How Can the GOP Keep on Making the Same Mistakes?


Even though the GOP knows that the President is going to veto the bill they keep on trying to defund the Accountable Care Act/ACA/Obamacare. So, again they try. The House on Friday passed a budget bill that would dismantle key parts of Obamacare and strip federal funds from Planned Parenthood for a year.

House members voted 240-189 to pass the bill, which would repeal the Affordable Care Act’s requirement for all Americans to obtain health insurance and for employers to offer it to their workers. It also would end a tax on medical devices.

The budget reconciliation bill faces an uncertain fate in the Senate, even though it requires only a simple majority of 51 senators to pass it instead of the super-majority of 60 senators usually needed to approve major legislation.

Three conservative Republicans — Sens. Ted Cruz of Texas, Mike Lee of Utah and Marco Rubio of Florida — said they will oppose it because it does not repeal Obamacare outright.

“This simply isn’t good enough,” the three senators said in a joint press release Thursday. “Each of us campaigned on a promise to fully repeal Obamacare…With millions of Americans now getting health premium increase notices in the mail, we owe our constituents nothing less.”

At the same time, three moderate Republican senators — Susan Collins of Maine, Mark Kirk of Illinois and Lisa Murkowski of Alaska — also may oppose the bill because it would defund Planned Parenthood.

There are 54 Republicans in the Senate, meaning that GOP leaders can only lose three of their senators if they hope to pass the bill. The 44 Democrats and two independents in the Senate are all expected to vote against the legislation.

Even if the Senate approves the bill, President Obama has vowed to veto it.

“This is a bill that . . . has no chance of becoming law,” said Rep. Chris Van Hollen, D-Md., the senior Democrat on the House Budget Committee.

Budget Committee Chairman Tom Price, R-Ga., said the non-partisan Congressional Budget Office and Joint Committee on Taxation estimate the bill would lower the deficit by $130 billion over 10 years by increasing economic growth.

“Obamacare puts Washington in charge,” Price said. “We want to put the American people in charge of their own health care decisions.”

Van Hollen said the bill would strip millions of Americans of medical insurance.

“The legislation, plain and simple, takes away affordable health care to 15 million Americans, including 3 million children,” he said, citing CBO estimates. “That is nothing to be proud of.”

The bill would also suspend federal funds for Planned Parenthood. Republicans have been trying to defund Planned Parenthood for months in the wake of controversial videos of employees of the nation’s largest abortion provider discussing payments for tissue and organs from aborted fetuses. Planned Parenthood vehemently denies the allegation that it sells the tissue for profit, saying that undercover videos taken by anti-abortion activists were heavily edited and misleading. The group recently announced that it would stop accepting payments to cover the costs of procuring fetal tissue for medical researchers.

Three House committees, including a new select panel, are investigating the allegations against Planned Parenthood. House Speaker John Boehner, R-Ohio, and announced Friday that he was appointing Rep. Marsha Blackburn, R-Tenn., to serve as chairman of the select panel. The Judiciary Committee and the Oversight and Government Reform Committee are continuing their own investigations.

Planned Parenthood receives more than $500 million a year from the federal government to provide medical checkups, cancer screenings, and birth control services. It is barred by federal law from using that money to pay for abortions.

I can understand the desire to defund it. Just look at other dominos falling left and right.

Under Obamacare, individuals face a penalty for not buying health insurance. But now even small businesses that choose to jump through hoops to help workers pay for healthcare costs could face penalties.

A new IRS regulation that went into effect on July 1 could impose a fine of $100 a day per worker—up to $36,500—for businesses that provide tax-free assistance with workers’ individual health insurance premiums or medical costs. The regulation would cost businesses over 18 times more than the Obamacare penalty for larger businesses not providing health insurance for employees, which is $2,000, said Kevin Kuhlman, NFIB Director of Legislative Affairs, in a conversation with radio host Frank Beckmann on WJR in Detroit.

According to NFIB research, one in seven non-offering small businesses have these policies in place—and the IRS regulation could mean cost increases for hundreds of thousands of workers.

“There’s no real justification for penalizing small businesses that do what the law’s strongest supporters claim to want, which is to help employees obtain coverage or pay medical bills,” Kuhlman said in an NFIB press release. “This is a rigid and thoughtless bureaucratic rule that undermines the purpose of the law, and it ought to be repealed immediately.”

