Tag Archives: Big Pharma

What You Need to Know about the Senate’s Obamacare “Vote-A-Rama”

It’s not a carnival ride—although it might prove even more adventurous. The Senate’s consideration of health-care legislation will soon result in a grueling series of votes dubbed “vote-a-rama.”

After 20 hours of debate on the budget reconciliation measure, equally divided between the majority and minority parties, the Senate will complete consideration of all pending amendments, with the process’ conclusion typically determined when senators exhaust all the amendments they wish to offer—not to mention themselves.

Here’s what you need to know about “vote-a-rama.”

1. It’s Physically Demanding

The “vote-a-rama” process during consideration of the 2010 reconciliation bill that “fixed” Obamacare provides an example. On Wednesday, March 24, senators began voting on amendments at 5:32 PM. Nearly nine hours later, at 2:17 on the morning of Thursday, March 25, senators had completed votes on 29 amendments. The Senate then took a brief break, re-convened at 9:45 the same morning, and disposed of a further 12 amendments over an additional four-plus hours, with a vote on final passage at 2 PM on March 25.

For 20-something or 30-something staffers—let alone senators several times their age—this lengthy process can prove grueling, with long hours, late nights, lack of sleep, and little food (or bad food) the norm.

2. It’s Mentally Confusing

Between votes on amendments, senators usually allow for brief one-minute speeches by the amendment’s proponent and an opponent (generally the majority or minority floor manager of the bill). However, as Senate procedural expert James Wallner notes, that habit has derived from custom and unanimous consent, not any formal rule. If any senator objects to the brief “well speeches” as part of “vote-a-rama,” then the Senate will vote on amendments without any debate or a summary of what the amendment does.

Even with the brief summaries by amendment sponsors, it’s often difficult for senators—and particularly Senate staff—to understand exactly what’s going on down on the Senate floor. Amendment text can occasionally change at the last minute, as can the sequence of amendments offered. On occasion, senators may have to “fly blind” without clear guidance or recommendations from their staff on how to vote. Coupled with the long hours and lack of sleep (for members and staff alike), it’s a recipe for mistaken votes and confusion.

3. It’s Hard to Pass Amendments with a Simple Majority…

As Wallner noted in an article earlier this week, the Senate’s rules essentially give preferential treatment to the underlying reconciliation bill, making it difficult to craft amendments that can pass with a simple (i.e., 50-vote) majority. The amendment must be germane (i.e., relevant) to the underlying bill, and cannot increase the deficit.

Moreover, to pass with a simple majority, an amendment must also comply with the six-part “Byrd rule” test. For instance, an amendment may not have only an incidental fiscal impact, make programmatic changes to Title II of the Social Security Act, or exceed the jurisdiction of the committees who received the reconciliation instructions (in this case, the Senate Finance and Health, Education, Labor, and Pensions committees). Other than simple motions striking particular provisions, amendments will face a difficult time running the procedural gauntlet necessary to pass on a 50-vote threshold.

4. …But It’s Easy to Get Amendment Votes

Even if an amendment does not comply with the budget reconciliation rules, senators can still offer a motion to waive those rules. The motion to waive requires the approval of three-fifths of senators sworn (i.e., 60 votes), which often does not materialize, but the motion to waive provides a way to get senators on the record on a specific issue. Many votes in a “vote-a-rama” series consist of a “motion to waive all applicable budgetary discipline”—i.e., the “Byrd rule” and other restrictions that make passing an amendment with a simple majority difficult.

5. It Will Result in Messaging Amendments

Perhaps the classic example comes from the Obamacare “vote-a-rama” in March 2010, when then-Sen. Tom Coburn (R-OK) offered an amendment that included the following language:

(b) Prohibiting Coverage of Certain Prescription Drugs—

(1) In general.–Health programs administered by the Federal Government and American Health Benefit Exchanges (as described in section 1311 of the Patient Protection and Affordable Care Act) shall not provide coverage or reimbursement for—

(A) prescription drugs to treat erectile dysfunction for individuals convicted of child molestation, rape, or other forms of sexual assault;

The “No Viagra for Sex Offenders” amendment drew no small amount of attention at the time, and led to political ads being run against the Democrats who voted against it (as some predicted prior to the amendment vote).

