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The President’s Health Care Law

As I travel around Wisconsin, I hear from more and more individuals who have serious concerns about what the implementation of the Affordable Care Act (ACA), commonly referred to as Obamacare, will mean for them, their families and their businesses.  Businesses, policy experts, government actuaries, and even some supporters of the law have confirmed what the country already knew: the ACA is bad policy that does not accomplish what it was designed to do.  Instead, the law spends trillions of dollars we don't have, raises taxes on workers, businesses and families, and puts the federal government squarely in the middle of health care decisions.  And as we have seen, it is resulting in cancellation notices and massive premium increases for families and individuals in Wisconsin and nationwide.

During the first week of the 114th Congress, the House took steps to mitigate some of the more egregious side effects of the ACA's mandates.  On January 6, 2015, the House passed H.R. 22, the Hire More Heroes Act of 2015.  This legislation would amend the Internal Revenue Code to permit an employer, when determining whether it must provide health care coverage to its employees under the ACA, to exclude employees who have coverage under a health care program administered by the Department of Defense—including TRICARE or coverage provided by the Department of Veterans Affairs.  This legislation, which has since become law, encourages small businesses across the country to hire veteran’s who have served our country honorably.  On January 8, 2015, the House passed H.R. 30, the Save American Workers Act.  This legislation would repeal the 30-hour definition of full-time employee in the ACA for purposes of the employer mandate and replace it with a 40-hour definition for a full-time employee.   The 30-hour definition of full-time employment in the ACA has harmed job creation and growth, especially among low income Americans.  I was pleased to support and see the passage of both of these bills in the House, and I look forward to further Senate consideration of H.R. 30.   

There is no doubt that health care reform is needed in this country, but the law the President signed aggravates the worst aspects of the U.S. health care system, without fixing what was and remains broken.  The troubled rollout of the ACA goes far beyond a dysfunctional website.  For too many Americans, the ACA simply means increased costs and cancellation notices.  The negative effects of this law on Americans are sweeping.  In fact, in early December 2015, the Congressional Budget Office noted that, “the labor force is projected to be about 2 million full-time-equivalent workers smaller in 2025 under the ACA than it would have been otherwise.”  Instead of offering quick fixes that only temper the consequences, Congress should instead be focused on offering much-needed reforms to our nation's health care industry.

As you may know, the House has acted boldly to make use of the reconciliation process this Congress.  After working to resolve budget differences between the House and the Senate, Representative Tom Price introduced a reconciled budget report on October 16, 2015.  This bill, H.R. 3762, the Restoring Americans' Healthcare Freedom Reconciliation Act of 2015, dismantles the president's demonstrably unworkable health care law.  H.R. 3762 repeals the individual mandate, the employer mandate, the medical device tax, and the "Cadillac" tax on high value insurance plans.  By eliminating the most coercive and onerous pieces of the Patient Protection and Affordable Care Act (ACA) and by laying the foundation for a patient-centered system, H.R. 3762 would force President Obama to deal with the fact that his health care law has resulted in higher costs and lower quality care for working families. 

 H.R. 3762 would also strip federal funds from Planned Parenthood for one year while the House conducts an investigation into whether or not this organization has committed federal crimes related to the harvest and sale of aborted babies' body parts for profit.  To make sure women have access to quality health care, this bill increases funding to the Community Health Center Fund by $235 million dollars in each of the next two fiscal years.  On October 23, 2015, in bipartisan fashion and with my support, the House passed H.R. 3762 by a vote of 240 to 189.  On December 3, 2015, the Senate passed this bill with minor changes by a vote of 52 to 47.  On January 6, 2015, the House once again acted in bipartisan fashion and passed the Senate's version of H.R. 3762 by a vote of 241 to 168.  However, on January 8, 2016, the President vetoed this legislation. 

Despite the president's veto, the passage of this budget reconciliation bill is a major victory for those who believe in patient-centered health care reform and the sanctity of human life.  After more than five years of trying to put a bill on the president's desk to repeal his health care law, the Congress was able to hold the president accountable for the unmitigated disaster that is his signature policy item. 

In the coming year, Congress will advance solutions that strengthen health care security by taking power away from the government and insurance companies; and instead empowering patients with control over their care.  These solutions should realign incentives so that individuals and their doctors—not government bureaucrats or insurance company bureaucrats—are the nucleus of our health care system.  This requires reforms — which I have introduced in the past — to equalize the tax treatment of health care insurance, invite true choice and competition, and ensure critical programs like Medicare and Medicaid can deliver on their promise in the 21st century.

