Support the “Helping Sick Americans Now Act”

[Note: Updates to this post are given below my by-line, at the very end of this post.]

Next week, the House may take up a bill (H.R.1549, the Helping Sick Americans Now Act), which has been purported to “fix” a part of ObamaCare, and some conservatives are crying foul.

I think those conservatives are misguided.

They should support the bill, or at least not oppose it.

FreedomWorks supports House consideration of the bill. Here’s why:

1) Enactment of the cleverly drafted bill would help impede the implementation of ObamaCare. Contrary to the assertions of some, H.R.1549 doesn’t “fix,” “expand,” or otherwise “improve” ObamaCare. It does not embrace or reinforce the provision of ObamaCare that bans preexisting conditions exclusions in insurance policies. Instead, the bill would effectively cannibalize ObamaCare to impede its implementation. In other words, it is profoundly anti- rather than, as some ignorant commentators have claimed, pro-Obamacare.

The bill would transfer $4,000,000,000 (four billion dollars) from an ObamaCare implementation slush fund to a program called the Pre-Existing Condition Plan, or PCIP.

The slush fund, formally known as the Prevention and Public Health Fund, is a big pot of money the Administration is using to set up exchanges in states that refuse to set them up (a resistance we’ve strongly encouraged). The slush fund will also be used to gin up public support for ObamaCare and boost enrollment in exchanges. HHS recently spent $8 million from the fund to hire a heavy-hitting p.r. firm to orchestrate a national ad campaign worth $300 million in the months leading up to the law’s full implementation date (1/1/14). That figure is not a typo. Three hundred million dollars on pro-ObamaCare ads are coming, folks. It is a truly staggering amount of advertising, and all paid for with our tax dollars, from the slush fund. If enacted, H.R1549 would prevent that by gutting the fund.

What is the PCIP? It is a subsidy for sick people, to help them obtain private health insurance coverage. PCIP is a federal version of the high-risk pool (or as I prefer to call it, preexisting-conditions or preex pool) subsidy that is employed in more than half the states to help private insurance markets work better. Democrats included PCIP in their ObamaCare takeover as a temporary bridge to the new system, which, as we’ve already noted, takes full effect on January 1st. In doing so, the Democrats were implicitly admitting that preex pools are a practical way to help the one percent of Americans who simply can’t access affordable health insurance due to a preexisting medical condition. PCIP is not, in itself, a good program. But if Congress had enacted only PCIP in 2010, instead of ObamaCare, America would be in a much, much better place today.

Now, I agree with those constitutional conservatives who hold that preex pool programs should be state- rather than federally run. But the harm here is slight, because PCIP is scheduled to expire on December 31st of this year. It’s a temporary subsidy, remember. 

H.R.1549 should be viewed as a tactical maneuver in a larger war, cannibalizing the implementation of ObamaCare exchanges in order to gain leverage in the larger fight for health care freedom. As everyone knows, exchange implementation is going poorly for the Administration, with more than half the states declining to set up an exchange. (FreedomWorks has been a leading voice in the resistance movement.) HHS has been frantically looking for ways to buy the states off, which of course takes money. Denying them four billion bucks at this stage seems like a pretty smart move. Think of H.R.1549 as a policy bazooka aimed at ObamaCare’s tail wing.

(Incidentally, the bill is estimated to reduce the federal deficit by about a billion dollars.)

In February, the Obama Administration cut off new enrollments in PCIP, pleading a lack of funding. But that hasn’t stopped them from funding all manner of bribes to the states, to induce them to go along with exchanges. H.R.1549 calls the Administration’s bluff, funds new enrollments in PCIP, and does so with the same money the Administration would otherwise use for ObamaCare bribes. Again, clever.

What, you ask, will happen to the PCIP enrollees after December 31st? If ObamaCare kicks in, they will have access to “free” health care coverage from the government. If ObamaCare has been repealed or delayed by then, Congress will have to decide whether to renew the PCIP program. I would urge them not to. But that brings me to the next point.

