Tag Archives: George W. Bush

What’s Congress Doing with SCHIP?

Amidst the wrangling over Obamacare, reauthorization of the State Children’s Health Insurance Program (SCHIP) expired on September 30, the end of the federal government’s fiscal year. The two committees of jurisdiction—energy and commerce in the House, and finance in the Senate—each marked up their reauthorization bills last week. But House Energy and Commerce Committee Chairman Greg Walden (R-OR) said Monday the bill would not come to the House floor this week.

What’s the holdup? Why the delays in bringing to the floor for votes a bill whose authorization has already expired?

Even though Republicans proposed a generous—some conservatives might argue too generous—reauthorization of SCHIP, House Democrats object because they don’t want millionaires and billionaires to pay for the new spending on children’s health insurance, and Senate Democrats object because they want to attach tens of billions of dollars in taxpayer subsidies to insurance companies.

I swear to you: I’m not making this up.

A Mixed House Package

The SCHIP reauthorization text varies little between the House and the Senate versions. On that front, conservatives may have qualms with supporting little more than a straight extension of the status quo. The bill extends—albeit for only one year, as part of a more gradual phase-out—enhanced funding to state SCHIP programs. The full 23 percent match increase would end in 2019, as under current law, while states would receive an additional 11.5 percent increase in 2020. Some states have received a 100 percent federal match for their child enrollees due to this Obamacare provision, which is a clear disincentive for states to fight fraud and improper spending.

Moreover, the bill extends Obamacare’s maintenance of effort requirement—limiting states from making changes to their programs—by an additional three years in most cases, from 2019 to 2022. The bill also does not include reforms the House proposed two years ago, which would require states to focus on covering poor children first—the program’s prime emphasis before the 2009 reauthorization signed by President Obama envisioned states expanding their programs to more affluent families.

On the positive side, however, the House did include good reforms to help pay for the new SCHIP spending. It includes several provisions designed to promote program integrity in Medicaid, including one that would effectively ensure that lottery winners, or others who receive large lump-sum payments, do not maintain coverage for this low-income program. The House bill would also increase Medicare means-testing for affluent families, reducing taxpayer subsidies for Part B (outpatient care) and Part D (prescription drug) coverage for individuals making over $160,000, and eliminating the subsidies entirely for individuals making more than $500,000.

Those pay-fors drew Democrats’ ire, and prompted the postponement of consideration on the House floor this week. To put it more bluntly: Democrats are holding children’s health hostage because they object to charging millionaires and billionaires more for Medicare. Should anyone remind them that Obamacare itself also increased Medicare means-testing for wealthy beneficiaries to pay for Obamacare?

In the Senate, a Stalemate

Meanwhile, over in the Senate—which has yet to decide how to pay for the new SCHIP spending—Minority Leader Chuck Schumer (D-NY) demanded last week that the Republican majority “immediately bring this bill to the Senate floor for a vote and include much-needed bipartisan provisions to stabilize the markets, lower premiums for 2018,” and extend other programs.

Schumer made those demands despite two inconvenient truths: Senate Health, Education, Labor, and Pensions Committee Chairman Lamar Alexander (R-TN) and Ranking Member Patty Murray (D-WA) haven’t yet reached agreement on a bipartisan “stabilization” bill—and most states finalized their 2018 insurance premiums on September 27, weeks ago. In other words, Schumer wants to enact an agreement that doesn’t exist to achieve premium reductions that can’t happen.

A cynic might surmise that, with his talk of “stabilization” measures, Schumer wants to use SCHIP to sneak through tens of billions of dollars in cost-sharing reduction payments to insurers—a provision that might prove unpopular, and controversial, as a stand-alone measure, but could pass through relatively unnoticed as part of a larger, “Christmas tree”-sized bill.

For conservatives, the current mixed policy outcomes on SCHIP could deteriorate significantly. Weakening the House’s “pay-fors”—which seems bound to happen, given Walden’s further attempts to negotiate with Democrats—could eliminate some, if not most, of the reasons conservatives could see to vote for the measure.

