Showing posts with label health care. Show all posts
Showing posts with label health care. Show all posts

Friday, June 28, 2019

From the Archives: Attorney General Ken Cuccinelli says Obamacare decision is 'a win for liberty'

Attorney General Ken Cuccinelli says Obamacare decision is 'a win for liberty'
June 28, 2012 11:30 AM MST

In a press conference today, Virginia Attorney General Ken Cuccinelli said that the Supreme Court’s health-care decision was a “victory for individual liberty” and that his initial reaction to the ruling was more negative than it ought to have been.

Ken Cuccinelli Obamacare SCOTUS health care commerce clause
Speaking to reporters in Richmond and via telephone conference call, Cuccinelli called the ruling “a win for liberty” and explained that for the first time in 85 years, the Supreme Court had set “an outer limit” on the expansion of federal authority through the Commerce Clause.

He said that by its 5-4 ruling on the limits of the Commerce Clause, the Court had put in place a “critically important containment of federal power” and that in the parts of the ruling dealing with Medicaid, the justices had for the first time since the New Deal said that Congress has limited power to compel states to act through its spending authority.

Politics and legislation

Moreover, Cuccinelli argued, by defining the individual mandate as a “tax,” as Chief Justice Roberts did in his majority opinion, the Court opened up political challenges to the law because Congress’s taxing authority is the most accountable and sensitive of its powers to popular will.

By calling it a tax, he said, the Court (specifically the Chief Justice) removes the political cover for those legislators who claimed not to have voted for a tax increase. They can no longer go back to their home districts and say they did not vote for a tax, he said, and thus they will be subject to the judgment of voters on Election Day.

Given that, Cuccinelli predicted that, with the impending elections this November, the ruling will show the critical role that voters play in “ensuring that their liberties are preserved.”

‘Bipartisan failure’
As a policy matter, Cuccinelli said, health-care legislation has been “a bipartisan failure” and that the Affordable Care Act is such a “bad policy” that even the people who supported it are backing away from it, as a constitutional matter, “individual liberty has been substantially preserved in this case.”

He also noted that, apart from the aspects of the law addressed in the decisions delivered by the Court today, there are still matters about the ACA that continue to be litigated. He gave as an example the lawsuit filed by the Catholic bishops with regard to contraceptives.

Federalism preserved
Cuccinelli said that the justices came to their decision in an “unlikely way,” but that “if there had been five votes to compel us into commerce, federalism would have been dead,” pointing out that Justice Ruth Bader Ginsburg, in her dissent on the Commerce Clause part of the ruling, claimed that the “Commerce Clause power is plenary,” that is, unlimited.

Wrapping up, the Virginia Attorney General said that upon reflection, his analysis of the Supreme Court’s health-care ruling is more muted than his initial reaction was, and that “by and large” the decision preserved individual liberty.


Publisher's note: This article was originally published on Examiner.com on June 28, 2012. The Examiner.com publishing platform was discontinued July 1, 2016, and its web site went dark on or about July 10, 2016.  I am republishing this piece in an effort to preserve it and all my other contributions to Examiner.com since April 6, 2010. It is reposted here without most of the internal links that were in the original.



Wednesday, February 07, 2018

From the Archives: Virginia Governor Bob McDonnell writes to HHS Secretary about Obamacare burdens

Virginia Governor Bob McDonnell writes to HHS Secretary about Obamacare burdens
February 7, 2011 12:49 PM MST

Arguing that the future of the Patient Protection and Affordable Care Act (PPACA, known colloquially as “Obamacare”) has resulted in uncertainty for consumers as well as providers of health care, Virginia Governor Bob McDonnell has sent a letter to Health and Human Services Secretary Kathleen Sebelius. In his letter, he asks for clarification of several provisions of the PPACA even while insisting that the law is both unconstitutional and bad public policy.


‘Fundamentally flawed’
In his letter, dated February 7, McDonnell says the law “is fundamentally flawed with unconstitutional and inflexible provisions, and should be repealed.” He also predicts that the PPACA will “ultimately be struck down by the U.S. Supreme Court.”

Bob McDonnell Virginia governor Obamacare
Federal judges in both Virginia and Florida have ruled that the law, in particular the so-called “individual mandate” that penalizes people who do not purchase health insurance, is unconstitutional. In the Florida case, the judge ruled that, in the absence of a clear severability clause, the entire law fails to meet the test of constitutionality.

While the judicial challenges to Obamacare are running their course, McDonnell argues in his letter to Sebelius, “states are faced with considerable uncertainty.” In this atmosphere of uncertainty, state government will still have to make decisions about health benefits exchanges and other aspects of PPACA, decisions that are more difficult because state budgets are in a precarious position right now.

Six issues
McDonnell lists six specific issues that require clarification by the federal government to alleviate the uncertainty and assure that the health-care system will not be disrupted between now and 2013, when the federal law is scheduled to take full effect (in the absence of a Supreme Court ruling that it is unconstitutional or the decision to repeal the law by Congress and the President).

Bob McDonnell 2009 Republican convention RPV Virginia
Among the six items McDonnell asks for are “waivers to the costly mandates” of the federal health-care law and permission for states to set their own eligibility rules; waivers of provisions of the law that hinder health savings accounts (or HSAs) that offer free-market solutions to problems in the health-care system; and the commissioning of an objective study that will show “how many people will end up in the exchanges and on Medicaid in every state as a result of the legislation.”

In his closing paragraph, McDonnell states that, if Secretary Sebelius agrees to his suggestions, “governors might be able to provide coverage to our citizens without destroying our budgets or perpetuating and magnifying the most costly aspects of our health care system.”

