Pine Tree Beat

• By Steve Bowen
• May 20, 2010
• Uncategorized

Live Blogging the first meeting of the “Joint Select Committee on Health Care Reform Opportunities and Implementation”

*Start at the bottom and read up

3:05: Adjournment. No date set for the next meeting, and really, why bother?  The committee sees its role very clearly: the soon-to-be outgoing administration will plow ahead, and the committee will meet periodically so it can be told what the administration is doing. Hardly seems worth the effort, really, though committee members did get their mileage for today and their meals reimbursed and got a per-diem for spending their day being told what the Baldacci administration will do to make Obamacare work.

Unbelievable.

3:02 pm A consensus seems to be developing. The committee will ask the Baldacci administration’s officials and the legislative staff to “guide” them on what to do next. Why reinvent the wheel and do their own work on what ObamaCare means for Maine when they can just be told what to do by the Baldacci administration, which will be out of power in a matter of months?

A separate, co-equal branch of government?

Hardly.

2:53 pm: Rep. Priest, who sponsored a single-payer bill this past legislative session, wants to know how we can move ahead to implement single payer here in Maine.

Of the 22 c0-sponsors of Rep. Priest’s single payer bill, by the way, six are on this committee.

2:51 pm: From Sen. Raye, lots of concern with the financial impact of Obamacare – where does Maine gain financially, and where does it lose financially from ObamaCare?

Good Question.

2:45 pm: Fifteen minutes to go and the executive branch team has been dismissed, leaving the committee and its staff on their own to move forward.

So what do they do now?

The committee’s House Chair, Rep. Treat, has thrown this question out to the committee. What do they need? How do they want to move ahead?

My question is, what will the committee do to ensure transparency for the entire process? In an hour of talk with the Baldacci administration staff, not one word about the need for this process to be completely and totally transparent moving forward.

2:38 pm: The first appearance by someone from the private sector today, an analyst from Deloitte, which is working with DHHS to get them focused on what they need to do to get ObamaCare implemented here in Maine. Deloitte, as DHHS Commissioner Brenda Harvey explained to the committee, has done a lot of work with DHHS since the collapse of the MECMS claims management system, and is evidently volunteering their time to help the Department get itself organized for Obamacare.

To illustrate, Commissioner Harvey showed off a three-foot long sheet of paper onto which Deloitte had put all kinds of lines and arrows and flowcharts and bullet lists, all of them in bright colors.  This piece of paper, evidently, will tell the Department how to implement ObamaCare moving forward.

The new MaineCare claims system, by the way, will go live on August 1, so those of you who are health care providers had better get your MaineCare claims in before then.

2:20pm: So we’ve been at this for a few hours now, and what seems to concern the committee the most? It seems to be this: in what ways do we need act in order to get more health care money from Washington? We’ve had three or four speakers so far, each has talked about different ObamaCare programs and initiatives, and the only response from legislators is “what do we have to do to get money from that initiative.”

Koffman has been talking about an element of the Obamacare bill that deals with retiree health care, for instance. The response from the committee? “Would we be able to access this money to help with health care costs for state employees and teachers?”

This is not about health policy at all at this point, or even about good health. It is all, and only, about the money.

1:55pm: Who is going to be doing the aforementioned rulemaking at the federal level? According to Commissioner Koffman, it will be a joint project of the federal Department of Health and Human Services, the federal Department of Labor, and the U.S. Treasury. These three departments will be developing “joint rules” for ObamaCare as it moves into the implementation phase.

So when I suggested earlier that these rules would be developed in the basement of some federal office building in Washington, they will actually be developed in the basement of three separate office buildings.

Just want to be accurate in my reporting.

1:39 pm: First word about the coming expansion of the failed Dirigo Health program. ObamaCare calls for the creation of a temporary high risk pool, and Riley proposes that Dirigo Health can be expanded, with federal funding, to cover the population that the high risk pool component of Obamacare is designed to cover, which is individuals who have been uninsured for at least 6 months and who have a preexisting condition.

Dirigo Health was launched, of course, with one-time federal money and has been propped up, at least in part, with federal Medicaid funding ever since. Even so, it looks like another federal bailout of Maine’s failing “public option” insurance program is on the way.

1:30 pm: Interesting question from Riley. Down the road, once Dirigo Health has been converted into the state health insurance “exchange” that federal law requires, the tax that funds Dirigo will no longer be needed. What should we do with the tax? We could get rid of the tax, Riley says, or we could use that “revenue” to do something else “health-related.”

Hmmm…What do you suppose they would prefer to do?

1:20pm: On the stand now are Trish Riley from the Governor’s Office of Health Policy, Brenda Harvey from DHHS, and Mila Kofman, the state’s insurance commissioner. Riley is taking the lead here, and tells the committee that as far as she sees it, “we are in pretty good shape” to implement Obamacare.  Our public health programs have already been dramatically expanded, so expending them a little more is no big deal. Indeed, she suggests that if we can just keep people in our Medicaid and other public programs, there is “serious money” from the feds that will come our way. The big question, it seems, is how do we get as many people as possible on these state-run programs?

1:12 pm: Back in action here and the committee staff is going through the materials that have been provided to the committee and are answering questions. One question from Lewiston’s Sen. Craven: “So is federal law going to supersede state law? We’re just going to have to go along with what they’ve….”(she trails off). Answer from staff – there will be some options for states, but yes, the state must follow federal law.

12:30 pm: Lunch. Don’t have much of an appetite, I have to say.

12:15 pm: Good question from Sen. Raye – Maine has already expanded Medicaid well beyond what most states have done – do we get access to the federal funds that other states are getting to expand eligibility to the level Maine is at already?

Convoluted answer from Wilson, but essentially no.

