NTF Issue Paper: cong65.doc.  8-09.




BACKGROUND.  Our health care system is the best in the world, yet it appears too expensive, confusing, inefficient, and uneven in outcomes, leaving too many with uncertain access to medical benefits.  Our system could function much better at delivering value for dollars. We can maximize our system by making the consumer the key decision maker regarding health dollar expenditures.  Instead of empowering citizens, ObamaCare in HR 3200 would erode our rights to make key health care decisions by centralizing crucial decision-making and benefits in Washington, D.C.  This agenda swiftly would transfer to the feds regulatory authority over health insurance and the kinds of benefits and medical treatments we receive in our health coverage.  It would dismiss the rights of families to obtain coverage compatible with  ethical, moral, and religious beliefs.  Bureaucrats and politicians, not families and doctors, would control our health care choices and decisions.  In our economic recession, Nebraskans may stand only one paycheck away from losing health care coverage.  To safeguard our health, we must urge Congress to promote free market action in health insurance reform. 


OBAMACARE.  Showing his leftist colors, Obama crowed at a Green Bay, WI. rally that “the free market has not worked perfectly when it comes to health care.”  Everyone must buy an insurance policy that meets specific federal requirements and benefit levels, not specific personal needs (pp.72, 85). All private plans must conform.  ObamaCare would add requirements for minimal coverage, so citizens must purchase more expensive policies. The Kennedy Bill would force us to pay about 10% more for insurance policies, meeting mandates we may not need.[1]  Nebraskans presently satisfied with their insurance policies would have to buy insurance that meets the Obama definition of acceptable insurance. All workers must enroll in a qualified plan or face a fine, even though you and your employer pay the whole cost of the health plan you already have and like.  A federal insurance plan like Medicare would compete with private insurance, consumers initially choosing either.  Subsidies and cost-shifting would encourage Nebraskans to gravitate to ObamaCare.  Lower costs for ObamaCare, which could charge lower premiums than private insurers, would drive the latter from the market.  83 million Americans forced into ObamaCare.[2]  The feds would subsidize and operate the development of a national system of electronic medical records, allowing Big Brother to view all our personal health information and provide hackers with a tempting target.[3]  Obama proposals would lead slowly but certainly to a wholly government-operated system as in Canada.  The feds would control most of our health insurance decisions, how we buy it, its content, our payments, and relationships among insurers, doctors, and patients.  Government bureaucrats, not medical professionals, would determine if we receive specific medical services. The Senate version would assign everyone to a primary care doctor who narrowly would control access to specialists.  A Medical Advisory Board, not your physician, would decide what procedures you can undergo.  A Federal Health Board would steer treatments in a particular direction. A Telehealth Advisory Committee would dispense medical care by phone (p.379, Sec. 1191). Millions would lose established relationships with their doctors.  ObamaCare would not lower the cost of health care, because there exists no evidence that its preventive care and computerized medical records would lower costs.  Proposals centered on cost containment actually limit patient access to health care, rationing.  This approach is in S. 703, introduced by Socialist Sen. Bernie Sanders (VT.), and HR 676, introduced by Rep. John Conyers (MI).  Their Canadian-style system would outlaw private health care spending, forcing all into ObamaCare.  With every state and hospital assigned a specific yearly budget, patients would face rejection after funding ended.  This single payer system will use our tax money to pay the bills, make rules, and decide precisely what care each receives.  The quality of our health care will drop, as with other government care.  Medicare has enormous gaps in coverage; Medicaid quality controls are notoriously poor.  Both offer substandard care compared to private insurance plans.  Instead of repairing these 2 systems, Obama seeks to make these programs the foundation of his universal scheme.[4]  Medicaid would expand to include those living with incomes below 133% of the poverty level!  Medicare would include those 55 and over.  Individuals up to age 26 could remain on parent insurance policies, though adults that age should have resources to pay for their own insurance.  The Senate version mandates 84 new federal programs, including over 100,000 new bureaucrats.[5]

 ONE SIZE FITS ALL.  ObamaCare will yoke all Americans to a managed care plan, our health care coordinated by a primary care provider, but not permitted to see specialists or receive special testing whenever one wishes.  Doctors would win payment with incentives or face penalties to encourage cost-effective care. The fewer tests and referrals allowed, the more the physician earns (Sec. 2707).   Only plans meeting all the restrictions listed in the bill and HHS criteria, plans with managed care controls, will pass muster (Secs. 3101 and 2707).  Cost controls a priority, these requirements are like the unpopular controls HMOs imposed decades ago that caused a public furor and state laws to avoid abuses.  These HMOs withheld 10% or more of physician fees until the end of the year and paid only to doctors who met targets for limiting how many referrals to specialists or diagnostic tests their patients used….rationed care.  The targets were so restrictive that, if exceeded, what your physician prescribed for you came from his profit at the end of the year, causing a conflict of interest (Sec. 161, pp. 111-115).[6] 

