RKMBs Forums .::Important::. Politics and Current Events A right to Health Care

WASHINGTON — Despite President Barack Obama’s assurance that a revamping of the United States health-care system would not swell the federal deficit, his goal of quick congressional passage seemed to grow a bit more tenuous on Sunday as Republicans dug in their heels while governors in both parties raised concerns that they will be handed costly new Medicaid obligations without the money to pay for them.

The states pay, on average, more than 40 percent of the cost of Medicaid, so they bear a significant burden of any expansion of the program to help more low-income Americans. At their annual summer meeting, in Biloxi, Miss., the governors said that their concerns dominated discussion, with striking levels of bipartisan hostility voiced during a closed-door luncheon on the topic on Saturday.

And Congressional Republicans said on Sunday that Mr. Obama could probably meet his deficit goal only by increasing taxes on the wealthiest Americans and requiring small business owners, already battered by the enduring recession, to assure coverage of their employees.

The Senate’s top Republican, Mitch McConnell of Kentucky, said on NBC’s “Meet the Press” that rising health-care costs, and the problem of millions of Americans who lack insurance, could be resolved without a costly revamping — estimates are that it could cost $1 trillion over a decade — that he said would lead to inferior care and an outsized government role.

most people want a government health care option.

BILOXI, Miss. — Many of the nation's governors said Sunday they don't want Congress to force states to pick up extra expenses, from health care to national security.

Democrats and Republicans attending the summer convention of the National Governors Association said state budgets are already strained by recession. Governors meet twice yearly to seek bipartisan consensus on issues affecting their states, including federal mandates for shared programs such as the Medicaid health insurance program for the needy. Only 25 governors attended the weekend meeting as some stayed home to tackle budgets.

Several governors joined Homeland Security Secretary Janet Napolitano in calling on Congress to revise requirements by this fall for secure driver's licenses that are intended to help boost national security. The governors said federal mandates for the licenses are too expensive, and 13 states have voted not to participate in the Real ID Act passed after the terrorist attacks of Sept. 11, 2001.

"Security standards are only useful if people are willing and able to use them," said Vermont Gov. Jim Douglas, a Republican.

Real ID-compliant driver's licenses would have layers of security to prevent forgery, such as verification of birth certificates, Social Security numbers and immigration status.

The Senate Homeland Security Committee last week started working on a revised and less expensive plan called Pass ID, supported by the governors association. States' cost to fulfill requirements of Real ID would be about $4 billion, and Napolitano said the cost of implementing Pass ID would be about $2 billion.

"Real ID, from a state perspective, was unreal," said Napolitano, a former Arizona governor.

Pass ID would be less expensive for states to implement and would be less stringent, though Napolitano said it would still help bolster national security. For example, Real ID would require that birth certificates be confirmed with the agency that issued the documents, while Pass ID would not.

During discussions about health care, several governors said they worry federal legislation could push billions of dollars in new expenses on their states for Medicaid, the government health insurance program for the needy.

Georgia Gov. Sonny Perdue, a Republican, said he believes some officials have "noble goals" of expanding coverage to more people who are currently uninsured. But he said Congress should not pass legislation that force states to pick up extra expenses.

"If we're asked to pick up on state increased costs in health care, it's going to take away from ... environment, transportation, education, public safety, all the other things that we as states do," Perdue said.

Washington Gov. Chris Gregoire, a Democrat, said too much of the discussion in Congress now is about the cost of health care. "If we're not also talking about how do we get better, higher quality health care to the people of this nation, I think we lose them in the process," he said.

New Mexico Gov. Bill Richardson said he likes President Barack Obama's plan to use public and private options for health care, but he worries Congress will dilute the plan and pass billions in new expenses on to states.

"We can't afford that, and that's not acceptable," Richardson said.

Also Sunday, Napolitano told governors to prepare in case there's a resurgence of swine flu in the nation this fall. She said state leaders should talk to education officials about preventing the disease's spread among children and being ready for schools to offer continued learning at home if they are forced to temporarily close.

Obama has said U.S. swine flu vaccinations could begin in October with children among the first to receive them.

New Mexico Gov. Bill Richardson said he likes President Barack Obama's plan to use public and private options for health care, but he worries Congress will dilute the plan and pass billions in new expenses on to states.

At the same time, the majority of Americans say they are satisfied with their own health care plans.

...

Poll: Most Back Public Health Care Option
CBS News/New York Times Survey Shows Most Americans Approve Of Government Intervention In Health Care Coverage

(CBS) A clear majority of Americans -- 72 percent -- support a government-sponsored health care plan to compete with private insurers, a new CBS News/New York Times poll finds. Most also think the government would do a better job than private industry at keeping down costs and believe that the government should guarantee health care for all Americans.

