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Archive for the ‘Health Care’ Category

We Were Wrong—and the Government May Soon Shut Down!

Sunday, September 22nd, 2013

No, it’s not our failure to read the tea leaves that threatens a government shutdown. But when we updated you on the spending situation last week, we thought that the House leadership would move a government funding bill that avoids a fight on Obamacare. They didn’t.

Instead, the House last week passed a spending bill that would fund the government through December 15th but that disallows spending to implement the Patient Protection and Affordable Care Act.

H.J. Res. 59, the Continuing Appropriations Resolution, 2014, funds the government through mid-December, defunds Obamacare, and prioritizes debt payments if the government shuts down.

(The cost of running the government through December 15th? A little over $7,000 per U.S. family.)

The House’s goal is to let blame fall on the Senate if the government shuts down. “Democrats in the Senate want Obamacare so bad that they’ll hold up spending on everything else in government just to keep it going.”

The Senate, meanwhile, is going to try to pass a bill that doesn’t defund Obamacare. Sending that bill back to the House may make it look more like the House’s fault if the government shuts down.

Katy, bar the door. It’s time to fight!

You’re the referee. If you go and vote on H.J. Res. 59, be sure to leave a comment explaining your vote.

At this writing, the vote is running pretty strongly against the bill. But is that because people don’t want that much spending? Because they don’t like the House’s plan? Or did the votes come in before H.J. Res. 59 had the Obamacare defunding provisions in it?

Comment on the bill or comment below. Let people know what you think!


Last week, we heard from the office of Rep. Jack Kingston (R-GA) with a response to a recent post on all these spending issues.

In “Your Last FY 2014 Spending Update,” we noted the appropriations subcommittee chairmen who hadn’t moved a bill this year. Rep. Kingston was one of them. But he wanted to.

In a letter he sent to Speaker John Boehner (R-OH) late last month, Kingston argued for moving his Labor-Health and Human Services spending bill and against the use of a continuing resolution to try to defund Obamacare.

“I have spent the bulk of this year preparing legislation that meets all the primary goals of our conference. This legislation is far stronger than a continuing resolution,” Kingston wrote.

And he wasn’t understated about the day’s hottest issue: “The bill COMPLETELY DEFUNDS OBAMACARE.”

There’s almost always more to the story, and our assessment that Kingston had failed to move a bill was simplistic. He has to work with others to get that done, and we see that at least in late August he implored House leadership to move his bill.

It’s good to see Rep. Kingston arguing for following the regular schedule on spending bills. Following the schedule and avoiding last-minute spending battles would give the public more opportunity to oversee what the Congress does—a good thing no matter where you are on the issues.

We don’t know whether Rep. Kingston heard about our reporting from a constituent or just saw it online. The lesson for WashingtonWatchers is that members of Congress do pay attention to what people think, and they want us to know better how they’re working to represent their districts in Congress. All is not lost for democracy. Thanks, Jack Kingston!

The Abortion Issue Comes to the Capitol

Sunday, June 16th, 2013

Kermit Gosnell is an abortion doctor recently sentenced to life in prison for the deaths of three infants who were born alive at his abortion clinic in Philadelphia. There was a good deal of consternation among media people about their handling of the story at the time, but Capitol Hill stayed fairly muted.

That changes this coming week when the Republican House brings up H.R. 1797, the Pain-Capable Unborn Child Protection Act. The bill would impose a nationwide ban on abortions after 20 weeks of pregnancy. It’s a response—if slightly tardy—to the Gosnell trial.

The sponsor of the bill is Rep. Trent Franks (R-AZ), and a huuuuge list of fellow Republicans, plus a few Democrats. (The bill’s page has a list of all the sponsors. Check to see if your representative is on there.)

And that’s kind of the point.

The bill is mostly a pitch to Republicans for support from their conservative base. It sure isn’t going to pass the Democrat-controlled Senate. (There is a Senate version, brought to you by Sen. Mike Lee (R-UT)). And, if by some miracle it did pass the Senate, President Obama would veto it.

As often is the case with issues like this, it’s about politics. It’s about Republicans making clear where they are and Democrats where they are so both parties can raise funds and seek votes from their bases. All well and good, though it’s certainly unfortunate to see rough-and-tumble politics handle this sensitive moral, ethical, and medical matter.


Sunday, May 19th, 2013

D.C. was rocked last week by the news that the Internal Revenue Service (IRS) had targeted certain conservative groups for closer scrutiny when they applied for non-profit status. Hearings got underway quickly, and they are sure to continue.

