Blog Archives

“Nuclear Option” Does Enable Democrats To Ensure One-Party Authoritarian Control of Health Care

By Michael F. Cannon

Last week, I explained that the U.S. Senate’s deployment of the “nuclear option” — lowering the threshold for approval of non-Supreme Court presidential nominees from 60 votes to 51 votes — does not make it easier for President Obama to use ObamaCare’s Independent Payment Advisory Board. I need to add this caveat: during his tenure. The nuclear option does enhance the ability of the president and his party to control the health care sector well after he leaves office.

It’s true that the rules change will make it easier for the president to have his IPAB nominees approved by the Senate, particularly through January 2015, when the Democratic caucus holds 55 seats. But if the president and Senate fail to seat anyone on the IPAB, the board’s sweeping legislative powers fall to the Secretary of Health and Human Services. If President Obama wants to use IPAB’s powers during his term, therefore, he need only retain Kathleen Sebelius as his HHS secretary.

ObamaCare permits IPAB to exercise its powers, however, only if Medicare’s actuaries project the program’s outlays will grow faster than a specified rate. A number of readers note that Medicare’s actuaries reported earlier this year that their projections currently do not show Medicare spending exceeding that target rate, and that their projections likely will not do so during the remainder of President Obama’s term. Those projections and the resulting determination could change next year. If so, and if the president and Senate have not placed confirmed any IPAB members, Secretary Sebelius could use IPAB’s powers during President Obama’s term. Those powers include the ability to raise taxes, to ration care to Medicare enrollees, and to appropriate funds to her own department, without the consent of the people’s elected representatives. (Critics will object that IPAB has none of these powers. In this study, Diane Cohen and I explain why we think they are incorrect.) Sebelius’ “proposal” would take effect during 2016.

Regardless of whether Medicare’s actuaries pull that trigger, however, President Obama and Senate Democrats face a huge incentive to nominate and confirm as many IPAB members as they can, as quickly as they can: with the nuclear option, Democrats now have it within their power to ensure Democratic control of IPAB — and with it, essentially the entire health care sector — at least through the first term of President Obama’s successor and the next three Congresses, even if Republicans capture the presidency, retain the House, and take control of the Senate. Consider.

  • Despite requirements that the president consult with the leaders of both parties in Congress on his IPAB picks, there is no obligation for the president to select members from both parties. The president can stack IPAB entirely with members of his own party and ideological persuasion.
  • IPAB members serve terms that are nominally six years, but actually serve until they are replaced. So a board member who is confirmed in 2014 will serve at least through 2020, and possibly longer.
  • If President Obama and Senate Democrats seat even one IPAB member, they can maintain Democratic control of IPAB for as long as they retain control of the Senate. If a Republican wins the White House in 2016, the fact that there is one sitting IPAB member is enough to prevent a Republican HHS secretary (Paul Ryan, maybe?) from wielding IPAB’s powers. Only one member need be seated for the “board” itself to do business. A Democratic Senate could then keep that one-member IPAB 100-percent Democratic by blocking any Republican nominees to the board.
  • If President Obama and Senate Democrats seat only eight IPAB members, they will guarantee a Democratic majority on the board through at least 2020 (and beyond if they then control the Senate and/or the presidency).
  • If President Obama and Senate Democrats seat all 15 IPAB members, his successor will not be able to appoint any members during her first term. Even if Republicans take the White House and the Senate. Nor would a Republican successor be able to remove any Obama appointees. The president may remove IPAB members “for neglect of duty or malfeasance in office, but for no other cause.”

Here’s where things get scary.

ObamaCare mandates certain procedures that Congress must follow if it wants to overrule IPAB’s, ahem, “proposals.” The people’s elected representatives must clear certain hurdles — some as high as IPAB wishes to set them — if they want to retain their authority as the ones who write laws regarding health care. (The Congress that enacted ObamaCare had no lawful power to enact such requirements, but no matter. George F. Will writes that Diane Cohen and I “well described” IPAB as “the most anti-constitutional measure ever to pass Congress.”)

As Cohen and I report, during the first term of President Obama’s successor, Congress loses even those limited powers to restrain IPAB:

Worse, if Congress fails to repeal IPAB through the restrictive procedure laid out in the Act, then after 2020, Congress loses the ability even to offer substitutes for IPAB proposals…To constrain IPAB at all after 2020, Congress must repeal it between January and August in 2017.

