Heritage Health Care Repeal Hooey

In recent days I've been in a twitter debate with some Tea Party/#TCOT Conservatives, for once it's actually been rational and respectful. I find that debating someone that disagrees isn't pointless if you goal isn't just to prove them wrong, but to actually improve your own position and understanding. As a result I've learned a great deal.

Most of the discussion has revolved, naturally, around the Health Care Reform Law, and this happens to be something I know very well. Now I know it even better.



Their primary objection is that it's a "Unconstitutional" for the Federal Government to require people to buy something when they don't want to. When you point out the State Governments already require people to buy auto liability insurance, they seem fine with that as not "Unconstitutional", and apparently seem to feel there's some kind of mutual exclusivity between what a State can do and what the Fed can do - and the problem is there isn't.

Written directly into the law (pdf) itself is a reference to a 1944 Supreme Court Decision which established that Congress has the ability to regulate Insurance under the Interstate Commerce Clause of the Constitution.

UNITED STATES V. SOUTH-EASTERN UNDERWRITERS, 322 U. S. 533 (1944) which found.

1. A fire insurance company which conducts a substantial part of its business transactions across state lines is engaged in "commerce among the several States," and subject to regulation by Congress under the Commerce Clause. P. 322 U. S. 539.

2. A conspiracy to restrain interstate trade and commerce by fixing and maintaining arbitrary and noncompetitive premium rates on fire and allied lines of insurance, and a conspiracy to monopolize interstate trade and commerce in such lines of insurance, held violations of the Sherman Antitrust Act. P. 322 U. S. 553.

3. Congress did not intend that the business of insurance should be exempt from the operation of the Sherman Act. Pp. 322 U. S. 553, 322 U. S. 560.

Even further in one of the numerous and sundry challenges to the Constitutionality of the Health Reform Act, a federal judge has already found that the Individual Mandate is in fact, Constitutional.

In Detroit today, U.S. District Court Judge George Steeh refused to issue a preliminary injunction to delay implementing the law in the state. He also dismissed the key contention of the bill's conservative opponents: that a mandate requiring individuals to buy health insurance is unconstitutional.

"This ruling marks the first time a court has considered the merits of any challenge to this law and we welcome the court's decision upholding the health care reform statute as constitutional," says DOJ spokeswoman Tracy Schmaler. "The court found that the minimum coverage provision of the statute was a reasonable means for Congress to take in reforming our health care system. The department will continue to vigorously defend this law in ongoing litigation."

Ok, so that's two steaming bowls of hot fail. But that doesn't stop them.

Tell me one other thing that the Federal Government Makes you Buy?

How about two? Social Security & Unemployment Insurance.

At this point they duck the issue and argue that they oppose Social Security, and think it should be privatized - ignoring the fact that the Federal Government makes you BUY IT by taxing you for it. The Individual Mandate is actually far more mild and less intrusive than Social Security as a tax because it comes with heaping piles of exemptions. Anyone on Medicare, Medicaid, Tricare, VA or Employee based insurance is Exempt. Anyone who can't find an affordable plan, even with subsidies, is EXEMPT from the requirement. If you don't have coverage, can afford coverage and refuse to buy coverage you pay a fine through your taxes - but if you choose not to pay that fine you are EXEMPT from further punishment.

This is where their Extra-Constititution outrage stems? From a provision that absolutely *is* Constitutional, if somewhat annoying, where about 95% of the public is completely Exempt from it? Only those people who have the funds, but refuse to take responsibility and protect their own health, instead putting themselves - and potentially the public - at risk are affected because their irresponsibility results in the Making the Public Pay For Them to the tune of $48 Billion a Year.

Yet somehow Conservatives simply don't like the idea of people paying their own way anymore and reducing this cost to government and the rest of us? Incredible.

To be fair, the truth is the people on the left don't like the Individual Mandate anymore than people on right, only they don't like it for a reason that's real: It has the potential to be a massive candy store give-away of new customers to the Insurance Industry.