A number of bills were introduced. Wakerider bills, we like to call them, because they surf the news. But surf’s up! So let’s see what is in the hopper.

H.R. 1950 is called the Taxpayer Nondiscrimination & Protection Act of 2013. Introduced by Rep. Michael Turner (R-OH), it would create criminal penalties for “misconduct against taxpayers by Internal Revenue Service employees,” such as violating their First Amendment rights.

H.R. 2025 would require the termination of IRS employees for discriminating against any taxpayer on the basis of political affiliation. It was introduced by Rep. Paul Gosar (R-AZ) with one cosponsor, fellow Arizonan Rep. Matt Salmon (R).

Rep. John Fleming (R) from Louisiana wants the IRS to stand down during Congress’s review of its actions. His bill, H.R. 2045, would prohibit the IRS from initiating any new audits for 180 days.

Then, of course, there was the news that the IRS official in charge of the office reviewing tax-exempt organizations for part of the time that it was allegedly doing partisan reviews is now in charge of the office implementing Obamacare. It’s a gift to Republicans, who had already scheduled a vote to repeal Obamacare last week.

New bills emphasizing this theme include:

H.R. 1993, which would prohibit the Internal Revenue Service from hiring new employees to enforce “the Federal Government’s invasion into the health care lives of American citizens.” It’s the brainchild of Rep. Randy Forbes (R-VA).

H.R. 2009 is the offering of Rep. Tom Price (R-GA). It would prohibit the Secretary of the Treasury from enforcing Obamacare.

Similar bill H.R. 2022 would prohibit the implementation or enforcement of any requirement of the Patient Protection and Affordable Care Act until certifications are made that taxpayer information is not and will not be used for targeting any individual or group that provides information to the Internal Revenue Service for political reasons or on the basis of political views. The bill’s sponsor is Rep. Diane Black (R) from Tennessee.

Senators are generally more circumspect, but there are a couple of bills inspired by the IRS scandal in the Senate.

S. 983 is the “Keep the IRS Off Your Health Care Act of 2013.” Its sponsor is Sen. John Cornyn (R-TX). It evidently would keep the IRS off your health care…

And there’s S. 962. The bill would go after the funding of Obamacare, prohibiting “amounts made available by the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 from being transferred to the Internal Revenue Service for implementation of such Acts.” The author of this bill is Sen. Dean Heller (R-NV), along with a quartet of cosponsors: Sen. David Vitter (R-LA), Sen. Saxby Chambliss (R-GA), Sen. Marco Rubio (R-FL), and Sen. James Inhofe (R-OK).

Senator Rubio has a bill of his own in this area. S. 941 would “prevent discriminatory misconduct against taxpayers” by Federal officers and employees. The text is not available, but it’s an amendment to the criminal code, so it’s likely a lot like H.R. 1950—fines and potential jail time for rogue IRS employees.

Scandal wakes up D.C.!

Things certainly were interesting over the past week. The IRS is not one of the government’s most beloved agencies, and the implication that it worked to throw the last election is electric for Beltway media and politicians.

Expect much more in this area during the weeks and months to come…

Obamacare Repeal, Take Three

Sunday, May 12th, 2013

Call ’em crazy. Call it the most important thing Congress could do. The House of Representatives will make another run at repealing Obamacare this week. Just like last time—and the time before that—the repeal vote is for show.

But it’s not all for show.

Republicans hope that, by showing their commitment to repeal, they can garner majorities in coming Congresses and win the presidency in 2016 so they can actually repeal the pair of laws that constitute Obamacare.

Obamacare was actually two laws. First, there was Public Law 111-148, the Patient Protection and Affordable Care Act. Then there was Public Law 111-152, The Reconciliation Act of 2010, which made further key changes to existing law. (Reconciliation bills don’t need 60 votes to reach debate on final passage in the Senate, so it was a way of squeaking through provisions that didn’t have super-majority support.)

The latest repeal bill is H.R. 45, and it was introduced by Rep. Michele Bachmann (R-MN) and a long list of her Republican colleagues.

Its companion bill in the Senate is S. 177, the ObamaCare Repeal Act. It was introduced by Senator Ted Cruz (R-TX) and a number of his Republican colleagues.