PRIVATE INSURANCE ENDED.  Democrat bills give the HHS secretary authority to limit profit margins of private insurance companies, making it difficult to survive subsidized government competition (Sec. 2704).[7]  Pres. Obama understands that, once his plan activates, it will force private insurance companies out of business, their function relegated to peddling supplemental coverage to those who can afford it, similar to Medicare supplements.  Obama already has grabbed banks and car companies; he would own the health industry also. One could retain private insurance only if keeping a job. If one purchases individual insurance, one must drop this plan, if its provisions change, such as a premium change, and move into ObamaCare.   Obama would extend rationing to private insurance plans.  Private insurers would face a myriad of new regulations, including one to insure all applicants and a prohibition on pricing premiums on the basis of risk or prior health.  Private companies could not deny coverage or charge higher premiums because of pre-existing medical conditions or chronic illness, forcing them to pass along higher costs to other premium holders.[8]  Such would encourage some to wait until seriously ill or diseased to buy health insurance.  ObamaCare would eliminate or phase out deductibility for individual health insurance premiums. The Congressional Budget Office (CBO) concluded that under the Kennedy plan, 23 million would lose their current private insurance, because ObamaCare would have a distinct advantage in the marketplace, subsidized by taxpayers.  Another analysis predicts that 119 million would shift into ObamaCare. One study by the Lewin Group, a health care policy company, estimates that ObamaCare would force 120 million into it, over half the private market, encompassing 2/3rds of Americans. The feds could keep premiums artificially low and offer extra benefits, because the U.S. Treasury would handle shortfalls.  ObamaCare presence in the marketplace would allow it to impose much lower reimbursement rates on doctors and hospitals, forcing insurers to raise premiums for privately insured, and making these companies less competitive and eventually defunct.   Premium caps would force private insurers to deny coverage for additional services, driving comprehensive health plans away.  ObamaCare gives the feds authority to disqualify Medicare Advance Plans and HMOs, forcing people into ObamaCare (p. 341).

STIFLING ENTERPRISE.  Obamacare will stifle innovative treatments and equipment.  The CBO estimates that new technology caused about 50% of the hike in health care costs over several decades.  Adjusted for inflation, health care spending per capita is 600% more than in 1969, but no one wants to return to 1960s medicine.  ObamaCare regulations would set charges for wheelchairs and other medical equipment and supplies, hindering competition. 

BAD FOR BUSINESS.  Pres. Obama would raise the cost of hiring employees by forcing employers to provide health insurance to all workers or pay a tax equal to 8% of their payroll to subsidize government coverage for them (p.149 HBill).  This tax, in addition to the present 15% payroll tax.  Companies with large payrolls that do not offer ObamaCare as an option would pay 2-6% tax on payroll (p. 150).  This penalty amounts to an added payroll tax on employees. If large corporations consider the higher tax cheaper than the higher cost of providing insurance to employees, they might cancel their health insurance, forcing employees into ObamaCare.[9]  As ObamaCare premiums rise, employers would pay more tax, ending their coverage and forcing employees to lose a good policy and accept one that their physician may not accept.  Employers could not enroll new workers in current health plans (p.145 HBill).  Employers must pay for health care for part-time employees and their families (p. 126 HBill).  Health savings accounts, used by many small businesses, would become illegal.

BIG BROTHER.   Citizens must attach proof of having a qualifying health plan in federal income tax filings, or the IRS, working with the federal office that keeps your electronic medical records in a new bureaucracy called Gateway, will pursue you, notify you of the default, and fine you $1,000 yearly (Sec. 59).  If you cannot prove to the IRS that you are in ObamaCare or its equivalent, the feds forcibly will enroll you randomly in a plan, fining you if you refuse to accept it (Hbill pp. 136, 142. Individuals who refuse an acceptable plan would pay a tax of 2.5% of total income (p.167 HBill).[10]  Individuals and businesses that refuse to obtain a specific level of coverage would pay fines or go to jail.  Falling exempt from this onerous provision are those on welfare and congressmen (Sec. 3116). ObamaCare would allow the feds to audit the books of all employers that self-insure (p.22 HBill) to check compliance.  Every American must carry a national health care ID card (p.58 HBill). Everyone eligible for Medicaid would forcibly become entered into the system (p. 102 HBill).  ObamaCare would monitor your physician care and treatment, bureaucrats viewing your medical records to ascertain that you receive quality care and having direct access to your accounts to transfer out funds for health care expenses (pp. 58-59 HBill).  Physicians would report individual body fat content, very embarrassing. 

WELCOME ILLEGALS.  ObamaCare would offer free medical care to all 12 million illegal aliens residing in the U.S. (p.50, Sec. 152).  The House bill lacks methods to verify eligibility to ensure that illegals could not access Obama health benefits.  Federation for American Immigration Reform compiled 2 pp. of huge loopholes.  No verification mechanisms would prevent illegals from receiving tax credits to help purchase private insurance.  Paid translators would assist the illegals (p. 91 HBill).  The president included illegal aliens in his program under the guise of aiding the uninsured; 60% of the uninsured in San Francisco are illegal aliens.  Rep. Dean Heller (NV) offered an amendment to require eligibility verification, but Dems killed it and another by Rep. Nathan Deal (GA.) that closed another loophole. 

