Critical Condition

House Energy and Commerce Amendment Highlights

The final committee to consider HR 3200, the House health-care-reform bill, was the Energy and Commerce Committee. Many of the issues raised in the other committees were also raised during this on-again, off-again mark up. Here are some of the highlights.  

Gutting Consumer Choice: (Stearns #9, Rogers and Gingrey #10) The president and his congressional allies routinely insist that if Americans like the health insurance that they currently have, they can keep it. But the simple fact is that this is a presidential promise that will not be kept if the House bill, in its current form, is signed into law. Under the House bill, the federal government is authorized to determine what health benefits must be included in Americans’ health insurance plans and federal officials will determine the health plans that would be considered “acceptable” coverage under the law.

Rep. Cliff Stearns (R., Fla.) offered an amendment that would ensure that nothing in the bill could prevent individuals from keeping their current health benefit plan. Based on their own reading of the language of the bill, several Committee members did not believe such a guarantee, as proposed by Representative Stearns, was necessary. So, they defeated the Stearns amendment.

On a related matter, health-benefits plans that include a Health Savings Account (HSA) are popular with many Americans, and they have been growing rapidly in recent years. They are particularly attractive to Americans who prefer high-deductible, low-premium health plans, and who want to have direct control over how their health-care dollars are spent. To protect the existing coverage of Americans who currently have these plans, Rep. Mike Rogers (R., Mich.), Rep. Jim Matheson (D., Utah), and Rep. Phil Gingrey (R., Ga.) offered an amendment that would include health-benefits plans with HSAs in the bill’s definition of a “qualified health benefits plan.” The Committee majority defeated this amendment. In other words, Americans who wish to buy HSA plans would be stripped of their freedom to choose them.

Jeopardizing Seniors’ Existing Coverage: (Rogers #4) Approximately 20 percent of Medicare enrollees obtain private coverage through Medicare Advantage (MA). MA offers seniors access to a wide variety of private insurance plans with richer benefits or specialized options that best suit their personal needs. The House bill calls for payment reductions to MA plans. Rep. Mike Rogers (R., Mich.) wanted to protect seniors’ current private coverage under MA. The Rogers amendment would prevent the House bill’s MA reductions from being implemented unless the Secretary of Health and Human Services (HHS) could certify that those provisions would not cause seniors to lose their current MA plans or be forced to switch plans. The Rogers amendment was defeated.

Government Price Fixing: (Schakowsky) Rep. Jan Schakowsky (D., Ill.) offered an amendment that would put the government in control of setting prices for insurance premiums for seniors’ prescription-drug coverage. The amendment would mandate that premiums for insurance plans offered on the National Health Exchange could not exceed 150 percent of the annual percentage increase in medical inflation, essentially placing a government price cap on premiums. In addition, the amendment would allow the Secretary of HHS to “negotiate” the drug prices in Medicare Part D and Medicare Advantage plans. In other words, the government, not the market, would fix prices for drugs. The Schakowsky amendment passed.

Federal Funding for Abortions: (Capps, Stupak and Pitts, Pitts #1) Concern over taxpayer dollars to fund abortion has been raised in all three House committees and in the Senate HELP committee. Rep. Lois Capps (D., Calif.) offered an amendment that would require at least one insurance plan to cover abortion in each geographical region. The amendment would also require the newly-created public plan to cover all abortion services, depending upon the fate of the Hyde Amendment, the measure that currently restricts federal funding of abortion. Representative Capps’s amendment would also allow affordability credits, which are taxpayer-funded subsidies, to be used for health-insurance plans that cover abortions.

Rep. Joe Pitts (R., Pa.) and Rep. Bart Stupak (D., Mich.) jointly introduced an amendment that would specifically prohibit federal funds from being used to cover abortion services. The Pitts-Stupak amendment failed. Representtive Pitts also offered an amendment to block any government requirement on health-insurance networks to include abortion. Although this second Pitts amendment initially passed, it was reconsidered and it failed on the second Committee vote. Based on the passage of the Capps amendment and failure of the Pitts and Stupak amendments, taxpayers would end up financing abortion.

Tilting the Playing Field: (Radanovich #22) Under the House bill, the Congressionally-created public health plan would receive favorable tax treatment and funding for start-up costs. Nearly all independent studies conclude, however, that the public plan would erode private health-insurance coverage for millions of Americans. A major reason is that the public plan would not compete on a truly level playing field with private health insurance.

Rep. George Radanovich (R., Calif.) proposed that the public plan be subject to the same legal rules and standards and operate in the same business environment as private health plans. He offered an amendment that would impose these various requirements, including payment of state taxes, on the public option. The Radanovich amendment failed.

Interfering with the Doctor-Patient Relationship: (Gingrey #14, Gingrey #48, Rogers) President Obama has repeatedly told Americans that any health-care-reform legislation he signs will keep the government out of health care decisions. Rep. Phil Gingrey (R., Ga.), himself a physician, offered an amendment to prohibit federal officials from interfering or dictating how medical providers should treat patients. The Gingrey amendment failed, with 33 Democrats voting against it.

The House bill authorizes the use of Comparative Effectiveness Research (CER) to determine which medical procedures are most effective at treating specific cases, considering both cost and clinical results. Although this provision of such information is perfectly sound policy, many members of Congress are concerned that federal officials could use CER to make treatment, coverage, or payment decisions. To prevent CER from becoming a rationing tool, Representative Gingrey offered an amendment that would prohibit the Center for Medicare and Medicaid Services (CMS) from using CER to make coverage decisions on the basis of cost. Rep. Mike Rogers (R., Mich.) also offered an amendment that would specifically prevent the federal government from using CER to deny or ration care. In these two cases, the Gingrey and the Rogers amendments both passed on voice votes.

The Energy and Commerce disposition of this issue will have to be resolved by the Speaker of the House and the House Rules Committee. The reason: amendments to prevent CER from being used as a rationing tool failed in both the Education and Labor and Ways and Means committees. Taxpayers should watch closely to see how these differences are reconciled.