“I am sick and tired of people who say that if you debate, and you disagree with this administration, somehow you’re not patriotic and we should stand up and say, ‘We are Americans and we have a right to debate and disagree – with any administration!’”
Do you know who uttered the above statement?
In thinking about it, perhaps it was a conservative who’s fed up with Barack Obama? Or, it simply had to be a conservative Senator who has had enough of Obama’s Chicago-style politics, right?
What if we told you the above quote was actually uttered by Hillary Clinton – in 2003?! This in fact is the case! She says it’s patriotic to exercise your freedom of speech and assembly.
…Now, fast-forward to August 10, 2009:
“Un-American”
That’s what House Speaker Nancy Pelosi says of the demonstrators and protestors at health care town halls taking place across the country.
Who do you agree with?
That’s right – Hillary Clinton was correct when she stated we have the right to debate and disagree with any administration. That is why American Future Fund is encouraging our members to attend town halls across the country – and make your voice heard!
By clicking HERE, you can view a list of all town hall meetings for August - November.
Like Hillary Clinton says – you’re patriotic if you disagree with ANY administration. This includes Barack Obama’s.
Attend a town hall and make your voice heard!
CLICK HERE to find out when and where!
Sincerely,
Tuesday, August 11, 2009
Article from Chuck Norris about intrusive govt. in the health care reform bill
Health care reforms are turning into health care revolts. Americans are turning up the heat on congressmen in town hall meetings across the U.S.
While watching these political hot August nights, I decided to research the reasons so many are opposed to Obamacare to separate the facts from the fantasy. What I discovered is that there are indeed dirty little secrets buried deep within the 1,000-plus page health care bill.
Dirty secret No. 1 in Obamacare is about the government's coming into homes and usurping parental rights over child care and development.
It's outlined in sections 440 and 1904 of the House bill (Page 838), under the heading "home visitation programs for families with young children and families expecting children." The programs (provided via grants to states) would educate parents on child behavior and parenting skills.
The bill says that the government agents, "well-trained and competent staff," would "provide parents with knowledge of age-appropriate child development in cognitive, language, social, emotional, and motor domains ... modeling, consulting, and coaching on parenting practices," and "skills to interact with their child to enhance age-appropriate development."
Are you kidding me?! With whose parental principles and values? Their own? Certain experts'? From what field and theory of childhood development? As if there are one-size-fits-all parenting techniques! Do we really believe they would contextualize and personalize every form of parenting in their education, or would they merely universally indoctrinate with their own?
Are we to assume the state's mediators would understand every parent's social or religious core values on parenting? Or would they teach some secular-progressive and religiously neutered version of parental values and wisdom? And if they were to consult and coach those who expect babies, would they ever decide circumstances to be not beneficial for the children and encourage abortions?
One government rebuttal is that this program would be "voluntary." Is that right? Does that imply that this agency would just sit back passively until some parent needing parenting skills said, "I don't think I'll call my parents, priest or friends or read a plethora of books, but I'll go down to the local government offices"? To the contrary, the bill points to specific targeted groups and problems, on Page 840: The state "shall identify and prioritize serving communities that are in high need of such services, especially communities with a high proportion of low-income families."
Are we further to conclude by those words that low-income families know less about parenting? Are middle- and upper-class parents really better parents? Less neglectful of their children? Less needful of parental help and training? Is this "prioritized" training not a biased, discriminatory and even prejudicial stereotype and generalization that has no place in federal government, law or practice?
Bottom line: Is all this what you want or expect in a universal health care bill being rushed through Congress? Do you want government agents coming into your home and telling you how to parent your children? When did government health care turn into government child care?
Government needs less of a role in running our children's lives and more of a role in supporting parents' decisions for their children. Children belong to their parents, not the government. And the parents ought to have the right -- and government support -- to parent them without the fed's mandates, education or intervention in our homes.
Kids are very important to my wife, Gena, and me. That's why we've spent the past 17 years developing our nonprofit KICKSTART program in public schools in Texas. It builds up their self-esteem and teaches them respect and discipline. Of course, whether or not they participate in the program is their and their parents' choice.
How contrary is Obamacare's home intrusion and indoctrination family services, in which state agents prioritize houses to enter and enforce their universal values and principles upon the hearts and minds of families across America?
Government's real motives and rationale are quite simple, though rarely, if ever, stated. If one wants to control the future ebbs and flows of a country, one must have command over future generations. That is done by seizing parental and educational power, legislating preferred educational methods and materials, and limiting private educational options. It is so simple that any socialist can understand it. As Josef Stalin once stated, "Education is a weapon whose effects depend on who holds it in his hands and at whom it is aimed."
Before so-called universal health care turns into universal hell care, write or call your representative today and protest his voting Obamacare into law. Remind him that what is needed in Washington is a truly bipartisan group that is allowed an ample amount of time to work on a compromise health care law that wouldn't raise taxes (for anyone), regulate personal medical choices, ration health care or restrict American citizens.
While watching these political hot August nights, I decided to research the reasons so many are opposed to Obamacare to separate the facts from the fantasy. What I discovered is that there are indeed dirty little secrets buried deep within the 1,000-plus page health care bill.
Dirty secret No. 1 in Obamacare is about the government's coming into homes and usurping parental rights over child care and development.
It's outlined in sections 440 and 1904 of the House bill (Page 838), under the heading "home visitation programs for families with young children and families expecting children." The programs (provided via grants to states) would educate parents on child behavior and parenting skills.
The bill says that the government agents, "well-trained and competent staff," would "provide parents with knowledge of age-appropriate child development in cognitive, language, social, emotional, and motor domains ... modeling, consulting, and coaching on parenting practices," and "skills to interact with their child to enhance age-appropriate development."
Are you kidding me?! With whose parental principles and values? Their own? Certain experts'? From what field and theory of childhood development? As if there are one-size-fits-all parenting techniques! Do we really believe they would contextualize and personalize every form of parenting in their education, or would they merely universally indoctrinate with their own?
Are we to assume the state's mediators would understand every parent's social or religious core values on parenting? Or would they teach some secular-progressive and religiously neutered version of parental values and wisdom? And if they were to consult and coach those who expect babies, would they ever decide circumstances to be not beneficial for the children and encourage abortions?
One government rebuttal is that this program would be "voluntary." Is that right? Does that imply that this agency would just sit back passively until some parent needing parenting skills said, "I don't think I'll call my parents, priest or friends or read a plethora of books, but I'll go down to the local government offices"? To the contrary, the bill points to specific targeted groups and problems, on Page 840: The state "shall identify and prioritize serving communities that are in high need of such services, especially communities with a high proportion of low-income families."
Are we further to conclude by those words that low-income families know less about parenting? Are middle- and upper-class parents really better parents? Less neglectful of their children? Less needful of parental help and training? Is this "prioritized" training not a biased, discriminatory and even prejudicial stereotype and generalization that has no place in federal government, law or practice?
Bottom line: Is all this what you want or expect in a universal health care bill being rushed through Congress? Do you want government agents coming into your home and telling you how to parent your children? When did government health care turn into government child care?
Government needs less of a role in running our children's lives and more of a role in supporting parents' decisions for their children. Children belong to their parents, not the government. And the parents ought to have the right -- and government support -- to parent them without the fed's mandates, education or intervention in our homes.
Kids are very important to my wife, Gena, and me. That's why we've spent the past 17 years developing our nonprofit KICKSTART program in public schools in Texas. It builds up their self-esteem and teaches them respect and discipline. Of course, whether or not they participate in the program is their and their parents' choice.
How contrary is Obamacare's home intrusion and indoctrination family services, in which state agents prioritize houses to enter and enforce their universal values and principles upon the hearts and minds of families across America?
Government's real motives and rationale are quite simple, though rarely, if ever, stated. If one wants to control the future ebbs and flows of a country, one must have command over future generations. That is done by seizing parental and educational power, legislating preferred educational methods and materials, and limiting private educational options. It is so simple that any socialist can understand it. As Josef Stalin once stated, "Education is a weapon whose effects depend on who holds it in his hands and at whom it is aimed."
Before so-called universal health care turns into universal hell care, write or call your representative today and protest his voting Obamacare into law. Remind him that what is needed in Washington is a truly bipartisan group that is allowed an ample amount of time to work on a compromise health care law that wouldn't raise taxes (for anyone), regulate personal medical choices, ration health care or restrict American citizens.
Monday, August 10, 2009
World's oldest dog turns 26
In dog years the terrier-cross is 182, the equivalent of being born in 1827.
He lives in Louisiana in the United States of America.
"I never spoiled Max," said his owner Janelle Derouen.
"I've never fed him anything but Kiddles and Bits [brand of dog food] and a few treats like those beefy doggy bones.
"We don't give him any food from our table," added Janelle, 49, who lives with her husband Billy, also 49, in New Iberia.
Max, who is greying, has a veterinary birth certificate to prove his age and is awaiting official confirmation from Guinness World Records.
Janelle and Billy bought Max from a local sugar cane farmer in 1983.
"He was the only one in the litter that was brown and I liked the colour so I took him home," said Janelle.
Max has been visiting the same vet since birth at the Robichaux Veterinary Clinic in New Iberia. An 80s puppy Max's birth was formally logged in 1983.
Until recently it was believed that Chanel, a geriatric Daschund-cross from New York was the oldest dog alive but Chanel, who turned 21 in May, is a full five years junior to Max.
Chanel is riddled with health problems, struggling desperately to see, walk and hear.
But Max is still in fine health and only suffers from mild arthritis and some cataracts. His secret, says Janelle, is not worrying about anything at all.
"He's a very, very laid back dog," said Janelle.
"He likes to lie down, relax, nap, sleep a lot and keep life simple. He'll play with the kids for a bit but if they bother him too long he'll wander off.
"He doesn't have any fancy toys, just a bit of rope and a regular squeaky ball."
Janelle and Billy held a special birthday party for Max on Sunday.
"We spoiled him just a little bit that once," said Janelle.
He lives in Louisiana in the United States of America.
"I never spoiled Max," said his owner Janelle Derouen.
"I've never fed him anything but Kiddles and Bits [brand of dog food] and a few treats like those beefy doggy bones.
"We don't give him any food from our table," added Janelle, 49, who lives with her husband Billy, also 49, in New Iberia.
Max, who is greying, has a veterinary birth certificate to prove his age and is awaiting official confirmation from Guinness World Records.
Janelle and Billy bought Max from a local sugar cane farmer in 1983.
"He was the only one in the litter that was brown and I liked the colour so I took him home," said Janelle.
