Democrats’ Anti-Choice Agenda

In response to various abortion legislation enacted in Alabama, Georgia, Missouri, and other states, the left has called for a national day of protest on this Tuesday. The groups calling for the protest object to “Donald Trump’s anti-choice movement.”

The groups know of which they speak. The left wants to prohibit choice in medicine, by forcing doctors and health-care providers with religious objections to perform abortions. Multiple Democrat health-care bills would not only force taxpayers to fund abortions, they would commandeer doctors to perform abortions—not to mention other medical procedures that might violate their deeply held religious beliefs.

Existing Conscience Protections

The second conscience provision, the Church Amendment, exists in permanent federal law. It prohibits organizations from discriminating against individuals who refuse to participate in abortions or sterilizations. However, the Church Amendment’s provisions only apply to entities receiving grants or loans under certain statutes and programs:

  • The Public Health Service Act;
  • The Community Mental Health Centers Act;
  • The Developmental Disabilities Services and Facilities Construction Act; and
  • Contracts for biomedical or behavioral research under any HHS program.

The last three programs in particular represent a relatively small percentage of federal funding. And while the Public Health Service Act encompasses a broad set of programs, it does not contain nearly the amount of federal funding as larger entitlements like Medicare and Medicaid.

Single Payer Undermines Conscience Protections

Single-payer legislation in both the House (H.R. 1384) and Senate (S. 1129) would undermine conscience protections. These bills would create a new, automatic funding mechanism for the single-payer program.

Because the single-payer program would not get funded through the Labor-HHS appropriations bill, the Weldon Amendment conscience protections included in that measure would not apply to the program. For the same reason, the Hyde Amendment’s prohibition on taxpayer funding of abortion, also included in the Labor-HHS spending bill, would also not apply.

In theory, the Church Amendment conscience protections would still apply. However, these protections only apply to the discrete federal programs listed above, and therefore may not apply in all cases. Moreover, if existing federal grant programs get subsumed into a new single-payer system—as the sponsors of the legislation would no doubt hope—then conscience protections might go away entirely.

Medicare for America: No Conscience Protections At All

Eliminating conscience protections would fit the rubric established by the Medicare for America bill (H.R. 2452). As I pointed out in the Wall Street Journal last week, the legislation belies its “moderate” label, as it would ban all private health care. On top of that, language on page 51 of the version of the bill introduced earlier this month makes clear that conscience protections do not apply to any medical professional, under any circumstance:

(3) HEALTH CARE PROVIDERS.—Health care providers may not be prohibited from participating in the Medicare for America [sic] for reasons other than their ability to provide covered services. Health care providers and institutions are prohibited from denying covered individuals access to covered benefits and services because of their religious objections. This subsection supercedes any provision of law that allows for conscience protection.

Even more than the Sanders bill, this language makes clear: Doctors have zero conscience protections under Medicare for America, whether about abortion or any other issue. To put it another way, medical professionals can practice their faith for one hour at church on Sunday, but if they wish to live their religious beliefs, they must join another profession.

Philosophical and Practical Concerns

Beyond the moral concerns outlined above, abolishing conscience protections could come with very severe unintended consequences. More than 600 Catholic hospitals (to say nothing of hospitals with other religious affiliations) serve more than one in seven U.S. patients.

Would passage of these bills force these religiously affiliated facilities to close, rather than have the facilities and the professionals within them violate their consciences? And if facilities close, or doctors leave the profession rather than performing procedures that violate their deeply held religious beliefs, who will pick up the slack? After all, our nation already faces looming physician shortages, and the promise of “free” care under a government-run system will only encourage more consumption of health services.

Liberals might want to keep the focus on the state initiatives in Alabama and elsewhere. But forcing people to violate their religious beliefs, and potentially chasing doctors and nurses out of the medical profession as a result, represents the truly radical policy.

This post was originally published at The Federalist.

Exclusive: Congress Should Investigate, Not Bail Out, Health Regulators Who Risked Billions

What if a group of regulators were collectively blindsided by a decision that cost their industry billions of dollars? One might think Congress would investigate the causes of this regulatory debacle, and take steps to ensure it wouldn’t repeat itself.

Think again. President Trump’s October decision to terminate cost-sharing reduction (CSR) subsidy payments to health insurers will inflict serious losses on the industry. For October, November, and December, insurers will reduce deductibles and co-payments for certain low-income exchange enrollees, but will not receive reimbursement from the federal government for doing so. America’s Health Insurance Plans, the industry’s trade association, claimed in a recent court filing that insurance carriers will suffer $1.75 billion in losses over the remainder of 2017 due to the decision.

As Dave Anderson of Duke University recently noted, the “hand grenade” of stopping the cost-sharing reduction payments, “if it was thrown in January or February of this year, would have forced a lot of carriers to do midyear exits and it would have destroyed the exchanges in some states.” Yet Congress has asked not even a single question of regulators why they did not anticipate and plan for this scenario—a recipe for more costly mistakes in the future.

