Restoring Americans’ Healthcare Freedom Reconciliation Act Of 2015

Targeted News Service

WASHINGTON, Oct. 25 -- The House Budget Committee has filed a report (H.Rpt. 114-293) on the Restoring Americans' Healthcare Freedom Reconciliation Act (H.R. 3762). The report was filed in the U.S. House by Rep. Tom Price, R-Ga., on Oct. 16.

CLEARING THE WAY FOR REAL HEALTH CARE REFORM

The essential failing of Obamacare runs deeper than its distortions of health care delivery and financing, its clumsy rollout, or the President's numerous unilateral changes in the lawafter its enactment. Beneath all these, the fundamental flaw of Obamacare is the conceit that Washington could somehow centrally manage a vast and complex medical sector serving nearly 320 million diverse individuals. That notion has proved a failure. It requires suffocating mandates and regulations. It stifles health care delivery, making it less responsive and more costly. Above all, it necessarily imposes government dictates on highly personal medical decisions, effectively placing a government agent in every examining room and alongside every hospital bed.

That is why Obamacare must be dismantled. The aim is not only to reject this illegitimately conceived government expansion, which still--more than 5 years after its enactment--lacks the support of even a simple majority of the American public. It is not just to replace one national health program with another. The point is to discard the entire pretense of nationalized medicine, and recognize that health care works best when it promotes the most important and basic relationship in medicine--the one between the patient and the doctor. Everything else in the $3 trillion health care network--hospitals, nurses, technicians, medical device makers, pharmaceutical companies, researchers, health insurers, and many more--revolves around that fundamental partnership.

Obamacare must be repealed to clear the way for genuine, compassionate, patient-centered health care reform. That is the broader aim of this legislation: the Restoring Americans' Healthcare Freedom Reconciliation Act of 2015.

Like so much of Washington's health care policy, this massive program--formally called the Affordable Care Act was designed to satisfy the ivory tower aspirations of academics and protect the fortresses of government bureaucracies. Instead of responding to the medical needs of real people in the real world, it adds layers of rules and directives to further systematize health care as a government-run service. It seeks to control costs from the top down--which can only lead to rationing health services--rather than trusting prices to emerge naturally from the free choices of millions of individuals.

[Footnote 1: Because the House and Senate could not agree on a single plan, they had to pass two bills, one modifying the other, to create the Affordable Care Act. The two measures were the Patient Protection and Affordable Care Act (H.R. 3590, Public Law 111-148) and the Health Care and Education Reconciliation Act of 2010 (H.R. 4872, Public Law 111-152).]

True health care reform can only arise from a different way of thinking about it. There is no one strategy for making health care more effective and efficient; there is no unified approach, especially not by government. True reform can only emerge from the flexibility and innovation of all the participants, always seeking creative ways to advance better and less costly health care. As spelled out in the fiscal year 2016 budget resolution, which led to this legislation, policymakers should apply the guiding principles below to develop real health care reform. 2

[Footnote 2: See section 6205 of the Conference Report accompanying the Concurrent Resolution on the Budget for Fiscal Year 2016 (S. Con. Res. 11).]

Affordability. Real reform should ensure that all Americans, no matter their age, income, or health status, can afford health coverage. The health care delivery structure should be improved, and individuals should not be priced out of the insurance market due to pre-existing conditions. Nationalized health care not only fails to accomplish these aims, but in fact undermines them. Individuals should be allowed to join together voluntarily to pool risk through mechanisms such as Individual Membership Associations and Small Employer Membership Associations.

Accessibility. Instead of Washington dictating to Americans how they may or may not use their health insurance, reforms should make health coverage more portable. Individuals should be able to own their insurance and have it follow them in and out of jobs throughout their careers. Small business owners should be permitted to band together across State lines through their membership in bona fide trade or professional associations to purchase health coverage for their families and employees at a low cost. This will increase small businesses' bargaining power, volume discounts, and administrative efficiencies while giving them freedom from State-mandated benefit packages. Also, insurers licensed to sell policies in one State should be permitted to offer them to residents in any other State; consumers should be permitted to shop for health insurance across State lines, as they are with other insurance products online, by mail, by telephone, or in consultation with an insurance agent.