Max has been visiting the same vet since birth at the Robichaux Veterinary Clinic in New Iberia. An 80s puppy Max's birth was formally logged in 1983.
Until recently it was believed that Chanel, a geriatric Daschund-cross from New York was the oldest dog alive but Chanel, who turned 21 in May, is a full five years junior to Max.
Chanel is riddled with health problems, struggling desperately to see, walk and hear.
But Max is still in fine health and only suffers from mild arthritis and some cataracts. His secret, says Janelle, is not worrying about anything at all.
"He's a very, very laid back dog," said Janelle.
"He likes to lie down, relax, nap, sleep a lot and keep life simple. He'll play with the kids for a bit but if they bother him too long he'll wander off.
"He doesn't have any fancy toys, just a bit of rope and a regular squeaky ball."
Janelle and Billy held a special birthday party for Max on Sunday.
"We spoiled him just a little bit that once," said Janelle.
Bachmann Seeks Transparency in Bailout Operations
As a member of the House Financial Services Committee, I recently had the opportunity to question Elizabeth Warren, the Chair of the panel that was charged with oversight of the $700-billion Wall Street bailout operations. I was then, and remain today, concerned that this panel is not operating with full transparency. It seems to me that a panel that was commissioned with giving taxpayers insight into how their money is being spent on the Wall Street bailout should itself be a model of openness.
Today, I followed up with my questioning with a letter to Ms. Warren. The text of my letter is below for your review:
Ms. Elizabeth Warren
Chair, Congressional Oversight Panel (COP)
732 North Capitol St., NW
Rooms C-320 and C-617
Washington, DC 20401
Dear Ms. Warren,
I was disappointed to hear that for a third time, the Congressional Oversight Panel (Panel) has rejected a motion by Congressman Jeb Hensarling to improve the Panel’s transparency and accountability measures.
As you know, this motion would have required that within 20 days of each Panel meeting, both an official transcript and minutes be made available to the public, including those conducted by telephone. The motion also included a confidentiality safeguard which stated that the Panel could refrain from making certain meetings public with a simple majority vote. In my view, this is more than reasonable and I urge the Panel to reconsider the motion.
The Panel’s main objective is to shed light on how the U.S. Treasury is spending the $700 billion of taxpayer money authorized under the Troubled Asset Relief Program (TARP). This is a serious responsibility. The public outrage against the TARP was, and still is, undeniable, and the taxpayers footing the bill for this program deserve to have access to all the oversight resources available. I’m very concerned about the signal the Panel has sent to the American people and Members of Congress by rejecting this transparency motion. In fact, I find it ironic that a panel created to provide oversight is rejecting oversight of its own operations. Your rejection of these very reasonable accountability measures seems contrary to your very mission.
Additionally, I’m concerned that the Panel’s oversight of the TARP is not sufficient. The Panel’s website clearly shows that it has only held on average one public hearing per month since December 2008. Until last Monday, the Panel had held no public hearings with the largest TARP recipients and has yet to question the largest financial institutions about their administration of TARP funds. And, only one hearing over the past 8 months included Treasury Secretary Tim Geithner – the main administrator of the TARP. How can the Panel achieve its oversight mission given this schedule?
There also seems to be a level of secrecy surrounding the basic functions of the Panel. As you made clear at the House Financial Services Subcommittee on Oversight and Investigations hearing on July 22, 2009, the Panel has no specified budget for its operations. And when I request two fundamental pieces of information, a public phone number and official transcripts of the Panel’s meetings, you responded with some confusion and stated, “We don't have official transcripts… We have typing that comes back from someone who listened to our tapes, who is not part of our panel, not part of this process, and no one has verified the accuracy of any part of it.” Your responses make a strong case that Congressman Hensarling’s transparency motion is critical to improving the Panel’s accountability.
For a Panel tasked with examining the transparency and effectiveness of the TARP, I am concerned that the Panel’s own operations are lacking in this very area. On behalf of the taxpayers that I represent, the Minnesotans who are footing the bill for the TARP, I would appreciate a written explanation as to why you voted against Congressman Hensarling’s motion for greater transparency. They deserve to know what is happening with their money.
I look forward to working together to strengthen the oversight of the TARP and ensure that the Panel’s activities are open and accessible to citizens across our nation. I appreciate your consideration of these concerns and look forward to hearing from you. Please do not hesitate to contact me should you have any questions.
Sincerely,
Michele Bachmann
Member of Congress
Today, I followed up with my questioning with a letter to Ms. Warren. The text of my letter is below for your review:
Ms. Elizabeth Warren
Chair, Congressional Oversight Panel (COP)
732 North Capitol St., NW
Rooms C-320 and C-617
Washington, DC 20401
Dear Ms. Warren,
I was disappointed to hear that for a third time, the Congressional Oversight Panel (Panel) has rejected a motion by Congressman Jeb Hensarling to improve the Panel’s transparency and accountability measures.
As you know, this motion would have required that within 20 days of each Panel meeting, both an official transcript and minutes be made available to the public, including those conducted by telephone. The motion also included a confidentiality safeguard which stated that the Panel could refrain from making certain meetings public with a simple majority vote. In my view, this is more than reasonable and I urge the Panel to reconsider the motion.
The Panel’s main objective is to shed light on how the U.S. Treasury is spending the $700 billion of taxpayer money authorized under the Troubled Asset Relief Program (TARP). This is a serious responsibility. The public outrage against the TARP was, and still is, undeniable, and the taxpayers footing the bill for this program deserve to have access to all the oversight resources available. I’m very concerned about the signal the Panel has sent to the American people and Members of Congress by rejecting this transparency motion. In fact, I find it ironic that a panel created to provide oversight is rejecting oversight of its own operations. Your rejection of these very reasonable accountability measures seems contrary to your very mission.
Additionally, I’m concerned that the Panel’s oversight of the TARP is not sufficient. The Panel’s website clearly shows that it has only held on average one public hearing per month since December 2008. Until last Monday, the Panel had held no public hearings with the largest TARP recipients and has yet to question the largest financial institutions about their administration of TARP funds. And, only one hearing over the past 8 months included Treasury Secretary Tim Geithner – the main administrator of the TARP. How can the Panel achieve its oversight mission given this schedule?
There also seems to be a level of secrecy surrounding the basic functions of the Panel. As you made clear at the House Financial Services Subcommittee on Oversight and Investigations hearing on July 22, 2009, the Panel has no specified budget for its operations. And when I request two fundamental pieces of information, a public phone number and official transcripts of the Panel’s meetings, you responded with some confusion and stated, “We don't have official transcripts… We have typing that comes back from someone who listened to our tapes, who is not part of our panel, not part of this process, and no one has verified the accuracy of any part of it.” Your responses make a strong case that Congressman Hensarling’s transparency motion is critical to improving the Panel’s accountability.
For a Panel tasked with examining the transparency and effectiveness of the TARP, I am concerned that the Panel’s own operations are lacking in this very area. On behalf of the taxpayers that I represent, the Minnesotans who are footing the bill for the TARP, I would appreciate a written explanation as to why you voted against Congressman Hensarling’s motion for greater transparency. They deserve to know what is happening with their money.
I look forward to working together to strengthen the oversight of the TARP and ensure that the Panel’s activities are open and accessible to citizens across our nation. I appreciate your consideration of these concerns and look forward to hearing from you. Please do not hesitate to contact me should you have any questions.
Sincerely,
Michele Bachmann
Member of Congress
What Does Health Care Reform Mean for the Most Vulnerable Amongst Us?
Michele Bachmann
When Congress returns to Washington from its district work period, the President’s health care reform proposal is expected to be at the very top of our agenda. Much of the discussion so far has been in sound bites and debate snippets and about numbers and sterile ideas. But, health care reform should be about people.
It’s important that we look deeper into statements of some of the Administration’s top advisors to get some insight into where the legislative proposals on the table may lead us. Betsy McCaughey, former Lieutenant Governor for New York and founder of the Committee to Reduce Infection Deaths, recently shared some statements by two of President Obama’s top advisors in the New York Post that should give us pause about the very human consequences of health care reform.
I encourage you to read her column from July 24th (Deadly Doctors: O Advisors Want to Ration Care):
THE health bills coming out of Congress would put the decisions about your care in the hands of presidential appointees. They'd decide what plans cover, how much leeway your doctor will have and what seniors get under Medicare.
Yet at least two of President Obama's top health advisers should never be trusted with that power.
Start with Dr. Ezekiel Emanuel, the brother of White House Chief of Staff Rahm Emanuel. He has already been appointed to two key positions: health-policy adviser at the Office of Management and Budget and a member of Federal Council on Comparative Effectiveness Research.
Emanuel bluntly admits that the cuts will not be pain-free. "Vague promises of savings from cutting waste, enhancing prevention and wellness, installing electronic medical records and improving quality are merely 'lipstick' cost control, more for show and public relations than for true change," he wrote last year (Health Affairs Feb. 27, 2008).
Savings, he writes, will require changing how doctors think about their patients: Doctors take the Hippocratic Oath too seriously, "as an imperative to do everything for the patient regardless of the cost or effects on others" (Journal of the American Medical Association, June 18, 2008).
Yes, that's what patients want their doctors to do. But Emanuel wants doctors to look beyond the needs of their patients and consider social justice, such as whether the money could be better spent on somebody else.
Many doctors are horrified by this notion; they'll tell you that a doctor's job is to achieve social justice one patient at a time.
Emanuel, however, believes that "communitarianism" should guide decisions on who gets care. He says medical care should be reserved for the non-disabled, not given to those "who are irreversibly prevented from being or becoming participating citizens . . . An obvious example is not guaranteeing health services to patients with dementia" (Hastings Center Report, Nov.-Dec. '96).
Translation: Don't give much care to a grandmother with Parkinson's or a child with cerebral palsy.
He explicitly defends discrimination against older patients: "Unlike allocation by sex or race, allocation by age is not invidious discrimination; every person lives through different life stages rather than being a single age. Even if 25-year-olds receive priority over 65-year-olds, everyone who is 65 years now was previously 25 years" (Lancet, Jan. 31).
The bills being rushed through Congress will be paid for largely by a $500 billion-plus cut in Medicare over 10 years. Knowing how unpopular the cuts will be, the president's budget director, Peter Orszag, urged Congress this week to delegate its own authority over Medicare to a new, presidentially-appointed bureaucracy that wouldn't be accountable to the public.
Since Medicare was founded in 1965, seniors' lives have been transformed by new medical treatments such as angioplasty, bypass surgery and hip and knee replacements. These innovations allow the elderly to lead active lives. But Emanuel criticizes Americans for being too "enamored with technology" and is determined to reduce access to it.