As it's written the law allows for "Waivers for State Innovation" that allow various states who come up with their own plan to be Exempt from the law, but from what I've read I don't think the scope of those waivers extend to allowing an entire State citizens to fore-go the mandate - but then again if a implement Single Payer as Vermont is currently considering, it becomes a moot point. If everyone in a State is covered, everyone in that State is exempt from the mandate.

Poof, No more mandate for that state.

The real meat of things came when they started suggesting that the solution to our Health Care problems have been provided by the Heritage Foundation.

Beyond the unprecedented mandates, new taxes, massive entitlement expansion, unworkable and costly insurance provisions, and its failure to control costs,[2] the new law concentrates enormous power in the U.S. Department of Health and Human Services (HHS). It creates a giant network for the federal micromanagement of health plans, benefits, insurance markets, and unprecedented intervention into the details of health care financing and the delivery of medical care.[3]

I would grant that the individual responsibility mandate is new and unique, but I wouldn't say it's completely "unprecedented". It's a tax credit, just like the first time home buyers tax credit. If you purchase you get a tax benefit, if you don't purchase you pay a tax. It's not that new an idea, but that's really the only "New Tax" in the plan - most of the rest of it includes tax relief and credits. Small Businesses - as of now - get a 35% tax credit on their Health Insurance Costs, which goes up to 50% in 2014. Individuals who buy health insurance get a tax credit too as well as subsidies if they are low income.

As far as "massive entitlement" expansion, that's actually not true. Medicaid was expanded somewhat and better funded up to 133% of the Federal Poverty Line, but generally speaking 90% of the plan doesn't change anything about how people currently buy their insurance via their employer. That stays the Same. This plan gives some people the ability to buy insurance on their own that they couldn't get before due to rescission and pre-existing condition limits. That's not an "entitlement" when people are purchasing a service out of their own pocket, it's an Empowerment.

Their "Unworkable and costly insurance provisions" are that insurance companies now have to actually grant claims for people who get sick, especially children. That parents can keep their kids on their plan until their 26 if they want, for which they have to PAY for by the way. There can be no co-pays or deductibles for preventive and cancer screenings. HHS estimates are that all of these provisions will have an cost impact to insurance companies of about 1 to 2%. That's "Unworkable"? Really? I don't think so.

More Heritage.

The early result is a veritable flood of controversial rules and regulations, administrative decisions, and guidelines directly affecting the lives of millions of Americans. This regulatory regime, administered by unelected bureaucrats, is even more onerous because of the fundamental flaws of the hastily enacted legislation itself, including undefined provisions and unrealistic timeliness.

Actually HHS hasn't yet finished writing their guidelines after all these months. There is no "Veritable Flood" of regulation, if anything it's been a slow trickle. Also this Bill wasn't "hasty", Congress spent the better part of a year working on it. Honestly, these guys couldn't find a true fact with guide dog and a GPS.

The real kicker though, is what they recommend after the bill is repealed.

* Provide individual tax relief for all persons purchasing private health insurance, regardless of where they work;
* Eliminate barriers to individuals purchasing health care coverage that best suits their personal needs across state lines;

Tax credits and the ability to purchase across state lines with multi-state plans (Sec. 1334. Multi-State plans) are specifically In the Current Bill.

* Allow employers to convert their health care compensation from a defined benefit package to a defined contribution system;

I'm honestly not sure what that means, but it sounds like you don't get to buy based on what you want - but just your ability to pay. Weird, but I don't see how it increases access or quality of care one wit.

* Promote new group purchasing arrangements based on individual membership organizations and various associations, including union, fraternal, ethnic, and religiously based groups;

Purchasing through the Exchanges (Subtitle C. PART 2—CONSUMER CHOICES AND INSURANCE COMPETITION THROUGH HEALTH BENEFIT EXCHANGES), which are a Republican Idea, already do that - and even without it, what exactly is stopping any one from doing that now?

