{"id":3412,"date":"2015-04-09T07:30:10","date_gmt":"2015-04-09T11:30:10","guid":{"rendered":"http:\/\/www.dougsbriefcase.com\/blog\/?p=3412"},"modified":"2015-04-11T07:20:52","modified_gmt":"2015-04-11T11:20:52","slug":"the-gops-gift-to-henry-waxman-part-ii","status":"publish","type":"post","link":"https:\/\/www.dougsbriefcase.com\/blog\/the-gops-gift-to-henry-waxman-part-ii\/","title":{"rendered":"The GOP\u2019s Gift To Henry Waxman \u2014 Part II<\/span>"},"content":{"rendered":"

<\/p>

\"Cold<\/a>

Cold War era Con\u00adgress\u00adman Chet Holifield want\u00aded the fed\u00ader\u00adal gov\u00adern\u00adment to finance a net\u00adwork of under\u00adground bomb shel\u00adters. His suc\u00adces\u00adsor, Hen\u00adry Wax\u00adman, want\u00aded the fed\u00ader\u00adal gov\u00adern\u00adment to take over health care. Holifield failed; Wax\u00adman did just fine. [Cred\u00adit: NY<\/span> Times]<\/p><\/div>Chet Holifield was obsessed with The Bomb.\n

Dur\u00ading a 32-year tenure that flow\u00adered dur\u00ading the Cold War, the Los Ange\u00adles Con\u00adgress\u00adman sought fed\u00ader\u00adal mon\u00adey to help Amer\u00adi\u00adcans sur\u00advive a nuclear war.  He called for <\/a>\u201c<\/span>a nation\u00adwide sys\u00adtem of under\u00adground shel\u00adters\u201d in which to hud\u00addle, safe from irra\u00addi\u00adat\u00aded debris.<\/p>\n

Though Holifield achieved suc\u00adcess in oth\u00ader areas \u2013 he was known as \u201c<\/span>Mr. Atom\u00adic Ener\u00adgy\u201d<\/a> for his pro\u00admo\u00adtion of nuclear pow\u00ader \u2014 he left Con\u00adgress in 1974 with\u00adout ful\u00adfill\u00ading his sub\u00adter\u00adranean vision.<\/p>\n

Holifield was suc\u00adceed\u00aded by a 35-year-old State Assem\u00adbly\u00adman who did not share his pre\u00adoc\u00adcu\u00adpa\u00adtion with nuclear war.  Hen\u00adry Wax\u00adman was focused on putting the fed\u00ader\u00adal gov\u00adern\u00adment in con\u00adtrol of health care. Repub\u00adli\u00adcans who last month vot\u00aded to reau\u00adtho\u00adrize and expand some of Wax\u00adman\u2019s pet pro\u00adgrams can learn a good deal from his habit of plant\u00adi\u00adng small pro\u00advi\u00adsions in bills that yield\u00aded big results.<\/p>\n

Those results con\u00adtin\u00adued beyond his retire\u00adment at the end of the last Con\u00adgress.  As I not\u00aded in my last post<\/a>,<\/span> the House two weeks ago over\u00adwhelm\u00ading\u00adly approved a bill<\/a> that lav\u00adished bil\u00adlions on com\u00admu\u00adni\u00adty health cen\u00adters, poured more mon\u00adey into efforts to enroll chil\u00addren and their par\u00adents in Med\u00adic\u00adaid and Oba\u00admacare, and reau\u00adtho\u00adrized the CHIP<\/span> pro\u00adgram despite CBO<\/span>\u2019s obser\u00adva\u00adtion<\/a> that it would at best neg\u00adli\u00adgi\u00adbly reduce the num\u00adber of unin\u00adsured children.<\/p>\n

The homage to Wax\u00adman didn\u2019t stop with reau\u00adtho\u00adriz\u00ading redun\u00addant pro\u00adgrams for chil\u00addren.  It also pro\u00adduced a new enti\u00adtle\u00adment pro\u00adgram for low-income seniors.<\/p>\n

