From today’s Morning Bell from the Heritage Foundation:

The new House health care bill (H.R. 3962) unveiled by Speaker Nancy Pelosi (D-CA) yesterday clocks in at 1,990 pages and about 400,000 words. As written, the bill purports to cost only $1.05 trillion over the first ten years and is paid for by over $700 billion in tax increases and cuts to Medicare Advantage and Medicare prescription drug payments. But as troubling as those numbers are, the scariest thing about the bill is the solid foundation it lays for a complete government take over of the health care sector of our economy.

The Washington Post describes the bill as “creating an expensive new entitlement program (subsidies to purchase health insurance) and dramatically expanding an existing one (Medicaid).” This is true by itself, but the Post later dismissively adds: “If you’ve noticed that we haven’t talked about the public option in the House bill, that’s not an oversight. For all the fury over the issue, it doesn’t matter that much; the CBO estimates that the government-run plan would actually have slightly higher premiums.” This is a breathtakingly naive statement by the Post and demonstrates that they have not yet fully grasped how all the different elements of the bill are designed to interact to produce President Barack Obama’s desired outcome.

The Medicaid Expansion: Under current law the CBO projects that only 35 million Americans would be on Medicaid by 2019. The House bill massively expands the Medicaid program by raising the upper income cutoff to 150 percent of the federal poverty line (FPL). As a result, the CBO now estimates some 50 million Americans will be enrolled in the program at a ten year cost to the federal government of $425 billion. This does not include the $34 billion in increased Medicaid costs that state governments will have to spend.

The Insurance Subsidies: The House bill also creates a Health Insurance Exchange through which individuals without employer based coverage could purchase insurance. The bill also provides “affordability credits” to people who are below 400% FPL. However, the bill also denies access to the credit for all people who are “eligible” for Medicaid. In essence, therefore, the House bill forces all Americans below 150% FPL to enroll in Medicaid or pay the individual mandate fine. The CBO explains why the Democrats chose this route: “The estimated costs of providing subsidies through the new insurance exchanges are now lower for several reasons: the larger expansion of Medicaid means that fewer people would be eligible for coverage through the exchanges.” In other words, it’s cheaper to force people into Medicaid then to give them subsidies high enough to buy private insurance. Furthermore, individuals are only allowed to enroll in the cheapest (”basic”) plans for the first two years. After that, they can only choose more expensive plans or the government run plan.

The Employer Mandate: The bill imposes a new 8% payroll tax on employers who don’t cover specified percentages of their employees’ health insurance. In the short term this will only result in job losses and lower wages. But further down the road, the health plans would have to meet new requirements to be specified later by Obama’s new Health Czar (“Health Choices Commissioner”). If your employer’s health plan doesn’t meet those requirements (which are all but guaranteed to drive up the cost of your health plan), you couldn’t keep it.

The Public Option: As health insurance premiums keep rising thanks to all the new requirements in the current bill and the Health Czar’s future regulations, more and more people will have no choice but to depend on the government plan or face a fine. At first, only individuals and employers with 25 employees or fewer would be eligible for the government run plan. But in year two (2014) individuals and employers with 50 employees or fewer become eligible, in year three (2015) employers with at least 100 employees become eligible but starting that year, the Health Czar permitted from this year forward to expand employer participation as appropriate, “with the goal of allowing all employers access to the Exchange.” In effect, the bill makes larger sized employers explicitly eligible and still turns over authority to the Health Czar to further open it up. The goal has been, and still clearly is, to open the exchange and the public plan to everyone. As the Post notes, the CBO now projects that the government run premiums will actually be higher than private plans. The Democrats will not allow this to continue. History shows that entitlement programs like this quickly devolve into price control central planning. A less “robust” public option today will almost certainly be a more robust public option tomorrow. Look no further than the history of Medicare. Medicare was initially designed to pay private rates, but now the program has a complex formula for administered pricing.

So that’s the plan: force all Americans to buy health insurance, regulate the private plans till they are too expensive, and then slowly expand the power and size of the public option as Americans are left with no choice but to turn to government run health care. That is how Pelosi aims to achieve Obama’s goal of “Everybody in, Nobody out” government run health care. The costs are going to be staggering. Not only will health care quality and choice suffer as more and more Americans are forced onto a government plan that reimburses providers at low government set rates, but the price tag is guaranteed to skyrocket. The only way the House managed to keep their price tag as low as $1.05 trillion is by pretending that Congress would cut Medicare reimbursement rates by 20% in 2010. The full ten-year cost of being honest about the Medicare reimbursement rates would be $250 billion. Less choice, lower quality health care, and trillion dollar deficits for years to come: that is the House’s prescription for health reform.