* Improve consumer-directed health options (such as health savings accounts, health reimbursement arrangements, and flexible spending accounts) that encourage greater transparency and consumer control over health care decisions;

Health Savings Accounts haven't worked because they go against the entire point of what Insurance does. Every form of Insurance decreases individual risk by sharing the burden (or wealth) across a group of contributors. In case your boat sinks, you contribute to a fund that provides for a rescue boat. A health savings account is like trying to save up for your own personal rescue boat, when you're still paying for your original boat. Some people might be able to afford two boats on their own, most won't. Pooling their funds is far more efficient, than everyone buying two boats just because one of them might sink. Yet again, this idea is a financial give-away to the insurance industry.

* Extend rational pre-existing condition protections in the non-group health insurance markets for those with continuous creditable coverage, thus rewarding responsible persons who buy and maintain coverage;

Meanwhile they would leave pre-existing condition limits in place for everyone else in the Group Markets they claim don't exist? Nice. The Current Bill bans these within the Exchange which affects the "Non-Group" market, but not for those currently getting their insurance on the Group/Employee market. So yet again, their suggestion is exactly what the law already does.

* Set up a fair competitive bidding process to determine government payment in traditional Medicare fee-for-service and Medicare Advantage programs;

That almost sounds like negotiating for the best price in the way that Bush barred Medicare from doing for drugs. Again weird.

* Review Medicare rules and regulations and eliminate those that unduly burden doctors and patients, such as the restriction preventing doctors and patients to contract privately for medical services outside of the traditional Medicare program;

Isn't contracting privately outside of Medicare exactly what Medicare Advantage Is, Supplemental Private Insurance over and above what Medicare itself does?

Yet again, reviewing the rules & regulations of Medicare is already in the current bill, and it's also what Conservatives have called a "CUT" of $500 Billion in the cost of Medicare. It's really just removing inefficiencies and duplication. Including...

PART 1—LINKING PAYMENT TO QUALITY OUTCOMES UNDER THE MEDICARE
PROGRAM
Sec. 3001. Hospital Value-Based purchasing program ................................
Sec. 3002. Improvements to the physician quality reporting system .........
Sec. 3003. Improvements to the physician feedback program ....................
Sec. 3004. Quality reporting for long-term care hospitals, inpatient rehabilitation
hospitals, and hospice programs .................................................

The goal here is primarily to improve the actual quality of care, and in the process reduce costs.

* Encourage the states to set up mechanisms such as high-risk pools and risk transfer models that help lessen the problems of individuals who are difficult to insure;

Again, this is in the bill - and these high-risk pools are already in place in over 30 states.

Sect 1101, Part 2, Paragraph (c) agree to utilize contract funding to establish and administer a qualified high risk pool for eligible individuals.

Where is the logic of repealing this bill, then immediately putting what you took away back in place again?

* Expand states’ ability to develop consumer-based reforms that enable states to customize solutions for their citizens;

For the Seventh time, that's also already in the bill in the form of "Waivers for State Innovation. Section 1335". Why does Heritage want to Repeal the Bill, then essentially Re-Instate the Same Bill?

* Strengthen premium assistance in Medicaid to enable young families to obtain private health insurance coverage;

Subsidies for Medicaid, isn't that an entitlement expansion? This is again, already in the bill (Sec. 1331. State flexibility to establish basic health programs for lowincome individuals not eligible for Medicaid) - but then so is extensive premium assistance for those who wish to buy their own private care instead. (Sect 1343, Part I)

* Improve patient-centered health care models for those on Medicaid;

That Medicaid just keeps getting bigger with Heritage doesn't? They have a single "Market Based" Solution other than tax cuts?

Also this is in the bill, and supplemented by suggestions to Congress from the newly formed Medicare Advisory Board under Sect 1322, Paragraph 4.

* Increase federal and state efforts to combat fraud and abuse in Medicaid, including tightening eligibility loopholes in Medicaid for long-term-care services;

Twelth Time, already in the bill under Sections 1102 & 1311 except not the part where we throw off people who need long term care, the ultimate "pre-existing condition".