Though this will be news even to most health policy wonks, I won’t explain here how ObamaCare produces this frightening result. I refer readers instead to the Cohen-Cannon study.

But the upshot is this. To the extent Democrats use the nuclear option to pack IPAB with Democratic appointees in 2014, and are able to retain the White House or the Senate in 2016 and beyond, they will be able to ensure one-party authoritarian control of the U.S. health care sector. That’s not just unfair or partisan or economically inefficient or unconstitutional. It’s also undemocratic.

This article appeared on Forbes.com on November 25, 2013.

Source

Advertisements

Saving Seniors from ObamaCare

By John C. Goodman

Two things about the Affordable Care Act (ObamaCare) are increasingly clear: (1) seniors have been singled out and forced to bear a disproportionate share of the cost of a new entitlement for young people and (2) the states are administratively just not ready to implement the new program in time for its January 1, 2014, start date.

So here’s a simple proposal that will not affect the federal deficit: Delay the scheduled cuts in Medicare spending by five years and pay for that expense by delaying the 2014 start date of ObamaCare by two years.

That would give everyone time to find a better way to reform the health care system. It would also impact this fall’s election. Every member of Congress would be asked to vote up or down on a single question: Who do you care more about: senior citizens or ObamaCare?

Over the next 10 years, ObamaCare will reduce Medicare spending by $716 billion. The Obama administration had hoped to achieve these spending reductions through increased efficiency, based on the results of pilot projects and demonstration programs. The problem: the Congressional Budget Office (CBO) has said in three consecutive reports that these projects are not working as planned and are unlikely to save money. As a fallback device, the health reform law set up a bureaucracy, the Independent Payment Advisory Board (IPAB), that will have the power to reduce doctor and hospital fees to such an extent that access to care for the elderly and disabled will be severely impaired.

In fact, the Medicare actuaries tell us that squeezing the providers in this way will put one-in-seven hospitals out of business in the next eight years, as Medicare fees fall below Medicaid’s. Harvard health economist Joseph Newhouse predicts senior citizens may be forced to seek care at community health centers and in the emergency rooms of safety net hospitals, just as Medicaid recipients do today.

Consider people reaching age 65 this year. Under ObamaCare, the average amount spent on these enrollees over the remainder of their lives will fall by about $36,000 at today’s prices. That sum of money is equivalent to about three years of benefits. For 55 year olds, the spending decrease is about $62,000—or the equivalent of six years of benefits. For 45 year olds, the loss is more than $105,000, or nine years of benefits.

In terms of the sheer dollars involved, the planned reduction in future Medicare payments is the equivalent of raising the eligibility age for Medicare to age 68 for today’s 65 year olds, to age 71 for 55 year olds and to age 74 for 45 year olds. But rather than keep the system as is and raise the age of eligibility, the reform law tries to achieve equivalent savings by paying less to providers. This will decrease access to care for seniors dramatically, and ultimately create a two-tiered health care system—with the elderly getting second class care.

A five-year delay in Medicare payment cuts can be paid for by pushing back the start date of ObamaCare from 2014 to 2016. The reason: Beginning in 2014, state health insurance exchanges are supposed to be up and running for individuals and families who lack access to employer-provided health coverage and do not qualify for Medicaid. But more than one-third of states (16) have done almost nothing to prepare for the exchanges. Another 20 states have made some progress but not enough. Further, health insurance exchanges will require significant investments in information technology that states simply cannot afford.

The delays contemplated here will give Congress time to replace ObamaCare’s command-and-control approach to health care with reforms that will empower patients, free doctors and allow competition in the marketplace.

In the meantime, delaying the start of these two major provisions will protect seniors, save taxpayers money and allow lawmakers time to enact health reforms that actually work.

Source

Do-Nothing Democrats

Senate Democrats set to reject Ryan, Obama budgets

https://i1.wp.com/freebeacon.com/wp-content/uploads/2012/05/Reid-540x394.png

BY: Andrew Stiles – May 16, 2012 5:00 am

Senate Democrats are poised to continue their impressive streak of budgetary negligence on Wednesday by unanimously rejecting as many as five different budgets, including the one offered by President Obama. Republicans, meanwhile, are hoping that voters will pick up on the disturbing trend.