While the policy outcomes seem uncertain, and could range from fair to poor, the political ramifications seem clear. In 2007 and 2008, when President George W. Bush vetoed SCHIP bills due to provisions that would have diverted the program from the low-income children for which it was designed, Democrats organized protests, and ran ads against him. This year, when Democrats are holding up an arguably too-generous SCHIP bill literally because they want to defend the wealthy and insurance companies, Republicans have responded by…negotiating with them.

If one wants reasons behind conservative discontent with Washington, look no further than this bill.

This post was originally published at The Federalist.

Obamacare Really Does Disadvantage Americans with Disabilities

My article last week regarding disability groups’ political and policy views prompted some comments and criticisms on Twitter. Rather than trying to explain detailed subjects in bursts of 140-character tweets, I considered it best to compile them into a longer-form article.

To summarize my prior work: Obamacare provides states with a greater incentive to expand Medicaid to able-bodied adults than to cover services for individuals with disabilities. States receive a 95 percent match this year (declining to 90 percent in 2020 and all future years) to cover the able-bodied, but a match ranging from 50-75 percent to cover individuals with disabilities, while more than half a million are on waiting lists to receive home or attendant care.

My article raised this disparity—essentially discrimination against individuals with disabilities—pointing out that the major disability advocacy consortium failed to object to it when Obamacare passed, and questioned why the groups were so silent on this issue then, but so vocal in their opposition to Republican legislative proposals to slow the growth of Medicaid spending now.

Many of the responses I discuss in greater detail below attempt to obscure two separate and distinct issues: The question of the amount of funding for programs versus the priorities within those programs.

As a conservative, I’m likely to disagree with liberals on the ideal size of many government programs, but I thought I would at least agree with them that individuals with disabilities should receive precedence within those programs. However, Obamacare actually tilted Medicaid’s preference away from individuals with disabilities, which makes disability groups’ silence on that front surprising.

There Is No Correlation Between Waiting Lists and Medicaid Expansion

The timeliest rebuttal comes from a story on a long-term care report none other than AARP released yesterday. Susan Reinhard with that organization—no right-wing conservative group, by any stretch—said that

Many states have struggled to expand home- and community-based options for Medicaid enrollees needing long-term care because that is an optional benefit. Nursing homes are mandatory under federal law. While states focus on Medicaid coverage for children and families — as well as non-disabled adults covered by the Medicaid expansion under the Affordable Care Act — adults with disabilities have received less attention. ‘Long-term care is a stepchild of the program and not a top focus for states,’ she said. (emphasis mine.)

That statement notwithstanding, several people cited two different analyses that compare states’ decisions on expansion to the able-bodied and their waiting lists for home-based care for individuals with disabilities. But each of those “studies” (based on only one year of data available) take an overly simplistic approach, and therefore don’t get at the core issue of the extent to which the skewed incentives Obamacare created have encouraged states to prioritize the able-bodied over those with disabilities.

A state’s decision to expand Medicaid to the able-bodied, or reduce its waiting lists for individuals with disabilities, depends on myriad factors. For instance:

  • A wealthy state with a greater tax base would have more resources both to expand Medicaid to the able-bodied and to reduce its waiting list of individuals with disabilities, while a poorer state with a smaller tax base might not have resources to do either;
  • A state with “bad” demographics (e.g., an older and sicker population), or higher costs for health and personal care services, might have more difficulty reducing their Medicaid waiting lists;
  • A state may face other fiscal pressures—controversy over school funding, a natural disaster, a pension crisis—that could affect overall Medicaid spending.

Numerous variables affect states’ budget choices, and therefore their Medicaid waiting lists. The “studies” controlled for exactly none of them. They examined whether a state expanded Medicaid and the total number of people on a state’s waiting list, and that’s it.

It’s not entirely surprising that wealthy states like California (2015 median income: $64,500) could both reduce disability waiting lists and expand Medicaid to the able-bodied, while poorer states like Alabama (2015 median income: $44,765) could afford neither, seeing their waiting lists grow while not expanding Medicaid. In general, non-expansion states are poorer than expansion states; the latter therefore have more resources to spend on Medicaid.

Moreover, under Obamacare, all states receive the same (higher) federal match to cover able-bodied adults—another change in policy (prior to Obamacare, all Medicaid match rates were based on states’ relative income) skewing the balance in favor of wealthier expansion states. Yet, as noted above, the analyses claiming no correlation between expansion and Medicaid waiting lists didn’t even attempt to control for these variables—or any other.

