same doctor, same plan.  It wasn’t Armageddon.”

Remarks by the President to the House Democratic Congress

Capitol Visitor Center Auditorium, Washington, D.C.

March 20, 2010

http://www.whitehouse.gov/the-press-office/remarks-president-house-democratic-congress

It turns out that in fact people who like their health insurance are going to be able to keep their health insurance; that there’s no government takeover.  People will discover that if they like their doctor, they’ll be keeping their doctor.  In fact, they’re more likely to keep their doctor because of a stronger system.”

Remarks by the President on Health Insurance Reform

George Mason University Patriot Center, Fairfax, Virginia

March 19, 2010

http://www.whitehouse.gov/the-press-office/remarks-president-health-insurance-reform-fairfax-virginia

If you like your doctor, you’re going to be able to keep your doctor.  If you like your plan, keep your plan.  I don’t believe we should give government or the insurance companies more control over health care in America.  I think it’s time to give you, the American people, more control over your health.”

Remarks by the President on Health Care Reform in Strongsville, Ohio

Strongsville, Ohio

March 15, 2010

http://www.whitehouse.gov/the-press-office/remarks-president-health-care-reform-strongsville-ohio

“Our proposal builds on the current system where most Americans get their health insurance from their employer.  So if you like your plan, you can keep your plan.  If you like your doctor, you can keep your doctor.  I don’t want to interfere with people’s relationships between them and their doctors.”

Remarks by the President on Health Insurance Reform in St. Charles, MO

St. Charles High School, St. Charles, Missouri

March 10, 2010

http://www.whitehouse.gov/the-press-office/remarks-president-health-insurance-reform-st-charles-mo

“So my proposal builds on the current system where most Americans get their health care from their employers.  If you like your plan, you can keep your plan.  If you like your doctor, you can keep your doctor.

Remarks by the President on Health Care Reform

East Room

March 03, 2010

http://www.whitehouse.gov/the-press-office/remarks-president-health-care-reform

“It builds on the current system where most Americans get their health insurance from their employer.  If you like your plan, you can keep your plan.  If you like your doctor, you can keep your doctor.  I can tell you as the father of two young girls, I would not want any plan that interferes with the relationship between a family and their doctor.

Remarks by the President in the State of the Union Address

U.S. Capitol

January 27, 2010

http://www.whitehouse.gov/the-press-office/remarks-president-state-union-address

Our approach would preserve the right of Americans who have insurance to keep their doctor and their plan. 

Remarks by the President on Small Businesses and Health Insurance Reform

South Court, Eisenhower Executive Office Building

October 29, 2009

http://www.whitehouse.gov/the-press-office/remarks-president-small-businessess-and-health-insurance-reform  

“The first thing I want to make clear is that if you are happy with the insurance plan that you have right now, if the costs you’re paying and the benefits you’re getting are what you want them to be, then you can keep offering that same plan.  Nobody will make you change it.

Remarks by the President at Rally on Health Insurance Reform

University of Maryland, College Park, Maryland

September 17, 2009

http://www.whitehouse.gov/the-press-office/remarks-president-rally-health-insurance-reform-college-park-md

“Let me say, if you already have health insurance, nothing in this plan will require you to change what you have. What this plan will do is make the insurance you have work better for you.”

Remarks By The President at a Rally on Health Insurance Reform

Target Center, Minneapolis, Minnesota

September 12, 2009

http://www.whitehouse.gov/the-press-office/remarks-president-rally-health-insurance-reform

“First of all, if you’re among the hundreds of millions of Americans who already have health insurance through your job, or you’ve got health insurance through Medicare or Medicaid or the VA, nothing — nothing in this plan will require you or your employer to change your coverage or your doc.  All right?  I want you to be clear about that.  Let me repeat:  Nothing in this plan requires you to change what you have if you’re happy with it.

Remarks by the President on Health Insurance Reform

Eisenhower Executive Office Building

September 10, 2009

http://www.whitehouse.gov/the-press-office/remarks-president-health-insurance-reform

Now, for the hundreds of millions of Americans who have health insurance, nothing in this plan will require you, or your employer, to change the coverage or the doctor you have.  Nothing will change for you if you have insurance.  Nothing in the plan will require any changes.