CONGRESS EXEMPT.  Congressmen and federal bureaucrats would fall exempt from ObamaCare (Sec. 3116).  Congressmen enjoy a wide selection of health plans, choosing from among consumer choice and high deductible plans that offer catastrophic risk protection with higher deductibles, health savings accounts with low premiums, fee for service plans, preferred provider organizations (PPOs), or health maintenance organizations (HMOs).[11]  Private companies manage their policies.  Conservative Rep. Lee Terry offered an amendment to allow the uninsured to participate in this health insurance system, but liberals killed it in committee. 

RATIONED CARE.  Rationing would interfere with treatment decisions (p.29 HBill).  The health rationing board in England recently told a WW II veteran going blind that, though his doctor recommended a medication to slow his macular degeneration, National Health would not pay for this medication because of his advanced age.  This board routinely denies cancer medications as too expensive.  Such is why cancer survival rates are much higher in the U.S.  Staff of the American board will include those who believe that chronically sick children and elderly we should encourage to die, not worth saving, because society does not have significant investments in them. Rationed care forces many consumers to accept less coverage than preferred and encourages insurers to avoid the sickest patients or skimp on their care, another form of rationing.  ObamaCare will drive doctors out of the profession, and people will wait longer for care. The Health Benefits Advisory Comm., created by the House bill, would decide what and how much treatment one received, a rationing committee.  The new Obama Surgeon-Gen., an abortion proponent, would lead this committee.  Rationing and government bureaucracy would reduce the quality of medical care and cost lives.  Bureaucrats will use draconian cost-benefit analyses to determine at what age to deny knee replacements and when to allow elderly with broken hips to go untreated.  ObamaCare would reduce physician services for the poor and elderly on Medicaid (p. 239 HBill).  The House bill proposes $500 billion in Medicare and Medicaid cuts, limiting and rationing services to millions of those retiring. Medicare will see massive cuts, 10% immediately.  Cancer patients could obtain treatment at only specific hospitals (p. 272 Sec. 1145).  ObamaCare will define and ration mental health services (pp. 494-98).


MEDICAL PROFESSION.  The Lewin Group estimates that, under ObamaCare, doctors and hospitals would see their net incomes fall by $70 billion in 2010, about $47,000 per physician.  Obama would reduce payments to doctors and hospitals, eroding quality care. Medical professionals will receive about 30% of current payments under ObamaCare, reduced payments as under Medicare (p. 127 HBill). Doctors, regardless of speciality, will receive similar payment (p. 241 HBill). Physicians would receive a flat fee per month per patient.  Reduced payments for doctors examining Medicaid and Medicare patients (p. 239 Hbill). Federal bureaucrats who know nothing about medical care would give physicians permission to conduct procedures. The government could mandate that a hospital not expand (pp. 317-18).  ObamaCare would penalize hospitals for whatever it considers preventable re-admissions, though contrary to physician advice (p.280).


LOST JOBS.  ObamaCare would destroy at least 1 million jobs in the private sector.[12] We would see increased unemployment that militates against low-wage workers and the ill.  The mandate would continue to eliminate jobs, as socialist health care costs outpace low-wage worker productivity. 

