Is new Sears bill another version of the Obamacare Medicaid expansion for Ohio?

I'll admit to not being an expert on the Medicaid expansion that Gov. John Kasich proposed for Ohio - as part of Affordable Care Act, also known as Obamacare - but this new bill introduced by Rep. Barbara Sears sure sounds a lot like it.

The House, after significant public pressure from conservatives and tea party groups, removed the Medicaid expansion from the budget bill (H.B. 59) earlier in the year. Rep. Sears was extensively criticized for her role in pushing the expansion and for what some considered was a violation of the Health Care Freedom Amendment overwhelmingly passed by Ohioans. She responded to those allegations, saying she did, in fact, support the Health Care Freedom Amendment, though she believed a pending bill would conflict with that amendment.

Speaker Bill Batchelder told reporters that a bill separate from the budget could be passed by the House before the end of June.

The press release below details some of the provisions of her legislation:

Rep. Sears Introduces Medicaid Reform Legislation

COLUMBUS—Today, State Representative Barbara Sears (R- Monclova Township) introduced legislation requiring the Director of Medical Assistance to implement Medicaid reforms that will identify ways to lower costs, reduce uncompensated care, and extend coverage to Ohio’s most vulnerable citizens.

The legislation would extend coverage to Ohioans under 138% of the federal poverty level and will provide critical health care services to Ohio’s poorest citizens. New enrollees in the Medicaid program will be fully funded by the federal government for the first three years. The bill provides protections for Ohio should the federal assistance percentage decrease below the specified amount after the third year.

Additional provisions of this legislation include encouraging personal responsibility through cost sharing, promoting employment-related services, and ensuring those who abuse narcotics receive proper treatment.

“Ohio’s Medicaid system has made substantial improvements over the past few years and this legislation furthers that effort,” Rep. Sears said. “By providing a ladder up and out of poverty through quality care, we are allowing for citizens to achieve greater self sufficiency and creating a healthier Ohio.”

The bill also includes requiring the Medicaid director to present a report to the General Assembly on the progress being made and specifies that the Joint Legislative Committee on Medicaid Technology and Reform consider and review the reforms implemented by this legislation.

-30-

The bill will be assigned a number Tuesday, but here is a link to the language submitted, as provided by her office.

Rep. Sears responds to claim that she's helping to implement Obamacare in Ohio

This past week Rep. Barbara Sears was accused of supporting the Affordable Care Act (also known as Obamacare) and opposing Ohio's Healthcare Freedom Act.

An article appearing at RedState.com and FreedomWorks.org also called into question her motivations, stating:

"Not only has she received a substantial amount of financial contributions from the health care industry, she currently works at a health insurance provider and recently passed her own bill which helps implement Obamacare."

I noted that the article did not quote her, nor did it say that she failed to respond to a request for comment. So I contacted her and asked her to respond.

Below is her response, as sent to me, though I have modified the formatting to make it easier to read.

It is always important to get both sides before making a decision and this response allows you to do just that. I understand Rep. Sears is also scheduled to be a guest with Fred LeFebvre on 1370 WSPD tomorrow morning.

From Rep. Sears:

The following are my thoughts regarding several issues discussed in Breeanne Howe’s article. First, it’s always disappointing when someone chooses to make inferences both personal and professional without taking the time to look at facts or do even the minimum amount of research.

I appreciate that you reached out to me for some background. I have tried to summarize my comments in order of the article not to infer that the article is remotely creditable but to simply to review and comment process.

HB 91(Young – Thompson)

I am supportive of our constitutional Healthcare Freedom Amendment as passed by Ohioans. In fact, Representative Maag and I sponsored HJR2 in the 129th General Assembly which was the Healthcare Freedom resolution; the Senate companion resolution SJR 5 which was the vehicle that passed the Senate and failed in the House by 1 vote (it received 59 and needed 60) prior to the Citizens initiated Healthcare Freedom Amendment reaching the ballot.

The same provisions that were added to protect our private marketplace and passed overwhelmingly by Ohioans make HB 91 unworkable in my opinion.

Below is a summary of my thoughts regarding the interaction of HB 91 and our Constitutional amendment – Healthcare Freedom Act. It seems illogical to push legislation that would work towards the destruction of our private healthcare marketplace. I have yet to hear a workable argument that suggests that HB 91 doesn’t violate our Constitution.

From HB 91

Sec. 3964.02. (A) A health insurance issuer operating in this state shall not accept any remuneration, credit, or subsidy, as described in 42 U.S.C. 18082, that may result in the imposition of penalties against any employer or individual in this state.