Quality. Incentives for providers to deliver high-quality, responsive, and coordinated care will promote better patient outcomes and drive down health care costs. Likewise, reforms should work to restore the patient-physician relationship by reducing administrative burdens and allowing physicians to do what they do best: care for patients.

Choices. Genuine reform should free individuals and families to secure the health coverage that best meets their needs, rather than instituting one-size-fits-all directives from Federal bureaucracies such as the Internal Revenue Service, the Department of Health and Human Services, and the Independent Payment Advisory Board.

Innovation. Instead of stifling innovation in health care technologies, treatments, medications, and therapies with Federal mandates, taxes, and price controls, a reformed health care system should encourage research, development, and innovation.

Responsiveness. Reform should vigorously apply the spirit of federalism, returning authority to States wherever possible, to make health care more responsive to patients and their needs. Instead of tying States' hands with Federal requirements for their Medicaid programs, the Federal Government should return control of this program to the States. The current Medicaid Program only drives up Federal debt and threatens to bankrupt State budgets. States are better positioned to provide quality, affordable care to those eligible for the program and to track down and weed out waste, fraud, and abuse. Beneficiary choices in the State Children's Health Insurance Program [SCHIP] and Medicaid should be improved. States should make available the purchase of private insurance as an option to their Medicaid and SCHIP populations (though they should not require enrollment).

Legal Reforms. Policymakers should develop reforms that prevent lawsuit abuse and curb the practice of defensive medicine, which are significant drivers increasing health care costs. The burden of proof in medical malpractice cases should be based on compliance with best practice guidelines and States should be free to implement those policies to best suit their needs.

CLEARING THE WAY FOR REAL HEALTH CARE REFORM

The essential failing of Obamacare runs deeper than its distortions of health care delivery and financing, its clumsy rollout, or the President's numerous unilateral changes in the lawafter its enactment. Beneath all these, the fundamental flaw of Obamacare is the conceit that Washington could somehow centrally manage a vast and complex medical sector serving nearly 320 million diverse individuals. That notion has proved a failure. It requires suffocating mandates and regulations. It stifles health care delivery, making it less responsive and more costly. Above all, it necessarily imposes government dictates on highly personal medical decisions, effectively placing a government agent in every examining room and alongside every hospital bed.

That is why Obamacare must be dismantled. The aim is not only to reject this illegitimately conceived government expansion, which still--more than 5 years after its enactment--lacks the support of even a simple majority of the American public. It is not just to replace one national health program with another. The point is to discard the entire pretense of nationalized medicine, and recognize that health care works best when it promotes the most important and basic relationship in medicine--the one between the patient and the doctor. Everything else in the $3 trillion health care network--hospitals, nurses, technicians, medical device makers, pharmaceutical companies, researchers, health insurers, and many more--revolves around that fundamental partnership.

Obamacare must be repealed to clear the way for genuine, compassionate, patient-centered health care reform. That is the broader aim of this legislation: the Restoring Americans' Healthcare Freedom Reconciliation Act of 2015.

Like so much of Washington's health care policy, this massive program--formally called the Affordable Care Act 1

[Footnote] --was designed to satisfy the ivory tower aspirations of academics and protect the fortresses of government bureaucracies. Instead of responding to the medical needs of real people in the real world, it adds layers of rules and directives to further systematize health care as a government-run service. It seeks to control costs from the top down--which can only lead to rationing health services--rather than trusting prices to emerge naturally from the free choices of millions of individuals.

[Footnote 1: Because the House and Senate could not agree on a single plan, they had to pass two bills, one modifying the other, to create the Affordable Care Act. The two measures were the Patient Protection and Affordable Care Act (H.R. 3590, Public Law 111-148) and the Health Care and Education Reconciliation Act of 2010 (H.R. 4872, Public Law 111-152).]

True health care reform can only arise from a different way of thinking about it. There is no one strategy for making health care more effective and efficient; there is no unified approach, especially not by government. True reform can only emerge from the flexibility and innovation of all the participants, always seeking creative ways to advance better and less costly health care. As spelled out in the fiscal year 2016 budget resolution, which led to this legislation, policymakers should apply the guiding principles below to develop real health care reform. 2

[Footnote]

[Footnote 2: See section 6205 of the Conference Report accompanying the Concurrent Resolution on the Budget for Fiscal Year 2016 (S. Con. Res. 11).]