In addition to sending the letter to Sebelius, McDonnell also provided copies to the entire Virginia congressional delegation and to Indiana Governor Mitch Daniels, who has been widely rumored to be a potential candidate for the Republican presidential nomination in 2012.


Publisher's note: This article was originally published on Examiner.com on February 7, 2011. The Examiner.com publishing platform was discontinued July 1, 2016, and its web site went dark on or about July 10, 2016.  I am republishing this piece in an effort to preserve it and all my other contributions to Examiner.com since April 6, 2010. It is reposted here without most of the internal links that were in the original.

Wednesday, June 28, 2017

From the Archives: Gay and libertarian GOP groups critique SCOTUS Obamacare ruling

Gay and libertarian GOP groups critique SCOTUS Obamacare ruling
June 28, 2012 1:59 PM MST

While politicians around the country have offered their views on the U.S. Supreme Court’s decision today regarding the Affordable Care Act (colloquially known as “Obamacare”), some discrete interest groups within the Republican party have added their voices to the mix.

Two groups with similar initials – LCR and RLC – have weighed in on the debate about the meaning and impact of the Court’s ruling.

Log Cabin Republicans (LCR), which calls itself the largest organization of gay and lesbian activists within the GOP, raised attention to the discriminatory provisions of the health-care laws.

Not ‘carved in stone’
Christian Berle, LCR’s deputy executive director, said in a press statement that Log Cabin Republicans "have not forgotten that Democrats in Congress stripped provisions protecting LGBT families out of healthcare reform when it was passed. We remain committed to ending the Internal Revenue Service’s discriminatory treatment of employer-provided healthcare for domestic partners. While the Court may have found Obamacare to be constitutional, that does not mean it has been carved in stone. Now is the time to go back to the drawing board and institute reforms that work for all Americans.”

Berle also criticized the individual mandate, which was upheld as constitutional based upon its status as a tax.

“By upholding even the most intrusive provision of Obamacare, the individual mandate, the court has enabled Washington’s addiction to big government and coercive taxes,” Berle said, explaining that “the individual mandate forced through Congress was an unprecedented expansion of federal power in blatant disregard of the will of the American people.”

The Republican Liberty Caucus (RLC), an organization of libertarian and classical liberal activists within the GOP, touted its endorsed candidates as the remedy for Obamacare.

‘Unreasonable taxation’

Gay libertarian Supreme Court health care Justin Amash RLC Obamacare
A statement emailed to members and the news media by RLC chair Dave Nalle argued that “while Obamacare may technically be Constitutional, because the 16th Amendment opens the door to all sorts of unreasonable taxation, that does not mean that it is good policy. Raising taxes enormously on every citizen, either directly in the form of penalties or indirectly in the form of mandated health insurance and inflated prices, is outrageous in a time of high unemployment and economic uncertainty.”

The RLC statement explained:

“As fewer and fewer people pay taxes at all, placing an even greater burden on the productive segment of the population is unconscionable. Even worse, this is just the first step. As insurance prices rise the call will come for more interference by government and we will slide into the complete control of the healthcare system by unaccountable bureaucrats, an end to individual choice and a rapid decline in quality of service.”

Saying that today’s ruling provides Republicans with “a winning issue” and “a rallying cry,” the RLC pointed to its candidates as supporters of repeal of the unpopular health-care law.

“Candidates like Ted Cruz in Texas and Barry Hinckley in Rhode Island are poised to join our prior endorsees like Rand Paul and Mike Lee in creating a powerful voting block in the Senate which will never compromise when liberty is threatened,” said the RLC statement.

“In the House those same values which are being championed today by Ron Paul and Justin Amash will be carried forward with reinforcements like Thomas Massie in Kentucky, Lauren Stephens in Wisconsin, Kerry Bentivolio in Michigan, Jessica Puente Bradshaw in Texas and scores of others,” the RLC continued. “With their guidance Congress will reassert its authority over the federal bureaucracy and demand accountability from the executive branch.”

Earlier in the day, an independent gay conservative group, GOProud, also issued a statement severely critical of the Supreme Court’s health-care decision.


Publisher's note: This article is part of a series to mark June as Gay Pride Month. It was originally published on Examiner.com on June 28, 2012. The Examiner.com publishing platform was discontinued July 1, 2016, and its web site went dark on or about July 10, 2016.  I am republishing this piece in an effort to preserve it and all my other contributions to Examiner.com since April 6, 2010. It is reposted here without most of the internal links that were in the original.

Saturday, August 20, 2016

From the Archives: Morgan Griffith, Robert Hurt vote against Rohrabacher amendment on medicinal pot

Publisher's note: This article was originally published on Examiner.com on May 30, 2014. The Examiner.com publishing platform was discontinued July 1, 2016, and its web site was scheduled to go dark on or about July 10, 2016.  I am republishing this piece in an effort to preserve it and all my other contributions to Examiner.com since April 6, 2010. It is reposted here without most of the internal links that were in the original.

Morgan Griffith, Robert Hurt vote against Rohrabacher amendment on medicinal pot

Early in the morning of May 30, the House of Representatives voted to approve an amendment to the Commerce, Justice, Science, and Related Agencies Appropriations Act, 2015 (HR 4660) that has the effect of prohibiting the federal government from interfering in the production or distribution of medical marijuana in those states that have legalized it.

Introduced by Representative Dana Rohrabacher (R-California), the amendment passed on a vote of 219-189, with 49 Republicans and 170 Democrats voting in favor of it. It was the first time the House had voted on a bill related to this topic since 1998.