.  The Obama socialist health care plan would cost a minimum of $634 billion over 10 yrs., perhaps $120 billion yearly. The CBO estimates that the Senate bill would cost at least $1.6 trillion over 10 yrs., not counting the planned expansion of Medicaid or interest costs, which would raise the sum to $2 trillion, mostly funded with borrowed money. The CBO director testified before a congressional committee that initial costs would reach $239 billion and would not significantly reduce federal health spending.  Squeezing fed payments to medical providers and adding new taxes will not defray this massive burden on our families.[13] Conservative senators predict that ObamaCare will hand us an $11 trillion debt in 5 yrs. and $17 trillion in 10 yrs.  To pay this bill, Obama would tax all employer-provided health benefits, though he campaigned against this tax before elected, restrict or end health savings accounts, and eliminate the deductibility of health expenses above 7.5% of adjusted gross income, hurting the middle class.  The feds would collect over $300 billion in new taxes on health insurance benefits gained from employers, $600 billion in total tax hikes.  Obama would tax our health care benefits, even if we do not use them. ObamaCare would severely limit the tax rate at which wealthy taxpayers can use itemized deductions, like mortgages and charity contributions. A federal income surtax would hit families earning $350,000 annually, rising for those earning $500,000, and rising again to 5.4% for those earning $1 million (House bill).  These rates could rise to fill deficits. Half of the wealthy paying the 15% income tax surcharge are small businesses that employ 25 or fewer workers.   Obama would hike the tax on liquor and beer, by 229% in the Senate bill. Currently, about 60% of the price of booze goes for federal, state, and local taxes.  In the House bill, businesses with payrolls over $500,000 would pay 8% of payroll to subsidize health insurance if not offering it to employees.  The Senate version would fine a company $750 per worker annually if no coverage.  These companies would pay higher taxes proportionately than Fortune 500 corporations. Liberals would place excise taxes of 35% on insurance companies that offer policies worth at least $16,000, taxes that would land on premium holders.   Some Dems plug a sales tax on soda pop and other soft drinks, and a new payroll tax of .3% on employees and employers.  They would implement a value added tax, a national sales tax.  Socialist health care will require taxing the middle class during a recession, further expanding our $1 trillion deficit.  As Americans grow increasingly intolerant of the higher taxes needed to fund ObamaCare, Congress would limit spending and ration treatments, especially medical care to the elderly. ObamaCare would impose lower reimbursement costs now applicable to Medicare across a much larger area.  Forcing hospitals and other medical venues to accept lower reimbursements under Medicare and Medicaid will only push higher costs onto the privately insured.  ObamaCare paying providers less than private insurance may see patients who have transferred to ObamaCare no longer able to see their doctors, just as Medicare enrollees have a tough time finding primary care physicians.  Premiums would spiral, as special interests demand that Congress mandate specific coverages; then more will require government subsidies to comply with insurance mandates.  Forcing private insurers to charge identical premiums to healthy and ill folks will encourage companies to avoid the ill and discourage the healthy to find insurance.  Mandates and premium controls would socialize private health insurance, ending both cheap and comprehensive insurance options.  If Obama controls the decision to buy, what we buy, and its price, we have socialist health care.[14]  ObamaCare relies on coercion, mandates, price controls, and rationing.  Employers would finance mandated health benefits by reducing wages.  Taxes would grow over time because of mandate creep.  Leftist advocates will demand that Congress mandate lower deductibles and co-insurance and coverage of additional services.  Since the 1970s, states gradually have passed about 2,000 laws forcing insurers to offer specific types of coverage, e.g., for prosthetics, dependent students, or gay partners.  The CBO estimates that these laws hike premiums about 3% annually.  There exists no evidence that anything above a basic health plan improves health outcomes, yet mandates gradually make coverage less affordable by outlawing less expensive options.  The CBO estimates that by 2050, economic output would be 20% lower than if government stayed at its current share of GDP.[15]  We will have no freedom to select what is in our health plans, because we must include mandated items.  No opportunity to choose high deductible coverage.  All patients will pay the same rates regardless of medical conditions or age, so young, healthy individuals will subsidize the chronically ill and aged.  Government price controls are responsible for the present surplus of specialists, where prices are high, and for the shortage of primary care doctors, where fed compensation is poor.  Medicaid reimbursement is so low that many doctors limit Medicaid patients seen.  20-30% refuse to see Medicaid patients, some of whom must travel hours to find a participating doctor.  In 2007, NE hospitals absorbed about $477 million in unpaid costs of government program care.  Expenditures of this magnitude are unsustainable.[16]  ObamaCare would pay less than true costs to medical providers, forcing them to cut services and close hospitals and clinics, a death knell for rural NE.  Under socialist health care present in Massachusetts, 140,000 search for doctors, patients wait weeks for primary care, and people wait months for physical exams.  Overall state health program costs have increased by 42% since 2006, though RomneyCare promised less expense. The state has insufficient funds to pay for coverage, forcing state officials to slice $100 million for Commonwealth Care, which subsidized the poor.  The most dangerous result is that ObamaCare would hinder and cut short lives of thousands by preventing markets from improving quality of care.  Socialist Democrats on the Senate Finance Comm. have threatened lobbyists that private health care views will not win inclusion, if their clients launch public campaigns against ObamaCare.[17]  The Medicare fraud rate is about 15-18%, private insurance less than 1%.  Medicare and Medicaid costs rise higher than private insurance costs annually. Medicare costs now run 7 times over original estimates.  As Medicare launched in 1965, proponents projected Part A costs at $9 billion by 1990; $67 billion was the actual cost.  After the Medicaid special hospitals subsidy began in 1987, the cost supposedly was $100 million annually, but it was a staggering $11 billion by 1992.[18]  States must increase amounts contributed to expanded Medicaid coverage, especially to the homeless.  Government has no reason to become cost-effective.  Cutting smoker numbers has not cut health care costs by raising cigarette taxes.  Taxing sweets by 10% to cut obesity likewise will not cut health care costs but would raise billions.[19]  ObamaCare provides no incentives to reduce costs and expensive tests, so the increased coverage base of patients would make health care costs explode.  Individuals and families with yearly income up to 400% of poverty level, or $88,000 for a family of 4, would gain subsidies for coverage. 

NEBRASKA BURDEN.  States and federal government share the cost of Medicaid for the poor.  Many governors of both parties condemn ObamaCare, knowing that the feds will dump on states new, expensive Medicaid obligations without funds to pay for them, a horrendous unfunded mandate.  Nebraska has a fiscal crisis, a horrid time to shift to us additional costs.  Large gaps in Medicaid funding will appear in 2010, when stimulus money disappears.  Medicaid already suffers from lower payment rates to state health care providers.  The NE Medical Association opposes ObamaCare, because the feds already manage unsound Medicare and Medicaid programs that compensate physicians poorly.  The average insured Nebraska family pays $1,800 annually to cover costs shifted from Medicare and Medicaid; ObamaCare would hike this cost greatly.  Medicare costs rise 34% higher annually than other medical costs. Estimates range from $1,200 to $1,874 annual cost to a Nebraska middle-class family of 4 for ObamaCare tax subsidy.[20]  Federal health care programs push rules and regs on doctors but offer no money to pay compliance costs.  As of this summer, doctors must create plans to guarantee secrecy of patient debt accounts to prevent ID theft and must provide interpreters for patients who do not speak English. 31% of Nebraskans would remain uninsured under the Senate-House compromise bill.  NE physicians collectively would lose $237 million yearly, giving doctors incentives to leave the profession.  NE hospitals would lose $763 million per year and might not make a profit.[21] 

