Thursday, August 24, 2017

Commentary: The Process Is Our Protection

by Tom Howarth
Originally published in the Northern Virginia Daily, August 4, 2017 

Takeaways
  • People are often fuzzy about what’s in the Constitution. This article briefly summarizes how the legislative branch is supposed to function.
  • When the Framers laid out the process, they designed in a method for achieving a broad consensus that achieves the greatest good for the greatest number.
  • James Madison designed a system of checks and balances to guard against fools and tyrants. 
  • For good or ill, our processes of government don’t lend themselves to quick decisions; our government was not designed to be efficient, but stable.

Often it appears that people equate the Constitution with the right to bear arms, the Second Amendment.  There is a lot more to the Constitution than that.

Some of the most important parts of the Constitution explain the separation of powers between the president, the Congress and the Supreme Court.  Only the Congress can raise and spend money.  The president can request or recommend spending money but only the Congress can do it.  The president proposes; the Congress diposes.

The Supreme Court is independent. The president recommends to Congress that it advise and consent to the appointment of a judge.  Once approved that judge is independent and serves for life.  The court interprets the actions of the political branches.

Members of the Senate serve six-year terms.  The Senate, like a saucer, can cool the actions of the House where temporary passions can rule the day.

When a bill is proposed it is referred to a committee and a subcommittee where its nature and merits are to be discussed.  If, based on public hearings, the committee finds merit in the bill, it moves it to a mark-up session where members of the committee, both Republicans and Democrats, can offer amendments.   The amendment process gives all members of the committee their day in court.

When a bill clears committee, it is reported to the floor of the respective houses.  The House Rules Committee determines the rules under which a measure will be taken to the House floor.  In the Senate that role falls to the Senate majority leader in consultation with the minority leader.

The Senate has no rules committee.  The majority leader sets the conditions under which a measure will be considered.  The Senate functions most of the time under unanimous consent.  Absent the ability to achieve unanimous consent, the work of the Senate will be very slow indeed.

The next step in the process is conference committee.  It has become an endangered species.  If the measures approved by the House and Senate have important differences, they are worked out in this committee. A conference committee is composed of Republicans and Democrats who represent the views of their respective bodies.

Conference committees went the way of the dodo bird when the Republican strategist Frank Luntz sold House Republicans on the idea of treating their Democratic colleagues as crooks and traitors rather than the political opposition.   A senator with a different point of view was now my enemy and not my colleague.  This poisoned the waters.  It meant that conference committees were deemed unnecessary; the majority party would impose its decisions on the minority.

The more hands that touch a legislative proposal, the stronger and better it will end up being.  The process lends itself to achieving a broad consensus on legislation.  Such legislation seeks the greatest good for the greatest number.

That’s all very nice. But where are we today?

There are things so important that a super-majority is required to approve them.  The approval of lifetime appointments to the Supreme Court was an example until Justice Gorsuch was deemed to require a simple majority.

The crafting of the health care bill behind closed doors in the Senate is the antithesis of how a bill is supposed to become a law.  Sen. McConnell’s approach is that the fewer hands that touch this bill the better.  Madison would be appalled.

Legislation that stands the test of time and provides sustained benefits to the people of the United States requires the buy-in of a broad consensus of Republicans and Democrats.  Legislation passed on a party-line basis will last only as long as the party in power stays in power.  In 1935, Social Security had substantial Republican support as did Medicare and Medicaid in 1965.

James Madison put it well when he said, “If men were angels, there would be no need for government.”  Madison was creating a process with checks and balances that would protect us against rash decisions and unbridled ambition.  For good or ill, our processes of government do not lend themselves to quick decisions.  Our system was not designed to be efficient but stable.

The Constitution and the legislative process conceived by its Framers are our best defense against fools and tyrants.

Bipartisanship allows our government to work well; its absence results in it not working at all.

Tom Howarth is a former legislative assistant to the late Sen. Frank R. Lautenberg, D-NJ. and a member of the Warren County Democratic Committee.  

Learn more about the Warren County Democratic Committee at www.warrencodems.org

Tuesday, August 15, 2017

Looking at the 2018 Individual Health Insurance Market in Virginia: Higher Costs and Fewer Choices

by Margret Straw

Takeaways
  • Big changes are coming in 2018 for the ACA's individual health insurance market in Warren County and across Virginia.
  • Major insurers are leaving the exchange, but all counties will have at least one insurer since Optima is expanding its availability across the state.
  • In addition to fewer choices of insurers, prices will go up for those who do not qualify for subsidies to help with premium costs.
  • Insurers cite uncertainty about the action (or inaction) of the Trump administration with regard to cost-sharing subsidy payments, enforcement of the mandate, and adequate promotion of the exchange market as reasons for price increases.

If you use the ACA Individual Health exchange to purchase insurance (Healthcare.gov), you will see changes next year.  In 2017, three insurers covered Warren County:  Health Keepers, Innovation Health, and Cigna.  Two of those three (Anthem’s Health Keepers and Innovation Health) are pulling out of the market.

In all, there were 10 insurers covering Virginia in 2017.  Three major insurers are pulling out of the Virginia health insurance exchange in 2018:  United Healthcare, Anthem, and Aetna.  Anthem (Health Keepers and Innovation Health) was the largest insurer on the individual market in Virginia, insuring 206,000 people, most through the exchange.  This leaves six insurers in the 2018 marketplace in Virginia, several of them available in very limited areas of the state.

Optima is expanding its area of coverage from 35 counties/independent cities to 124 counties/cities.  This means that every county in Virginia will have at least one insurer on the exchange.  However, choices will clearly be reduced in many parts of the state and costs are up across the board.

According to Healthinsurance.org, the proposed rate increases are as follows:
  • CareFirst Blue Choice:  16.1%
  • Cigna:  44.7%
  • Group Hospitalization and Medical Services:  48.2%
  • Kaiser Foundation Health Plan of the Mid-Atlantic:  24.2%
  • Optima Health Plan (HMO): 19.3%
  • Piedmont Community Healthcare (and Piedmont HMO): 9.95%

Insurers point to uncertainty about whether the Trump administration will pay for the cost-sharing reduction subsidies*, whether they will enforce the individual mandate, and whether they will adequately promote the exchanges as the primary reasons for pricing increases.

In looking at those rate increases, it is important to recognize that most consumers will not pay that much.  In 2017, 81.5% of consumers using the exchanges received a premium subsidy that substantially reduced their costs.  The average premium in 2017 was $405 a month without the subsidy; the average amount paid by consumers after the subsidy was $146.

For more detail on the topic, see:  https://www.healthinsurance.org/virginia-state-health-insurance-exchange/.

*A note on subsidies:
Insurers are required to provide a set of plans with very low co-payments and with low deductibles for people in the lowest income brackets using the exchanges.  The system was designed so that the government would reimburse insurers for those expenses after the fact.  The reimbursement is called a cost-sharing reduction subsidy.  The administration is not willing to provide insurers with a guarantee that they will reimburse them, although the insurers would still be required to offer these plans to people meeting the income guidelines.  Uncertainty about this reimbursement means that some insurers are setting rates assuming that they will not receive it.

The premium subsidies are designed to cover a portion of the premium costs (much like many employers cover part of premium costs for employees).  Because these subsidies are based on what someone with a particular income is expected to be able to afford (not on a percent of the premium), lower income consumers should be protected from most of the sticker shock from 2018 rate increases.  However, consumers who pay the full cost will see substantial premium increases.

Margret Straw is a former AARP researcher with a special interest in health and long-term care issues and a member of the Warren County Democratic Committee

Learn more about the Warren County Democratic Committee at www.warrencodems.org