Dr. David Blumenthal, another key Obama adviser, agrees. He recommends slowing medical innovation to control health spending.
Blumenthal has long advocated government health-spending controls, though he concedes they're "associated with longer waits" and "reduced availability of new and expensive treatments and devices" (New England Journal of Medicine, March 8, 2001). But he calls it "debatable" whether the timely care Americans get is worth the cost. (Ask a cancer patient, and you'll get a different answer. Delay lowers your chances of survival.)
Obama appointed Blumenthal as national coordinator of health-information technology, a job that involves making sure doctors obey electronically delivered guidelines about what care the government deems appropriate and cost effective.
In the April 9 New England Journal of Medicine, Blumenthal predicted that many doctors would resist "embedded clinical decision support" -- a euphemism for computers telling doctors what to do.
Americans need to know what the president's health advisers have in mind for them. Emanuel sees even basic amenities as luxuries and says Americans expect too much: "Hospital rooms in the United States offer more privacy . . . physicians' offices are typically more conveniently located and have parking nearby and more attractive waiting rooms" (JAMA, June 18, 2008).
No one has leveled with the public about these dangerous views. Nor have most people heard about the arm-twisting, Chicago-style tactics being used to force support. In a Nov. 16, 2008, Health Care Watch column, Emanuel explained how business should be done: "Every favor to a constituency should be linked to support for the health-care reform agenda. If the automakers want a bailout, then they and their suppliers have to agree to support and lobby for the administration's health-reform effort."
Do we want a "reform" that empowers people like this to decide for us?
When Congress returns to Washington from its district work period, the President’s health care reform proposal is expected to be at the very top of our agenda. Much of the discussion so far has been in sound bites and debate snippets and about numbers and sterile ideas. But, health care reform should be about people.
It’s important that we look deeper into statements of some of the Administration’s top advisors to get some insight into where the legislative proposals on the table may lead us. Betsy McCaughey, former Lieutenant Governor for New York and founder of the Committee to Reduce Infection Deaths, recently shared some statements by two of President Obama’s top advisors in the New York Post that should give us pause about the very human consequences of health care reform.
I encourage you to read her column from July 24th (Deadly Doctors: O Advisors Want to Ration Care):
THE health bills coming out of Congress would put the decisions about your care in the hands of presidential appointees. They'd decide what plans cover, how much leeway your doctor will have and what seniors get under Medicare.
Yet at least two of President Obama's top health advisers should never be trusted with that power.
Start with Dr. Ezekiel Emanuel, the brother of White House Chief of Staff Rahm Emanuel. He has already been appointed to two key positions: health-policy adviser at the Office of Management and Budget and a member of Federal Council on Comparative Effectiveness Research.
Emanuel bluntly admits that the cuts will not be pain-free. "Vague promises of savings from cutting waste, enhancing prevention and wellness, installing electronic medical records and improving quality are merely 'lipstick' cost control, more for show and public relations than for true change," he wrote last year (Health Affairs Feb. 27, 2008).
Savings, he writes, will require changing how doctors think about their patients: Doctors take the Hippocratic Oath too seriously, "as an imperative to do everything for the patient regardless of the cost or effects on others" (Journal of the American Medical Association, June 18, 2008).
Yes, that's what patients want their doctors to do. But Emanuel wants doctors to look beyond the needs of their patients and consider social justice, such as whether the money could be better spent on somebody else.
Many doctors are horrified by this notion; they'll tell you that a doctor's job is to achieve social justice one patient at a time.
Emanuel, however, believes that "communitarianism" should guide decisions on who gets care. He says medical care should be reserved for the non-disabled, not given to those "who are irreversibly prevented from being or becoming participating citizens . . . An obvious example is not guaranteeing health services to patients with dementia" (Hastings Center Report, Nov.-Dec. '96).
Translation: Don't give much care to a grandmother with Parkinson's or a child with cerebral palsy.
He explicitly defends discrimination against older patients: "Unlike allocation by sex or race, allocation by age is not invidious discrimination; every person lives through different life stages rather than being a single age. Even if 25-year-olds receive priority over 65-year-olds, everyone who is 65 years now was previously 25 years" (Lancet, Jan. 31).
The bills being rushed through Congress will be paid for largely by a $500 billion-plus cut in Medicare over 10 years. Knowing how unpopular the cuts will be, the president's budget director, Peter Orszag, urged Congress this week to delegate its own authority over Medicare to a new, presidentially-appointed bureaucracy that wouldn't be accountable to the public.
Since Medicare was founded in 1965, seniors' lives have been transformed by new medical treatments such as angioplasty, bypass surgery and hip and knee replacements. These innovations allow the elderly to lead active lives. But Emanuel criticizes Americans for being too "enamored with technology" and is determined to reduce access to it.
Dr. David Blumenthal, another key Obama adviser, agrees. He recommends slowing medical innovation to control health spending.
Blumenthal has long advocated government health-spending controls, though he concedes they're "associated with longer waits" and "reduced availability of new and expensive treatments and devices" (New England Journal of Medicine, March 8, 2001). But he calls it "debatable" whether the timely care Americans get is worth the cost. (Ask a cancer patient, and you'll get a different answer. Delay lowers your chances of survival.)
Obama appointed Blumenthal as national coordinator of health-information technology, a job that involves making sure doctors obey electronically delivered guidelines about what care the government deems appropriate and cost effective.
In the April 9 New England Journal of Medicine, Blumenthal predicted that many doctors would resist "embedded clinical decision support" -- a euphemism for computers telling doctors what to do.
Americans need to know what the president's health advisers have in mind for them. Emanuel sees even basic amenities as luxuries and says Americans expect too much: "Hospital rooms in the United States offer more privacy . . . physicians' offices are typically more conveniently located and have parking nearby and more attractive waiting rooms" (JAMA, June 18, 2008).
No one has leveled with the public about these dangerous views. Nor have most people heard about the arm-twisting, Chicago-style tactics being used to force support. In a Nov. 16, 2008, Health Care Watch column, Emanuel explained how business should be done: "Every favor to a constituency should be linked to support for the health-care reform agenda. If the automakers want a bailout, then they and their suppliers have to agree to support and lobby for the administration's health-reform effort."
Do we want a "reform" that empowers people like this to decide for us?
The Economic Impact of The Waxman-Markey Cap-and-Trade Bill on Western States
Testimony before
The House and Senate Western Caucus
July 30, 2009
My name is Ben Lieberman. I am the Senior Policy Analyst for Energy and Environment in the Thomas A. Roe Institute for Economic Policy Studies at The Heritage Foundation. The views I express in this testimony are my own, and should not be construed as representing any official position of The Heritage Foundation.
I would like to thank the House and Senate Western Caucus for the privilege of participating in today's hearing. I'll be discussing the costs of the cap-and-trade approach to addressing global warming and The Heritage Foundation's economic analysis of H.R. 2454, the American Clean Energy and Security Act of 2009 (Waxman-Markey). As you know, the House narrowly passed this bill, which is similar to, but has more stringent targets and timetables than, the Lieberman-Warner cap-and-trade bill that was rejected by the Senate last June.
It is clear that cap and trade is very expensive and amounts to nothing more than an energy tax in disguise. After all, when you sweep aside all the complexities of how cap and trade operates--and make no mistake, this is the most convoluted attempt at economic central planning this nation has ever attempted--the bottom line is that cap and trade works by raising the cost of energy high enough so that individuals and businesses are forced to used less of it. Inflicting economic pain is what this is all about. That is how the ever-tightening emissions targets will be met.
The only entities directly regulated by Waxman-Markey would be the electric utilities, oil refiners, natural gas producers, and some manufacturers that produce energy on site. So the good news for the rest of us--homeowners, car owners, small business owners, farmers and ranchers--is that we won't be directly regulated under this bill. The bad news is that nearly all the costs will get passed on to us anyway.
What are those costs? According to an analysis we conducted at The Heritage Foundation, an updated version of which will be out shortly, the higher energy costs kick in as soon as the bill's provisions take effect in 2012. For a household of four, energy costs go up $436 that year, and they eventually reach $1,241 in 2035 and average $829 annually over that span. Electricity costs go up 90 percent by 2035, gasoline by 58 percent, and natural gas by 55 percent by 2035. The cumulative higher energy costs for a family of four by then will be nearly $20,000.
But direct energy costs are only part of the consumer impact. Nearly everything goes up, since higher energy costs raise production costs. If you look at the total cost of Waxman-Markey, it works out to an average of $2,979 annually from 2012-2035 for a household of four. By 2035 alone, the total cost is over $4,600.
Beyond the cost impact on individuals and households, Waxman-Markey also affects employment, and especially employment in the manufacturing sector. We estimate job losses averaging 1,145,000 at any given time from 2012-2035. And note that those are net job losses, after the much-hyped green jobs are taken into account. Some of the lost jobs will be destroyed entirely, while others will be outsourced to nations like China and India that have repeatedly stated that they'll never hamper their own economic growth with energy-cost-boosting global-warming measures like Waxman-Markey.
Since farming is energy-intensive, that sector will be particularly hard-hit. Higher gasoline and diesel fuel costs, higher electricity costs, and higher natural gas-derived fertilizer costs all erode farm profits, which are expected to drop by 28 percent in 2012 and average 57 percent lower through 2035. As with American manufacturers, Waxman-Markey also puts American farmers at a global disadvantage, as other food exporting nations would have no comparable energy price-raising measures in place.
Overall, Waxman-Markey reduces gross domestic product by an average of $393 dollars annually between 2012 and 2035, and cumulatively by $9.4 trillion. In other words, the nation will be $9.4 trillion poorer with Waxman-Markey than without it.
It should also be noted that the costs are not distributed evenly. Low-income households spend a disproportionate share of their incomes on energy, and thus would be hit harder than average by Waxman-Markey. Of course, the bill has provisions to give back some revenues to low-income households, but it is likely that these rebates will amount only to some portion of each dollar that was taken away from them in the first place in the form of higher energy costs and higher costs for other goods and services. Waxman-Markey also disproportionately burdens those states, especially in the Midwest and South, that still have a substantial number of manufacturing jobs to lose, as well as those that rely more heavily than others on coal for electric generation. In addition, because the bill raises energy costs, it hurts rural America much more than urban America. Rural Americans, farmers and non-farmers, spend an average of 58 percent more on energy as a percentage of income than their urban counterparts, and those costs would go up.