The debate might have more energy because of a recent study in Oregon comparing two random groups of Medicaid applicants, one of which was allowed into the program and one of which was not. The group in Medicaid enjoyed some benefits, such as lower rates of depression, but there weren’t statistically significant effects on blood pressure or cholesterol. These mild benefits came at a cost of $1200 in medical costs annually, or an increase of about 35 percent in spending per patient.

So maybe insurance-supported, buffet-style health care provides meager results at great cost. Maybe health insurance programs, public and private, should be oriented toward covering catastrophic illness and injury.

Maybe the debate this week will get to that. More likely, it will be all about the political posturing that Republicans and Democrats must to both do to try and win future elections and solidify their positions.

Here is the current vote on H.R. 45, to repeal the Patient Protection and Affordable Care Act and health care-related provisions in the Health Care and Education Reconciliation Act of 2010. Click to vote, comment, learn more, or edit the wiki article on the bill.

But it DID Originate in the House

Friday, July 20th, 2012

H. Res. 735 would expressing the sense of the House that the Patient Protection and Affordable Care Act of 2009 violates article I, section 7, clause 1 of the United States Constitution because it was a ”Bill for raising Revenue” that did not originate in the House of Representatives.

That’s an argument that has been raised since the Supreme Court ruled that Obamacare was constitutional as an exercise of the power to tax.

But there’s a problem with that argument: Obamacare originated in the House as H.R. 3590, and it was originally called the “Service Members Home Ownership Tax Act of 2009.” Yes, it was amended, and amended heavily, in the Senate, but the Constitution says of revenue bills, “the Senate may propose or concur with Amendments as on other Bills.”

If there is some other way to look at this, say so in the comments, but this seems to be an open and shut case—no, make that a shut and shut case.

The slim chance of repeal is the better hope than an Origination Clause challenge for those who want no Obamacare.

Obamacare Repeal … Again

Sunday, July 8th, 2012

The bill to repeal Obamacare that House Republicans will run to the floor this coming week has not been introduced yet. Consistent with their promise of advance notice, though, they have made a copy available.

This one is blessedly brief at six-and-a-quarter pages. Five of those pages are introductory material and “findings,” the statements Congress sometimes attaches to bills to show why they’re doing what they do. One page is dedicated to getting rid of the main Obamacare law and the follow-up law that Congress passed to complete the president’s health care revamp.

But you don’t need to read it (unless you’re obsessed). Just like the last time the House passed an Obamacare repeal, this is for show.

A bill to repeal Obamacare has to be passed by the Senate, and the president must sign it. In the Senate, a bill must pass by a majority of its 100 members, and Republicans don’t have a majority. They have 47. To top it off, most bills require a 60-vote majority because of a thing called the “cloture” rule, which requires 60 votes to end debate and prevent a filibuster. Were the bill to get out of the Senate, there is, of course, the president, who is not going to sign a bill to repeal his signature legislative achievement.

A veto override takes 2/3rds majorities in both the House and Senate. That means 290 votes in the House and 67 votes in the Senate. Obamacare passed 219 – 212 in the House and 60 – 39 in the Senate. Not gonna happen.

As before, House Republicans are signaling with all their might that they represent the only hope of getting rid of Obamacare after the next election. In a post called “Obamacare and Reconciliation,” we recently went through how that would work next year, if Republicans’ stars align.

Sophisticated followers of politics and policy like us don’t need to pay much attention to the debate in the House this week. It’s Republicans’ hope of pushing through the media filter that electing people from their party next year will get rid of the health care law. Democrats are equally interested in showing the public that they are going to protect the law.

This is Congress working to take an issue to the people in November. Make sure you’re there to have your say in the next election.

Obamacare and Reconciliation

Sunday, July 1st, 2012

When we wrote “Obamacare Repeal: For Show or For Real?” back in January, the point was that House Republicans were making a great show of trying to repeal Obamacare, but there was no chance their bill was going to pass. Their hopes for getting rid of the new national health care regulations were in the Supreme Court.

But Chief Justice Roberts found Obamacare constitutional as an exercise of Congress’s power to tax. (If you’re interested in the Court’s internal politics, the linked article is a good one.)

So now the only hope for Obamacare‘s opponents is Republican victories at the polls this November, delivering a new president and a Republican Senate.

But even that doesn’t guarantee a repeal. Under long-standing Senate traditions, bills can be held up if they don’t have 60 (out of 100) votes. Plenty of bills that could win a majority don’t go through the Senate because of a thing called the “cloture” rule.