A Brewing Legal and Political Storm

The controversy surrounds federal payments that reimburse insurers for lower deductibles, co-payments, and out-of-pocket expenses for qualifying low-income households purchasing exchange coverage. While the text of Obamacare requires the U.S. Department of Health and Human Services to establish a program to reimburse insurers for providing the discounts, it nowhere includes an explicit appropriation for such spending.

As the exchanges launched in 2014, the Obama administration began making CSR payments to insurers. However, later that year, the House of Representatives, viewing a constitutional infringement on its “power of the purse,” sued to stop the executive from making the payments without an explicit appropriation. In May 2016, Judge Rosemary Collyer ruled the payments unconstitutional absent an express appropriation from Congress.

The next President could easily wade into this issue. Say a Republican is elected and he opts to stop the Treasury making payments related to the subsidies absent an express appropriation from Congress. Such an action could take effect almost immediately….It’s a consideration as carriers submit their bids for next year that come January 2017, the policy landscape for insurers could look far different.

One week after my article, Collyer issued her ruling calling the subsidy payments unconstitutional. At that point, CSR payments faced threats from both the legal and political realms. On the legal front, the ongoing court case could have resulted in an order terminating the payments. On the political side, the new administration would have the power to terminate the payments unilaterally—and it does not appear that either Hillary Clinton or Trump ever publicly committed to maintaining the payments upon taking office.

Yet Commissioners Stood Idly By

In the midst of this gathering storm, what actions did insurance commissioners take last year, as insurers filed their rates for the 2017 plan year—the plan year currently ongoing—to analyze whether cost-sharing payments would continue, and the effects on insurers if they did not? About a week before the Trump administration officially decided to halt the payments, I submitted public records requests to every state insurance commissioner’s office to find out.

Two states (Indiana and Oregon) are still processing my requests, but the results from most other states do not inspire confidence. Although a few states (Illinois, Utah, and California’s Department of Managed Health Care) withheld documents for confidentiality or logistical reasons, I have yet to find a single document during the filing process for the 2017 plan year contemplating the set of circumstances that transpired this fall—namely, a new administration cutting off the CSR payments.

In many cases, states indicated they did not, and do not, question insurers’ assumptions at all. North Dakota said it does not dictate terms to carriers (although the state did not allow carriers to re-submit rates for the 2018 plan year after the administration halted the CSR payments in October). Wyoming said it did not issue guidance to carriers on CSRs “because that’s not how we roll.” Missouri did not require its insurers to file 2017 rates with regulators, so it would have no way of knowing those insurers’ assumptions.

Other states admitted that they did not consider the possibility that the incoming administration would, or even could, terminate the CSR payments. North Carolina said it did not think the court case was relevant, or that cost-sharing reduction payments would be an issue. Massachusetts’ insurance Connector (its state-run exchange) responded that “there was no indication that rates for 2017 were affected by the pendency of House v. Burwell,” the case Collyer ruled on in May 2016.

Despite the ongoing court case and the deep partisan disputes over Obamacare, many commissioners’ responses indicate a failure to anticipate difficulties with cost-sharing reduction payments. Mississippi stated that, during the filing process for 2017, “CSRs weren’t a problem then, as they were being funded.” Minnesota added that “it was not until the spring of 2017 that carriers started discussing the threat [of CSR payments being terminated] was a real possibility.” Nebraska stated that “I don’t think that there’s anyone who allowed for the possibility of non-payment of CSRs for plan year 2017. We were all waiting for Congress to act.”

However, as an e-mail sent by the National Association of Insurance Commissioners (NAIC) to state regulators demonstrates, federal authorities at the Centers for Medicare and Medicaid Services (CMS) stated their “serious concerns” with the Texas and New Mexico proposals. Federal law requires insurers to reduce cost-sharing for qualifying beneficiaries, regardless of the status of the reimbursement program, and CMS believed the contingency language—which never went into effect in either Texas or New Mexico—violated that requirement.

In at least one case, an insurer raised premiums to reflect the risk that CSR payments could disappear in 2017. Blue Cross Blue Shield of Montana submitted such request to that state’s insurance authorities. However, regulators rejected “contingent CSR language”—apparently an attempt to cancel the reduced cost-sharing if reimbursement from Washington was not forthcoming, a la the Texas and New Mexico proposals. The insurance commissioner’s office also objected to the carrier’s attempt to raise premiums over the issue: “We will not allow rates to be increased based on speculation about outcomes of litigation.”

Of course, had insurers requested, or had regulators either approved or demanded, premium increases last year due to uncertainty over cost-sharing reduction payments, they would not now face the prospect of over $1 billion in losses due to non-payment of CSRs for the last three months of 2017. But had regulators approved even higher premium increases last year, those increases likely would have caused political controversy during the November elections.