Virginia Members vote 'no'

Among the members of the Virginia delegation, Representatives Rob Wittman (R-VA1), J. Randy Forbes (R-VA4), Robert Hurt (R-VA5), Bob Goodlatte (R-VA6), Eric Cantor (R-VA7), Morgan Griffith (R-VA9), and Frank Wolf (R-VA10) voted no, while Representatives Scott Rigell (R-VA2), Bobby Scott (D-VA3), Jim Moran (D-VA8), and Gerald Connolly (D-VA11) voted yes.

Morgan Griffith's “no” vote came as something of a surprise, since he has introduced legislation similar to the Rohrabacher amendment. In April, Griffith submitted HR 4498, the ``Legitimate Use of Medicinal Marijuana Act'' or the ``LUMMA''. The bill would restrict the federal government from applying the Controlled Substances Act (as it relates to cannabis) in states that have legalized the medicinal use of marijuana.

Robert Hurt's “no” vote was not as surprising, although in an exclusive interview with the Charlottesville Libertarian Examiner before the Rohrabacher amendment came to the floor, the Fifth District congressman said he was open to the concept.

Hurt explains his position on cannabis
Speaking specifically about Griffith's bill, Hurt told Examiner.com that “I think that the case that [Griffith] makes is very compelling.”

Hurt explained that “it's not good when the government gets between patients and their physicians,” such as when doctors “diagnose chronic and significant pain, nausea, and other issues that could be ameliorated by this treatment.”

The policy change envisioned by Griffith's bill, he said, is “something that we ought to look at and, as Morgan points out, the Virginia law [on medical marijuana] would allow for this if there was no federal ban.”

(Former Delegate Harvey Morgan, a Republican from Gloucester, sought to clarify and strengthen Virginia's medical marijuana statute several years ago.)

Hurt was careful to note that, although he has “the highest amount of respect” for Congressman Griffith, “it's important to just point out that I am not, and never have been, in favor of legalizing marijuana. I don't think it should be legalized.”

The Chatham Republican added, with regard to legalization efforts in Colorado and Washington state, “that those states that have done that in the West, I fear they're going to be sorry that they've done that [and] gone down that road.”

Hurt said he has not yet taken a position on Griffith's medical pot bill, but he is looking at it carefully.

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Original URL: http://www.examiner.com/article/morgan-griffith-robert-hurt-vote-against-rohrabacher-amendment-on-medicinal-pot


Monday, July 18, 2016

From the Archives: Presidential candidate Bernie Sanders stumps for support in Charlottesville

Publisher's note: This article was originally published on Examiner.com on May 13, 2015. The Examiner.com publishing platform was discontinued July 1, 2016, and its web site was scheduled to go dark on or about July 10, 2016.  I am republishing this piece in an effort to preserve it and all my other contributions to Examiner.com since April 6, 2010. It is reposted here without most of the internal links that were in the original.

Presidential candidate Bernie Sanders stumps for support in Charlottesville

White House hopeful Bernie Sanders spoke to an enthusiastic audience in Charlottesville, Virginia, on Monday, May 11, laying out his policy vision and contrasting it directly with that of the Republican Congress and indirectly to that of his opponent for the Democratic presidential nomination, former Secretary of State Hillary Rodham Clinton.

Sanders delivered his remarks to an overflow crowd at Trinity Episcopal Church, whose sanctuary has chairs for just 100 people. Another 175 or so squeezed into a basement room and the narthex.

The event, which was billed as a town hall meeting on the federal budget, had been announced in April, before Sanders, an independent senator from Vermont who caucuses with Democrats on Capitol Hill, had declared his intention to seek the Democratic party's nomination for president.

In what is likely to become his standard stump speech, self-defined Socialist Sanders addressed a range of issues that were only related to the budget in the sense that they are items the government spends money on, such as free college tuition for students in public institutions and a multi-trillion dollar program to improve transportation infrastructure. He decried the Supreme Court's decision in the Citizens United case and proposed public financing for federal election campaigns.

Health care and free trade
Sanders proposed raising the federal minimum wage to $15 per hour and creating a single-payer health care insurance program to replace the Affordable Care Act (so-called Obamacare), or what he called “universal Medicare.”

Sanders also took aim at the Obama administration's support for free trade agreements in the Pacific Rim, pointing out that the minimum wage in Vietnam is about 50 cents an hour.

“All of us, I know, want to see poor people around the world do better. We all do, but there are ways that we can do that without engaging in a race to the bottom in this country,” he said. “Our job is to uplift the poor people around the world, not sink the working people of this country.”

Sanders said he voted against NAFTA (the North American Free Trade Agreement), CAFTA (Central American Free Trade Agreement), and permanent normal trade relations with China, “because these were all trade agreements that were pushed by corporate America, the big monied interest, and I intend to play an active role in defeating the Trans-Pacific Partnership.”

Asked later by the Charlottesville Libertarian Examiner whether he supports renewal of the African Growth and Opportunity Act (AGOA), which expires in September 2015, Sanders offered no position, saying: “You know what? To be very honest, I've been focusing more on the TPP than that.”

'Perpetual warfare'
In a question and answer session following his prepared remarks, Sanders contrasted himself most explicitly with Clinton (without ever mentioning her name) in his discussion of foreign policy.

On foreign policy, he noted that when he was first elected to Congress back in 1991, one of his first votes was against the first Gulf War. His wife predicted that vote would earn him a short congressional career, a remark met with laughter from the audience.