* Encourage personal savings and the development of a robust private insurance market for long-term-care needs;

This sounds like Health Savings Accounts Redux.

* Make the ban on taxpayer-funded abortion permanent and government-wide and extend a similar permanent policy to ensure protection of the right of conscience among medical providers and personnel; and

The law follows the ban, and even goes a step further with the Stupak Amendment which restricts federal subsidies from being used to pay for abortion services by required the insured to pay for those services separately.

* Stop new tax increases and promote tax cuts that would expand private insurance coverage and grow the economy.

There are numerous tax cuts in the bill, both to individuals and to small business.

For example:

For purposes of subparagraph (A)(i), the amount of the monthly premium an individual is required to pay under either the standard health plan or the applicable second lowest cost silver plan shall be determined after reduction for any premium tax credits and cost-sharing reductions allowable with respect to
either plan

And ...

(F) Coverage within the small group market for small businesses and their employees, including reinsurance for] early retirees under section 1102, tax credits available under section 45R of the Internal Revenue Code of 1986 (as added by section 1421), and other information specifically for small businesses regarding affordable health care options.

That's 14 suggestions that are already in the law and a few Conservative Wish List Items that have never worked. It's almost like these guys didn't even read the law, and instead put out a political position paper of Talking Points that have no relation to the actual facts.

Oh, wait - we are talking about Heritage aren't we? They generate partisan lies for a living, it's why they exist.

The reality is that many on the left are frustrated with this bill as well. Those who wanted single payer are not happy (although the State Innovation Waivers do allow the possibility of them), and those who wanted the Public Option as an alternative are frustrated that this is missing. Conservative scream this is a "government takeover" when there really Isn't any new government component to the law at all other than the Exchanges where you can buy - Private Insurance.

Except for one thing... the bill allows the director of the Office of Personnel Management to sub-contract for two multi-state plans to be included in the Exchanges - one of whom has to be Not For Profit. The director can negotiate the premiums, medical loss ratio (over and above the 85% required by Exchanges) and profit margins of these contractors. It's essentially an outsourced Public Option, but it's just two of the plans that will be offered among others in the Exchange and still a long long way from a "Government Takeover".

CBO Scored the Bill after the Public Option was outsourced - along with some other changes - as actually being $2 Billion Cheaper than it had been previously.

You would think this might cheer up those on the left, but they've hardly even heard about it.

My twitter frenemies argue that this law was "Rammed down our throats" (And I couldn't believe he was actually repeated that tired old talking point) but the fact is that most people support reform, and in fact wanted reform that was Stronger than this bill including the full-on Public Option if not Single Payer.

Ipsos/McClatchy put out a health care poll two weeks ago. The topline results were nothing special: 34 percent favored "the health care reform proposals presently being discussed", versus 46 percent opposed, and 20 percent undecided. The negative-12 net score is roughly in line with the average of other polls, although the Ipsos poll shows a higher number of undecideds than most others.

Ipsos, however, did something that no other pollster has done. They asked the people who opposed the bill why they opposed it: because they are opposed to health care reform and thought the bill went too far? Or because they support health care reform but thought the bill didn't go far enough?

It turns out that a significant minority of about 25 percent of the people who opposed the plan -- or about 12 of the overall sample -- did so from the left; they thought the plan didn't go far enough.

If you take that 12 percent and put them in the Pro-Health Care Reform column it jumps from 34% approval to 46% and those opposed drops to 34%. The results FLIP.

This bill didn't go against the will of the American people, it implemented their will. The people who want to Repeal this Change aren't in the majority, the true majority stayed home this November.

If they'd known that an outsourced version of the Public Option actually did survive in the final bill providing exactly the downward cost pressure required to keep the mandate from becoming a Financial Free-For-All for the Insurance Industry, that outcome might have been very different.

Vyan