Analyzing the Gimmicks in Warren’s Health Care Plan

Six weeks ago, this publication published “Elizabeth Warren Has a Plan…For Avoiding Your Health Care Questions.” That plan came to fruition last Friday, when Warren released a paper (and two accompanying analyses) claiming that she can fund her single-payer health care program without raising taxes on the middle class.

Both her opponents in the Democratic presidential primary and conservative commentators immediately criticized Warren’s plan for the gimmicks and assumptions used to arrive at her estimate. Her paper claims she can reduce the 10-year cost of single payer—the amount of new federal revenues needed to fund the program, over and above the dollars already spent on health care (e.g., existing federal spending on Medicare, Medicaid, etc.)—from $34 trillion in an October Urban Institute estimate to only $20.5 trillion. On top of this 40 percent reduction in the cost of single payer, Warren claims she can raise the $20.5 trillion without a middle-class tax increase.

The Left’s Health Care Vision a Prescription for Brute Government Force

Even as Democrats inveigh against President Trump for his alleged norm-shattering and contempt for the rule of law, their health care plans show a growing embrace of authoritarianism. For instance, Rep. Adam Schiff (D-CA) recently dubbed the President’s July 25 call with Ukrainian President Volodymyr Zelensky “a classic mafia-like shakedown.” He knows of which he speaks, because the Democratic agenda on health care now includes threats to destroy any entities failing to comply with government-dictated price controls.

The latest evidence comes from Colorado, where several government agencies recently submitted a draft report regarding the creation of a “state option” for health insurance. The plan would not create a state-run health insurer; instead, it would see agencies dragooning private sector firms to comply with government diktats.

The plan would “require insurance carriers that offer plans in a major market,” whether individual, small group, or large group, “to offer the state option as well.” In these state-mandated plans insurers must offer, carriers would have to abide by stricter controls on their administrative costs, in the form of medical loss ratio requirements, than those dictated by Obamacare.

For medical providers, the Colorado plan would use “payment benchmarks” to cap reimbursement amounts for doctors and hospitals. And if hospitals decline to accept these government-imposed price controls, the report ominously says that “the state may implement measures to ensure health systems participate.”

In comments to reporters, Colorado officials made clear their intent to coerce providers into this price-controlled system. Insurance Commissioner Michael Conway admitted that “If our hospital systems don’t participate, this won’t work….We can’t allow that to happen.” The head of Colorado’s Department of Health Care Policy and Financing, Kim Bimestefer, said that “if we feel that the hospitals are not going to participate, we will require their participation.”

State officials did not elaborate on the mechanisms they would use to compel participation in the state option. But they could attempt to require hospitals and insurers to participate in the new plan to maintain their license to operate in Colorado—a likely unconstitutional condition of licensure.

In threatening this level of coercion—agree to price controls, or we’ll shut down your business—Colorado Gov. Jared Polis imitated his fellow Democrat, House Speaker Nancy Pelosi. Pelosi’s proposed drug pricing bill, up for a vote in the House as soon as next month, would impose excise taxes of up to 95 percent of a drug’s sale price if companies refuse to “negotiate” with the federal government.

In its analysis of Pelosi’s legislation, the Congressional Budget Office (CBO) noted that, because drug makers could not deduct the 95 percent excise tax for income tax purposes, “the combination of income taxes and excise taxes on the sales could cause the drug manufacturer to lose money if the drug was sold in the United States.” Perhaps unsurprisingly, CBO concluded that the excise tax would not generate “any significant increase in revenues,” as “manufacturers would either participate in the negotiating process”—because they have no effective alternative—“or pull a particular drug out of the U.S. market entirely.”

CBO also noted, in a classic bit of understatement, that Pelosi’s bill “could result in litigation,” for threatening losses on any company that dares defy the government’s offer of “negotiation.” But the left seems uninterested in abiding by limits on government power—or the consistency of its own arguments. As I noted this spring, other proposed legislation in Congress would abolish the private health care market. Less than one decade after forcing all Americans to buy a product for the first time ever, in the form of Obamacare’s insurance mandate, liberals now want to prohibit all Americans from purchasing care directly from their doctors.

These recent proposals continue a virulent strain of authoritarianism that has permeated progressivism’s entire history. Franklin Roosevelt threatened to invoke emergency powers during his first inaugural address, and Rahm Emanuel infamously said during the Great Recession that “you never want a serious crisis to go to waste.” Make no mistake: The health care system needs patient-centered reform. But the true crisis comes from the progressives who would utilize blunt government force to seize control of one-fifth of the nation’s economy.