Therefore, in the absence of a quality study examining the issue, I’ll go with something far simpler: Common sense. If you’re a state that wants to spend more money on Medicaid, and you can do something (i.e., cover the able-bodied) that gives you 95 cents on the dollar, or something (i.e., reduce waiting lists for individuals with disabilities) that gives you 50 cents on the dollar, which are you going to do first?

I thought so. The incentives in Obamacare strongly favor coverage of the able-bodied over coverage for individuals with disabilities. And no number of crude analyses attempting to provide retroactive justification for this bad policy can hide that fact.

Waiting Lists Are Worst In Two Non-Expansion States

This comment reinforces the crudeness of the analysis being cited. All else being equal, as the second- and third-largest states in the Union, Texas and Florida would be expected to have a larger number of people on its waiting lists for home- and community-based services than a smaller expansion state like Connecticut. All else isn’t equal, of course, but did the analysts attempt to control for these kinds of factors? Nope. They examined raw waiting list numbers, rather than waiting lists as a percentage of the population.

But just suppose for a second that the commenters above are correct, and there is no correlation between expansion to the able-bodied and waiting lists for home-based care. That means that the greater incentives Obamacare gives to states to cover the able-bodied—and while the advocacy community might not want to admit it, Obamacare clearly does give states greater incentives to cover the able-bodied—didn’t affect state behavior, or decisions about whether to reduce disability waiting lists at all.

In that case, why has the disability community expressed such outrage about the impact of per capita caps or block grants on Medicaid beneficiaries with disabilities? If states make decisions without considering federal incentives—the point of the claims that there is no correlation between expanding Medicaid to the able-bodied and longer waiting lists for individuals with disabilities—then why also claim that “cost-shifting to states will force massive cuts in Medicaid services?” Why wouldn’t states shift around resources to protect individuals with disabilities—what the disability community claims that states did to reduce waiting lists even while expanding Medicaid under Obamacare?

There are really only two credible possibilities:

  • States are affected by incentives, therefore Obamacare—by giving states a higher match to cover the able-bodied—encouraged discrimination against individuals with disabilities; or
  • States are not affected by incentives, and therefore the per capita caps—which generate a comparatively small amount of savings in the House repeal bill—will have little impact, because states will re-prioritize their budgets to protect the most vulnerable.

It’s therefore worth asking why some appear to be trying to argue both sides of this question, and doing so in a way that neatly lines up with partisan lines—trying to ignore Obamacare’s skewed incentives, while roundly castigating the House Republican bill for incentives that will “force massive cuts in Medicaid.”

Republicans’ Bill Would Cut Program Helping People Live at Home

This is a true statement: Section 111(2) of the American Health Care Act, House Republicans’ “repeal-and-replace” bill, would sunset the enhanced match for the Community First Choice program on January 1, 2020. That option provides states with a 6 percent increase in their federal match for home- and community-based services, including to individuals with disabilities. But here again, raising this issue demonstrates the inherent disconnect between the incentives being offered to states, and the disability community’s responses to those incentives.

  • Obamacare provides states with a match ranging from 20-45 percentage points higher to cover the able-bodied than individuals with disabilities: “No correlation between expansion and waiting lists for individuals with disabilities!”
  • Obamacare provides states with a 6 percentage point increase for home-based services: A “huge change to improve HCBS [home and community-based services] care.”
  • The Republican alternative to Obamacare would reduce Medicaid spending for traditional (i.e., non-expansion) populations by a comparatively small amount: “Massive cuts to Medicaid services.”

Isn’t there a slight contradiction in these responses—both in their tone and in their logic? And isn’t it worth noting that these contradictions all happen to align perfectly with the natural partisan response to each of these issues?

This Is A Political Problem, Not a Policy Problem

Claiming that the greater federal match to cover able-bodied adults than individuals with disabilities stems from a “political history problem” deliberately obscures its roots. This “history” did not take place half a century ago, at Medicaid’s creation, it took place in the past few years, as part of Obamacare.

