Guess Which Abortion Provider Is Still Being Funded During the Shutdown

The government shutdown has reached the one-week mark and there has been much discussion of what services are not available and which government workers are not getting paid, but one organization has been overlooked. Despite years of Republican efforts aimed at defunding the abortion provider, even shutting down nonessential government services doesn’t appear to have cut off the group from its government money.

The reason that Planned Parenthood continues to get federal checks when air traffic controllers, park rangers, and members of the Coast Guard do not is that most of Planned Parenthood’s federal money comes through the Medicaid program. As with most of the federal entitlement programs, Medicaid money continues to flow during the shutdown. Kaiser Health News reports that Medicare and Medicaid are already funded through the second quarter. That would take the health programs through the end of March.

There are some aspects of Planned Parenthood’s federal funding that could be interrupted by the shutdown. In addition to Medicaid, the group is a major recipient of Title X family planning grants. According to the group’s website, Planned Parenthood serves 1.5 million of the approximately 4 million Title X patients. The Title X grants make up about 19 percent of revenue for participating clinics. These grants could quickly expire in a protracted shutdown.

Defunding Planned Parenthood wasn’t the goal of the current government shutdown, but it would have been a nice added benefit, especially since Democrats don’t seem any more inclined to deal on the wall than they were a week ago. However, even if all federal money dried up, it wouldn’t totally bankrupt the group. Planned Parenthood gets about a third of its funding from the government and the rest from private donations.

For years now, Republicans have embraced a number of quixotic goals such as defunding Planned Parenthood, repealing Obamacare, and building a border wall. They have also embraced government shutdowns as a tactic in achieving several of these goals. Obamacare survived a shutdown in 2013 that also left Planned Parenthood funding intact. This year it appears that the wall will not be funded but that Planned Parenthood will.

Perhaps it is time for Republicans to find a new strategy.

Why Mitch McConnell Is Right About Cutting Social Security

Truth is something that we are not used to hearing in the current political climate so it can come as a bit of a shock when a politician blurts out a harsh dose of reality. That was the case yesterday when Mitch McConnell confronted the American people with the bitter fact that the deficit is too large and the only way to cut it is by slashing the sacred cows of Social Security, Medicare and Medicaid.

“It’s disappointing but it’s not a Republican problem, McConnell told Bloomberg. “It’s a bipartisan problem. Unwillingness to address the real drivers of the debt by doing anything to adjust those programs to the demographics of America in the future.”

While it is not solely a Republican problem, the GOP has done little in the way of deficit reduction recently. This week the Treasury Department revealed that the deficit grew to $779 billion, its highest level since shortly after the Tea Party revolution. After trimming budgets during the Obama Administration, the Republican Congress enacted tax reform that stimulated the economy but slashed corporate tax revenues. At the same time, spending increased due to a larger military budget as well as increased interest payments on the national debt and increased Social Security spending.

The entitlement problem is so big that it really doesn’t matter how much cutting we do in other parts of the budget if we don’t reform entitlements. For example, the entire defense budget is only 14 percent of federal spending. The sum total of all foreign aid is only 1.2 percent of the federal budget.

The entitlement programs are at a crisis stage. The Social Security trustee report predicts that in only four years Social Security will begin to pay out more than it takes in. If nothing is done, only 16 years from now in 2034 the Social Security trust fund will be bankrupt.

The truth is that not even conservative voters really want to reform Social Security. Many conservatives have bought into the lie that the Social Security tax that comes out of their paychecks is a contribution that goes into their account. In reality, involuntary Social Security “contributions” go into a trust fund, per the Social Security Administration, from which benefits are paid from the trust fund and the excess “must be invested, on a daily basis, in securities guaranteed as to both principal and interest by the Federal government.” This is another way of saying that the Social Security benefits are paid from current contributions. Any funds left over are loaned to the federal government, which must pay them back with interest.