The Democratic-led Senate has not formally proposed a federal budget resolution in more than three years, and is not expected to offer one Wednesday. Senate Majority Leader Harry Reid (D., Nev.) and Budget Committee chairman Kent Conrad (D., N.D.) have made explicitly clear that they have no intention of doing so before the November election.

Senate Republicans plan to offer four GOP budgets—authored by Sens. Mike Lee (R., Utah); Rand Paul (R., Ky.); Pat Toomey (R., Pa.); and House Budget Committee chairman Paul Ryan (R., Wis.)—as well as the president’s budget. None of them are expected to draw any support from Democrats.

It would mark the second year in a row that Senate Democrats have unanimously opposed the White House budget proposal. The House of Representatives has already voted to reject Obama’s budget 414-0.

In total, members of Congress have cast more than 500 votes in favor of what is widely seen as the official Republican budget (Ryan’s) and zero in support of the president’s plan.

It is a sign, Republicans say, that Democrats are not serious about solving what experts have called “the most predictable economic crisis in history.”

“They simply don’t want to be held accountable,” Sen. Ron Johnson (R., Wis.) told the Washington Free Beacon. “Either they don’t have a plan, or they are totally unwilling to tell the American people what their plan is.”

Sen. Jeff Sessions (R., Ala.), the ranking Republican on the Senate Budget Committee, said he thought the latter was true. “I actually think they do have a plan,” he told the Free Beacon. “Their goal is to increase spending and increase taxes. But that plan will be rejected by the American people.”

“If they believed their plan was popular, they’d want to put it out in front of people, vote on it, and brag about it,” said Grover Norquist, president of Americans for Tax Reform. “That’s not what they’re doing. They’d rather run for reelection without the American people knowing what their vision of the budget would look like. It’s one thing for me to say their plan is unpopular. That’s what they’re saying.”

Democrats have been particularly reticent to propose a credible plan to reform federal entitlement programs such as Medicare and Medicaid, despite the fact that these programs are the primary drivers of the national debt. Medicare’s trustees project that the program will be insolvent by 2024.

Earlier this year, Treasury Secretary Timothy Geithner admitted that, even if Congress were to enact President Obama’s latest budget, “We would still be left with … what are still unsustainable commitments in Medicare and Medicaid.”

Obama pledged to make entitlement reform a priority as a candidate in 2008. “We’re going to have to take on entitlements, and I think we’ve got to do it quickly,” he said during a debate moderated by NBC. “I can’t guarantee that we’re going to do it in the next two years, but I’d like to do it in my first term as president.”

Nearly four years later, the closest thing to Medicare reform the president has offered is the Independent Payment Advisory Board, a council of appointed “experts” given sweeping power to reduce federal reimbursements to healthcare providers. Medicare’s chief actuary, Richard Foster, has raised doubts about the board’s ability to control costs.

Ryan’s budget, on the other hand, proposes to save trillions of dollars by gradually transitioning Medicare from a “fee-for-service” model to a market-oriented “premium support” plan modeled after a bipartisan proposal co-authored by Sen. Ron Wyden (D., Ore.).

Democrats have countered by accusing Republicans of trying to “end Medicare as we know it”—a charge the nonpartisan fact-checking site PolitiFact rated “Lie of The Year” in 2011—and in one case by portraying Ryan as literally throwing the elderly off a cliff.

Geithner summed up the Democratic position on entitlement reform during a House Budget Committee hearing in February when he told Ryan, “we’re not coming before you today to say we have a definitive solution to that long-term problem. What we do know is, we don’t like yours.”

President Obama and his Democratic allies have been far more resolute in their determination to raise taxes. Obama’s most recent budget calls for nearly $2 trillion in tax increases over the next decade. Conrad, the Senate budget chairman, has indicated that a similar amount would be appropriate.

Raising taxes is not something on which many politicians are eager to base their re-election campaigns. Studies have also shown that it is a particularly ineffective way to solve a nation’s debt and deficit problems. One report produced by the American Enterprise Institute examined data from a variety of countries between 1970-2007 and found “strong evidence that expenditure cuts outweigh revenue increases in successful consolidations.”

The findings echo those of a recent report from the Organization for Economic Co-Operation and Development, which concluded: “International experience shows expenditure-based fiscal consolidation tends to be more successful.”

The nonpartisan Congressional Budget Office recently concluded that the president’s budget, if enacted, would have a negative impact on long-term economic growth.