The new poll shows the idea of a government-sponsored plan, or "public option," to be fair non-controversial, though Democrats in the Senate have considered nixing the proposal in order to win Republican support for the bill. House leaders on Friday unveiled a health care reform plan that includes a public option.

The poll reveals, however, the obstacles that remain in the way of the public option and broader reform efforts. Many Americans are concerned that their own health care may be compromised if the government is involved, and while they are generally willing to pay more in taxes for universal coverage, that support drops when dollar amounts are mentioned. ...

WASHINGTON — Heading into a critical period in the debate over health-care reform, public approval of President Obama's stewardship on the issue has dropped below the 50-percent threshold for the first time, according to a new Washington Post-ABC News poll.

And with skepticism about the president's effort also mounting on Capitol Hill — even within his own party — the White House has launched a new phase of its strategy designed to dramatically increase public pressure on Congress: all Obama, all the time.

Senior White House aides promise "an aggressive public and private schedule" for Obama as he presses his case for reform, including a prime-time news conference on Wednesday, a trip to Cleveland, and heavy use of Internet video to broadcast his message beyond the reach of the traditional media.

"Our strategy has been to allow this process to advance to the point where it made sense for the president to take the baton. Now's that time," said senior adviser David Axelrod. "I don't know whether he will Twitter or tweet. But he's going to be very, very visible."

Today, his advisers say, he will do a round of interviews to drive the narrative for the week. Private meetings with lawmakers will become more frequent and urgent.

Since April, approval of Obama's handling of health care has dropped from 57 percent to 49 percent, with disapproval rising from 29 percent to 44 percent.

Obama's approval ratings on other front-burner issues, such as the economy and the federal budget deficit, have also slipped over the summer, as rising concern about spending and continuing worries about the economy combine to challenge his administration. Barely more than half approve of the way he is handling unemployment, which now tops 10 percent in 15 states and the District of Columbia.

But even as Obama returns to full-time campaign mode, he is facing increasing calls to show that his presidency can manage the tough, nitty-gritty of lawmaking by cutting deals with his allies to keep health-care legislation moving in the House and Senate committees.

Conservative Democrats in the House are promising to vote against reform as it now stands, and are preparing two dozen amendments, including measures aimed at lowering the effort's long-term cost. In the Senate, members from both parties are urging the president to break his campaign promise to preserve the tax-free status of health benefits. And a chorus of weary voices from Capitol Hill is urging him to abandon his demand for passage of bills in the House and Senate by Aug. 7.

"I don't think we should be bound by a timetable that isn't realistic," Sen. Olympia Snowe, R-Maine, a key swing vote on health care, told Obama last week as she reminded him that President Lyndon Johnson took 11/2 years to pass Medicare.

Obama has not officially budged on the timetable, although he and aides have notably failed to note the August deadline in recent remarks. But Obama is quietly working with conservative, Blue Dog Democrats in the House on an amendment to create an independent panel to govern Medicare reimbursement rates that could help reverse crippling health-care inflation.

The decision to vault Obama to the front carries huge risks.

The decades-long drive to reform the health-care system now rests largely on Obama's ability to quell revolts among his Democratic allies, many of whom have spent the past several weeks picking at pieces of his proposals.

If conservative House Democrats succeed in sowing fear of rising deficits, it will be seen as Obama's fault that he could not rein them in. If Democrats in the Senate fail to agree on financing, Obama must explain the failure despite his party's majorities in both chambers.

Approval of Obama's handling of the overall economy stands at 52 percent, with 46 percent disapproving, and, for the first time in his presidency, more Americans strongly disapprove of his performance on the economy than strongly approve. Last month, 56 percent gave him positive marks on this issue.

The president's overall approval rating remains higher than his marks on particular domestic issues, with 59 percent giving him positive reviews and 37 percent disapproving. But the poll is the first time in his presidency that Obama has fallen under 60 percent in Post-ABC polling, and he is six percentage points lower than he was a month ago.

A total of 1,001 randomly selected adults were interviewed for this poll; the margin of sampling error is plus or minus three percentage points.

Middle-class families are struggling every day with rising costs of housing, food, transportation, and taxes. But for many, rising costs of health care are the most devastating of all. That’s why Americans’ top priority during the ongoing health care debate is a plan that will reduce costs. Unfortunately, the government takeover of health care offered by the Washington Democrats will not reduce costs; instead, it will dramatically increase costs – for your family, America’s small businesses, and all taxpayers.

Last week, Douglas Elmendorf, the director of the nonpartisan Congressional Budget Office (CBO) sent shockwaves through Washington when he told Congress that the Democrats’ plans would make health care more costly. Throughout this debate, President Obama has spoken of the need to “bend the cost curve” or drive health care costs down. During a congressional hearing, however, Mr. Elmendorf testified that the Democrats’ plans would have the opposite effect, saying that under their proposals, “The curve is being raised” and costs would “significantly expand.” That’s because the Democrats’ plan adds a new layer of taxes, mandates, and bureaucracy on top of the current system. If that’s not bad enough, the Democrats’ plan cuts Medicare and takes away choices for millions of seniors. What does all of this mean? Higher costs for the medicine and treatments you need.