Voters seem to be of two minds about Social Security. On one hand, many believe that Social Security is a socialist Ponzi scheme, redistributing wealth from workers to retirees. Nevertheless, the voters also become militant at the very suggestion that benefits might be cut and that they could lose some of their “contributions.”

Even though there is no individual account containing their Social Security savings, American workers have been promised that their taxes will go to fund their retirement. It would be unconscionable for the government to break this promise to those in or near retirement. That is why Republican plans to reform the entitlements would preserve the status quo for retirees and older workers while giving younger workers the option to take part in a plan that has a better chance of being there when they retire.

Bernie Sanders Wants to Turn Medicaid into National Single-payer

Senator Bernie Sanders (I-Vt.) thinks the Republican health care plan is going to fail, but he has a plan. The sometimes-Democrat from The Green Mountain State announced that after the presumed defeat of the Republican bill, he intends to introduce legislation to make “Medicare for All” the national health care system of the United States.

“We are going to introduce it literally as soon as we’re through with this debate. I don’t want to confuse the two issues,” Sanders said on CNN’s “State of the Union.”

Sanders said that the initial phase of his plan would lower Medicaid eligibility to age 55, but would ultimately expand to cover all Americans. “Longer term, we need a Medicare for all,” Sanders said.

Sanders has been talking about universal Medicaid for years. The further expansion of Medicaid was a plank of Mr. Sanders presidential platform in 2016. Details of the plan are still available on BernieSanders.com. Last March, after the Republican bill failed its initial vote in the House, Sanders raised the prospect of introducing his Medicaid plan to the Republican-controlled Congress.

“President Trump, come on board. Let’s work together,” Sanders said in Politico at the time. “Let’s end the absurdity of Americans paying by far the highest prices in the world for prescription drugs.”

Sanders claims that his plan would save the typical middle class family more than $5,000 in annual health care costs. In reality, the plan would shift costs from insurance premiums to private companies to healthcare taxes paid to the government. Families would pay a 2.2 percent tax and employers would pay a 6.2 percent payroll tax for the health insurance. The increase in payroll taxes would likely translate into lower wages.

The Sanders plan contains a long list of other taxes that would be increased to pay for his healthcare plan as well. These include increases in the income tax, the dividend tax, the capital gains tax and the estate tax. He would also limit deductions for households earning more than $250,000 per year.

What would Americans get for their money? The Sanders plan does not go into detail about what the expanded Medicaid would cover or out-of-pocket costs such as deductibles and coinsurance, but there are well-known problems with Medicare. The government only reimburses doctors for part of their costs in treating patients. Under the current system, states pay for Medicaid services and then the federal government reimburses the state for a percentage of its Medicaid costs. Forbes notes that Medicaid pays less than private insurers at the same time that Medicaid patients take more time than other patients. Increased paperwork and delays in payment mean that many doctors limit access for Medicaid patients or don’t see them at all. FactCheck.org estimates that only about 70 percent of the nation’s doctors participate in Medicaid.

Despite Sanders’ claims that expanding Medicaid would save money, the plan merely shifts the burden of paying for healthcare to the states and the federal government. Already, Medicaid is the second largest budget item for most states, only coming in behind education spending.

When states face budget crunches, a common response is to cut reimbursement rates. These cuts can cause increase in wait times for treatment, lead to higher out-of-pocket costs for patients or even cause some providers that rely heavily on Medicaid funds to go out of business.

With Republicans in control of both Houses of Congress, the Sanders plan for national Medicaid will be dead-on-arrival when he submits the bill. However, if Republicans fail to reform the health insurance system, the threat of single-payer from leftists like Bernie Sanders will not go away.

 

Red States Consider Medicaid Expansion After Health Bill Fail

The failure of the American Health Care Act may have an unintended consequence that will make it harder to dislodge Obamacare’s entitlements in the future. After Speaker Paul Ryan’s admission that “We’re going to be living with Obamacare for the foreseeable future,” several red states are considering Medicaid expansions under the Affordable Care Act.