Affordability. Real reform should ensure that all Americans, no matter their age, income, or health status, can afford health coverage. The health care delivery structure should be improved, and individuals should not be priced out of the insurance market due to pre-existing conditions. Nationalized health care not only fails to accomplish these aims, but in fact undermines them. Individuals should be allowed to join together voluntarily to pool risk through mechanisms such as Individual Membership Associations and Small Employer Membership Associations.

Accessibility. Instead of Washington dictating to Americans how they may or may not use their health insurance, reforms should make health coverage more portable. Individuals should be able to own their insurance and have it follow them in and out of jobs throughout their careers. Small business owners should be permitted to band together across State lines through their membership in bona fide trade or professional associations to purchase health coverage for their families and employees at a low cost. This will increase small businesses' bargaining power, volume discounts, and administrative efficiencies while giving them freedom from State-mandated benefit packages. Also, insurers licensed to sell policies in one State should be permitted to offer them to residents in any other State; consumers should be permitted to shop for health insurance across State lines, as they are with other insurance products online, by mail, by telephone, or in consultation with an insurance agent.

Quality. Incentives for providers to deliver high-quality, responsive, and coordinated care will promote better patient outcomes and drive down health care costs. Likewise, reforms should work to restore the patient-physician relationship by reducing administrative burdens and allowing physicians to do what they do best: care for patients.

Choices. Genuine reform should free individuals and families to secure the health coverage that best meets their needs, rather than instituting one-size-fits-all directives from Federal bureaucracies such as the Internal Revenue Service, the Department of Health and Human Services, and the Independent Payment Advisory Board.

Innovation. Instead of stifling innovation in health care technologies, treatments, medications, and therapies with Federal mandates, taxes, and price controls, a reformed health care system should encourage research, development, and innovation.

Responsiveness. Reform should vigorously apply the spirit of federalism, returning authority to States wherever possible, to make health care more responsive to patients and their needs. Instead of tying States' hands with Federal requirements for their Medicaid programs, the Federal Government should return control of this program to the States. The current Medicaid Program only drives up Federal debt and threatens to bankrupt State budgets. States are better positioned to provide quality, affordable care to those eligible for the program and to track down and weed out waste, fraud, and abuse. Beneficiary choices in the State Children's Health Insurance Program [SCHIP] and Medicaid should be improved. States should make available the purchase of private insurance as an option to their Medicaid and SCHIP populations (though they should not require enrollment).

Legal Reforms. Policymakers should develop reforms that prevent lawsuit abuse and curb the practice of defensive medicine, which are significant drivers increasing health care costs. The burden of proof in medical malpractice cases should be based on compliance with best practice guidelines and States should be free to implement those policies to best suit their needs.

CLEARING THE WAY FOR REAL HEALTH CARE REFORM

The essential failing of Obamacare runs deeper than its distortions of health care delivery and financing, its clumsy rollout, or the President's numerous unilateral changes in the lawafter its enactment. Beneath all these, the fundamental flaw of Obamacare is the conceit that Washington could somehow centrally manage a vast and complex medical sector serving nearly 320 million diverse individuals. That notion has proved a failure. It requires suffocating mandates and regulations. It stifles health care delivery, making it less responsive and more costly. Above all, it necessarily imposes government dictates on highly personal medical decisions, effectively placing a government agent in every examining room and alongside every hospital bed.

That is why Obamacare must be dismantled. The aim is not only to reject this illegitimately conceived government expansion, which still--more than 5 years after its enactment--lacks the support of even a simple majority of the American public. It is not just to replace one national health program with another. The point is to discard the entire pretense of nationalized medicine, and recognize that health care works best when it promotes the most important and basic relationship in medicine--the one between the patient and the doctor. Everything else in the $3 trillion health care network--hospitals, nurses, technicians, medical device makers, pharmaceutical companies, researchers, health insurers, and many more--revolves around that fundamental partnership.