Since 1997, states have been required to pay Medicare Part B pre\u00admi\u00adums for ben\u00ade\u00adfi\u00adcia\u00adries with incomes between 120 and 135 per\u00adcent of the fed\u00ader\u00adal pover\u00adty lev\u00adel ($14,124 \u2014 $15,890), through the Med\u00adic\u00adaid QI<\/span> (\u201cqual\u00adi\u00adfied indi\u00advid\u00adual\u201d) pro\u00adgram.  Con\u00adgress lim\u00adit\u00aded QI<\/span> spend\u00ading by stip\u00adu\u00adlat\u00ading in the statute<\/a> the amount the fed\u00ader\u00adal gov\u00adern\u00adment would spend each year on the pro\u00adgram.  H.R. 2 changes all that, essen\u00adtial\u00adly turn\u00ading QI<\/span> into an open-end\u00aded enti\u00adtle\u00adment pro\u00adgram by autho\u00adriz\u00ading the HHS<\/span> Sec\u00adre\u00adtary to increase spend\u00ading annu\u00adal\u00adly and in per\u00adpe\u00adtu\u00adity. The chart below traces the upward path of that spending.<\/p>\n

\"QI<\/a><\/p>\n

Pri\u00ador to H.R. 2, Con\u00adgress nev\u00ader appro\u00adpri\u00adat\u00aded more than $885 mil\u00adlion to the pro\u00adgram, the result of a one-time splurge cre\u00adat\u00aded by the Oba\u00adma Administration\u2019s \u201c<\/span>stim\u00adu\u00adlus bill.\u201d<\/a>  The House-passed bill allo\u00adcates a record $980 mil\u00adlion, then gives HHS<\/span> author\u00adi\u00adty to hike out\u00adlays annu\u00adal\u00adly based on pop\u00adu\u00adla\u00adtion growth and increas\u00ades in Medicare pre\u00admi\u00adums.  CBO<\/span> projects that in 2025, annu\u00adal fed\u00ader\u00adal QI<\/span> out\u00adlays will total $2.2 bil\u00adlion.  In the ten-year peri\u00adod from 2005 through 2014, the fed\u00ader\u00adal gov\u00adern\u00adment spent less than $5.9 bil\u00adlion on the pro\u00adgram; under H.R. 2, CBO<\/span> esti\u00admates that the gov\u00adern\u00adment will spend almost that much \u2013$5.4 bil\u00adlion \u2013 over the next five years and a total of $14.2 bil\u00adlion between 2015 and 2025.<\/p>\n

As with the rest of the H.R. 2\u2019s $30 bil\u00adlion in new social wel\u00adfare spend\u00ading, Repub\u00adli\u00adcans seem not to have noticed the bill\u2019s effect on the QI<\/span> pro\u00adgram.  The QI<\/span> spend\u00ading spree starts small, but is pro\u00adject\u00aded to grow rapid\u00adly and with\u00adout lim\u00adit, a pat\u00adtern Hen\u00adry Wax\u00adman estab\u00adlished in a series of Med\u00adic\u00adaid expan\u00adsions that he engi\u00adneered long ago.<\/p>\n

When Wax\u00adman arrived in Wash\u00ading\u00adton in ear\u00adly 1975, Med\u00adic\u00adaid ben\u00ade\u00adfit\u00aded a lim\u00adit\u00aded pop\u00adu\u00adla\u00adtion.  Eli\u00adgi\u00adbil\u00adi\u00adty depend\u00aded on whether an indi\u00advid\u00adual was \u201ccat\u00ade\u00adgor\u00adi\u00adcal\u00adly needy\u201d \u2013 with lit\u00adtle income, vir\u00adtu\u00adal\u00adly no assets and qual\u00adi\u00adfied by age, dis\u00adabil\u00adi\u00adty or sin\u00adgle par\u00adent\u00adhood for AFDC<\/span> (a cash wel\u00adfare pro\u00adgram) or SSI<\/span> (an income sup\u00adport pro\u00adgram for indi\u00adgent aged, blind and dis\u00adabled peo\u00adple).   Because income alone did not make peo\u00adple eli\u00adgi\u00adble for the pro\u00adgram, growth in the num\u00adber of Med\u00adic\u00adaid recip\u00adi\u00adents was, to a great extent, constrained.<\/p>\n