When crafting that legislation, Democrats could have come up with other policy solutions that expanded Medicaid to the able-bodied without discriminating against individuals with disabilities in the process. They could have proposed increasing the federal match for coverage of individuals with disabilities, in exchange for states covering the able-bodied at the existing federal match rates. Congress enacted a similar type of “swap” in the Medicare Modernization Act. The federal government took over the prescription drug cost of Medicare-Medicaid “dual eligibles” in exchange for a series of “clawback” payments from states.

Democrats in Congress could have considered other ways to expand Medicaid without giving states a greater match to cover the able-bodied than individuals with disabilities. To the best of my knowledge, they chose not to do so. President Obama could have insisted on a more equitable Medicaid formula, but he chose not to do so. And the disability community could have pointed out this disparity to the president and leaders in Congress, but chose not to do so.

Agree or disagree with them, these were deliberate policy choices, not a mere historical accident.

How Can You Support Lower Funding While Complaining About Access?

The argument about lower funding levels misses several points. First, while the Congressional Budget Office has not released estimates of how much the per capita caps (as opposed to changes associated with scaling back Obamacare’s Medicaid expansion) will reduce federal spending, multiple estimates suggest a comparatively small amount of savings from this particular change—at most 1 or 2 percent of spending on traditional Medicaid populations over the coming decade.

Second, if given sufficient flexibility from Washington, states can reduce their Medicaid spending, rendering the discussion of “cuts” under the caps moot. Rhode Island’s Global Compact Waiver, approved in January 2009, actually resulted in a year-on-year decline of Medicaid spending per beneficiary. Moreover, the non-partisan Lewin Group concluded that Rhode Island’s waiver reduced that spending by improving beneficiary access and care, not by denying medical services.

Third, if caps on Medicaid are so harmful and damaging, then why did Obamacare cap spending on Medicare—and why did disability groups remain silent about it? Current law imposes a per capita cap on Medicare spending, one enforced by Obamacare’s Independent Payment Advisory Board (IPAB) of unelected bureaucrats.

What’s more, Obamacare imposes an annual inflation adjustment (gross domestic product growth plus 1 percent) likely to be lower than the inflation adjustment for disabled populations included in the House-passed bill (medical inflation plus 1 percent). Yet a critique of the Medicare payment caps or IPAB appears nowhere in the disability community’s 14 pages of comments regarding the bill that became Obamacare.

So the question to the disability community is obvious: Why does a Democratic proposal to impose per capita caps on Medicare raise no objections, but a Republican proposal to impose (potentially higher) per capita caps on Medicaid guaranteed to prompt “massive cuts in Medicaid services?”

Let’s Just Pay More for Everyone

This comment attempts to obscure the distinction between the amount of funding and the priorities for that funding. I might disagree with liberals about the overall level of funding for the program—not least because efforts like that in Rhode Island demonstrate the potential for Medicaid to become more efficient—but I should agree with them about the need to prioritize care for the most vulnerable. Unfortunately, Obamacare’s Medicaid expansion goes in the opposite direction.

In thinking about the important distinction between overall program funding and priorities within a program, I’m often reminded of a speech that former House Majority Leader Steny Hoyer (D-MD) gave on the House floor in September 2009: “At some point in time, my friends, we have to buck up our courage and our judgment and say, if we take care of everybody, we won’t be able to take care of those who need us most. That’s my concern. If we take care of everybody…then we will not be able to take care of those most in need in America.”

Yes, Hoyer’s speech discussed Medicare, not Medicaid, and he voted for Obamacare (and its Medicaid expansion) six months after giving it. But the speech raises an important point about the need to prioritize entitlements, one that the notion of giving higher reimbursement rates to all populations ignores.

That’s what’s wrong with focusing solely on the question on the amount of funding for a program. Reasonable people can (and will) disagree about where to draw the funding line, but it has to be drawn somewhere. “Solving” the question of funding priorities by increasing reimbursements for all populations—the equivalent of promising everyone a pony—will, by failing to choose wisely now, cause even tougher fiscal choices for generations to come.