Remarks by the President to a Joint Session of Congress on Health Care

U.S. Capitol, Washington, D.C.

September 9, 2009

http://www.whitehouse.gov/the-press-office/remarks-president-a-joint-session-congress-health-care

“First, if you are among the hundreds of millions of Americans who already have health insurance through your job, or Medicare, or Medicaid, or the VA, nothing in this plan will require you or your employer to change the coverage or the doctor you have.  Let me repeat this:  Nothing in our plan requires you to change what you have. 

Remarks by the President in the Organizing for American National Health Care Forum

DNC Headquarters, Washington, D.C.

August 20, 2009

http://www.whitehouse.gov/the-press-office/remarks-president-organizating-america-national-health-care-forum

First, no matter what you’ve heard, if you like your doctor, you can keep your doctor under the reform proposals that we’ve put forward.  If you like your private health insurance plan, you can keep it.  If your employer provides you health insurance on the job, nobody is talking about messing with that.

Remarks by the President in Town Hall on Health Care

Central High School, Grand Junction, Colorado

August 15, 2009

http://www.whitehouse.gov/the-press-office/remarks-president-town-hall-health-care-grand-junction-colorado  

I just want to be completely clear about this; I keep on saying this but somehow folks aren’t listening — if you like your health care plan, you keep your health care plan.  Nobody is going to force you to leave your health care plan.  If you like your doctor, you keep seeing your doctor.  I don’t want government bureaucrats meddling in your health care.

Remarks by the President in Town Hall on Health Care

Gallatin Field Airport, Belgrade, Montana

August 14, 2009

http://www.whitehouse.gov/the-press-office/remarks-president-town-hall-health-care-belgrade-montana

“And if you do have health insurance, we’ll help make sure that your insurance is more affordable and more secure. If you like your health care plan, you can keep your health care plan. This is not some government takeover. If you like your doctor, you can keep seeing your doctor. This is important. I don’t want government bureaucrats meddling in your health care, but I also don’t want insurance company bureaucrats meddling in your health care either.  That’s what reform is about.”

Remarks by the President in Health Insurance Reform Town Hall

Portsmouth High School, Portsmouth, New Hampshire

August 11, 2009

http://www.whitehouse.gov/the-press-office/remarks-president-town-hall-health-insurance-reform-portsmouth-new-hampshire

“Now, the way we have approached it, is that if you’ve got health care under a private plan, if your employer provides you health care or you buy your own health care and you’re happy with it, you won’t have to change.

Remarks by the President at Town Hall

Broughton High School, Raleigh, North Carolina

July 29, 2009

http://www.whitehouse.gov/the-press-office/remarks-president-town-hall-raleigh-north-carolina

“First of all, nobody is talking about some government takeover of health care.  I’m tired of hearing that.  I have been as clear as I can be.  Under the reform I’ve proposed, if you like your doctor, you keep your doctor.  If you like your health care plan, you keep your health care plan.  These folks need to stop scaring everybody.  Nobody is talking about you forcing — to have to change your plans.”

Remark by the President in an AARP Tele-Town Hall on Health Care Reform

AARP Headquarters, Washington, D.C.

July 28, 2009

http://www.whitehouse.gov/the-press-office/remarks-president-aarp-tele-town-hall-health-care-reform

Here’s a guarantee that I’ve made: If you have insurance that you like, then you will be able to keep that insurance. If you’ve got a doctor that you like, you will be able to keep your doctor. Nobody is trying to change what works in the system. We are trying to change what doesn’t work in the system.”

Remarks by the President at Health Care Reform Town Hall

Shaker Heights High School, Shaker Heights, Ohio

July 23, 2009

http://www.whitehouse.gov/the-press-office/remarks-president-health-care-reform-town-hall

“Reform will keep the government out of your health care decisions, giving you the option to keep your coverage if you’re happy with it.  So don’t let folks say that somehow we’re going to be forcing government-run health care.  It’s just not true.