With regard to the war in Iraq that started in 2003, “I had serious doubts about what [President George W.] Bush and [Vice President Dick] Cheney were saying and I had serious concerns about the kind of destabilization that would take place and, sadly, much of what I feared has in fact taken place. I not only voted against that war, I helped lead the opposition to it and, unfortunately, we were not successful.” (Hillary Clinton, then a senator from New York, voted in favor of the Iraq War.)

“Where we are right now is in a very difficult world and I wish I could tell you otherwise but as all of you know, there are terrorists out there who want to do us harm,” he said, adding “we've got to be vigilant in protecting this country against them.”

Sanders continued: “What I would also tell you is that, while some of my colleagues apparently have no idea of what the war in Afghanistan has meant, what the war in Iraq has meant. Some of these guys seem to be itching for another war. I fear very much that, if we don't stand up, we could be in perpetual warfare in the Middle East.”

Referring to the so-called Islamic State (sometimes called ISIS or ISIL), the Vermont senator said that group should be opposed. “Here, I think, is the main point: the United States and Western countries should be very, very supportive but at the end of the day, the only way, in my view, that the war against ISIS is won, is when the Muslim countries stand up themselves and lead that fight.”

Senator Sanders' budget town hall in Charlottesville was the third and last in a series. The other two took place in Maryland and Washington, D.C.

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Original URL:  http://www.examiner.com/article/presidential-candidate-bernie-sanders-stumps-for-support-charlottesville




Friday, June 13, 2014

Interview with Morgan Griffith about medicinal marijuana

U.S. Rep. Morgan Griffith (R-VA9)
Although he voted against a budget amendment designed to circumscribe federal interference in the production and distribution of medical marijuana in states that have legalized it, U.S. Representative Morgan Griffith (R-VA9) has introduced his own legislation to address implications for federalism and individual liberty by reforming the nation's drug laws.

Griffith's bill, the “Legitimate Use of Medicinal Marijuana Act” or the “LUMMA,” would allow physicians to prescribe marijuana for various ailments and provide for experimentation and research by universities and pharmaceutical companies. Prescription of cannabis is currently prohibited under federal law and research is severely limited.

Congressman Griffith explained the aims of his bill in an interview with me on the sidelines of the Republican Party of Virginia's state convention in Roanoke on June 7.

Most of the states that have legalized medicinal marijuana “haven't adopted a policy that I would advocate,” Griffith said. “That is a policy that says that you have doctors involved with a prescription, not just a note that says it might be good for you but a prescription so that we can actually see what we're doing.”


'Loosey-goosey'
Griffith's bill “would also allow for universities and pharmaceutical companies and whomever to start doing experiments with the levels of the THC,” he explained, “because one of the problems you have is, even where people want to use it for medical reasons, whether it be epilepsy or glaucoma and cancer – which is authorized [by law] in Virginia – we don't really know what the right mix of THC and cannabinoid oils are to make the most effective for particular patients.”

Currently, he continued, “because it's a Schedule One drug and the DEA won't reduce it to Schedule Two, you really can't get the research that you need to use it for real medicinal purposes.”

Griffith was critical of the way medical marijuana is regulated in those states where it's legal.

“A lot of the states have a loosey-goosey plan,” he said.

“What we need is to have marijuana treated like any other serious drug, like we treat hydrocodone, like we treat barbiturates, like we treat morphine – treat it seriously, [because] it's a serious medication.”

Once the law treats it that way, he said, then the federal government should “step back and let the states decide whether their doctors can make the prescription. Right now they can't because it's against the federal law and you lose your DEA license to prescribe any drug if you do it.”

Now there are “22 states where the federal government looks the other way and doesn't enforce the law [while] we have a federal law that actually makes it a felony for a hospital or a doctor to actually use it in any kind of an efficacious way.”


Rescheduling
Under the terms of Griffith's bill, the Drug Enforcement Administration (DEA) would reschedule marijuana from Schedule One to Schedule Two. “Some would argue it ought to be Schedule Three, or maybe even lower but Schedule Two gets us the research and allows doctors to use it,” he explained.

While Dana Rohrabacher's amendment to a budget bill last month would have ended DEA and Department of Justice interference in states with legal medical marijuana, that approach does not go far enough for Griffith.

“I think a lot of folks feel that voting for these budget amendments is solving the problem,” he said, adding that it “actually makes the problem more complex because then you have a patchwork set of rules across the nation and it's still a violation of federal law.”

As a result, “whenever a new president comes in, they say to the DEA, 'Go get those people, they're in violation of federal law.' I don't want to do that. I want there to be a respect for the law but let's get the law right.”

The right way to reform the law, he explained, is to “have our doctors, our trained medical professionals, prescribing it, and have our universities and our pharmaceutical companies testing it to get the dosage right.”

Griffith's bill, designated HR 4498, currently has two cosponsors: Rep. James Moran (D-VA8) and Rep. Alan Lowenthal (D-CA47). It has been referred to the House Committee on Energy and Commerce, chaired by Michigan Republican Fred Upton, where it awaits action.

Reason magazine this month posted two informative articles about legalize marijuana. In "Weed Isn't All That Scary," syndicated columnist Steve Chapman reports on his experience visiting legal pot shops in Colorado. Elizabeth Nolan Brown published "FAQ: All About Legal Pot," to answer readers' burning questions.

(This article appeared in slightly different form on Examiner.com.)




Monday, April 14, 2014

Will Medicaid expansion actually make poor people healthier?

Members of the General Assembly who oppose Governor Terry McAuliffe's proposals to expand Medicaid in Virginia under the terms of the Affordable Care Act (ACA, also called "Obamacare") may find some intellectual ammunition to bolster their case in a study published on March 24 by the Mercatus Center at George Mason University.