The disproportionate burdens affect the West. Coal mining will be very hard-hit, so Montana and Wyoming and other coal-producing states will see this important sector of their economies shrink significantly. Western oil and natural gas producers will face higher costs as well. The promise of oil shale in Colorado, Utah, and Wyoming will never be realized under Waxman-Markey. As I mentioned, agriculture is hard-hit, and that particularly includes things common in parts of the West that are not well positioned to partially defray their costs by availing themselves of offsets, like ranching on federal lands, fruits and vegetables, and potatoes. And of course the long distances rural Westerners have to drive in the course of each day means that gasoline and diesel price increases hurt them more than other Americans.
In conclusion, it is not surprising that support for Waxman-Markey is heaviest in those parts of the country, the urban centers in the West Coast and Northeast, that are least harmed by it. Even there, the economic damage would be bad enough, but the citizens in the rest of the country and their representatives, and especially those who represent the rural West, should really be asking many tough questions about the economic impact of cap and trade.
The House and Senate Western Caucus
July 30, 2009
My name is Ben Lieberman. I am the Senior Policy Analyst for Energy and Environment in the Thomas A. Roe Institute for Economic Policy Studies at The Heritage Foundation. The views I express in this testimony are my own, and should not be construed as representing any official position of The Heritage Foundation.
I would like to thank the House and Senate Western Caucus for the privilege of participating in today's hearing. I'll be discussing the costs of the cap-and-trade approach to addressing global warming and The Heritage Foundation's economic analysis of H.R. 2454, the American Clean Energy and Security Act of 2009 (Waxman-Markey). As you know, the House narrowly passed this bill, which is similar to, but has more stringent targets and timetables than, the Lieberman-Warner cap-and-trade bill that was rejected by the Senate last June.
It is clear that cap and trade is very expensive and amounts to nothing more than an energy tax in disguise. After all, when you sweep aside all the complexities of how cap and trade operates--and make no mistake, this is the most convoluted attempt at economic central planning this nation has ever attempted--the bottom line is that cap and trade works by raising the cost of energy high enough so that individuals and businesses are forced to used less of it. Inflicting economic pain is what this is all about. That is how the ever-tightening emissions targets will be met.
The only entities directly regulated by Waxman-Markey would be the electric utilities, oil refiners, natural gas producers, and some manufacturers that produce energy on site. So the good news for the rest of us--homeowners, car owners, small business owners, farmers and ranchers--is that we won't be directly regulated under this bill. The bad news is that nearly all the costs will get passed on to us anyway.
What are those costs? According to an analysis we conducted at The Heritage Foundation, an updated version of which will be out shortly, the higher energy costs kick in as soon as the bill's provisions take effect in 2012. For a household of four, energy costs go up $436 that year, and they eventually reach $1,241 in 2035 and average $829 annually over that span. Electricity costs go up 90 percent by 2035, gasoline by 58 percent, and natural gas by 55 percent by 2035. The cumulative higher energy costs for a family of four by then will be nearly $20,000.
But direct energy costs are only part of the consumer impact. Nearly everything goes up, since higher energy costs raise production costs. If you look at the total cost of Waxman-Markey, it works out to an average of $2,979 annually from 2012-2035 for a household of four. By 2035 alone, the total cost is over $4,600.
Beyond the cost impact on individuals and households, Waxman-Markey also affects employment, and especially employment in the manufacturing sector. We estimate job losses averaging 1,145,000 at any given time from 2012-2035. And note that those are net job losses, after the much-hyped green jobs are taken into account. Some of the lost jobs will be destroyed entirely, while others will be outsourced to nations like China and India that have repeatedly stated that they'll never hamper their own economic growth with energy-cost-boosting global-warming measures like Waxman-Markey.
Since farming is energy-intensive, that sector will be particularly hard-hit. Higher gasoline and diesel fuel costs, higher electricity costs, and higher natural gas-derived fertilizer costs all erode farm profits, which are expected to drop by 28 percent in 2012 and average 57 percent lower through 2035. As with American manufacturers, Waxman-Markey also puts American farmers at a global disadvantage, as other food exporting nations would have no comparable energy price-raising measures in place.
Overall, Waxman-Markey reduces gross domestic product by an average of $393 dollars annually between 2012 and 2035, and cumulatively by $9.4 trillion. In other words, the nation will be $9.4 trillion poorer with Waxman-Markey than without it.
It should also be noted that the costs are not distributed evenly. Low-income households spend a disproportionate share of their incomes on energy, and thus would be hit harder than average by Waxman-Markey. Of course, the bill has provisions to give back some revenues to low-income households, but it is likely that these rebates will amount only to some portion of each dollar that was taken away from them in the first place in the form of higher energy costs and higher costs for other goods and services. Waxman-Markey also disproportionately burdens those states, especially in the Midwest and South, that still have a substantial number of manufacturing jobs to lose, as well as those that rely more heavily than others on coal for electric generation. In addition, because the bill raises energy costs, it hurts rural America much more than urban America. Rural Americans, farmers and non-farmers, spend an average of 58 percent more on energy as a percentage of income than their urban counterparts, and those costs would go up.
The disproportionate burdens affect the West. Coal mining will be very hard-hit, so Montana and Wyoming and other coal-producing states will see this important sector of their economies shrink significantly. Western oil and natural gas producers will face higher costs as well. The promise of oil shale in Colorado, Utah, and Wyoming will never be realized under Waxman-Markey. As I mentioned, agriculture is hard-hit, and that particularly includes things common in parts of the West that are not well positioned to partially defray their costs by availing themselves of offsets, like ranching on federal lands, fruits and vegetables, and potatoes. And of course the long distances rural Westerners have to drive in the course of each day means that gasoline and diesel price increases hurt them more than other Americans.
In conclusion, it is not surprising that support for Waxman-Markey is heaviest in those parts of the country, the urban centers in the West Coast and Northeast, that are least harmed by it. Even there, the economic damage would be bad enough, but the citizens in the rest of the country and their representatives, and especially those who represent the rural West, should really be asking many tough questions about the economic impact of cap and trade.
Thursday, August 6, 2009
Health Reform and the Polls
By SCOTT RASMUSSEN
For all the back and forth about the “public option,” Congressional Budget Office estimates and proposed tax hikes, the fundamentals are really what make health-care reform a hard sell to American voters. As members of Congress head home for the August recess, they should take a close look at some poll numbers before they attempt to pass any new legislation.
The most important fundamental is that 68% of American voters have health-insurance coverage they rate good or excellent. That number comes from polling conducted this past weekend of 1,000 likely voters. Most of these voters approach the health-care reform debate fearing that they have more to lose than to gain.
Adding to President Barack Obama’s challenge as he sells health-care reform to the public is the fact that most voters are skeptical about the government’s ability to do anything well. While the president says his plan will reduce costs, 53% believe it will have the opposite effect.
There’s also the reality that 74% of voters rate the quality of care they now receive as good or excellent. And 50% fear that if Congress passes health-care reform, it will lead to a decline in the quality of that care.
Advocates of health-care reform on Capitol Hill are up against something bigger than voters’ reactions to a variety of specific proposals. Our polling in February found that by a 2-1 margin, voters believe that no matter how bad things are Congress can always make matters worse. That’s one reason 78% believe passage of the current congressional health-care proposals is likely to mean higher taxes for the middle class.
However, there are some numbers congressional Democrats can celebrate. Specifically, 63% of voters agreed with the president earlier this year when he said, “We must make it a priority to give every single American quality affordable health care.” Yet while they agree in theory, only 28% are currently willing to pay higher taxes to achieve that goal.
Another point in the reformers’ favor is that a significant number of the voters we polled in May had experienced financial hardship brought on by health issues. One in four Americans—26%—say that health-care costs have at some point caused them to miss credit-card, rent or mortgage payments. That figure includes 21% of those who have health insurance coverage.
Finally, voters strongly believe that medical care should be provided when needed, regardless of insurance coverage. In May, Rasmussen Reports found that just 31% of voters believe young and healthy adults who choose not to buy health insurance should be forced to do so. But a follow-up question asked: “What if those who chose not to buy health insurance end up needing emergency room care?” Only 16% said treatment should be denied; 74% said they should be treated even if they did not have insurance.
Taken together, the data shows that at this point voters are pretty evenly divided. Last week’s polling showed that 47% at least somewhat favored the plan while 49% are somewhat opposed.
Though voters are torn about reform, there is intensity among the opposition. Just 25% strongly favor the reform effort, while 41% are strongly opposed. And that gets back to the very first point: 68% currently have good or excellent coverage. It’s going to be hard to generate passionate support for change among this group of voters.
Those opposed to Mr. Obama’s reform appear to have momentum on their side. Polling last weekend showed that 48% of voters rate the U.S. health-care system as good or excellent. That’s up from 35% in May and up from 29% a year ago. Only 19% now rate the system as poor, down from 37% a year ago. It appears that the prospect of changing health care has made the existing system look better to a lot of people.
Beyond the intensity of the opposition and its momentum, there is also a huge partisan gap that puts congressional Democrats in a very difficult position. Currently, 76% of Democratic voters favor the health-care reform plan proposed by Mr. Obama and the congressional Democrats, and they are counting on their representatives to deliver.
But delivering for the Democratic base has the potential to hurt the party’s standing among independents. Among the unaffiliated, 35% are in favor of the Democrats’ health-care reform initiative, and 60% are opposed. Notably, just 16% of unaffiliated voters strongly favor the legislative effort; 47% strongly oppose it.
As the Democrats scramble to pass a health-care reform bill by the fall, they appear to have two choices. One is to stick with the broad outlines of the plan that has been laid out by various congressional committees. Those proposals would be well received within the party, but will cause some angst beyond it.
The other option would be to pass smaller scale reform and declare victory. That approach would probably be well received by voters in the middle, but create turmoil within the party.
In political terms, the most important reality will be how the reform affects the 68% who say they have good or excellent health-insurance coverage. If they end up having to change their coverage, pay significantly higher taxes, or encounter some other unpleasant reality, congressional Democrats will look back on this August as a time when they should have listened more closely to the folks back home.
For all the back and forth about the “public option,” Congressional Budget Office estimates and proposed tax hikes, the fundamentals are really what make health-care reform a hard sell to American voters. As members of Congress head home for the August recess, they should take a close look at some poll numbers before they attempt to pass any new legislation.
The most important fundamental is that 68% of American voters have health-insurance coverage they rate good or excellent. That number comes from polling conducted this past weekend of 1,000 likely voters. Most of these voters approach the health-care reform debate fearing that they have more to lose than to gain.
