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How the Republican Congress Can Win the Public’s Trust: GOP Members of Congress Should Deal Transparently With Their Health Insurance Subsidies November 25, 2014

The Hill, November 23, 2014

By Doug Badger

Republicans have won the elections. They have not won the public’s trust. Earning that trust will require them to prove that they put the public interest ahead of their own. A good first step would be for GOP members of Congress to deal transparently with their health insurance subsidies.

Congressional employees have no legal entitlement to such subsidies. The Senate Finance Committee in 2009 adopted an amendment written by Sen. Chuck Grassley (R-Iowa) expelling congressional employees from the Federal Employees Health Benefits (FEHB) program and requiring them to obtain coverage through the new healthcare exchanges. The Grassley language explicitly permitted those employees to continue to receive a federal contribution to their premiums. The provision authorizing the subsidies was removed from the final Senate version, which eventually became law. The excision of the subsidies was evidently inadvertent, an error that Grassley has attributed to aides to outgoing Senate Majority Leader Harry Reid (D-Nev). Who is responsible for this error is irrelevant. The fact is that the law, as written, prohibits congressional employees from receiving the subsidies.

They are receiving them nevertheless because of a regulation promulgated by the Office of Personnel Management (OPM). By providing federal subsidies to congressional employees, the regulation directly contravenes the law. It is the sort of regulatory malfeasance that Republican leaders ordinarily condemn. They have fallen strangely silent on this one.

Their silence is understandable. Many are looking out for their employees, most of whom are far less well-compensated than they. Their aides work long hours. Some have young children. Others are themselves barely more than children, recent college graduates who struggle to make rent. Those sympathies are well-placed. As a retired Senate and White House employee, I very much value my FEHB benefit. I would resent having it taken away.

But it was Congress, after all, that voted to take their own subsidies away. They, unlike the millions of Americans who lost the insurance they liked (including coverage they formerly received through the workplace), have no one to blame but themselves. They continue to receive the subsidies only due to an OPM regulation that could never withstand legal scrutiny. Sen. Ron Johnson’s (R-Wis.) lawsuit challenging the rule was dismissed for lack of standing, not lack of merit.

A skeptical public expects Congress to rail against executive excess on ObamaCare, immigration and the environment while gladly accepting health insurance subsidies that required similar regulatory acrobatics. They expect their elected representatives, with annual salaries of $174,000, to collect subsidies that average 72 percent of premium, while denying subsidies to individuals who earn as little as $47,000.

Republicans should not live down to these expectations. Instead they should recognize that low congressional approval ratings stem in part from the perception that members don’t practice what they preach. Congress should vote early next year to deny themselves these unlawful health insurance subsidies. If they want to protect their employees, the measure could include a Grassley-like provision that provides health insurance subsidies to congressional staff.

Such an exercise would not instantly mend the public’s negative perception of Congress, but it would lend the new majority a needed measure of credibility.

Badger was formerly deputy assistant to the president for legislative affairs, where he helped formulate the George W. Bush administration’s policy and legislative strategy.

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Reed S. Wilson, MD, FACC, FACP: The “Selfish, Selfless” Health Care Worker November 10, 2014

The “Selfish, Selfless” Health Care Worker

By Reed S. Wilson, MD, FACC, FACP, President of Private Practice Doctors

As a physician, my job includes treating the disease at hand, managing patient expectations and dealing with the psychological aspect of the patient’s illness.  It’s part of the beauty and the burden of taking care of people.  That is why I find it so disconcerting to read about the attitude of three healthcare professionals who have been in West Africa where they treated or reported on Ebola victims.  In spite of this, it should be recognized that going to West Africa and helping this devastated region takes a lot of courage and empathy.  But it should also be noted that one must have the financial wherewithal or backing and not have significant family and patient responsibilities at home to be able to go half way around the globe to volunteer one’s services.

In the first instance, it appears that Dr. Craig Spencer, who ultimately was infected with Ebola, lied to authorities about his self-imposed home quarantine in New York.   Apparently, he stated that he isolated himself in his apartment but neglected to mention he rode subways, took a taxi, visited The High Line and went bowling.  The police discovered his isolation violations when they examined his Metro Card and credit card statements.  Dr. Spencer was in Guinea – he saw firsthand the devastation caused by Ebola.  He traveled back to the US knowing that the incubation for this disease is 21 days.  He started feeling tired on a Tuesday but continued his outings for two days before calling for help.  There is absolutely no excuse for this behavior.

The second healthcare worker, Kaci Hickox, was initially required to be quarantined at a New Jersey Hospital after arriving back in the US from Sierra Leone where she was involved in fighting the outbreak of Ebola.  She fought her hospital quarantine and was allowed to go home to Maine to wait for the duration of the incubation period.  She has refused to isolate herself and has caused havoc in the community around her.

Dr. Nancy Snyderman, a physician who returned to the US from Ebola ravaged West Africa agreed to a 21 day quarantine only to violate that promise, a violation that including driving to a restaurant to pick-up takeout food.

All of these health care professionals are shameful to the medical profession.  There is so much we don’t know about Ebola.  Sixteen physicians from Doctors without Borders have fallen ill from the disease, of whom 9 have died – just over 50% mortality among probably the most experienced personnel handling this virus.  The two physicians who were transported to the US for treatment and survived, do not understand or know how they contracted the disease.   We learned just recently that Ebola can live in sneezed particles and inhaled by those near the infected individual.  There are so many questions regarding the ravages of Ebola that the phrase “abundance of caution” is bandied about whenever discussing measures taken to limit this disease that has a fatality rate of about 70%.