(B) If a health insurance issuer violates division (A) of this section, the issuer's license to issue new business in the state shall be suspended immediately and until such time as the issuer represents it has returned that remuneration, credit, or subsidy to its source and will decline any such future remuneration, credit, or subsidy. Such suspensions shall not be construed as impairing the right of contract or the right to continue or renew existing business in the state.

I believe that if we pass HB 91, we violate Section 21(b) and Section 21(c) of the Healthcare Freedom Amendment.

To put this into practical terms, if a carrier were to accept funding under the terms outlined in the PPACA, it is possible that an employer could be penalized. How could this happen?

The PPACA requires that:

1. If an employer with more than 50 fulltime equivalent employees, who does not offers health insurance coverage and has at least one employee who receives a premium tax credit or cost sharing subsidy in the exchange, the employer would then be subject to a penalty for not offering coverage. The penalty is $2,000 annually times the number of full-time employees minus 30 in the first year, and grows annually.

2. If an employer with more than 50 fulltime equivalent employees offers health insurance that does not cover at least 60% of typical health care expenses and an employee chooses to buy on the Exchange and receive a premium tax credit, the employer would then be subject to a penalty for not offering affordable coverage. The penalty is $3,000 for each fulltime employee receiving a tax credit up to $2,000 annually times the number of full-time employees minus 30 in the first year, and grows annually.

3. If an employer with more than 50 fulltime equivalent employees offers health insurance with any employee paying more than 9.5% of family income for the employer coverage and an employee chooses to buy on the Exchange and receive a premium tax credit, the employer would then be subject to a penalty for not offering affordable coverage. The penalty is $3,000 for each fulltime employee receiving a tax credit up to $2,000 annually times the number of full-time employees minus 30 in the first year, and grows annually.

If any employer is put in a position “that may result in the imposition of penalties against any employer or individual in this state.” “[T]he issuer’s license to issue new business in the state shall be suspended immediately” (HB 91-130).

The issuer can renew policies but shall be prohibited from the sale of health insurance and Ohioans will be prohibited to purchase health insurance through the carrier. (HB 91-130)

The Healthcare Freedom Constitutional Amendment passed by 66% of Ohio and in all 88 counties in Ohio states:

• Section 21 (A) No federal, state, or local law or rule shall compel, directly or indirectly, any person, employer, or health care provider to participate in a health care system.
• Section 21 (B) No federal, state, or local law or rule shall prohibit the purchase or sale of health care or health insurance.
• Section 21 (C) No federal, state, or local law or rule shall impose a penalty or fine for the sale or purchase of health care or health insurance.

Section 21 (E) (3) “Penalty or fine” means any civil or criminal penalty or fine, tax, salary or wage withholding or surcharge or any named fee established by law or rule by a government established, created, or controlled agency that is used to punish or discourage the exercise of rights protected under this section.”

I could suggest that if we pass HB 91, then we violate Section 21(b) and Section 21(c) in that we will be prohibiting both the sale of health insurance and an individual’s right to purchase health insurance by imposing law and rules that would be specifically used to punish a carrier should they accept any remuneration, credit, or subsidy as provided in the PPACA.

I appreciate the effort to find an appropriate way to protect our healthcare freedom and our private marketplace. However I believe that HB 91 does not get that accomplished no matter how some would like to characterize the interaction of HB 91 with the Healthcare Freedom Constitutional Amendment.

HB 3(Sears)

This is what the PPACA says about the role of a Navigator:

NAVIGATORS.—
(1) IN GENERAL.—An Exchange shall establish a program under which it awards grants to entities described in paragraph (2) to carry out the duties described in paragraph (3).

(2) ELIGIBILITY.—

(A) IN GENERAL.—To be eligible to receive a grant under paragraph (1), an entity shall demonstrate to the Exchange involved that the entity has existing relationships, or could readily establish relationships, with employers and employees, consumers (including uninsured and underinsured consumers), or self-employed individuals likely to be qualified to enroll in a qualified health plan.

(B) TYPES.—Entities described in subparagraph (A) may include trade, industry, and professional associations, commercial fishing industry organizations, ranching and farming organizations, community and consumer-focused nonprofit groups, chambers of commerce, unions, small business development centers, other licensed insurance agents and brokers, and other entities that—

(i) are capable of carrying out the duties described in paragraph (3);
(ii) meet the standards described in paragraph (4); and
(iii) provide information consistent with the standards developed under paragraph (5).