2) The bill gives the House a chance to talk about preex pools. House Republicans have long embraced preex pools as an alternative to government-run health care. In 2009, the House GOP alternative to ObamaCare contained a new $25,000,000,000 (twenty-five billion dollar) subsidy for state-run preex pools. FreedomWorks supports that approach as vastly superior to a government takeover. Think about it. Only one percent of Americans are unable to obtain affordable health insurance due to a preexisting condition. Wouldn’t we want to target help to that one percent, rather than completely overhaul the system for 100 percent of Americans? ObamaCare will lead to government rationing and price controls, contentious fights about mandatory coverage of abortion, sterilization, etc., and ultimately worse health care outcomes. Isn’t that worth stopping? Shouldn’t we be imaginative in trying to stop it?

What to do with PCIP enrollees after December 31st? My advice would be to enact the House GOP preex bills bill, and transfer those folks into state-run preex pools.

3) H.R.1549 gets ObamaCare opponents back on offense on the most important political issue of our time, health care. Since 2010, FreedomWorks has been urging the opponents of ObamaCare to get and stay on offense. In this fight, you are either on offense or defense, and the Left nevers stands idly by, waiting to be put on defense. Last Congress, the House leadership admirably allowed many votes to repeal, defund, and dismantle ObamaCare. But what they didn’t do very well, and continue to do pretty darn poorly, is fight for the better system they want to replace ObamaCare with. 

Republicans, wake up. You can’t beat something with nothing. You have to say what you’re for. People don’t care what you know, until they know that you care. (Sorry for all the cliches, but they’re cliches for a reason.) H.R.1549 shows a level of compassion truly lacking on the Left. It says, “We’re for helping the one percent of Americans who truly need help affording good private health coverage. We think this is a better way than a government takeover.” 

Polls show that when Republicans talk about health care, their numbers go up. Here’s a chance for them to start talking. 

Dean Clancy is FreedomWorks’ Vice President for Public Policy and leads the group’s efforts to replace the government takeover of health care with a patient-centered system.


P.S. None of this is to suggest we shouldn’t fully repeal ObamaCare. We should, and we must. But that vital goal will only be achieved by simultaneously doing two things. 1) Attach full repeal to must-pass legislation, and stick to our guns. In my opinion, full repeal is what the House should demand as the price of the next debt-ceiling hike, come May. In the meantime, H.R.1549 provides an excellent way to impede the law’s implementation. 2) Pass positive legislation to address our health care system’s legitimate flaws and show people what we’re for. What kind of legislation. House Republicans came up with a pretty good bill in 2009, on this score. They should dust if off and pass it. Also, FreedomWorks has come up with a list of our favorite bills to replace ObamaCare. Those, too, should be taken up and passed.

P.P.S. As a convenience, I’ve pasted in below some talking points being circulated by the House Energy & Commerce Committee Republican staff in support of H.R.1549:

The Helping Sick Americans Now Act (H.R. 1549)

Legislation Targets Obamacare Implementation Slush Fund, Prioritizes Funding for Vulnerable Americans, and Cuts the Deficit