Ryan’s budget, on the other hand, simplifies the notoriously complex federal tax code by eliminating various loopholes and tax shelters while lowering tax rates.

Wednesday’s vote encapsulates what ought to be central issue in the 2012 campaign, Republicans say.

“This is an opportunity for the American people to assess the differences between the two parties,” a GOP budget committee aide told the Free Beacon. “We’re headed for financial disaster, and Senate Democrats are making no effort to take us off that path.”

“Republicans are actually putting forward proposals that are serious, that address the major challenges—on tax reform, entailment reform, spending reductions,” said another Republican aide. “Democrats have punted on all these issues.”

Few things better illustrate this lack of leadership more than unwillingness of Democratic lawmakers to support the president’s plan, Republicans say. Senate Democrats in all likelihood will vote in lockstep against every budget proposal, including Obama’s, and quickly move to change the subject.

“It’s a tear-off-the-Band-Aid kind of moment for them,” the GOP budget aide said. “They want to get it over with quickly so they can avoid a serious conversation about the budget.”

Even though Ryan’s budget, or any other GOP plan, has no chance of passing the Senate, Republicans want to use the moment to lay the groundwork for a winning political agenda.

“This is preparation for a Romney presidency,” Norquist said. “Republicans can line up and vote for an actual, written down budget. If Romney wins, they can turn and say, ‘I was elected to do this.’ That’s not something Obama could say about anything he did.”

Source

Tax and Debt Bomb

image
By: Larry Kudlow

We thought tax reform meant lowering rates and broadening the base by eliminating or cutting back on various deductions, credits, and loopholes. That’s what the Bowles-Simpson commission proposed. That’s what Paul Ryan and David Camp are working on. And that’s the pro-growth model.

But President Obama unveiled a much different tax-reform vision in his much-anticipated debt speech on Wednesday. He would raise tax rates on upper-income earners and small businesses. He also would eliminate deductions and credits, or so called “tax expenditures.” The president referred to these tax-expenditure reductions as “spending cuts.” In his context, they most certainly are not. They are more tax hikes.

Basically, the president is giving successful earners and small-business filers a double tax hike. That’s what it really is.

Of course, the president’s formula of estimating higher revenues to lower the deficit is completely wrong. The reality is that higher tax rates will slow the economy, inhibit new start-up companies, penalize investors, and may very well lose revenues and increase the deficit.

In the latter part of his speech the president did mention some kind of middle-class and corporate tax reform. But he gave no specifics.

He also touted $750 billion in discretionary spending cuts, but again without any details. Most of that amount probably comes from the recent continuing resolution to avoid a budget shutdown. Since Obama is extrapolating out twelve years, who knows how this is scored.

On the entitlement front, Obama rejected Paul Ryan’s consumer-choice and competition approach to Medicare reform. Instead, he invoked the Obamacare central-planning agency called the Independent Payment Advisory Board, which is supposed to make reductions in Medicare. Medicare itself would exercise more price controls on prescription drugs, rolling back the consumer choice and competition established under George W. Bush.

In total, President Obama is claiming $4 trillion in deficit reduction over twelve years. But we’ll never see it. Interest expense savings is supposed to make up $1 trillion of that amount, while the rest will somehow come from a concoction of fewer tax deductions, higher tax rates, and $400 billion in defense-spending cuts.

In effect, the president has moved to the left. He has embraced the Democrats’ so called progressive caucus in the House by slashing defense and jacking up taxes, all while offering no serious entitlement reform. (Hat tip to Jimmy Pethokoukis for nailing this earlier in the week.)

My final point is this: President Obama’s harsh-rhetoric rejection of the Ryan budget and his new (presidential) campaign to raise taxes on the rich sets up a huge confrontation with House Republicans on the eve of the hugely important debt-limit expiration.

Sometime in mid to late May, the debt ceiling to allow the government to borrow more money is going to run out. The Treasury can move money inside government accounts to forestall a debt breakdown for another couple of months. But the potential for a major political conflict on the eve of this process sets up the worst possible outcome: Failure of the U.S. to pay the interest on its own debt.

This is unnerving to financial markets. Instead of compromise, the president decided to seek confrontation.

Caveat emptor. Investors beware.

( Original Article )

nationalreview.com

%d bloggers like this: