Politico Pro has published a short but remarkable article [$] stemming from an interview with HHS secretary Kathleen Sebelius. It offers a couple of illuminating items, and one very glaring one.
First, Sebelius undermines the White House’s claim that “28 States and the District of Columbia are on their way toward establishing their own Affordable Insurance Exchange” when she says:
We don’t know if we’re going to be running an exchange for 15 states, or 30 states…
So it turns out that maybe as few as 20 states are on their way toward establishing this “essential component of the law.” Or maybe fewer.
Second, the article reports the Obama administration has reversed itself on whether it has enough money to create federal Exchanges in states that decline to create them. The administration has repeatedly claimed that the $1 billion ObamaCare appropriates would cover the federal government’s costs of implementing the law. And yet the president’s new budget proposal requests “another $1 billion” to cover what Sebelius calls “the one‐time cost to build the infrastructure, the enrollment piece of [the federal exchange], the IT system that’s needed.”
In other words, as I blogged yesterday, the Obama administration does not have the money it needs to create federal Exchanges. Therefore, if states don’t create them, ObamaCare grinds to a halt. (Oh, and this billion dollars is the last billion the administration will request. Honest.)
Most important, however, is this:
Even if Congress does not grant the president’s request for more health reform funding, Sebelius said her department will find a solution. “We are going to get it done, yes,” she said.
An HHS staffer prevented the reporter from asking Sebelius what she had in mind.
This is a remarkable statement. Sebelius basically just copped to a double‐subversion of the Constitution: Congress appropriates money for X, but not Y. Sebelius says, “I know better than Congress. I’m going to take money away from X to fund Y.” Sebelius has already shown contempt for the First Amendment, first by threatening insurance carriers with bankruptcy for engaging in non‐fraudulent speech, and again by crafting a contraceptives mandate that violates religious freedom. Now, she has decided the whole separation of powers thing is for little people. What will Sebelius do the next time something gets in the way of her implementing ObamaCare?
I don’t see why a federal official should remain in office after showing so much contempt for the Constitution she swore to uphold.
On Friday, President Obama tried to quell the uproar over his ongoing effort to force Catholics (and everyone else) to pay for contraceptives, sterilization, and pharmaceutical abortions. Unfortunately, the non‐compromise he floated does not reduce by one penny the amount of money he would force Catholics to spend on those items. Worse, this mandate is just one manifestation of how the president’s health care law will grind up the freedom of every American.
From the Portland Oregonian:
House Republicans block Oregon’s health insurance exchange in surprise vote
Updated: Monday, February 13, 2012, 1:08 PM
A coalition of 30 Republicans and 1 Democrat in the state House of Representatives blocked approval of Oregon’s health insurance exchange this morning…
Last year, a bill to set up the exchange passed both houses of the Legislature with broad bipartisan approval.
House Bill 4164, which would give final approval to the exchange, cruised through its committee hearings without incident. But then, as the House met Monday morning to forward the bill to the Senate, Rep. Tim Freeman, R‑Roseburg, made a motion to instead refer the bill to the Joint Ways and Means Committee, where he co‐chairs a subcommittee on human services.
Freeman said questions had arisen in a recent caucus meeting of House Republicans over what commitments existed over federal funding of the program, as well as the potential for a change to the legal status of federal health care reforms, currently under consideration by the U.S Supreme Court…
The move led by House Republicans comes as Republicans in the Senate have vowed to block a companion bill on health care reform unless it is modified to include limits on lawsuit awards against health providers.
(HT: Eric Fruits.)
According to Politico Pro [$]:
More than $860 million of President Barack Obama’s proposed $1 billion increase in the CMS budget will go to building the federal exchange, acting [Centers for Medicare and Medicaid Services] Administrator Marilyn Tavenner said during a budget briefing at HHS on Monday.
This funding is necessary in part because the amount originally appropriated for the federal costs of implementing the Affordable Care Act — $1 billion — is expected to be gone by the end of this year, HHS officials said.