“No good deed goes unpunished,” Sen. Raye observes.

12:08 pm: Good question from Rep. Flood – isn’t it true that the debate about shrinking the size of Medicaid, (an argument we at MHPC have made for years), is now over? The law of the land, he observes, is that Medicaid will grow, correct?

Wilson: Correct.

Get your wallets out.

Noon: Wilson: “I’m going to stop.” Only an hour-long presentation on her part, but seems like it was twice as long. Perhaps it was the 50-slide Powerpoint presentation that hurt her. Not a single picture or graph in the entire presentation, just page after page after page of text.  Painful.

Brannigan plans to have Wilson take questions, then break for lunch in a half-hour or so.

11:52 am: Committee co-chair Sen. Brannigan (along with some other members of the committee, if  body language is any indication), is starting to weary of all this.  He has asked Wilson to wrap it up.

Could it be that only now the members of this committee have  come to realize (a.) the enormity of what they have gotten themselves into, and (b.) how little actual authority they have over any of it? They are just along for the ride on this, but I don’t know that they figured that out until Wilson’s seemingly endless presentation.

11:45am: ObamaCare is clearly an enormous piece of legislation, but there are still a lot of details to be worked out. How will this be done? Through rulemaking, of course. Under rulemaking, unelected bureaucrats will get to decide what constitutes a “preexisting condition,” for instance.  In fact, plans are already in place, Wilson says, to adopt “interim final rules” for ObamaCare, which gets my award for the phrase of the day so far – “interim final rule.”

This is what happens when you turn to government to solve your problems, folks. Your life, and the life of everyone you know and love, ends up being governed by “interim final rules” developed in the basement of some federal office building somewhere. This is where we are as a nation at the start of the 21st century.

11:35am: Just over an hour in, and finally an attack on the insurance companies. (How did we go a whole hour without it?)

The law, Wilson says, limits how much the insurance companies can spend on administrative costs versus costs for providing coverage. “That seems simple” Wilson says, but those darned insurance companies disagree with the feds about what constitutes administrative costs and what constitutes the provision of health care.  Why don’t they do what Wilson’s NCSL did and simply get on their knees before the feds and do what they are told?  Instead, the “debate rages on,” says Wilson with a sigh.

Thank God.

11:25am: Does the 10th amendment to the Constitution really exist? As Wilson continues through the seemingly endless list of provisions in the ObamaCare law, there seems to be no part of the health care universe that remains untouched – long-term care, child health, physician reimbursement, prescription drugs, “tobacco cessation for pregnant women,” “aging and disability resource centers,” psychiatric care, “promoting healthy lifestyles,” and on and on.

When was it decided that there is nothing –nothing– about the way we live our lives that is beyond the reach of the federal government?  When did the states – whose legislatures are represented in Washington my Wilson’s NCSL – decide that they would simply surrender to the feds and allow their reserved powers under the Constitution to be completely trampled by the U.S. government?

Wilson’s only complaints so far have been that the feds are not paying the states more to do this. She has no problem whatsoever, evidently, with whether this unprecedented expansion of federal power is unconstitutional.

11:10 am: How can the feds encourage overspending by the states? How about by creating a program to help states with their Medicaid costs, but only if the governor certifies that the state “is in deficit or will be in deficit.”  Hmmm…what do you think states will do?

11:04 am: A focus now on the state’s obligations under Medicaid, which include expanding coverage to new groups and raising eligibility levels for others. NCSL, Wilson says, pushed to have 100% of the cost of these expansions covered by the feds, but didn’t get it.

Better get your wallets out.

10:55 am: Key elements of the bill, according to Wilson?

• It preserved the employer-based system.
• Expands Medicaid as the “foundation” program though which reforms are driven.
• Includes a coverage mandate.
• Establishes premiums to help low-income folks buy the insurance they are mandated to buy.
• Establishes state-level health care exchanges for those outside the employer structure.

Simple, right?

10:50 am: To begin, Wilson uses a home renovation metaphor to characterize the reform bill as a “major renovation,” as opposed to either a minor fix-up on the one hand or a complete tear down on the other.

She had also stated that though the GOP ended up opposing the bill, they have their fingerprints all over the thing too. (Gotta make sure to spread the blame as far and wide as possible.)

10:40 am: First up on the agenda is Joy Johnson Wilson, from the National Council of State Legislatures, a lefty-leaning organization of legislators from across the nation.  She has evidently been traveling around the nation giving this speech to like committees elsewhere.

10:35 am: As the self-congratulatory speeches continue, it is probably important to report that the committee room is packed. Everyone who is anyone in Maine’s health care – industrial complex is here, including many advocates for a government-run single payer health care system, drawn here no doubt by a line in the joint order creating the committee which explains that among the duties of the committee is to figure out “how federal legislation affects the ability of the State to adopt a system of universal health care through a single-payer plan or other mechanism…”

10:25 am: To start off, we get speeches from each of the legislators on the committee. Each one, no doubt, will talk about (a.) how pleased they are to be here, (b.) how impressive and important a committee this is, (c.) how critically important this issue is, and (d.) that they look forward to working in an open, bipartisan manner to make sure that Maine properly implements the federal health care law while preserving all the good things (?) we are doing on health care in Maine today.

See how easy it is to be a legislator?

10:15 am: Now that ObamaCare is the law of the land, how will it be implemented in Maine?  If this is a question that worries you, fear not. The legislature is swinging into action. Through a joint order, it created a special select committee to study this very issue. The Joint Select Committee on  Health Care Reform Opportunities and Implementation is meeting for the first time today.

Information on the panel and its work today can be found on a new website, which can be found here.

The goal of today’s meeting seems to be to get the committee up to speed on what the state will need to do to to comply with the new federal health care law.