During an appearance on WBUR’s On Point this morning, Rep. Michael Burgess (R-TX) celebrated the demise of CLASS, the Affordable Care Act’s long-term care insurance program, and boasted that he is “one of the 7 million” Americans enrolled in a private long-term insurance program. But as Howard Gleckman, a resident fellow at the Urban Institute, pointed out, very few individuals can afford long-term policies and often deplete their personal savings in order to qualify for coverage available through Medicaid. “Congressman Burgess bought a long-term care insurance policy,” Gleckman observed. “With all respect, he’s a physician. His income was probably quite a bit higher than the average American. Long-term insurance premiums are about $2,000 a year. Most people can’t afford it.”

“This is just something that you budget for,” Burgress responded and claimed that the government can encourage the purchase of private long-term care insurance through tax credits. He also speculated that “the same type of premium would have been paid by people in the CLASS.” “The loss of this does not trouble me at all,” he added.

But when a listener from Massachusetts highlighted the inadequacy of the private market — an insurance company increased his premiums by 70 percent — Burgess appeared caught off guard. He reiterated his claim that CLASS was unsustainable and urged listeners to purchase private health insurance sooner. Listen to the exchange:

Judy Feder, a former senior fellow at CAP who is now with the Urban Institute, also added that private insurers were already abandoning the long-term care market and characterized Burgess’ tax credit solution as “support for the rich.” “The tax benefit benefits the high income population and is likely simply to replace some of the dollars that better-off people are is already paying in premiums,” Feder explained. “What a government program, even a limited one offers, is an opportunity to put government behind an education, a marketing effort. It can actually support the purchase of private long-term care insurance alongside a modest public benefit,” she said.

Feder expressed frustration with the government’s decision to bandon CLASS and argued that the Affordable Care Act provided HHS Secretary Kathleen Sebelius with sufficient flexibility to ensure that the program can remain sustainable over the next 75 years. Gleckman suggested that administration lawyers seemed overly concerned that some of the Secretary’s authority could be challenged in court. Listen to the whole program here.

Rep. Michael Burgess (R-TX) called on the super committee to lower the deficit by repealing the Affordable Care Act during a floor speech yesterday, arguing that it could “find the bulk of the $1.5 trillion in budget savings required under the recent deal to raise the federal debt ceiling by cutting back the programs created under last year’s healthcare law”:

“The Select Committee is getting to work, and I encourage both parties, all 12 members, to put the Affordable Care Act on the table, alongside other entitlements in need of reform,” he said on the House floor.

Burgess said other existing programs are on the table in the supercommittee, “so why shouldn’t new entitlements created by the Affordable Care Act be as well?” Burgess cast his proposal as an easy way to cut the deficit, since many of the programs under the law have not yet been implemented. “The Select Committee is getting to work, and I encourage both parties, all 12 members, to put the Affordable Care Act on the table, alongside other entitlements in need of reform,” he said on the House floor.

Burgess said other existing programs are on the table in the super committee, “so why shouldn’t new entitlements created by the Affordable Care Act be as well?” Burgess cast his proposal as an easy way to cut the deficit, since many of the programs under the law have not yet been implemented.

Burgess is certainly no fan of reform, but peeling back a measure that will lower the deficit over 10 years and slow the rate of growth in health care spending is particularly short sighted. If he wants to reduce how much the government spends on health services, then he should be offering a strong public option, a federal exchange, speeding up the delivery reforms, and a host of other cost containment initiatives that would actually save some money. Delaying coverage expansion isn’t fixing anything. It’s only kicking the health can down the road.

Rep. Michael Burgess (R-TX) tells Inside Health Policy’s Sahil Kapur that he is considering introducing legislation to delay the implementation of the Affordable Care Act for two years or more until the Supreme Court rules on the constitutionality of the mandate and the economy is in better shape to handle the upfront costs of the measure:

In an interview Tuesday afternoon (Aug. 16), Burgess said delaying the law’s spending measures that begin 2014 would save money, though like other Republicans he would like total repeal of the law.

Burgess said the health law poses long-term financial concerns. “We’ve got the other looming problem in 2014, when the spending really accelerates out of the Affordable Care Act that’s really going to be disruptive to the budget,” he told Inside Health Policy. “On a larger scale, if we really wanted to control spending, we could look at postponing the 2014 start date and move that out by — fill in the blank — 2 years was my suggestion, but I’m willing to listen to other arguments.” [...]

“Clearly it’s all building up to a point where the Supreme Court is eventually going to rule,” Burgess said. “All I would ask is, can we postpone the expense of implementation until we see which way this thing is going.” Burgess said the federal government is spending tens of billions every year to implement the law — money that, he argued, may end up being spent for no good purpose if the Supreme Court decrees some or all of the measure unconstitutional. “So if we could just agree to put a hold on the spending until we see the direction that this thing is going to go.”

