Republican Ways and Means RSS Articles

Health Care Subsidies for Illegal Immigrants Still a Problem for Democrats

Fri, 06 Nov 2009 05:00:00 GMT

ROLL CALL: Rep. Velazquez and the CHC will vote against the bill if “language restricting the rights of illegal immigrants to buy insurance is ADDED to the bill.” (Emphasis added, but not restrictions on illegal immigrants getting taxpayer subsidies.)

THE HILL: “Congressional Hispanics have threatened to vote against the bill because of a last-minute threat from within the Democratic Caucus to bolster the House bill’s immigration restrictions.”

POLITICO: The CHC “has 20 votes for the current immigration language and would oppose the verification requirements in the Senate bill.”

Hispanic Caucus Threatens to Block Health Bill Over Immigration Language
By Jennifer Bendery
Nov. 5, 2009, 6:42 p.m.

Congressional Hispanic Caucus Chairwoman Nydia Velázquez (D-N.Y.) warned President Barack Obama on Thursday that 20 members of her caucus are prepared to vote against the House Democratic health care plan if language restricting the rights of illegal immigrants to buy insurance is added to the bill.

Velazquez met with Obama at the White House with a handful of other CHC members, including House Democratic Caucus Vice Chairman Xavier Becerra (D-Calif.) and Reps. Charlie Gonzalez (D-Texas) and Lucille Roybal-Allard (D-Calif.).

“He listened to us and he knows where we stand,” Velazquez said. “We made it very clear that we support the language that is in the House. We expect that the current language will not change.”

At issue is whether to adopt Senate language that would bar illegal immigrants from buying insurance with their own money through a new national insurance exchange. The White House and the Senate Finance Committee have backed such a ban, but House liberals and the CHC in particular are strongly opposed to the idea.

Velazquez said she didn’t know who is trying to have the language changed. Asked where Speaker Nancy Pelosi (D-Calif.) is on the matter, Velazquez said, “We will continue to have discussions.”

Rep. Chris Van Hollen (D-Md.) — charged with looking out for politically vulnerable Democrats as Assistant to the Speaker and Democratic Congressional Campaign Committee chairman — has pushed to move the House bill closer to the Senate’s hard line. He huddled with the CHC on Thursday to tell them he supports the bill as currently written but warns that differences between the chambers’ approaches will have to be reconciled at some point, a senior Democratic aide said. The aide described the session as cordial.

Rules Chairwoman Louise Slaughter (D-N.Y.) said that in recent discussions people seem happy with the immigration language already in the bill, which prohibits illegal immigrants from getting subsidies but allows them to buy insurance with their own money.

“As far as I know ... everybody’s pretty content with the rule the way it is,” she said.
Slaughter and other Members were heading into a meeting Thursday evening to discuss changes to the abortion language in the bill in an effort to assuage the concerns of Democrats opposed to abortion rights.

Illegal immigration issue threatens healthcare vote
By Jared Allen - 11/05/09 07:38 PM ET

The illegal immigration issue is emerging as the biggest threat to passing healthcare reform in the House.

Congressional Hispanics have threatened to vote against the bill because of a last-minute threat from within the Democratic Caucus to bolster the House bill’s immigration restrictions to match those included in the Senate Finance bill.

And they’re also fighting President Barack Obama, the original sponsor of the language prohibiting illegal immigrants from accessing the public health insurance exchange.

On Thursday afternoon, four leaders of the Congressional Hispanic Caucus (CHC) traveled to the White House to meet with Obama on behalf of the entire group.

Officially, the purpose of their meeting was to talk to the president about healthcare.
But CHC members, speaking on the condition of anonymity, said the group’s message was clear: Drop your insistence on preventing illegal immigrants from accessing the public exchange, even if their only option is to pay for insurance plans entirely out of their own pockets.

A public exchange is a nationwide pool of health insurance providers that would facilitate access to coverage for individuals and employers.

Obama has promoted the concept as a key component of healthcare reform.

The House healthcare bill already bars illegal immigrants from enrolling in the public option and from receiving subsidies for health plans.

But if the final Senate healthcare bill contains the exchange-prohibition provision that’s in the Finance Committee bill, the provision could also be included in a conference report.

And CHC members have said publicly that they would have a very difficult time voting for any healthcare bill that contained such a provision.

“I am concerned about the manner in which the exchange has been characterized, and I understand the politics of it,” said CHC Vice Chairman Rep. Charles Gonzalez (D-Texas), “but it is very bad policy.”

