Massachusetts Rationing Shows What’s Coming to All America Under Obamacare

By Burke J. Balch, J.D., director of NRLC’s Powell Center for Medical Ethics President Obama is holding up the Massachusetts health care law as a good precedent for what Obamacare will bring when fully implemented. It’s a good precedent, all ...MORE

Exchange enrollees finding insurance plans that limit specialists and hospitals

By Jennifer Popik, JD, Robert Powell Center for Medical Ethics As Americans engage in the increasingly frustrating process of attempting to enroll in health plans in new health care exchanges, many are finding their alternatives limited to cut-rate plans that allow...MORE

Will Obama Make Recess Appointments to Controversial IPAB?

Over the past several weeks, the White House has been scrambling to gain support for one of the most contentious and central provisions of the Obama Health Care Law, the Independent Payment Advisory Board (IPAB). Now it appears the Administration could ensure the Board’s operation even if the Senate refused or appeared unlikely to confirm those whom President Obama will appoint as its members by making what are called “recess appointments.” In light of a mounting bi-partisan call in the House to repeal the IPAB, this attempt virtually guarantees an immense fight.

Although many news accounts have focused on the Board’s mandate to impose Medicare cuts that a Congressional majority may not reduce, less attention has been given to the IPAB’s role in reducing what all Americans will be permitted to use out of their own private funds for their family’s health care. The Obama law directs the IPAB to issue recommendations to limit what ordinary citizens and their health insurance coverage can pay for medical treatment so as to prevent it from keeping up with the rate of medical inflation.

To implement these recommendations, the federal Department of Health and Human Services is empowered to impose so-called “quality” and “efficiency” measures on health care providers. Doctors who violate a “quality” standard by prescribing more lifesaving medical treatment than it permits will be disqualified from contracting with any of the health insurance plans that individual Americans, under the Obama Health Care Law, will be mandated to purchase. Few doctors would be able to remain in practice if subjected to that penalty.

This means that treatment that a doctor and patient deem advisable to save that patient’s life or preserve or improve the patient’s health, but which exceeds the standard imposed by the government, will be denied even if the patient is willing and able to pay for it.

A bill before Congress for IPAB’s repeal has 144 co-sponsors from both sides of the aisle. The Hill newspaper reports that over 270 medical organizations sent a letter to Congress urging repeal late last week.

However, even if passed by the House, it is nearly certain that repeal this year or next would stall in the Senate, or face an Obama veto.

Now public attention is being drawn to the President’s potential ability to get the Board up and running even in the face of Senate opposition to his appointments to the Board.

Responding to an inquiry from pro-life Senator Tom Coburn (R-OK), the non-partisan Congressional Research Service concluded that President Obama could make enough recess appointments, including a chair, to conduct business. While the law does not require the Board to begin issuing reports until 2014, it provides funding for its operations starting October 1 of this year when federal Fiscal Year 2012 begins.

Both President Obama and Kathleen Sebelius, his Secretary of Health and Human Services, have been insistent in defending the Board. In an April 13 deficit speech, the President advocated directing the Board to limit even further which of their resources private citizens will be permitted to devote to saving their lives and those of their family members. In a recent op-ed piece, Sebelius lashed back at its critics, making the self-contradictory claim that it will be both “independent” and “accountable to Congress and the president.”

To prevent an end-run, the House of Representatives could use its constitutional power to prevent the Senate from adjourning for more than three days without its consent to attempt to prevent the occurrence of a “recess” that would enable Presidential recess appointments. Those concerned about the dangerous rationing in which the IPAB recommendations would play so critical a role would be well advised to urge their Representatives to ensure that the House does so.

More details on the rationing in the Obama Health Care Law are available here.

Even Critics of ObamaCare’s Independent Payment Advisory Board Miss Its Worst Rationing

Recently there has been a fair amount of press coverage of the effort to repeal a central aspect of the Obama Health Care Law—the unelected 18-member Independent Payment Advisory Board given sweeping powers to limit what people are allowed to spend for health care. Strangely, however, most critics focus only on its impact on Medicare spending, and at least one of its defenders appears ignorant of the authority it will exercise to limit Americans’ use of their own private funds.