Disability Groups Have More Important Priorities

Yes, I have. For one, in 2013, I served on the Commission on Long-Term Care Congress created in the wake of the CLASS Act’s failure and repeal. We took many hours of public testimony from disability groups and others, and received dozens of other written comments—many from dedicated and passionate parents or caregivers of individuals with disabilities, and all of which I made a point to read. I won’t claim to have made disability policy my life’s work, but my jobs over the years have intersected with the disability community on several occasions.

By claiming that disability groups have “way more priorities than comparing their FMAP [i.e., their federal match rate],” this comment actually makes my point for me. The January 2010 letter by the Consortium of Citizens with Disabilities (CCD) setting out priorities for what became Obamacare was 14 pages in length, amounted to over 5,500 words, and included (by my count) 73 separate bulleted recommendations regarding the legislation. All that, and yet not one word on the bill prioritizing coverage of the able-bodied over individuals with disabilities? Frankly, the issue seems quite conspicuous by its absence.

Just Interview Someone From This Consortium

I received a series of tweets—culminating in a dramatic “Shame on you”—attacking me for not having contacted any members of the Consortium for Citizens with Disabilities (CCD) prior to writing my piece. It is correct that I didn’t reach out to any CCD member groups before printing the article. I didn’t need to because I had already spent years working with them.

The charge that I never spoke to “ONE SINGLE CCD MEMBER” is false—and demonstrably so. For nearly four years, from the spring of 2004 until the end of 2007, I worked as a lobbyist for the National Association of Disability Representatives (NADR). During that time, I spent many hours in CCD task force meetings, interacting both directly and indirectly with CCD members. The commenter’s accusation that if I had reached out to CCD members, I would know about the lengthy adjudication process for many Social Security disability claims holds no small amount of irony—I handled those issues over a decade ago.

In reality, my time working with CCD members while representing the disability representatives prompted me to write my article last week. While attending CCD meetings, I saw firsthand how some meeting participants—several of which remain in their current positions and active in CCD activities—made offhand comments of a rather partisan nature. Not everyone joined in the political commentary, but several felt comfortable enough to make clear their partisan affiliations in open discussions, even if I and others did not.

Similarly, I recall how the disability community fought against George W. Bush’s idea for personal accounts within Social Security almost uniformly, and even before Congress and the administration had an opportunity to fully develop their proposals. At the time, my client, the National Association of Disability Representatives, took an agnostic view towards the personal account concept, focusing more on the specifics of whether and how it could work for the disability community.

For instance, NADR wanted to ensure that any personal account proposal would hold the Social Security Disability Trust Fund (separate from the Old Age and Survivors Trust Fund) harmless, and that people who spent time receiving disability benefits would not be financially harmed (e.g., lack the opportunity to save wage earnings in a personal account, yet have their retirement benefits reduced) for having done so.

By contrast, most CCD members opposed the proposal from the get-go, often coordinating with Nancy Pelosi, Sander Levin, and other Democrats for events and strategy meetings. Archives on the disability coalition’s website from that era appear incomplete, but a 2005 August recess “Action Alert: Efforts to Privatize Social Security Continue!” gives a sense of the message coming from most CCD members, and the organization as a whole.

At this point any liberals still reading might applaud the disability community for having come out so strongly against the Bush proposal. But that idea focused on the Social Security retirement system, not the disability program, and the Bush administration and Republicans in Congress wanted to engage with disability groups to ensure any reforms held the disability community harmless. So how did failing to engage them—choosing instead to oppose from the outset—help the disability community?

In truth, early and vocal opposition to personal accounts may have put the disability community at greater risk had the personal account proposal been enacted without disability groups’ technical expertise on how best to structure it. And given both the partisan comments I heard from at least some CCD members at CCD meetings, it’s worth asking whether partisan or ideological concerns—separate and distinct from the interests of the disability community—unduly or improperly influenced the organization’s collective judgment back then.

Their inherent contradictions in the current debate—remaining silent about Obamacare’s unfair Medicaid match rate disparity and Medicare payment caps, while strenuously objecting to Republican attempts to impose payment caps on Medicaid—reinforce those concerns about undue partisanship.

It isn’t always easy stating inconvenient truths—pointing out that laws one doesn’t like should be enforced along with every other law, or where policies proposed by lawmakers with whom one might ordinarily be aligned fall woefully short. But such truth-telling remains an essential ingredient to authenticity and credibility. As I argued last week, I don’t think the disability community has done that in this case. I wish they had.