Adding to President Barack Obama’s challenge as he sells health-care reform to the public is the fact that most voters are skeptical about the government’s ability to do anything well. While the president says his plan will reduce costs, 53% believe it will have the opposite effect.
There’s also the reality that 74% of voters rate the quality of care they now receive as good or excellent. And 50% fear that if Congress passes health-care reform, it will lead to a decline in the quality of that care.
Advocates of health-care reform on Capitol Hill are up against something bigger than voters’ reactions to a variety of specific proposals. Our polling in February found that by a 2-1 margin, voters believe that no matter how bad things are Congress can always make matters worse. That’s one reason 78% believe passage of the current congressional health-care proposals is likely to mean higher taxes for the middle class.
However, there are some numbers congressional Democrats can celebrate. Specifically, 63% of voters agreed with the president earlier this year when he said, “We must make it a priority to give every single American quality affordable health care.” Yet while they agree in theory, only 28% are currently willing to pay higher taxes to achieve that goal.
Another point in the reformers’ favor is that a significant number of the voters we polled in May had experienced financial hardship brought on by health issues. One in four Americans—26%—say that health-care costs have at some point caused them to miss credit-card, rent or mortgage payments. That figure includes 21% of those who have health insurance coverage.
Finally, voters strongly believe that medical care should be provided when needed, regardless of insurance coverage. In May, Rasmussen Reports found that just 31% of voters believe young and healthy adults who choose not to buy health insurance should be forced to do so. But a follow-up question asked: “What if those who chose not to buy health insurance end up needing emergency room care?” Only 16% said treatment should be denied; 74% said they should be treated even if they did not have insurance.
Taken together, the data shows that at this point voters are pretty evenly divided. Last week’s polling showed that 47% at least somewhat favored the plan while 49% are somewhat opposed.
Though voters are torn about reform, there is intensity among the opposition. Just 25% strongly favor the reform effort, while 41% are strongly opposed. And that gets back to the very first point: 68% currently have good or excellent coverage. It’s going to be hard to generate passionate support for change among this group of voters.
Those opposed to Mr. Obama’s reform appear to have momentum on their side. Polling last weekend showed that 48% of voters rate the U.S. health-care system as good or excellent. That’s up from 35% in May and up from 29% a year ago. Only 19% now rate the system as poor, down from 37% a year ago. It appears that the prospect of changing health care has made the existing system look better to a lot of people.
Beyond the intensity of the opposition and its momentum, there is also a huge partisan gap that puts congressional Democrats in a very difficult position. Currently, 76% of Democratic voters favor the health-care reform plan proposed by Mr. Obama and the congressional Democrats, and they are counting on their representatives to deliver.
But delivering for the Democratic base has the potential to hurt the party’s standing among independents. Among the unaffiliated, 35% are in favor of the Democrats’ health-care reform initiative, and 60% are opposed. Notably, just 16% of unaffiliated voters strongly favor the legislative effort; 47% strongly oppose it.
As the Democrats scramble to pass a health-care reform bill by the fall, they appear to have two choices. One is to stick with the broad outlines of the plan that has been laid out by various congressional committees. Those proposals would be well received within the party, but will cause some angst beyond it.
The other option would be to pass smaller scale reform and declare victory. That approach would probably be well received by voters in the middle, but create turmoil within the party.
In political terms, the most important reality will be how the reform affects the 68% who say they have good or excellent health-insurance coverage. If they end up having to change their coverage, pay significantly higher taxes, or encounter some other unpleasant reality, congressional Democrats will look back on this August as a time when they should have listened more closely to the folks back home.
Wednesday, August 5, 2009
Pelosi Rallies for a Vote on Health Care this Week!
Please continue calling your Representative and Senators and tell them to oppose the Obama plan!
July 28, 2009
Don't be fooled by reports that the so-called "fiscally conservative" Blue Dog House Democrats have killed Obama's plan for a government takeover of the American health care system. Roll Call reported today that House Speaker Nancy Pelosi (D-CA) is more determined than ever to bring the House bill, H.R. 3200, to the floor for a vote by the end of this week. She is reportedly turning up the pressure on the House Energy & Commerce Committee as well as the Senate Finance Committee to reach a "deal" on the 1,000 page, $1 trillion-plus bill and to "pull the plug" on Sen. Max Baucus' (D-MT) bipartisan negotiations altogether and just jam it through for a vote.
As Democrats attempt to frame Republicans as the party of "No," congressional liberals have revealed their health care bill to be the nightmare that its critics have claimed all along. Over the past two weeks, Democrats have defeated and said "NO" to 31 common-sense Republican amendments to H.R. 3200, including:
* Preventing bureaucrats from making personal medical decisions for patients (offered by Rep. Phil Gingrey, R-GA).
* Requiring all Members of Congress to get their health insurance through the proposed government-run plan (offered by Rep. Dean Heller, R-NV).
* Protecting Americans from "hurry up and wait," the rationing mechanism when average waiting time for a medical treatment exceeds the average wait times in private plans (offered by Rep. Kevin Brady, R-TX).
* Preventing taxpayer-funded health benefits from going to illegal immigrants (offered by Rep. Dean Heller, R-NV).
* Specifying that Congress should read the health care bill before voting on it (offered by Rep. Kevin Brady, R-TX).
* Ensuring that workers who like their current health plan can keep it (offered by Rep. Judy Biggert, R-IL).
* Stopping seniors from being stripped of their health care choices, as the Democrat bill cuts the Medicare Advantage program (offered by Rep. Ginny Brown-Waite, R-FL).
* Allowing states to opt out (offered by Rep. Tom Price, R-GA).
* Allowing Americans to continue to enroll in private individual market health plans (offered by Rep. Dave Reichert, R-WA).
* Waive the employer mandate if it will cause layoffs, worker salary cuts, or reductions in hiring (offered by Dave Reichert, R-WA).
A recent Rasmussen poll found that a majority of Americans oppose Obama's plan for government-run health care, an ever increasing trend as more details of the bill, and information about defeated amendments which most Americans would support, are disclosed.
Since our last action alert on this topic, many more dangerous provisions have surfaced in the text of H.R. 3200, particularly those that target senior citizens by cutting funding for Medicare and by mandating "end of life" counseling, which should be seen as the beginning of a treacherous path toward government-encouraged euthanasia. Even President Obama told the The New York Times in an interview about his health care plan: "The chronically ill and those toward the end of their lives are accounting for potentially 80 percent of the total health care bill out here...There is going to have to be a very difficult democratic conversation that takes place." So-called "universal health care" depends on a rationing mechanism, and in the Democrats' bill, the rationing will begin with and directly affect the elderly.
H.R. 3200 also provides for the following seriously concerning items:
* Government real-time access to individual's finances and a national health care ID card (p.58).
* Government use of left-wing community groups, such as ACORN and AmeriCorps, to register individuals for the government health care plan (p. 95).
* No company or business can sue the federal government for price fixing, which means that there will be no judicial review against a government monopoly of the health care industry (p. 124).
* Any nonresident alien is exempt from the individual taxes, insurance purchasing mandates, and fines which are required of every legal, U.S. citizens (p. 170).
* Government will restrict the enrollment of special needs people (p. 354).
* Government mandates Advance Care Planning Consultation-that is, end-of-life counseling on "the use of artificially administered nutrition and hydration" and other end of life treatments. (Section 1233).
* "Advance Care Planning Consultation" may include a government order for end of life plans (p. 429).
* Government Marriage & Family therapy sessions (p. 489).
* Government will design and implement the Home Visitation Program for families with young children and families expecting children, parenting counseling is included (p. 838-845).
* Government-established National Medical Device Registry (p. 1001).
Make no mistake, Obama's and congressional liberals' goal is to vote before the August Recess because they know that when their Democrat colleagues return to their states and districts to hold townhall meetings, they will not be able to avoid the outrage of opposition from their constituents!
Take Action!
It's now or never to turn up the heat on your representative and your two Senators to defeat this bill! The phone lines on Capitol Hill are nowhere near jammed, so we need you to keep up the pressure (remember, phone calls are best) and not allow Nancy Pelosi to bring this bill to a vote this week.
The August Recess is scheduled to begin at the end of Friday, July 31st, so there is no time to waste-start calling now! We cannot allow Pelosi, Obama, or their liberal allies in Congress to think that the opposition has cooled down!
Capitol Switchboard: 202-224-3121
July 28, 2009
Don't be fooled by reports that the so-called "fiscally conservative" Blue Dog House Democrats have killed Obama's plan for a government takeover of the American health care system. Roll Call reported today that House Speaker Nancy Pelosi (D-CA) is more determined than ever to bring the House bill, H.R. 3200, to the floor for a vote by the end of this week. She is reportedly turning up the pressure on the House Energy & Commerce Committee as well as the Senate Finance Committee to reach a "deal" on the 1,000 page, $1 trillion-plus bill and to "pull the plug" on Sen. Max Baucus' (D-MT) bipartisan negotiations altogether and just jam it through for a vote.
As Democrats attempt to frame Republicans as the party of "No," congressional liberals have revealed their health care bill to be the nightmare that its critics have claimed all along. Over the past two weeks, Democrats have defeated and said "NO" to 31 common-sense Republican amendments to H.R. 3200, including:
* Preventing bureaucrats from making personal medical decisions for patients (offered by Rep. Phil Gingrey, R-GA).
* Requiring all Members of Congress to get their health insurance through the proposed government-run plan (offered by Rep. Dean Heller, R-NV).
* Protecting Americans from "hurry up and wait," the rationing mechanism when average waiting time for a medical treatment exceeds the average wait times in private plans (offered by Rep. Kevin Brady, R-TX).
* Preventing taxpayer-funded health benefits from going to illegal immigrants (offered by Rep. Dean Heller, R-NV).
* Specifying that Congress should read the health care bill before voting on it (offered by Rep. Kevin Brady, R-TX).
* Ensuring that workers who like their current health plan can keep it (offered by Rep. Judy Biggert, R-IL).
* Stopping seniors from being stripped of their health care choices, as the Democrat bill cuts the Medicare Advantage program (offered by Rep. Ginny Brown-Waite, R-FL).
* Allowing states to opt out (offered by Rep. Tom Price, R-GA).
* Allowing Americans to continue to enroll in private individual market health plans (offered by Rep. Dave Reichert, R-WA).
* Waive the employer mandate if it will cause layoffs, worker salary cuts, or reductions in hiring (offered by Dave Reichert, R-WA).
