An Obama Head Fake. Watch Out State Governors!

Stanley Feld M.D.,FACP,MACE

Once again, President Obama is being disingenuous. He told the nation’s governors he was willing to amend his healthcare reform act. He said he would give states the ability to opt out of its most controversial requirement the mandate for citizens to buy insurance in 2014.

Last week he started his speech by spinning his charm at the National Governors Association meeting by saying:

“I am aware that I have not convinced everybody here to be a member of the Affordable Care Act fan club,"

He said he understood that the majority of the public were not members of the Affordable Care Act fan club either.

He did promise “to give states the power to determine their own health-care solutions.” His qualifications to state power are the deal breaker.

President Obama’s qualifications to state power change in his healthcare reform act as it relates to Medicaid are:

1. The Administration retains the power to decide which states deserve a waiver.
2. The state would still need to cover the same number of uninsured.
3. Its coverage would still need to include the same comprehensive benefits.
4. It must be as "affordable" as determined by the Administration.
5. States could opt out of some consumer or employer mandates. This is a minor concession.
6. In reality, his conditions leaves no room for the states to innovate.
7. Innovations such as;
   1. Straight tax deduction or credit to purchase individual coverage.
   2. Alternative insurance designs such as;

              i. The high-deductible ideal medical savings accounts,

              ii. Plans that can be bought across state lines.

1. Even if the change was approved, it could be difficult for states to meet the federal requirements for the waivers.

Mr. Obama also asked the governors to come up with a bipartisan group to find ways to reduce Medicaid costs. There is no way to reduce Medicaid costs under the structure of President Obama’s healthcare reform act. The structure is defective.

President Obama must have stayed up all night trying to figure out ways to fake out the State Governors. President Obama is trying to reposition himself to the political center issues in the wake of the drubbing his party took in the November midterm elections. This proposal will not do it.

He has once again used smoke and mirrors.

This is not a shift. The mandate in particular is under fierce attack in the courts, where federal judges have issued conflicting opinions on its constitutionality. The mandate is also a rallying cry for conservatives and Tea Party supporters, who regard it as a prime example of overreaching by the federal government.

President Obama will not allow states to cut Medicaid rolls to ease their fiscal distress.

President Obama said. “I am not open to refighting the battles of the last two years,” he said, “or undoing the progress that we’ve made.”

Gov. Rick Perry of Texas, chairman of the Republican Governors Association said. “Pretty much all he did was to reset the clock on what many of us consider a ticking time bomb that is absolutely going to crush our state budgets. The states need more than that.”

Indiana’s Mitch Daniels and 20 other Governors recently wrote to President Obama requesting a genuine relaxation of the waiver standards. He has also asked for states to have the ability to be innovative and control each individual Medicaid program.

"Healthy Indiana" the Medicaid reform Governor Daniels initiated in Indiana is run because of special federal permission. The program has been a huge success. Federal support for the program is about to disappear.

The Health and Human Services(HHS) department does not like the Healthy Indiana program because it features health savings-like accounts. Healthy Indiana decreases federal control over the Medicaid system in Indiana. The program puts the healthcare dollars under patients’ control.

‘The reality is that the liberals who wrote this bill really do think they have a monopoly on good ideas, and they do not include markets. Democrats are more than happy to give the states more freedom, as long as the states use it to impose comparable government control.’

That may be why we hear that White House health staffers Stephanie Cutter and Nancy-Ann DeParle have been privately telling liberal interest groups that this is a way to increase centralization—for instance with a state-based "public option" or even single payer.

President Obama’s “flexibility” is a shame. He is telling the states you can do anything you want. However, you must do what we want you to do. We will determine what we will approve.

The list is defined arbitrarily by unelected bureaucrats and a non- congressional approved head of CMS (Don Berwick) who refuses to answer any congressional questions directly.

I believe President Obama wants the healthcare reform act to fail. He wants the federal government to get complete control over the entire healthcare system.

He is stalling for time with his most recent tactic. It is essential to him to get all new 256 agencies up and running. Then it will be difficult to close down new agencies.

I hope the state governors are not faked out by his charade.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.