Gonzalez was at the White House meeting along with CHC Chairwoman Rep. Nydia Velázquez (D-N.Y.), Rep. Lucille Roybal-Allard (D-Calif.) and Democratic Caucus Vice Chairman Xavier Becerra (D-Calif.), the only Hispanic member of the Democratic leadership.

Vulnerable Democrats may push for language that would match the Senate provision on preventing illegal immigrants from accessing a public exchange.

And while there was no identifiable sponsor or group of members pushing for that last-minute change, a Democrat with direct knowledge of the process for guiding the healthcare bill through the Rules Committee described it as a distinct possibility.

If House leaders determined that they needed to insert the Senate immigration language in order to pass the healthcare bill, the Senate language would be included in a “self-executing” rule allowing for consideration of the healthcare bill containing the change.

Should that occur, members of the CHC have said they will vote against the rule. Assuming all Republicans vote no, a revolt of any more than 37 Democrats would torpedo the legislation. The CHC has 27 members.

But a significant number of Democrats — largely from conservative districts — may demand such a change if they believe Obama and Senate Democrats will stand firm on their support for stronger language than the current House language.

“I have to be able to reassure my constituents that those who are here illegally cannot avail themselves of the provisions provided in this healthcare bill,” said freshman Democratic Rep. Gerry Connolly (Va.). “The Senate language may tighten that up a bit.”

Connolly said he wouldn’t necessarily need the Senate language to allay his concerns, but he said that he can’t make that determination until he sees the final language of the bill.

“You’ve got real competing interests among Democrats in the House over abortion and immigration, and I believe the immigration issue is the more significant of the two,” he said.

Pelosi still dealing as vote nears
By: Patrick O'Connor
November 6, 2009 05:09 AM EST

House Speaker Nancy Pelosi has conjured up plenty of old ghosts since launching the health care fight back in July, invoking Democrats who laid the foundation for this year’s push — like Franklin Roosevelt and Harry S. Truman.

In a way, those titans came up short. Pelosi owes her current place on the cusp of a historic health care vote Saturday to far more anonymous contemporaries, like New Jersey Rep. Robert Andrews and California Rep. Xavier Becerra, whom Pelosi sent out to get the votes.

The fate of the bill itself rests on the shoulders of a new generation of Democrats whose young careers will be defined, in part, by the votes they cast Saturday — votes sure to be used against many of them in 2010.

But Pelosi, ever mindful of the political stakes, seems to have convinced them that there is more danger in not passing a bill after all this time, than in passing one. It just had to be the right bill, one that tried to take into account the whims of her caucus — with a provision here, and language there and compromise over there, that built a majority vote by vote.

Yet all the deal-making signaled that the ever-pragmatic Pelosi was keenly aware of the limits to her own power, reminding her rank and file, “We have to work this out because this has to work in your district.”

Freshmen Reps. Jared Polis of Colorado and Gerry Connolly of Virginia, for instance, organized their fellow freshmen to ask the speaker to raise the income threshold for the so-called “millionaire’s tax” to ensure small business owners wouldn’t bear the burden for reform.

In dealing with the speaker, Polis and others suggested the key was to keep your list short and if she could deliver, live up to your end of the bargain.

Our ask was something she could do,” Polis said. "Ultimately, they decided to move the bill in the right direction."

Added Andrews: “Every member was given real input into the bill. This is pretty rare. Normally, the chairman writes the bill, and the whip goes out and gets the votes.”

But Pelosi’s not there yet, as she acknowledged Thursday — saying she’ll have the 218 votes by the time she needs them. Last-minute flare-ups on abortion and immigration Thursday threatened to complicate the bill — but at this point didn’t seem enough to derail it.

Members of the Congressional Hispanic Caucus fought back against reports that leaders would add Senate language to block illegal immigrants from participating in the insurance exchange. New York Rep. Nydia Velazquez, the chairwoman of CHC, said they told the president during a White House meeting Thursday afternoon that the caucus has 20 votes for the current immigration language and would oppose the verification requirements in the Senate bill. Obama was receptive to their concerns, she said.

And a small group of anti-abortion Democrats, led by Indiana Rep. Brad Ellsworth, continued haggling over the final language to ensure federal funds can’t be used to pay for abortions under programs created by the bill.

Negotiators are working closely with the United States Conference of Catholic Bishops to finalize language the church can accept. Vulnerable anti-abortion Democrats don’t want to support any bill that the bishops haven’t signed off on.