Not only will the Democrats’ government-run health care plan raise your costs, but it also will raise costs for our nation’s employers – particularly small businesses. At the heart of their proposal is a small business tax that, for tens of millions, means diminished job security. The National Federation of Independent Businesses warns that the small business tax and mandates in the Democrats’ plan will destroy 1.6 million jobs – one million of them in small businesses alone. And according to methodology developed by Dr. Christina Romer, the chair of the White House Council of Economic Advisors, the government takeover would cost Americans 4.7 million jobs over the next 10 years. With our economy at its weakest since the Great Depression and unemployment soaring far beyond the levels promised by the Administration, why would Congress promote policies that make jobs even more scarce?

In addition to warning that the Democrats’ plan will raise health care costs, the Congressional Budget Office also has projected that the House Democrats’ proposal would increase the deficit by another $239 billion over the next 10 years. And even though the President continues to claim that those who like their current health care plans can keep them under the Democrats’ proposal, independent analysts disagree. One analysis shows that 114 million Americans may be forced off their current coverage and onto a government-run plan as a result of the House Democrats’ legislation. That means more costs to the taxpayers. The bottom line: while Democratic leaders continue to claim that health care legislation must be “paid for,” the House Democrats’ bill is not. Instead, it will force us to borrow more from China and countries in the Middle East and stick our children and grandchildren with the tab.

Faced with the Democratic bill’s extraordinary costs to families, small businesses, and taxpayers, House Majority Leader Steny Hoyer (D-MD) suggested last week that Democrats should go “back to the drawing board.” I agree, and that’s why House Republicans have offered real reforms that would lower health care costs. Our plan roots out waste, fraud, and abuse in the system and reforms medical liability rules that cost families millions each year – millions that line the pockets of trial lawyers at the expense of patients and doctors. It lets small businesses band together through associations and purchase health insurance for workers at a lower cost, just like large corporations and unions do. It offers incentives to help Americans who do not have access to quality health care get the coverage they can afford, while giving states tools to design programs that make health care coverage more affordable. And it reforms regulations so insurance companies compete for your business and you can shop around for the best coverage and price.

Health care reform is too important to rush through a flawed proposal that will raise costs – the opposite of what the American people want. After the Obama Administration insisted that Congress rush to enact a “stimulus” bill that – by any objective account – has not created the jobs that were promised, Washington cannot afford to make that same mistake on health care. Nonetheless, it appears Democratic leaders will stubbornly try to ram through this bill before Congress leaves for the August break with little debate or discussion, even as many rank-and-file Democrats express serious concerns about what a costly government-run plan would mean for families and small businesses. It’s time for Democrats to scrap their government takeover of health care and work with Republicans on a plan that gives more Americans access to affordable coverage.

That poll is a couple of years old.

Polls these days show different results...

Although there are some positive provisions in the current House Tri-Committee bill – including insurance for all and payment reform demonstration projects – the proposed legislation misses the opportunity to help create higher-quality, more affordable health care for patients. In fact, it will do the opposite.

In general, the proposals under discussion are not patient focused or results oriented. Lawmakers have failed to use a fundamental lever – a change in Medicare payment policy – to help drive necessary improvements in American health care. Unless legislators create payment systems that pay for good patient results at reasonable costs, the promise of transformation in American health care will wither. The real losers will be the citizens of the United States.

As noted above, the support for Obama's plan is based on a premise that it would improve things when ... it would not.

A new poll suggests public approval of the way President Barack Obama is handling health care reform is slipping.

The Washington Post-ABC News survey says since April, Obama's approval rating on the issue has declined from 57 percent to 49 percent, with disapproval rising from 29 percent to 44 percent.

The president's overall approval rating stands at 59 percent positive and 37 percent negative. It's the first time Obama's approval rating has fallen below 60 percent in Post-ABC polling since he took office.

The poll has a margin of sampling error of plus or minus 3 percentage points.

Don't let MEM see that. He lives and dies by the polls.

Barack Obama disclosed an unusual meeting with the CBO, presumably its director Doug Elmendorf, in his Today Show appearance this morning with Meredith Viera. The relevant clip comes at the three-minute mark, where Viera challenges Obama on the CBO scoring of the health-care reform bills:

OBAMA: And so, what we’ve got to do, is to bend the cost curve over the long term. And we’ve put forward a whole series of proposals to do that, and the Congressional Budget Office and every health care expert have looked at many of our proposals, and they’ve said, “You know, this has a good chance of working.” Not all of them have been adopted by Congress yet –

VIERA: But — not to beat a dead horse here, but again, the Congressional Budget Office is looking at those bills that are out there, and they’re saying they do not contain costs. Any one of those bills, would you sign them, based on what you see?

