Medicaid

“Disease does not discriminate, but apparently Medicaid coverage does. A 26-year-old South Carolina tile-layer has found himself with breast cancer and out of luck for one reason: He is a man. While breast cancer affects an estimated 2,000 men annually, Medicaid does not cover treatment of the disease in men,” reports the Daily Caller. “The South Carolina Department of Health and Human Services said that the discriminatory policy lies with the federal government. ‘We are again urging CMS [Centers for Medicare and Medicare Services] to reconsider,’ the South Carolina Department of Health and Human Services said in a statement. ‘It’s a very clear example of how overly rigid federal regulations don’t serve the interests of the people we’re supposed to be helping.’”

The man with cancer, Raymond Johnson, is hardly an anomaly.  There have been high-profile cases of men with breast cancer, like former Senator Ed Brooke (R-Mass.), the first popularly-elected black U.S. Senator.  But the federal geniuses who are taking over our healthcare system don’t seem to read the paper. [click to continue…]

Post image for CEI Files Another Amicus Brief Challenging Obamacare

Debate over the constitutionality of the massive health care law passed in 2010 has focused on its “individual mandate”: the requirement that individuals buy health insurance, a requirement that the law’s defenders claim is authorized by Congress’s power to regulate interstate commerce. (I took issue with that argument here.)

But the individual mandate is not the only provision in Obamacare that violates the Constitution. It also violates the Tenth Amendment and limits on Congressional power under the Constitution’s Spending Clause, through its huge expansion of Medicaid, which imposes unfunded mandates on state governments. Florida and other states argue that Obamacare’s Medicaid expansion provisions are unconstitutionally coercive in violation of the Tenth Amendment under the principles laid down by the Supreme Court’s decisions in United States v. Butler (1936) and South Dakota v. Dole (1987).

On May 11, I filed an amicus brief in support of Florida’s challenge on behalf of a majority of Minnesota’s State House of Representatives and the leaders of the North Carolina and Minnesota legislatures. That brief explains how the health care law violates the “clear statement” rule in the Supreme Court’s Pennhurst decision by imposing vague, indefinite, open-ended additional burdens on states, including massive, unpredictable costs in the billions of dollars. Federal officials have issued over a thousand waivers of burdensome rules imposed by Obamacare, mostly to unions or other entities with political connections.  Meanwhile, HHS officials have vastly expanded the reach of other burdensome provisions of the law. For example, they have largely nullified the law’s grandfather clause, which was put into the law to keep Obama’s broken promise to let you keep your existing health insurance if you like it. They also issued a rule rewarding end-of-life counseling, even though such a provision was removed from the bill prior to passage after the so-called “death panels” controversy.

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Post image for Obamacare’s Costs Rise, as Obama Backers Get Preferential Treatment

The cost of Obamacare continues to explode and exceed its sponsors’ predictions. HHS Secretary Kathleen Sebelius has now admitted to double-counting in the Obamacare budget, using the same $500 billion twice, first “to sustain” the existing Medicare program and then to “pay for” brand new Obamacare entitlements. Last year, the CBO hiked its estimate of Obamacare’s costs by $115 billion, even as many of its promised benefits failed to materialize.

Obamacare was supposed to save patients money by curbing insurance company profits and expanding state Medicaid programs to cover millions more people. (This expansion was criticized by state officials, including a few Democrats such as former Tennessee Gov. Phil Bredesen, who called it “the mother of all unfunded mandates.” Bredesen’s health care legal advisor concluded that Obamacare’s Medicaid-expansion provisions were unconstitutional.)

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Thanks to food stamps, Medicaid, and housing subsidies, and other welfare benefits, many “poor” people have far more disposable income than self-supporting households earning $40,000 to $60,000 a year.  Veronique de Rugy points to a finding that “a one-parent family of three making $14,500 a year (minimum wage) has more disposable income than a family making $60,000 a year” — even excluding benefits from Supplemental Security Income.  “America is now a country which punishes those middle-class people who not only try to work hard, but avoid scamming the system.”

These disincentives to work were expanded in the job-killing $800 billion stimulus package, which largely repealed welfare reform and increased the refundable tax-credits given to non-taxpaying “poor” households.  These refundable credits are being perpetuated in the costly $900 billion deal recently reached between Obama and congressional leaders.

The analysis de Rugy cites actually understates the disincentives to work, because it ignored the fact that many households that are “poor” in terms of taxable income are not poor at all once you factor in tax-free income from non-governmental sources.  For example, child support is tax-free to the recipient family, no matter how huge the payments they receive (for example, a billionaire may pay several million dollars a year in child support to each of his ex-girlfriends with kids, leaving them in tax-free luxury, and under New York’s child support guidelines, everyone is supposed to pay at least 17 percent of their gross income in child support for just one child, regardless of how high that income is.  In Massachusetts, middle-income households pay 25 percent of gross income for just one kid — which is around a third of their after-tax income — under that state’s child support guidelines).