Democrats will almost certainly offer similar messaging amendments this year, including amendments unrelated to the bill, or even health care. They may offer amendments regarding the Russia investigation—those would likely be subject to a 60-vote threshold, as foreign policy is not germane to a budget reconciliation bill, but if Democrats wish to get Republicans on record, any vote will do.

Doubtless Democrats will offer amendments related to Donald Trump’s taxes—the reconciliation bill is in the jurisdiction of the Finance Committee, so these amendments could theoretically prove germane, but amendments specifically targeting the president (i.e., making policy, with only an incidental fiscal impact) could violate the “Byrd rule,” making them subject to a 60-vote threshold. For Democratic political consultants, the possibilities are virtually endless.

6. It May Lead to Chicanery—and ‘Strategery’

Senate Republican Leader Mitch McConnell (R-KY) has generally opposed allowing reimportation of prescription drugs from Canada or other countries, with one noteworthy exception. In December 2009, McConnell, along with several other Republicans, supported one of two reimportation amendments offered on the Senate floor.

While opposing reimportation on the merits, some Republicans supported these particular amendments because they wanted to break up the “rock-solid deal” between Democrats and Big Pharma—whereby pharma agreed to support Obamacare in exchange for a promise from Democrats not to support reimportation of prescription drugs.

As it happened, Democrats spent an entire week—from December 8 through December 15, 2009—without floor votes on amendments to Obamacare. The delay—effectively, Democrats filibustering their own bill—came in part because party leaders could not persuade fellow Democrats to vote against the reimportation amendment—and could not afford to allow the amendment to pass.

One can expect similar gamesmanship by the Democratic minority this time around, as evidenced by their tactical decision to abstain from voting on Tuesday’s motion to proceed to the bill until Republican senators mustered a majority solely from within their own ranks. If only three Republicans defect on an amendment, Democrats could have the power to play a decisive role in that amendment’s outcome. It’s an open question how they will do so.

For instance, will some or all of the 12 Democrats who voted against reimportation earlier this year—during January’s “vote-a-rama,” when the Senate passed the budget enabling the current reconciliation process—switch their votes so the amendment will pass, causing Republicans heartburn with the pharmaceutical lobby? When and how will Democrats use other tactical voting to gum up the process for Republicans? The answers range from possible to likely, but it remains to be seen exactly how the process will play out.

7. It Will Inflict Political Pain

Consider for instance a flashpoint in the reconciliation bill: Whether to defund Planned Parenthood. Two Republican senators, Susan Collins and Lisa Murkowski, have already stated they oppose defunding the organization. If one more Republican defects, Democrats would likely have the votes to strip the defunding provision. (While Democratic Sen. Joe Manchin previously supported defunding Planned Parenthood two years ago, in the immediate aftermath of sting videos featuring organization leaders, he has since reversed his position, and will presumably vote with all Democrats to strip the provision.)

To put it another way: Sen. Dean Heller (R-NV) may not just have to be the 50th vote supporting the underlying bill, he may also have to provide the 50th vote to keep the Planned Parenthood defunding provision in the legislation. Will Heller vote to defund the nation’s largest abortion provider—and what will happen to the bill if he, and the Senate as a whole, votes to strip the provision out? Senate leaders will face several of these white-knuckle amendment dramas during “vote-a-rama,” any one of which could jeopardize the entire legislation.

8. It Could Unravel the Entire Bill

Ultimately, with no agreement among Republicans to preserve the underlying bill text, and no clear roadmap on how to proceed, “vote-a-rama” could resemble pulling on the proverbial thread—one good tug and the whole thing unravels. What if Heller ends up helping to strip out Planned Parenthood defunding—and conservatives respond by blocking more funding for Medicaid expansion states? What if moderates vote to strip the “consumer freedom” amendment offered by Sen. Ted Cruz (T-TX), and conservatives retaliate by taking out the “side deals” included to assuage moderates’ concerns?

At the end of “vote-a-rama,” senators could be left with an incoherent policy mess, legislation that no one would readily support. It’s the big potential downside of the freewheeling amendment strategy—but a chance that McConnell apparently feels he has no other choice but to take.

9. It’s Why Senate Leadership Is Talking about a Conference with the House

In recent days, Senate Majority Whip John Cornyn (R-TX) and others have floated the idea that, rather than having the House pass the Senate’s bill whole, sending it straight to the White House, members may instead want to have a House-Senate conference to resolve differences between the two chambers. Some have gone so far as to propose the Senate passing a “skinny” bill—repeal of the individual and employer mandates, along with the medical device tax—as a placeholder to get the reconciliation measure to a conference committee.