THE UNINSURED.  Obama claims that there exist 47 million uninsured Americans.  10 million Americans who can afford insurance simply do not want it, yet Obama would subsidize it for many up to 300% over the poverty line.  6.4 million of this number already are on Medicaid.  4.3 million more are eligible for Medicaid but refuse to apply.  Only 10.6 million actually are uninsured and want insurance.[22]  45% are uninsured for less than 4 months, only 16% uninsured for over 18 months.  Only 4% of Americans are chronically uninsured, and only ½ of these folks desire insurance, according to research done by conservative Cong. Steve King (IA.).  The Census Bureau found that almost 40% of the uninsured in 2007 had yearly family incomes of $50,000 or more.  By 2018, ObamaCare would offer insurance to 37 million uninsured at $234 billion cost, about $6,300 per person annually, plus premiums paid by covered individuals.[23]  The average yearly premium for non-group health insurance in 2007 was about $2,600 for individuals and $8,500 for families.[24]


SOCIAL ISSUES.   Mandates would force taxpayers to fund abortion and sex changes.  The bills would make abortion more available and more common by forcing insurance plans to fund procedures and subsidizing plans that pay for them.  Government funding would help to construct abortion facilities.  Taxpayer-funded abortions on demand under ObamaCare would alienate and offend many social conservatives.  Citizens deserve the freedom to select doctors and health plans that reflect their values.  Doctors, nurses, and other medical professionals need protections of conscience, so that they can practice according to personal convictions.  Medical professionals employed in religious medical settings provide much of the care for poor families, especially in rural areas.  Yet, ObamaCare would overturn crucial federal protections of health care provider conscience, forcing them to engage in abortion and euthanasia procedures anathema to their religious or moral beliefs.[25]  Cong. Lee Terry offered an amendment to protect hospitals from a mandate to provide abortion services.  Another amendment would have barred Congress from imposing requirements for abortion coverage in Planned Parenthood health clinics, both measures killed in committee. Planned Parenthood would gain millions in funding.   John Holdren, the White House science czar now advising Obama on health care after sailing through a Senate confirmation hearing, co-authored Eco-Science, in which he stated that women have a duty to get abortions and that the feds should pump sterilants in our water to control the population. ObamaCare will foster tolerance for euthanasia, targeting a category of humanity deemed unfit, unwanted, and too expensive to maintain.   


LET GRANNY DIE.  PP. 425-430 in HR 3200 discuss mandatory counseling for the elderly every 5 yrs., more often if a person is ill or resides in a nursing home.  The 2007 census found 38 million elderly.  End of life counseling our president promotes, because he believes the sick elderly too expensive to maintain. Rationing will only encourage the elderly to die.  Providers mandatorily would counsel the ill elderly on end of life options, like refusing nourishment, water, or medications, and living wills and power of attorney (p. 425).  Bureaucrats would decide what level of treatment one receives toward the end of life (p.430).  ObamaCare would mandate a program for end of life orders (p. 427).  Death counselors would receive Medicare reimbursements.  Doctors would receive financial incentives to coax elderly to make living wills and enter hospices.  The elderly and physically impaired would become undesirables who cost society too much.  No counseling for those considering abortions, however. 


CANADACARE.   Canada banned all private insurance in the 1980s.  Critically ill patients wait months for care and flock to the U.S. to save their lives.  ObamaCare would consign these people to a death watch.  Canadian patients die waiting for rationed care.  In Canada, 27% of those who undergo surgery wait 4+ months.  Only 5% of Americans wait that long.  Canadian patients wait about 10 weeks to get an MRI to find out why they ail, prolonging their suffering.[26]  Americans have much quicker access to MRIs than Canadians or Brits.  1.8 million wait for a specialist or surgery.  Only 40% of Canadians admire their health care system,[27] yet 70+% of them believe it requires fundamental changes.[28]


OBAMACARE ALLIES.  The cheering section for socialist health insurance in Nebraska includes the leftist NE Appleseed Center, which also champions illegal aliens residing here.  The Left accuses conservatives of engaging in scare tactics and fear-mongering, especially among the elderly.  Vilifying those who expose the bankruptcy of leftwing health plans does not improve the civil debate or achieve real reform.  Liberal supporters in Congress, under their health care plans, can get whatever they want whenever they want, a literal smorgasbord of options, but they refuse the same for their constituents.  Organizing for America is mobilizing leftwing groups in every state, including Nebraska, to promote socialist health care by lining up poor, uninsured people to plead their cases to the media. Unions would not suffer, as Pres. Obama has exempted them from socialist health care.  Subsidized ObamaCare would assist labor union retirees and families and community organizations like ACORN (p.65, Sec. 164). The government would use groups like ACORN and Americorps to sign up individuals (p.95 HBill).  The American Association of Retired Persons (AARP) endorsed ObamaCare; its vulnerable members are resigning from this Am. Assoc. of Reducing People.  Obama urges his followers to respond to skeptics with twice the force of conservative opponents.  His army of union goons and ACORN thugs are assaulting citizens who dare to ask pertinent questions at town hall meetings scheduled by congressmen.  Liberal reps are bringing union goons to their meetings to guard themselves from irate constituents.  Labor bosses instruct their members to confront and muzzle conservative attendees.  Socialist Democrats air TV and radio ads condemning town hall protesters.  The Administration urges supporters to act as informants, to report names, addresses, and phone numbers of socialist health care critics to flag@whitehouse.gov.  A ploy reminiscent of Nazi Germany. 