(3) DUTIES.—An entity that serves as a navigator under a grant under this subsection shall—

(A) conduct public education activities to raise awareness of the availability of qualified health plans;
(B) distribute fair and impartial information concerning enrollment in qualified health plans, and the availability of premium tax credits under section 36B of the Internal Revenue Code of 1986 and cost-sharing reductions under section 1402;
(C) facilitate enrollment in qualified health plans;
(D) provide referrals to any applicable office of health insurance consumer assistance or health insurance ombudsman established under section 2793 of the Public Health Service Act, or any other appropriate State agency or agencies, for any enrollee with a grievance, complaint, or question regarding their health plan, coverage, or a determination under such plan or coverage; and
(E) provide information in a manner that is culturally and linguistically appropriate to the needs of the population being served by the Exchange or Exchanges.

(4) STANDARDS.—

(A) IN GENERAL.—The Secretary shall establish standards for navigators under this subsection, including provisions to ensure that any private or public entity that is selected as a navigator is qualified, and licensed if appropriate, to engage in the navigator activities described in this subsection and to avoid conflicts of interest. Under such standards, a navigator shall not—

(i) be a health insurance issuer; or
(ii) receive any consideration directly or indirectly from any health insurance issuer in connection with the enrollment of any qualified individuals or employees of a qualified employer in a qualified health plan.

(5) FAIR AND IMPARTIAL INFORMATION AND SERVICES.—The Secretary, in collaboration with States, shall develop standards to ensure that information made available by navigators is fair, accurate, and impartial.

(6) FUNDING.—Grants under this subsection shall be made from the operational funds of the Exchange and not Federal funds received by the State to establish the Exchange.

(j) APPLICABILITY OF MENTAL HEALTH PARITY.—Section 2726 of the Public Health Service Act shall apply to qualified health plans in the same manner and to the same extent as such section applies to health insurance issuers and group health plans.

(k) CONFLICT.—An Exchange may not establish rules that conflict with or prevent the application of regulations promulgated by the Secretary under this subtitle.

I have attached my Sponsor Testimony. The House passed HB 3. SB 9 is the Senate companion bill which has also passed the on Senate floor.

Ms. Howe states in her article “So why would a Republican propose a bill that seeks to further regulate a government created job that will cost the state untold amount of money? It would appear that insurance brokers across the country are getting nervous about the prospect of competition from navigators and have been lobbying for stricter standards on them.”

First I would like to point out to Ms. Howe, and would have if she would have contacted me, that the State of Ohio is not offering a State Exchange. The State of Ohio is not hiring nor are we paying Navigators. A quick read of the law clearly states that: “(6) FUNDING.—Grants under this subsection shall be made from the operational funds of the Exchange and not Federal funds received by the State to establish the Exchange”. We are expecting hundreds of additional pages of Federal regulation soon regarding the role of the Navigator.

In Ohio, the Federal Government will be managing the Exchange and funding will come from the Exchange. Carriers that choose to sell on the Exchange will be charged a tax that will create the funding. Ms. Howe’s statement that “California is slated to spend hundreds of millions of dollars to hire 21,000 navigators” is consistent with the fact California is opting for a State run Exchange; Ohio is not!

Second, are brokers concerned about the impacts of the PPACA on their jobs? Of course; it would be illogical to suggest otherwise. They are joined by almost every other healthcare provider who has concerns regarding how this law will impact them and their ability to provide services.

Most importantly, the PPACA does not allow carriers to require that Navigators have E&O (Errors and Omission) coverage or liability insurance. This is coverage that carriers require from licensed insurance agents. I, along with others, felt it was important to require that Ohioans have basic protections when providing detailed personal information to Navigators. HB 3 requires training and educational requirements on such topics as ethics. HB 3 requires that they submit a disclosure regarding conflict of interest and that they complete criminal records checks (requirements that are consistent with licensed agents). I believe these are important protections to have in place before Ohioans allow Navigators into their homes and provide them with detailed personal and financial information. HB 3 requires that they are certified and registered with the Ohio Department of Insurance and their employer is listed. HB 3 allows the Ohio Department of Insurance to set fees and fines, revoke or non renew Navigators or Business Entity should they act improperly.

HB 3 also includes language that permits any insurer that is a qualified health plan under the PPACA to offer their plan through the Exchange.

I believe HB 3 is very consist with Ohio regulatory position as enforced through the Department of Insurance and would be very surprised if Ms. Howe truly felt comfortable with have Navigators work in the State of Ohio without any basic protections against bad acts. I can not imagine that she would feel it appropriate if the legislature allowed unregulated, potential felons into someone home to collect their personal financial and medical data.