OBAMA: Right now, they’re not where they need to be. But I promise you, I just met with the Congressional Budget Office today, so I know exactly what they’re saying. And what they’re saying is, is that the cost savings that are in those bills right now, some of them may actually work, but they’re not enough to offset the additional costs of bringing in 46 million new people to provide.

Why is this important? The CBO exists to keep a check on the executive branch. The “Congressional” part of CBO is no accident. Congress created the CBO as a means to provide oversight over the White House and its use of the budget and its fiscal projections:

Two developments provided the impetus for the enactment of the Budget Act in 1974. One development was an increasing realization by Congress that it had no means to develop an overall budget plan. Prior to 1974, Congress responded to the President’s budget (which contains the President’s many spending and revenue proposals) each year in a piece-meal fashion. There existed no framework for Congress to establish its own spending priorities before work began on specific spending and revenue bills during the spring and summer.

A second, and more immediate, cause for passage of the Budget Act was a dispute in the early 1970’s regarding presidential authority to impound money appropriated by Congress. During this time, President Nixon repeatedly asserted authority (as had many of his predecessors) to withhold from Federal agencies money appropriated by Congress. By 1973, it was believed that President Nixon had impounded up to $15 billion of spending previously approved by Congress. A large portion of these funds were to have gone towards the building of highways and pollution control projects. Many in Congress disputed these actions by the President.The authorization for the pollution control projects, for example, had been enacted by Congress in 1972 with a strong vote in both Houses overriding President Nixon’s veto. Nonetheless, the President impounded much of this spending. These events led Members of Congress to seek a legislative solution.

In 1974 Congress enacted the Congressional Budget and Impoundment Control Act to establish procedures for developing an annual congressional budget plan and achieving a system of impoundment control. The Budget Act also created, for the first time, congressional standing committees devoted solely to the budget. It also created the Congressional Budget Office (CBO) to serve as the “scorekeeper” for Congress. CBO is responsible for producing an annual economic forecast, formulating the baseline, reviewing the President’s annual budget submission, scoring all spending legislation reported from committee and passed by the Congress, and preparing reports in compliance with the Unfunded Mandates Reform Act. CBO’s policy with respect to providing estimates is set out in Appendix B. The Joint Committee on Taxation scores all revenue measures.

In other words, the CBO exists for independence from the executive branch in fiscal matters. If Barack Obama needs clarification on CBO scoring, he should work through Congress to get it, rather than demand face time with the CBO director. Even more appropriately, the President should work through his own Office of Management and Budget (OMB) director for analysis of CBO scoring. In this case, Obama has Elmendorf’s immediate predecessor, Peter Orszag, as his OMB Director, who should be able to figure out a CBO analysis on his own and help Obama understand it and respond to it.

After this came to my attention, I contacted two sources in Washington and asked if presidents routinely conferred with the CBO on budget scoring. Both called this highly unusual and could not recall if or when it had been done in previous administrations. It treads on the entire process of legislative oversight and threatens the independence of the CBO from the administration, which is essential for Congress — if it’s interested in independent analysis.

At best, this looks like a move made out of ignorance of the constitutional checks and balances of the federal government. It appears more like an attempt to browbeat the CBO into more sympathetic scoring of presidential initiatives. Congress should act quickly and forcefully to remind Obama about the boundaries of his executive power.

Update: Elmendorf blogs about this meeting:

I was invited to the White House to meet with the President, his key budget and health advisers, and some outside experts. The President asked me and the outside experts for our views about achieving cost savings in health reform. I presented CBO’s assessment of the challenges of reducing federal health outlays and improving the long-term budget outlook while simultaneously expanding health insurance coverage–just as we had explained these challenges in a letter to Senator Conrad and Senator Gregg last month. I also described CBO’s view of the effects of the health legislation we have seen so far, as I did last Thursday in a hearing at the Senate Budget Committee and a mark-up at the House Ways and Means Committee. In addition, I discussed various policy options that could produce budgetary savings in the long run, drawing on CBO’s Budget Options for Health Care released in December, our letter to Senators Conrad and Gregg last month, and my comments last Thursday. Other participants in the meeting expressed their own views on these various topics.

But the CBO doesn’t create policy. It’s supposed to be a scorekeeper, and allow Congress to create policy. This feels like an attempt to either intimidate or co-opt the CBO, neither of which would be a good thing. The entire meeting seems highly inappropriate.

Just 35% of U.S. voters now support the creation of a government health insurance company to compete with private health insurers.

I'd explain it to you but you would just fall back on your programming and not listen.