This post was originally published at The Federalist.

Will the “Doc Fix” Include a Compromise on Children’s Health Insurance?

Democrats on the Senate Finance Committee issued a news release Saturday expressing concern about provisions for children’s health insurance in the Medicare “doc fix” bill taking shape in the House. Media coverage of the children’s health program has largely focused on the length of the extension: Senate Democrats want a four-year extension, while a summary of the House agreement released Friday has a two-year reauthorization. But there are other, fundamental policy disagreements.

The disagreements are rooted in a letter issued by the Centers for Medicare and Medicaid Services (CMS) in August 2007. Congress was due to reauthorize the children’s health insurance program that fall, and the letter applied two principles to state programs: It targeted resources first toward families making less than 200% of the federal poverty level (now $48,500 for a family of four). If states wished to expand children’s health insurance to families with incomes greater than 250% of the federal poverty level, they had to first cover at least 95% of children in the lowest income group. The letter also instructed states to take steps to ensure that children and families were not dropping private, employer-provided coverage to enroll in taxpayer-funded programs.

Democrats reacted to the letter by refusing to vote on President George W. Bush’s nominee for CMS administrator in the Senate. The Democratic-controlled Congress passed legislation expanding children’s health insurance October 2007 and January 2008, but President Bush, viewing the bills as inconsistent with the policy goals his administration had outlined, vetoed the measures. House Republicans sustained his veto on both occasions.

Upon taking office, President Barack Obama ordered his secretary of health and human services, Kathleen Sebelius, to rescind the August 2007 memo. In February 2009 congressional Democrats enacted the children’s health insurance program expansion that had previously eluded them. Many Republicans believe the program should be targeted toward the lowest-income families, as it was initially designed. Draft reauthorization language issued by the House Energy and Commerce Committee last month would focus “funding on low-income families” to “address concerns about crowding out private coverage and subsidizing upper-middle-class families,” according to a summary.

The bipartisan deal to amend Medicare’s “doc fix” includes a two-year reauthorization of the children’s health insurance program, but policy details of that extension haven’t been released. Unless Republicans and Democrats can agree on a compromise—which eluded Congress and the Bush administration in 2007-08—one party may have to renege on policies it has adhered to for years. There are questions about the fiscal sustainability of the “doc fix,” but the philosophical questions may be no less difficult.

This post was originally published at the Wall Street Journal’s Think Tank blog.

Why the President’s Failsafe Proposal Fails, Part II

As a follow-up to my analysis from last night regarding the President’s “fail-safe” deficit mechanism, there’s one question the White House should be answering: If the President is so interested in budgetary “fail-safes” as a way to reduce the federal deficit, why doesn’t he abide by the Medicare “fail-safe” that’s already in law – a “fail-safe” he has completely ignored?

In case you weren’t aware, Medicare is ALREADY subject to a “fail-safe” mechanism designed to ensure the program will be sustainable in the long term.  The Medicare Modernization Act included provisions requiring the Medicare trustees to determine when the program is relying too heavily on general revenues (as opposed to the Medicare payroll tax) for its funding needs, thus crowding out other important government priorities such as defense, education, etc.  A section on pages 52-55 of last August’s trustees report made such a determination of “excess general revenue Medicare funding” for the fifth straight year.  Therefore, under the procedures outlined within the MMA, the President must within 15 days of submitting his budget propose to Congress legislation remedying the funding warning – to make the program more financially sustainable for current taxpayers and future generations alike.  This provision was codified in statute, meaning the President is required to submit a legislative proposal (which the leaders of both parties will formally introduce at his request).  In his three budget submissions thus far, the President has ignored this statutory requirement under the Medicare “fail-safe” to propose legislation remedying the program’s funding shortfalls.

