Republicans and much of the private sector blasted away Monday at the mammoth healthcare bill that Democrats plan to gift wrap and deliver to the American public by Christmas Eve – a measure The Wall Street Journal slams as a "vast expansion of federal control."
Although President Barack Obama is hailing the bill's imminent passage as "historic," observers say it actually represents the abrogation of several promises he made on the campaign trail last year.
"This is not the change the American people were promised, this is Washington at its worst," Rep. Mike Pence, R-Indiana, charged in a statement released Monday morning. "Horse trading in Congress is always distasteful but it is especially repugnant when legislators trade away our values."
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The facts regarding aspects of the bill that Republicans find most objectionable:
- Rising insurance premium costs. How much premiums increase will vary from state to state. But even supporters of the bill concede they probably will rise. That's because the Senate levies a $70 billion "premium tax" on some insurance plans, while collecting billions in fees from medical-device manufacturers, drug companies, and others who will pass those costs on to their customers. Insurer Wellpoint sifted its actuarial data and predicted the Senate bill could double some customers' premiums. Other estimates show the average premium increases in the neighborhood of 10 percent.
- Abortion coverage. Pro-life advocates are lambasting Sen. Ben Nelson, the last Democratic holdout who had objected that the bill would use public funds to underwrite subsidized policies that included abortion coverage. One example from a statement issued by Rep. Steve King, R-Iowa: "Ben Nelson has traded innocent unborn human lives, a fundamental moral principle, for a monetary concession set aside exclusively for Nebraska." The new language on abortion requires each state to offer at least one policy that would not cover abortion. Theoretically, this means an individual could opt for a policy not offering abortion coverage, if they have a moral objection. It also recognizes that states can opt out of providing plans with abortion coverage. And it also establishes accounting rules – which House Minority Leader John Boehner calls "accounting gimmicks" – to give the appearance that public funds are not being used to pay for abortions. The problem, however, is that taxpayer dollars will still go to subsidize abortions in policies offered in at least some states. "If states opt out," King says, "their citizens, through federal taxes, will still be compelled to pay for abortions in other states, just not in their own states." Boehner adds that the bill "levies an abortion premium and does not fix the problem of government funds being used to subsidize elective abortions."
- Coverage still won't be universal. While Democrats say the plan will cover an additional 31 million Americans, they concede that Obamacare will still leave 21 million Americans without insurance coverage. Because the bill would assess a relatively small fine for those who refused to obtain insurance, droves of healthy younger folks are expected to opt out and just pay the fine. This will increase the costs of premiums for those who do have coverage, because healthier policyholders incur fewer medical expenses than those who are older.
- Medicare cuts (sort of). Senate Democrats claim the bill will insure 31 million more people but will actually reduce the federal budget deficit by $132 billion by 2019. They accomplish this sleight of hand by trimming federal Medicare expenses by close to $500 billion. Very few experts take these paper cuts seriously, however. Democrats say the money will be saved through largely unidentified savings and efficiencies. Congress frequently adds money back into the budget to reimburse doctors and hospitals for their Medicare expenses – the latest example was a two-month "patch" on Medicare reimbursements slipped into the Defense Department appropriations bill the House passed on Dec. 16th. Moreover, reduced Medicare payments result in "cost shifting" to regular insurance customers in the form of higher premiums. Obama had promised that those satisfied with their policies could keep them. Karen Ignagni, president and CEO of the America's Health Insurance Plans trade group, predicts cuts in Medicare Advantage benefits will "ultimately result in millions of seniors losing their current coverage."
- No public option as promised. During the campaign, then candidate-Obama criticized Hillary Clinton for a healthcare reform proposal that didn't include a public option. Ironically, the Senate compromise worked out over the weekend, which Obama supports, doesn't include the public option Obama wanted, but does include the mandate. The left is laying the blame for the jettisoning of the public option squarely at the doorstep of the White House. Sen. Russ Feingold, D-Wis., complains "the lack of support from the administration made keeping the public option in the bill an uphill struggle." Hardcore liberals are as dissatisfied with the bills as are conservatives.
- A lack of interstate competition. Many conservatives have belatedly come to the recognition that the anti-trust exemption that granted to insurance companies helped open the door to a massive federal takeover of healthcare services. In some states, only a few providers control more than 80 percent of the market. This has opened the door to the liberal assertion that strong federal action is needed to make markets competitive. The Senate bill leaves the exemption that permits monopolistic market share intact, although it does establish exchanges that would increase healthcare choices for those not currently insured.
- An acceleration in the rapid escalation of medical costs. The entire objective of healthcare reform was to "bend the cost curve" so costs would not escalate as rapidly. Many experts, however, expect that Obamacare will actually accelerate the growing amount of the nation's GDP being spent on healthcare. Ignagni says the bill "lacks accountability to ensure that costs will be brought under control."
- Premium tax to hit middle class. Despite the president's promise not to raise taxes "one dime" on anyone earning less than $250,000 per year, the Heritage Foundation estimates the bill collects $400 billion in new taxes. Some of the taxes will hit a small percentage of citizens – the 10 percent tax on tanning salons, for example. Some taxes will be levied indirectly, when providers' higher costs are passed along to consumers. And the penalties for Americans who opt not to insure themselves will also come in the form of a tax, which will disproportionately impact those earning less than $100,000 annually.
- Prodigious pork for individual senators. The bill is packed with billions of dollars of special incentives to help individual senators win re-election – what used to be called earmarks. These include the $100 million "Louisiana purchase" for moderate Democratic Sen. Mary Landrieu; the permanent 100 percent Medicaid bailout for Nebraska that helped win Sen. Nelson's holdout vote; other bailouts for states such as Hawaii, Vermont, and Massachusetts; a $10 billion expansion of community health centers sought by Vermont Sen. Bernie Sanders; and many more. "You've got to compliment Ben Nelson for playing The Price Is Right," Sen. Richard M. Burr, R-N.C., said, according to The New York Times. "He negotiated a Medicaid agreement for Nebraska that puts the federal government on the hook forever. Not for six years, not for 10 years. This isn't the Louisiana purchase; this is the Nebraska windfall."
- A lack of transparency. Sensing that the tide of public opinion, as reflected in a host of polls, is steadily rising against their healthcare proposals, Democrats elected to force their bill through before many senators had an opportunity to review, let alone read, the most recent version. The Wall Street Journal reported senators only had 38 hours to study the latest iteration before the 1 a.m. vote Monday.
"The rushed, secretive way that a bill this destructive and unpopular is being forced on the country shows that "reform" has devolved into the raw exercise of political power for the single purpose of permanently expanding the American entitlement state," the Journal's editors wrote.
Not all segments of American business oppose the bill, of course. The American Hospital Association supports the bill because it expands coverage and could spur competition among insurance firms. The American Medical Association has yet to endorse the Senate's final version, but has supported many of its features.
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