The speaker won support for the bill Thursday when AARP and the American Medical Association both announced they were backing the House bill.

Their support proved important enough for President Barack Obama to make a surprise appearance in the White House briefing room to tell Congress that it ought to heed the two powerful lobbies.

“We are closer to passing this reform than ever before, and now that the doctors and medical professionals of America are standing with us, now that the organizations charged with looking out for the interests of seniors are standing with us, we are even closer,” Obama said.
Obama himself will come to Capitol Hill on Friday to make a personal pitch to House Democrats. The president’s audience includes first-year Democrats from often-overlooked parts of the country who came to Congress on Obama’s coattails, like Reps. John Boccieri from northeast Ohio, Kathleen Dahlkemper from northwest Pennsylvania and Thomas Perriello from Virginia’s Southside. Their votes are critical to his success, just like his voters were critical to theirs.

From the beginning, the bill has been the sum of the caucus parts.

The low-profile Becerra has taken the lead in negotiating with a handful of aggrieved constituencies, balancing the priorities of his lower-income largely Hispanic constituents with those of his party. And Andrews has become something of an in-house expert on the legislation who explains portions of the bill to confused colleagues and even more confused members of the press.

A collection of Democrats spent months haggling over Medicare’s controversial reimbursement rates. The House Education and Labor Committee based a key component of its bill — banning insurance companies from discriminating against the sick and most expensive to insure — on a bill first introduced by Connecticut Rep. Joe Courtney. And the entire caucus went back and forth for weeks on what form of government insurance to include in the final bill.

First-year Democrats were particularly productive. Dahlkemper and North Carolina Rep. Larry Kissell persuaded the speaker to add billions to expand coverage for young people. And New Mexico Rep. Ben Ray Lujan, another freshman, pushed for the addition of money for American Indian health care programs.

Party leaders have had to baby-sit this process, but they are rarely the loudest voices in the room.

Minnesota Rep. Betty McCollum, who rarely speaks in caucus meetings, was among the first to raise the Medicare reimbursement issue with her colleagues, arguing one day that the historic imbalance tends to direct more money to doctors and hospitals in urban areas at the expense of less-populated regions that often get better results for less money. After she spoke, the speaker turned to her and said, “Yes, that’s not fair.”

When Pelosi did try to pound her caucus in place, the votes weren’t there, forcing her to retreat on a public plan in which doctors and hospitals would be paid 5 percent higher rates than Medicare, even though she lost more than $80 billion in savings in the process.

But Pelosi’s patience has its limits, and she occasionally let her frustration show, publicly questioning the always-agreeable Earl Pomeroy about which way he would vote when the North Dakota Democrat questioned the inclusion of a controversial long-term care program.

However, the speaker called Pomeroy a few days later to let him know that it looked like his top priority — a public option that lets doctors and hospitals negotiate rates with the government — would be included in the final bill. By the end of the 10-minute chat, Pomeroy seemed to suggest he was willing to back the bill.

And so last week, before she and her colleagues marched outside to the West Front of the Capitol to unveil their bill, the speaker apologized to Pomeroy in front of the entire caucus after trying to embarrass him in the same room a week earlier.

Touched, Pomeroy apologized, too, prompting Connecticut Rep. John Larson to joke that they were having a “real ‘Kumbaya’ moment.”

Pomeroy, who had been on the fence, took that moment one step further when he told his colleagues that he was ready to support the bill. They returned the favor by giving him rousing applause.

“When negotiated rates were in there, I felt duty-bound to support the bill,” Pomeroy said.

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Democrats’ Health Care Taxes Threaten Millions More American Jobs Even as Unemployment Soars to 10.2 Percent