CONSERVATIVE ALTERNATIVES.  We need more value per $ in medical care.  The free market will drive down costs.  NTF believes that individual consumers should make the key decisions in selecting health care, medical treatments, and health insurance.  Personal choice and competition.  Transparency means that people can shop for quality and price.  Employers should no longer manage every detail but assist employees by providing financial decision support, to help them select a package more efficiently.  Workplaces could distribute information to help workers choose coverage from a menu of options during open enrollment time.  Because federal tax policy considers worker compensation for health care tax-free to the employee, if it passes through employer hands, employers can ensure that employee spending on health insurance and medical care utilizes favorable tax treatment.  Employers or insurance brokers under contract could help employees select insurance plans to best meet personal or family circumstances and preferences. Employers could offer workers a range of services, like workplace clinics, wellness programs, information on various costs, risks, and benefits of common treatments, and comparative info on the quality and results of health care providers.   Many existing companies  eagerly would bring these and other programs into a workplace.  Government should focus only on providing the poor with necessary funds to purchase health services, shifting welfare from a defined benefit model to a premium support model.  Now, the feds operate defined benefit separate public health insurance plans for the poor and illegal aliens, which they cannot accomplish competently. Using the premium support model, the feds would manage programs only to supplement those who have insufficient savings to buy adequate health insurance and medical care in the free market. In poor areas, to ensure availability of basic health services, the feds could fund clinics and offer incentives for health professionals to practice in such areas.  Health insurance coverage must become an agreement between private insurer and individual.  Consumers must have a choice of competing products and companies, so there exists opportunity for individuals to select health insurance coverage best suited for their preferences.  They must have ability to choose among a diverse number of competing health insurance plans, because health insurance is the prime financial mechanism for  medical care.  As the most sophisticated consumer might not have all the relevant info available or have time to find and analyze it when deciding among providers and treatments, health plans have this info and expertise to help consumers make decisions, guaranteeing the best medical care at the best price.  Insurers succeed and profit by offering customers a better value than competitors, finding ways to navigate the health care system, and helping customers minimize their medical spending by staying or becoming healthy.  In a competitive market, providers must have a wide range to innovate in meeting customer demands and preferences.  Thus, lawmakers should avoid unduly restricting options available to consumers or the scope for supplier innovation in developing new and better products and features.   Such is crucially important in the health care sector, where continually expanding scientific knowledge and resulting innovations in medical treatment press continued reassessment of what is best for individual patients and specified medical conditions.  Congressmen should avoid imposing regulations that micromanage health professionals and insurance companies, stifle innovation in clinical practices, or favor one subset of providers over others.   In establishing coverage standards, Congress should limit itself to specifying basic coverage categories, like physician services, hospital care, and RX drugs, and avoid micromanaging the market by imposing mandates for specific conditions or treatments or stipulating how plans should contract with providers. The feds should avoid price-mandating, because such setting distorts the market, but could establish basic pricing regs, which allows consumers to comparison shop effectively with clear information about the price of each option.[29]  Shift tax advantages to individual consumers by offering tax credits and deductions with proof of health care insurance.  States could refrain from taxing a portion of paychecks on a sliding scale, to incentivize obtaining health insurance. Push reform at the state level in a decentralized environment to maximize choice.  Insurance policies would become portable, moving from one job to another.  Encourage states to end special interest mandates that force specific coverage like acupuncture on all insurance plans. Individuals, not employers, would purchase health insurance and share risk in large pools not now available.  Those eligible for Medicare could opt out of this creaky system and buy private insurance like others, with identical tax advantages.  Fight the trial lawyer lobby and enact tort reform to reduce the estimated 30-40% of health care and drug costs related to fear of frivolous litigation.[30]   Limit jury awards in medical malpractice lawsuits, something Obama and his trial lawyer supporters oppose. Conservative Arthur Laffer has designed a proposal for tort reform, to stop avaricious attorneys from plundering physicians in malpractice lawsuits.  Remove regulations limiting risk-based pricing and competition among health insurers.  Cure the inequities of federal law, which penalize individuals and families that buy health insurance outside the workplace.  Those who personally own and control their health policies should not face a crushing tax penalty.  Address long-term health care costs by focusing on fundamental reform of tax treatment of health insurance. Start real Medicare and Medicaid entitlement reform to relieve future generations of crushing debt and taxes.[31]  Instead of one plan for every American regardless of location, allow individual states to achieve value for dollars by widening coverage options and lowering costs.[32]  Establish a supportive legal and regulatory environment that will allow creative competition in the market to develop health insurance products and services that will meet needs of everyone.  Competition in the free market is the best solution to lower costs and offer better services and quality and more convenience and choices. NE has some of the lowest premiums in the nation because of competition among private insurers and lower health care costs.   Legislation should focus on increasing competition among insurers and other providers.  Private systems can make health information readily available to and understood by consumers.  Armed with reliable information, consumers fully can accept a major role in their health care.  Private incentives would lead to an infusion of technology to lower costs, improve efficiency in coverage, and distribute information.[33]  Allow employees to place a minimum of 4% of monthly paycheck, 2% from employer and 2% from employee, into a private HSA, invested in the marketplace, growing each year. Allow more businesses and other entities to create larger insurance pools to gain cheaper rates. Employers could offer workers a catastrophic HSA plan, while employees paid for routine care using their own options.   Give Medicaid dollars to individuals to select their own doctors, other health professionals, and insurance.  They could dial an 800 exchange and view choices. Those eligible for Medicaid could use the value of their benefit to buy a private plan.  Lobby state and federal legislators to terminate the confusing patchwork of restrictions and regulations that supposedly lower costs but in reality increase our health care costs and make it impossible for private enterprise to work effectively.  Allow consumers to buy policies across state lines, to obtain the kind of insurance that best meets their needs in coverage and cost. Many states force residents to purchase minimum insurance packages that include many services that only a few require.  These extraneous mandates hike the price of basic insurance by up to 50%. End overlapping federal regs that force insurers to hire thousands of lawyers, adding to premium costs.  Allow private insurers to offer more financial incentives to promote healthy lifestyles that positively impact the costs and utilization of health care. Individuals could buy high-deductible catastrophic health insurance.  Reduce Medicare and Medicaid fraud. 