A recent Rasmussen poll found that a majority of Americans oppose Obama's plan for government-run health care, an ever increasing trend as more details of the bill, and information about defeated amendments which most Americans would support, are disclosed.
Since our last action alert on this topic, many more dangerous provisions have surfaced in the text of H.R. 3200, particularly those that target senior citizens by cutting funding for Medicare and by mandating "end of life" counseling, which should be seen as the beginning of a treacherous path toward government-encouraged euthanasia. Even President Obama told the The New York Times in an interview about his health care plan: "The chronically ill and those toward the end of their lives are accounting for potentially 80 percent of the total health care bill out here...There is going to have to be a very difficult democratic conversation that takes place." So-called "universal health care" depends on a rationing mechanism, and in the Democrats' bill, the rationing will begin with and directly affect the elderly.
H.R. 3200 also provides for the following seriously concerning items:
* Government real-time access to individual's finances and a national health care ID card (p.58).
* Government use of left-wing community groups, such as ACORN and AmeriCorps, to register individuals for the government health care plan (p. 95).
* No company or business can sue the federal government for price fixing, which means that there will be no judicial review against a government monopoly of the health care industry (p. 124).
* Any nonresident alien is exempt from the individual taxes, insurance purchasing mandates, and fines which are required of every legal, U.S. citizens (p. 170).
* Government will restrict the enrollment of special needs people (p. 354).
* Government mandates Advance Care Planning Consultation-that is, end-of-life counseling on "the use of artificially administered nutrition and hydration" and other end of life treatments. (Section 1233).
* "Advance Care Planning Consultation" may include a government order for end of life plans (p. 429).
* Government Marriage & Family therapy sessions (p. 489).
* Government will design and implement the Home Visitation Program for families with young children and families expecting children, parenting counseling is included (p. 838-845).
* Government-established National Medical Device Registry (p. 1001).
Make no mistake, Obama's and congressional liberals' goal is to vote before the August Recess because they know that when their Democrat colleagues return to their states and districts to hold townhall meetings, they will not be able to avoid the outrage of opposition from their constituents!
Take Action!
It's now or never to turn up the heat on your representative and your two Senators to defeat this bill! The phone lines on Capitol Hill are nowhere near jammed, so we need you to keep up the pressure (remember, phone calls are best) and not allow Nancy Pelosi to bring this bill to a vote this week.
The August Recess is scheduled to begin at the end of Friday, July 31st, so there is no time to waste-start calling now! We cannot allow Pelosi, Obama, or their liberal allies in Congress to think that the opposition has cooled down!
Capitol Switchboard: 202-224-3121
Thursday, July 30, 2009
Here is a great reason why medical costs are so high.
If it's a medical emergency, Erie County 911 will respond, but there is one address many of its dispatchers know by heart.
They find Scott Graham usually waiting at that Buffalo address for his ambulance several times a week.
"Sometimes two times a day," Graham told 2 On Your Side. He suffers from Sickle Cell Anemia, a blood disorder. If left untreated, it can block blood flow to limbs and organs.
"It feels like somebody shooting me with battery acid, and I'm stepping on razor blades, and I'm having a heart attack at once," he said talking about the pain the disorder causes.
Graham doesn't have a job, insurance or car. So, when he feels bad, he doesn't call a cab. He calls 911 to have an ambulance drive him to the hospital.
A 2 On Your Side investigation found that from January 2006 to May of this year, Rural Metro Ambulance picked him up 603 times.
Medicaid picked up the tab for each ride, costing taxpayers at least $118,158.
Graham estimates he's requested even more rides. "I'd say about a thousand times."
Rural Metro and Erie County chose not to respond on camera about Graham's case. The county follows the same rules most emergency systems follow across the country. If you call, they must haul you to the hospital, no matter what your call is about.
Graham says he requests an ambulance because he can't see his doctor as much as he needs. He also says he gets help quicker by arriving in an ambulance rather than by cab.
2 On Your Side contacted Medicaid to have them look into the number of times Graham used an ambulance. Medicaid appeared more interested in how we got the information, rather than how much it cost taxpayers to pick him up.
Medicaid fraud and abuse costs $60 billion each year nationwide.
2 On Your Side contacted our lawmakers to discuss how to lower that number.
"As we look at health care reform," Senator Kirsten Gillibrand (D-NY) said, "we should also look at oversight and accountability for those programs to make sure that people aren't abusing the system."
Gillibrand says cracking down on abuse should be part of the major health care reform going through Congress to force more oversight.
Take Mr. Graham's case. His trips cost Medicaid $118,000, but the government reimbursements are low. In fact, most ambulance companies lose money, up to 30% or more, when they transport Medicaid patients, because the government simply does not pay the full cost. Therefore, Mr. Graham's actual cost to the ambulance company and to the health care system in general, is much more, as high as $360,000.
Erie County Executive Chris Collins, a Republican, says government is not the answer to limiting that type of alleged abuse and waste.
"Fundamentally, inherently I think the private sector is better able to do anything and everything compared to government," Collins said.
Instead, Collins said the solution is insurance that is private and not public.
"Would the type of reform that you're suggesting here be able to crack down more on this type of fraud?" asked 2 On Your Side's Michael Wooten.
"I'm actually talking about the basic design of the program in New York," Collins said. "where fraud is something we have to look at everyday. But the actual larger cost is the actual design of the program and the fact that we took the entire menu and said we'll provide it all."
Gillibrand disagrees.
"Bottom line then, expanded government-run health care can be efficient you believe?" 2 On Your Side's Michael Wooten asked Gillibrand. "Absolutely," she responded. "Talk to your mother. Talk to your father. Talk to someone who has Medicare. They're pretty happy."
Currently, New York has a dubious distinction of having the highest Medicaid costs in the entire country, about $2,300 per person. Collins said if we had a system similar the one in California, which does not provide as much care, we would save enough money to completely eliminate the county property tax.
They find Scott Graham usually waiting at that Buffalo address for his ambulance several times a week.
"Sometimes two times a day," Graham told 2 On Your Side. He suffers from Sickle Cell Anemia, a blood disorder. If left untreated, it can block blood flow to limbs and organs.
"It feels like somebody shooting me with battery acid, and I'm stepping on razor blades, and I'm having a heart attack at once," he said talking about the pain the disorder causes.
Graham doesn't have a job, insurance or car. So, when he feels bad, he doesn't call a cab. He calls 911 to have an ambulance drive him to the hospital.
A 2 On Your Side investigation found that from January 2006 to May of this year, Rural Metro Ambulance picked him up 603 times.
Medicaid picked up the tab for each ride, costing taxpayers at least $118,158.
Graham estimates he's requested even more rides. "I'd say about a thousand times."
Rural Metro and Erie County chose not to respond on camera about Graham's case. The county follows the same rules most emergency systems follow across the country. If you call, they must haul you to the hospital, no matter what your call is about.
Graham says he requests an ambulance because he can't see his doctor as much as he needs. He also says he gets help quicker by arriving in an ambulance rather than by cab.
2 On Your Side contacted Medicaid to have them look into the number of times Graham used an ambulance. Medicaid appeared more interested in how we got the information, rather than how much it cost taxpayers to pick him up.
Medicaid fraud and abuse costs $60 billion each year nationwide.
2 On Your Side contacted our lawmakers to discuss how to lower that number.
"As we look at health care reform," Senator Kirsten Gillibrand (D-NY) said, "we should also look at oversight and accountability for those programs to make sure that people aren't abusing the system."
Gillibrand says cracking down on abuse should be part of the major health care reform going through Congress to force more oversight.
Take Mr. Graham's case. His trips cost Medicaid $118,000, but the government reimbursements are low. In fact, most ambulance companies lose money, up to 30% or more, when they transport Medicaid patients, because the government simply does not pay the full cost. Therefore, Mr. Graham's actual cost to the ambulance company and to the health care system in general, is much more, as high as $360,000.
Erie County Executive Chris Collins, a Republican, says government is not the answer to limiting that type of alleged abuse and waste.
"Fundamentally, inherently I think the private sector is better able to do anything and everything compared to government," Collins said.
Instead, Collins said the solution is insurance that is private and not public.
"Would the type of reform that you're suggesting here be able to crack down more on this type of fraud?" asked 2 On Your Side's Michael Wooten.
"I'm actually talking about the basic design of the program in New York," Collins said. "where fraud is something we have to look at everyday. But the actual larger cost is the actual design of the program and the fact that we took the entire menu and said we'll provide it all."
Gillibrand disagrees.
"Bottom line then, expanded government-run health care can be efficient you believe?" 2 On Your Side's Michael Wooten asked Gillibrand. "Absolutely," she responded. "Talk to your mother. Talk to your father. Talk to someone who has Medicare. They're pretty happy."
Currently, New York has a dubious distinction of having the highest Medicaid costs in the entire country, about $2,300 per person. Collins said if we had a system similar the one in California, which does not provide as much care, we would save enough money to completely eliminate the county property tax.
Wednesday, July 29, 2009
State Health Reform: The Significance of Utah Health Insurance Reforms
Here is an inovative interesting health reform system being implimented in Utah that works to help with the problems. This one is not set up to take control of every part of our lives like the federal programs.
by Edmund F. Haislmaier
WebMemo #2569
Utah is currently implementing consumer-centered health insurance reforms enacted in March of this year.[1] The reforms are designed to increase choice, portability, and availability of private health insurance coverage. They are the product of a continuing, multi-year health reform process in that state.
This first set of Utah health reforms includes three key elements:
Insurance market reforms to create a new "defined contribution" coverage option for businesses and their workers;
A board to design and manage a companion risk adjustment mechanism; and
A "virtual" health insurance exchange to coordinate the various administrative functions of a consumer-choice market.
Creating a "Defined Contribution" Option
The centerpiece of Utah's reforms is a new option for employment-based health insurance that will enable employers to offer health benefits to their workers on a "defined contribution" basis.
An employer electing this option will no longer need to manage a traditional "one-size-fits-all" group plan for its workers. Rather, each worker, during the annual open season, will be able to pick from a menu of health insurance plans, all of which will conform to federal standards (such as guaranteed issue to employees and limits on pre-existing condition exclusions) so as to qualify for favorable federal tax treatment as employer-sponsored health benefits.
Utah will make this defined contribution option available to small businesses (those with two to 50 employees) effective January 1, 2010. The legislation also specifies that starting in January of 2012, businesses of any size will be allowed to elect this option.
Employers will still have the option of offering health benefits on a traditional group policy basis--either purchased from a commercial insurer or self-insured by the employer. However, the new defined contribution option will be less costly and less burdensome for employers to offer, and will give workers more choice and control over their coverage.
