WHERE’S THE MONEY GOING? HOW MUCH? WHAT FOR?
The federal health care law known as “ObamaCare” gets more unpopular every week, but the question for citizens and policymakers is the same: What can be done about it?
Many of the law’s critics contend that it can be nullified. What many advocates of this approach do not, perhaps, appreciate is the nature of the federal government’s power over states. Outright nullification would not be upheld by the U.S. court system and fails to address the fact that some states, including South Carolina, that have publicly “rejected” key provisions and regulations of ObamaCare are in fact already quietly implementing these same provisions. In South Carolina these implementations are in the form of increased Medicaid enrollment through practices and regulatory modifications such as auto enrollment, presumptive eligibility, modified adjusted gross income (an expansion of the eligible Medicaid population by raising the income eligibility cutoff), increased Medicaid payments for primary care, physician Certification of Incontinence, modification to Federally Qualified Healthcare Center and Rural Health Center enrollment and claims submission criteria, care provided by free-standing birth centers, face-to-face home health care, and others.
South Carolina is able to implement these provisions of ObamaCare for the same reason it is unable to fully reject the law through a simple legislative decree: the acceptance of federal funds. The federal government has offered billions of dollars to each state to implement provisions of ObamaCare and South Carolina has readily accepted some of these funds to grow its Medicaid population. When South Carolina or any state accepts federal funds, the state voluntarily waives its sovereignty and agrees to use the funds to implement whatever policy the federal government has tied to the monies.
The only way to stop ObamaCare’s implementation, therefore, is to turn down the money – not rhetorically but actually. And the only way to do that is by requiring the legislature to approve – openly and publicly – any money coming to the state as a result of the Affordable Care Act.
The process must start with the beginning of the state budget process (agency budget requests) and continue through the final ratification of the state budget. Moreover, any state agency requesting federal funds to implement or enforce any provision or program of ObamaCare would be required to submit to the governor and post on its website the following information:
- A full and detailed list of each of those programs to be implemented.
- The precise amount of federal dollars requested.
- The precise amount of state dollars requested.
- Every regulation, mandate, requirement, or action that will result from the program’s implementation or the spending of the dollars.
- Every type of business that would be affected by the regulation.
- Every type of individual who would be affected by the regulation.
- The authority by which the federal government directs the program.
- The authority by which the state would direct the program.
- The method by which the state would receive the dollars.
- All agreements, plans, or documents the state would have to submit to federal authorities.
- The names of those authorities that would sign any authorization of the state for the purposes of federal authorities holding the state accountable.
- All specific reporting or implementation requirements for the state.
- All penalties imposed by the federal government on the state for any breach of the terms as described in writing by federal or state authorities .
- All projected costs to any public entity.
- All projected costs to business and individuals.
- The stated goals of the program and the expected results as described in writing by federal authorities overseeing the program and the state agency.
- The costs of the program as described in writing by federal authorities over the program, and by the state agency.
- The specific process by which the agency will measure the results of the program each year.
Following this, the governor would submit, through the executive budget, the following information:
- A detailed description of all federal dollars requested by state agencies to implement, either purposefully or in practice, any program contained in or described by ACA, for any program the governor believes should be included in the budget.
- The specific revenue through which all monies for the programs will be derived.
- All authorizations to be submitted by the state.
- All costs not described in the above section but that would be incurred by the state or its citizens or its businesses or its subdivisions and any entity that receives or spends any public dollars.
- All entities that will be implementing the programs.
- The length of the programs and any and all other impact as a direct or indirect result of the program.
This information must be specifically detailed and noted as having a connection to the the Affordable Care Act, precisely what that connection is and the specific means by which the governor will measure the results of each program, as well as any other South Carolina laws that would pertain to each of the programs described.
Following the submission of the executive budget, the standing budget committees of the legislature must consider the proposed acceptance of federal dollars tied to programs that are part of ObamaCare as well as the rest of the executive budget in joint open sessions no more than five days after the governor’s submission of the executive budget as required by state law section 11-11-90.
All of the information required along with a request for federal funds tied to ObamaCare should also be available for public inspection on agency websites, the governor’s website, and all legislators’ websites. In addition to this public availability, all businesses who will be affected by regulations, mandates, or new costs associated with the acceptance of these federal funds should be contacted directly by the appropriate licensing agency and be made aware of these effects.
This process should have to be repeated each year; every relevant program should have to be reauthorized through this process. In any year following the initial implementation of any program tied to ObamaCare, there must also be a full description of the costs of the program, cost overruns, the success of the program, any new regulations or mandates associated with the program’s implementation. This information should also be available to the public.
Finally, each program and any amendments to programs funded in whole or in part by funds tied to enforcement or implementation of ObamaCare should receive a full recorded up or down vote in both chambers of the legislature. Any public official who benefits from these programs must also disclose the relevant income on his or her statements of economic interest.
If South Carolina citizens and elected officials are serious about stopping ObamaCare, it will take more than outlawing it with a single bill, and certainly more than rhetorical denunciations from elected officials. It will take, first, complete transparency about the acceptance of federal money, and second the will turn it down.
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