ONE EXAMPLE.  Cong. Jim DeMint has sponsored the Health Care Freedom Act, believing that there is insufficient competition in the insurance industry because of state monopolies.  His opening insurance wider to the free market would drive down prices.  Those who could not obtain insurance through their workplace could obtain a $5,000 tax credit voucher to purchase an insurance policy or utilize HSAs to pay premiums.  Tort reform, too.  Insurance companies in each state could establish a pool to insure high-risk people through federal block grants.  HSAs would encourage individuals to conserve in consuming health care expenses.  Employer wellness programs would incentivize healthy living.

HEALTH STATUS INSURANCE.  Medical insurers charge those with unhealthy lifestyles more than healthy people. If you have a long-term expensive health problem, a health status insurance policy would offer you the financial resources to pay higher medical insurance premiums.  This insurance covers the risk of premium reclassification. One can obtain this medical insurance no matter how ill one becomes, with no change in out of savings costs.  Policies are portable, and one can change medical insurers.[34] 

PERSONAL RESPONSIBILITY. Individuals must control key decisions regarding coverage, treatment, provider selection, and spending personal funds. Individuals should receive rewards for compliance with self-help programs and medical care and treatment, with educational supports for better personal health management.  Participation in wellness programs and preventive care would count.  Insurance would become more affordable for those who maintain healthy lifestyles, diet, exercise, support and educational programs, and adherence to disease management.[35] 

TAX REFORM.  State taxes on insurance premiums average over 2%, sometimes as high as 7+%.  These taxes apply only to individual and insured group policies, mostly for small employers.  Collected from insurers, these taxes raise the cost of individual and small group insurance.  State legislatures could end state premium taxes on health savings account (HSA) high deductible plans without losing much tax revenue.  New companies targeting HSA sales would find Nebraska a business-friendly state in which to develop and sell these policies.  Individually-bought health insurance does not receive the same federal or state tax advantages as employer-bought health insurance.  Eliminate both federal income and employment taxes on HSA premiums.  Allow a reduction for HSA premiums in federal adjusted gross income.  In many states, such legislation would generate an automatic reduction in state income taxes.  Our state legislature could pass state income tax deductibility for individually-bought HSAs.  It should explore ways to incentivize small employer groups to buy HSAs through tax credits, which could lower government supports for Medicaid and other uncompensated care.  The feds could provide a $500 tax credit to small employers that offer an HSA, employers now less likely to offer health insurance to employees.  Milliman, a leading actuarial company that prices health plans for major employers and insurers, showed in a 2005 study of health care premium hikes that, while HMO and PPO premiums increased by 8%, consumer HSA plans increased by only 1%!  Speed the use of electronic medical records and other non-paper systems through investment tax credits.  Hospitals, doctors, and pharmacies then could invest in health information technology. The legislature should join with our insurance commissioner to identify and accept policy approvals from other states with laws and regs similar to ours.  The commissioner should develop a regional HSA market of reciprocal agreements.  The Unicameral should permit Internet buying of HSAs approved for sale in other states yet not sold in our state.  Permitting individuals to shop for a better deal in a competitive atmosphere across state lines will increase the availability of health care coverage and lower costs.  A quick approval process would allow new HSA policies with creative incentives and rewards to receive immediate attention.  Wide availability and price ranges for individual insurance policies are the keys to covering the uninsured.   Under present law, it is illegal to cross state lines to buy health insurance, but HSA products more likely will find a market in areas where approval becomes widely accepted.  82% of Americans polled said that they would cross state lines to reduce insurance premiums. Banks are promoting HSAs and would join insurers to offer competitive HSA products with features not now available in NE.  Barriers to services such as banking deposits, exorbitant licensing costs, minimum number of employees required in a state, should disappear.  NE should create a friendly environment in which to create jobs, sell insurance, and offer new healthcare products.[36]  Tax treatment of health insurance now does not give one a discount on expenses paid for by savings.  Tax relief must accrue to all policies and employers.  Congress must provide health care tax credits and allow individuals and small businesses to enter state-based pools, increasing choice and competition. Tax credits to small businesses. Refundable tax credits could cover the first several thousands in medical expenditures. Employees could become more mobile, and employers, especially small ones, would rid themselves of a burdensome part of employee compensation costs. 