This is the fifth in a five-part week-long series on how Obamacare will affect you from the Heritage Foundation.

Lost in all of last weeks headlines on how the Senate Finance Committee (SFC) finally delivered a health care product that the Congressional Budget Office (CBO) was willing to say would reduce the deficit, was how exactly they achieved it. At a price tag of $829 billion, the SFC ’framework’ will reduce the number of uninsured Americans by 29 million, moving the overall percentage of nonelderly Americans with health insurance from 83% in 2010 to 94% in 2019. But of those 29 million with new insurance coverage, almost half (14 million), will get their coverage through the welfare programs Medicaid and the State Children’s Health Insurance Program (SCHIP).  That is equivalent to adding every resident of Ohio and Nevada to the welfare rolls.

In other words, for half of those Americans who are being promised health reform, they are going to be stunned to find themselves in a welfare office applying for Medicaid. Under the current baselines for Medicaid and the State Children’s Health Insurance Program (SCHIP), there will be 76 million individuals served by these programs for at least some part of the year in 2019. If the SFC proposal becomes law, the number on Medicaid/SCHIP will top 90 million. So why do Obamacare supporters want to put 90 million Americans on the welfare rolls? It is cheaper than providing them with real quality health care.

Medicaid was originally created to provide access to health care for families on welfare. Medicaid pays providers 20-25 percent less than does the private sector, forcing doctors and hospitals to subsidize Medicaid through lower rates. This deters doctors and hospitals from participating in the program, creating a lack of access that itself is a form of rationing. As Time magazine reported this July: “But there are real questions as to whether the program could handle the strain of that many new clients. Already, it is difficult in some areas to find health-care providers who are willing to accept Medicaid patients.”

Even those who are not pushed into welfare will feel the strain on the health care system. The majority of individuals moved into Medicaid will be young and healthy. Keeping them on welfare rolls will shift even more costs to individuals and families buying private health insurance, as doctors and hospitals recoup their losses from Medicare/SCHIP by charging more to the privately insured. In effect, the congressional policy seems to be to expand dependency by discriminating against individuals based on their income.

And then there is the effect on states. The CBO estimates that the Finance Committee plan will cost states $33 billion over 10 years. But even that may be a low estimate. Governor Phil Bredesen (D-TN) has warned that the costs for his state alone could be as high as $3 billion. Thanks to strings attached to Obama’s failed stimulus, states already are facing an erosion of their authority to manage their Medicaid programs. The true cost to taxpayers in the states will only become apparent as spending for education, child welfare, public health, and investment in transportation systems and infrastructure are crowded out over time.

As Heritage Senior Fellow Dennis Smith reminds us:

In June, President Obama told Senate Democrats, “As we move forward on health care reform, it is not sufficient for us simply to add more people to Medicare or Medicaid.” Unfortunately, that is precisely what Congress is going to do with the Baucus proposal.

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This is the fourth in a five-part week-long series on how Obamacare will affect you from the Heritage Foundation.

“Under our plan, no federal dollars will be used to fund abortions,” Or so President Barack Obama promised to the American people in his health care address before a Joint Session of Congress on September 9th. But then why did the U.S. Conference of Catholic Bishops send a letter to Congress on October 8th writing: “No one should be required to pay for or participate in abortion. … No current bill meets this test”?

Who is telling the truth? The President or the Bishops? Last Wednesday, White House Press Secretary Robert Gibbs was asked this question during his daily press briefing and answered: “Well, I don’t want to get me in trouble at church, but I would mention there’s a law that precludes the use of federal funds for abortion that isn’t going to be changed in these health care bills.” Unsatisfied, the CNS News’ Fred Lucas again pressed on Friday:

The Catholic bishops have repeatedly said that the Hyde amendment would not apply to the health care bill and yesterday in the letter that they sent to Congress they said that if language expressly prohibiting abortion funding is not added to the health care bill, they will vigorously — “vigorously oppose” — that’s a quote — the bill. My question on that, does the President support the bishops on this?

Gibbs replied:

My answer isn’t different than it was on Wednesday. There may be a legal interpretation that has been lost here, but there’s a fairly clear federal law prohibiting the federal use of money for abortion. I think it is — again, it’s exceedingly clear in the law.

How to put this politely … it is safe to say that Gibbs’ above statement is less than true. The next time anyone tries to convince you otherwise, that the White House is telling the truth ask them where exactly in the Federal Code it says this. The truth is…it doesn’t.