Obamacare must be repealed to clear the way for genuine, compassionate, patient-centered health care reform. That is the broader aim of this legislation: the Restoring Americans' Healthcare Freedom Reconciliation Act of 2015.

Like so much of Washington's health care policy, this massive program--formally called the Affordable Care Act 1

[Footnote] --was designed to satisfy the ivory tower aspirations of academics and protect the fortresses of government bureaucracies. Instead of responding to the medical needs of real people in the real world, it adds layers of rules and directives to further systematize health care as a government-run service. It seeks to control costs from the top down--which can only lead to rationing health services--rather than trusting prices to emerge naturally from the free choices of millions of individuals.

[Footnote 1: Because the House and Senate could not agree on a single plan, they had to pass two bills, one modifying the other, to create the Affordable Care Act. The two measures were the Patient Protection and Affordable Care Act (H.R. 3590, Public Law 111-148) and the Health Care and Education Reconciliation Act of 2010 (H.R. 4872, Public Law 111-152).]

True health care reform can only arise from a different way of thinking about it. There is no one strategy for making health care more effective and efficient; there is no unified approach, especially not by government. True reform can only emerge from the flexibility and innovation of all the participants, always seeking creative ways to advance better and less costly health care. As spelled out in the fiscal year 2016 budget resolution, which led to this legislation, policymakers should apply the guiding principles below to develop real health care reform. 2

[Footnote]

[Footnote 2: See section 6205 of the Conference Report accompanying the Concurrent Resolution on the Budget for Fiscal Year 2016 (S. Con. Res. 11).]

Affordability. Real reform should ensure that all Americans, no matter their age, income, or health status, can afford health coverage. The health care delivery structure should be improved, and individuals should not be priced out of the insurance market due to pre-existing conditions. Nationalized health care not only fails to accomplish these aims, but in fact undermines them. Individuals should be allowed to join together voluntarily to pool risk through mechanisms such as Individual Membership Associations and Small Employer Membership Associations.

Accessibility. Instead of Washington dictating to Americans how they may or may not use their health insurance, reforms should make health coverage more portable. Individuals should be able to own their insurance and have it follow them in and out of jobs throughout their careers. Small business owners should be permitted to band together across State lines through their membership in bona fide trade or professional associations to purchase health coverage for their families and employees at a low cost. This will increase small businesses' bargaining power, volume discounts, and administrative efficiencies while giving them freedom from State-mandated benefit packages. Also, insurers licensed to sell policies in one State should be permitted to offer them to residents in any other State; consumers should be permitted to shop for health insurance across State lines, as they are with other insurance products online, by mail, by telephone, or in consultation with an insurance agent.

Quality. Incentives for providers to deliver high-quality, responsive, and coordinated care will promote better patient outcomes and drive down health care costs. Likewise, reforms should work to restore the patient-physician relationship by reducing administrative burdens and allowing physicians to do what they do best: care for patients.

Choices. Genuine reform should free individuals and families to secure the health coverage that best meets their needs, rather than instituting one-size-fits-all directives from Federal bureaucracies such as the Internal Revenue Service, the Department of Health and Human Services, and the Independent Payment Advisory Board.

Innovation. Instead of stifling innovation in health care technologies, treatments, medications, and therapies with Federal mandates, taxes, and price controls, a reformed health care system should encourage research, development, and innovation.

Responsiveness. Reform should vigorously apply the spirit of federalism, returning authority to States wherever possible, to make health care more responsive to patients and their needs. Instead of tying States' hands with Federal requirements for their Medicaid programs, the Federal Government should return control of this program to the States. The current Medicaid Program only drives up Federal debt and threatens to bankrupt State budgets. States are better positioned to provide quality, affordable care to those eligible for the program and to track down and weed out waste, fraud, and abuse. Beneficiary choices in the State Children's Health Insurance Program [SCHIP] and Medicaid should be improved. States should make available the purchase of private insurance as an option to their Medicaid and SCHIP populations (though they should not require enrollment).

Legal Reforms. Policymakers should develop reforms that prevent lawsuit abuse and curb the practice of defensive medicine, which are significant drivers increasing health care costs. The burden of proof in medical malpractice cases should be based on compliance with best practice guidelines and States should be free to implement those policies to best suit their needs.