Fri, 06 Nov 2009 05:00:00 GMT

$154 Billion Tax on Small Businesses. The bill would impose a 5.4 percent “surtax” on the modified adjusted gross income of individuals – including many small employers who file as individuals. According to the Joint Committee on Taxation (JCT), one-third of this tax increase (about $154 billion) would fall on the income of small businesses – making it harder for them to meet payroll and avoid layoffs. Worse yet, the income thresholds for this tax are not indexed for inflation, meaning each year it will ensnare more and more families and businesses.
Payroll Tax Penalty to Hit a Majority of Small Businesses and Their Employees. Under the House Democrats’ bill, employers who fail to provide coverage that is deemed “acceptable” by the new Health Choices Commissioner would have to pay a payroll tax of up to 8% of wages. According to data provided by the Kaiser Family Foundation, more than half of small employers with fewer than 200 employees currently fail to meet that standard and thus would be forced to spend even more of their income on health benefits or become subject to the payroll tax.
Half-Million Dollar Penalties for Unintentional Failures. The House Democrats’ bill also imposes on employers who promise to provide government-approved health insurance to their employees, but fail to do so at some point a penalty of $100 per day, per uncovered employee. Small businesses committing an unintentional mistake still could be subject to a penalty of $500,000.
Massive Tax Increases Mean Massive Job Losses. The House Democrats’ bill raises taxes by a total of more than $750 billion over the next decade. Using methodology developed by Christina Romer, President Obama’s top economic advisor, these tax hikes could cost the country 5 million jobs, something this morning’s news shows we can scarcely afford.
- “Economic research has shown time and again that mandates such as these are a “one-two punch” where the cost is first borne by the employer, but is ultimately borne by the employee – through job loss and lower wages.” National Federation of Independent Business

(Click to Enlarge)

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Remarks Before the Rules Committee, H.R. 3962 and the Republican Alternative, "Common Sense Health Care Reforms and Affordability Act"

Fri, 06 Nov 2009 05:00:00 GMT

(Remarks as Prepared)

Madame Chairman,

The people have spoken: they do not want a trillion-dollar government plan to replace their health care. Republicans have listened to the American people; it is clear from the Speaker’s health care bill, H.R. 3962, the Democratic majority has not.

The bill Speaker Pelosi crafted over the last three months, behind closed doors – which doubled in size from 1,000 pages to 2,000 pages – will do lasting damage to our economy, medical innovation, and heap mountains of additional debt on our children and grandchildren, especially when combined with an unpaid for bill to address the flawed Medicare physician payment system.

This bill will kill American jobs. Using methodology developed by the President’s top economic advisor, this bill could cause us to lose another 5 million jobs, something we can’t afford to do when our unemployment rate just reached 10.2% and shows no signs of improvement.

The Democrats’ bill will cut Medicare – by up to one-half trillion dollars, which will harm the health care 11 million seniors currently have and like.

The Democrats’ bill will pile debt on our children.

The Democrats’ bill will increase the federal commitment to health care by $600 billion according to the Congressional Budget Office. And an earlier report by the non-partisan Medicare actuary confirmed that the bill approved by Ways and Means would bend the curve upward, meaning health care would consume an even faster-rising share of our economy.

Office of Management and Budget Director Peter Orszag has stated that, “The single most important thing we can do to improve the long-term fiscal health of our nation is slow the growth rate in health care costs.”

If the Budget Director is to be believed, then the worst thing we could do for our nation’s long-term fiscal health is to increase the growth rate in health care costs by enacting the Speaker’s health care bill.

The Democrats’ bill will raise taxes by over $700 billion. Many of those tax increases will hit families with incomes below $250,000, something the President has repeatedly promised he would not do.

The Democrats’ bill will use federal funds to pay for abortions.

The Democrats’ bill will allow taxpayer money to subsidize health insurance for millions of illegal immigrants.

I share the commitment of each of the Members on the panel here today that we must do something to make our health care system better and more efficient. But the solution put forward by the Majority’s deep flaws make it one I cannot support.

Republicans have a better solution and I am here to let the American people know, and urge the Rules Committee to make in order for the purposes of a substitute, the House Republican alternative to this government takeover of health care.

Let’s be clear about the Republican bill: it delivers what the American people want – lower health care costs.

According to the Congressional Budget Office, the Republican health care reforms would reduce premiums by up to 3 percent for Americans who get insurance through a large business, up to 8 percent for Americans without employer sponsored insurance, and up to 10 percent for those working for a small business (50 or fewer employees). CBO has not made a claim that the Democrats’ bill would lower premiums.

The Republican bill will significantly reduce health care premiums, insures millions of Americans, guarantees those with pre-existing conditions have access to quality, affordable health care and does all of this without raising taxes, without spending $1 trillion we don’t have, without cutting Medicare and without putting some new Health Czar in between doctors and patients, which is what the Democrat majority does in their government takeover bill.

Americans’ health care is too important and too complex to risk on Democrats gamble. Instead, Republicans are promoting a step-by-step approach to comprehensive health care reform, and the first step is to make health insurance affordable for families, affordable for small businesses and affordable for America.