The stimulus package contained provisions encouraging states to temporarily ratchet up their child support guidelines to reap more federal matching funds.  Maryland recently increased its child support guidelines to excessive levels, permanently.  Ohio is now weighing a massive proposed child-support increase, also apparently based on erroneous reasoning.  However, these increases probably will not provide a net benefit to state budgets, because increased federal funding is offset by incarceration and other direct and indirect costs associated with enforcement of excessive child-support guidelines).

Federal matching funds are having a negative effect on child welfare in other contexts, such as unwarranted CPS seizures.  (The federal government is increasingly using matching funds to meddle in areas of tort, criminal, family and domestic violence law traditionally handled by the states, sometimes in ways that actually increase domestic-violence-related deaths and injuries.) Financial obligations imposed by divorce courts are also harming soldiers and small businesses.

Federal food stamp allotments are so generous that they clearly exceed the amount needed to actually feed a family on a bare-bones budget.

Approximately 22,000 senior citizens just lost their health plan with Harvard Pilgrim Health Care, which dropped its Medicare Advantage Program due to “cuts in Medicare” that “are being used to fund national health care reform.”  As the Washington Examiner notes, “President Obama’s most frequently repeated health care reform claim — ‘If you like your present health insurance, you can keep it’ — sounds about as credible these days as the finger-wagging Bill Clinton did when he said, ‘I did not have sexual relations with that woman.’”

While Obamacare cuts Medicare for the elderly, it does nothing to slow the growth of health-care spending, since it adds costly new Medicaid mandates for people on welfare, as former New York Lieutenant Governor Betsy McCaughey, a healthcare expert, notes in the New York Post.  She calls it “Obamacare’s redistribution of health.”  Obamacare will also cause Medicaid lawsuits to proliferate at taxpayer expense.

President Obama falsely claimed that the health care law would cut health care costs, but regulators in some states are now approving increases in premiums precisely because Obamacare increases costs.

As columnist David Freddoso notes, the Obama administration has been a windfall for wealthy trial lawyers.  As I noted in the Examiner‘s print edition, “Obamacare will also result in an explosion of lawsuits against employers’ health plans by stripping them of protection against unnecessary lawsuits based on paperwork technicalities, and by displacing settled exhaustion principles in employee benefits litigation.”

Richard Morrison, Jeremy Lott, Greg Conko and Michelle Minton bring you Episode 85 of the LibertyWeek podcast. We put the big vote on health care front and center, while also touching on protests over immigration and legal challenges to the EPA’s greenhouse gas rules. We wrap up with a discussion of WWF’s Earth Hour and its scrappy competitor, Human Achievement Hour.

The health care bills backed by President Obama will cost $2.3 trillion, not the $900 billion Obama claims, and will be a “budgetary disaster” that drives up the national debt, explains health care expert James C. Capretta.  The Obama administration managed to hide $1.4 trillion in costs generated by the health care reform bill though a series of budgetary “gimmicks” that the Congressional Budget Office (CBO) is required to treat as valid in scoring the bill’s enormous cost.

Although the CBO is low-balling the costs of ObamaCare, even it concedes that as a whole, “President Obama’s policies would add more than $9.7 trillion to the national debt over the next decade.”

ObamaCare spends money on frills like “cultural competency,” while cutting spending on crucial things like anesthesia.

Most Americans oppose the health care legislation backed by the president. It would reduce lifesaving medical innovation, raise taxes, drive up insurance premiums, break many campaign promises, and increase state budget deficits.  It  would jeopardize the quality of medical care, while imposing restrictions that failed when tried at the state level.  It ignores advice from doctors and federal experts, and lessons from countries with universal health care, about how to keep costs down.

Fact-checkers say Obama is lying about health care. Obama often contradicts himself. In the very same speech, Obama claimed that Medicare is “unsustainable” and “running out of money,” then contradicted himself by claiming that “Medicare is a government program that works really well,” making it a model for national health care.  The bill does nothing to curb massive waste and fraud in Medicare and Medicaid, even though it proposes to make massive cuts in Medicare (cuts so painful that most of them will never happen: year after year, Congress waives “the annual cut in fees paid by Medicare to physicians” mandated by an earlier law).

A CNN commentary noted that Obama’s plan would take away “5 freedoms,” contradicting Obama’s claim that the bill will leave you free to choose your doctor and keep your health care plan without government interference.