This strategy would have one beneficial outcome for the Senate’s Republican leadership: By allowing congressional leaders to re-write the bill in conference, it would save them from having to abide by the results of “vote-a-rama.” If, for instance, senators vote to strip out Planned Parenthood defunding, or to add in reimportation language, congressional leaders could re-write the bill in conference to negate the effects of those votes—presenting a new measure to both chambers with a binary choice to approve the bill or not. (In other words, rather than a “wrap-around bait-and-switch” on the Senate floor, senators could instead face a bait-and-switch in conference.)

That leadership has mooted a conference committee speaks to the nature of the “vote-a-rama” ahead. Despite the complaints on both ends of Pennsylvania Avenue about the lengthy nature of the health-care process, Senate leaders are now looking to extend the process further via a House-Senate conference—because they may need to regain control of the legislation after a wild and unpredictable debate on the Senate floor.

This post was originally published at The Federalist.

Democrats’ Medicare Chutzpah

One little-noticed element in the “fiscal cliff” debate hasn’t attracted much attention – the glaring hypocrisy of Democrats when it comes to the Medicare program.  Last Thursday, Democrats in the House offered a motion to recommit spending reduction legislation (full text available here) that would have required HHS to disclose:

1)      The number of Medicare beneficiaries in such district…who, at any time during the ten-year period beginning on the first day of the first fiscal year that begins after the date of the enactment of this Act, will A) lose coverage under the Medicare program… or B) experience an increase in premiums, cost-sharing, or other out-of-pocket costs under such respective program as a result of the implementation of this Act; and

2)      The name and location of each hospital and nursing facility that would experience a reduction in payments under the Medicare program…as a result of the implementation of this Act.

It’s more than a bit rich for the Democrat leadership to offer such a motion, given that Obamacare:

  • Takes “half a trillion dollars out of Medicare” to pay for Obamacare’s new programs, according to none other than Nancy Pelosi;
  • Raises Part D premiums, according to the Congressional Budget Office, so that Big Pharma can benefit from its “rock-solid deal” struck behind closed doors with President Obama and Congressional Democrats;
  • Cuts Medicare Advantage by more than $300 billion, which will reduce the program’s enrollment by half and plan choices by two-thirds, causing millions of seniors to lose their current health insurance; and
  • Makes up to 40 percent of providers unprofitable over the long-term, according to the non-partisan Medicare actuary, potentially forcing providers “to withdraw from providing services to Medicare beneficiaries.”

The Medicare program is in dire need of reform to make it fiscally sustainable.  But no one should take lessons on entitlement “reform” from the crowd that – by its own admission – raided the Medicare program to pay for yet more irresponsible entitlement spending.

Pharmacies Join Obamacare Propaganda Campaign

The Hill reports this afternoon that several major pharmacies “will promote [Obamacare]…to seniors,” providing brochures about all the law’s supposed new benefits.  In a conference call announcing the program, CMS Acting Administrator Marilyn Tavenner refused to give a straight answer to the question about whether the pharmacies came up with the idea for the program, or the Administration proposed it – strongly suggesting that the Obama Administration proposed this idea to pharmacies as yet another propaganda effort to win support for their unpopular law.

One unanswered question remains: Will these pharmacies also educate seniors about the law’s cuts to Medicare Advantage – which will cut enrollment in Medicare Advantage in half and reduce plan choices by two-thirds?  Or does the Administration’s call for seniors to be able to “make informed healthcare decisions” only apply to the information the Administration wants seniors to see?

It’s perhaps not surprising that pharmacies would look to advertise Big Pharma’s “rock-solid deal” struck behind closed doors with President Obama — after all, pharmacies have the same financial incentives to sell more brand-name prescriptions that Big Pharma companies do.  However, the more than 17 million seniors participating in Medicare Part D who are facing higher premiums thanks to this “rock-solid deal” may not be so happy.