Remarks by the President on Health Care and the Senate Vote on F-22 Funding

Rose Garden

July 21, 2009

http://www.whitehouse.gov/the-press-office/remarks-president-health-care-and-senate-vote-f-22-funding

“America — Americans will be able to compare the price and quality of different plans, and pick the plan that they want. If you like your current plan, you will be able to keep it.  Let me repeat that:  If you like your plan, you’ll be able to keep it.

Remarks by the President in an Online Town Hall on Health Care

Northern Virginia Community College, Annandale, Virginia

July 1, 2009

http://www.whitehouse.gov/the-press-office/remarks-president-online-town-hall-health-care-reform

“There’s no doubt that we have to preserve what’s best in the health care system, and that means allowing Americans who like their doctor and their health care plan to keep their plan.  And that’s going to be a priority for us. 

Remarks by the President in ABC “Prescription for America” Town Hall on Health Care

East Room

June 24, 2009

http://www.whitehouse.gov/the-press-office/remarks-president-abc-prescription-america-town-hall-health-care-6-24-09

“So what we’re saying is, if you are happy with your plan and your doctor, you stick with it. 

Press Conference by the President

James S. Brady Press Briefing Room

June 23, 2009

http://www.whitehouse.gov/the-press-office/press-conference-president-6-23-09

There’s no doubt that we must preserve what’s best about our health care system, and that means allowing Americans who like their doctors and their health care plans to keep them.

Remarks by the President in Town Hall Meeting on Health Care

Southwest High School,  Green Bay, Wisconsin

June 11, 2009

http://www.whitehouse.gov/the-press-office/remarks-president-town-hall-meeting-health-care-green-bay-wisconsin

If you’re happy with your plan, you keep it.

Remarks by the President on Reforming the Health Care System to Reduce Costs

State Dining Room

May 11, 2009

http://www.whitehouse.gov/the-press-office/remarks-president-reforming-health-care-system-reduce-costs

“But I’m also committed to ensuring that whatever plan we design upholds three basic principles: First, the rising cost of health care must be brought down; second, Americans must have the freedom to keep whatever doctor and health care plan they have, or to choose a new doctor or health care plan if they want it; and third, all Americans must have quality, affordable health care.”

Remarks by the President at the Opening of the White House Forum on Health Reform

East Room

March 5, 2009

http://www.whitehouse.gov/the-press-office/remarks-president-opening-white-house-forum-health-reform

“I think most of us would agree that if we want to cover all Americans, we can’t make the mistake of trying to fix what isn’t broken.  So if somebody has insurance they like, they should be able to keep that insurance.  If they have a doctor that they like, they should be able to keep their doctor. 

Remarks of Senator Barack Obama

Jacksonville, FL

November 3, 2008

http://www.barackobama.com/2008/11/03/remarks_of_senator_barack_obam_155.php

“If you already have health insurance, the only thing that will change under my plan is that we will lower premiums.”

Remarks of Senator Barack Obama

Columbus, OH

November 02, 2008

http://www.barackobama.com/2008/11/02/remarks_of_senator_barack_obam_153.php

“If you already have health insurance, the only thing that will change under my plan is that we will lower premiums.”

Remarks of Senator Barack Obama

Des Moines, IA

October 31, 2008

http://www.barackobama.com/2008/10/31/remarks_of_senator_barack_obam_154.php

“If you already have health insurance, the only thing that will change under my plan is that we will lower premiums.”

Remarks of Senator Barack Obama

Sarasota, FL

October 30, 2008

http://www.barackobama.com/2008/10/30/remarks_of_senator_barack_obam_151.php

”If you already have health insurance, the only thing that will change under my plan is that we will lower premiums.”

Remarks of Senator Barack Obama

Raleigh, NC

October 29, 2008

http://www.barackobama.com/2008/10/29/remarks_of_senator_barack_obam_150.php

“If you already have health insurance, the only thing that will change under my plan is that we will lower premiums.”