This post was originally published at The Daily Wire.

How the Impeachment Frenzy Could Block Bad Health Care Policies

House Democrats’ headlong rush to impeach President Trump will have many implications for American politics and the presidential election. On policy, it could have a salutary effect for conservatives, by precluding the enactment of harmful policies that would push our health care system in the wrong direction.

Congress should of course do something about our health care system, particularly the millions of individuals priced out of insurance by Obamacare, also known as the Unaffordable Care Act. But in recent weeks, it appears that Republicans have fallen into the typical definition of bipartisanship—when conservatives agree to do liberal things. As a result, if the controversy over impeachment leads to a legislative stalemate over health care, it will at least prevent Congress from making our current flawed system any worse.

Renewed Impeachment Push

The emerging controversy over Trump’s interactions with Ukraine, and whether those actions constituted an impeachable offense, resulted in analyses of whether and how the impeachment push will affect the legislative agenda on multiple issues, including health care.

Multiple Republicans suggested impeachment could bring Congress’ other work to a halt, whether by consuming the time and energy of members of Congress and staff, poisoning the proverbial well for negotiations and compromise, or a combination of the two. Consider the following quotes from Republicans in a Wednesday story:

  • House Ways and Means Committee Ranking Member Kevin Brady (R-Texas): “Impeachment makes a toxic environment more toxic.”
  • Former House Freedom Caucus Chairman Mark Meadows (R-N.C.): “There is more oxygen on impeachment than there is on legislation….My Democratic colleagues have put everything on hold to try to make sure that this President is not the one that signs any proposed bills.”
  • President Trump: Nancy Pelosi has “been taken over by the radical left. Unfortunately, she’s no longer the Speaker of the House.”
  • The White House: Democrats have “destroyed any chances of legislative progress” with their focus on impeachment.

Ultimately, whether any major legislation passes in this environment, whether on health care or other issues, will depend on two factors. First, will President Trump want to strike legislative bargains with House Democrats at the same time the latter are working to impeach and remove him from office? On that front, color me skeptical, at best.

Second, at a time when Trump will need Republicans to support him in an impeachment fight, will he aggressively push policies that many of them oppose?

Controversial Agenda in Congress

In July, the Senate Finance Committee approved drug pricing legislation over the concerns of many Republicans. A majority of Republicans voted against the Finance Committee bill, believing (correctly) that its provisions limiting price increases for pharmaceuticals amounted to price controls, which would have a harmful impact on innovation.

Since that time, House Speaker Nancy Pelosi (D-Calif.) has taken ideas from Senate Finance Committee Chairman Chuck Grassley (R-Iowa), and the Trump administration, and put them on steroids. The drug pricing legislation she recently introduced as H.R. 3 would force drug companies into a “negotiation” with defined price limits, confiscating virtually all their revenues if they do not submit to these government-imposed price controls.

Likewise, Congress’ action on “surprise” billing appears ominous. While Washington should allow states to come up with their own solutions to this issue, some Republicans want Congress to intervene.

Save Us from ‘Socialism-Lite’

If Congress’ legislative agenda grinds to a halt over a combination of the impeachment food fight and the impending 2020 presidential campaign, it would mean that lawmakers at least did not make the health care system worse via a series of socialist-style price controls.

The American people do deserve better than the failed status quo. They need the enactment of a conservative health care agenda that will help lower the skyrocketing cost of health care.

But if Republicans have failed to embrace such an agenda, as by and large they have, at least they can stop doing any more damage through new policies that will push us further in the direction of government-run health care. Thankfully, Pelosi’s newfound embrace of a march towards impeachment may slow the march towards socialized medicine—at least for the time being.

This post was originally published at The Federalist.

The Good, The Bad, and The Ugly of Nancy Pelosi’s Drug Pricing Proposal

During the midterm election campaign, Democrats pledged to help lower prescription drug prices. Since regaining the House majority in January, the party has failed to achieve consensus on precise legislation to accomplish that objective.

However, on Monday a summary of proposals by House Speaker Nancy Pelosi (D-CA)—which became public via leaks from lobbyists, of course—provided an initial glimpse of the Democrat leadership’s policy approach. Party leaders claimed the leaked document describes an old legislative draft (they would say that, wouldn’t they?).