Fact Checking David Axelrod on…Everything

Speaking on ABC’s This Week yesterday, Obama campaign adviser David Axelrod made a series of misleading statements about Obamacare and the House Republican budget.  Take for instance the claims made in this doozy of a paragraph:

AXELROD:  Well, first of all, they want to turn — let’s talk about the $700 billion.  Congressman Ryan, what he doesn’t say is that he’s incorporated that same $700 billion into his plan, so he’s embraced exactly what the president’s done.  The difference is the president is trying to strengthen the Medicare program.  Under the changes that the president made, seniors are getting more prescription coverage and preventive care. We extended the life of Medicare by eight years, according to the Congressional Budget Office.  The Ryan-Romney plan would not do that.  And in fact, by turning it into a voucher program, throwing seniors onto the tender mercies of the private insurance market and capping growth the way they do, ultimately they are going to shift thousands of dollars onto the backs of seniors, and Medicare itself will be in a death spiral because it will — it will be dissipated by seniors who — healthy seniors going into the private system, leaving sick seniors in the existing Medicare program.

Where to begin?  Well, let’s analyze the claims one by one:

“Congressman Ryan, what he doesn’t say is that he’s incorporated that same $700 billion into his plan, so he’s embraced exactly what the president’s done.”  This is FALSE.  While Democrats took savings from Medicare to pay for their costly new Obamacare entitlement, the House Republican budget would use that money to save Medicare first.  And you don’t even need to take my word for it.  Because in November, Nancy Pelosi admitted that Democrats “took a half a trillion dollars out of Medicare in [Obamacare], the health care bill” to pay for more federal spending.  (One related point worth thinking about: If Congressman Ryan actually HAD embraced the President’s proposal, why would Axelrod criticize him…?)

“The difference is that the President is trying to strengthen the Medicare program.”  There’s one problem with this allegation: Medicare actuary Foster has written that the Medicare provisions in the law “cannot be simultaneously used to finance other Federal outlays (such as the coverage expansions under the PPACA) and to extend the [Medicare] trust fund, despite the appearance of this result from the respective accounting conventions.”  Even President Obama himself admitted this irrefutable logic in a 2010 interview, when he stated that “You can’t say that you are saving on Medicare and then spending the money twice.”

“Seniors are getting more prescription coverage…”  That’s an interesting claim to make, because more than 17 million seniors participating in Medicare Part D are facing higher premiums so that Big Pharma can benefit from its “rock-solid deal” struck behind closed doors with President Obama and Congressional Democrats.  Of course, it’s unsurprising for David Axelrod to make this claim, because he received a multimillion dollar severance package indirectly paid for by the pharmaceutical industry, thanks to Big Pharma’s backroom Obamacare deal with the White House.

“We extended the life of Medicare by eight years, according to the Congressional Budget Office.”  That’s not what the Congressional Budget Office said.  The non-partisan CBO said that the Medicare reductions in Obamacare “will not enhance the ability of the government to pay for future Medicare benefits” — because those savings will be used to fund other unsustainable entitlements.  If the President wants to use the Medicare savings provisions to extend the life of the Medicare trust fund — and not to fund the new entitlements created by the law — the Congressional Budget Office previously estimated what the fiscal impact would be:  “A net increase in federal deficits of $260 billion” through 2019.

“Capping the growth the way they [i.e., Republicans] do…”  This is another interesting statement for Axelrod to make, because it was Obamacare that capped Medicare’s growth rate for the first time ever.  What’s more, the House Republican budget caps the growth of Medicare spending at exactly the same growth rate as Obamacare.  The difference is that Obamacare delegates the power to cut Medicare spending to a board of 15 unelected bureaucrats, whereas conservatives would empower patients to make their own choices — reducing costs through competition, NOT government fiat.

“[Under premium support,] Medicare itself will be in a death spiral…”  I’ll let Cokie Roberts — scion of two prominent Democrats — answer this one.  Later in the ABC This Week program, here’s what she said about Axelrod’s claims that Obamacare would strengthen the Medicare program, while premium support proposals would undermine it:

It’s also intellectually dishonest, because the truth is, as you know, they say they’re taking it away from providers.  And every year, Congress votes to do what’s called the doc fix, to give the providers back the money that has been cut.  So, you know, that $700 billion, I won’t look for it to be gone anytime soon.

And because Obamacare takes those Medicare savings out of Medicare to pay for new spending, any attempt to reverse some or all of the $700 billion in reductions would increase the federal deficit.  It’s a perfect example of why Obamacare is so harmful both to seniors and the federal budget.  And no amount of misleading statements by the Obama campaign can disguise that fact.

The ‘Rock Solid Deal’ the American People Reject

The House Energy and Commerce Committee released its latest report into the backroom dealings behind Obamacare on Friday. This report, as well as a memo released the previous week, and the supplemental documents related to each report, provide for an interesting read, on multiple levels.