The Economics of Medicaid: Assessing the Costs and Consequences, edited by Jason J. Fichtner, contains a lot of wonkish economic analysis, such as Nina Owcharenko's chapter on "the state side of the budget equation," which shows the astronomical growth in Medicaid spending and enrollment over the past two decades (see the graph to the upper left), but the most significant findings may be in the book's last chapter, by Robert F. Graboyes and titled "Medicaid and Health."

Graboyes relies on previous studies in several states and on reports from the Government Accountability Office and other federal agencies to demonstrate that people who rely on Medicaid for health insurance not only have worse health comes than those who have other types of insurance, but worse than people with no insurance at all.

What's more, rather than taking patients out of emergency rooms and putting them in doctors' offices for routine health care, expansion of Medicaid coverage tends to increase emergency room visits by Medicaid recipients.

I'll let Graboyes -- a senior research fellow who was formerly an economist with Chase Manhattan Bank and the Federal Reserve Bank of Richmond, as well as a faculty member at the University of Richmond -- tell it in his own words (end notes omitted).

Pages 175-76:
A Mercatus publication I authored in 2013 stated the following: “An ideal health care system will provide better health to more peo­ple at lower cost on a continuous basis.” By this standard, Medicaid is an abject failure. For lower-income Americans, Medicaid yields poor coverage, poor care, and poor medical outcomes. While prom­ising coverage far beyond the program’s original scope, it fails to enroll millions of people who are among its intended population and who are eligible for enrollment. The data suggest that Medicaid does surprisingly little to improve its recipients’ health and in some ways may even harm them indirectly. It is a pennywise-and-pound-foolish program that, paradoxically, sends costs soaring by underpaying pro­viders. And the coverage, care, and cost elements show little or no improvement over time.

Pages 181-82:

In 2010, the University of Virginia conducted a large-scale study that suggested that an individual without insurance has better health outcomes than an individual on Medicaid.47 Even after adjusting for risk factors, Medicaid patients had higher in-hospital mortality, longer hospital stays, and higher costs—compared with the uninsured, those on Medicare, and those on private insurance plans.48 A University of Pennsylvania study examined data on patients receiving surgery for colorectal cancer; Medicaid patients had higher mortality and surgical complications than uninsured patients.49 A 2011 Johns Hopkins study found that “Medicare and Medicaid patients have worse survival after [lung transplantation] compared with private insurance/self-paying patients.”

Perhaps the most damning of all the recent studies is the Oregon Experiment. This was a rare example of a large-scale, fully ran­domized experiment in health care. In 2008, Oregon expanded its Medicaid program. Approximately 90,000 people applied for 30,000 newly available slots, and the state used a lottery to choose who got in and who did not. Afterward, the state tracked the health of 6,387 adults who were chosen and 5,842 who were not. From a standpoint of physical health, the results were devastating: “This randomized, controlled study showed that Medicaid coverage generated no sig­nificant improvements in measured physical health outcomes in the first 2 years, but it did increase use of health care services, raise rates of diabetes detection and management, lower rates of depression, and reduce financial strain.” Supporters of Medicaid point to positives that follow the word “but” in the preceding sentence.

Page 177:


Rapid expansion of Medicaid, as envisioned under the ACA, also has the potential to touch off a cycle of expansion, financial over­load, and mass cancellations of coverage. The best example of such a process is the TennCare disaster that began in 1994 in Tennessee. The state sought to convert Medicaid to managed care, assuming this would lead to enough savings (from efficiency gains) to cover children and the uninsured. In less than a decade, however, enroll­ ment swelled far beyond what had been predicted, and the savings proved elusive. The expansion threatened the state government with bankruptcy and, by 2006, the program was forced to cancel cover­age for approximately 200,000 Tennesseans. A high-profile study of Oregon’s Medicaid expansion provides powerful new evidence that expansion increases rather than decreases the use of emergency services; putting it another way, one of the principal arguments in favor of expansion now appears illusory [emphasis added].

The whole book, which is also available in a Kindle edition, is chock-a-block with nuggets like these. Even legislators who don't read bills before they vote on them should read this book.

Cross-posted from Bearing Drift (April 12, 2014).

Sunday, January 24, 2010

Fifth District Republicans Debate

Last Friday evening, six of the seven declared candidates for the Republican nomination for Congress in Virginia's Fifth District came together for a forum sponsored by the Lynchburg and Jefferson Area Tea Parties. The candidates' forum took place at the Lane Auditorium in the Albemarle County Office Building in Charlottesville.

The forum was carried live on the radio on WCHV-AM 1260 and -FM (94.1) and that station's morning host, Joe Thomas, welcomed the audience and introduced the participants, including moderator Robert Tracinski, editor and publisher of The Intellectual Activist.

Keith McGilvery covered the debate for WVIR-TV (NBC29) in Charlottesville:

Within minutes, talk turned to health care, where the candidates thought it had gone wrong, and how they would fix it.

Candidate Michael McPadden says, "I don't see where the federal government has any role in mandating any sort of healthcare reforms, we can do this via free market reforms, there's a number of things we can do."

A number of candidates at the tea party sponsored showdown argued that creating competition is key.

Candidate Ron Ferrin said, "The bottom line is, my philosophy in government is capitalism is the cure and that is exactly what we're talking about to cure health care."

Candidate Feda Morton says, "We do need to be able to have access to insurance across state lines to make competition between the different insurance companies, so people can compete and choose the insurance they want."

Laurence Verga says, "The health care system needs to move from an employer based system with a limited amount of companies buying insurance to an open market system."

Ken Boyd said, "We need to move out there to the people and let them negotiate for their own health care, that's just one step in the right direction."