The Wall Street Journal reports that 19 states, most of which are reliably Republican, rejected the ACA’s Medicaid expansion to cover low-income families after the Supreme Court struck down the mandatory expansion of Medicaid and made it optional for the states. Federal funding for the expanded program was covered at 100 percent for three years and would reduce to 90 percent in 2020. The federal government typically pays about 60 percent of Medicaid spending.

“The thing that held states back was that they were going to end Medicaid expansion,” Adam Searing, a research professor at Georgetown University’s Center for Children and Families, told the Journal. “Now when you have the House speaker saying this is going to stay, it’s like, ‘We may get the money, why not explore it?”

The Kansas Senate voted to approve the Medicaid expansion on Tuesday, two working days after the Republican health bill failed. CNN reports that the Kansas House had passed the bill earlier this year. The bill now goes to Gov. Sam Brownback (R) who is not expected to sign it into law.

“To expand Obamacare, when the program is in a death spiral, is not responsible policy,” Gov. Brownback said.

The Journal reports that several other states are expected to reconsider the Medicaid expansion since the ACA now appears to have survived the Republican challenge. These include Idaho, Florida, Georgia, Missouri, Utah and Wyoming.

North Carolina’s Democrat governor, Roy Cooper, initiated the Medicaid expansion process after taking office in January. The Winston-Salem Journal said that the expansion was a top priority for Gov. Cooper, but he has met resistance from Republicans in the General Assembly.

Ironically, a Republican administration may make it more likely that red states buy into the Medicaid expansion. Secretary of Health and Human Services Tom Price has the power to issue regulations that affect how Medicaid money is spent. A more conservative approach that includes work requirements and more leeway on how states spend Medicaid money may entice Republican state governments to opt in.

If more states enact the expanded Medicaid entitlement, it will be even harder to kill Obamacare in the future. The AHCA was derailed by Freedom Caucus members who, among other things, objected to the way the bill handled the expansion. The AHCA’s slow phase out of the Medicaid expansion was made necessary by four Republican Senators (Lisa Murkowski of Alaska, Corey Gardner of Colorado, Rob Portman of Ohio and Shelly Moore Capito of West Virginia) whose states elected to buy into Obamacare’s Medicaid expansion. If more states expand Medicaid, it is likely that more Republican congressmen will decide to protect the federal Medicaid money flowing to their states.

Some popular Republican governors are already resisting the repeal of the Medicaid expansion as well. John Kasich (R-Ohio), who finished third in the 2016 Republican primary, called the Republican plan to repeal the expansion “a very, very bad idea” according to CNN.

The Trump Administration denies that the effort to repeal Obamacare is over, but there seem to be no plans to move forward. “Have we had some discussions and listened to ideas? Yes,” Press Secretary Sean Spicer told the Journal. “Are we actively planning an immediate strategy? Not at this time.”

As more states and taxpayers receive federal Obamacare money, the law will be harder and harder to repeal. Government money has the power to make addicts of both individuals and states.

How Obamacare Was Passed – And Why It Can’t Be Repealed By Reconciliation

 

A common question since President Trump took office is why Republicans can’t simply repeal the entire Affordable Care Act with a budget reconciliation. The Democrats passed it that way, the argument goes, so why should Republicans have to worry about filibusters, cloture votes and the arcane rules of the Senate when they try to repeal Obamacare?

The most obvious reason is that with the four Republican Senators who are holding out to preserve the Medicaid expansion, Republicans don’t even have a simple majority that would vote for a clean repeal. The Medicaid Four, Lisa Murkowski of Alaska, Cory Gardner of Colorado, Rob Portman of Ohio and Shelly Moore Capito of West Virginia, vowed to oppose any repeal and replace bill that did not allow a phase out of Obamacare’s Medicaid expansion.

