CNSNews.com - As Health Care Deadline Looms, Congress Leaves Key Reform Details to Administration

CNSNews.com - As Health Care Deadline Looms, Congress Leaves Key Reform Details to Administration

(CNSNews.com) – With its self-imposed deadline for health care reform only four weeks away, major health care overhaul proposals in both chambers of Congress leave key details up to unelected Obama administration officials, giving the administration the power to ultimately define what health care reform will look like.



In fact, bills working their way through both chambers give the administration broad powers over a key "reform" component -- health insurance “exchanges,” a new national purchasing pool from which individuals and businesses could choose health insurance from a range of options, including private plans and a government alternative.

The health insurance exchanges would be run by the administration, allowing Obama administration officials and the bureaucrats they employ to design and run a permanent government health care bureaucracy designed to act as part insurer, part enforcer for the new exchanges.

Congressional leaders are hoping to complete work on a bill before their summer break begins in August. They want to have the bill on Obama’s desk by October.

A plan authored by Sen. Edward Kennedy (D-Mass.) is currently under consideration in the Senate, with a second Senate proposal expected soon. Three separate House committees are currently debating identical proposals.

Under the Kennedy plan currently being debated in the Senate, the Health and Human Services (HHS) secretary is granted broad discretion in fleshing out the details of the health insurance exchanges – called “gateways” – including which insurance plans qualify, which state-developed gateways receive federal assistance, and what qualifies as “quality” health care.

Under the Kennedy proposal, either a state or the HHS secretary can establish a gateway. If a state declines to establish a gateway, the administration will establish one for them, which it, rather than the state, would run.

“A Gateway shall be established by — ‘‘(A) a State, in the case of an establishing State (as described in section 3104); or ‘‘(B) the Secretary, in the case of a participating State (as described in section 3104),” the bill states.

If a state wants the government to establish its gateway, the government will do so, but it would run that gateway for at least five years.

If a state refuses to establish a gateway, fails to establish one after four years, or establishes one the HHS secretary does not like, the administration can establish one anyway.

“Upon the expiration of the 4-year period following the date of enactment of this section, in the case of a State that is not otherwise a participating State or an establishing State — ‘‘(A) the Secretary shall establish and operate a Gateway in such State,” the bill states.

Regardless of who establishes the gateway, the administration would determines the details under which they operate. Under the Kennedy bill, it is up to HHS to set guidelines for how each gateway is run.

“The Secretary shall develop guidance that may be used by a Gateway to carry out the activities described in subsection (c) [the section which defines what a gateway is],” the bill states.

The administration is even allowed to define a “qualifying” health plan and how that plan pays for care, meaning that while states can establish a gateway, they can only establish the type of gateway the federal government wants them to.

“The Secretary shall, by regulation, establish criteria for certification of health plans as qualified health plans,” and “The Secretary, in consultation with experts in health care quality and stakeholders, shall develop guidelines concerning,” how qualifying plans pay for health care.

The health care overhaul being considered in the House is even more direct, establishing a new government agency – the Health Choices Administration – and a new administration appointee to oversee it, the Health Choices Commissioner.

“There is established within the Health Choices Administration and under the direction of the Commissioner a Health Insurance Exchange,” the House bill says.

The new commissioner is empowered to set guidelines for the exchange and determine which plans qualify as a “qualified health benefit plan” as well as negotiate with insurance companies offering such plans.

“[T]he Commissioner shall— (1) under section 204 establish standards for, accept bids from, and negotiate and enter into contracts with QHBP offering entities for the offering of health benefits plans through the Health Insurance Exchange,” the bill states.

The commissioner is also empowered to establish what benefit packages will be offered by exchange-eligible plans for three benefit levels; basic, enhanced, and premium plans.

“The Commissioner shall specify the benefits to be made available under Exchange-participating health benefits plans,” the House bill states.