POLLING.  A 7-09 Zogby Poll found that 50% of Americans oppose the ObamaCare House bill.  Another poll showed that 70% oppose taxing health benefits to pay for ObamaCare.  A July Wall Street Journal poll found that 46% disapproved of ObamaCare, only 41% approving.  A CBS July poll discovered that 69% evidenced serious concern that ObamaCare would cause their own health care to worsen, up from 63% in June. 


TAKE ACTION NOW.  Government management of Social Security, Medicare, and the postal service offers great reason why we should not trust it with managing our health care.  Government should not practice medicine.  ObamaCare would control half our national economy, placing the federal boot on our financial necks.  Ask your senators and representative if they would accept ObamaCare for themselves and their families.  A dynamic and competitive market will see health care become better, cheaper, and safer.  Socialist health care, with its mandates and price controls, will mean higher costs, additional medical errors, more uncoordinated care, and more deaths, because people with ObamaCare could not find the medical practitioners and treatments to assist them.[37]  Do not allow government bureaucrats to make your medical decisions.  Medical professionals, pharmaceutical firms, medical equipment manufacturers, and consumers should not allow fed agencies to determine the value of their services and lives.  Recall how the feds drove out private flood plain insurance; the federal insurance program operates with a half-billion deficit.  Car insurance normally does not pay for oil changes or new tires; health insurance originally was not meant to pay for routine care, only for catastrophic events.  Liberals wish to ram through this medical care scheme so rapidly that congressmen have insufficient time to read and analyze it before voting.  Rushed also so that citizens will have little accurate knowledge of its contents.  Urge your congressman and senators to vote NO on ObamaCare and YES on free market alternatives! 

Website: http://republicans.energycommerce.house.gov/
Heritage Foundation: www.askheritage.org.

Cato Institute.

Savings Lives & Saving Money, by Newt Gingrich.


Research, analysis, and documentation for this issue paper done by Nebraska Taxpayers for Freedom.  This material copyrighted by Nebraska Taxpayers for Freedom, with express prior permission granted for its use by Citizens for Local Control, Cherry County Taxpayers, Dawes County Taxpayers, and other groups in the Tax Freedom Network.  8-09.  C





[1] How Health Care Reforms Will Mess with Your Coverage, by Betsy McCaughey( former NY lt.-gov.), 6-24-09. 

[2] Heritage Foundation, 7-09.

[3] Obama Care to Come, by Michael Tanner, Cato Institute, May 21, 2009.

[4] Health Care, by Edwin Feulner, Heritage Foundation, 6-18-09.

[5] Sen. James Coburn (R.-OK.), 7-09.

[6] Dissecting the Kennedy Health Bill, by Betsy McCaughey, 6-19-09.

[7] How Health Care Reforms Will Mess With Your Coverage, by Betsy McCaughey,  6-24-09.

[8] Obama Care to Come, by Michael Tanner, Cato Institute, May 21, 2009.

[9] Wall Street Journal, 7-15-09.

[10]  Bloomberg.com, 7-15-09.

[11] Dissecting the Kennedy Health Bill, by Betsy McCaughey, 6-19-09.

[12] National Federation of Independent Business, 2009. 

[13] Health Care, by Edward Feulner, Heritage Foundation, 6-18-09.

[14] Intensive ObamaCare, by Michael Tanner, June 17, 2009.

[15] Doug Elmendorf, CBO chief, testifying before Congress, 7-09.

[16] 2008 NE Hospitals Community Benefits Report. 

[17] Wall Street Journal, June, 2009.

[18] Cato Institute analysts Michael Tanner and Chris Edwards.

[19] Money Magazine.com., 7-09. 

[20] Wall Street Journal, June, 2009.

[21] Heritage Foundation, 7-31-09.

[22] Investors Daily.

[23] Congressional Budget Office, 2008.

[24] America’s Health Insurance Plans, 12-07.

[25] Obama’s Health Care Agenda: How it Will Hurt American Families, Heritage Foundation Fact Sheet #33.

[26] Fraser Institute.

[27] Stanford U. Hoover Institute study, 7-09. 

[28] National Center for Policy Analysis. 

[29] Edmund Haislmaier, Center for Health Policy Studies, Heritage Foundation, May, 2009.

[30] USA Health Alert.org. 6-09.

[31] Obama’s Health Care Agenda: How it Will Hurt American Families, Heritage Foundation Fact Sheet #33.

[32] Health Care, by Edwin Feulner, Heritage Foundation, 6-18-09.

[33] 2008 Center for Health Transformation.

[34] Health-Status Insurance: How Markets Can Provide Health Security, by John H. Cochrane, 2-18-2009.

[35] 2008 Center for Health Transformation.

[36] 2008 Center for Health Transformation.

[37] Placebo, Why the Democrats’ Proposals Will Not Work, by Michael Cannon, 5-13-09.