It is of course interesting to learn precisely how candidate Obama went from criticizing Big Pharma’s CEO for exerting improper influence in a 2008 campaign ad to cutting a “rock-solid deal with the very same executive he had earlier criticized. It’s just as ironic to find a President who pledged to televise all health care negotiations on C-SPAN cutting legislative deals behind closed doors. And perhaps the piece de resistance is the way the Administration endorsed the creation of secret advocacy groups designed to run pro-Obamacare ads — the same kind of “shadow groups that President Obama has repeatedly criticized as being insufficiently transparent.

But over and above the irony — and hypocrisy — readily apparent in these documents lies a simpler yet more profound truth: Practically every health care group in Washington SUPPORTED Obamacare, and moved heaven and earth to build public support for the law, yet the American people OPPOSED it — and still oppose it to this day. The documents reveal just how desperate special interests were to enact the massive 2,700-page law:

  • Big Pharma spent $69.7 million on advertising supporting the law through various coalitions — and that’s just one trade association.
  • The CEO of AARP personally called Senator Ben Nelson to solicit his support for the measure — after multiple requests from the White House.
  • The heads of the major hospital associations let White House officials edit their press releases about their own “deals” with the Administration.

A separate study from Bloomberg Government released late last week demonstrated just why all these special interests were so keen on passing Obamacare. The study found that a Supreme Court decision striking down the law could cost pharmaceutical companies, hospitals, and other health care interests as much as $740 billion in revenue over the next ten years. Hospitals alone could lose $430 billion. Coming on the heels of last month’s study indicating insurers benefit from Obamacare to the tune of $1 trillion, the Bloomberg report illustrates perfectly why all the health care special interests were desperate to pass the law — as the Energy and Commerce documents reveal.

As might be expected, the documents also include some comedic moments. Given that experts have concluded that Obamacare will make 40 percent of hospitals unprofitable, the frantic struggle among hospital association executives to get Democrat members to vote for the bill may be (to paraphrase an historic expression) the first time in recorded history that turkeys desperately lobbied Congress to vote for Thanksgiving. In a moment of candor, one Pharma executive — a Democrat and former Clinton Administration official — after telling his colleague the bill “raises taxes, raises [insurance] premiums and cuts Medicare,” admitted that “I’ve seen them [i.e., Pharma's campaign ads about Obamacare]. But I don’t believe them.”

He’s not the only one who didn’t believe the ads.  The American people didn’t believe the hype about Obamacare then, and they don’t believe it now.  And no amount of special interest lobbying, or “rock-solid deals,” can change that fact.

C-SPAN Much? Obamacare Still Lacking Transparency

Yesterday afternoon the Administration released new guidance regarding a federal fallback Exchange for those states who decide not to create a state-based Exchange under Obamacare. The 19-page guidance follows on the heels of other “bulletins” issued this year regarding actuarial value and essential health benefits; yesterday’s document also admits that additional guidance documents will follow.

Politico this morning hints at why the Administration is releasing all these “guidance”and “bulletin” documents rather than going through the official notice-and-comment rulemaking process: “The Department hasn’t yet crunched the numbers on how much [a federal Exchange] would cost….Those details won’t be hashed out until the fall.” In other words, the Administration doesn’t want to reveal the full costs of Obamacare — both the federal spending required and the impact of its many new regulations — until after the presidential election. Does anyone want to guess whether these official rules and cost-estimates get released BEFORE or AFTER November 6 — to pick a date completely at random?

On a related note, the House Energy and Commerce Committee released a memo into other forms of non-transparency by the Administration — this time regarding the “rock-solid deal” between Democrats and Big Pharma. The memo relies on internal documents to confirm that such a deal took place — and the White House was a direct party to it. It quotes an e-mail from Jim Messina, Deputy White House Chief of Staff, to Pharma lobbyists saying “This wasn’t part of our deal.”

The irony of Messina’s statement is that the American people are saying the same thing — these backroom horse-trades and political shenanigans weren’t part of Barack Obama’s “deal” with voters. He repeatedly promised that he would hold all the negotiations on C-SPAN, “so that people can see who is making arguments on behalf of their constituents, and who are making arguments on behalf of the drug companies or the insurance companies.” Yet the Obama Administration made an explicit deal with Big Pharma behind closed doors, and is still attempting to hide the details of both its Pharma “deal” and the true costs of Obamacare’s regulations to the American people. That may be a change in position from four years ago — and a big one at that — but it’s not one the American people can believe in.