House Proposals to Reform Medicare

Our government has a spending problem—a problem so large that it is driving up our debt, hurting our nation’s ability to create jobs, and threatening our future.  In the past, Washington has not been truthful about the magnitude of these problems facing our country, but we can no longer afford to put off an honest, fact-based conversation on how to solve them.

No one person or party is responsible for the looming crisis.  Yet the facts are clear: major spending increases have failed to deliver promised jobs.  The safety net for the poor is coming apart at the seams.  Government health and retirement programs are growing at unsustainable rates.  The new health care law has created a tremendous fiscal burden, and a complex, inefficient tax code is holding back American families and businesses.

The House-passed budget, which was passed last year, repeals the President’s disastrous new health care law and protects the health and retirement security of those who need it.  With the creation of Medicare in 1965, the United States made a commitment to help fund the medical care of elderly Americans to ensure that a serious illness would not exhaust their life savings or the assets and incomes of their working children and younger relatives. 

With approximately 10,000 “Baby Boomers” turning 65 every day, Medicare’s structural imbalance threatens beneficiaries’ access to quality, affordable care.  Currently, Medicare reimburses health care providers for services, creating a perverse incentive to order more tests and perform more services than may be necessary as a way to maximize a health care providers’ profits under the program.  By basing payment on volume, not quality, costs rise and efficiency is reduced.  Ultimately, this flaw in the structure of the program is driving up health care costs, which are, in turn, threatening to bankrupt the system – and ultimately the nation.  Unless Congress fixes what’s broken in Medicare, without breaking what’s working, the program will end up causing exactly what it was created to avoid – millions of American seniors without adequate health security and a younger working generation saddled with enormous debts to pay for spending levels that cannot be sustained.

It is morally unconscionable for elected leaders to cling to an unsustainable status quo with respect to America’s health and retirement security programs.  Current seniors and future generations deserve better than empty promises and a diminished country.  Current retirees deserve the benefits around which they organized their lives.  Future generations deserve health and retirement security they can count on.  By making gradual structural improvements, Congress can preserve America’s social contract with retired workers.

Recognizing the problems facing Medicare, the House-Passed Budget:

  • Strengthens health and retirement security by taking power away from government bureaucrats and empowering patients with control over their care.

  • Repeals the new health care law’s unaccountable board of bureaucrats empowered to cut Medicare in ways that would jeopardize seniors’ access to care.

  • Saves Medicare for current and future generations, with no disruptions for those in and near retirement.

  • For younger workers, when they become eligible, Medicare will provide a premium-support payment and a list of guaranteed coverage options – including a traditional fee-for-service option – from which recipients can choose a plan that best suits their needs.

  • Premium support, competitive bidding, and more assistance for those with lower incomes or greater health care needs will ensure guaranteed affordability for all seniors.

Allowing the federal government to break its promises to current seniors and to future generations is unacceptable.  The reforms outlined in the budget passed by the House protect and preserve Medicare for those in and near retirement, while saving and strengthening this critical program so that future generations can count on it to be there when they retire.

House Proposals to Reform Medicaid

Medicaid is meant to offer affordable care to those with limited financial resources including: low income children, parents, women who are pregnant and seniors.  Unfortunately, the program’s costs are bursting at the seams.  The Congressional Budget Office projects federal spending on this program to be $335 billion in Fiscal Year 2015; this amount is expected to grow by 75 percent within the next 10 years.  Should this worrying trend continue to be ignored, Medicaid will continue to overwhelm state and federal budgets and fail the vulnerable people who need it most.

Specifically, the House-Passed Budget, which passed last year:

  • Secures the Medicaid benefit by converting the federal share of Medicaid spending into a block grant tailored to meet each state’s needs, indexed for inflation and population growth. This reform ends the misguided one-size-fits-all approach that has tied the hands of so many state governments.  States will no longer be shackled by federally determined program requirements and enrollment criteria.  Instead, they will have the freedom and flexibility to tailor a Medicaid program that fits the needs of their unique populations.

  • Improves the health care safety net for low-income Americans by giving states the ability to offer their Medicaid populations more options and better access to care.  Medicaid recipients, like all Americans, deserve to choose their own doctors and make their own health care decisions, instead of having Washington dictate those decisions for them.

  • Repeals the Medicaid expansion contained in the President’s Health Care Law and removes the laws burdensome programmatic mandates on state governments.

All Americans will pay more because of this broken Medicaid system – and not just in higher taxes. Because Medicaid’s reimbursement rates have been ratcheted down to below-market levels, the care that Medicaid patients receive is often substandard.  Offering states more flexibility for their Medicaid beneficiaries will remove the stigma Medicaid recipients face, and allow them to take advantage of a range of available options.  Several of the nation’s governors have made innovative proposals to fix Medicaid.  The House passed budget encourages further efforts in this direction.

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