As it was, news of the average 25 percent premium increase for 2017 gave Trump a political cudgel to attack Clinton in the waning days of the campaign. One can certainly question why Democratic insurance commissioners who did not utter a word about premium increases and CSR “uncertainty” during Clinton’s campaign suddenly discovered the term the minute Trump was elected president.

However, at least some ardent Obamacare supporters just did not anticipate a new administration withdrawing cost-sharing reduction payments. Washington state’s commissioner, Mike Kreidler, published an op-ed last October regarding the House v. Burwell court case. He did so at the behest of NAIC consumer representative Tim Jost, who wanted to cite Kreidler’s piece in an amicus curiae brief during the case’s appeal. But despite their focus on the court case regarding CSRs, it appears neither Jost nor Kreidler ever contemplated a new administration withdrawing the payments in 2017.

Congressional Oversight Needed

The evidence suggests that not a single insurance commissioner considered the impact of a new administration withdrawing cost-sharing reduction payments in 2017, a series of decisions that put the entire health of the individual insurance market at risk. What policy implications follow from this conclusion?

First, it undercuts the effectiveness of Obamacare’s “rate review” process. That mechanism requires states to evaluate “excessive” premium increases. However, the program’s evaluation criteria do not explicitly include policy judgments such as those surrounding CSRs. Moreover, the political focus on lowering “excessively” high premium increases might result in cases where regulators approve premium rates set inappropriately low—as happened in 2017, where no carriers priced in a contingency margin for the termination of CSR payments, yet those payments ceased in October.

As noted above, Montana’s regulators called out that state’s Blue Cross Blue Shield affiliate for proposing a rate increase relating to CSR uncertainty. The state’s insurance commissioner, Monica Lindeen, issued a formal “letter of deficiency” in which she stated that “raising rates on the basis of this assumption [i.e., loss of cost-sharing reduction payments] is unreasonable.” But events proved Lindeen wrong—those payments did disappear in 2017. Yet the insurer in question has no recourse after their assumptions proved more accurate than Lindeen’s—nor, for that matter, will Lindeen face any consequences for the “unreasonable” assumptions she made.

Second, it suggests an inherent tension between state authorities and Washington. Several regulators specifically said they looked to CMS’ advice on the cost-sharing reduction issue. Iowa requested guidance from Washington, and Wisconsin said the status of the payments was “out of our hands.” But given the impending change of administrations, any guidance CMS provided in the spring or summer of 2016 was guaranteed to remain valid only through January 20, 2017—a problem for regulators setting rates for the 2017 plan year.

Obamacare created a new layer of federal oversight—and federal policy—surrounding regulation of insurance, which heretofore had laid primarily within the province of the states. The CSR debacle resulted from the conflict between those two layers. Unless and until our laws reconcile those tensions—in conservatives’ case, by repealing the Obamacare regime and returning regulation to the states, or in liberals’ preferred outcome, by centralizing more regulatory authority in Washington—these conflicts could well recur.

Third, and perhaps most importantly, it should spark Congress to examine state oversight of health insurance in greater detail. The fact that insurance commissioners escaped the equivalent of a Category 5 hurricane—the withdrawal of CSR payments in January—and struggled through a mere tropical storm with payments withdrawn in October instead, had no relevance on their regulatory skill—to the contrary, in fact.

Unfortunately, Congress has demonstrated little interest in examining why the regulatory apparatus fell so short. The same Democratic Party that investigated regulators and bankers following the financial crisis has shown little interest in questioning why insurers and insurance regulators failed to anticipate the end of cost-sharing reduction payments. With their focus on getting Congress to appropriate funds restoring the CSR payments President Trump terminated, insurance commissioners’ lack of planning and preparation represents an inconvenient truth that Democrats would rather ignore.

Likewise, Republicans who wish to appropriate funds for the cost-sharing reduction payments have no interest in examining the roots of the CSR debacle. In September, Sen. Lamar Alexander (R-TN) convened a hearing of the Health, Education, Labor, and Pensions (HELP) Committee to take testimony from insurance commissioners on “stabilizing” insurance markets.

At the hearing, Alexander did not ask the commissioners why they did not predict the “uncertainty” surrounding cost-sharing reductions last year. HELP Committee Ranking Member Patty Murray (D-WA) asked Kreidler, her state’s insurance commissioner, about regulators’ “guessing games” regarding the status of CSRs with regard to the 2018 plan year. But neither she nor any of the members asked why those regulators made such blind and ultimately incorrect assumptions last year, by not even considering a scenario where CSR payments disappeared during the 2017 plan year.