ObamaCare has also attracted criticism from groups like the Civil Rights Commission for containing both racial preferences and lower standards for treatment in predominantly-minority institutions, potentially harming both white applicants and minority patients.  This racial discrimination appears to violate court rulings like the Supreme Court’s Adarand decision, and the Rothe ruling by the Federal Circuit Court of Appeals.

Richard Morrison, William Yeatman and Ryan Young join forces to bring you Episode 74 of the LibertyWeek podcast. We investigate the Department of Homeland Security’s antiterrorism efforts, China’s climate change conundrum and California’s chance at closing her budget gap. We finish with some dangerous snowballing in the streets and the last echoes in the Ballad of Kwame Kilpatrick.

On Saturday, the Senate voted 60-to-39, along party lines, to press towards passage of a massive health care bill, by blocking a Republican filibuster.  Senators ignored the fact that the bill received a failing grade from health care experts like the Dean of Harvard Medical School, since it will raise taxes, deficits, and medical costs, while reducing lifesaving medical innovations.

Afterward, however, the bill drew criticism even from moderate Democrats who usually support the Obama administration, which backs the bill.  Veteran Washington Post editorialist David Broder called the bill a “budget buster in the making,” saying it will violate President Obama’s “pledge that health insurance reform will not add to our federal budget deficit over the next decade.”  He pleaded with the Obama administration and Congress not to “pass along unfunded programs to our children and grandchildren.”

In the Examiner, a Democrat who backed Obama in 2008 criticized the administration for backing a health care bill that violates Obama’s campaign promises by raising taxes on the middle class, citing the bill’s many tax increases, such as its tax on uninsured people and taxes on cosmetic surgery and other medical procedures.

Earlier, Tennessee Governor Phil Bredesen (D) criticized ObamaCare for driving up state spending and budget deficits, calling it “the mother of all unfunded mandates.”

Washington Post columnist Robert Samuelson today called ObamaCare a generational rip-off.  Earlier, he noted that the health care bill is “hypocritical” and “dishonest” and aggravates the worst features of the “status quo.”

In the Senate, all Democrats voted for the bill.  But many received payoffs for doing so.  And there really are no “moderate” Democrats left in the Senate: most of its so-called “moderate” Democrats are not moderate or conservative on anything except on a handful of social issues needed to survive in a “red state,” like gun control.  No Senate Democrat today deviates from the liberal party line as often as the moderate Democrats who once served in the Senate, like Senators Alan Dixon of Illinois and J. James Exon of Nebraska.

As I noted yesterday, Senate Majority Leader Harry Reid (D-Nev.) lined up the 60 votes through payoffs to wavering Senators and powerful unions (some mismanaged unions will receive a taxpayer bailout of their health plans, to the tune of up to $10 billion).

The Dean of Harvard Medical School recently gave Obama’s health care plan a “failing grade,” saying it will harm America’s health and finances, and hamper medical innovations needed to save patients’ lives.  Dean Jeffrey S. Flier wrote in The Wall Street Journal that along “with dozens of health-care leaders and economists,” he had concluded that the bill “will markedly accelerate national health-care spending,” would harm care “by overregulating the health-care system in the service of special interests such as insurance companies,” and would reduce “our capacity to innovate and develop new therapies” that save lives.

Other experts agree.  The health care “reform” bill backed by President Obama “would reduce senior care,” increase “medical costs,”  and “could jeopardize access to care for millions,” report health care experts at the federal Centers for Medicare and Medicaid Services.  The House recently passed a similar bill by the razor-thin margin of 220 to 215.

The bill will raise taxes on the middle class.  It will increase taxes on individuals, employers, and hospitals, impose new taxes on medical devices and cosmetic surgery, and levy a 40% tax on health-care plans above $8,500.  It will increase the deficit, drive up state government spending, and cost taxpayers at least twice as much as predicted.  It is one of the most expensive bills of all time.

It contains special-interest pork, such as payoffs for trial lawyers, and racial preferences that drew criticism from the U.S. Commission on Civil Rights. The bill restricts national competition in health insurance, which is permitted in countries with cheaper health care.

ObamaCare spends money on frills like “cultural competency,” while cutting spending on crucial things like anesthesia.

“ObamaCare is all about rationing,” and tax increases, says one of Obama’s own economic advisers, Martin Feldstein.

Fact-checkers say Obama is lying about health care. Obama often contradicts himself. In the very same speech, Obama claimed that Medicare is “unsustainable” and “running out of money,” then contradicted himself by claiming that “Medicare is a government program that works really well,” making it a model for national health care.

CNN noted that Obama’s plan would take away “5 freedoms,” contradicting Obama’s claim that the bill will leave you free to choose your doctor and keep your healthcare plan without government interference.