Personal questions:

Yes, I am employed by an independent insurance agency and I’m thankful that they consider me a “resource”. It would be personally disappointing to be employed but someone as a nonresource. I have disclosed my position freely. I believe that it is important for our elected official to work under the rules and laws that they impose. I complete disclosures both for licensing and in my elected position that are filed with the Department and with the State.

It is surprising to believe that Ms. Howe would believe that we should work to serve Ohio and our district only on committees that we have little understanding of the issues. Clearly, if we are looking at insurance issues, someone with an insurance background would be helpful; as legal issues come up we look at our attorneys; additional it would make little sense to ask our urban legislators to be the legislative lead on our farming issues and our farming legislators to solve urban issues. Being knowledgeable and specializing in specific areas of study should be valued, even when parties disagree. I am thankful that I have a reputation for being more of a legislative policy “geek” than a party politics based legislator, although I have always been considered conservative.

Ms. Howe writes “the fact that she works at an insurance agency that will benefit from her bill seems a conflict of interest.” I would refer Ms. Howe again to HB 3 which states “(3) The superintendent shall not certify as a navigator, and shall revoke any existing navigator certification of, any individual, organization, or business entity that is receiving financial compensation, including monetary and in-kind compensation, gifts, or grants, on or after October 1, 2013, from an insurer offering a qualified health benefit plan through an exchange operating in this state.”

We very specifically drafted the bill to prevent someone from working as either a licensed insurance agent or a navigator and receiving a financial gain from both the exchange and qualified health benefit plans. Quite frankly, I ensured that I could not gain from HB 3. I suppose that I could quit my position as a licensed insurance agent and work as a navigator whose expected income will be between $10 and $14 dollar hourly rate, however I will suggest that is not likely.

Currently I serve the 47th House District which includes most of Western Lucas County and much of Fulton County. As a Representative I serve as the House Majority Floor Leader andserve on the Finance and Appropriations Committee, the Human Services SubCommittee, Health and Aging Committee and the Insurance Committee.

Maggie, I thank you for reaching out to me. I am happy to provide additional information regarding any of these topics and look forward to talking to you.

Rep. Sears, Obamacare and Ohio's Health Care Freedom Act

Over the past 24 hours, many of us in this area (and around the country, for that matter) have been informed about actions and comments made by Rep. Barbara Sears in a House committee during the discussion of the Health Care Freedom Act, the Affordable Care Act (also known as Obamacare) and the proposal to accept the Medicaid expansion in Ohio.

The FreedomWorks article, cross-posted on RedState.com, says:

In early March, Ohio State Representative Ron Young and Rep. Andy Thompson introduced a bill known as, “The Health Care Freedom Act,” (HCFA) that proposed a new line of defense against the Patient Protection and Affordable Care Act, or, Obamacare. The bill, when passed, will prohibit health insurance companies in Ohio from accepting any federal funding that would trigger penalties for employers or individuals who aren’t compliant with Obamacare. Wednesday, when the bill was brought up in committee, opposition arose; but not only from the expected side of the aisle. While the Democrats did balk at the bill, Republican Majority Floor Leader Barbara Sears also took issue with HCFA. One needn’t look too deep to understand why Sears wouldn’t want the HCFA to pass in Ohio. Not only has she received a substantial amount of financial contributions from the health care industry, she currently works at a health insurance provider and recently passed her own bill which helps implement Obamacare.

Rep. Sears is not quoted in the article, nor does it say if they tried to contact her to get a comment or response.

I've known Barbara for a long time - we've worked on each other's campaigns and supported each other over the years. So I emailed her and asked for her response. Here is her reply:

Thank you - I can respond however I'm in Columbus with a full calendar of budget meetings today and tomorrow.

It would be helpful if they would read or call...Thank you for your reach out.

Barbara

When she does respond, I will post it here.

1851 Center: beware of back-door Obamacare in Ohio

From the 1851 Center for Constitutional Law:

Two Years Ago: Obamacare Passed

Today: The US Supreme Court Hears Oral Arguments to Decide if Obamacare is Constitutional

With all attention on the Supreme Court, Ohio officials could quietly impose the mandate and restrict choice in Ohio through creating a state Obamacare exchange.

Ohio left-wing and Democratic Party front groups have recently ratcheted-up pressure on state officials to create an Obamacare exchange for Ohio. Meanwhile, it's unclear whether the Kasich Administration buys rhetoric that enacting its own Obamacare exchange will give Ohio increased flexibility.

But the issue should be a non-starter: Ohioans have already fought and won this battle. The Ohio Health Care Freedom Amendment prohibits Ohio from implementing Obamacare in Ohio through creating an exchange.