The Good: Realigning Incentives in Part D

Among other proposals, the Pelosi proposal would rearrange the current Part D prescription drug benefit, and “realign incentives to encourage more efficient management of drug spending.” Under current law, once beneficiaries pass through the Part D “doughnut hole” and into the Medicare catastrophic benefit, the federal government pays for 80 percent of beneficiaries’ costs, insurers pay for 15 percent, and beneficiaries pay for 5 percent.

This existing structure creates two problems. First, beneficiaries’ 5 percent exposure contains no limit, such that seniors with incredibly high drug spending could face out-of-pocket costs well into the thousands, or even tens of thousands, of dollars.

The Pelosi proposal follows on plans by MedPAC and others to restructure the Part D benefit. Most notably, the bill would institute an out-of-pocket spending limit for beneficiaries (the level of which the draft did not specify), while reducing the federal catastrophic subsidy to insurers from 80 percent to 20 percent. The former would provide more predictability to seniors, while the latter would reduce incentives for insurers to drive up overall drug spending by having seniors hit the catastrophic coverage threshold and thus can shift most of their costs to taxpayers.

The Bad: Price Controls

The Pelosi document talks about drug price “negotiation,” but the policy it proposes represents nothing of the sort. For the 250 largest brand-name drugs lacking two or more generic competitors, the secretary of Health and Human Services would “negotiate” prices. However, Pelosi’s bill “establishes an upper limit for the price reached in any negotiation as no more than” 120 percent of the average price in six countries—Australia, Canada, France, Germany, Japan, and the United Kingdom—making “negotiation” the de facto imposition of price controls.

Drug manufacturers who refuse to “negotiate” would “be assessed an excise tax equal to 75 percent of annual gross sales in the prior year,” what Pelosi’s office called a “steep, retroactive penalty creat[ing] a powerful financial incentive for drug manufacturers to negotiate and abide by the final price.” Additionally, the “negotiated” price would apply not just to Medicare, but would extend to other forms of coverage, including private health insurance.

But the solution to that dilemma lies in trade policy, or other solutions short of exporting other countries’ price controls to the United States, as outlined in both the Pelosi and Trump approaches. Price controls, whether through the “negotiation” provisions in the Pelosi bill, or related provisions that would require rebates for drugs that have increased at above-inflation rates since 2016, have brought unintended consequences whenever policy-makers attempted to implement them. In this case, price controls would likely lead to a significant slowdown in the development and introduction of new medical therapies.

The Ugly: New Government Spending

While the price controls in the drug pricing plan have attracted the most attention, Democrats have mooted some version of them for years. Price controls in a Democratic drug pricing bill seem unsurprising—but consider what else Democrats want to include:

With enough savings, H.R. 3 could also fund transformational improvements to Medicare that will cover more and cost less—potentially including Medicare coverage for vision, hearing, and dental, and many other vital health system needs.

In other words, Pelosi wants to take any potential savings from imposing drug price controls and use those funds to expand taxpayer-funded health care subsidies. In so doing, she would increase the fiscal obligations to a Medicare program that is already functionally insolvent, and relying solely on accounting gimmicks included in Obamacare to prevent shortfalls in current seniors’ benefits.

This post was originally published at The Federalist.

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

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

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

Democrats Don’t Want to Vote on Hyde

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

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

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

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

How Far Will They Go?

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

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

This Is All Just Failure Theater

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

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

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

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

Flip-Flops Ahead

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

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

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

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

This post was originally published at The Federalist.

Democrats’ Single-Payer Health Care Bill Raises Serious Questions

On Tuesday, the House’s Democratic majority will hold its first formal proceedings on single payer legislation. The House Rules Committee hearing will give supporters an opportunity to move past simplistic rhetoric and answer specific questions about H.R. 1384, the House single payer bill, such as:

Section 102(a) makes “every individual who is a resident of the United States” eligible for benefits, regardless of their citizenship status. But in September 1993, Hillary Clinton testified before Congress that she opposed “extend[ing]” benefits to “those who are undocumented workers and illegal aliens,” because “too many people come [to the United States] for medical care as it is.” Do you agree with Secretary Clinton that single payer will encourage “illegal aliens” to immigrate to the United States for “free” health care?