Wax\u00adman began to change that in 1984.  The Demo\u00adc\u00adrat-con\u00adtrolled House was con\u00adsid\u00ader\u00ading major deficit reduc\u00adtion leg\u00adis\u00adla\u00adtion favored by the Rea\u00adgan Admin\u00adis\u00adtra\u00adtion. Some mod\u00ader\u00adate Democ\u00adrats sup\u00adport\u00aded the leg\u00adis\u00adla\u00adtion, but Wax\u00adman argued that the White House should be forced to make some con\u00adces\u00adsions to House liberals.<\/p>\n

The con\u00adces\u00adsion he sought seemed innocu\u00adous enough.  It required states to extend Med\u00adic\u00adaid cov\u00ader\u00adage to cer\u00adtain women who were preg\u00adnant for the first time and to preschool chil\u00addren in two-par\u00adent fam\u00adi\u00adlies born after Sep\u00adtem\u00adber 30, 1983.  These two new sym\u00adpa\u00adthet\u00adic groups of ben\u00ade\u00adfi\u00adcia\u00adries were made eli\u00adgi\u00adble for Med\u00adic\u00adaid even if they were inel\u00adi\u00adgi\u00adble for cash wel\u00adfare ben\u00ade\u00adfits under AFDC<\/span>, although they were required to meet the program\u2019s income and asset tests.  The link between AFDC<\/span> and Med\u00adic\u00adaid was bro\u00adken, at least for these groups, set\u00adting a prece\u00addent for fur\u00adther enlarge\u00adments of fed\u00ader\u00adal health care programs.<\/p>\n

In 1986, the law was again amend\u00aded, again as part of a deficit reduc\u00adtion bill.  This time, it per\u00admit\u00adted (but did not require) states to cov\u00ader chil\u00addren under age 5 liv\u00ading in house\u00adholds with incomes below the fed\u00ader\u00adal pover\u00adty lev\u00adel.   For the first time, a group of indi\u00advid\u00adu\u00adals could gain Med\u00adic\u00adaid cov\u00ader\u00adage sole\u00adly on the basis of house\u00adhold income, with\u00adout regard to their fam\u00adi\u00adly\u2019s assets or eli\u00adgi\u00adbil\u00adi\u00adty for AFDC<\/span>.<\/p>\n

In 1989, the state option became a fed\u00ader\u00adal man\u00addate in yet anoth\u00ader deficit reduc\u00adtion bill.  Begin\u00adning in that year, the fed\u00ader\u00adal gov\u00adern\u00adment required states to cov\u00ader all chil\u00addren under age 6 in house\u00adholds with incomes less than 100 per\u00adcent of FPL<\/span>.<\/p>\n

A year lat\u00ader, in the 1990 bill deficit reduc\u00adtion bill that famous\u00adly saw Pres\u00adi\u00addent Bush break his \u201cno new tax\u00ades\u201d pledge, Con\u00adgress went fur\u00adther.  It man\u00addat\u00aded that states pro\u00advide Med\u00adic\u00adaid cov\u00ader\u00adage to low income chil\u00addren born after Sep\u00adtem\u00adber 30, 1983, until their eigh\u00adteenth birthdays.<\/p>\n

Med\u00adic\u00adaid cov\u00ader\u00adage had been com\u00adplete\u00adly trans\u00adformed, at least for preg\u00adnant women and chil\u00addren, from a pro\u00adgram for the cat\u00ade\u00adgor\u00adi\u00adcal\u00adly needy to one that cov\u00adered every child under 100 per\u00adcent of FPL<\/span> with\u00adout regard to parental assets and eli\u00adgi\u00adbil\u00adi\u00adty for oth\u00ader income sup\u00adport pro\u00adgrams.  The num\u00adber of chil\u00addren on Med\u00adic\u00adaid increased year by year.<\/p>\n