  • H.R. 1549, the Helping Sick Americans Now Act [offered by Rep. Joseph Pitts, Republican of Pennsylvania], addresses Obamacare’s broken promise to help those with pre-existing conditions by redirecting the law’s slush fund money, which has gone toward implementation of Obamacare’s core structure, to help sick patients. 
  • On February 15, 2013, the Centers for Medicare and Medicaid Services (CMS) announced they were closing enrollment in the law’s federal and state high-risk pool program (known as the Pre-Existing Condition Insurance Plan, or PCIP) due to funding constraints. H.R. 1549 would require HHS to transfer approximately $4 billion in FY 2013-2016 funding from the Prevention and Public Health Fund to PCIP. This would allow CMS to enroll sick Americans who have been denied coverage because of the Administration’s decision.  
  • The bill would also eliminate four years of funding from the Prevention and Public Health Fund – one of Obamacare’s worst programs which is rife with waste and abuse.  For example, the “Prevention” fund has financed:
    • The Centers for Disease Control’s (CDC) Communities Putting Prevention to Work Program.  This program has used stimulus and Obamacare dollars on projects such as pet neutering campaigns, bike/park signs, and gardening.  This program has also funded lobbying campaigns to enact fast food construction moratoriums and soda taxes (included polling to test messages for higher soda taxes). 
    • CDC’s Community Transformation Grant Program – funding similar lobbying efforts to increase soda, sugar, and tobacco taxes, as well as enact fast food density laws.  
  • The legislation also would help defund implementation of Obamacare.  The Administration has tapped $54 million from the Prevention Fund to pay individuals and community groups to sign people up for Obamacare exchanges. Just last week, the Administration announced that is about to tap $304 million for enrollment and advertising campaigns for Obamacare.  The Prevention Fund is one of the last sources the Administration has to use for 2014 implementation of its $1 trillion exchange program.
  • Rather than spend money on lobbying campaigns for higher taxes and Obamacare media campaigns, H.R. 1549 redirects funding toward sick Americans with pre-existing conditions.
  • Republicans have traditionally supported high-risk pools to help sick Americans. House Republicans proposed $25 billion in funding for these programs in their alternative to Obamacare. 
  • CONSERVATIVES SUPPORT: “[D]efunding, dismantling, cannibalizing—these are all achievable, with smart tactics,” said Dean Clancy, vice president for health care policy at FreedomWorks….“We absolutely support using Obamacare slush fund money to fully fund pre-ex pools, even the law’s somewhat flawed pools.”
  • H.R. 1549 also eliminates federal red tape that requires individuals to go without coverage for six months in order to gain eligibility for the program.  While PCIP could be improved further, it makes sense to prioritize funding for vulnerable Americans over slush funds for the remainder of 2013. Preliminary estimates also show that H.R. 1549 will reduce the deficit by approximately $1 billion.


Page 1


1ST SESSION H. R.[1549]


Mr. PITTS introduced the following bill; which was referred to the Committee

on [Energy and Commerce].


To amend Public Law 111–148 to transfer fiscal year 2013

through fiscal year 2016 funds from the Prevention and

Public Health Fund to carry out the temporary high

risk health insurance pool program for individuals with

preexisting conditions, and to extend access to such program

to such individuals who have had creditable coverage

during the 6 months prior to application for coverage

through such program.

1 Be it enacted by the Senate and House of Representa2

tives of the United States of America in Congress assembled,

Page 2


2 This Act may be cited as the ‘‘Helping Sick Ameri

3 cans Now Act’’.


5 Section 4002(c) of Public Law 111–148 (42 U.S.C.

6 300u–11(c)) is amended by adding at the end the fol

7 lowing: ‘‘Notwithstanding any other provision of this sec

8 tion, the Secretary shall transfer amounts that are in the

9 Fund that are attributable to fiscal year 2013 that are

10 not otherwise obligated as of the date of the enactment

11 of this sentence and funds that would otherwise be made

12 available to the Fund for fiscal year 2014, fiscal year

13 2015, and fiscal year 2016 to the account within the De

14 partment of Health and Human Services that provides for

15 funding to carry out the temporary high risk health insur

16 ance pool program under section 1101 and such funds

17 shall become available for obligation under such section

18 on such date of enactment and remain so available

19 through December 31, 2013.’’.



22 (a) IN GENERAL.—Section 1101(d) of Public Law

23 111–148 (42 U.S.C. 18001(d)) is amended—

24 (1) in paragraph (1), by adding at the end

25 ‘‘and’’;

26 (2) by striking paragraph (2); and

Page 3

1 (3) by redesignating paragraph (3) as para

2 graph (2).

3 (b) EFFECTIVE DATE.—The amendments made by

4 subsection (a) shall apply with respect to individuals ap

5 plying for coverage through the high risk insurance pool

6 program on or after the date of the enactment of this Act.



Page 1


OFFERED BY ________.

