Questions on Health Care

Now that the historic health care bill has been signed and become law, there are a number of important questions that need to be addressed by Senators Murray, Cantwell, and Representative Larsen.  I am addressing this as an open letter to them in the hope they are willing to reply to these important questions.  No bill ever gets implemented as planned, so the real question of whether this will ultimately be beneficial is what will happen over the next few years as assumptions turn into reality.

 1)  Why does it take 4 years before the key components of the legislation are in place and almost a decade before everyone has health insurance?  If the benefits are so important (and deficit neutral), can’t we accelerate the schedule and provide insurance to everyone within the next year?

2)  The Congressional Budget Office (CBO) estimates that the health care bill is deficit neutral.  What will you do if one of the following scenarios occur:  (1) revenue is lower than anticipated, (2) insurance rates continue to climb and the cost is greater than forecast, or (3) we decide Medicare cannot be cut by $500 billion?

3)  A lawsuit has been filed by a number of state attorneys general claiming the law is unconstitutional.  The argument to support its constitutionality is that Social Security is constitutional and this is a similar mandate.  In the Supreme Court case it was argued that Social Security was a tax and it was fully within in the purview of the federal government to tax people.  In order to survive a Supreme Court case, it will likely have to be similarly argued that the health care mandate is a tax.  In this case the “tax” would be paid directly to the insurance companies.  Previously we paid our taxes to the federal government, who in turn gave the money to multinational corporations.  This raises the question, should we just assume that multinational corporations and the federal government are one in the same, given we are now paying our “tax” dollars directly to multinational corporations?

4)  The Democrats in Washington D.C. spent over a year berating the insurance companies and then handed them billions of dollars in new revenue by mandating everyone buy from an “approved” insurance company.  This seems a little incongruous, can you please explain why it is suddenly imperative we now turn over our health care decisions to the insurance industry after you told us how bad they were?  Are you going to regulate the insurance industry to the same degree Fannie Mae, Freddie Mac and the financial industry have been regulated?  (We all know how that turned out.)

5)  This bill is supposed to lower the cost of health care.  It is unclear how this will happen, but if health care costs continue on the current trajectory, what changes would you propose to bring down health care costs?  Why didn’t you include those ideas in the current legislation?

6)  The health care reform bill calls for an increase in the number of Medicaid patients, and a portion of Medicaid is funded by state governments.  It appears for the first few years the federal government will cover all the increased costs, but at some point state governments will have to pick up the additional Medicaid spending.  Given that we are already facing a tight budget for the next few years, what taxes would you propose increasing, or what cuts in spending would you propose, to cover the additional Medicaid costs to the state budget?

7)  One of the provisions of the health care bill allows states to set up insurance exchanges and gives states flexibility in terms of how to set those up.  Given that our current state government cannot even figure out how to balance a budget even when revenues are increasing, can you provide some guidance in terms of how you would set up the regulations to govern those exchanges? (Our state government could use some advice.)

8)  The regulations for federal government contracts make it impossible for small and medium-sized local businesses to win federal contracts.  Do you anticipate the exchanges to end up in the same situation, one where only large insurance companies are able to participate, shutting down smaller insurance companies that exist today?

9)  In a related question, there are well over 1,000 companies that provide health insurance.  Do you anticipate a consolidation of insurance companies where only a few large insurance companies remain?  What would be the impact if that happens?  Would we be better served by having only having a few large insurance companies?

10)  Do you expect every citizen to comply with the mandate to purchase their insurance through an exchange?  If someone refuses to purchase health insurance, what do you think should be done?

11)  There is a lot of discussion right now about whether the American people support the bill or not.  The Democrats claim once people understand what is in the bill they will support it, Republicans claim the people do not support it.  There is no way of knowing at the moment who is right, but the November election may determine the answer to that question.  If it is clear after the November election the American people do not support the bill, will you vote to repeal it?