Remembering that part of the job of physicians and nurses also is to manage the expectations and psychology of the illness, why would the three aforementioned healthcare workers selfishly not obey quarantine?  Even if they did not believe it necessary, what harm would come from staying at home for 21 days?  Obviously, they were able to take off months at a time, indicating that financial pressures were not in play, as if that would have been an actual excuse.  Ignorance of the disease could not possibly have played a factor as these individuals had experienced the disease first hand.  “Making a statement” is a possibility, but isn’t there a better way to accomplish this after the 21 day waiting period?  There is no reason to cause public consternation and anger when simply following state (and I hope one day federal) mandated orders.

I will not even hypothesize about the logic of their actions.  There is none.  But the public should know, these individuals do not represent me or my ideals.  I suspect they do not represent the vast majority of physicians and nurses in the country.  It is truly a shame that their noble selflessness helping the victims of Ebola in West Africa are more than cancelled by their selfishness to their friends and neighbors at home.

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Lanhee Chen and Topher Spiro: Health Care Everyone Can Agree On November 4, 2014

BloombergView, November 3, 2014

Republicans and Democrats have little occasion to agree on anything in these toxic times. Nowhere are their differences more acute than on health-care policy.

The two of us disagree on whether the Affordable Care Act is improving the U.S. health system, whether it is good policy, and whether it should continue to exist. It’s such a lightning rod that broad consensus on alterations to the law may never be reached.

Yet it is still possible to make progress on changes that will improve the health-care system. Disagreements about the future of Obamacare need not stop us from agreement in other areas. And it starts with emphasizing the role that states can and should play in slowing the increase in health-care costs.

Conservatives and progressives agree that cost growth will continue to be a problem in the coming years. We agree that this makes it harder for American families to make ends meet. Conservatives worrythat such increases worsen yearly deficits and the national debt. Progressives believe that increasing costs contribute to rising inequality by consuming larger shares of workers’ incomes, while crowding out public investment in education, infrastructure and research.

We propose a model in which states could opt to be responsible for health-care costs and quality, earning financial rewards for success. They would become the driving force for action to constrain costs.

States are well-suited to take the lead here for several reasons.

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Rick Moran: Obamacare price tag since 2010: $73 billion and couting September 26, 2014 ,

American Thinker, September 25, 2014

An analysis by Bloomberg Government has found that the start up costs for Obamacare “are far greater than anything publicly discussed.” The report shows that the total cost has exceeded $73 billion dollars, with $2 billion alone – and counting – spent on the Obamacare website, healthcare.gov.

Health care analyst Peter Gosselin:

“Whether policymakers and the public judge the $73-billion-plus tab for health reform reasonable or exorbitant may ultimately turn on what’s used as the measuring stick,” wrote senior healthcare analyst Peter Gosselin.

“Measured against the development costs for the F-35 joint strike fighter [$54.9 billion], the Defense Department’s single most expensive weapons system, the tab for the healthcare effort can seem quite high,” he continued.

“Measured against the U.S. healthcare industry that the administration seeks to overhaul, however, the costs of the reform effort appear tiny.”

Why would you want to measure Obamacare start up costs against the entire US health industry? The fact that the rollout of this turkey has cost the US taxpayer more than development costs for a supersonic jet fighter is absurd.

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Jame C. Capretta and Yuval Levin in The Weekly Standard: Getting There September 16, 2014

The Weekly Standard, September 22, 2014

Obamacare—or at least the version of it that the president and his advisers currently think they can get away with putting into place—has been upending arrangements and reshuffling the deck in the health system since the beginning of the year. That’s when the new insurance rules, subsidies, and optional state Medicaid expansions went into effect. The law’s defenders say the changes that have been set in motion are irreversible, in large part because several million people are now covered by insurance plans sold through the exchanges, and a few million more are enrolled in Medicaid as a result of Obamacare. President Obama has stated repeatedly that these developments should effectively shut the door on further debate over the matter.

Of course, the president does not get to decide when public debates begin or end, and the public seems to be in no mood to declare the Obamacare case closed. Polling has consistently shown that more Americans oppose the law than support it, and that the opposition is far more intense than the support. The law is built on a foundation of dramatically expanded government power over the nation’s health system, which strikes many voters as a dangerous step toward more bureaucracy, less choice, higher costs, and lower quality care. The beginning of the law’s implementation does not appear to have eased these fears, and in some cases has exacerbated them.

But opponents of Obamacare must also reckon with the reality that the goal of repealing the law and replacing it with real, market-based health reform to bring down costs and enable more people to get covered is no longer aimed at a system that exists only in theory. When President Obama won reelection in 2012, it became inevitable that some version of the law would get implemented starting this year. And it was also a pretty good bet that, despite the law’s internal contradictions and problems, it would not, as some had surmised, collapse on the launch pad. Massive federal spending authority can prop up many a teetering edifice. The surprise is not that some 6 million people or so eligible for nearly free insurance under Obamacare took advantage of the offer; the surprise is that many millions more who were eligible declined to take it.

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