Add at the end the following:



3 Section 1101(b) of Public Law 111–148 (42 U.S.C.

4 18001(b)) is amended by adding at the end the following

5 new paragraph:


7 Secretary shall administer this section in accordance

8 with the regulations under part 152 of title 45, Code

9 of Federal Regulations, as in effect as of April 16,

10 2013, except as is necessary to reflect the amend

11 ments made by the Helping Sick Americans Now

12 Act.’’. ◊


UPDATE: April 18th — A member of the New Jersey congressional delegation cornered me today and rather rudely interrogated me, prosecutor-style, trying to prove me out as a hypocrite for suggesting that it’s okay to amend an unconstitutional program (in his opinion, the PCIP is unconstitutional), even in the cause of helping to repeal a much more plainly unconstitutional and freedom-reducing program (ObamaCare). My retort: That’s silly. Some people, including me, think Medicare is unconstitutional. That doesn’t stop us from supporting efforts to make it more constitutional (as by making it voluntary for individuals). The politically absurd position of the gentleman from New Jersey is that we should eliminate Medicare, immediately — that we cannot vote to reform or “fix” it without soiling our constitutional souls. But of course, the record shows that he has voted to “fix” Medicare. And he will undoubtedly end up voting to “fix” ObamaCare too, if we fail to repeal it. So either he is a hypocrite himself, or just takes pleasure in giving people like me the bulldog treatment. At any rate, his duty and ours is the same: to keep moving our laws and government back toward true north, to our Constitution as actually written. H.R.1549 helps do that by impeding the implementation of ObamaCare, the most monstrous violation of our Constitution in living memory.

UPDATE: April 23rd — House Republicans are contemplating amendments that would make H.R.1549, even better.  House Leaders have agreed to make the following changes to the bill when it comes to the House floor (expected to occur tomorrow, April 24th).

  1. The amended bill will now eliminate the entire Prevention [ObamaCare implementation] slush fund, not just the money authorized for Fiscal Years 2013-2016. As a result, according to the Congressional Budget Office (CBO), H.R.1549 will reduce the deficit by $8,000,000,000 (eight billion dollars) over 10 years (as opposed to about one billion dollars, in the original bill).  
  2. Like the original bill, the amended bill will transfer money to the existing federal preex pool program [PCIP] for the remainder of the year. But …
  3. The amended bill will also authorize (subject to appropriation) beginning in January 2014 the creation of a funding stream for state-based preex pools, consistent with Republican reform legislation offered over the past several Congresses. The particular language of this amendment is drawn from a bill (S.1324, 111th Congress) offered by Sen. Jim DeMint (R-SC) in 2009.

All of these changes are welcome. They make a good bill even better.

UPDATE: April 24th — Today House leaders pulled H.R.1549 from floor consideration, for lack of sufficient support. Although the majority of the members of the repeal coalition publicly supported the bill — only one group threatened to key-vote against the bill — a number of House Republicans refused to support a bill they regarded as not going far enough to repeal the president’s health care law or impede that law’s implementation. These Members may have been confused by ignorant claims that the bill “fixes” a part of ObamaCare, which, as I explained in my post, isn’t the case. This all confirms my view that moving H.R.1549 in the House was a win-win proposition for the advocates of patient-centered care. Embarrassed House leaders now have an unmistakable signal of just how badly rank and file Republicans want to take down the whole law, not just a key piece of its implementation machinery. If H.R.1549 had passed, it would have lent momentum to our effort to impede ObamaCare’s implementation. Now that it has failed, at the hands of repeal advocates, the pressure for full repeal has gone up. Power on this issue has shifted to those who want it all. Let’s keep up the pressure for full repeal, by insisting that it be done on a must-pass bill.

UPDATE: June 3rd — Today House Majority Leader Cantor announced that the bill will be amended as a result of the controversy, and brought to the House floor this month. The new version eliminates the ObamaCare Prevention and Public Health Fund entirely, and shifts some of the money, not to the federal high-risk pool created by ObamaCare, but rather to state high-risk pools. As an appropriation, it is not an entitlement. CBO estimates this legislation would save $8.5 billion over ten years. FreedomWorks supports the amended version. It’s even better than the original.


Return of the Helping Sick Americans Now Act (6/3/2013)

FreedomWorks Health Care Strategy Memos

Ross Douthat: The Republican Health Policy Trainwreck (NYT 4/20/13)

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