Section 102(b) prevents individuals from traveling to the United States “for the sole purpose of obtaining” benefits. Does this provision mean that foreign nationals can receive taxpayer-funded health care so long as they state at least one other purpose—for instance, visiting a tourist site or two—for their travels?

Section 104(a) prohibits any participating provider from “den[ying] the benefits of the program” to any individual for any of a series of reasons, including “termination of pregnancy.” What if the nation’s more than 600 Catholic hospitals—which collectively treat more than one in seven American patients—refuse to join the government program because this anti-conscience provision forces them to perform abortions and other procedures in violation of their deeply-held religious beliefs? How will the government program make up for this lost capacity in the health care system?

Section 201(a) requires the Secretary of Health and Human Services (HHS) to compile a list of “medically necessary or appropriate” services that the single payer program will cover. Does anything in the bill prohibit the Secretary from including euthanasia—now legal in at least eight states—on that list of covered benefits?

Section 401(b) requires HHS to compile an “adequate national database,” which among other things must include information on employees’ hours, wages, and job titles. Will America’s millions of health care workers appreciate having the federal government track their jobs and income? Why does the bill contain not a word about employees’ privacy in this “adequate national database?”

Section 611 creates a system of global budgets to fund hospitals’ entire operating costs through one quarterly payment. But what if this lump-sum proves insufficient? Will hospitals have to curtail operations at the end of each quarter if they exceed the budget government bureaucrats provide to them?

Section 614(b)(2) prohibits payments to providers from being used for any profit or net revenue, essentially forcing for-profit hospital, nursing home, hospice, and other providers to convert to not-for-profit status. Coming on top of the bill’s virtual abolition of private insurers, how much will this collective destruction of shareholder value hurt average Americans’ 401(k) balances?

Section 614(c)(4) prohibits hospital providers from using federal operating funds to finance “a capital project funded by charitable donations” without prior approval. Does this restriction—preventing hospitals from opening new wings funded by private dollars—demonstrate how single payer will ration access to care, by limiting the available supply?

Section 614(f) bars HHS from “utiliz[ing] any quality metrics or standards for the purposes of establishing provider payment methodologies.” Does this prohibition on tying any provider payments to quality metrics serve as confirmation of the low-quality care a single payer system will give to patients?

Section 616 states that, if drug and device manufacturers will not agree to an “appropriate” price for their products—as defined by the government, of course—the HHS Secretary will license their patents away to other companies. But the average pharmaceutical costs approximately $2.6 billion to bring to market. How many fewer drugs will come to market in the future due to this arbitrary restriction on innovation?

Section 701(b)(2)(B) sets future years’ appropriations for the program based in part on “other factors determined appropriate by the [HHS] Secretary.” But this month, Nancy Pelosi filed suit against President Trump’s border emergency declaration, after she claimed that the declaration “undermines the separation of powers and Congress’s [sic] power of the purse.” How does allowing an unelected executive branch official to determine trillions of dollars in appropriations uphold Congress’ “power of the purse?”

Section 901(a)(1)(A) states that “no benefits shall be available under Title XVIII of the Social Security Act”—i.e., Medicare—two years after enactment. How does abolishing the current Medicare program square with the bill’s supposed title of “Medicare for All?”

If single payer supporters can answer all these queries at Tuesday’s hearing, many observers will only have one other question: Why anyone thought the legislation a good idea to begin with.

This post was originally published at Fox News.

Nancy Pelosi Violated Her Oath of Office

At their swearing in, members of Congress take an oath to “support and defend the Constitution of the United States.” Few members would openly admit to violating that oath. Nancy Pelosi just did.

In filing a lawsuit against Donald Trump’s border emergency late last week, the House speaker claimed that “the House will once again defend our democracy and our Constitution, this time in the courts.” But the facts demonstrate that the last time the House defended the Constitution in the courts, Pelosi actively worked to undermine that defense of constitutional principles.

Lawsuits, Then and Now

The complaint Pelosi filed last week claims that, in using the National Emergencies Act to redirect funds towards border security, President Trump violated both underlying statutes and Congress’ constitutional duty to appropriate funds. Unfortunately, however, as I pointed out at the time of the border declaration, it did not represent the first time the executive has violated both statutes and Congress’ appropriations power.