Finally, unlike the Democrat plan that increases taxes almost immediately but delays health reforms for several years, the Republican plan will immediately begin to lower costs.

Madame Chairman, clearly the bill offered by the Speaker is not what the American people want. Americans are clamoring for lower cost health care and that is what the Republican plan offers – lower costs health care without tax increases, without Medicare cuts, without adding to the deficit and without eliminating jobs.

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PELOSI: Buy a $15,000 Policy or Go to Jail

Fri, 06 Nov 2009 05:00:00 GMT

Today, Ranking Member of the House Ways and Means Committee Dave Camp (R-MI) released a letter from the non-partisan Joint Committee on Taxation (JCT) confirming that the failure to comply with the individual mandate to buy health insurance contained in the Pelosi health care bill (H.R. 3962, as amended) could land people in jail. The JCT letter makes clear that Americans who do not maintain “acceptable health insurance coverage” and who choose not to pay the bill’s new individual mandate tax (generally 2.5% of income), are subject to numerous civil and criminal penalties, including criminal fines of up to $250,000 and imprisonment of up to five years.

In response to the JCT letter, Camp said: “This is the ultimate example of the Democrats’ command-and-control style of governing – buy what we tell you or go to jail. It is outrageous and it should be stopped immediately.”

Key excerpts from the JCT letter appear below:

“H.R. 3962 provides that an individual (or a husband and wife in the case of a joint return) who does not, at any time during the taxable year, maintain acceptable health insurance coverage for himself or herself and each of his or her qualifying children is subject to an additional tax.” [page 1]

- - - - - - - - - -

“If the government determines that the taxpayer’s unpaid tax liability results from willful behavior, the following penalties could apply…” [page 2]

- - - - - - - - - -

“Criminal penalties

Prosecution is authorized under the Code for a variety of offenses. Depending on the level of the noncompliance, the following penalties could apply to an individual:

• Section 7203 – misdemeanor willful failure to pay is punishable by a fine of up to $25,000 and/or imprisonment of up to one year.

• Section 7201 – felony willful evasion is punishable by a fine of up to $250,000 and/or imprisonment of up to five years.” [page 3]

When confronted with this same issue during its consideration of a similar individual mandate tax, the Senate Finance Committee worked on a bipartisan basis to include language in its bill that shielded Americans from civil and criminal penalties. The Pelosi bill, however, contains no similar language protecting American citizens from civil and criminal tax penalties that could include a $250,000 fine and five years in jail.

“The Senate Finance Committee had the good sense to eliminate the extreme penalty of incarceration. Speaker Pelosi’s decision to leave in the jail time provision is a threat to every family who cannot afford the $15,000 premium her plan creates. Fortunately, Republicans have an alternative that will lower health insurance costs without raising taxes or cutting Medicare,” said Camp.

According to the Congressional Budget Office the lowest cost family non-group plan under the Speaker’s bill would cost $15,000 in 2016.

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CBO Confirms Pelosi’s Health Care Bill Covers 2.5 Million More Illegal Immigrants Than H.R. 3200

Thu, 05 Nov 2009 05:00:00 GMT

According to analysis from the non-partisan Congressional Budget Office (CBO) the number of illegal immigrants covered under Speaker Pelosi and House Democrats’ health care bill (H.R. 3962) has increased by 2.5 million from their original bill, H.R. 3200:

According to CBO, H.R. 3962 leaves “18 million nonelderly residents uninsured (about one-third of whom would be unauthorized immigrants).” That equates to roughly 6 million illegal immigrants uninsured. According to CBO, H.R. 3200 left “17 million nonelderly residents uninsured (nearly half of whom would be unauthorized immigrants).” That equates to roughly 8.5 million illegal immigrants uninsured. So Speaker Pelosi’s new bill expanded coverage for illegal immigrants by 2.5 million people. How many of them will receive free health insurance paid for by American taxpayers?

                        8.5 million uninsured illegal immigrants under HR 3200
            -           6 million uninsured illegal immigrants under HR 3962
            =          2.5 million MORE INSURED illegal immigrants under HR 3962

Democrats previously rejected Republican amendments to improve verification of citizenship status for taxpayer-subsidized health insurance that would prevent illegal immigrants from receiving taxpayer subsidies.
Democrats instead chose to include watered-down verification language in H.R. 3962 for citizenship verification.
The Democrats’ language is based on earlier legislation that was widely criticized for allowing states to simply check Social Security number and place of birth to verify citizenship status. But according to the Social Security Administration (SSA), more than 46 million SSNs have been issued to non-citizens. Some of these individuals may now be U.S. citizens, but others may continue to reside in the United States illegally.
Thus, the mere possession of a valid SSN does not establish U.S. citizenship or legal presence in the United States. In fact, over 7 million employees worked under false SSNs in 2008 (from SSA, most recent year with data available).

