Health Care Bill Gives Obama Power to Appoint Government 'Commissioner' With Sweeping Power to Dictate Health Coverage

By Fred Lucas | September 2, 2009 | 6:50 PM EDT

House Speaker Nancy Pelosi speaks at a news conference following a roundtable discussion on health care issues with religious leaders at St. James Episcopal Church in San Francisco on Thursday, Aug. 20, 2009. (AP Photo/Jeff Chiu)

( – The health care bill under consideration in the House of Representatives would give President Obama the authority to name a new federal “Health Choices Commissioner” who would have sweeping power to govern the health insurance plans offered in a so-called "exchange" where millions of Americans would get their health insurance if the bill is enacted.

These powers would include deciding which treatments are covered, which companies can participate, which states can run their own exchange, and enrolling individuals into the public exchange.
Though the bill, House Resolution 3200, faces many political hurdles, it has passed three House committees and could be ready for a floor vote after Congress returns from recess. The overhaul package calls for establishing a health insurance exchange where people earning up to 400 percent of the poverty level will be able to purchase health insurance with the help of federal subsidies. This exchange would include a "public option" government-run health care plan as well as private plans that provide a minimum benefits package dictated by the government. 
 The Health Choices Commissioner would establish “the benefits to be made available under Exchange-participating health benefit plans during each plan year,” according to page 84 of the 1,018-page bill. That means the commissioner would determine what benefits the participating insurance companies must offer participating customers in the exchange.
The commissioner would also set rules for insurance companies to participate in the health insurance exchange, and establish criteria for individuals to receive federal subsidies to purchase insurance in the exchange, according to section 142 on page 42 of the legislation.
Further, the commissioner would have the authority to establish “automatic enrollment” of individuals who qualify for the health insurance exchange.
“The Commissioner shall provide a process under which individuals who are Exchange-eligible individuals described in subparagraph (B) are automatically enrolled under an appropriate Exchange participating health benefits plan,” the legislation says, beginning on page 97. “Such process may involve a random assignment or some other form of assignment that takes into account the health care providers used by the individual involved or such other relevant factors as the Commissioner may specify.”
The exchange eligible individuals [determined by subparagraph (B)] include someone who “has not opted out from receiving such affordability credit,” someone who “does not otherwise enroll in another exchange participating health benefits plan,” and someone “enrolled in an Exchange-participating plan that is terminated (during or at the end of the plan year) and who does not otherwise enroll in another Exchange participating health benefits plan.”
House Minority Leader John Boehner (R-Ohio) believes giving one bureaucrat this much power over the health insurance of Americans is among the least noticed provisions of the legislation.
“The American people want two things from health care reform: lower costs and more choices,” Boehner said in a statement. “Yet Democrats have done exactly the opposite coming up with a bill that actually raises costs--increasing the deficit by $240 billion--and letting a new federal bureaucrat make health care decisions that should be left to patients and their doctors.”
The legislation also gives the commissioner power to determine who can participate and under what conditions.
“The commissioner shall have the authority to establish such rules as may be necessary to deal with special situations with regard to uninsured individuals and employers participating as Exchange-eligible individuals and employers,” the bill says on page 82, “such as transitions periods for individuals and employers who gain or lose, Exchange-eligible participation status, and to establish grace periods for premium payment”
The exchange proposal in the legislation would work with state insurance departments to establish and enforce insurance reforms and consumer protections. It also establishes “affordability credits” that are made available to Americans earning up to 400 percent of poverty level ($88,000 per year for a family of four) to purchase insurance. The exchange is supposed to expand, according to a House Democratic summary of the legislation, to be open to more than just small employers. 
The exchange will have at least three different tiers of exchange coverage, “Basic, Enhanced and Premium” according to the legislation. And the commissioner would be in charge of setting standards for defining each of these tiers.
The commissioner would also decide the “cost sharing” difference between each of these plans, according to pages 85-87 of the legislation. The variation in government subsidy between the cost for “Basic, Enhanced and Premium” plans could not exceed 10 percent, the bill says.
The national exchange would not replace state health care exchanges, such as the Commonwealth Connector in Massachusetts. Rather, such state plans could complement the national exchange. But that is only if these exchanges meet federal criteria set by the commissioner.
Otherwise, the commissioner could shut the state exchanges down.
“The Commissioner may terminate the approval (for some or all functions) of a State-based Health Insurance Exchange,” the legislation says on page 114.
Page 112 of the legislation says a state plan “must demonstrate the capacity to provide assurances satisfactory to the Commissioner that the State-based Health Insurance Exchange will carry out the function specified for the Health Insurance Exchange in the State (or States) involved.”