The Heritage Foundation

The Morning Bell


FRIDAY, OCT 30, 2009

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

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

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

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

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

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

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