A more technical reason is that Obamacare was not passed with a budget reconciliation. Not exactly anyway.

At the beginning of the 111th Congress in 2009, Democrats held 58 seats in the Senate. The wave election of 2008 had given them a majority that was just short of filibuster proof. Then the Democrats got two lucky – or at least underhanded – breaks. First, in what is often considered to be a stolen election, Al Franken unseated Republican Norm Coleman in a hotly contested recount. Second, Arlen Specter (R-Pa.) switched his party affiliation to Democrat in April 2009. Suddenly, the Democrats had the 60 votes necessary to stop a Republican filibuster in its tracks.

Specter’s defection set the stage for the Senate to pass the Affordable Care Act. On December 23, 2009, the Senate voted to end debate on the bill. The next day, Christmas Eve, the Senate passed the bill in a strict party line vote with every Republican voting “no.” The bill then went to the House of Representatives.

The next month, the Democrats faced a setback when Senator Edward Kennedy (D-Mass.) died suddenly. In a special election widely interpreted to be a referendum on the health care bill, Scott Brown defeated the heavily favored Democrat candidate and broke the Democrats’ filibuster-proof majority.

What saved the Democrats was the fact that the House and Senate had negotiated most of their differences prior to the introduction of the bill into the Senate. To win over the final few House Democrats, the Democrat leadership urged them to pass the Senate bill with no changes and then pass a second bill via the reconciliation process. If the Senate bill was passed without changes, it would avoid going to conference and being subjected to a second Republican filibuster attempt before a final vote. The reconciliation bill, although its content would be restricted to tax, spending and debt limit legislation by Senate rules, would also not be subject to a filibuster.

After President Obama signed an Executive Order that purported to ensure that federal funds would not be used for abortion, Rep. Bart Stupak (D-Mich.) and the last few Democrat holdouts signed onto the bill. The promise not to fund abortion was broken almost immediately.

The Affordable Care Act was passed by the House without amendment on March 21, 2010 and went directly to the president’s desk. The Health Care and Education Reconciliation Act of 2010 was passed by both Houses of Congress on March 25, 2010. President Obama signed the Affordable Care Act into law on March 23 and the Health Care Reconciliation Act on March 30.

The bottom line is that Obamacare passed with two bills. One was a reconciliation bill and one was not. The largest part of Obamacare legislation was passed in a normal bill that Republicans did not have the numbers to filibuster. The Republicans cannot pass a clean repeal because they do not have the votes to stop the Democrat filibuster that would be certain to come.

But what about the 2015 repeal bill that was vetoed by President Obama? How could this bill repeal the entirety of Obamacare and get past the Democrat filibuster to the president’s desk if it was limited to the Senate rules on budget reconciliations?

The answer is that the bill, HR 3762, which was assigned the unwieldy name “To provide for reconciliation pursuant to section 2002 of the concurrent resolution on the budget for fiscal year 2016,” was not a clean repeal of Obamacare any more than the AHCA was. The 2015 bill, like the AHCA, begins with the statement that the Affordable Care Act is amended, not repealed.

A House Republican fact page about HR 3762 also doesn’t make the claim that the bill would have repealed Obamacare in full. The bill summary on the page says, “HR 3762 repeals the health exchange subsidies and the Medicaid expansion included in the Affordable Care Act (ACA), repeals the ‘Obamacare slush fund,’ eliminates federal funding for Planned Parenthood, repeals the individual and employer mandate penalties, and repeals the medical device and ‘Cadillac’ tax, among other provisions.” If you doubt this, you can read the text of the bill for yourself here.

HR 3762 might have been a better bill than the AHCA, but the Republican position in Congress was also better in 2015. Republicans held 54 Senate seats and 246 House seats in the 115th Congress. In the squeaker election of 2016, President Trump’s short coattails reduced those numbers to 52 Senate seats and 241 House seats. There is still a GOP majority in both houses, but a slimmer one with less margin for defections on votes.