Alexander and Murray claim the legislation they developed following the hearing, which would appropriate CSR funds for two years, does not represent a “bailout” for the insurance industry. But the fact remains that last fall, when preparing for the 2017 plan year, insurance regulators dropped the ball in a big way.

Ignoring their inaction, and appropriating funds for cost-sharing reductions without scrutinizing their conduct, would effectively bail out insurance commissioners’ own collective negligence. Congress should think twice before doing so, because next time, a regulatory debacle could have an even bigger impact on the health insurance industry—and on federal taxpayers.

This post was originally published at The Federalist.

Obamacare Strikes Out with Voters — Again

Last night, voters in the critical bellwether state of Ohio sent a clear message to the Administration regarding Obamacare.  Voters in the state approved a constitutional amendment designed to allow individuals to choose their own health care without being subjected to diktats from bureaucrats, in Washington or elsewhere.  This amendment against Obamacare’s individual mandate passed overwhelmingly – at press time, the amendment had nearly 66% support, and more than 2.1 million votes in favor. (Final results will be available here.)

While clearly decisive, the Ohio result was entirely unsurprising.  A ballot initiative in Missouri (another swing state) last year passed with an even higher 71% margin, and received significant Democrat support in the process.  And even former Democratic National Committee Chairman Howard Dean has admitted that “the American people aren’t going to put up with a mandate.”

The Ohio results come as polling shows that approval ratings surrounding the law – never popular with a majority of voters – has fallen even further, to an all-time low.  When it comes to the entire 2700-page law, or its unprecedented and constitutionally dubious mandate for all individuals to purchase health coverage, Tuesday’s result further illustrates that the only thing bipartisan about Obamacare has been the opposition to it.

Another Carrier to Exit Insurance Markets; 840,000 to Lose Their Current Coverage

Both the New York Times and the Wall Street Journal have stories this morning on the exit from the health insurance marketplace of Principal Financial Group, which currently covers about 840,000 lives.  All these individuals will have to change their current coverage in the coming months as their policies expire.

More troubling however are the concluding paragraphs of the Times piece, which suggests that Principal’s decision may be one of many made by smaller carriers to exit the health insurance marketplace thanks to the health care law:

More insurers are likely to follow Principal’s lead, especially as they try to meet the new rules that require plans to spend at least 80 cents of every dollar they collect in premiums on the welfare of their customers. Many of the big insurers have been lobbying federal officials to forestall or drastically alter those rules.

“It’s just going to drive the little guys out,” said Robert Laszewski, a health policy consultant in Alexandria, Va. Smaller players like Principal in states like Iowa, Missouri and elsewhere will not be able to compete because they do not have the resources and economies of scale of players like UnitedHealth, which is among the nation’s largest health insurers.

Mr. Laszewski is worried that the ensuing concentration is likely to lead to higher prices because large players will no longer face the competition from the smaller plans. “It’s just the UnitedHealthcare full employment act,” he said.

Democrats claimed that their unpopular health care law would protect Americans from abuses by “Big Insurance.”  But if the overhaul leads to industry consolidation – and higher prices as a result – how effective can it be?

Health Care “Reform” Implementation By the Numbers

Six months after enactment of Democrats’ new health care law,[i] a look at the first stages of its implementation reveals how the legislation falls short with respect to costs, premiums, preserving Americans’ existing coverage, and providing full transparency and accountability:

4,103—Pages of regulations issued on the health care law through September 17, 2010[ii]

12—Number of final regulations not subjected to public scrutiny before taking effect[iii]

5—Missed implementation deadlines to date[iv]

16—Unanswered letters from House and Senate Republicans to the Administration on the health law[v]

22—States that have joined legal actions to block all or part of the law from taking effect[vi]

667,680—Number of Missouri voters that rejected the health care law’s individual mandate, supporting a ballot referendum objecting to the federal law by a 71%-29% margin[vii]

500,000—Individuals with pre-existing conditions who could be denied coverage due to under-funding of the law’s high-risk pool program, according to the Congressional Budget Office (CBO)[viii]

40,000,000—Firms subject to the health law’s new 1099 reporting requirements, which the National Federation of Independent Business called a “tremendous new paperwork compliance burden”[ix]

9—Regulations released to date that will increase premium costs for individuals and employers, according to the Administration’s own estimates[x]

$2,500—Premium reduction promised by candidate Obama “by the end of my first term as President”[xi]

750,000—Reduction in the American labor force due to provisions in the law that “will effectively increase marginal tax rates, which will also discourage work,” according to the CBO[xii]

$310,800,000,000—Projected increase in health care costs as a direct result of the legislation, according to the Administration’s own actuaries[xiii]

7,400,000—Reduction in Medicare Advantage enrollment as a result of the health care law, resulting in a loss of choice for seniors and millions of beneficiaries losing their current health plan[xiv]

51%—Percentage of American workers who will lose their current health coverage by 2013, according to the Administration’s own estimates[xv]

0—Public hearings held before President Obama appointed Dr. Donald Berwick—an advocate of health care rationing—to head an agency that “finances health care for one in three Americans” and spends $800 billion annually[xvi]

Even though we have seen only a few of the law’s initial provisions take effect, the impact can already be felt by American families and businesses, who face higher costs, economic uncertainty, and loss of their current coverage. How much longer will these ill effects persist before the President and Democrats in Congress admit that their legislation will harm, not help, the American people?