One candidate made the case that keeping an eye on our borders could help curb costs. Candidate Jim McKelvey says, "again, shut the borders illegal immigration is a huge burden on our health care system, and it needs to stop."
McGilvery noted, as did others, that state Senator Robert Hurt did not participate in the forum alongside his six opponents for the GOP nod. A playful effigy of Hurt, however, was erected on the dais. Surprisingly, Hurt's absence (and the presence of his cardboard image) was only mentioned once or twice by the other candidates, who chose to focus on the issue-oriented questions that were posed to them by moderator Tracinski.

Brian McNeill, a reporter for The Daily Progress, noted a few of the candidates' other responses in a story on GoDanRiver.com:
Each was asked what his or her top priority would be if elected to Congress with a GOP majority.

Ron Ferrin, a businessman from Campbell County, said he would try to erase everything passed so far during the Obama administration

“I would propose the Liberty Recovery Act of 2011 that would repeal everything that Obama was going to induce in his first two years of office,“ he said.

Michael McPadden, a commercial pilot from North Garden, said he would seek to boost economic activity by cutting taxes and reducing government spending. “You want jobs in this country, then you cut taxes,“ he said. “Cut the size and scope of the federal government."

Laurence Verga, a private real estate investor from Ivy, said he would slash a long list of taxes, including corporate and small business taxes, as well as the estate and capital gains taxes.

Verga said the voters deserve better than the “devastation of Tom Perriello” when it comes to the economic problems facing the district. “We can and we will do better,“ he said.

Jim McKelvey, a Franklin County real estate developer, said he would reduce the size of the federal government by 20 percent and bring to the floor of Congress a bill that would implement the so-called FairTax that would eliminate federal income taxes and replace them with a retail sales tax.

The candidates were asked if they disagreed with any actions undertaken during the George W. Bush administration.

Verga said he objected to the Troubled Asset Relief Program bank bailout, the McCain-Feingold limits on campaign finance and the No Child Left Behind education reform.

Feda Kidd Morton, a Fluvanna County biology teacher and GOP activist, said she opposed the bank bailout and also the North American Free Trade Agreement, which was actually signed by Bill Clinton in 1994.

“I go back to NAFTA, definitely. NAFTA is draining our jobs overseas,“ Morton said. “I would take NAFTA off the table and bring our manufacturing jobs and businesses back into this country."

McPadden also looked to earlier administrations for his sources of criticism. “I’d go back to the Carter administration, get rid of the Education Department first,“ he said. “Go back to the Clinton administration, AmeriCorps has got to go. Go back to the Bush administration, TARP funding has got to go. And no funding for ACORN ever."

Albemarle County Supervisor Kenneth C. Boyd told the crowd that he has a decade’s worth of experience reducing government spending and balancing budgets.

“We need someone willing to step up, cut spending and balance the budget,“ he said. “That’s something we’ve done here in Albemarle County."

Boyd said he, too, would take drastic steps to reduce the size of the federal government.

“The federal Department of Education should be done away with,“ Boyd said, saying it is unconstitutional.
The whole discussion lasted about 90 minutes, and I was able to capture virtually all of it on video, which I had to upload to YouTube in small bites. (That is why the Democratic blog, Blue Virginia, has just two segments posted within its report on the event.)

Here is the complete discussion, in eleven parts:

Part I is the introduction by Joe Thomas and Robert Tracinski:


Part II includes the opening statements by the six candidates:


Part III has the answers to Tracinski's first question,"Would you consider opposing a bill for no other reason than that it grants powers to the government that are not specifically authorized by the Constitution?":


Part IV has the answers to the moderator's second question,"What should we do about health care?":


Part V begins a "lightning round," with two questions requiring answers just 30 seconds long. The first question of the two asks what should be the top priority of a Republican-controlled Congress after next November's elections; the second asks, "What legislation or other measure would you reverse ... from the Bush administration?":


Part VI also includes two questions, "What is the most important thing the government should to to get people back to work?..." and "What will you do to defend [the right to work]?":



Part VII continues the fast-track questions, with one on "cap-and-trade" and the EPA's authority to regulate carbon dioxide, and the other on the candidates' favorite or most influential philosopher or thinker:

After a short intermission and the announcement that the audience had 400 people in it, Part VIII returned to questions requiring a 90-second answer. That question focused on what the candidates thought about the Tea Party movement.


Part IX continues with an answer to the question asked in Part VIII; Michael McPadden's response didn't fit into the 10 minutes allotted to a video clip by YouTube:


The question in Part X assumes there is a Republican majority in the 112th Congress and looks back at the 1994 GOP takeover, asking how the candidates would vote if there was a conflict with a Democratic president like the budget showdown in 1995 between Bill Clinton and the House under the leadership of Newt Gingrich.


In Part XI, the final segment, Robert Tracinski asks about "big middle-class entitlements," namely Social Security and Medicare.

A straw poll taken after the candidates' forum gave Mike McPadden a strong lead at 56.2 percent. Full results can be seen at Virginia Fifth District Watchdog.



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Monday, January 11, 2010

Virginia Attorney General Issues Opinion on Health Care Legislation

At the request of Lieutenant Governor Bill Bolling, Virginia Attorney General William Mims has issued a two-page opinion on the constitutionality of the health care legislation (HR 3590) currently under consideration by the U.S. Congress.

The substantive text of his opinion letter follows (footnotes omitted):

I write in response to your recent letter concerning the “Patient Protection and Affordable Care Act,” pending in the Congress of the United States. You inquire about the constitutional validity of two provisions. One provision would, after a period of several years, exempt Nebraska in perpetuity from increased costs associated with the expansion of Medicaid. No other state, including Virginia, is afforded similar treatment. The other provision would require every citizen of the United States to obtain health insurance or face significant penalties. I share your concerns about the constitutionality of both provisions.