THE ROLE OF THE COMMITTEE ON THE BUDGET

As required by the conference agreement accompanying the Concurrent Resolution on the Budget for Fiscal Year 2016 (S. Con. Res. 11), this reconciliation legislation comprises provisions from three committees of the House of Representatives with jurisdiction related to the Affordable Care Act: the Committee on Education and the Workforce, the Committee on Energy and Commerce, and the Committee on Ways and Means. Each committee met its instruction to achieve at least $1 billion in deficit reduction over 10 years, submitting targeted provisions aimed at deconstructing the foundation of the Affordable Care Act.

At this stage of the process, the role of the Committee on the Budget is to determine whether the bill complies with the deficit reduction targets in the budget resolution. It then binds together the submissions of the three committees into a single bill. The Committee on the Budget subsequently reports the combined bill to the House with the recommendation that it be passed by the entire House. The Congressional Budget Act of 1974 precludes the Committee on the Budget from making any substantive change in the bill during the course of its markup. If a change in the reported bill is necessary, section 310(d)(5) of the Act prescribes the following procedure: `The Committee on Rules of the House of Representatives may make in order amendments to achieve changes specified by reconciliation directives contained in a concurrent resolution on the budget if a committee or committees of the House fail to submit recommended changes to its Committee on the Budget pursuant to its instruction.'

During markup, the Committee on the Budget adopted a motion granting the Chairman, at his discretion, the authority to request the Committee on Rules to report a rule for consideration of this measure that would make in order an amendment to the bill.

It is not unusual for amendments to budget reconciliation legislation to be made in order at the Rules Committee for reasons other than one or more committees failing to meet reconciliation instructions. Amendments often are needed to make technical and conforming changes in complex legislation. At other times, changes are needed to address any of the many House and Senate budget rules. On occasion, amendments are needed to resolve the inevitable interactions among multiple committees' submissions or to address unresolved policy issues.

THE COMMITTEES' SUBMISSIONS

The submissions from the three reporting committees detail and explain their specific provisions and outline how they fulfill their instructions and provide the required amount of deficit reduction over the next 10 years. A summary of the provisions is as follows:

TITLE I: COMMITTEE ON EDUCATION AND THE WORKFORCE

Section 101: Repeal of Automatic Enrollment Requirement. Repeals Section 18A of the Fair Labor Standards Act (29 U.S.C. 218a), as added by section 1511 of the Affordable Care Act. Section 1511 requires employers with more than 200 employees to automatically enroll new full-time equivalents into a qualifying health plan if offered by that employer, and to automatically continue enrollment of current employees.

Net Change in Deficit, 2016-2025: -$7.9 billion.

TITLE II: COMMITTEE ON ENERGY AND COMMERCE

Section 201: Repeal Prevention and Public Health Fund. Repeals the Prevention and Public Health Fund [PPHF] and rescinds unobligated balances. The PPHF allows the Secretary of Health and Human Services to transfer amounts from the fund to Department of Health and Human Services accounts to increase funding for Public Health Service Act-authorized prevention, wellness, and public health activities, including prevention research and health screenings.

Section 202: Federal Payment to States. Prohibits Medicaid reimbursement for 1 year for a defined entity, which includes its affiliates, subsidiaries, successors, and clinics.

Section 203: Funding for Community Health Center Program. Increases funding to the Community Health Center Fund by $235 million in each of fiscal years 2016 and 2017, as extended by the Medicare Access and CHIP Reauthorization Act (H.R. 2).

Net Change in Deficit, 2016-2025: -$12.4 billion.

THE COMMITTEES' SUBMISSIONS

The submissions from the three reporting committees detail and explain their specific provisions and outline how they fulfill their instructions and provide the required amount of deficit reduction over the next 10 years. A summary of the provisions is as follows:

TITLE I: COMMITTEE ON EDUCATION AND THE WORKFORCE

Section 101: Repeal of Automatic Enrollment Requirement. Repeals Section 18A of the Fair Labor Standards Act (29 U.S.C. 218a), as added by section 1511 of the Affordable Care Act. Section 1511 requires employers with more than 200 employees to automatically enroll new full-time equivalents into a qualifying health plan if offered by that employer, and to automatically continue enrollment of current employees.