The text of Obamacare did not contain an appropriation for cost-sharing subsidies, which offset discounts on co-pays and deductibles provided to low-income individuals. The Obama administration requested funds for those subsidies, just as Trump requested funds for border security. In both cases, Congress turned down those requests—and in both cases, the executive concocted legal arguments to spend the funds anyway.

But when the House of Representatives sued in 2014 seeking to block President Obama’s unconstitutional appropriation of funds, did Pelosi—who claimed last week to “defend our democracy and our Constitution”—support the complaint? Quite the contrary. In fact, she filed two legal briefs in court objecting to the House’s suit, and claiming that Obamacare implied an appropriation for the cost-sharing subsidies.

Abrogating Congress’ Institutional Prerogatives

In a word, no. In the Obamacare lawsuit, she not only attacked House Republicans’ claims regarding the merits of their case, she attacked the House’s right to bring the claim against the executive in court.

When it comes to whether the House has suffered an injury allowing it to file suit, compare this language in the House’s lawsuit against Trump: “The House has been injured, and will continue to be injured, by defendants’ unlawful actions, which, among other things, usurp the House’s legislative authority,” with Pelosi’s claims in her brief regarding the Obamacare lawsuit:

Legislators’ allegations that a member of the executive branch has not complied with a statutory requirement do not establish the sort of “concrete and particularized” injury sufficient to satisfy Article III’s standing requirements….

[Permitting the House’s suit] would disturb long-settled and well-established practices by which the political branches mediate interpretive disputes about the meaning of federal law, and it would encourage political factions within Congress to advance political agendas by embroiling the courts in innumerable political disputes that are appropriately resolved using those long-established practices….Allowing suit in this case undermines, rather than advances, [Members’ institutional] interests—inevitably subjecting Congress to judicial second-guessing never contemplated by the Framers of the Constitution and compounding opportunities for legislative obstruction in ways that could greatly increase congressional dysfunction.

Also compare Pelosi’s language when talking about remedies available to the House with regards to Trump: “The House has no adequate or available administrative remedy, and/or any effort to obtain an administrative remedy would be futile,” with her claims that House Republicans had all sorts of options available to them to stop President Obama’s unconstitutional payments, short of going to court:

Concluding that there is standing in this case is…completely unnecessary given alternative and more appropriate tools available to legislators to object to executive branch actions that they view as inconsistent with governing law….

To start, legislators may always challenge executive action by enacting corrective legislation that either prohibits the disputed executive action or clarifies the limits or conditions on such action….Further, Congress has other means to challenge disputed interpretive policies, including many that do not require the concurrence of both houses. For example, Congress can hold oversight hearings, initiate legislative proceedings, engage in investigations, and, of course, appeal to the public.

Put Principle over Politics

I find Trump’s border security declaration troubling for the same reason I found the Obamacare payments troubling: they usurp Congress’ rightful constitutional authority. I took some solace in knowing that several congressional Republicans—not enough, but several—voted against the emergency declaration, while many others who voted with the president nevertheless expressed strong misgivings about the move, as well they should.

Compare that to congressional Democrats, not a single one of whom aired so much as a peep about Barack Obama “stealing from appropriated funds,” to use Pelosi’s own words regarding the Obamacare lawsuit. Would that more elected officials—both Republicans and Democrats—put constitutional first principles above partisan affiliations and political gain.

This post was originally published at The Federalist.

Liberals’ Situational Ethics on Constitutional Violations

A president requests billions of dollars to fulfill his main campaign promise. Congress turns him down, but the president finds a way to go around them and get his money anyway.

Donald Trump and his border emergency? Sure. But this description also applies to Barack Obama’s treatment of Obamacare. Examined from this context, the health care history raises questions about whether liberals’ outrage over Trump’s emergency declaration stems from his extralegal actions—or their underlying opposition to his border policies.

The Obama administration knew full well it lacked a lawful appropriation for the insurer payments. In 2013, it requested billions of dollars from Congress for such spending. But Congress refused to appropriate the money. Republicans, who by then controlled the House of Representatives, had no interest in giving dollars to prop up Obamacare, and even Democratic appropriators seemingly had other priorities to fund rather than insurer payments.

Facing a refusal from Congress to appropriate the cost-sharing subsidies, the Obama administration went ahead and spent the funds anyway. Administration officials concocted a theory that even though an express appropriation for the payments did not exist in law, the health care law implied an appropriation of funds. They paid the cost-sharing subsidies to insurers in conjunction with Obamacare’s premium subsidies, even though the two programs are authorized in different sections of the law, and should operate via two different cabinet departments.