The Constitution creates a Federal Government of enumerated powers. See U.S. Const. Art. I, § 8. As James Madison wrote: “[t]he powers delegated by the proposed Constitution to the federal government are few and defined. Those which are to remain in the state governments are numerous and indefinite.” The Federalist No. 45, pp. 292-93 (C. Rossiter ed. 1961); see also U.S. Const. amends. IX-X. This constitutionally mandated division of authority “was adopted by the Framers to ensure protection of our fundamental liberties.” Gregory v. Ashcroft, 501 U.S. 452, 458 (1991) (internal quotation marks omitted). “Just as the separation and independence of the coordinate branches of the Federal Government serve to prevent the accumulation of excessive power in any one branch, a healthy balance of power between the states and the federal government will reduce the risk of tyranny and abuse from either front.” Id Therefore, to justify federal legislation, a source of authority must be located in the Constitution. Equally important, legislation may not infringe on rights provided by the Constitution. With those considerations in mind, I address your specific concerns below.

I. Mandatory purchase of insurance
Among the powers accorded to Congress is the power “to regulate Commerce ... among the several States.” U.S. Const. Art. I, § 8, cl. 3. Following the enactment of President Roosevelt’s New Deal program, the Supreme Court of the United States “ushered in an era of Commerce Clause jurisprudence that greatly expanded the previously defined authority of Congress under that Clause.” United States v. Lopez, 514 U S 549, 556 (1995) The Court has concluded that Congress’ authority s not limited to “the regulation of commerce among the states,” Ed. at 555, but further allows Congress to regulate activities that “affect interstate commerce.” Id. The Commerce Clause power is broad, but it is not without limits. In Lopez, 514 U.S. 549, the Supreme Court struck down as unconstitutional the Gun-Free School Zones Act of 1990. See also United States v. Morrison, 529 U.S. 598 (2000) (invalidating Violence Against Women Act of 1994). Although health care is an economic activity, the failure to purchase health insurance is not an economic activity. The insurance mandate is open to constitutional challenge — although it is not clear that such a challenge would succeed, given the breadth of the Supreme Court’s interpretation of the Commerce power.


II. The “Nebraska exception”
You inquire whether the Equal Protection Clause of the Fourteenth Amendment would provide a basis for challenging the Nebraska Exception. The Equal Protection Clause, by its plain terms, applies only to the states, not to the United States. U.S. Const. amend. X1V § 14. Therefore, a state could not bring a viable equal protection challenge to the Nebraska exception currently found in the pending legislation.

The Nebraska exception is vulnerable, however, on other constitutional grounds. The Constitution provides Congress with the power to collect taxes and to spend money for the “general Welfare of the United States.” U.S. Const. Art. I § 8, cl. 1. Once again, the Supreme Court has given Congress very broad latitude in the exercise of this power. See South Dakota v. Dole, 483 U.S. 203 (1987). Nevertheless, that latitude “is of course not unlimited.” Id. at 207. One of those limits is that Congress must, as the Constitutional text unambiguously commands, spend in pursuit of the “general welfare.” Id. In my view, carving out an exception for a specific state, unrelated to any policy objective other than to secure the vote of a particular senator, would exceed the bounds of what Congress may do under the Spending Clause. Where the taxing and spending is intended to effectuate a benefit for a single state, solely to gamer the vote of a particular senator from that state rather than for the general welfare, the spending at issue is unconstitutional. To conclude otherwise, would mean that the General Welfare Clause is meaningless.

This will not be the final word on this subject.  I expect other states will also be weighing in on the constitutionality of Obamacare.



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Tuesday, September 08, 2009

The Cost of Health Care 'Reform' to Virginians

The Virginia Institute for Public Policy released a new study today on the effects of proposed health care reforms on families in the Old Dominion. Produced by a team of economists that includes Arthur Laffer, the study is entitled "The Prognosis for National Health Insurance: A Virginia Perspective."

Among its conclusions are these bullet-points, from a news release released at a press conference in Richmond:

-- Funding health-care reform based on President Obama's priorities will [cost] $4,176 for every person in Virginia. This comes to $32.4 billion in total costs that Virginians will have to bear.

-- In addition to federally-funded expenditures, Virginia government expenditures through 2019 that will occur as a result of federal health-care reform is $2.1 billion, or a $275 bill for every person in Virginia.

-- Virginia would see reduced economic growth in 2019 by 4.5 percent.

-- If the federal government pushes the financial responsibility for covering the expansion of lower-income individual's health-insurance coverage off to the states, Virginia's costs will increase by a total of $6.8 billion, while the federal costs will decline.
While the full study is 44 pages long, a four-page executive summary is available on the Virginia Institute's web site.

I was able to capture the entire news conference today, divided up per YouTube's rules into six unequal parts.

In Part I, John Taylor of the Virginia Institute opens the news conference and introduces the participants, economist Donna Arduin of Arduin, Laffer & Moore Econometrics and U.S. Representative J. Randy Forbes (R-VA4).


Part II features the remarks of Donna Arduin, one of the study's three co-authors:


Congressman Forbes talks about the politics of health care reform on Capitol Hill in Parts III and IV:




Donna Arduin and Randy Forbes take questions from the audience in Part V and Part VI:







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Thursday, July 16, 2009

To Sur, With Love

As part of the gargantuan (1,000-page-plus) health care "reform" package introduced by members of the Democratic majority in Congress, the Obama administration proposes to raise taxes through a "surtax" on Americans who earn the most money.