Net Change in Deficit, 2016-2025: -$7.9 billion.

TITLE II: COMMITTEE ON ENERGY AND COMMERCE

Section 201: Repeal Prevention and Public Health Fund. Repeals the Prevention and Public Health Fund [PPHF] and rescinds unobligated balances. The PPHF allows the Secretary of Health and Human Services to transfer amounts from the fund to Department of Health and Human Services accounts to increase funding for Public Health Service Act-authorized prevention, wellness, and public health activities, including prevention research and health screenings.

Section 202: Federal Payment to States. Prohibits Medicaid reimbursement for 1 year for a defined entity, which includes its affiliates, subsidiaries, successors, and clinics.

Section 203: Funding for Community Health Center Program. Increases funding to the Community Health Center Fund by $235 million in each of fiscal years 2016 and 2017, as extended by the Medicare Access and CHIP Reauthorization Act (H.R. 2).

Net Change in Deficit, 2016-2025: -$12.4 billion.

TITLE III: COMMITTEE ON WAYS AND MEANS

Subtitle A--Revenue Provisions

Section 301: Repeal Individual Mandate Tax. Repeals the penalty on individuals who do not obtain qualified health insurance, effective after 1 December 2014.

Section 302. Repeal of Employer Mandate. Repeals the penalty on employers who do not offer their employees qualified health insurance, effective after 1 December 2014.

Section 303: Repeal Medical Device Tax. Repeals the 2.3-percent excise tax, effective 31 December 2012, on the sale of any taxable medical device by a manufacturer, producer, or importer of such device.

Section 304: Repeal of the Excise Tax on Employee Health Insurance Premiums and Health Benefits and Related Reporting Requirements (i.e. the Cadillac Tax). Repeals the 40-percent excise tax on high-value health plans.

Subtitle B--Repeal of the Independent Payment Advisory Board

Section 311: Repeal Medicare Independent Payment Advisory Board [IPAB]. Repeals IPAB, which would have been required under certain circumstances to modify the Medicare Program to achieve specified savings in the Medicare Program. See also H.R. 1190, which passed the House on 23 June 2015.

Net Change in Deficit, 2016-2025: -$37.1 billion.

Due to interactions between the provisions submitted by the House committees, an additional net change in the deficit of -$19.4 billion for fiscal years 2016-2025 was determined by the Congressional Budget Office. The reconciliation bill's total net change in the deficit for all reported provisions is -$78.9 billion for fiscal years 2016-2025.

RECONCILIATION AND THE BUDGET RESOLUTION

Budget resolutions and reconciliation bills have a special relationship in the congressional budget process. The adoption of a budget resolution--formally designated a concurrent resolution on the budget--establishes the reconciliation process for a fiscal year in addition to providing rules that assist in guiding a reconciliation bill through the congressional legislative procedure. Conversely, a reconciliation bill may be essential to fulfilling the aims of a given budget resolution.

THE RECONCILIATION PROCESS

The term `reconciliation' refers to both a form of legislation and a specific legislative procedure. Only by adopting a concurrent resolution on the budget that includes reconciliation instructions can Congress initiate the reconciliation process, 3

[Footnote] ideally culminating in the enactment of reconciliation legislation. Such a measure is termed a `reconciliation bill' because it is designed to amend existing law to reflect the assumptions underlying the budget resolution from which it has commenced; that is, it reconciles current law to the budget resolution framework.

[Footnote 3: Section 310 of the Congressional Budget Act of 1974 (2 U.S.C. Sec. 641).]

S. Con. Res. 11, the conference report accompanying the Concurrent Resolution on the Budget for Fiscal Year 2016, 4

The full text of the report is found at: http://thomas.loc.gov/cgi-bin/cpquery/50?cp114:temp/~cp114dRhgY&sid=cp114dRhgY&item=50&sel=TOCLIST&l_f=251&l_file=list/cp114ch.lst&l_b=201&l_file=list/cp114ch.lst&report=hr293.114&hd_count=50&39&&&l_t=339&&&

Myron Struck, editor, Targeted News Service, Springfield, Va., 703/304-1897; [email protected]; http://www.targetednews.com

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