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August 2011
Contents:
Countering HHS Doublespeak on Health Insurance ExchangesThe U.S. Department of Health and Human Services (HHS) has released its first set of proposed regulations on the American Health Benefits Exchanges required under President Obama's health "reform" law. The deadline for public comments is September 28, 2011. In its announcement on the proposed rules, HHS officials claimed that exchanges:
However, the claim that exchanges are "state-based" is countered by 811 uses of the word "require" in the first set of proposed regulations, according to Chris Jacobs of the Republican Policy Committee, as reported by Politico Pulse. Shortly after the release, HHS was forced to retract a key part of its claim:
Trumpeting the advent of the exchanges, the administration said Monday that they would "give Americans the same insurance choices as members of Congress." However, in response to questions after a news conference on Monday, health officials acknowledged that this claim was not necessarily correct.
Under the rules, an employer may allow employees to choose any health plan at a given level of coverage. But an exchange may also allow an employer to limit its workers to one or two health plans - far fewer than the number available to members of Congress and other federal workers.
The claim that exchanges are competitive "marketplaces" with choice and clout is also challenged by the fact that the law outlaws catastrophic major medical insurance and limits insurance options in the exchanges to managed-care plans.
Calling an exchange a marketplace is a carefully crafted strategy. Herndon Alliance published a two-page paper that strongly encourages using the word "marketplace" when discussing exchanges. Its list of "good words" - which includes "control," "choice," "consumer" - features the word "marketplace" with the following statement:
[T]his term was preferred over exchange. Public associates marketplace with purchasing and exchange did not conjure up the notion of purchasing. Also use marketplace not market (the public identifies "market" with groceries)
HHS asserts that the draft proposal gives states significant flexibility to build an exchange that works for them. But Michael Cannon of the Cato Institute has already refuted that assertion in National Review:
[S]upporters have sought to frighten Republican governors into implementing the law by holding out the nightmare scenario of the federal government's administering the exchanges. Who administers the exchanges, however, is unimportant. What counts is who writes the rules that govern them. Those rules will be written entirely in Washington.
Four more exchange regulation proposals will be published. Despite the rhetoric, it's clear that Washington intends to govern the states through the exchanges. As evidence, using a word search feature, here is a list of key words and the number of times they appear in the 62-page proposed "Establishment of Exchanges" rule, the longest of the first set of proposed rules:
Public comments are due by 5 p.m. September 28, 2011. Refer to file code CMS-9989-P for the Exchange Framework rule or CMS-9975-P for the Reinsurance, Risk Corridors and Risk Adjustment rule. Electronic comments can be submitted at
Sources:
Is there a Moral Case for ObamaCare?
By
Editor's Note: This is an excerpt from an article that appeared in NCPA'S Health Alert, July 6, 2011.
There is considerable consternation on the political left these days over whether Barack Obama failed to make a moral case for his signature health legislation. See
I'm sure many readers are astonished that the question is even asked.
After all, how can there be a moral case for a 2,700 page bill that was shaped and molded by self-seeking interests, with no more regard for principle than one would find in a game of musical chairs? Isn't asking for a moral defense of ObamaCare sort of like asking what is the moral case for the IRS Code?
Even if you believe that some of us have a moral obligation to others in the matter of health care, what does that belief have to do with legislation in which costs and benefits are strewn about with all the care of a drunken sailor? Isn't the Affordable Care Act (ACA) self-evidently immoral? Or at least amoral?
I generally try to avoid ethical discussions with my friends on the left for two reasons. First, with respect to actual legislation they seem incapable of distinguishing what really happened from their ideal vision of what should have happened. More fundamentally, I find that people on the left seem incapable of thinking rationally about the ethics of public policy.
I realize that's harsh. But it's true!
Take the first issue. Ted Marmor thinks that the most important ethical justification for ObamaCare is that it provides "affordable health care for every American."
Here's the problem: Nowhere in the ACA is there any guarantee at all that health care will be affordable. More importantly, there is no guarantee that it will be accessible. And if it's not accessible, that means that millions will find that alternative avenues for seeking care are unaffordable. As I have argued before, it is very likely that we will spend close to $1 trillion over the next 10 years and leave
Even if we agree with Marmor that everyone should have access to affordable care, that couldn't possible justify the Affordable Care Act. Almost everybody already has access to affordable care! At last count, there were about 22,000 Americans with serious health problems who could not obtain health insurance because of a pre-existing condition. (See
What cries out for moral justification are the mandates and regulations being forced on the other 300 million people. Why are they being forced to pay more, or allowed to pay less, than the true cost of their insurance? What moral principle can justify that?
Search the world's ethical codes and you will have a hard time finding any that are consistent with a health reform that:
Debt Ceiling Cuts MedicareCongress's approval of a $2.4 trillion increase in the U.S. government's debt limit is shocking when compared to the history of America's national debt. As CNSNews.com reports, "The total debt of the federal government did not hit $2.4 trillion until November 1987, according to the U.S. Treasury Department." Thus it took 211 years for the debt of the United States of America to reach $2.4 trillion, but in one act of the 112th Congress, the national debt will increase by that amount in less than two years.
The debt ceiling will be raised in two phrases. The first phase is a $900 billion increase paired with discretionary spending cuts spread over ten years. The remaining $1.5 trillion increase will be paired with the formation of a committee of 12 members of Congress - some are calling it a "Super Congress" - that can recommend spending cuts, tax increases, or both. If the committee fails to reach at least $1.2 trillion in deficit reduction, there will be an automatic across-the-board cut of $1.5 trillion, half from defense spending and the other half from domestic spending.
These cuts are will be based on "sequestration." Wikipedia defines
Under the proposed domestic cuts, payments to doctors, hospitals, and other providers of Medicare services could be cut up to 2 percent. However, the Medicare sequestration provision of the
If a reduction in payment amounts is made ... the person furnishing the services shall be considered to have accepted payment of the reasonable charge for the services, less any reduction in payment amount made pursuant to a sequestration order, as payment in full. [Emphasis added.]
The Medicare sequestration law does not force doctors to participate in Medicare, however, and doctors are increasingly closing their offices to Medicare patients. Medicare payments are already scheduled to be cut by 29.5 percent in 2012 as a result of the sustainable growth rate formula established by the 1997 Balanced Budget Act. With additional cuts likely through the debt deal's sequestration requirements, Medicare patients could experience reduced access to care.
Sources:
"Text of Budget Control Act" August 1, 2011
"Budget Control Act and Medicare"(email to author), Chris Jacobs, Republican Policy Committee, August 1, 2011.
"Reform Medicare Physician Payment Formula," (see section on Sustainable Growth Rate (SGR) History and Background), American College of Emergency Physicians, accessed online August 3, 2011.
Health Freedom Watch is a monthly email newsletter published by the Citizens' Council for Health Freedom (formerly Citizens' Council on Health Care), a national nonprofit, educational organization whose mission is to support patient and doctor freedom, medical innovation and the right to a confidential patient-doctor relationship. Health Freedom Watch provides reports on national and state policies that impact citizens' freedom to choose their health-care treatments and practitioners, and to maintain their health privacy - including genetic privacy. Citizens' Council for Health Freedom (CCHF) is not affiliated with any other organization. © Citizens' Council for Health Freedom.
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