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Opening Statement: Hearing on Foreign Bank Account Reporting and Tax Compliance

Thu, 05 Nov 2009 05:00:00 GMT

(Remarks as Prepared)

Thank you, Mr. Chairman.

Earlier this year this Subcommittee met to examine issues surrounding banking secrecy and illegal tax evasion. At that hearing, we all agreed that criminal tax evasion should be Aggressively pursued and punished.

I also said that I hoped our efforts in this area would remain focused on compliance; that the line between illegal tax evasion and legal tax practices used by U.S. taxpayers around the world is distinct, and to blur that line may only make our compliance efforts more difficult.

I’m very pleased that you have called this hearing to discuss legislation recently introduced by Chairman Rangel and you that seeks to address the issues of illegal tax evasion. During these challenging economic times, honest, hard-working taxpayers who play by the rules expect others to do the same. I’m anxious to hear from our witnesses about some of the details of this bill and certainly hope it is a workable solution to the problem of offshore tax evasion that avoids unintended consequences.

I will note, however, that I am very pleased the bill does not blur the issues of evasion and legal tax practices, and does not include the most controversial international tax policy changes proposed by the Administration.

We’ve heard a lot of rhetoric in recent months from the Administration and others designed to confuse these issues and characterize them as one in the same. I’m pleased to see, Mr. Chairman, that you have cut through that and drawn a bright line separating the two. I look forward to continuing to work with you on all of these issues in the days, weeks, and months ahead.

Thank you to our witnesses for joining us today, I look forward to your testimony.

With that, Mr. Chairman, I yield back my time.

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Fox News: GOP Health Care Bill Delivers Lower Premiums Than Democrats' Plan

Thu, 05 Nov 2009 05:00:00 GMT

(Click to Play)

Americans repeatedly say their top health care reform priority is lowering the cost of health coverage. In an analysis conducted by the Congressional Budget Office (CBO), health insurance premiums for many families would be nearly $5,000 more expensive under Democrats’ bill compared to those in the Republicans’ plan.

CBO estimated that the Republican bill would reduce health insurance premiums for those who do not have access to employer-provided coverage by up to 8 percent, for employees who get coverage through a small business (50 or fewer employees) by up to 10 percent, and for employees who get coverage through a large business (more than 50 employees) by up to 3 percent.

According to CBO, average annual health care premiums for families who do not have access to employer-provided health care would be $11,000 in 2016 if Congress does not pass a health reform bill. Under the Democrats’ bill, CBO predicts these premiums would actually increase to $15,000, and that’s for the Democrats' cheapest insurance plan!

Given that CBO predicts the GOP bill would reduce expected premiums in 2016 by up to 8 percent, this would mean the annual premium for the cheapest plan under the Democrats’ bill ($15,000) would be nearly $5,000 more expensive than those under the GOP bill ($10,120). Incidentally, CBO says the Democrats’ “cheapest” plan is unlikely to attract many families, meaning average premiums would be even higher in the Democrats' exchange.

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CBO Data Confirms Republican Health Care Reforms Deliver Across the Board Savings

Thu, 05 Nov 2009 05:00:00 GMT

Washington, DC – Ways and Means Ranking Member Dave Camp (R-MI) today released additional analysis of a Congressional Budget Office (CBO) report showing that the GOP health care reform plan would lower premiums for individuals and families, whether they bought insurance on their own or through an employer.

“Under Republican health care reforms, premiums will go down, making coverage more affordable for families and employers, which is the first step to reducing the number of uninsured Americans,” said Camp. “This proves that Republicans’ common-sense ideas to lowering costs are a better approach than the Democrats' plan to spend over $1 trillion, increase taxes, cut Medicare by one-half trillion dollars and put the federal government in charge of Americans’ health care.”

According to the CBO analysis, the Republican health care reforms would reduce premiums by up to 3 percent for employees who get insurance through a large business (more than 50 employees), up to 8 percent for Americans without employer sponsored insurance, and up to 10 percent for those working for a small business (50 or fewer employees).

The Republican premium reductions would mean an average annual savings of nearly $1,800 for millions of families.