The Washington Post explained this "soak the rich" policy in a front-page article on July 15:

The surtax would start at 1 percent and rise to 5.4 percent on income exceeding $1 million. Combined with the expiration next year of tax cuts enacted during the Bush administration, the surtax would drive the top federal tax rate to 45 percent, the highest level since lawmakers rewrote the tax code in 1986.
The Washington Times, for its part, points out that this raises U.S. marginal tax rates to their highest levels since the 1980s:
A new surtax of 5.4 percent in the health care bill, which would apply to married couples' income above $1 million, would bring the top federal income tax rate to 45 percent.

After consideration of state and local income taxes and the Medicare payroll tax, which applies to all wage and salary income, taxpayers in 39 states would face a top marginal income tax rate of more than 50 percent, according to a study by the Tax Foundation, a nonprofit tax research group based in the District.

"That means government would be taking more than half of every additional dollar from high-income taxpayers," said Tax Foundation President Scott Hodge. "The lowest tax rate would be 47 percent - and that's in the nine states that don't tax wages."

Businesses say the surtax would hurt the economy.

"The intention of this plan is to tax high-income households, but the real victims would be America's small-business owners," said Thomas Donohue, president of the U.S. Chamber of Commerce. "Placing a big tax burden on the small-business community would rob them of the resources they need to create the jobs that will lead us out of the recession."
President Obama would be wise to look to history to see what happened the last time a president made a surtax the centerpiece of his economic program. (Some might object that this is a "health care" program. That's true, up to a point. The fact that the bill has been referred to the Finance Committee in the House suggests that this is really a revenue bill.)

In Yanek Mieczkowski's 2005 book, Gerald Ford and the Challenges of the 1970s, the Dowling College historian relates what happened when Ford proposed a 5 percent surtax on all incomes above $15,000 (more than it sounds like; remember, these were 1974 dollars) in his first major economic legislative package:
As what he termed "the acid test of our joint determination to whip inflation in America," Ford pronounced the cornerstone of his new economic program, a one-year, 5 percent surcharge on corporate and personal incomes. The surtax was directed at individuals with yearly earnings of $15,000 or more for married taxpayers and $7,500 for the unmarried. (Taxpayers would have to figure out what they normally owed the government, then add the 5 percent surtax to it.) The advantages of the surtax were that it would be mildly progressive, since the rich would pay more, and temporary, lasting only the calendar year 1975. Nor was it onerous. For example, a single person earning $15,000 would pay a federal income tax of $2,549; the surcharge would add $78. (p. 121)
Despite its modest appearance, Ford's proposal was met with strong opposition, especially from the Democrats who held a majority in Congress (a majority that would grow substantially after the midterm elections a few weeks after his proposal was announced). Republicans were not too fond of it, either.
Ford took a political risk by proposing a surtax less than a month before congressional elections. Unveiling a tax increase at such a time was like unleashing a skunk at a picnic; representatives and senators ran in the opposite direction, refusing to embrace or even come close to it. Officeholders facing difficult reelection battles, such as GOP senators Bob Dole of Kansas and Marlow Cook of Kentucky, deserted their president rather than support the proposal....

The program itself was a political bomb. The jumble of proposals gave the whole thing an eclectic feel, and the centerpiece -- a tax increase -- fell flat. One poll showed that Americans opposed the surtax, 58 to 34 percent. Members of Congress resisted it. Just two days after the speech, William Baroody warned Ford that it was "in serious trouble on the Hill and very unpopular politically" and that Congress was in no mood to reduce spending. Two weeks before the election [William] Seidman publicly acknowledged that the surtax faced an uphill struggle on Capitol Hill and called its prospects "uncertain." The overwhelming Republican repudiation in the ensuing elections turned "uncertain" to "doomed." Ford's policy making was off to a rocky start. (p. 124; footnotes omitted)
In one of the more significant parenthetical partial paragraphs of any work of recent history, however, Mieczkowski writes:
(One economist's skepticism about the surtax generated what later became a mainstay of Ronald Reagan's "supply-side" economics. Arthur Laffer doubted that the 5 percent surtax would generate much revenue, and while dining at a restaurant with Ford administration members Don Rumsfeld and Dick Cheney, he drew a graph on a napkin to illustrate his belief that tax cuts -- rather than increases -- would raise more revenue because of increased business activity. His illustration became known as the "Laffer Curve.") (p. 122)
Apparently other economists caught on, even if they hadn't seen the napkin. Yanek Mieczkowski writes on page 130:
By November, many economists, realizing that Ford had miscalculated, urged him to drop the surtax proposal and switch his focus to fighting the recession. The president stuck by the surtax and still urged budget cuts.
In the end, the surtax proposal crashed and burned. Mieczkowski notes on page 131:
A political science axiom says that "the president proposes, Congress disposes." Congress certainly disposed of Ford's surtax, and quickly. Although he developed a fiscally balanced program incorporating many recommendations from the economic summit conferences, it was also like a multipronged barb that Congress could not swallow. And it soon became incongruous. The deteriorating economy, coupled with the inherent unpopularity of a tax increase, doomed Ford's first major economic initiative. But that failure was fortunate; as events played out, a surtax would have aggravated the downturn. (emphasis added)
History teaches us, and not just in this example from the mid-1970s, that raising taxes during a recession is a bad idea.

Barack Obama and congressional Democrats have not absorbed this lesson of history and economics. Should they succeed in raising taxes to finance their ambitious program to socialize medicine, they -- or, rather, we -- will live to regret it.



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