But the Wax\u00adman project wasn\u2019t yet com\u00adplete.  In 1997, he worked for the cre\u00adation of the Chil\u00addren\u2019s Health Insur\u00adance Pro\u00adgram (CHIP<\/span>), ini\u00adtial\u00adly intend\u00aded for chil\u00addren under 200 per\u00adcent of FPL<\/span>.  Con\u00adgress pro\u00advid\u00aded so much mon\u00adey for the new pro\u00adgram so rapid\u00adly that states couldn\u2019t find ways to spend it all.  They sought new pop\u00adu\u00adla\u00adtions to cov\u00ader.  With\u00adin a mat\u00adter of years, states were obtain\u00ading waivers from CMS<\/span> to spend \u201cchildren\u2019s\u201d health insur\u00adance mon\u00adey on par\u00adents and even on child\u00adless adults.<\/p>\n

By the time Oba\u00admacare was enact\u00aded, 24 states were cov\u00ader\u00ading chil\u00addren liv\u00ading in house\u00adholds with incomes over 250 per\u00adcent of pover\u00adty.  The Kaiser Fam\u00adi\u00adly Foun\u00adda\u00adtion<\/a> esti\u00admat\u00aded that in June 2013, 33.7 mil\u00adlion chil\u00addren were cov\u00adered under Med\u00adic\u00adaid or CHIP<\/span> and anoth\u00ader 5.2 mil\u00adlion kids were eli\u00adgi\u00adble but not enrolled.  Wax\u00adman\u2019s grad\u00adual expan\u00adsions had made near\u00adly 39 mil\u00adlion of the nation\u2019s 73.6 mil\u00adlion<\/a> chil\u00addren eli\u00adgi\u00adble for Med\u00adic\u00adaid or CHIP<\/span> even before Oba\u00admacare was implemented.<\/p>\n

With that imple\u00admen\u00adta\u00adtion, three fed\u00ader\u00adal pro\u00adgrams (Med\u00adic\u00adaid, CHIP<\/span> and Oba\u00admacare) com\u00adpete with each oth\u00ader \u2014 and employ\u00ader-spon\u00adsored plans \u2014 to cov\u00ader chil\u00addren from low and mid\u00addle income house\u00adholds.  Despite this redun\u00addan\u00adcy, House con\u00adser\u00adv\u00ada\u00adtives last month vot\u00aded over\u00adwhelm\u00ading\u00adly<\/a> to reau\u00adtho\u00adrize the expir\u00ading CHIP<\/span> pro\u00adgram as part of a larg\u00ader mea\u00adsure to increase Medicare pay\u00adments to doctors.<\/p>\n

Repub\u00adli\u00adcans who would rather have eat\u00aden sushi from a gas sta\u00adtion than vote for a bill to fund the Home\u00adland Secu\u00adri\u00adty Depart\u00adment<\/a> for a few months lined up to spend tens of bil\u00adlions to finance a gov\u00adern\u00adment health insur\u00adance pro\u00adgram of dubi\u00adous val\u00adue, turn a rel\u00ada\u00adtive\u00adly small pro\u00adgram for low-income seniors into a cost\u00adly enti\u00adtle\u00adment, com\u00admit bil\u00adlions in new spend\u00ading to com\u00admu\u00adni\u00adty health cen\u00adters, and pour more resources into the government\u2019s efforts to enroll peo\u00adple in Obamacare.<\/p>\n

House con\u00adser\u00adv\u00ada\u00adtives could sore\u00adly use a dose of Wax\u00adman\u2019s leg\u00adisla\u00adtive acu\u00admen.  They pro\u00advoke unwinnable con\u00adfronta\u00adtions over some bills, then inex\u00adplic\u00ada\u00adbly acqui\u00adesce in others.<\/p>\n