But what about the Hyde amendment mentioned by the White House reporter? Is the Hyde amendment not the law of the land? No, it is not even a statute. First passed in 1976 by Rep. Henry Hyde (R-IL) as a rider to the Health and Human Services appropriations bill, the Hyde amendment must be passed again every year as part of the HHS appropriations bill and even then it only applies to current HHS programs. The Hyde amendment would do nothing to stop Obamacare from funding abortions and all the versions of Obamacare passed by Congressional committees so far do exactly that.

Conservatives introduced amendments in all five committee markups (three in the House and two in the Senate) that would have specifically prohibited federal funds from being used to cover abortion. None of them passed. Worse, the “compromise” the White House has adopted is an amendment sponsored by Rep. Lois Capps (D-CA) who has a 100% pro-abortion voting record according to the National Abortion Rights Action League (NARAL). Not only does the Capps amendment allow for federal money to subsidize abortions in private plans and mandate federal funding for abortions in the public option (this according to FactCheck.org), it also requires that at least one insurance plan cover abortion in every geographical region in the country.

In 2007, then candidate Barack Obama promised Planned Parenthood: “We’re gonna set up a public plan that all persons and all women can access if they don’t have health insurance. It will be a plan that will provide all essential services including reproductive services. … We will also subsidize those who choose to stay in the private insurance market, except, the insurers are going to have to abide by the same rules in terms of providing comprehensive care including reproductive care.” A Rasmussen poll released last month showed that only 13% of Americans want the health-care reform bill to use tax dollars to fund abortions, clearly demonstrating that even most pro-choice believers do not favor taxpayer funded abortions. A Pew Research Center poll two weeks ago showed that support for legalized abortion has dropped to its lowest level in years to 47%, down from 54% last year. Obama can either please NARAL and Planned Parenthood or he can honor the beliefs of the overwhelming majority of Americans. He can’t do both.

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This is the third in a five-part week-long series on how Obamacare will affect you from the Heritage Foundation.

The scariest part about yesterday’s Senate Finance Committee vote passing its version of Obamacare, is not what is in their bill (to the extent that it even exists), but that the Finance Committee bill promises to be the high water mark for “bipartisanship” in health care reform.

Now all of the other bills will be merged together behind the closed doors. All the bills are fundamentally flawed and will only get worse as the leaders in the House and Senate have to commit to actual details.

COST — All the proposals carry a hefty price tag. The Finance bill estimates start at $829 billion. Preliminary estimates of the House Tri-Committee bill put the price tag over $1 Trillion and adding another $245 billion to the deficit. Preliminary estimates of the HELP Committee bill would add $598 billion to the deficit over the next 10 years. And the outlook for the following ten years looks far far worse.

EMPLOYER MANDATE - More spending means more taxes. All the proposals include new taxes on employers. Taxes on employers will ultimately result in lower wages, fewer jobs, and slower economic growth. According to The Heritage Foundation, the mandates, like those in the House bill, could cost businesses up to $49 billion a year, 10.2 million workers will be at risk of slower wage growth and cuts in other benefits, and as many as 9 million low-wage and part-time workers will lose their employer-based health insurance.

PUBLIC PLAN - All the proposals include the creation of a new government health plan. The Finance proposal calls it a co-op while the House Tri-Committee bill and the Senate HELP Committee all call it a new public plan. Despite what activists on the left claim, a government run health insurance “option” will not be on a level playing field with other private options. The playing field will be skewed to push millions of Americans out of their current private health insurance and into the government run plan.

INDIVIDUAL MANDATE - All the proposals force every Americans to buy health insurance or pay a penalty, some even threatening jail time if they do not comply. Such a mandate is a massive tax increase on individuals and families whose health insurance does not meet the new federally determined standards. This means that Congress will, for the first time in U.S. history, force Americans to buy federally designed packages of health benefits, even if they do not want or need those benefits.

MEDICAID EXPANSION - Hidden in all the proposals is a massive expansion of the Medicaid program. The result is millions more Americans would be dependent on this growing entitlement program. This means more costs to taxpayers, less flexibility for the states, and worsening markets for the privately insured.

MEDICARE CUTS - All the proposals depend heavily on billions in Medicare cuts to pay for their versions of Obamacare. Traditionally, such cuts rarely come to fruition. Special interests lobby to stop any real cuts from occurring after the bill is passed. And some so-called fraud, waste and abuse cuts, like those to the Medicare Advantage, will put millions of seniors’ benefits at risk.

Do high costs, government expansion, huge tax increases, major unfunded expansions in Medicaid and major cuts to Medicare sound like a recipe for success? It’s all downhill from here.