There are some votes in the Senate that don’t require a cloture vote, though. “Reconciliation” is part of the annual budget process in which Congress marries up its new budget plan with the programs the government has running. You can get to a final vote on a reconciliation bill with a simple majority, not the 60 votes you need for other bills. It says so right there in 2 USC § 641(e)(2)!

Now, substantive law changes aren’t supposed to go on reconciliation bills—just budget stuff. You can change the level of spending on a government program, for example—that’s budgetary—but you couldn’t outlaw the possession of a rare breed of snake. That kind of thing doesn’t affect the budget.

Obamacare’s opponents are starting to see a silver lining in the cloud of the Supreme Court’s ruling. It makes pretty clear—Obamacare being a tax program—that it is something Congress can deal with on reconciliation. (Democrats used reconciliation in the process of passing Obamacare, the Reconciliation Act of 2010, specifically, so the goose and gander may cook in the same juice.)

That means Republicans don’t need to reach the impossible goal of having 60 senators in the next Congress. They just need to get to a majority. Oh, and they need the presidency, of course.

That’s the way to get rid of Obamacare. When the House passed H.R. 2, the “Repealing the Job-Killing Health Care Law Act” earlier this year, it was just for show. The real show is at the polls this November.

If Republicans win the presidency and the Senate, while keeping the House, watch for them to move legislation to repeal the Obamacare mandate as part of the budget process. You would think that a procedure with the name “reconciliation” would be about everyone getting along, but it might be the most explosive procedure the Senate ever uses.

The Latest Repeal Bill

Friday, June 29th, 2012

Hot on the heels of the Supreme Court’s approval of Obamacare, also known as Public Law 111-148, the Patient Protection and Affordable Care Act, there’s another bill in Congress to repeal it. Another bill would defund it.

These might be just for show.

Republicans’ Health Care Approach

Sunday, June 10th, 2012

With a Supreme Court ruling on Obamacare coming down the pipeline, it’s a good idea for the two sides of the debate to have something to say about health care. The Republicans showed their hand last week when the House passed H.R. 436, the Health Care Cost Reduction Act of 2012. You can’t really call it a health care “plan.” The idea is more to let people plan their own health care. So it’s all about tax cuts.

The bill the House passed combines several bills that already existed, a confusing, but common, practice. First, there was the idea in the original version of H.R. 436, which was previously called the “Protect Medical Innovation Act.” The original version repealed an excise tax on medical devices that was scheduled to take effect in January 2013. That tax increase was going to collect a whopping $29 billion dollars over the next ten years. Getting rid of that tax makes medical devices cost that much less for the next ten years.

The content of H.R. 1004, the Medical FSA Improvement Act of 2011 was also rolled into H.R. 436. FSA stands for “flexible spending account.” That’s a tax-advantaged account that allows an employee to set aside a portion of earnings to pay for qualified expenses as established in a cafeteria plan. They’re usually used for medical expenses, but often for dependent care or other expenses. Money deducted from an employee’s pay into an FSA is not subject to payroll taxes, which can save big money. But funds not used by the end of the plan year are lost to the employee. This is known as the “use it or lose it” rule. H.R. 1004 and now H.R. 436 get rid of the “use it or lose it” rule, which leaves about $4 billion with people to spend on health care, dependent care, and so on.

The next thing rolled into H.R. 436 is the content of H.R. 5842, the Restoring Access to Medication Act. That bill repeals provisions of the Internal Revenue Code that were added by the Patient Protection and Affordable Care Act (“Obamacare”). Those provisions limited payments for over-the-counter medications from health savings accounts, medical savings accounts, and flexible spending arrangements. Only prescription drugs or insulin can be paid from these accounts currently. That would allow people to spend about $4 billion more of their money.

Finally, there’s a provision in H.R. 436 that would require collections of certain overpayments of health insurance subsidies. (Apparently, they have to pass a law to prevent overpayments.) That would bring in about $12 billion over the next ten years.

The net result is about $450 in savings per U.S. family. That’s money left with people to spend as they choose (on health care and dependent care), and money that doesn’t get spent by the government. It would also lower the national debt by about $40 per U.S. family. (That’s a small part of the $156,000 every family owes, but it’s something.)

Below are the current votes on H.R. 436 and the two bills that have been rolled into it. Click to vote, comment, learn more, or edit the wiki articles about the bills.

You’re Fat

Wednesday, April 25th, 2012

So H.R. 4604 would provide for a national program to conduct and support activities toward the goal of significantly reducing the number of cases of overweight and obesity among individuals in the United States. …Fatty.