American Elephants

What Are the New Rules for ObamaCare? Whatever Secretary Sebelius Says They Are. by The Elephant's Child

When the Democrats dreamed up ObamaCare in the back rooms (closed doors) of Congress, and came up with 2,700 pages of mandates and musts and requireds, which were signed into law by President Obama, followed by another deluge of amendments which were signed into law by President Obama — then the bill and the amendments were sent off to  HHS Secretary Kathleen Sebelius to flesh out all the named departments and agencies and offices. All the 2,700 pages didn’t include just how things were supposed to work.

What we have learned about the Independent Pay Advisory Board (IPAB) and the new rules for the Health Insurance Exchanges demonstrates pretty clearly that HHS has no business making up regulations because they simply don’t have the needed skill set.

So last Monday, HHS released its proposed regulations (244 pages) for the ObamaCare version of health insurance exchanges, which go live in 2014.

In paragraph (a) of proposed §155.105, we propose to codify section 1321(c)(1)(B) of the Affordable Care Act that directs the Secretary to determine by January 1, 2013 whether a State’s Exchange will be fully operational by January 1, 2014. We believe that “fully operational” means that an Exchange is capable of beginning operations by October 1, 2013 to support the initial open enrollment period proposed in §155.410. HHS will make this determination through applying the State Exchange approval standards and process established in this section.

In paragraph (b), we outline the standards upon which HHS will approve a State Exchange. First, an Exchange must be established consistent with this subpart and be capable of carrying out the required functions of an Exchange consistent with the subparts contained within this part, including: subpart C related to minimum Exchange functions; subpart E related to enrollment; subpart H related to the operation of a SHOP; and subpart K related to certification of QHPs.

State lawmakers want to know what exactly they  have to do by January 1, 2013 (the date that state exchanges have to be approved).  The answer is yet to come.  HHS says that it will issue future”guidance” on what has to be in the “exchange plan” and how “operational readiness” will be determined.  State officials correctly see ObamaCare as a federal, not a shared , program.  The states don’t own this legislation or its implementation.  Many are committed to reversing it, others want to design and operate their own exchanges.  The big question is how much damage their federal “partners” will inflict on the states and how can the states limit it.

The Independent Pay Advisory Board suffers from the same top-down control errors. Fifteen unelected and unaccountable bureaucrats will decide how much Medicare will pay for anything and everything, and when they will not pay.  The federal government will decide what the best procedures are for whatever illness or problem and doctors will be expected to follow “best procedure”rules. And they know what is best because…?

Paul Ryan attempted to school Secretary Sebelius in a little, well, common sense, when she appeared before Congress.

There is evidence for socialized medicine, from every country that has tried it. There is evidence for things like IPAB in Britain’s NICE.  Democrats, looking through their usual rose-colored glasses, see only how it has cut costs, but not the people it has killed nor the misery it has caused.  They just know that single-payer socialized medicine is better, because it is — what?  Fair?  Tell that to these folks.

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Dear Kathleen Sebelius: If obamacare is so great, why are there some 1,500+ waivers including many from labor unions and nancy pelosi’s san francisco district. Socialized medicine does’nt work!! Hopefully the US supreme court will throw this out on a 5-4 vote. If not we must wait until 2013, when the Republicans have control of the White House,Senate, and House of Reps.If obamacare does go into effect, our employees in washington and oregon will be on the governments dime. My wife and I will gladly pay the fines. It’ll be cheaper then the premiums.


Comment by Douglas Allen

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