 

[i] Patient Protection and Affordable Care Act (PPACA), P.L. 111-148

[ii] Includes 52 separate proposed rules, interim final rules, requests for information, notices, and other related regulatory actions related to PPACA released by federal agencies or published in the Federal Register between March 23, 2010 (the date of enactment) and September 17, 2010. Spreadsheet with citations and page counts available upon request.

[iii] Refers to interim final rules published without public scrutiny or comment prior to taking effect. Ibid.

[iv] Four missed deadlines are noted in “White House Misses Early Deadlines in ObamaCare Implementation” by Jonathan Strong, June 2, 2010, http://dailycaller.com/2010/06/02/white-house-misses-early-deadlines-in-implementing-obamacare/. In addition, the Administration failed to implement provisions of Section 1101 creating new high-risk pools within 90 days of enactment (i.e. June 21, 2010), as required under the statute.

[v] Spreadsheet with additional details available upon request

[vi] “Missouri to Vote on Health Law” by Kevin Sack, New York Times August 1, 2010, http://www.nytimes.com/2010/08/01/health/policy/01missouri.html

[vii] Missouri Secretary of State’s office, Proposition C results from August 3, 2010 primary election, http://www.sos.mo.gov/enrmaps/20100803/ballot_Issue_map.asp?eid=283&oTypeID=20&Wednesday,%20August%2004,%202010

[viii] Congressional Budget Office, Letter to the Honorable Mike Enzi regarding high-risk pool funding, http://cbo.gov/ftpdocs/115xx/doc11572/06-21-High-Risk_Insurance_Pools.pdf

[ix] National Taxpayer Advocate, Report to Congress: Fiscal Year 2011 Objectives, June 30, 2010, http://www.irs.gov/pub/irs-utl/nta2011objectivesfinal.pdf, pp. 9-13; National Federation of Independent Business release, July 25, 2010, http://www.nfib.com/LinkClick.aspx?fileticket=e8uuuI20Cbs%3d&tabid=1083

[x] Administration regulations whose economic impact analyses assumed an increase in health insurance premiums (whether the regulations quantified those increases or not) included those on coverage of dependent children under age 26, published in Federal Register May 13, 2010, http://edocket.access.gpo.gov/2010/pdf/2010-11391.pdf; coverage of pre-existing conditions for children, annual and lifetime limits, rescissions, designation of primary care providers, designation of pediatrician as primary care providers, patient access to obstetrical and gynecological care, and coverage of emergency services, all published in Federal Register June 28, 2010, http://edocket.access.gpo.gov/2010/pdf/2010-15278.pdf; and coverage of preventive services, published in Federal Register July 19, 2010, http://edocket.access.gpo.gov/2010/pdf/2010-17242.pdf.

[xi] Obama for America campaign document, “Background Questions and Answers on Health Care Plan,” http://www.barackobama.com/pdf/Obama08_HealthcareFAQ.pdf; “Health Plan from Obama Spurs Debate” by Kevin Sack, New York Times July 23, 2008, http://www.nytimes.com/2008/07/23/us/23health.html?ei=5124&en=59763b2937c15bd3&ex=1374552000&partner=permalink&exprod=permalink&pagewanted=print

[xii] Congressional Budget Office, “The Budget and Economic Outlook: An Update,” August 2010, http://cbo.gov/ftpdocs/117xx/doc11705/08-18-Update.pdf Box 2-1, Effects of Recent Health Care Legislation on Labor Markets, pp. 66-67. CBO estimated a labor force reduction of “roughly half a percent.” The 750,000 figure is based on current Bureau of Labor Statistics data indicating more than 150 million Americans in the workforce.

[xiii] Richard Foster, Centers for Medicare and Medicaid Services, Estimate of the “Patient Protection and Affordable Care Act,” as amended, April 22, 2010, http://www.cms.gov/ActuarialStudies/Downloads/PPACA_2010-04-22.pdf

[xiv] Ibid.