By creating an Obamacare exchange in Ohio, state government would be doing the following:

* indirectly compelling the forced purchase of government-defined health care insurance
* prohibiting Ohioans from choosing doctors and insurance plans of their choice
* imposing a host of new taxes and fees on Ohioans
* turning Ohio's health care markets over to the federal government
* gift-wrapping a victory for Obamacare by making it easier for the federal government to enforce in Ohio and elsewhere
* undermining the sincerity of Ohio's current Supreme Court challenge to Obamacare

"Any state that creates an Obamacare exchange is ultimately voluntarily choosing to enforce Obamacare and its mandates and restrictions on freedom of choice, while simultaneously reducing the chance that Obamacare will repealed or rewritten," according to 1851 Center Director Maurice Thompson in Does Ohio's Health Care Freedom Amendment Prohibit it from Imposing an Obamacare Exchange? Thompson suggests that legal action would be appropriate to stop the exchange, and that the 1851 Center may take it. Read the entire report here.

More information on this important topic is available at www.StoptheExchange.com, where Ohioans can directly share their feeling on this topic with the Kasich Administration.

Post-election thoughts and upcoming hypocrisy

Unions, with significant out-of-state support, raised over $25 million to defeat Issue 2. They are probably looking at it as money well spent since the measure was soundly defeated 61% to 39). Of course, it was their livelihood (union - not individual member - livelihood) that was at stake.

But Issue 3, which opposes the individual mandate required as part of Obamacare, was passed by a margin that was larger than Issue 2's, winning 66% to 34%. And, Issue 3 passed in every single one of Ohio's 88 counties.

So what does this mean?

Some are saying that the failure of Issue 2 shows that Ohio is still a 'blue' state despite the election results of 2010. But Issue 3 debunks that theory.

If the defeat of Issue 2 was a 'strong message' to Gov. John Kasich, the passage of Issue 3 is an even stronger message to President Barack Obama and to all of the Ohio Congressional delegation.

The question now is whether or not Ohio's representatives in the U.S. House and Senate will heed the message of Ohio voters on Obamacare, as so many are saying Kasich must now do regarding collective bargaining reform.

Or, will those who supported Issue 2 employ a double standard and act like hypocrites by continuing to support Obamacare?

I could tell you what I expect but, considering my cynical nature on such things, I believe you already know.

546,074 signatures submitted to place Ohio Health Care Freedom Amendment on November ballot

Press Release:

Columbus, OH - Supporters today will deliver more than 546,000 signatures to the Ohio Secretary of State to place the Ohio Health Care Freedom Amendment on the November ballot. The amendment would add a 21st Section to Ohio's Bill of Rights "to preserve the freedom of Ohioans to choose their health care and health care coverage."

"In Ohio, the initiative process has typically been controlled by special interests that have much to gain, at the expense of the rest of us. This is our first significant effort to limit government," said Maurice Thompson, Executive Director of the 1851 Center for Constitutional Law. "This amendment, once enacted will not only protect Ohioans' health care freedom from state and local government, but will also place Ohioans in the nation's strongest position to challenge invasive elements of the Patient Protection and Affordable Care Act. This will be the only provision in the nation that explicitly creates a state constitutional right to health care freedom."

For the amendment to move forward, approximately 386,000 signatures must be declared valid. Internal due diligence indicates that over 440,000 of the collected signatures (over 85 percent) are valid. This is believed to be the most signatures collected by a volunteer-only organization in Ohio history for a constitutional amendment.

The amendment provides as follows:

* In Ohio, no law or rule shall compel, directly or indirectly, any person, employer, or health care provider to participate in a health care system;
* In Ohio, no law or rule shall prohibit the purchase or sale of health care or health insurance; and
* In Ohio, no law or rule shall impose a penalty or fine for the sale or purchase of health care or health insurance.

"This amendment is a reminder of our view, and the founders' view, that government exists to secure rights, rather than to take from some so as to provide benefits, amenities, and comfort to others," added Thompson.

The 1851 Center drafted and has represented the amendment's efforts, including winning a successful challenge before the Ohio Supreme Court to former Secretary of State Brunner's attempts to prohibit proponents from gathering the signatures needed to place the amendment on the ballot. The Center has vowed to defend the amendment, at no cost to taxpayers, through Election Day and thereafter.

The 1851 Center for Constitutional Law is a non-profit, non-partisan legal center dedicated to protecting the constitutional rights of Ohioans from government abuse. The 1851 Center litigates constitutional issues related to property rights, voting rights, regulation, taxation, and search and seizures.