(Click Chart to Enlarge)

Average savings compared to the Democrats’ plan are even larger. According to CBO, the Democrats’ bill would actually increase premiums to at least $15,000. As a result, families could see savings of nearly $5,000 per year under the Republican plan.

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Snowe: House Bill Not Within American Mainstream

Thu, 05 Nov 2009 05:00:00 GMT

It's safe to say Sen. Olympia Snowe (R-Maine), the only Republican who appears to be entertaining support for the Democratic health reform bills, is no fan of the House legislation.

"I do not know what world they live in," Snowe said in an interview. "But all I know is it is totally detached from the average person, the average business owner who is struggling to keep their doors open and to have that level of taxation is breathtaking in its dimensions. I just think it is so out of proportion with reality and with mainstream America that it is hard to believe, frankly."

On a day when the $1 trillion House bill picked up support from key interest groups -- which, in turn, prompted President Barack Obama to make a personal visit to the White House press room to tout the endorsements -- Snowe's words are a reminder of the dissent surrounding the bill.

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Health bills too timid on cutting costs, experts say

Wed, 04 Nov 2009 05:00:00 GMT

Democrats in Congress are embracing the spirit of President Obama's call to slow the runaway rise of health-care costs but are shying away from some of the most aggressive techniques for achieving that.

Instead of revolutionizing how care is delivered and paid for, experts say, the legislation being shaped takes a cautious approach to reining in costs.

"The bills are directionally correct, but they're not going far enough," said George Halvorson, chairman and chief executive of Kaiser Permanente and the author of "Health Care Will Not Reform Itself."

In years past, policymakers tried taming health-care growth with price controls -- in government reimbursements and through managed care. The Obama administration has advocated a third way: moving away from fee-for-service payments, which reward providers for doing more procedures, to a coordinated system that pays doctors and hospitals for doing better.

Under that vision, providers would be given a few years to move to performance-based medicine, in which fees and results are published, money is directed to evidence-based therapies, and harmful errors such as preventable infections are reduced. In short, the goal is to save money by modernizing and improving.

Now, as the debate reaches a critical juncture, many are worried that the president's ambitious hopes to constrain costs could result in tepid half-measures on Capitol Hill. Among the concerns:

-- A Senate plan to tax high-priced insurance policies saves far less money -- and is less likely to change medical consumption -- than eliminating the tax exemption for employer-sponsored coverage.

-- Proposals on comparative-effectiveness research and a new Medicare cost-cutting commission have been watered down.

-- An array of Medicare pilot projects aimed at paying doctors and hospitals for quality rather than quantity would take years to be implemented nationally -- if they ever were.

-- None of the bills addresses medical liability, even though the Congressional Budget Office has concluded that tort reform could save $54 billion over the next decade.

'Tried and true'

Overall, Democratic lawmakers have turned to "tried and true" strategies for reducing spending that merely ratchet down payments rather than fundamentally changing how the health-care system operates, said Drew Altman, head of the nonpartisan Kaiser Family Foundation.

More than $110 billion worth of Medicare "savings," for example, simply comes from a cut in reimbursements to insurers that run the private Medicare Advantage program, and much of the $80 billion extracted from drug companies is in the form of higher Medicaid rebates to the government. Both proposals would reduce costs but have little to do with fundamentally refashioning health care.

What's more, Congress has a history of reversing itself on politically unpopular cuts, so it is risky to count on those savings, Altman said.

Unlike past reform efforts that barely gave a nod to tackling double-digit medical inflation, the bills this year "have some of the right rhetoric," but they fall short of real-world applicability, said Jack Lewin, chief executive of the American College of Cardiology. Without significant financial incentives and strict deadlines, he predicted, few doctors would rush to move toward the coordinated-care models reformers say are needed to save money and maintain high quality.

Ralph Neas, head of the nonpartisan National Coalition on Health Care, noted that "these bills do very little in terms of reining in long-term cost growth," adding: "There is not enough in the public sector and virtually none in the private sector."

Neas called on Congress to adopt up to $2 trillion worth of potential savings trumpeted by Obama and industry leaders at a White House event in May. Only a few of the specific ideas, such as streamlining insurance claims forms, have been included in the legislation.

"Voluntary efforts are never enough," Neas said. "There has to be some way to make it enforceable."

Richard Foster, the chief actuary of the federal Centers for Medicare and Medicaid Services, said lawmakers could achieve far greater savings in the health system if they aggressively pursued research that identifies the best, most cost-effective treatments.