The bill does nothing to curb massive waste and fraud in existing government health care systems like Medicare and Medicaid, even though it proposes to make massive cuts in Medicare (cuts so painful that most of them will never happen: year after year, Congress waives “the annual cut in fees paid by Medicare to physicians” mandated by an earlier law.  The cuts were added to the bill only to reduce its apparent cost.  As economist and former Congressional Budget Office director Douglas Holtz-Eakin notes in The Wall Street Journal, the promised cuts to pay for ObamaCare will not happen: “Senate Democrats chose to ignore this reality and rely on the promise of a cut to make their bill add up. Taking note of this fact . . . destroys any pretense of budget balance.”)

Backers of ObamaCare have refused to cut medical costs through malpractice reform, with Senate Majority Leader Harry Reid saying that such reforms would save “only” $54 billion.  The Pacific Research Institute estimates that just one type of cost that could be reduced through malpractice-lawsuit reform — defensive medicine — costs around $200 billion annually (which is almost as much as France spends annually on health care for all of its citizens; like most countries, France has no punitive damages, and fewer lawsuits against doctors).

One reform opposed by the Democrats — setting up specialized health tribunals to hear malpractice cases — would be particularly helpful. Replacing uninformed juries with specialized health courts would provide more consistent rulings from case to case, eliminate meritless cases, reduce defensive medicine, and more speedily compensate injured people who truly are victimized by doctors’ carelessness. Such tribunals already exist in countries like “Sweden, Denmark, Finland, Iceland and New Zealand.”

Martin Feldstein, one of Obama’s own advisors, has said that Obama’s health-care plan would explode the federal budget deficit and lead to “crippling deficits,” as well as “higher taxes, debt payments, and interest rates” that would cut America’s standard of living. Feldstein also noted that Obama’s health-care plan would harm people with insurance, and predicted that it would lead to massive tax increases. Other analysts have predicted that it will drive up medical costs and inflation.

Obama has relied on $2 trillion in imaginary savings to pay for healthcare “reform.”

A college professor once described what he called the “Rudy’s Test” to his class.  The Rudy’s test involves going into Rudy’s (a bar) sitting down next to any guy at the bar, and asking them their opinion about a proposed policy.  Typically, the professor said, the Rudy’s Test would reveal what the policy would really do.  Many times, the average man’s common sense view of government will provide a simple, clear insight into public policy.

One current statement that fails the Rudy’s Test is that health care reform is going to save us money.  As Saturday Night Live satirically noted, “How exactly is extending health care coverage to 30 million people going to save you money?”

The savings in the health care bills are predicted over the course of the next 10 years.  These predictions are derived by comparing the projected savings with the projected costs of health care reform.  This approach is flawed on both sides.  Government routinely fails to predict how much an entitlement will cost, and also fails in predicting exactly how much a new tax can gather in terms of revenue.

A recent Washington Times story shows fairly conclusively that government economists and bureaucrats do not possess the gift of prophecy.  In 1965, Medicare’s hospital insurance program was estimated at 9 billion dollars.  The actual cost of the program was 67 billion dollars.  In 1987, Medicaid’s projected cost was less than 1 billion dollars.  The actual cost of the program was 17 billion dollars.  In 1993 the cost of Medicare’s home care benefit program was projected to be 4 billion dollars.  The actual cost of the program was 10 billion dollars.  These are only a few examples of how estimated and actual costs are rarely consistent.  There are many reasons for this, as Michael Cannon points out in his article on Medicare Part D cost overruns, including the facts that politicians intentionally conceal costs (accurate in this case because the “doc fix” of Medicare reimbursements, which will cost an estimated 250 billion dollars, has been moved into another bill), that people alter their behavior to maximize the benefits of an entitlement, and that Congress often later expands programs.  I would add a fourth item to this list; that politicians and economists simply do not have the detailed knowledge of every human being in America to be able to predict the future.  In a complex economy filled with rational actors, no economic projection can ever truly capture the future.  There are simply too many parts moving independently of each other to boil down the human behavior of 300 million people into an accurate mathematical formula.  Cost estimates simply cannot be accurately predicted with any regularity.

Further, income estimates are impossible to predict.  Take, for instance, the cosmetic surgery tax included in the Senate’s health care reform proposal.  A similar tax has been instituted in New Jersey, and has been such a failure at bringing in the amount of revenue expected that the assemblyman who first introduced the tax in 2004 introduced a measure to repeal it in 2006.  At the time of it was enacted, the tax was estimated to generate 24 million dollars.  It actually generated 6.8 million dollars.  We have tried this kind of tax before, and it simply doesn’t work the way it is expected.  No doubt the amount of revenues expected by the Obama administration from a host of new taxes will be lower than expected.

Always think about the Rudy’s Test when considering a new policy.  If it sounds too good to be true, it probably is.