Remarks of Senator Barack Obama

Chester, PA

October 28, 2008

http://www.barackobama.com/2008/10/28/remarks_of_senator_barack_obam_149.php

“If you already have health insurance, the only thing that will change under my plan is that we will lower premiums.”

Senator Barack Obama’s Closing Argument Speech: ‘One Week’

Canton, Ohio

October 27, 2008

http://www.barackobama.com/2008/10/27/senator_barack_obamas_closing.php

“If you already have health insurance, the only thing that will change under my plan is that we will lower premiums.”

Remarks of Senator Barack Obama

Reno, NV

October 25, 2008

http://www.barackobama.com/2008/10/25/remarks_of_senator_barack_obam_147.php

“If you have health insurance, the only thing that will change under my plan is that we will lower premiums.”

Remarks of Senator Barack Obama

Indianapolis, IN

October 23, 2008

http://www.barackobama.com/2008/10/23/remarks_of_senator_barack_obam_146.php

“If you have health insurance, the only thing that will change under my plan is that we will lower premiums.”

Remarks of Senator Barack Obama

Richmond, VA

October 22, 2008

http://www.barackobama.com/2008/10/22/remarks_of_senator_barack_obam_145.php

“If you have health insurance, the only thing that will change under my plan is that we will lower premiums.”

Remarks of Senator Barack Obama

Miami, FL

October 21, 2008

http://www.barackobama.com/2008/10/21/remarks_of_senator_barack_obam_142.php

“If you have health insurance, the only thing that will change under my plan is that we will lower premiums.”

Remarks of Senator Barack Obama

Tampa Bay, FL

October 20, 2008

http://www.barackobama.com/2008/10/20/remarks_of_senator_barack_obam_140.php

“If you have health insurance, the only thing that will change under my plan is that we will lower premiums.”

Remarks of Senator Barack Obama

Fayetteville, NC

October 19, 2008

http://www.barackobama.com/2008/10/19/remarks_of_senator_barack_obam_143.php

“If you have health insurance, the only thing that will change under my plan is that we will lower premiums.”

Remarks of Senator Barack Obama

St. Louis, MO

October 18, 2008

http://www.barackobama.com/2008/10/18/remarks_of_senator_barack_obam_139.php

“If you have health insurance, the only thing that will change under my plan is that we will lower premiums.”

Remarks of Senator Barack Obama

Roanoke, VA

October 17, 2008

http://www.barackobama.com/2008/10/17/remarks_of_senator_barack_obam_138.php

“If you have health insurance, the only thing that will change under my plan is that we will lower premiums.”

Remarks of Senator Barack Obama

Londonderry, NH

October 15, 2008

http://www.barackobama.com/2008/10/15/remarks_of_senator_barack_obam_137.php

“If you have health insurance, the only thing that will change under my plan is that we will lower premiums.”

Remarks of Senator Barack Obama

Dayton, OH

October 09, 2008

http://www.barackobama.com/2008/10/09/remarks_of_senator_barack_obam_132.php

“If you have health insurance, the only thing that will change under my plan is the amount you pay in premiums. That will be less.”

Remarks of Senator Barack Obama

Indianapolis, IN

October 8, 2008

http://www.barackobama.com/2008/10/08/remarks_of_senator_barack_obam_133.php

“If you have health insurance, the only thing that will change under my plan is the amount you pay in premiums. That will be less.”

Remarks of Senator Barack Obama

Daytona Beach, FL

September 20, 2008

http://www.barackobama.com/2008/09/20/remarks_of_senator_barack_obam_116.php

“Under my plan, if you have health insurance, nothing changes for you, except that my plan will lower your health care costs.” 

Cutting Costs and Covering America: A 21st Century Health Care System

University of Iowa

May 29, 2007

http://www.barackobama.com/2007/05/29/cutting_costs_and_covering_ame.php

“If you already have health insurance, the only thing that will change for you under this plan is the amount of money you will spend on premiums. That will be less.”

