In North Dakota, the business community is committed to finding solutions to the pressing issues of health care cost and access. Unfortunately, while Congress seems ready to vote on some health care reform package, no one is certain what is in, or out, of the final bill. In fact, no one is really sure if Congress will actually vote on the bill or just “deem it passed” under a technical rule while voting on amendments through budget reconciliation. We commend our delegation for their efforts to move health reform forward. However, based on the Senate bill, which we think is what will be voted on, we must express our concern and opposition to what could be passed.
There are some good things in the Senate bill. A significant number of the uninsured will get insurance coverage. Lower income people and some small businesses will receive subsidies to help them buy insurance. North Dakotans will get a new electronic marketplace to help them choose coverage. In addition, health insurance companies will not require medical questions before issuing coverage. These are good things, which we support, but they are offset by a host of bad things that are in the Senate bill.
The final bill may or may not include additional Medicare payments for hospitals and physicians in North Dakota. In North Dakota, this is a big issue as our health care providers are reimbursed at a lower rate than other parts of the nation…for the same procedures. Our concern is that even if our hospitals receive more reimbursement, it may not be enough to pay North Dakota health care providers the actual cost of providing care to Medicare payments and it will be offset by future Medicare cuts in the bill. Hospitals will still lose money on Medicare patients and our private insurers and businesses will still be asked to pick up the difference.
Health insurance will be more expensive for everyone who doesn’t get a subsidy. The Senate bill includes $70 billion in new taxes on health insurance. These taxes will be passed on to North Dakotans through higher premiums as there is just no way around it. The bill also puts taxes on drugs and medical equipment. The Senate bill requires higher benefits than North Dakotans are currently buying and it limits the benefit choices that will be available to those who receive subsidies. Restrictions on age rating will require our major health care insurer, Blue Cross Blue Shield, to dramatically raise premiums for young people, further reducing reasons for young people to stay in the state. Finally, while the bill requires individuals to have insurance, the penalties are weak. We believe that many North Dakotans who have insurance will drop it rather than pay the higher premiums. This will raise costs for everyone still covered.
The Congressional Budget Office says that the Senate bill will reduce the deficit. The CBO estimates rely on 10 years of taxes to pay for six years of benefits and future cuts to Medicare that may or may not happen. Congress has ignored prior laws requiring cost cuts in Medicare. Current law requires deep cuts in physician payments in order to make up for the cuts that were avoided in past years. Congress wants to change the law to avoid these cuts, but the cost of changing this law is not included in the health reform estimates. If it were, health reform would substantially add to the deficit. Covering all Americans will add to the deficit and we will pay for it with taxes. Pretending otherwise is merely politics as usual.
The Senate bill does nothing to control health care costs. President Obama wants Congress to add a new federal bureaucracy to control health insurance prices. Controlling health insurance prices does not control health costs. In the end, this goes back to a basic principle of personal responsibility.
We can do better than this bill. If our Congressional delegation does the right thing for North Dakota and votes against this bill, the business community pledges to ask Blue Cross Blue Shield, the leaders in the legislature, hospitals, physicians, business and our communities to craft a proposal for health reform for North Dakota. We can get everyone covered with a North Dakota solution that will work better than a 2,000 page bill. Contrary to what Nancy Pelosi said, we should really understand what is in this bill before it passes. Not try to figure it out after the “fog of debate.”