Democratic representatives are increasingly joining Republicans in co-sponsoring H.R. 452, a bill to repeal the Independent Payment Advisory Board. As noted in an April 19 New York Times article by Robert Pear,

Democrats and Republicans are joining to oppose one of the most important features of President Obama’s new deficit reduction plan, a powerful independent board that could make sweeping cuts in the growth of Medicare spending. Mr. Obama wants to expand the power of the 15-member [sic] panel, which was created by the new health care law, to rein in Medicare costs. But not only do Republicans and some Democrats oppose increasing the power of the board, they also want to eliminate it altogether. Opponents fear that the panel, known as the Independent Payment Advisory Board, would usurp Congressional spending power over one of the government’s most important and expensive social programs. Under the law, spending cuts recommended by the presidentially appointed panel would take effect automatically unless Congress voted to block or change them. In general, federal courts could not review actions to carry out the board’s recommendations.

In an April 21 piece defending the board, Paul Krugman, one of the paper’s op-ed columnists, wrote, “Before you start yelling about ‘rationing’ and ‘death panels,’ bear in mind that we’re not talking about limits on what health care you’re allowed to buy with your own (or your insurance company’s) money. We’re talking only about what will be paid for with taxpayers’ money.”

Yet Krugman’s statement is flatly wrong.

As documented with specific quotes from the legislation at http://bit.ly/itblQZ, the Obama Health Care Law specifically directs the board to make “recommendations to slow the growth in national health expenditures” for private—not just governmentally funded—dollars devoted to health care. These recommendations are supposed to limit what ordinary citizens and their health insurance coverage can pay for medical treatment to force it below the rate of medical inflation.

To implement these recommendations, the federal Department of Health and Human Services is empowered to impose so-called “quality” and “efficiency” measures on health care providers. Doctors who violate a “quality” standard by prescribing more lifesaving medical treatment than it permits will be disqualified from contracting with any of the health insurance plans that individual Americans, under the Obama Health Care Law, will be mandated to purchase. Few doctors would be able to remain in practice if subjected to that penalty.

This means that treatment that a doctor and patient deem advisable to save that patient’s life or preserve or improve the patient’s health, but which exceeds the standard imposed by the government, will be denied even if the patient is willing and able to pay for it.

“It is truly astounding that this extreme form of rationing has gone almost unremarked even by critics of the Independent Payment Advisory Board,” said National Right to Life Executive Director David N. O’Steen, Ph.D. “That means it is up to grassroots pro-lifers to make both their elected representatives and media outlets aware of the facts, and of how important it is that the Independent Payment Advisory Board be repealed.”

More details on the rationing in the Obama Health Care Law are available at http://bit.ly/161yrt.

OBAMA PROPOSES TO LIMIT AMERICANS’ HEALTH CARE EVEN MORE THAN UNDER OBAMACARE

In the much ballyhooed debt-reduction “framework” President Obama revealed this week in a speech at George Washington University, the President proposed a dramatically graver limit on what Americans will be allowed to spend for our own healthcare than that which will be imposed by the Obama Health Care Law if it is not repealed before 2015.

As now enacted, the Obama Health Care Law directs an unelected 18-member panel called the “Independent Payment Advisory Board” to limit what Americans are permitted to spend on health care out of their own, nongovernment, funds to less than enough to keep up with medical inflation. However, Obama is now proposing what the White House framework calls “a more ambitious target of holding . . . cost growth . . . to GDP [gross domestic product] plus 0.5 percent beginning in 2018, through strengthening the Independent Payment Advisory Board (IPAB).”

Suppose this proposal had been in effect in 2009, the most recent year for which statistics are available. In 2009, because of the recession the overall real GDP per capita, as reported by the Bureau of Labor and Statistics, actually shrank by 2.1 percent. If you use President Obama’s formula for that period of time, after adding .5% , Americans would have been forced to decrease what we would be allowed to spend to save our lives and preserve our health by 1.6 percent.

In 2009, the actual rate of medical inflation was 2.7%. Had the Obama Health Care Law (ObamaCare) been in effect, Americans would have been able to increase their medical spending, but not enough to keep up with the 2.7% medical inflation rate.

But under the Obama proposal announced this week, what Americans of all ages would be permitted to spend for health care, taking into account the increased cost of medical goods and services, would in real terms be 3.3% less than in the previous year.

While there has been increasingly widespread opposition to the Independent Medical Payment Advisory Board from physician groups, Republicans, and an increasing number of Democrats, the public focus has been on its mission to make cuts in government Medicare spending. Far too little attention has been given to the rationing it would impose through limits on the resources Americans will be allowed to devote to our own health care.