HR 3762 passed the Senate by a 52-47 vote. Two Republicans voted against the measure, Mark Kirk of Illinois and Susan Collins of Maine. Mark Kirk lost his reelection bid in 2016, but Susan Collins remains in the Senate as a prospective “no” vote on the AHCA.

The Medicaid Four were all in the Senate in 2015 and all voted for HR 3762. These four Senators switched their positions on the Medicaid expansion and made it necessary to present a weaker bill to Congress. It is ultimately these four Senators, along with Susan Collins, who should be held responsible for the failure of the GOP to repeal Obamacare because, without their votes, not even a reconciliation bill can pass, let alone a cloture vote on a clean repeal bill.

The failure of the Republicans to pass a clean repeal bill is not due to a lack of will on most members of the party. It is due to math. Democrats used the extremely rare and temporary 60 vote majority to force Obamacare through Congress with no Republican support. The current Republican position is much weaker than that of the Democrats in 2010.

If it is the fault of “RINOs” in Congress, it must be noted that Speaker Paul Ryan (R-Wisc.) is not the RINO to blame. Ryan and other Republican leaders worked to provide the strongest bill possible given the electoral realities of their caucus.

The blame lies with a handful of Republican Senators who are holding up the drive for a strong bill to replace Obamacare. Their names are Lisa Murkowski (Alaska), Cory Gardner (Col.), Rob Portman (Ohio), Shelly Moore Capito (W. V.) and Susan Collins (Maine).

Texas Moves to Defund Planned Parenthood

The Texas Tribune reports that the State of Texas has served notice to Planned Parenthood that it will defund the organization. The notice gives Planned Parenthood 15 days to appeal the decision to the Texas Health and Human Services Commission.

Planned Parenthood has indicated that their response will be through the courts rather than through state administrative channels. “Planned Parenthood continues to serve Medicaid patients and will seek a preliminary injunction in an ongoing lawsuit filed in November 2015, following the state’s original threats to take action against Planned Parenthood’s patients,” Yvonne Gutierrez, executive director of Planned Parenthood Texas Votes, said in the Tribune.

The battle over funding in Texas began in October 2015 when Texas officials first gave Planned Parenthood notice of the state’s intent to cut off funding. The original notice gave the organization 30 days to respond or a “final notice of termination” would be issued. The final notice was actually issued more than a year later after there was no formal response from Planned Parenthood. Planned Parenthood filed a lawsuit against the Texas defunding effort last year, but the suit lay dormant without the final notice.

The group previously received $3.1 million from Texas in Medicaid funds. About 90 percent of that figure is federal money while the remainder is paid for by the state.

The notice cited a series of undercover videos that allegedly show that Planned Parenthood officials illegally conspired to sell body parts of aborted babies. Planned Parenthood denies the charges and claims that the videos were edited.

“Your misconduct is directly related to whether you are qualified to provide medical services in a professionally competent, safe, legal and ethical manner,” Texas Health and Human Services Inspector General Stuart Bowen wrote in the letter to the group. “Your actions violate generally accepted medical standards, as reflected in state and federal law, and are Medicaid program violations that justify termination.”

Several states have attempted to cut off funding for Planned Parenthood and the group has sued to keep the public money coming in. In recent months, Planned Parenthood has won suits against defunding in Louisiana, Mississippi, Kansas, and Utah.

At issue is a portion of federal Medicare law that allows patients free choice of providers. “Longstanding Medicaid law prohibits states from restricting individuals with Medicaid coverage from receiving their care from any qualified provider,” a U.S. Department of Health and Human Services representative said in a statement in 2015. “Every year, millions of women benefit from critical preventive services, such as cancer screenings, that Planned Parenthood provides. State efforts to restrict women from using qualified providers puts these important health care services at risk.”

If state efforts to defund Planned Parenthood are stymied by federal law, then the problem might be solved by the new Republican Congress. Congressional Republicans tried to defund the group at the federal level, but were blocked by Democrats and the threat of a veto by President Obama.

