Thursday, November 12, 2009

Michael Ciamarra: Can states protect themselves against massive health care intrusion?

  As the U.S. House of Representatives leadership muscled through its complex, bureaucratic overhaul of 17 percent of our economy, states have not been waiting on the final outcome, if any, in the U.S. Senate.

  Alabama State Rep. Mac Gipson (R-Prattville) will introduce in the 2010 session of the Legislature the Alabama Health Care Freedom Act constitutional amendment that will protect the rights of patients to make their own health care choices. Further, his measure prohibits penalties levied on patients for declining participation in any big government passed Pelosi/Obama health care plan. To date, 22 states have introduced similar initiatives.

  Indeed, states have much to lose whatever should pass Congress. Rather than address the current health care market distortions imposed by heavy-handed government policies, the Pelosi/Obama health care bill would expand Washington’s reach and exacerbate what is broken in health care. Specifically, the legislation passed by the House proposes:

·One-Size-Fits-All-Health Care. The bill’s rating restrictions, coverage mandates, and benefit requirements will halt innovation and drive individualized health products out of the market. All plans would be subject to approval by a new Health Choices Commissioner who would have the authority to penalize any health plan that does not comply with this new federal bureaucracy.

·Government Rationing. In an unprecedented power grab, this bill provides the federal government even greater leverage in deciding which medical treatments are worth paying for and which are not. In an effort to contain costs of its new health care entitlement, a new “Comparative Effectiveness Research” program will inevitably impose government control over physicians’ medical decisions and cause private-sector insurers to limit coverage in line with the government’s choices.

  The Pelosi/Obama plan dramatically adds to the federal government’s already unsustainable liabilities, including the following specific spending concerns:

·$3 Trillion Ten-year Price Tag. Proponents continue to tout a massive budget gimmick, using 10 years of revenues but only seven years of cost. Even with this timing trick, the Congressional Budget Office asserts that the Pelosi/Obama plan remains in excess of $1 trillion. Once the spending is fully phased in after 2014, its true cost exceeds $3 trillion over ten years.

·Driving States Deeper Into the Red. Rather than make quality health coverage more affordable, the Pelosi/Obama plan attempts to cover the uninsured by adding them to expansive government-run programs. The dramatic expansion of Medicaid would force cash-strapped states to spend an additional $34 billion over the next 10 years – on top of the unsustainable Medicaid burdens states already face. One estimate indicates that 237,000 more people could be added to the Medicaid rolls in Alabama, adding $1.2 billion a year to the state's Medicaid budget.

  Moreover, the Pelosi/Obama plan imposes $729.5 billion in new taxes on families, employers and workers, including the following:

·A total of $460.5 billion in job-killing surtaxes on small businesses

·Another $135 billion in employer mandates, including the “play-or-pay” scheme punishing even small companies that are unable to provide group health insurance

·An additional $33 billion in individual mandates – including an unprecedented Washington requirement that everyone must buy health insurance or be subject to federal penalties.

  But states can also weigh in and challenge these mandates should this particular bill or any similar one pass Congress.

  With President Obama's intensity of wanting to rush through an unprecedented big government managed system, Rep. Gipson's bill, if approved as a constitutional amendment, will become an essential tool in securing the rights of patients to make their own health care choices.

  When consumers control the dollars, they make the decisions. On the other hand, a single-payer health system — which forces patients to enroll in a one-size-fits-all plan with rich benefits and weak cost-sharing — will cause spending to skyrocket and policymakers to ration care as a cost-containment measure.
  The Alabama Health Care Freedom Act ensures a person's right to pay directly for medical care. Single-payer systems, like in Canada , make it illegal for citizens to go outside the government's health care plan and contract for their own medical services.

  Rep. Gipson's bill ensures that patients — not government officials — will decide which doctor to see, what treatments to get, and whether or not to get a second or third opinion.

  Should the Alabama Health Care Freedom Act pass, along with many other states passing similar measures, it could cause a federalism clash. Rep. Gipson stated in a recent Tuscaloosa News interview that, "the main thing I want to do is have something for a legal challenge. Letting people vote gives us a vehicle if there is to be a court challenge." 
  Rep. Gipson's bill would challenge any congressionally passed bill that imposes costly, bureaucratic penalties for choosing to obtain or decline health coverage. This provision strikes at the heart of an individual mandate — implemented in Massachusetts and elsewhere — that penalizes individuals and businesses for failing to purchase health insurance.

  The Massachusetts example is particularly instructive for states facing an individual mandate. Three years into the mandate, Massachusetts still hasn't achieved 100 percent coverage. In fact, the Bay State still has more than 200,000 uninsured residents. Many of the uninsured were exempt from the mandate because coverage was too expensive. Over half of those who did get insurance got fully- or partially-subsidized coverage, courtesy of Massachusetts taxpayers.

  Simply put, Rep. Gipson's Alabama Health Care Freedom Act would protect against intrusive mandates that just don't work and the fatal conceit that government planners can spend health care dollars better than patients and doctors in the marketplace.
  About the author: Michael Ciamarra is vice president of the Alabama Policy Institute and a fellow with the Center for Health Transformation. He can be reached at The author wishes to acknowledge Christie Herrera of the American Legislative Exchange Council and U.S. Rep. Tom Price of Georgia for their insights.

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