Enzi-Coburn Letter on Abortion Funding in High-Risk Pools

Wanted to draw your attention to a letter signed by Sens. Enzi, Coburn, and 9 other Republican Senators regarding federal funding for abortions in the new high-risk pools established under the health care law.  The letter follows the release of a Congressional Research Service report indicating that neither current law (Hyde Amendment), nor the health care law, nor the Executive Order signed by the President, nor HHS’ contract solicitation for the high-risk pool program specifically prevent federal funds from being used to finance abortion coverage in state high-risk pools.

Sen. Enzi Letter on High-Risk Pools

Attached is the final letter signed by Sen. Enzi and 30 other Republican Senators to Secretary Sebelius about high-risk pools.  This program was scheduled to start Monday (i.e. 90 days after the health law’s enactment), but is still not operational – and the Congressional Budget Office earlier this week found that the program is under-funded by $5-10 billion, which could result in as many as 500,000 individuals with pre-existing conditions not obtaining coverage that would have been available had the Democrat legislation devoted adequate funding to the high-risk pool program.

In this vein, it’s worth noting that the Wall Street Journal this morning reports that the high-risk pool program “is months behind schedule in several states” – including California, Maryland, and Michigan, where officials said they don’t expect enrollment to begin until September, at least three months behind schedule.  Also of note: Kansas – home state of HHS Secretary Sebelius – said it “will limit its state pool to 25 enrollees per month” due to concerns about lack of federal funding.  This latter problem would not be occurring had Democrats – instead of spending federal taxpayers’ money to finance slush funds and backroom deals – adequately funded the high-risk pool program in the first place.

 

Dear Secretary Sebelius:

As you know, the President signed the Patient Protection and Affordable Care Act (PPACA) into law on March 23, 2010.  Section 1101 of PPACA states “not later than 90 days after the date of enactment of this Act, the Secretary shall establish a temporary high risk health insurance pool program to provide health insurance coverage for eligible individuals during the period beginning on the date on which such program is established and ending on January 1, 2014”.  To date, the federal government has failed to provide any funding for this program and Americans with pre-existing coverage have not been able to enroll in the new high risk pools.

We have supported providing assistance to individuals who have difficulty obtaining health insurance and have supported the creation of high risk pools.  We are disappointed, therefore, to note the Administration’s failure or inability to meet this important deadline for providing health insurance benefits to individuals with pre-existing conditions.

We also continue to have concerns that the high risk pool provisions in the new health care law will fail to provide the assistance promised by supporters of the new law.  While some sources (including the White House health reform website) estimate that as many as 12 million people are denied coverage due to a pre-existing condition, the funding provided under the new law will provide coverage to only a fraction of those individuals.

In a new estimate, released on June 21, 2010, the Congressional Budget Office stated that the high risk pool provisions in the new law will provide coverage to only 200,000 individuals.  They further estimated that the true cost of providing coverage to eligible individuals through high risk pools would likely cost an additional $5 to $10 billion.   This analysis is consistent with the estimates prepared by your own chief Medicare actuary, Richard Foster.  In his April 22, 2010, memo regarding the estimated financial effects of the new health care law, Mr. Foster estimates that the high risk pool program could run out of money within the next one to two years.  These funding issues have led at least 19 States to decline to participate in this program.

Unfortunately, the debate and subsequent passage of the new health care law have been marred by many similar episodes that have attempted to disguise the true cost of the proposals.  Coupled with concerns over how the regulations mandated by the new law will cause up to 1.4 million individuals to lose their current coverage and the law’s failure to provide any assistance to individuals currently enrolled in existing high risk pools, these facts raise serious issues about whether the existing statutory provisions will meet the needs of individuals with pre-existing conditions.  In order for Congress to review the ongoing efforts to implement the high risk pool provisions and determine what changes may need to be made, we would request that you provide answers to the following questions by June 30, 2010:

  1. When will the money authorized under the new health reform law be distributed to those states that have agreed to participate in the new high risk pool program?
  2. When will you provide funding to operate high risk pools in the 19 states that have declined to participate in the new federal program?
  3. Please identify how many individuals are estimated to be covered under the new high risk pool, year by year through 2014.

Sincerely,