208 Things in Obamacare That Democrats Support

Last week, former HELP Committee staffer John McDonough wrote a list of “50 provisions I ask the media to ask Romney et al. if they are committed to repealing as President.”  McDonough noted that “there are [Obamacare] provisions opponents could pick out to create an alternative list for elimination.”

We know a challenge when we hear one; our list is submitted below, with sections from the statute duly noted.  Remember when reading this list:  We KNOW that President Obama and Democrats all support these provisions in Obamacare – because they all voted to enact them into law.  So members of the media can readily ask President Obama and Democrat Members of Congress why they supported a law that…

  1. Imposes $800 billion in tax increases, including no fewer than 12 separate provisions breaking candidate Obama’s “firm pledge” during his campaign that he would not raise “any of your taxes” (Sections 9001-9016)?
  2. Forces Americans to purchase a product for the first time ever (Section 1501)?
  3. Creates a board of 15 unelected and unaccountable bureaucrats to make binding rulings on how to reduce Medicare spending (Section 3403)?
  4. Pays over $800 billion in subsidies straight to health insurance companies (Sections 1401, 1402, and 1412)?
  5. Requires all individuals to buy government-approved health insurance plans, imposing new mandates that will raise individual insurance premiums by an average of $2,100 per family (Section 1302)?
  6. Forces seniors to lose their current health care, by enacting Medicare Advantage cuts that by 2017 will cut enrollment in half, and cut plan choices by two-thirds (Section 3201)?
  7. Imposes a 40 percent tax on health benefits, a direct contradiction of Barack Obama’s campaign promises (Section 9001)?
  8. Relies upon government bureaucrats to “issue guidance on best practices of plain language writing” (Section 1311(e)(3)(B))?
  9. Provides special benefits to residents of Libby, Montana – home of Max Baucus, the powerful Chairman of the Senate Finance Committee, who helped write the law even though he says he hasn’t read it (Section 10323)?
  10. Imposes what a Democrat Governor called the “mother of all unfunded mandates” – new, Washington-dictated requirements of at least $118 billion – at a time when states already face budget deficits totaling a collective $175 billion (Section 2001)?
  11. Imposes reductions in Medicare spending that, according to the program’s non-partisan actuary, would cause 40 percent of all Medicare providers to become unprofitable, and could lead to their exit from the program (Section 3401)?
  12. Raises premiums on more than 17 million seniors participating in Medicare Part D, so that Big Pharma can benefit from its “rock-solid deal” struck behind closed doors with President Obama and Congressional Democrats (Section 3301)?
  13. Creates an institute to undertake research that, according to one draft Committee report prepared by Democrats, could mean that “more expensive [treatments] will no longer be prescribed” (Section 6301)?
  14. Creates a multi-billion dollar “slush fund” doled out solely by federal bureaucrats, which has already been used to fund things like bike paths (Section 4002)?
  15. Subjects states to myriad new lawsuits, by forcing them to assume legal liability for delivering services to Medicaid patients for the first time in that program’s history (Section 2304)?
  16. Permits taxpayer dollars to flow to health plans that fund abortion, in a sharp deviation from prior practice under Democrat and Republican Administrations (Section 1303)?
  17. Empowers bureaucrats on a board that has ruled against mammograms and against prostate cancer screenings to make binding determinations about what types of preventive services should be covered (Sections 2713 and 4104)?
  18. Precludes poor individuals from having a choice of health care plans by automatically dumping them in the Medicaid program (Section 1413(a))?
  19. Creates a new entitlement program that one Democrat called “a Ponzi scheme of the first order, the kind of thing that Bernie Madoff would have been proud of” – a scheme so unsustainable even the Administration was forced to admit it would not work (Section 8002)?
  20. Provides $5 billion in taxpayer dollars to a fund that has largely served to bail out unions and other organizations who made unsustainable health care promises to retirees that they cannot afford (Section 1102)?
  21. Creates a tax credit so convoluted it requires seven different worksheets to determine eligibility (Section 1421)?
  22. Imposes multiple penalties on those who marry, by reducing subsidies (and increasing taxes) for married couples when compared to two individuals cohabiting together (Sections 1401-02)?
  23. Extends the Medicare “payroll tax” to unearned income for the first time ever, including new taxes on the sale of some homes (Section 1402)?