Next year, President Obama will not be able to block legislation cutting off taxpayer funding for Planned Parenthood, but Donald Trump’s position on the issue has not been consistent. Throughout much of the campaign, Trump opposed defunding Planned Parenthood, saying the group “does do wonderful things, but not as it relates to abortion.” On several occasions, Trump supported cutting off Planned Parenthood’s funding for abortion, but not defunding the group entirely. In September, Trump did issue an unequivocal statement calling for full defunding of the group.

Under the Hyde amendment, originally passed in 1976, federal funds cannot be used for most abortions. The current version of the amendment contains an exception that does allow Medicaid funds to be used in cases of rape, incest or when the life of the mother is in danger. Due to this law, federal funding for Planned Parenthood is already limited to providing services that are not related to abortion.

The Texas effort is unlikely to succeed due to its conflict with federal law. An effort by congressional Republicans stands a better chance, even with Donald Trump’s mixed record on Planned Parenthood.

Fun with fraud: Government watchdog duped Obamacare 96 percent of the time

As I write this piece, two Obama administration officials are taking a bruising from House Republicans over the Affordable Care Act (ACA). The reason: Anti-fraud controls in the ACA are about as effective as a sieve.

According to the Government Accountability Office (GAO), in three years of testing the ACA’s protections against fraud, its efforts to get around the systems were successful 96 percent of the time.

The head investigator, who is also testifying to Congress this morning, was quite clear in an interview with me yesterday:

“I think the point I’ve made in the past is that these are significant vulnerabilities in the process itself, and the checks and controls,” Seto Bagdoyan […] explained. “We were able to overcome them, using the system’s own instructions.”

One set of instructions told GAO’s investigators to contact a representative by phone to gain insurance coverage. According to Bagdoyan, “We were able to talk our way into getting coverage and subsidies by engaging in a conversation with a representative on the other end of the phone. And this was consistent, year on year on year.”

The systems in exchanges across the country – including ones that are state-run and federally-run – were so incompetent that even using fake Social Security numbers didn’t deter fraudulent coverage:

In 2015, “fictitious applications for subsidized health plans” were used 10 times, according to the GAO report for that year. Medicaid coverage was approved in seven out of eight fake applications. Four states – New Jersey, North Dakota, California, and Kentucky – were targeted.

The 2016 investigation included four applications out of the eight submitted that were follow-ups from prior years. West Virginia and Virginia federal-run exchanges failed in this examination, as did California’s state-run exchange.

The most recent investigation included applications that included non-existent Social Security numbers. One included a fake immigration card, and in four cases GAO investigators gained subsidized health insurance by falsely claiming they were turned down for Medicaid coverage.

Speaking of Medicaid coverage, conservatives have been warning for years that expansion would likely increase the tax dollars lost to incompetence and fraud. More than $136 billion was lost across the federal government to improper payments in 2015 alone, with Medicaid responsible for about $29 billion.

Of course, a hearing less than two months before an election, and just a couple of weeks before our esteemed public officials go back to campaigning, won’t actually lead to substantive changes anytime soon. Despite tens of billions of dollars lost to various inefficiencies in federal health care programs, Congress earlier this year was only able to push a bill that saves…$2.8 million per year.

The GAO reported that a number of officials at the state and federal levels agreed to fix some of the problems, which is good, but the real change needed is to scrap and replace the ACA in its entirety, and make major changes to both Medicare and Medicaid.

Rick Perry’s Freedom Agenda

This morning’s post on Texas generated a lot of commentary. I’ve talked to people close to Governor Perry and want to give some information from their perspective. Yesterday, the Texas House voted to begin the expansion of medicaid under Obamacare. Later in the evening, they rescinded the effort. Several reporters and others I talked with explained that while Governor Perry is “rock solid” on the | Read More »