[xv] Interim final rule by Departments of Labor, Treasury, and Health and Human Services regarding grandfathered health insurance status, released June 14, 2010, http://edocket.access.gpo.gov/2010/pdf/2010-14488.pdf, Table 3, p. 34553

[xvi] “New Health Official Faces Hostility in the Senate” by Robert Pear, New York Times July 27, 2010, http://www.nytimes.com/2010/07/27/us/politics/27berwick.html?_r=2&src=twt&twt=nytimeshealth; CMS Fiscal Year 2010 Budget Justification, http://www.cms.gov/PerformanceBudget/Downloads/CMSFY10CJ.pdf, p. 2; “Rethinking Comparative Effectiveness Research,” An Interview with Dr. Donald Berwick, Biotechnology Healthcare June 2009, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2799075/pdf/bth06_2p035.pdf

Health Care Law MORE Unpopular

Key take-aways from this month’s Kaiser Tracking Poll, released this morning:

  • The health law became more unpopular in August, with approval falling seven points to 43%, and disapproval rising by ten points, to 45%.
  • Fewer than one in three (29%) voters believe the law will make them better off – up only one point from the historic low of 28%, set in June.
  • Only 39% of respondents believe that health “reform” will help the country as a whole – the lowest rating since the current health care debate began, and down 20 points from the 59% who thought health reform would benefit the country in February 2009.
  • A net majority of 50% believes the health care law will not be successful in “reducing the total amount the country spends on health care” (31% disagree strongly), compared to only 46% who believe the law will contain costs (only 14% strongly).
  • Among registered voters, 34% are more likely to oppose a candidate who supported the health care law (26% strongly), while 31% are likely to support a candidate who voted for the law (only 18% strongly).
  • A majority (52%) of voters strongly disapprove of the health care law’s individual mandate to purchase insurance.  A further 18% somewhat disapprove, leading to an overall negative rating for the mandate of 70% – almost the same margin by which voters in Missouri rejected the mandate in a referendum earlier this month.
  • Informing those who initially approved of the individual mandate that such a provision “could mean that some people would be required to buy health insurance that they find too expensive or did not want” led nearly half of the mandate’s supporters to reconsider their position, driving the mandate’s net disapproval up to a whopping 83%.

Politico has a brief summary of the poll, noting that the results are “a far cry from the bump proponents had hoped to see as some of the law’s more consumer-friendly provisions kick in.”  And unfortunately for Democrats, future months are unlikely to see many welcome developments either.  Among the “coming attractions” for individuals heading into open-enrollment periods this fall: Premiums will go up, many Americans will discover they will lose their existing coverage as soon as next year thanks to the law’s new mandates and regulations, and millions of seniors will lose access to Medicare Advantage plans they have and like.  No wonder the polls remain clear that Democrats’ government takeover of health care is a change most Americans do not believe in.

Democrats Admit: Health Law IS Unpopular

Politico reports this afternoon on a new messaging effort by liberal groups (including AARP, SEIU, the AFL-CIO, and Families USA) in an attempt to bolster support for the President’s floundering flagship initiative – the health care law.  The full presentation is online, and contains the following nuggets (with my comments in bold italics):

The “Challenging Environment”

  • “Straightforward ‘policy’ defenses fail to be moving voters’ opinions about the law;”
  • “Women in particular are concerned that [the] health law will mean less provider availability – scarcity an issue;”
  • “Many don’t believe health reform will help the economy;”  [Confirmed this morning when the Congressional Budget Office estimated the law will kill 500,000 jobs]

Messaging Points

  • “Keep claims small and credible; don’t overpromise or ‘spin’ what the law delivers;”
  • “Use transition or bridge language…‘The law is not perfect, but it does good things and helps many people.  Now we’ll work to improve it.”  [House Democrats already voted to “improve” the law by repealing just one of its many onerous tax increases on small businesses.]
  • “Address provider scarcity and cost concerns.  Let the public know that…an unprecedented number of new health care providers are being trained.”  [The Medicare actuary confirmed this fear earlier this year – “supply constraints might initially interfere with providing the services desired by the additional 34 million insured persons.”]
  • “Tap into individual responsibility to blunt opposition to the mandate to have health insurance.”[Tens of thousands of Democrats in Missouri didn’t accept this argument, and voted for Proposition C this month, resulting in a 71% statewide vote against the individual mandate.]
  • “It is critical to reassure seniors that Medicare will not be cut.”  [The Medicare actuary notes that the health care law’s reductions in Medicare spending would make 15 percent of providers unprofitable within 10 years, “possibly jeopardizing access to care for beneficiaries.”]
  • “Don’t make grand claims about the law.  Use ‘improve it’ language.”

 

 

 

Do Not…

  • “Assume the public knows the health reform law passed or if they know it passed understand how it will affect them;”
  • “List benefits outside of any personal context;”
  • “Barrage voters with a long list of benefits;”
  • “Use complex language or insider jargon;”
  • “Use heated political rhetoric or congratulatory language;”
  • “Say the law will reduce costs and deficit.”  [What happened to the President’s statements that “our health care problem is our deficit problem” and “If any bill arrives from Congress that is not controlling costs, that’s not a bill I can support?”]