The penalty even kicks in for businesses with fewer than 50 employees who are exempt from being required to establish group plans under Obamacare. Small businesses with too few resources to set up group healthcare plans could still face insurmountable fines for providing for their workers’ well-being.

“The penalty for compensating employees for healthcare-related expenses is enough to destroy most small businesses,” Kuhlman said. “Reimbursing employees for the cost of insurance or medical services is a way for small businesses to help their workers, without the administrative headaches of setting up a costly group plan.”

There are currently two bills awaiting congressional action to remedy the problem.

“If there’s an opportunity for a bipartisan improvement toward affordable healthcare, this has to be it,” said Kuhlman, who was quoted in a press release put out by Iowa Sen. Chuck Grassley that was picked up by the River Cities’ Reader.

And even that lack of administrative competence, oversight and accountability.

The federal government awarded over $5 billion to help states set up ObamaCare exchanges, with the vast majority – $4.6 billion – going to 16 states and Washington, D.C.

But, according to a recent Government Accountability Office (GAO) report, much of that money has not been accounted for – and yet not returned, either.

So where did those taxpayer dollars go?

That’s the billion-dollar question.

The Patient Protection and Affordable Care Act (PPACA) required the establishment of health insurance exchanges – known as marketplaces – to help small employers and consumers compare and purchase insurance plans. States opted to either develop their own state-based exchanges or hand authority to the Centers for Medicare & Medicaid Services (CMS). And between 2010 and 2014, CMS awarded federal grants mostly to states setting up their own marketplaces, to help them get started.

About $4.6 billion was given to these 17 recipients, including California, New York, Washington state and Kentucky.

But the GAO report found that so far, just $1.4 billion of that has been spent on IT projects, and a total of $3 billion has been “spent or drawn down,” though not all the spending is detailed.

That, then, leaves at least $1.6 billion unaccounted for. Yet only three states returned any portion of the money – a total of just over $1 million was given back.

“The specific amount spent on marketplace-related projects was uncertain, as only a selected number of states reported to GAO that they tracked or estimated this information,” the report said.

Even though states were supposed to set up their marketplaces by the end of last year, they are not yet legally required to return unused funds.

Chuck Young, with the GAO, explained that the grants also could have covered non-IT costs not addressed in the study, and the funding devoted to IT projects will generally remain available for states’ use until December – albeit with restrictions. “CMS said that, since March 2015, states may have spent additional grant funds for IT projects, re-purposed those funds for non-IT costs, or returned funds,” he said, adding that the office expects to conduct a follow-up to this report.

But in an article on the GAO report by the American Spectator, health care adviser and contributor to the publication David Catron highlighted the monetary discrepancy and raised the question of whether Democratic officials improperly diverted or spent more than $3 billion in taxpayer grant money.

“It’s hard to know with any degree of certainty where the money went,” he told “So all we know with any confidence is how much was awarded, how much went to IT and what the difference is.”

Catron pointed out that 85 percent of federal funds went to Democrat-controlled states, and that only three states returned any money to CMS while the remaining 13 states and D.C. have yet to return any funds.

The spending is different from state to state. Oregon has withdrawn just over $293 million of its $305 million and spent almost all of the $78.5 million authorized for its IT expenses – but based on the report, has not returned any leftover funds. California was given over $1 billion and spent $709 million. GAO found that less than a half-million dollars has been returned to the federal government.

Representatives for the Department of Health in Oregon told that the IT funds listed on the report were only one part of setting up the exchange, implying that remaining funding was directed elsewhere. A spokesperson for the ObamaCare marketplace Covered California said that when they released the 2015-2016 budget in June, there was approximately $100 million in federal funds left and carried it over thanks to an extension by the federal government; they now have until the end of December to draw on the funds for the program.

A representative for the U.S. Department of Health and Human Services insisted that if any funds are misallocated the CMS “will work to recover the funds using remedies available under law and regulation.”

“To safeguard taxpayer funds, HHS has also put in place additional program integrity regulations and has implemented, or is in the process of implementing, the GAO’s recommendations,” said HHS senior adviser Meaghan Smith.