Granted, the Obama administration used much more surreptitious means to accomplish its unconstitutional ends. Unlike Trump, who announced his emergency declaration to much fanfare, his predecessor did not draw attention to his extralegal maneuvering. It took House Republicans seven months to authorize a suit objecting to Obama’s actions. But the only two federal courts to rule on the matter found that the law did not include an appropriation for the cost-sharing payments, meaning that Obama violated the Constitution’s appropriations clause by spending funds without authorization.

In two separate legal briefs, the then-House minority leader claimed Obamacare did appropriate funds for the cost-sharing payments to insurers—a claim that federal courts rejected. But her briefs went even further, claiming that Congress had no standing to object to the executive’s encroachment on its spending power.

Pelosi’s briefs in the Obamacare case present numerous objections to Congress’ suit against the executive. She claimed that “allowing suit in this case undermines, rather than advances, [the House’s institutional] interests,” and would “subject Congress to judicial second-guessing” and allow for “legislative obstruction.” She argued that the House of Representatives had no standing to pursue claims against the executive on its own, without the Senate’s concurrence. And she pointed out that “Congress has numerous tools at its disposal to resolve routine disputes,” for instance “corrective legislation that…prohibits the disputed executive action.”

Pelosi claimed last week that Republicans’ decision to endorse Trump’s emergency declaration will set a precedent they will come to regret. She knows of which she speaks. While researching the issue in recent months, I found that Pelosi’s briefs from the Obamacare case mysteriously disappeared from her website (although thankfully are still archived online.) Quite possibly, Pelosi’s staff decided to remove the briefs from her website upon retaking the majority, because they recognize the inconvenient precedent they set—and which Pelosi will now have to explain away in both the legal and political realms.

Call this a hunch, but I doubt that…the Democratic lawmakers would content themselves with the remedies they have laid forth in their brief about Obamacare’s cost-sharing subsidies. Faced with a President spending billions of dollars on a deportation force never appropriated by Congress, would Nancy Pelosi merely content herself with conducting hearings and ‘appeal[ing] to the public,’ as her brief argues in the Obamacare context? Hardly.

That November 2016 article proved prescient in highlighting the dangers of situational ethics—politicians putting immediate policy wins ahead of larger constitutional principles. More than two years later, Pelosi may soon reap the whirlwind, when Trump’s Justice Department uses her Obamacare briefs to argue that the House of Representatives has no standing to challenge his emergency declaration.

Congressional Republicans should learn from Pelosi’s example, stand fast to their principles, and call Trump’s action for what it is: A usurpation of Congress’ power of the purse, a breach of the separation of powers, and a violation of the principles of limited government that conservatives hold dear.

This post was originally published at The Federalist.

Congress Prepares to Pass Another Huge Bill No One Has Read. Again.

Stop me if you’ve heard this one before: Congress rams through a massive piece of legislation costing hundreds of billions of dollars without bothering to read it. Meet Congress under a Democratic majority—same as under the old majority.

Late Wednesday evening, congressional leaders still had not publicly released their omnibus appropriations legislation, and were not planning to do so until near midnight—hardly an auspicious time to embark on reading a bill exceeding 1,000 pages.

Those predictions ended up largely on the mark. The bill as introduced amounted to “only” 1,169 pages. But House leaders didn’t post the final version online until 1:20 a.m. on Thursday—the same day as the intended vote.

As Yogi Berra might say, when it comes to Congress’s bipartisan willingness to ram through massive bills, “It’s déjà vu all over again.”

Pelosi Breaks Her Promise

Of all things, Politico reported that one of the major holdups preventing an earlier public release included provisions having nothing to do with government spending—or, for that matter, border security:

“Congressional leaders are still haggling over an extension of the landmark Violence Against Women Act—one of the final hold-ups in a funding deal to avert a shutdown on Friday….One dispute centers on a Democratic push to add protections for transgender people, which the GOP is resisting; meanwhile, Republicans want more time to negotiate a broader deal, according to lawmakers and aides.”

Democrats in the House of Representatives promised that this time would be different. In a summary of their rules package for the 116th Congress—one which they released fewer than six weeks ago, remember—they pledged the following:

“ALLOW TIME TO READ THE BILL Require major bill text to be available for 72 hours before the bill can proceed to the House Floor for a vote. The current House rule only requires slightly more than 24 hours of availability.”