"If you did comparative effectiveness in a way that looked at whether to approve a new therapy because it is cost effective and is an improvement, then you'd have a fighting chance of slowing down the rate of growth," he said in an interview. "Nobody's proposing that."

Taxing benefits

White House budget chief Peter Orszag said in an interview that changing the tax treatment of employer-sponsored health benefits "is among the most important single things that could be done to constrain costs and improve quality."

Employees currently do not pay taxes on insurance purchased through the workplace. Lifting the exemption would be likely to make workers more price sensitive and prompt insurance companies to market more affordable policies, according to most economists.

Eliminating the exemption could raise $250 billion a year and more than pay for the enormous expansion of coverage envisioned by Obama and Democrats. But the Senate compromised, with a proposal to tax only high-priced "Cadillac" plans. That approach is estimated to save $200 billion over a decade, and House Democrats have opposed the idea, raising concerns that it may be dropped.

Orszag also bragged that a set of Medicare pilot projects could dramatically reshape how medicine is practiced in this country. The proposals include reducing reimbursements to hospitals that have unnecessarily high readmission rates, "bundling" payments to medical teams that coordinate patient care and providing bonuses to doctors who meet quality standards.

"We're creating incentives for a more efficient system," he said. Because lawmakers are still negotiating and the proposals could change, Orszag said, it is impossible to quantify the eventual savings.

'Just do it'

While Orszag says a go-slow approach will help determine the best course, others say the ideas are promising enough to pursue aggressively now.

"I wish they had the courage of their convictions," said Douglas Holtz-Eakin, a former Congressional Budget Office director and adviser to Sen. John McCain (R-Ariz.). "Just do it."

Mark McClellan, a physician who ran two health agencies in the Bush administration, endorsed the ideas in the legislation but warned that pilot projects take too long to adopt broadly and that not enough emphasis is being placed on financial rewards and penalties based on health outcomes.

Orszag has high hopes for a proposed Medicare cost commission as well, suggesting that the panel of independent experts would guide the government program to deliver more efficient care. But the hospital industry has already struck a deal exempting it from any suggested cuts for 10 years, and Congress is likely to limit the panel's power to recommendations that do not touch eligibility or benefits.

Many remain skeptical that Congress will let stand spending reductions included in this year's comprehensive reform initiative, particularly $400 billion in Medicare trims. They point to 1997's Balanced Budget Act, in which Congress set a Medicare fee schedule that would squeeze physician payments if costs rose too steeply. But nearly every year, at the behest of the American Medical Association, lawmakers override the scheduled reductions.

That history "teaches us that single provisions that can be easily lobbied against tend not to survive the political process," said Helen Darling, president of the National Business Group on Health.

But for Orszag, the cost-control efforts on Capitol Hill represent significant progress.

"There's always the potential to do more," he said. "When you look at the details in the legislation, it is a substantial step, especially within the realm of the politically viable and realistic, as opposed to a think tank or academic ideal."

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Markup of: H.R. 598

Thu, 18 Jun 2009 21:10:15 GMT

Hearing on Scientific Objectives for Climate Change Legislation

Thu, 18 Jun 2009 21:05:33 GMT

Hearing on IRS Assistance for Taxpayers Experiencing Economic Difficulties

Thu, 18 Jun 2009 21:03:11 GMT

Hearing on the President’s Fiscal Year 2010 Budget Overview with U.S. Department of the Treasury Secretary Timothy F. Geithner

Thu, 18 Jun 2009 21:01:49 GMT

Hearing on the President’s Fiscal Year 2010 Budget Overview with OMB Director Peter R. Orszag

Thu, 18 Jun 2009 20:59:53 GMT

Markup of: Views and Estimates Letter to Budget Committee

Thu, 18 Jun 2009 20:53:40 GMT

Hearing on Health Reform in the 21st Century: Expanding Coverage, Improving Quality and Controlling Costs

Thu, 18 Jun 2009 20:51:45 GMT

Hearing on Protecting Lower-Income Families While Fighting Global Warming

Thu, 18 Jun 2009 20:46:28 GMT

Hearing on MedPAC’s Annual March Report to the Congress on Medicare Payment Policy

Thu, 18 Jun 2009 20:45:07 GMT

Hearing on the Troubled Asset Relief Program: Oversight of Federal Borrowing and the Use of Federal Monies

Thu, 18 Jun 2009 20:43:43 GMT