Liberals in Congress, under the guise of emergency economic
stimulus legislation, are attempting to push forward their radical
health care agenda. These provisions would fuel fiscal
irresponsibility in state Medicaid programs, expand dependence on
the already-unsound Medicaid entitlement program, distort health
care choices for unemployed workers, and set up a federal
infrastructure that could be used as a tool for government
rationing of medical treatments, procedures, and services.
If Members of Congress insist on these provisions, they should
at the very least require a review of Medicaid spending by the
states, prioritize Medicaid spending on a state-by-state basis,
empower families who want to secure alternative private coverage
options, and prevent government interference in the doctor-patient
Fast-Tracking Government Control of
Congressional efforts to fast-track passage of an economic
stimulus package and expansion of the State Children's Health
Insurance Program (SCHIP), which recently passed both chambers of
Congress, would guarantee greater government control over
Americans' health care. House of Representatives Majority Whip
James Clyburn (D-SC) has stated as much.
Without broader debate, America is rushing toward the financial
tipping point in health care--the point where the federal
government controls more health care spending than will the private
sector. Today, the government controls 46 percent of all health
care spending, and its share is expected to reach 49 percent by
2017. The sundry health provisions in the
proposed economic stimulus, in combination with the expansion of
SCHIP, will only move the country faster toward more government
control over the health benefits, medical treatments, and
procedures that Americans receive.
Lasting Impact of the Health Care
Buried deep in the House economic stimulus bill are
health-related provisions that would have far-reaching consequences
for the way Americans finance and obtain health care. These
provisions would also have a long-lasting impact on the future of
the American health care system.
Bailing Out State Medicaid Programs. The House and Senate
bills would give every state a temporary, across-the-board increase
in their federal match for the nation's largest health care welfare
program, Medicaid. Unfortunately, neither bill holds state
officials accountable with regard to their past management of their
Medicaid programs. For example, there is no assessment of whether a
state has expanded the program beyond the traditional federal
income thresholds and/or adopted policies that place the program's
fiscal solvency at risk.
Health Care for the Unemployed. The House and Senate
bills would give subsidies for unemployed workers on COBRA
coverage. Even with a subsidy, COBRA coverage is a prohibitively
costly option for the unemployed as well as taxpayers funding the
subsidy. The House bill goes even further, opening the Medicaid
program to those unemployed workers without health care coverage.
The proposed expansion of the Medicaid entitlement program to new
categories, regardless of income, further destabilizes the already
troubled and poor-performing program.
An Infrastructure for Rationing. The House and Senate
bills would establish a framework and funding for comparative
effectiveness research and health information technology. While the
Senate's language is broad and vague, the House language provides
further clarity. The House committee report states that "those
[items] that are found to be less effective and in some cases, more
expensive, will no longer be prescribed." This type of alarming
language is similar to what exists today in the British National
In addition, billions of dollars would be spent on a health IT
information "architecture" for exchanging information and training
health care professionals. Combining the comparative effective
research with the health IT portal opens the door to direct
government intervention in the clinical decisions by physicians and
other health care providers.
Three Essential Changes
Congress must make three changes to these controversial health
care provisions in the so-called economic "stimulus" package.
- Set criteria and demand accountability on Medicaid bailout
funds. Instead of bailing out
all states, Congress should set up a priority list based on
the actions of the states, with the most fiscally responsible
states receiving higher priority. Furthermore, Congress should
require each state to outline how they plan to reform Medicaid to
reach long-term fiscal solvency.
- Expand health care options for unemployed workers. Instead of forcing unemployed
workers to choose between a plan they can not afford (COBRA) and an
inferior welfare program for the poor, Congress should allow
unemployed workers to opt for any private coverage that works best
for them and their families during these difficult economic
- Remove funding for comparative effectiveness and health
information technology. Congress should strip these two
provisions. Understanding the basic impact these two elements could
have on the current system of delivery of care should be debated in
the context of health reform, not stimulus. At the very least,
Congress should thoroughly debate these provisions and consider
their likely impact on medical research, innovation, and the
doctor-patient relationship. Congress should also ensure that it
provides an appeals process for doctors and patients affected by
President Obama would break a fundamental promise to the
American people by enacting the trillion-dollar economic stimulus
package in its present form. President Obama said, "In order for us
to reform our health care system, we must first begin reforming how
government communicates with the American people."
Veiled under this massive economic stimulus proposal are
profoundly controversial and far-reaching health care provisions
that would set the country on a path toward more fiscal
irresponsibility, mounting unfunded entitlement liabilities, and
less control of families over their personal health care decisions.
If Congress wants to enact such provisions, it should do so not
tagged on a fast-tracked stimulus bill but with a full and public
debate so that the American people understand the impact of these
health care decisions on their lives. Any other course would be a
betrayal of the President's promise of openness with American
Nina Owcharenko is
Senior Policy Analyst in the Center for Health Policy Studies at
The Heritage Foundation.
Cusack, "Top Dem: No Comprehensive Health Care Reform This Year,"
The Hill, January 25, 2009, at http://thehill.com/leading-the-news/citing-1994-clyburn-embraces-incremental-health-
reform-2009-01-25.html (February 3, 2009); "Health Care
Overhaul Likely to Slip to Next Year," CQ Politics, January
29, 2009, at http://www.cqpolitics.com/wmspage.cfm?docID=cqmidday-000003021031
(February 3, 2009).