In examining how states have used federal funds for IT projects and CMS’s role in overseeing them, the non-partisan GAO found that marketplaces reported spending nearly 89 percent of the funds on “IT contracts,” but that the CMS is still trying to track states’ IT spending in more detail.

The GAO urged CMS to improve its existing oversight roles and responsibilities and ensure that senior executives adequately review and approve funding decisions.

And despite all the money issued to states specifically for IT use, the GAO underscored an array of problems – from poor system performance to software and hardware problems – plaguing the state-based and federally run marketplaces.

According to Dennis Santiago, risk analyst and director of the Bank Monitor Division for Total Bank Solutions, the uncertainty doesn’t necessarily mean the money was misused.

“What is missing is the proof that diversions did or did not occur, and if so where,” he said. “IT costs are only part of the process. It could be legitimate, classic pocket lining at work – or some of both.”

Interestingly, Texas, Louisiana and Kansas filed a lawsuit against the federal government Thursday accusing it of forcing states to pay an unconstitutional tax to help fund the Affordable Care Act.
The lawsuit alleges that the law’s excise tax on insurers is unconstitutional because it effectively forces states to cover the cost or risk of losing Medicaid funding when it’s imposed on the companies that hold contracts for Medicaid managed care.
Managed care companies had to start paying the fee last year. This year, the American Academy of Actuaries adopted a standard calling for capitation rates in managed care organization agreements to be high enough to recover the amount of that tax from their states. If the rates are deemed inadequate, states could wind up losing federal matching funds for the Medicaid plans.
“By functionally requiring that the plaintiff states reimburse managed care organizations for payment of tax liabilities, the United States has imposed those taxes on the states,” according to the lawsuit.
A Justice Department spokesman declined to comment on the lawsuit Thursday afternoon.
A victory for the states in the suit could cost the ACA billions of dollars, according to Josh Blackman, an associate professor at South Texas College of Law who informally consulted with Texas before it filed the lawsuit.
But Tim Jost, a law professor at Washington and Lee University who is a proponent of the healthcare law, said previous lawsuits challenging the ACA’s individual mandate and insurance premium subsidies posed more serious threats.
“We’re talking about a hit … but it’s nothing like King v. Burwell or NFIB v. Burwell,” Jost said, referring to the two major attacks on the ACA that made it to the Supreme Court. In King, the justices upheld premium subsidies, and in NFIB, the justices upheld the individual mandate but said states didn’t have to expand Medicaid under the law.
Blackman said the lawsuit would test the reach of the Supreme Court’s reasoning in the Medicaid part of the NFIB opinion. The justices said that threatening to pull states’ Medicaid funding unless they expand Medicaid amounts to coercion. Texas and the other states joining the new suit claim the same type of coercion is at play.
“This threat to cut Medicaid funding to Texans unless the state continues to pay hundreds of millions in taxes to Washington amounts to the very ‘gun to the head’ the Supreme Court warned about in earlier rulings on Obamacare,” Texas Attorney General Ken Paxton said in a statement. “This represents yet another huge overstep of authority for this administration, which once again has demonstrated their willingness to circumvent the Constitution in order to achieve their policy goals.”
The states also argue that the U.S. Constitution requires that state officials clearly understand the conditions they’re agreeing to when they accepts federal dollars, and the ACA doesn’t address whether states have to pay for the law or risk losing Medicaid money.
They also allege that the tax is unconstitutional because it delegated duties of Congress to a private entity, the American Academy of Actuaries. And they say the new regulation amounts to a tax on the states, in violation of the constitutional doctrine prohibiting taxation of a sovereign state.

So, we continue to try to get rid of the ACA and the next step will probably bring this state related problem to the Supreme Court.

However, we know from all the maneuvers in courts and in the House and the Senate that the President and his loyal supporters are not going to allow the President’s legacy be tarnished by any strategies. The GOP should concentrate on the big picture, getting an electable candidate for the 2016 election as well as coming up with a workable health care plan. Otherwise they, the GOP and all its members, will look like clowns. I am concerned that the ultra-conservative maniacs will sink the boat and we will be suffering the same poor choices and bad decisions with Queen Hillary!

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