A Backdoor for Medicare gutting?
by pipe, Tue Apr 24, 2007 at 12:58:06 PM EDT
I was reading the summary of the trustees' report and noticed this under the Medicare heading:
The Act requires that an affirmative determination in two consecutive reports be treated as a "funding warning" for Medicare that would, in turn, require a Presidential proposal to respond to the warning and expedited Congressional consideration of such proposal. The 2007 Report projects that the difference will surpass 45 percent in 2013 and therefore makes a determination of excess general revenue funding. Because the 2006 report also made such a determination, a "Medicare funding warning" is hereby triggered that requires the President to propose legislation that responds to this warning within 15 days of the submission of the Fiscal Year 2009 budget and for Congress to consider the proposal on an expedited basis. This requirement will help call additional attention to Medicare's impact on the Federal budget.
Was this a back door to gutting Medicare assuming a Republican congress? What exactly does the trigger and the 'expedited basis' mean? It sure doesn't sound good. I dug into US code as best I could. I've looked through the
MEDICARE PRESCRIPTION DRUG, IMPROVEMENT, AND MODERNIZATION ACT OF 2003
With the caveat that I have no legal training it looks like it bakes in Senate and House rule changes to facilitate pushing through a proposal for eliminating excess general revenue medicare funding by limiting debate. This is accomplished through overriding House and Senate rules for the purpose of acting on a Presidential proposal to respond to a "Medicare funding warning". The house and the senate can re-override the rule changes, but the existence of the rules in the bill will make it easier for future congresses to force through changes, be they increased taxes or decreased services. I feel this expediting process needs to be removed as soon as possible.
The 2003 act asks the president to propose a plan to reduce Medicare's excess general revenue funding. It looks like it can be a pretty sweeping proposal, it doesn't appear to be limited to Part D.
Judging from this:
(b) Sense of Congress.--It is the sense of Congress that legislation
submitted pursuant to section 1105(h) of title 31, United States Code,
in a year should be designed to eliminate excess general revenue
medicare funding (as defined in section 801(c)) for the 7-fiscal-year
period that begins in such year.
(c) Definitions.--For purposes of this section:
(1) Excess general revenue medicare funding.--The term
``excess general revenue medicare funding'' means, with respect
to a fiscal year, that--
(A) general revenue medicare funding (as defined in
paragraph (2)), expressed as a percentage of total
medicare outlays (as defined in paragraph (4)) for the
fiscal year; exceeds
(B) 45 percent.
(2) General revenue medicare funding.--The term ``general
revenue medicare funding'' means for a year--
(A) the total medicare outlays (as defined in
paragraph (4)) for the year; minus
(B) the dedicated medicare financing sources (as
defined in paragraph (3)) for the year.
(3) Dedicated medicare financing sources.--The term
``dedicated medicare financing sources'' means the following:
(A) Hospital insurance tax.--Amounts appropriated to
the Hospital Insurance Trust Fund under the third
sentence of section 1817(a) of the Social Security Act
(42 U.S.C. 1395i(a)) and amounts transferred to such
Trust Fund under section 7(c)(2) of the Railroad
Retirement Act of 1974 (45 U.S.C. 231f(c)(2)).
(B) Taxation of certain oasdi benefits.--Amounts
appropriated to the Hospital Insurance Trust Fund under
section 121(e)(1)(B) of the Social Security Amendments
of 1983 (Public Law 98-21), as inserted by section
13215(c) of the Omnibus Budget Reconciliation Act of
1993 (Public Law 103-66).
(C) State transfers.--The State share of amounts
paid to the Federal Government by a State under section
1843 of the Social Security Act (42 U.S.C. 1395v) or
pursuant to section 1935(c) of such Act.
[[Page 117 STAT. 2359]]
(D) Premiums.--The following premiums:
(i) Part a.--Premiums paid by non-Federal
sources under sections 1818 and section 1818A (42
U.S.C. 1395i-2 and 1395i-2a) of such Act.
(ii) Part b.--Premiums paid by non-Federal
sources under section 1839 of such Act (42 U.S.C.
