Wednesday, February 28, 2024

“Bait-and-Switch” Health Package Illustrates Washington’s Addiction to Government Spending

You can say this about Washington: Members of Congress are nothing if not predictable when it comes to their addiction to more government spending.

Back in September, I wrote the following about a health care package House leadership wanted to bring to the floor for a vote: “The transparency provisions [in the legislation] ultimately amount to fancy window dressing — the proverbial lipstick on the pig. The main driver of this legislation — the thing that makes it ‘must-pass’ — comes from its spending.”

Nearly six months later, and what do you know? Lawmakers appear ready to ditch the transparency provisions, which would leave nothing but the spending provisions intact. So much for Congress’s desire to “reform” health care.

Rumored Objections

Multiple Capitol Hill publications reported Monday and Tuesday that talks on the health care package had hit the skids. Roll Call noted that lawmakers were “now working on a pared-down deal that could exclude the vast majority of health proposals previously in the works, including legislation to codify and strengthen price transparency rules [and] crack down on practices of pharmacy benefit managers,” or PBMs.

These Capitol Hill publications, citing numerous lobbyists, because of course lobbyists know the details of legislation before most members of Congress do, claim that several objections have stifled the broader health care package. In particular, Sen. Bill Cassidy, R-La., wants to apply the PBM provisions to all forms of health insurance, including those in the private marketplace, while the House legislation would confine the changes only to government programs like Medicare and Medicaid.

Apparently, Democrats also object to using Medicare funding to pay for spending outside the Medicare program, as the House legislation did. That objection seems highly disingenuous coming from a party that repeatedly raided Medicare to pay for its big-spending legislation. That said, lawmakers should find other sources to fund spending than a functionally insolvent Medicare program.

Better yet, given the $34 trillion in debt our country faces, they should nix the new giveaways entirely. Just don’t hold your breath waiting for that to happen.

Lawmakers Spend, Spend, Spend

With the transparency and PBM provisions facing various objections, what elements of the health care package remain? Politico provides a nice summary:

Lawmakers are eyeing a smaller package that would address extenders that would secure funding for community health centers, boost payment for doctors under Medicare, and avert cuts to disproportionate share hospitals, according to three of the lobbyists.

In other words, the smaller package contains three provisions that would 1) spend money, 2) spend money, and 3) spend money.

As noted above, this package wouldn’t include the fig leaf of health care “reform” included in the House bill from late last year. But it would contain additional Medicare spending on a physician payment “fix” that House leaders excluded from their bill last fall. To top it off, Roll Call notes that “Senate [Health, Education, Labor, and Pensions Committee] Chairman Bernie Sanders (I-VT) is asking for billions of dollars more in community health center funding than what was included in a bipartisan House bill” — even though that House bill already included spending increases for the health centers.

Big Spending Train Continues

In sum: House Republicans who bought into the notion late last year that they would vote to pass a health “reform” package got sold a bill of goods. Leadership in both chambers has effectively decided to do a “bait-and-switch,” removing the substantive policy changes to leave a bunch of spending programs behind. And they will slap this spending package onto one or more appropriations bills — either a massive omnibus or slightly smaller “minibuses” — that will spend even more money, and that members of Congress will not have time to read or understand.

But the real kicker comes in the fact that these health care spending programs will almost certainly see only temporary extensions, hence the name “extenders.” That moniker doesn’t mean those programs won’t get extended for years, and likely decades, to come. Instead, Congress will only extend these spending programs in one- or two-year increments, to disguise their true costs.

In other words: Lawmakers suckered by the “bait-and-switch” last fall will get asked to foot the bill for these spending programs again, in a year or two, when the bill for the expiring provisions again comes due. As with my missive back in September, don’t say you weren’t warned.

This post was originally published at The Federalist.