Employers who elect the defined contribution option must agree to establish a qualified "cafeteria plan" or "health reimbursement arrangement" in accordance with federal tax law, allowing their workers to pay any employee share of the premiums on a pre-tax basis regardless of what the employer contributes or which plan the employee picks.
Starting with Risk Adjustment
A second important element of the reforms is the creation of a "Utah Defined Contribution Risk Adjuster" with a board consisting of representatives of health insurers and private employers as well as the state's insurance department, the public employee health plan, and the Governor's Office of Consumer Health Services.
This board was created to determine the insurance rating (pricing) rules for the defined contribution market and to design a mechanism for adjusting (or pooling) risk across all insurers in the market. The objective is to enable consumers to easily compare the benefits and prices for various competing plans on the "front end" while on the "back end" adjusting payments to insurers so that the costs of expensive cases is spread among all insurers and all plans have incentives to compete in offering the best value to both healthier and sicker enrollees.[2]
The board is now finalizing its initial design for both elements. In general, the agreed design will work as follows:
Plan offerings will be partially risk-adjusted through pricing based on family status and age. There will be four family status categories: single adult, one adult plus one child, couple with no children, and family--which could be either a single adult with more than one dependent or a couple with one or more dependents. Age rating will be in five-year bands for adults between 20 and 64, with insurers permitted to vary premiums by no more than 4 to 1 between the lowest and highest priced age bands. The age of the employee will determine the applicable age band.
Thus, by simply entering his or her age and choosing one of the four family status categories, an employee will be able to compare competing plan benefits and applicable premiums. There will be no geographic adjustment to premiums as regional differences in health care costs were determined to not be a significant factor in Utah.
A common underwriting questionnaire will be completed by all employees signing up for coverage as part of a participating employer group in order to construct an insurance profile for the group. This is the same process as is currently used in rating traditional group coverage, and Utah law allows insurers to vary premiums by up to +/- 30 percent on a group basis. Thus, when an employee logs on and enters his or her employer's ID number, the software will automatically adjust the entire schedule of age and family premiums for the competing plans to reflect the rating factor assigned to the worker's employer group.
After the employees all pick their coverage, the employer will transmit a monthly total amount for all of the chosen coverage. A portion of that total will be what the employer contributes directly to coverage--determined according to the rules established by each employer for its plan--with the balance coming from pre-tax payroll withholding by the employees. The system has been designed to also accept payments from other sources, such as government subsidies for lower-income individuals.
The amounts transmitted to the insurers will be adjusted further based on which individuals chose which plan. For example, if two individuals have the same employer, are the same age, elect the same coverage status, and choose the same plan, then both will pay the same premium. However, if one is diabetic and the other is not, the insurer will receive a somewhat larger payment for the diabetic employee. Where this will really help is if the two employees opt for different plans. In that case, the differences in the premiums they pay will only reflect the differences in the design of the competing benefit packages--not differences between the employees in health status. Yet the plan chosen by the diabetic will get a somewhat larger slice of the total paid collectively by the employer and all of its workers for coverage.
Finally, an end-of-year adjustment among all participating insurers will compensate for any insurer ending up with a share of high-costs enrollees or claims significantly greater than the normal variation. Those adjustments will be done by the participating insurers--who will debit and credit each other in accordance with the rules they collectively established through the board--and will have no effect on the premiums paid by either the enrollees or their employers.
Everyone involved recognizes that this initial risk adjustment design will likely need further refinement and revisions as the insurers gain experience from operating in the new consumer-choice market. For example, the board will likely need to eventually phase-out the employer-group rating factor. That way, when a worker changes jobs but keeps the same coverage, his or her premium will not increase or decrease simply because the new employer has a different group-rating factor than the old employer.
Health Insurance Exchange
The law also established the Office of Consumer Health Services (within the Governor's Office of Economic Development) and gave it the job of designing and administering an Internet-based health insurance "portal" to function as Utah's health insurance exchange.[3] Any insurer will be able to offer coverage through the exchange if it is licensed in Utah and the plan it offers meets state and federal standards.
The exchange will be an online administrative system for employers to offer the new defined contribution coverage option to their employees; for workers and insurance brokers to use in comparing and choosing coverage; for employers, insurers, individuals, and intermediaries such as banks to use to collect and transmit premium payments from multiple sources; and for the state government to use to administer any premium assistance payments for private coverage on behalf of low-income individuals.
Utah's particular innovation is that rather than creating a single entity to perform all of the different administrative functions, the state is using a contracting process to simply network the different pieces and vendors, both existing and new, into a "virtual" health insurance exchange.
Current plans are for the exchange to begin signing up employers who want to participate the week of August 17, with the rest of the system in place for employees to choose coverage during the first open season in November, and for the coverage to take effect January 1, 2010.
The legislation also contains a number of other provisions that augment the key reform elements, including:
Consumer transparency requirements for insurance agent compensation and insurance plan benefits and practices;
Authorization of new "mandate-lite" health insurance policies; and
Authorization of a new lower-cost "conversion" policy for individuals eligible under federal or state law to elect conversion coverage following employment termination.
Benefits of Utah's Approach
Utah is looking to derive a number of benefits from this insurance reform approach.
More Employers Offering Health Coverage. Nationally, only 43 percent of employers with 50 or fewer workers currently offer employer-sponsored health insurance, and Utah's rate (32 percent) is even lower.[4] A major reason is that traditional one-size-fits-all group coverage puts most of the risk on the employer. In essence, the decision by a small business to start offering health insurance to its employees is a decision to jump onto the health cost escalator. Before deciding to offer group coverage, the employer has to be confident that it can handle future cost increases and also be willing to endure the annual hassle of finding or negotiating coverage that 75-80 percent of its employees will take, and then dealing with their complaints.
Utah's "defined contribution" option will allow employers to offer their workers quality health benefits while avoiding most of the associated risks and hassles. Under a defined contribution arrangement each employee gets to decide which plan best suits his or her needs and situation. Furthermore, employees can reevaluate their decisions each year at open season. When faced with a premium increase for the plan he or she picked last year, it is the worker who will decide whether the benefits are worth the extra cost or if another plan offers a better cost-benefit proposition.
A new insurance option that takes most of the risk off of the employer, combined with shared administrative functions through an exchange that also relieves the employer of most of the hassle factor, could eventually result in almost every employer in the state offering at least that coverage option to its workers.
A New Risk Management Tool for Workers. While it is true that defined contribution shifts risk to the employee, it also gives the employee a new tool to manage that risk: annual choice of coverage from a menu of plans with different benefit designs and premiums offered by different insurers. From the employees' perspective, that is a far better option than the current situation in which their employer picks a plan that is probably not their first choice and, as the premiums go up year after year, shifts more of the cost onto them by requiring them to pay higher co-pays or larger shares of the premium.
Better Value. As seen from the experience of the Federal Employee's Health Benefit Program--the country's largest and longest operating defined contribution health insurance system--a consumer choice market puts simultaneous downward pressure on prices and upward pressure on benefits/quality, the only effective way to attain better value in a health system.[5]
Protecting and Assisting Consumers. Under Utah's defined contribution approach, all the insurance sold through the exchange will be state regulated and meet federal standards for employer-sponsored coverage. Participating employers and their workers can be certain that all the policies offered will be quality coverage from responsible insurers. In addition, insurance agents will be compensated not just for helping the employer offer coverage to its workers but also for helping the workers compare plans and select the ones that best meet their individual needs. Thus, employers can be confident that their workers will have access to licensed and trained professionals for help with picking their coverage.
Increased Portability. Over time, as more employers opt to offer health benefits on a defined contribution basis, more and more workers will be able to take their coverage with them from job to job.
Reducing the Number of Uninsured. Utah lawmakers view the creation of a defined contribution option for employer-based coverage as a first step in covering more of the uninsured. Making it both easier for employers to offer coverage and easier for workers to find and keep the coverage they prefer should result in fewer individuals experiencing gaps in coverage and thus being uninsured.
An Innovative Approach
Other states are pursuing their own variations of consumer-centered health reform. What Utah will soon offer is a working model of how states can design and implement a consumer-centered health insurance market that leverages existing resources with minimal regulation or disruption to existing arrangements.
Of particular interest to other states should be Utah's technological solutions for creating a "virtual" health insurance exchange and the lessons and insight that will come from its experience in designing a robust risk adjustment mechanism to support a consumer-choice market.
Utah's approach is, in effect, a marriage of advanced health care reform with advanced information technology.
Edmund F. Haislmaier is Senior Research Fellow in the Center for Health Policy Studies at The Heritage Foundation.
--------------------------------------------------------------------------------
[1]State of Utah, "H.B. 188 Health System Reform--Insurance Market," 2009 General Session, at http://le.utah.gov/~2009/bills/hbillenr/hb0188.pdf (July 29, 2009).
[2]For a further discussion of risk adjustment in health insurance, see Edmund, F. Haislmaier, "State Health Care Reform: A Brief Guide to Risk Adjustment in Consumer-Driven Health Insurance Markets," Heritage Foundation BackgrounderNo. 2166, August 1, 2008, at http://www.heritage.org
/Research/HealthCare/bg2166.cfm.
[3]Additional information can be found at the Utah Office of Consumer Health Services Website at http://goed.utah.gov/programs/consumer-health
-services/ (July 29, 2009).
[4]Kaiser Family Foundation, "Percent of Private Sector Establishments That Offer Health Insurance to Employees, by Firm Size, 2006," at http://www.statehealthfacts.org/comparemaptable.jsp?ind=176&cat=3 (July 29, 2009).
[5]For a more detailed discussion of FEHBP's performance, see Walton Francis, "The FEHBP as a Model for Medicare Reform: Separating Fact from Fiction," Heritage Foundation Backgrounder No. 1674, August 7, 2003, at
by Edmund F. Haislmaier
WebMemo #2569
Utah is currently implementing consumer-centered health insurance reforms enacted in March of this year.[1] The reforms are designed to increase choice, portability, and availability of private health insurance coverage. They are the product of a continuing, multi-year health reform process in that state.
This first set of Utah health reforms includes three key elements:
Insurance market reforms to create a new "defined contribution" coverage option for businesses and their workers;
A board to design and manage a companion risk adjustment mechanism; and
A "virtual" health insurance exchange to coordinate the various administrative functions of a consumer-choice market.
Creating a "Defined Contribution" Option
The centerpiece of Utah's reforms is a new option for employment-based health insurance that will enable employers to offer health benefits to their workers on a "defined contribution" basis.