1395r), including any adjustments in premiums
under such section.
(iii) Part d.--Monthly beneficiary premiums
paid under part D of title XVIII of such Act, as
added by section 101, and MA monthly prescription
drug beneficiary premiums paid under part C of
such title insofar as they are attributable to
basic prescription drug coverage.
Premiums under clauses (ii) and (iii) shall be determined
without regard to any reduction in such premiums attributable to
a beneficiary rebate under section 1854(b)(1)(C) of such title,
as amended by section 222(b)(1), and premiums under clause (iii)
are deemed to include any amounts paid under section 1860D-13(b)
of such title, as added by section 101.
(E) Gifts.--Amounts received by the medicare trust
funds under section 201(i) of the Social Security Act
(42 U.S.C. 401(i)).
(4) Total medicare outlays.--The term ``total medicare
outlays'' means total outlays from the medicare trust funds and
(A) include payments made to plans under part C of
title XVIII of the Social Security Act that are
attributable to any rebates under section 1854(b)(1)(C)
of such Act (42 U.S.C. 1395w-24(b)(1)(C)), as amended by
(B) include administrative expenditures made in
carrying out title XVIII of such Act and Federal outlays
under section 1935(b) of such Act, as added by section
(C) offset outlays by the amount of fraud and abuse
collections insofar as they are applied or deposited
into a medicare trust fund.
(5) Medicare trust fund.--The term ``medicare trust fund''
(A) the Federal Hospital Insurance Trust Fund
established under section 1817 of the Social Security
Act (42 U.S.C. 1395i); and
(B) the Federal Supplementary Medical Insurance
Trust Fund established under section 1841 of such Act
(42 U.S.C. 1395t), including the Medicare Prescription
Drug Account under such Trust Fund.
The President is required to submit a plan to stop the excess general fund revenue of all of Medicare.
This is also neat, maybe its standard, but still its interesting. In specifying that the legislation that the President proposes needs to be expedited it mentions that any bill with the same required name, "A bill to respond to a medicare funding warning.", qualifies on this section. I don't know if that means it's granted all the expedite provisions or not. That's for the house parliamentarian I guess.
(2) Medicare funding legislation.--For purposes of this
section, the term ``medicare funding legislation'' means--
(A) legislation introduced pursuant to subsection
(a)(1), but only if the legislative proposal upon which
the legislation is based was submitted within the 15-day
period referred to in such subsection; or
(B) any bill the title of which is as follows: ``A
bill to respond to a medicare funding warning.''.
This part deals with the fact that the expediting process is based on rules of the house and senate:
(g) Rulemaking Power.--The provisions of this section are enacted by the Congress--
[[Page 117 STAT. 2363]]
(1) as an exercise of the rulemaking power of the House ofRepresentatives and, as such, shall be considered as part of the
rules of that House and shall supersede other rules only to the
extent that they are inconsistent therewith; and
(2) with full recognition of the constitutional right of
that House to change the rules (so far as they relate to the
procedures of that House) at any time, in the same manner, and
to the same extent as in the case of any other rule of that
(f) Rules of the Senate.--This section is enacted by the Senate--
(1) as an exercise of the rulemaking power of the Senate and
as such it is deemed a part of the rules of the Senate, but
applicable only with respect to the procedure to be followed in
the Senate in the case of a bill described in this paragraph,
and it supersedes other rules only to the extent that it is
inconsistent with such rules; and
(2) with full recognition of the constitutional right of the
Senate to change the rules (so far as relating to the procedure
of the Senate) at any time, in the same manner, and to the same
extent as in the case of any other rule of the Senate.
So it looks like the Senate and House can override the rules, but if ever one of them isn't inclined to it looks like debate is severly limited. The part dealing with the limits on debate is a little beyond me. There is the standard waiving of points of order, and a five minute rule in the house and 2 hours debate in the Senate. I think a US code reader would be required to get a full read on what all this entails.
Anyway, looks like an end run around debate on gutting Medicare to me. I hope I'm wrong. If not this needs to be acted on and these provisions removed.