After spending several months arguing that support for the law was increasing, Democrats have finally bowed to the reality that the American people do not like the majority’s government takeover of health care.  The question is, when will the majority finally admit that the problem lies not with the messaging regarding the health care law, and rather with the message itself – that Democrats should repeal the law and replace it with reform that actually works.

Howard Dean: “The American People Aren’t Going to Put Up with a Mandate”

Former Vermont Governor and Democratic National Committee Chairman Howard Dean was on MSNBC this morning.  Asked about Tuesday’s resounding victory for Missouri’s Proposition C, whereby 71% of voters expressed their opposition to the health care law’s individual mandate, Gov. Dean said that the American people would not stand for such an imposition on their rights – “people don’t like to be told what to do” – that the mandate could well be ruled unconstitutional, and that it would be stripped from the legislation eventually regardless.

Video of the Governor’s comments can be found here (relevant excerpts start at 3:45) – it’s well worth watching.

Health Care “Reform” Implementation By the Numbers

More than four months after enactment of Democrats’ new health care law,[i] a look at the first stages of its implementation reveals how the legislation falls short with respect to costs, premiums, preserving Americans’ existing coverage, and providing full transparency and accountability:

3,833—Pages of regulations issued on the health care law through July 31, 2010[ii]

11—Number of final regulations not subjected to public scrutiny before taking effect[iii]

5—Missed implementation deadlines to date[iv]

14—Unanswered letters from House and Senate Republicans to the Administration on the health law[v]

22—States that have joined legal actions to block all or part of the law from taking effect[vi]

667,680—Number of Missouri voters that rejected the health care law’s individual mandate, supporting a ballot referendum objecting to the federal law by a 71%-29% margin[vii]

500,000—Individuals with pre-existing conditions who could be denied coverage due to under-funding of the law’s high-risk pool program, according to the Congressional Budget Office[viii]

40,000,000—Firms subject to what the National Federation of Independent Business called a “tremendous new paperwork compliance burden for small business” included in the health law[ix]

9—Regulations released to date that will increase premium costs for individuals and employers, according to the Administration’s own estimates[x]

$2,500—Premium reduction promised by candidate Obama “by the end of my first term as President”[xi]

$115,000,000,000—Increase in federal discretionary spending as a result of the law, despite not being included in official cost estimates prior to its passage[xii]

$310,800,000,000—Projected increase in health care costs as a direct result of the legislation, according to the Administration’s own actuaries[xiii]

7,400,000—Reduction in Medicare Advantage enrollment as a result of the health care law, resulting in a loss of choice for seniors and millions of beneficiaries losing their current health plan[xiv]

51%—Percentage of American workers who will lose their current health coverage by 2013, according to the Administration’s own estimates[xv]

0—Public hearings held before President Obama appointed Dr. Donald Berwick—an advocate of health care rationing—to head an agency that “finances health care for one in three Americans” and spends $800 billion annually[xvi]

Even though we have seen only a few of the law’s initial provisions take effect, the impact can already be felt by American families and businesses, who face higher costs, economic uncertainty, and loss of their current coverage. How much longer will these ill effects persist before the President and Democrats in Congress admit that their legislation will harm, not help, the American people?

 

[i] Patient Protection and Affordable Care Act, P.L. 111-148

[ii] Includes 52 separate proposed rules, interim final rules, requests for information, notices, and other related regulatory actions related to PPACA released by federal agencies or published in the Federal Register between March 23, 2010 (the date of enactment) and July 31, 2010. Spreadsheet with citations and page counts available upon request.

[iii] Refers to interim final rules published without public scrutiny or comment prior to taking effect. Ibid.

[iv] Four missed deadlines are noted in “White House Misses Early Deadlines in ObamaCare Implementation” by Jonathan Strong, June 2, 2010, http://dailycaller.com/2010/06/02/white-house-misses-early-deadlines-in-implementing-obamacare/. In addition, the Administration failed to implement provisions of Section 1101 creating new high-risk pools within 90 days of enactment (i.e. June 21, 2010), as required under the statute.

[v] Spreadsheet with additional details available upon request

[vi] “Missouri to Vote on Health Law” by Kevin Sack, New York Times August 1, 2010, http://www.nytimes.com/2010/08/01/health/policy/01missouri.html

[vii] Missouri Secretary of State’s office, Proposition C results from August 3, 2010 primary election, http://www.sos.mo.gov/enrmaps/20100803/ballot_Issue_map.asp?eid=283&oTypeID=20&Wednesday,%20August%2004,%202010

[viii] Congressional Budget Office, Letter to the Honorable Mike Enzi regarding high-risk pool funding, http://cbo.gov/ftpdocs/115xx/doc11572/06-21-High-Risk_Insurance_Pools.pdf