Assistant Secretary for Financial Resources Ellen Murray said at the briefing that half of these funds have already been obligated, and the remaining amount will be used by the end of the year.
She also said states will still be able to get help building exchanges, because other ACA funds are still available for exchange work.
“Funding for [state grants] was provided in the Affordable Care Act, so the money we’re asking for in this budget is just for the federal exchange,” Murray said.
In other words, the federal government doesn’t have the money to create ObamaCare Exchanges, and the administration has no hope of getting that funding through the Republican‐controlled House. So if states don’t create Exchanges, they might not exist. (And even if the federal government does create them, they won’t work.)
Never mind the lawsuits. The Exchanges may be ObamaCare’s most serious vulnerability.
On Friday, President Obama announced an “accommodation” to those who object to his contraceptives mandate. Since then, I have been astonished at how many reporters have portrayed the president’s announcement as some sort of compromise, even though it would not reduce — not by one penny — the amount of money he would force Catholics and others with a religious objection to spend on contraception.
In fact, the only reporter who seemed to grasp this may also have been the first out of the box. The Washington Post’s Sarah Kliff:
“If a charity, hospital or another organization has an objection to the policy going forward, insurance companies will be required to reach out to directly offer contraceptive care free of charge,” one administration official explained…
Numerous studies have shown that covering contraceptives is revenue‐neutral, as such preventive measures can lower the rate of pregnancies down the line…
“Contraceptives save a lot of money,” a senior administration official argued.
The catch here is that there’s a difference between “revenue neutral” and “free.” By one report’s measure, it costs about $21.40 to add birth control, IUDs and other contraceptives to an insurance plan. Those costs may be offset by a reduction in pregnancies. But unless drug manufacturers decide to start handing out free contraceptives, the money to buy them will have to come from somewhere.
Where will it come from, since neither employers nor employees will be paying for these contraceptives? That leaves the insurers, whose revenues come from the premiums that subscribers pay them. It’s difficult to see how insurance companies would avoid using premiums to cover the costs of contraceptives.
The Post’s subsequent coverage would have benefited from such scrutiny of the president’s spiel. If I missed such scrutiny in the Post or elsewhere, I hope someone will let me know.
Salting mandated health insurance with birth control is exactly the same as a tax — on employers, on Catholics, on gay men and women, on couples trying to have children and on the elderly — to subsidize one form of birth control…
The tax rate and spending debates that occupy the media are a small part of the effective taxes and spending that the government achieves by these regulatory mandates…
The natural compromise is simple: Birth control, abortion and other contentious practices are permitted. But those who object don’t have to pay for them. The federal takeover of medicine prevents us from reaching these natural compromises and needlessly divides our society…
Sure, churches should be exempt. We should all be exempt.
My only quibble is with his claim, “Insurance is a bad idea for small, regular and predictable expenses.”
That’s generally true. But medicine is an area where, potentially at least, small up‐front expenditures (e.g., on hypertension control) could prevent large losses down the road. So it may be economically efficient for health plans to cover some small, regular, and predictable expenses. Both the carrier and the consumer would benefit. In fact, that would be the market’s way of telling otherwise uninformed consumers, “Hey! Controlling your hypertension is a really good for you!” And really, if someone is so risk‐averse that they want health insurance with first‐dollar coverage of everything — and they’re willing to pay the outrageous premiums that would accompany such coverage — why should we take issue with that?
ObamaCare’s contraceptive‐coverage mandate demonstrates that government does a horrible job of picking only those types of “preventive” services for which first‐dollar coverage will leave consumers better off. But I also think advocates of free‐market health care generally need to let go of the idea that health insurance exists only for catastrophic expenses.
Republicans at the General Assembly are falling prey to the fallacy of the false alternative…
[H]ere are the real options facing Virginia: (a) federal bureaucrats determine the form of our exchange, or (b) federal bureaucrats determine the form of our exchange. There is no ©…
Running a health‐insurance exchange would cost a lot of money — money Virginia does not have. Since Washington will dictate how it will be run, Washington should pick up the tab.