An employer electing this option will no longer need to manage a traditional "one-size-fits-all" group plan for its workers. Rather, each worker, during the annual open season, will be able to pick from a menu of health insurance plans, all of which will conform to federal standards (such as guaranteed issue to employees and limits on pre-existing condition exclusions) so as to qualify for favorable federal tax treatment as employer-sponsored health benefits.
Utah will make this defined contribution option available to small businesses (those with two to 50 employees) effective January 1, 2010. The legislation also specifies that starting in January of 2012, businesses of any size will be allowed to elect this option.
Employers will still have the option of offering health benefits on a traditional group policy basis--either purchased from a commercial insurer or self-insured by the employer. However, the new defined contribution option will be less costly and less burdensome for employers to offer, and will give workers more choice and control over their coverage.
Employers who elect the defined contribution option must agree to establish a qualified "cafeteria plan" or "health reimbursement arrangement" in accordance with federal tax law, allowing their workers to pay any employee share of the premiums on a pre-tax basis regardless of what the employer contributes or which plan the employee picks.
Starting with Risk Adjustment
A second important element of the reforms is the creation of a "Utah Defined Contribution Risk Adjuster" with a board consisting of representatives of health insurers and private employers as well as the state's insurance department, the public employee health plan, and the Governor's Office of Consumer Health Services.
This board was created to determine the insurance rating (pricing) rules for the defined contribution market and to design a mechanism for adjusting (or pooling) risk across all insurers in the market. The objective is to enable consumers to easily compare the benefits and prices for various competing plans on the "front end" while on the "back end" adjusting payments to insurers so that the costs of expensive cases is spread among all insurers and all plans have incentives to compete in offering the best value to both healthier and sicker enrollees.[2]
The board is now finalizing its initial design for both elements. In general, the agreed design will work as follows:
Plan offerings will be partially risk-adjusted through pricing based on family status and age. There will be four family status categories: single adult, one adult plus one child, couple with no children, and family--which could be either a single adult with more than one dependent or a couple with one or more dependents. Age rating will be in five-year bands for adults between 20 and 64, with insurers permitted to vary premiums by no more than 4 to 1 between the lowest and highest priced age bands. The age of the employee will determine the applicable age band.
Thus, by simply entering his or her age and choosing one of the four family status categories, an employee will be able to compare competing plan benefits and applicable premiums. There will be no geographic adjustment to premiums as regional differences in health care costs were determined to not be a significant factor in Utah.
A common underwriting questionnaire will be completed by all employees signing up for coverage as part of a participating employer group in order to construct an insurance profile for the group. This is the same process as is currently used in rating traditional group coverage, and Utah law allows insurers to vary premiums by up to +/- 30 percent on a group basis. Thus, when an employee logs on and enters his or her employer's ID number, the software will automatically adjust the entire schedule of age and family premiums for the competing plans to reflect the rating factor assigned to the worker's employer group.
After the employees all pick their coverage, the employer will transmit a monthly total amount for all of the chosen coverage. A portion of that total will be what the employer contributes directly to coverage--determined according to the rules established by each employer for its plan--with the balance coming from pre-tax payroll withholding by the employees. The system has been designed to also accept payments from other sources, such as government subsidies for lower-income individuals.
The amounts transmitted to the insurers will be adjusted further based on which individuals chose which plan. For example, if two individuals have the same employer, are the same age, elect the same coverage status, and choose the same plan, then both will pay the same premium. However, if one is diabetic and the other is not, the insurer will receive a somewhat larger payment for the diabetic employee. Where this will really help is if the two employees opt for different plans. In that case, the differences in the premiums they pay will only reflect the differences in the design of the competing benefit packages--not differences between the employees in health status. Yet the plan chosen by the diabetic will get a somewhat larger slice of the total paid collectively by the employer and all of its workers for coverage.
Finally, an end-of-year adjustment among all participating insurers will compensate for any insurer ending up with a share of high-costs enrollees or claims significantly greater than the normal variation. Those adjustments will be done by the participating insurers--who will debit and credit each other in accordance with the rules they collectively established through the board--and will have no effect on the premiums paid by either the enrollees or their employers.
Everyone involved recognizes that this initial risk adjustment design will likely need further refinement and revisions as the insurers gain experience from operating in the new consumer-choice market. For example, the board will likely need to eventually phase-out the employer-group rating factor. That way, when a worker changes jobs but keeps the same coverage, his or her premium will not increase or decrease simply because the new employer has a different group-rating factor than the old employer.
Health Insurance Exchange
The law also established the Office of Consumer Health Services (within the Governor's Office of Economic Development) and gave it the job of designing and administering an Internet-based health insurance "portal" to function as Utah's health insurance exchange.[3] Any insurer will be able to offer coverage through the exchange if it is licensed in Utah and the plan it offers meets state and federal standards.
The exchange will be an online administrative system for employers to offer the new defined contribution coverage option to their employees; for workers and insurance brokers to use in comparing and choosing coverage; for employers, insurers, individuals, and intermediaries such as banks to use to collect and transmit premium payments from multiple sources; and for the state government to use to administer any premium assistance payments for private coverage on behalf of low-income individuals.
Utah's particular innovation is that rather than creating a single entity to perform all of the different administrative functions, the state is using a contracting process to simply network the different pieces and vendors, both existing and new, into a "virtual" health insurance exchange.
Current plans are for the exchange to begin signing up employers who want to participate the week of August 17, with the rest of the system in place for employees to choose coverage during the first open season in November, and for the coverage to take effect January 1, 2010.
The legislation also contains a number of other provisions that augment the key reform elements, including:
Consumer transparency requirements for insurance agent compensation and insurance plan benefits and practices;
Authorization of new "mandate-lite" health insurance policies; and
Authorization of a new lower-cost "conversion" policy for individuals eligible under federal or state law to elect conversion coverage following employment termination.
Benefits of Utah's Approach
Utah is looking to derive a number of benefits from this insurance reform approach.
More Employers Offering Health Coverage. Nationally, only 43 percent of employers with 50 or fewer workers currently offer employer-sponsored health insurance, and Utah's rate (32 percent) is even lower.[4] A major reason is that traditional one-size-fits-all group coverage puts most of the risk on the employer. In essence, the decision by a small business to start offering health insurance to its employees is a decision to jump onto the health cost escalator. Before deciding to offer group coverage, the employer has to be confident that it can handle future cost increases and also be willing to endure the annual hassle of finding or negotiating coverage that 75-80 percent of its employees will take, and then dealing with their complaints.
Utah's "defined contribution" option will allow employers to offer their workers quality health benefits while avoiding most of the associated risks and hassles. Under a defined contribution arrangement each employee gets to decide which plan best suits his or her needs and situation. Furthermore, employees can reevaluate their decisions each year at open season. When faced with a premium increase for the plan he or she picked last year, it is the worker who will decide whether the benefits are worth the extra cost or if another plan offers a better cost-benefit proposition.
A new insurance option that takes most of the risk off of the employer, combined with shared administrative functions through an exchange that also relieves the employer of most of the hassle factor, could eventually result in almost every employer in the state offering at least that coverage option to its workers.
A New Risk Management Tool for Workers. While it is true that defined contribution shifts risk to the employee, it also gives the employee a new tool to manage that risk: annual choice of coverage from a menu of plans with different benefit designs and premiums offered by different insurers. From the employees' perspective, that is a far better option than the current situation in which their employer picks a plan that is probably not their first choice and, as the premiums go up year after year, shifts more of the cost onto them by requiring them to pay higher co-pays or larger shares of the premium.
Better Value. As seen from the experience of the Federal Employee's Health Benefit Program--the country's largest and longest operating defined contribution health insurance system--a consumer choice market puts simultaneous downward pressure on prices and upward pressure on benefits/quality, the only effective way to attain better value in a health system.[5]
Protecting and Assisting Consumers. Under Utah's defined contribution approach, all the insurance sold through the exchange will be state regulated and meet federal standards for employer-sponsored coverage. Participating employers and their workers can be certain that all the policies offered will be quality coverage from responsible insurers. In addition, insurance agents will be compensated not just for helping the employer offer coverage to its workers but also for helping the workers compare plans and select the ones that best meet their individual needs. Thus, employers can be confident that their workers will have access to licensed and trained professionals for help with picking their coverage.
Increased Portability. Over time, as more employers opt to offer health benefits on a defined contribution basis, more and more workers will be able to take their coverage with them from job to job.
Reducing the Number of Uninsured. Utah lawmakers view the creation of a defined contribution option for employer-based coverage as a first step in covering more of the uninsured. Making it both easier for employers to offer coverage and easier for workers to find and keep the coverage they prefer should result in fewer individuals experiencing gaps in coverage and thus being uninsured.
An Innovative Approach
Other states are pursuing their own variations of consumer-centered health reform. What Utah will soon offer is a working model of how states can design and implement a consumer-centered health insurance market that leverages existing resources with minimal regulation or disruption to existing arrangements.
Of particular interest to other states should be Utah's technological solutions for creating a "virtual" health insurance exchange and the lessons and insight that will come from its experience in designing a robust risk adjustment mechanism to support a consumer-choice market.
Utah's approach is, in effect, a marriage of advanced health care reform with advanced information technology.
Edmund F. Haislmaier is Senior Research Fellow in the Center for Health Policy Studies at The Heritage Foundation.
--------------------------------------------------------------------------------
[1]State of Utah, "H.B. 188 Health System Reform--Insurance Market," 2009 General Session, at http://le.utah.gov/~2009/bills/hbillenr/hb0188.pdf (July 29, 2009).
[2]For a further discussion of risk adjustment in health insurance, see Edmund, F. Haislmaier, "State Health Care Reform: A Brief Guide to Risk Adjustment in Consumer-Driven Health Insurance Markets," Heritage Foundation BackgrounderNo. 2166, August 1, 2008, at http://www.heritage.org
/Research/HealthCare/bg2166.cfm.
[3]Additional information can be found at the Utah Office of Consumer Health Services Website at http://goed.utah.gov/programs/consumer-health
-services/ (July 29, 2009).
[4]Kaiser Family Foundation, "Percent of Private Sector Establishments That Offer Health Insurance to Employees, by Firm Size, 2006," at http://www.statehealthfacts.org/comparemaptable.jsp?ind=176&cat=3 (July 29, 2009).
[5]For a more detailed discussion of FEHBP's performance, see Walton Francis, "The FEHBP as a Model for Medicare Reform: Separating Fact from Fiction," Heritage Foundation Backgrounder No. 1674, August 7, 2003, at
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