This is very hard to take seriously. First, it’s true that the Affordable Care Act requires an upfront investment to establish a structure for universal coverage that reduces the deficit (and the rate of growth of health care expenditures) over a 10-year window. But since health care costs rise annually, delaying implementation not only postpones benefits, it also increases government expenditures. Everything is more expensive in the future and the longer we wait, the more the government will have to spend on premium subsidies, out of pocket cost sharing, etc.

The other point to make is that Burgess is going about this the wrong way. If he’s interested in balancing the budget, he should raise some taxes. If he wants to lower health care spending, then he should be offering a strong public option, a federal exchange, speeding up the delivery reforms, and a host of other cost containment initiatives that would actually save the government some money. Delaying implementation isn’t fixing anything. It’s only kicking the health can down the road.

Yesterday, the House voted to eliminate federal grant money to help states establish their own insurance exchanges — market places that will help consumers purchase and compare coverage options beginning in 2014. As the Hill’s Sam Baker reports, “[t]he measure passed 238-183 after Republicans dismissed complaints that the bill would tie states’ hands and shift power to the federal government.” Rep. Michael Burgess (R-TX) maintained that “Washington would dictate operation and structures of the exchanges” to the states:

BURGESS: Will Washington or Austin choose the official benefits that will be paid to patients. Section 102 of the Patient Protection and Affordable Care Act. Section 102 says that responsibility is Washington’s. Will Washington or Austin control whether health savings accounts and other consumer driven plans can be offered? Section 4202 D2 says Washington wins that round….I think Mr. Speaker you begin to get the impression, this is not state flexibility this is of and run by Washington D.C.

Watch it:

But as Rep. Frank Pallone (D-NJ) pointed out, the amendment would not remove the requirement for states to set-up the new market structures by 2014 and would therefore increase federal control over the states. As the Congressional Budget Office has pointed out, “[u]nder H.R. 1213, CBO assumes that some states will move forward without federal funding to establish exchanges, but that the federal government will be required to take responsibility for setting up exchanges in more states than is expected under current law.”

“My colleague on the other side, I don’t understand. You are saying that you want Austin to do it. You want Austin to have the flexibility to frame a program that is done best because you think Austin and the state is going to do it best, well if that’s the case, why in the world are you putting this bill on the floor,” an exasperated Pallone said in response to Burgess. “By passing this bill you are simply abdicating the right of the state to make a decision and to have the flexibility to set up a good program that’s tailored to the state. It’s the exact opposite of what you’re saying you want to do.”

While the Affordable Care Act does establish a federal baseline of protections and regulations, states that choose to operate their own exchanges still have a great deal of flexibility. For instance, states can establish their own governance structure for the exchange — through a state government agency or a nonprofit entity or partner with different states — develop sub-state exchanges, join a regional exchange, decide whether or not to have separate exchanges for businesses and individuals and families, and develop a process of selecting which plans can participate in the exchange. States can also include public plan options or insurance cooperatives (co-ops) in their exchanges.

Today’s Politico notes that the GOP is “stumbling” to find new ideas for reforming the health care system:

There’s no Republican plan yet. No Republicans leading the charge who have coalesced the party behind them. Their message is still vague and unformed. Their natural allies among insurers, drug makers and doctors remain at the negotiating table with the Democrats. So Republicans now worry the party has waited so long to figure out where it stands that it will make it harder to block what President Barack Obama is trying to do.

To the extent that Republicans are discussing health care, they’re relying on trite McCain-campaign talking points and old-hands from the 1990s. In other words, they’ve outsourced the conversation to attack dogs Conservatives for Patients Rights, Betsy McCaughey, and Sally Pipes and have, for the most part, relinquished the serious debate about how to lower costs, increase access and improve quality.

The truth is, and what the Politico article hints at, is that the GOP leadership has little understanding of the health care issues. So much so, in fact, that Rep. Michael Burgess (R-TX), M.D. published a “Health Care Primer for Members” in the run-up to the general election. The document, whose only notable feature is the resemblance of its front page to Sen. Baucus’ white paper, is like a ‘health care for dummies’ introduction to Medicare, Medicaid, SCHIP, FDA, CDC, NIH etc… The package contains most of Burgess’ editorials, poll data, and talking points that instruct GOP members to stress that “freedom is the foundation of life in America” and “we must work to pass forward-looking, long-lasting legislation dealing with doctors first.”

So while Sens Max Baucus and Ted Kennedy just sent the White House a letter “affirming their commitment to marking up health care legislation in June,” most Republicans are busy recycling old free-market ideology that even elementary economic textbooks dismiss as impractical.