[ix] National Taxpayer Advocate, Report to Congress: Fiscal Year 2011 Objectives, June 30, 2010, http://www.irs.gov/pub/irs-utl/nta2011objectivesfinal.pdf, pp. 9-13; National Federation of Independent Business release, July 25, 2010, http://www.nfib.com/LinkClick.aspx?fileticket=e8uuuI20Cbs%3d&tabid=1083

[x] Administration regulations whose economic impact analyses assumed an increase in health insurance premiums (whether the regulations quantified those increases or not) included those on coverage of dependent children under age 26, published in Federal Register May 13, 2010, http://edocket.access.gpo.gov/2010/pdf/2010-11391.pdf; coverage of pre-existing conditions for children, annual and lifetime limits, rescissions, designation of primary care providers, designation of pediatrician as primary care providers, patient access to obstetrical and gynecological care, and coverage of emergency services, all published in Federal Register June 28, 2010, http://edocket.access.gpo.gov/2010/pdf/2010-15278.pdf; and coverage of preventive services, published in Federal Register July 19, 2010, http://edocket.access.gpo.gov/2010/pdf/2010-17242.pdf.

[xi] Obama for America campaign document, “Background Questions and Answers on Health Care Plan,” http://www.barackobama.com/pdf/Obama08_HealthcareFAQ.pdf; “Health Plan from Obama Spurs Debate” by Kevin Sack, New York Times July 23, 2008, http://www.nytimes.com/2008/07/23/us/23health.html?ei=5124&en=59763b2937c15bd3&ex=1374552000&partner=permalink&exprod=permalink&pagewanted=print

[xii] Congressional Budget Office, Letter to the Honorable Jerry Lewis regarding the effects of H.R. 3590, May 11, 2010, http://www.cbo.gov/ftpdocs/114xx/doc11490/LewisLtr_HR3590.pdf

[xiii] Richard Foster, Centers for Medicare and Medicaid Services, Estimated Financial Effects of the “Patient Protection and Affordable Care Act,” as amended, April 22, 2010, http://www.cms.gov/ActuarialStudies/Downloads/PPACA_2010-04-22.pdf

[xiv] Ibid.

[xv] Interim final rule by Departments of Labor, Treasury, and Health and Human Services regarding grandfathered health insurance status, released June 14, 2010, http://edocket.access.gpo.gov/2010/pdf/2010-14488.pdf, Table 3, p. 34553

[xvi] “New Health Official Faces Hostility in the Senate” by Robert Pear, New York Times July 27, 2010, http://www.nytimes.com/2010/07/27/us/politics/27berwick.html?_r=2&src=twt&twt=nytimeshealth; Centers for Medicare and Medicaid Services Fiscal Year 2010 Budget Justification, http://www.cms.gov/PerformanceBudget/Downloads/CMSFY10CJ.pdf, p. 2; “Rethinking Comparative Effectiveness Research,” An Interview with Dr. Donald Berwick, Biotechnology Healthcare June 2009, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2799075/pdf/bth06_2p035.pdf

More on Missouri’s Mandate Meltdown

The Washington Post carries a story this morning analyzing the impact of Proposition C’s overwhelming victory in Missouri on Tuesday, noting that even supporters of the law admitted that “a lack of public support” evidenced by the Missouri result “could make it hard to put the law into practice.”  Supporters of the law also argued that “People don’t understand that the mandate is not happening in a vacuum.”  This argument is akin to earlier assertions that because individuals like some parts of the law (i.e. the benefits), it will become popular – which is a bit like saying that individuals will support the idea of the federal government giving them a free car, if only you don’t mention to them that their taxes will go up to pay for it (as they will under the health care law).

The Post article also includes comments from health care law supporters stating that the Missouri result was skewed by “a very small percentage of registered voters…very conservative primary races were being decided.”  However, as this morning’s Wall Street Journal editorial notes (and as we commented in this space yesterday), the referendum won “with 668,000 votes, yet just 578,000 Republicans cast a ballot in the concurrent primaries,”  meaning tens of thousands of Democrats – Democrats who vote in primaries (i.e. the party base) – supported the referendum and opposed the mandate.

On a related note, Jonathan Gruber and the Center for American Progress released a paper today regarding the individual mandate (which, coincidentally, is very similar to a paper on the same subject Gruber and CAP released in April).  It alleges that removing the law’s mandate would result in only 6.8 million newly insured individuals, as opposed to the 32.1 million he estimates will obtain coverage under the law.

In other words, a paid Administration advisor has publicly admitted that more than 25 million individuals will obtain health coverage, not because they need it, want it, or find it of particular value – but solely because the federal government is forcing them to buy it, and taxing them if they do not.  So it’s worth asking:  Why do Democrats insist on moving forward with this intrusive and punitive system imposed by the federal government, even when voters say they don’t want it?  And how does forcing 25 million Americans to buy insurance coverage under penalty of taxation classify as “reform?”