  24. Impedes state flexibility by requiring Medicaid programs to offer a specific package of benefits, including benefits like family planning services (Sections 2001(a)(2), 2001(c), 1302(b), and 2303(c))?
  25. Requires individuals to go to the doctor and get a prescription in order to spend their own Flexible Spending Account money on over-the-counter medicines (Section 9003)?
  26. Expands the definition of “low-income” to make 63 percent of non-elderly Americans eligible for “low-income” subsidized insurance (Section 1401)?
  27. Imposes a new tax on the makers of goods like pacemakers and hearing aids (Section 9009)?
  28. Creates an insurance reimbursement scheme that could result in the federal government obtaining Americans’ medical records (Section 1343)?
  29. Permits states to make individuals presumptively eligible for Medicaid for unlimited 60-day periods, thus allowing any individual to receive taxpayer-funded assistance ad infinitum (Section 2303(b))?
  30. Allows individuals to purchase insurance on government exchanges – and to receive taxpayer-funded insurance subsidies – WITHOUT verifying their identity as American citizens (Section 1411)?
  31. Gives $300 million in higher Medicaid reimbursements to one state as part of the infamous “Louisiana Purchase” – described by ABC News as “what…it take[s] to get a wavering senator to vote for health care reform” (Section 2006)?
  32. Raises taxes on firms who cannot afford to buy coverage for their workers (Section 1513)?
  33. Forces younger Americans to pay double-digit premium increases so that older workers can pay slightly less (Section 1201)?
  34. Prohibits states from modifying their Medicaid programs to include things like modest anti-fraud protections (Section 2001)?
  35. Includes a special provision increasing federal payments just for Tennessee (Section 1203(b))?
  36. Allows individuals to purchase health insurance across state lines – but only if politicians and bureaucrats agree to allow citizens this privilege (Section 1333)?
  37. Allows the HHS Secretary and federal bureaucrats to grant waivers exempting people from Obamacare’s onerous mandates, over half of which have gone to members of union plans (Section 1001)?
  38. Creates a pseudo-government-run plan overseen by the federal government (Section 1334)?
  39. Removes a demonstration project designed to force government-run Medicare to compete on a level playing field with private plans (Section 1102(f))?
  40. Gives the Secretary of HHS an UNLIMITED amount of federal funds to spend funding state insurance Exchanges (Section 1311(a))?
  41. Creates a grant program that could be used by liberal groups like ACORN or AARP to conduct “public education activities” surrounding Obamacare (Section 1311(i))?
  42. Applies new federal mandates to pre-Obamacare insurance policies, thus proving that you CAN’T keep the insurance plan you had – and liked – before the law passed (Sections 2301 and 10103)?
  43. Prohibits individuals harmed by federal bureaucrats from challenging those decisions, either in court or through regulatory processes (Sections 3001, 3003, 3007, 3008, 3021, 3022, 3025, 3133, 3403, 5501, 6001, AND 6401)?
  44. Earmarks $100 million for “construction of a health care facility,” a “sweetheart deal” inserted by a Democrat Senator trying to win re-election (Section 10502)?
  45. Puts yet another Medicaid unfunded mandate on states, by raising payments to primary care physicians, but only for two years, forcing states to come up with another method of funding this unsustainable promise when federal funding expires (Section 1202)?
  46. Imposes price controls that have had the effect of costing jobs in the short time since they were first implemented (Section 1001)?
  47. Prohibits individuals from spending federal insurance subsidies outside government-approved Exchanges (Section 1401(a))?
  48. Provides a special increase in federal hospital payments just for Hawaii (Section 10201(e)(1))?
  49. Imposes new reporting requirements that will cost businesses millions of dollars, and affect thousands of restaurants and other establishments across the country (Section 4205)?

And instead of including a 50th item on our list, we’re going to include 159 separate items.  These are the 159 new boards, bureaucracies, and programs created by Obamacare.  You can find the list here.

No matter which way you look at it, this list provides 208 easy reasons why the American people still continue to reject Democrats’ unpopular 2700-page health care law.

Administration (Still) Peddling a Raw Deal for Seniors

USA Today reports this morning that the Administration will attempt to trot out more data today regarding the Part D discount program as a way to show seniors are benefiting from Obamacare.  But, as the Associated Press has previously noted, this story comes with a major catch:  Only a fraction – about 1 in 20 – of the 47 million Medicare beneficiaries have benefited from the new discount program.  That means a very small percentage of program participants actually are receiving benefits from Obamacare.

