Wednesday, March 11, 2015

CORRECTION: Rep. McDermott’s American Health Security Act


(My thanks to Chuck Pennacchio for catching my error. - Don)

In the Quote of the Day for March 9, 2015 - "Rep. Jim McDermott
introduces The American Health Security Act of 2015" - I wrote the

"Those of us at Physicians for a National Health Program support John
Conyers' H.R.676, which would establish a national single payer program
(after all, "national" is in our name). Those who believe that we should
follow the lead of Saskatchewan and first establish single payer on a
state level may prefer H.R.1200/S.1782. Regardless, since these bills
will not receive a vote in the current Congress, they should be used as
advocacy pieces as we explain to the public why single payer is an

For clarification, the 2013 version of The American Health Security Act
states the following:

(a) In General.--There is hereby established in the United States a
State-Based American Health Security Program to be administered by the
individual States in accordance with Federal standards specified in, or
established under, this Act.
(b) State Health Security Programs.--In order for a State to be
eligible to receive payment under section 604, a State shall establish a
State health security program in accordance with this Act."

In my casual reading of this, I assumed that the state could decline to
establish a State Health Security Program, thereby forfeiting the
federal funds. However, Sec. 404 states the following:

(a) Submission of Plans.--
(4) States that fail to submit a plan.--In the case of a
State that fails to submit a plan as required under this subsection, the
American Health Security Standards Board Authority shall develop a plan
for a State health security program in such State."

Thus, although the American Health Security Act would establish a
state-based program, this legislation, as it is written, would not allow
one or more states to establish their own single payer programs while
other states are left with their current systems intact, as all states
would be required to participate (though they could join together in
regions). So this legislation in its 2013 version could not be used to
establish a single-state, single-payer plan - modeled after Saskatchewan
- within the United States.

In a previous Quote of the Day I had discussed a draft of legislation
that would allow states to act on their own while receiving funds that
are currently used in other federal health care programs. Unfortunately,
I didn't realize that the draft was confidential. On learning so, we
withdrew the post from the PNHP website. Although it still has not been
introduced as legislation, it is important to realize that the concept
has been and will continue to be under consideration.

In a note of irony, it appears that the 2013 version of this Act would
replicate the issues in King v. Burwell. Sec. 404(a)(4) would require
the federal government to develop a state health security program in any
state that failed to submit its own plan. Yet, under Sec. 101(b), it
appears that any state that failed to establish its own health security
program would not be eligible to receive funds under Sec. 604 - Federal
payments to states - from the American Health Security Trust Fund. What
would Justices Scalia and Alito make of that? "It says what it says."

At any rate, whenever we finally have a receptive Congress, whatever
bill that would be introduced would have an extensive markup before it
would be enacted. So we do not want to bog down in minutiae at this
stage. In the meantime, the primary thrust of my prior message on the
McDermott legislation still holds: "State versus federal is a secondary
issue. We'll have neither unless the people understand and start
demanding single payer. Let's work on that."

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