By Jane Norman, CQ HealthBeat Associate Editor
December 20, 2010 -- Health and Human Services Secretary Kathleen Sebelius said that "there is no going back" when it comes to the health care overhaul, warning that repeal would cost jobs in an uncertain economy, drive up health care costs, and endanger the lives of those who run up against benefit caps.
In a conference call with regional reporters, Sebelius also declined to endorse any alternatives to the requirement that all Americans have insurance, which is under attack in legal challenges. A federal judge in Virginia on Dec. 13 ruled the individual mandate unconstitutional, although judges in two other lawsuits have upheld it.
Sebelius' remarks came following that Virginia ruling as well as oral arguments in a multistate suit in Florida on Dec. 16 in which a federal judge appeared sympathetic to opponents of the law. In addition, Republicans about to take control of the House continue to push for repeal, and though that is not likely, they are expected to try to strip the law's funding and rework specific provisions. Rep. Phil Gingrey, R-Ga., vowed recently to "absolutely pull the plug" on spending.
As HHS seeks to bolster public perception of the law, Sebelius will hold another press event Tuesday morning at which she will announce "efforts to bring unprecedented transparency and accountability to the health insurance market." That is widely expected to be an announcement of details of a regulation that lays out a process for federal review of premium increases, as authorized under the health care law. The regulation has been under review at the Office of Management and Budget.
Sebelius in the call warned that repeal would lead to continued private insurance company dominance of health care. "We know that there are some across the country and some who will be new members of Congress who are coming to town, declaring that their number one goal is to eliminate the benefits and put insurance companies back in charge," she said.
"I think it's important that folks understand that there is no going back," said Sebelius. "We can't return to the days when over the last 10 years insurance charges went up 131 percent and people have less coverage and less options."
A repeal of the law would mean a return to a time when insurance companies could place annual limits on payouts of health care benefits, she said. It could also bring back lifetime caps "that I've heard directly from parents and others that put people in a life-or-death situation," said Sebelius.
Repeal would make it harder to find a doctor because it would cut new funding for underserved communities and affect job creation as well, she said.
It would mean that instead of the investment we're making in new community health centers across the country to double the number of patients that are able to be served, we would stop those new jobs and new services, bring that construction to a halt, make it tougher for people in the most underserved areas to actually access health care," Sebelius warned.
Rather than making insurance more affordable and available, "repeal would make sure that insurance was even further out of reach and that our costs continue to skyrocket," she said.
But Republicans say that the anticipated burden of the health care law on employers is keeping employers from expansions and job creation. "Right now, small businesses across the land are in desperate fear, " said Rep. John Fleming, R-La., in recent special orders organized by the House GOP Doctors Caucus. "I would say that the largest cause of this is health care, the health care reform."
Sebelius, asked about proposals by Nebraska Sen. Ben Nelson that would replace the individual mandate with financial incentives to buy insurance, Sebelius was skeptical.
Nelson wants to take an approach advocated by two Republicans—Leslie Norwalk, who ran Medicare and Medicaid under President George W. Bush, and Gail Wilensky, who ran the programs under President George Bush.
Both have noted that the "Part B" doctor care and "Part D" prescription drug parts of Medicare are voluntary but that a high percentage of seniors sign up as soon as they are eligible because they must pay much higher premiums if they delay enrolling.
Sebelius did not endorse the Nelson approach and said she has not seen specific language from him. "I think we're likely to see, you know, a variety of opinions as we travel toward the Supreme Court," she said. "The mandate, as you know, doesn't even become effective until 2014."
She added, "As Sen. Nelson knows very well, because he is a former insurance commissioner, as I am, right now the real promoters of the personal-responsibility initiative were often the insurance companies." Insurers have said repeatedly that the requirement is needed so that enough healthy people are in the insurance pool to balance out the claims of the sick.
Sebelius said she agrees the individual mandate is necessary. "It's like, you know, allowing people to buy car insurance only after they have a wreck," Sebelius said. "That market would quickly, I think, disintegrate and dissolve."