The White House hasn’t talked about the Medicare funding warning mechanism much – and not just because health “reform” engaged in fiscal double-counting by diverting savings from Medicare to establish new entitlements.  On the one occasion when an Administration document did discuss the Medicare “fail-safe” – the Analytical Perspectives to the President’s April 2009 budget – the Administration claimed that “in accordance with the recommendations clause of the Constitution, the President considers this requirement to be advisory and not binding.”  This wording is particularly ironic, as it echoes the signing statement issued by President Bush at the time the Medicare Modernization Act was enacted in 2003.*

Medicare is already running cash flow deficits in the tens of billions of dollars, and according to the Congressional Budget Office, its Hospital Insurance Trust Fund will be insolvent in nine short years.  The Medicare trustees report notes that the program needs major fiscal reform NOW – not after the President’s re-election campaign, when the White House’s deficit reduction plan would finally take effect.  Instead the White House continues to rely on a presidential signing statement to duck the tough questions regarding Medicare reform, breaking his campaign promises in the process.  Since the President has for years failed to lead on Medicare reform despite a legal “fail-safe” requiring him to do so, why should anyone believe his newfound conversion to targets and “fail-safes” now?

 

* It should be noted that President Bush, unlike President Obama, followed the statutory requirements and submitted Medicare reform legislation as required in February 2008 – meaning his concerns over entitlement spending, and desire to propose solutions regarding same, outweighed any concerns about constitutional prerogatives.  (The proposals were introduced by request in both chambers as bill H.R. 5480/S. 2662 of the 110th Congress.)  President Obama apparently feels no such compunction to put comprehensive entitlement reform ahead of any separation-of-powers concerns, or for that matter the political benefit he may perceive from avoiding the issue until after the next election.

Obama’s Double Standards on Signing Statements and Medicare Reform

As previously discussed, the Administration failed today to send to Congress legislation to remedy general revenue funding shortfalls in Medicare – a requirement codified in statute.  Almost as interesting however is WHY President Obama chose to ignore this requirement.*  The White House hasn’t talked about the Medicare funding warning mechanism (aka the Medicare “trigger”) much – probably because doing so would draw attention to the fact that health “reform” diverted savings from Medicare to establish new entitlements, engaging in fiscal double-counting and budgetary prestidigitation that did little to resolve Medicare’s structural shortfalls.

But on the one occasion when an Administration document did discuss the Medicare “trigger” – the Analytical Perspectives to the President’s April 2009 budget submission – the Administration claimed that “in accordance with the recommendations clause of the Constitution, the President considers this requirement to be advisory and not binding.”  This wording is particularly ironic, as it echoes the signing statement on the “trigger” issued by President Bush at the time the Medicare Modernization Act (which included the “trigger” mechanism) was enacted in 2003.

It should be noted however that President Bush, unlike President Obama, followed the statutory requirements and submitted Medicare reform legislation under the “trigger” as required in February 2008 – meaning his concerns over entitlement spending, and desire to propose solutions regarding same, outweighed any concerns about constitutional prerogatives.  (The “trigger” proposals were introduced by request in both chambers as bill H.R. 5480/S. 2662 of the 110th Congress.)  President Obama apparently feels no such compunction to put comprehensive entitlement reform ahead of any separation-of-powers concerns, or for that matter the political benefit he may perceive from avoiding the issue until after the next election.

So after promising during his presidential campaign that he would NOT use presidential signing statements to “get [his] way,” President Obama is now relying on a signing statement by President Bush to avoid putting forward concrete proposals for Medicare reform – effectively attempting to get his way by avoiding the big issues of entitlement reform 18 months before his re-election bid.  But, with federal deficits running at record highs, some may wonder whether ducking on the biggest issue of our generation – massive and unsustainable federal debts sparked largely by uncontrolled entitlements – represents the kind of change the American people can believe in.
 

* To be sure, the President’s budget does propose SOME savings from Medicare.  But the total savings in Fiscal Year 2012 – $1.6 billion from Medicare, Medicaid, and other government health programs combined – is comparatively miniscule compared to the “at least $40 billion” of spending reductions in FY2012 from Medicare alone that the trustees said would be needed to meet the “trigger” requirements.  Moreover, the President proposes spending its budgetary “savings” on a two year Medicare “doc fix” costing $54 billion, meaning total Medicare spending would actually increase during the fiscal years examined by the Medicare “trigger” under the President’s budget – meaning the proposals are clearly insufficient to meet the statutory requirements.  See pages 194-96 (Table S-8) of the budget, and pages 52-55 of the trustees report, for additional details.