Under the Obama Health Care Law, these limits will be subject to enforcement by the federal Department of Health and Human Services, which will be empowered to impose so-called “quality” and “efficiency” measures on health care providers. Any doctor who dares to provide life-saving treatment in excess of these limits will be disqualified from contracting with any of the insurance plans which, under the individual mandate, Americans will be required to purchase.

The Obama Health Care Law must be repealed, and his still more draconian proposals defeated. If not, as is now true of Canadians who must often come to the United States to obtain life-saving health care, Americans will increasingly have to find locations abroad if we want to be able to use our own money effectively to save their own lives.

SENATE VOTE EXPECTED THIS WEEK

This week, the Senate is scheduled to vote on H. Con. Res. 35, which would remove funding for the entire Obama health care law that was enacted in 2010. The Obama health care law contains multiple provisions that will, if fully implemented, result in government-imposed rationing of lifesaving medical care.

Among the most dangerous provisions: The Department of Health and Human Services (HHS) will be empowered to impose so-called “quality” and “efficiency” measures on health care providers, based on recommendations by the Independent Payment Advisory Board, which is directed to force private health care spending below the rate of medical inflation. In many cases treatment that a doctor and patient deem needed or advisable to save that patient’s life or preserve or improve the patient’s health but which runs afoul of the imposed standards will be denied, even if the patient wants to pay for it.

Information regarding NRLC’s position on rationing in the Patient Protection and Affordable Care Act may be obtained by visiting here.
The action alert is available here.

PRESIDENT’S SUPPORT FOR STATE “FLEXIBILITY” IN IMPLEMENTING OBAMA HEALTH CARE LAW WON’T AVOID RATIONING

President Obama made headlines in a speech before the National Governors Association, when he endorsed a Senate bill described as allowing states to seek “waivers” of certain requirements in the Obama Healthcare Law. However, the offer comes with strings, and would do nothing to change the elements of the federal law that will impose rationing of medical treatment if it is not repealed.

There would be no “waiver” from the duty of the Independent Payment Advisory Board to recommend, or the authority of the federal Department of Health and Human Services to impose, so-called “quality” and “efficiency” standards on health care providers designed to limit what Americans will be permitted to spend on life-saving medical care for themselves and their families, forcing it below the rate of medical inflation.

Senate Bill 248, for which the President expressed support, would move from 2017 to 2014 the date when states would be allowed to seek exemptions from certain Obama Health Care Law requirements, such as state insurance exchanges, and the individual and employer mandates. Such a waiver would be granted, however, only if the Administration is convinced that the state’s alternative would 1) make insurance just as "affordable" as under Obamacare (translation: limit what resources people are allowed to devote to their own health care); 2) Cover as many people as Obamacare with health insurance which is as “comprehensive” as Obamacare; and 3) Not increase the federal budget deficit.

Most States are struggling with their health care budgets, and many expect the situation to become worse under the requirements of the Obama health care law. Politico reported, “The move comes as governors, particularly Republican state leaders, say the law is overly burdensome on the already stretched states. Much of the expansive legislation has to be implemented at the state level.”

Were the bill to be enacted, the most likely result would be that proposals threatening the most dangerous rationing would see new life in the states. For example, Vermont officials are pushing hard to secure a waiver to implement their proposed “single-payer” system – under which all Vermont citizens would be forced into a single state government health plan, subject to state budgetary limits, with no opportunity to choose other insurance less likely to ration. Said Senator Bernard Sanders (Socialist-VT), “At a time when 50 million Americans lack health insurance and when the cost of health care continues to soar, it is my strong hope that Vermont will lead the nation in a new direction through a Medicare-for-all, single-payer approach.”

While it is, in theory, possible for states to craft any sort of plan they wish within the requirements, it is difficult to see how the Obama administration might approve ones that did not dramatically curtail what people are allowed to spend for their health care. It is precisely the policy of preventing people from being allowed, if they choose, to use their own funds to keep up with health care inflation that creates the gravest threat of rationing.

The Senate proposal may have a difficult time in the House, where congressional Republicans want states to have much more flexibility. Inside Health Policy wrote that the plan to bump up the waiver dates, “was met with disdain from GOP lawmakers, who said the opt-out criteria are too stringent and called the move a confession that the bill is unworkable in its current form.”

Politico reported, “Mandating many of the same requirements, this plan would treat states as agents of the very law these governors are running away from,” said Michael Steel, spokesman for Speaker John Boehner. “A better approach would be working with reform-minded governors to give states more flexibility . . . . Now that the administration has conceded that Obamacare is unworkable, we hope they will work with us to repeal the law and replace it with common-sense reforms . . . .”