Their lack of leg\u00adisla\u00adtive strat\u00ade\u00adgy may have some\u00adthing to do with the cir\u00adcum\u00adstances that pro\u00adduced the Tea Par\u00adty insur\u00adgency.  It was born of well-jus\u00adti\u00adfied hos\u00adtil\u00adi\u00adty \u2013 to bailouts, to \u201cstim\u00adu\u00adlus\u201d spend\u00ading, to Oba\u00admacare.  Now that they have pow\u00ader in Con\u00adgress, they seem unsure of what to do with it.  Mak\u00ading big changes in a short time against a deter\u00admined oppo\u00adsi\u00adtion is hard\u00ader than they\u2019d imag\u00adined.  So they seem to have trans\u00adferred their hos\u00adtil\u00adi\u00adty to their par\u00adty lead\u00aders and to the leg\u00adisla\u00adtive process itself.  Their odd cou\u00adpling of ide\u00ado\u00adlog\u00adi\u00adcal pas\u00adsion with intel\u00adlec\u00adtu\u00adal lazi\u00adness has led them to prize the defi\u00adant pose over the hard work of leg\u00adisla\u00adtive accomplishment.<\/p>\n

That work, as Hen\u00adry Wax\u00adman demon\u00adstrat\u00aded, requires time, per\u00adsis\u00adtence and a neu\u00adrot\u00adic atten\u00adtion to detail.  It rewards work\u00adman\u00adship over show\u00adman\u00adship, incre\u00admen\u00adtal change over grand ges\u00adtures. Most Repub\u00adli\u00adcans who vot\u00aded in favor of H.R. 2 nev\u00ader took the time to learn what was in it.  All they knew was that doc\u00adtors back home (and Gov\u00ader\u00adnors eager for more fed\u00ader\u00adal CHIP<\/span> mon\u00adey) were lob\u00adby\u00ading for it and talk radio hosts weren\u2019t ful\u00admi\u00adnat\u00ading against it.  And that was enough to win their support.<\/p>\n

Had they served in Con\u00adgress dur\u00ading the 80s and 90s, they prob\u00ada\u00adbly would not have noticed that Wax\u00adman was seed\u00ading deficit reduc\u00adtion bills with the antecedents of Oba\u00admacare.  That auda\u00adcious law did not arise ex nihi\u00adlo<\/em>.  It was the prod\u00aduct of small steps toward a fed\u00ader\u00adal takeover of health care, a project that has pro\u00adgressed grad\u00adu\u00adal\u00adly but inex\u00adorably over decades and still is not com\u00adplete.  It is a trib\u00adute to Hen\u00adry Wax\u00adman that the most stri\u00addent foes of his project vot\u00aded to car\u00adry it anoth\u00ader small step forward.<\/p>\n

Now that they have embraced some of Waxman\u2019s pro\u00adgrams, per\u00adhaps Repub\u00adli\u00adcans might con\u00adsid\u00ader emu\u00adlat\u00ading his approach to law\u00admak\u00ading.  The alter\u00adna\u00adtive is to doom the agen\u00adda of this extra\u00ador\u00addi\u00adnary con\u00adser\u00adv\u00ada\u00adtive major\u00adi\u00adty to the same fate as Chet Holifield\u2019s nuclear catacombs.<\/p>\n","protected":false},"excerpt":{"rendered":"

Chet Holifield was obsessed with The Bomb. Dur\u00ading a 32-year tenure that flow\u00adered dur\u00ading the Cold War, the Los Ange\u00adles Con\u00adgress\u00adman sought fed\u00ader\u00adal mon\u00adey to help Amer\u00adi\u00adcans sur\u00advive a nuclear war.  He called for \u201ca nation\u00adwide sys\u00adtem of under\u00adground shel\u00adters\u201d in which \u2026 Con\u00adtin\u00adue read\u00ading \u2192<\/span><\/a><\/p>\n","protected":false},"author":3,"featured_media":3425,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"nf_dc_page":"","wp_typography_post_enhancements_disabled":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"nfd_image_url":"","nfd_onboarding_generated":"","footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2},"jetpack_post_was_ever_published":false},"categories":[17,480,16,60,35,124,552],"tags":[537,1135,829,1129,1184,1183,1136,1137,800],"class_list":["post-3412","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-entitlements","category-government-spending-2","category-health-care","category-medicaid","category-medicare","category-obamacare","category-welfare-spending","tag-afdc","tag-chet-holifield","tag-chip","tag-henry-waxman","tag-medicaid","tag-medicare","tag-qi","tag-ssi","tag-stimulus"],"aioseo_notices":[],"aioseo_head":"\n\t\t\n\t\n\t\n\t\n\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t