(Emphasis in the original.)

Their rules package did change the prior House rule, which had previously called for a three-calendar-day “reading period”—meaning that a bill promulgated at 11:59 p.m. on Monday could be voted on at 12:01 a.m. Wednesday, barely 24 hours after its release—to allow a full 72 hours for review.

And particularly in this case, Democrats find giving people time to read the bill inconvenient. Even though government funds won’t expire until Friday at midnight—and Congress could always extend that funding temporarily, to allow for more time to review the bill—both chambers want to vote on Thursday. Because heaven forbid Congress 1) do actual work on a Friday and 2) delay their “recess” (read: vacation) and their overseas trips during same. (Democratic leaders claimed their members have been “sufficiently briefed”—because it’s very easy to “brief” someone on most, let alone all, of the contents of a 1,200 page bill.)

In other words, the new House Democratic majority has spent barely one month in office, and we’re already back to Speaker Nancy Pelosi (D-CA), circa 2010: “We have to pass the bill so that you can find out what is in it.”

Garbage In, Garbage Out

After last year’s omnibus fiasco, I wrote that members of Congress only had themselves to blame for the awful process leading to that 2,232 page bill:

“As the old saying goes, the true test of a principle comes not when that principle proves convenient, but when it proves inconvenient. Only when Members find themselves willing to take tough votes—and to abide by the outcome of those votes, even if it results in policy outcomes they disfavor—will the process become more open and transparent.”

This post was originally published at The Federalist.

Do House Republicans Support Socialized Medicine?

Health care, and specifically pre-existing conditions, remain in the news. The new Democratic majority in the House of Representatives has lined up two votes — one last week and one this week — authorizing the House to intervene in Texas’ lawsuit against the Affordable Care Act, also known as Obamacare. Speaker Nancy Pelosi, D-Calif., claims that the intervention will “protect” Americans with pre-existing conditions.

In reality, the pre-existing condition provisions represent Obamacare’s major flaw. According to the Heritage Foundation, those provisions have served as the prime driver of premium increases associated with the law. Since the law went into effect, premiums have indeed skyrocketed. Rates for individual health insurance more than doubled from 2013 through 2017, and rose another 30-plus percent last year to boot.

As a result of those skyrocketing premiums, more than 2.5 million people dropped their Obamacare coverage from March 2017 through March 2018. These people now have no coverage if and when they develop a pre-existing condition themselves.

A recent Gallup poll shows that Americans care far more about rising premiums than about being denied coverage for a pre-existing condition. Given the public’s focus on rising health care costs, Republicans should easily rebut Pelosi’s attacks with alternative policies that address the pre-existing condition problem while allowing people relief from skyrocketing insurance rates.

Unfortunately, that’s not what the Republican leadership in the House did. Last Thursday, Rep. Kevin Brady, R-The Woodlands, offered a procedural motion that amounted to a Republican endorsement of Obamacare. Brady’s motion instructed House committees to draft legislation that “guarantees no American citizen can be charged higher premiums or cost sharing as the result of a previous illness or health status, thus ensuring affordable health coverage for those with pre-existing conditions.”

If adopted — which thankfully it was not — this motion would only have entrenched Obamacare further. The pre-existing condition provisions represent the heart of the law, precisely because they have raised premiums so greatly. Those premium increases necessitated the mandates on individuals to buy, and employers to offer, health insurance. They also required the subsidies to make that more-expensive coverage “affordable” — and the tax increases and Medicare reductions needed to fund those subsidies.

More to the point, what would one call a health care proposal that treats everyone equally, and ensures that no one pays more or less than the next person? If this concept sounds like “socialized medicine” to you, you’d have company in thinking so. None other than Kevin Brady denounced Obamacare as “socialized medicine” at an August 2009 town hall at Memorial Hermann Hospital.

All of this raises obvious questions: Why did someone who for years opposed Obamacare as “socialized medicine” offer a proposal that would ratify and entrench that system further?

Republicans like Brady can claim they want to “repeal-and-replace” Obamacare from now until the cows come home, but if they want to retain the status quo on pre-existing conditions then as a practical matter they really want to uphold the law. Conservatives might wonder whether it’s time to “repeal-and-replace” Republicans with actual conservatives.

This post was originally published in the Houston Chronicle.