Remember:  All seniors will be pay higher Part D premiums so that only some beneficiaries can receive richer coverage.  The Congressional Budget Office estimated that “the law would lead to an average increase in premiums for Part D beneficiaries of about 4 percent in 2011, rising to about 9 percent in 2019.”  That means that 17 million seniors will higher premiums, but only about 400,000 beneficiaries passing through the doughnut hole will actually receive the full benefit of the discount regime established in the law. (Many of the beneficiaries in the “doughnut hole” are low-income seniors, and the Medicare program already covered their additional costs in the coverage gap prior to Obamacare.)  Some would categorize this redistributive scenario as “spreading the wealth around.”

This drug discount program is clearly a big benefit to special interests, as Big Pharma is virtually guaranteed to increase sales thanks to its “rock-solid deal” struck behind closed doors.  But in reality, Obamacare will provide only modest benefits to a select few seniors, while raising costs for everyone else – and that’s not “reform.”

Obamacare Not a “Rock-Solid Deal” for Seniors

The Associated Press ran a story yesterday on the Medicare “doughnut hole” changes included in Obamacare, which provides some anecdotal examples of potential savings.  But the most important numbers quoted in the article are these:  Only about two million Americans out of 47 million Medicare beneficiaries have benefited from the new discount program.  That means a very small percentage of program participants actually are receiving benefits from Obamacare.

Second, the true savings for beneficiaries in the doughnut hole may in reality be less than they appear; if the richer benefits in the coverage gap just prompt seniors to continue buying more expensive brand-name drugs rather than using less costly generics, they won’t really have “saved” much.  (It also would increase health costs, not lower them.)

Last but not least, all seniors will be paying higher Part D premiums in order for a select group of beneficiaries to receive richer coverage.  The Congressional Budget Office estimated that “the law would lead to an average increase in premiums for Part D beneficiaries of about 4 percent in 2011, rising to about 9 percent in 2019.”  That means that 17 million seniors are paying higher premiums, but only about 400,000 beneficiaries passing through the doughnut hole will actually receive the full benefit of the discount regime established in the law. (Many of the beneficiaries in the “doughnut hole” are low-income seniors, and the Medicare program already covered their additional costs in the coverage gap prior to Obamacare.)  Some would categorize this redistributive scenario as “spreading the wealth around.”

Of course, Big Pharma is virtually guaranteed to benefit from its “rock-solid deal” struck behind closed doors with President Obama and Congressional Democrats.  But will seniors actually benefit from this portion of Obamacare?  The evidence is clear that most beneficiaries won’t.

Obamacare and Transparency

This morning the Administration released proposed new regulations regarding information disclosure to consumers, so that individuals considering insurance policies will have information to make apples-to-apples comparisons.  Transparency of information is generally a good thing, and providing consumers with clear information on which to make choices may have a positive effect (provided compliance won’t significantly raise costs for businesses).

But questions about Obamacare’s “consumer-friendly” nature still persist.  If Democrats want to allow consumers to make choices, then why reduce choice by allowing Exchanges to carry only “Washington-approved” insurance policies?  Why not permit individuals to buy any policy they wished across state lines, rather than just allowing individuals to purchase those that meet federal mandates (and then only if the state permits it)?  And from a broader perspective, how consumer friendly can 2,700 pages of law, more than 9,000 pages (and counting!) of regulations and notices, and 159 new boards, commissions, and programs be?

And don’t forget what the ultimate impact of all this “consumer choice” propounded by federal mandates will be.  HHS’ proposed template for insurance coverage under Obamacare runs to six pages – but I can summarize it in five simple words: “Your. Premiums. Will. Go. Up.”  There, that wasn’t too hard, was it?

On a related note, Politico reports about a federal judge’s ruling allowing a lawsuit against the Administration to go ahead.  The complaint alleges that the White House’s backroom deals with its health reform “Gang of Six” – including industry groups like Pharma and liberal groups like AARP and SEIU – violated federal open meetings laws.  This of course raises an obvious question for Secretary Sebelius and others:  If it cares so much about openness and disclosure for consumers, then why doesn’t the “most transparent” Administration reveal all its backroom dealings with industry groups to get Obamacare passed in the first place?