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This is the second in a five-part week-long series on how Obamacare will affect you from the Heritage Foundation.

“I will not sign a plan that adds one dime to our deficits – either now or in the future. Period.” President Barack Obama promised this to the American people in his health care address before a Joint Session of Congress on September 9th. Problem is, no one believes him.

The Congressional Budget Office has issued reports on the Senate Health Committee bill (HELP), the House Tri-Committee Bill (HR 3200), and the Senate Finance Committee bill (Baucus bill). According to the CBO, the HELP bill would add $600 billion to the deficit in just the first ten years, HR 3200 would add $239 billion to the deficit in just the first ten years, and the Baucus bill claims to reduce the deficit by $81 billion.

But nobody believes that the Baucus bill will accomplish what it claims to do. As the Washington Post reported:

The cost difference stems from the fact that the House measure is honest enough to include the full 10-year cost of the so-called “doc fix” — $245 billion to reverse scheduled cuts in Medicare payments to physicians — although not fiscally responsible enough to pay for it. The Senate just patches the problem for one year and pretends that doctors take a 25 percent cut in reimbursements the following year and then stay at that low level forever. No one believes that will happen, so the money is going to have to be scrounged up later or else add more to the deficit.

The Washington Post is right: claims that the Baucus bill reduces the deficit are a complete fraud since there is simply no way Congress is going to cut doctor pay by 25% in one year. But all of these bills are deeply dishonest about their true costs in a more fundamental way.

Look at these charts on spending levels in the HR 3200 and the Baucus bill over time. Notice how in both bills the increased revenues (a.k.a. tax hikes) occur immediately but the increased spending doesn’t really ramp up until 2013. In other words, in order to game the CBO scoring system (explained by former CBO Director Donald Marron here), Democrats have packed ten years of taxing, but only six years of spending, into the CBO’s ten-year budgeting window.

So what happens to the deficit in those years after the CBO budget window? Rep. Jason Altmire (D-PA), a member of the Democratic Blue Dog Coalition explains: “Every year, you lose ground. It’s likely after 10 years, we fall off a cliff.”

Falling off a cliff. That is the verdict from members of his own party on what Obamacare will actually do to the federal deficit.

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This is the first in a five-part week-long series on how Obamacare will affect you from the Heritage Foundation.

Throughout his campaign, and even in to the first few months in office, President Barack Obama repeatedly promised the American people that his health care plan would reduce their health insurance premiums by $2,500 a year. It has been a while since President Obama made that promise, and any honest look at the health legislation being considered in Congress explains why.

The Senate Finance Committee bill written by Chairman Max Baucus (D-MT) (the Baucus bill) first drives up the cost of health insurance for all Americans and then forces everyone to buy it or face tax penalties or jail time. While the Baucus bill does cap out-of-pocket costs based on a person’s income, the effect on American families is still staggering. According to the Center for Data Analysis, the Baucus bill would:

• For individuals making $34,140 (three times the Federal Poverty Level) the Baucus health care proposal could mandate up to $4,097 in annual premiums, a sum which could have been spent on over nine months of food, almost four months of housing or well over a year of utilities.
• For a family of four making $69,480 (300% above poverty) the Baucus bill mandates annual health insurance premiums of $8,338, which would be worth the equivalent of over ten months of food, four months of housing or almost two years of utilities.
• For individuals earning $45,520(400% above poverty) Baucus mandates $5,462 for health insurance, or over a year of food, four months of rent or a year and a half of utilities.
• For families earning $92,640 (400% above poverty) Baucus mandates $11,117 in health premiums, the equivalent of over a year of food, five months of housing or two years of utilities.

And those numbers include the subsidies for health insurance in the Baucus bill. To pay for all this new health care spending, plus the massive expansion of Medicaid, the Congressional Budget Office estimates that the Baucus bill will collect $4 billion in fines from those who do not purchase insurance, $200 billion taxing health insurance companies with generous health plans, and $25 billion in taxes on employers. Not to mention the billions in cuts to Medicare payments to hospitals which will result in significant cost shifting to consumers.

PricewaterhouseCoopers has done a study on what all these new taxes and regulations will do to Americans health insurance premiums and the results are not pretty. Instead of reducing the average family’s health insurance premiums by $2,500 per year, as President Obama promised, the Baucus bill would actually raise them by $4,000 more than they would have been without reform.

The Baucus bill spends at least $1 trillion, fails to cover all Americans, taxes employers for creating jobs, and inflicts higher out-of-pocket health care costs on all Americans. We can do better.

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