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TN House Dems Have Fingers Crossed for Longshot Haslam Vetoes

Tennessee House Democrats held a post-session press conference Tuesday voice their disappointment with much of what the GOP supermajority-controlled Legislature passed this year.

Minority Leader Craig Fitzhugh of Ripley was joined by House Caucus Chair Mike Turner of Old Hickory and Memphis Rep. Antonio Parkinson to speak to reporters about what issues they wish the General Assembly would have acted on and new laws they think the state could do without.

Turner charged that the session was a boon for the wealthy Tennesseans and corporations but “if you were in the middle class, it was a terrible session for you.”

Chief amongst the concerns Turner mentioned was the Haslam administration’s overhaul of workers’ compensation that he called “a tax on sick workers.”

“That did not really address the problem that keeps the cost rising—the medical costs—and just took more money out of workers’ pockets,” said Turner.

Leader Fitzhugh, meanwhile, said his biggest disappointment was the governor’s decision not to accept nearly $1.2 billion in federal Medicare expansion money. But Fitzhugh didn’t fault Haslam completely, saying some of the blame rests with his own party for not doing enough to rally their base on the issue.

“I think our problem, as Democrats, this time is we didn’t get the message out to the people who could have been affected, Fitzhugh said. “I think there are people out there that don’t really that they were this close to having the ability to have health insurance when before they couldn’t afford it… and I’m just sorry we didn’t get the word out to more of them so they could have risen up a little bit and tried to convince the governor.”

While the Democratic lawmakers weren’t shy about questioning many of the session’s Republican-backed initiatives, they were hesitant, when asked by reporters, to choose which new laws they thought were the worst, saying they didn’t want to jinx the possibility, however slim, that Haslam might choose to veto some of them.

“There are a lot of things he could veto and we’ll sustain him on probably all of them if he vetoed them,” Turner told reporters. “I don’t want to influence his veto one way or another until after the fact. Come back with that question after—what’s he got, 10 days or something like that?”

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Improper Release of Health Info Highlighted in Federal Report

The private health information of more than 13,000 Tennessee Medicare recipients was released to the public by a state contractor — the most wide-ranging breach nationally uncovered by federal investigators.

A just-released report, from the Department of Health and Human Services Office of the Inspector General, found 14 breaches of protected health information between 2009 and 2011 by the federal agency that administers Medicare and Medicaid. The largest breach of records took place in Tennessee.

Those are exactly the kind of records that, if in the wrong hands, can lead to medical identity theft, a scam that hurts both those on Medicare and the taxpayer. Scams run the gamut from the simple, when thieves use someone’s medical information to get prescription drugs, to the complex, when sham doctors’ offices use the information to bill the government for quick cash.

“The information obtained can be used to file false claims under Medicare or TennCare,” Yarnell Beatty, the Tennessee Medical Association’s director of legal and government affairs told TNReport. TennCare is the state’s version of Medicaid, the healthcare program for the poor. “Even one breach is cause for concern.”

The report stated that medical identity theft “can lead to erroneous entries in beneficiaries’ medical histories and even to the wrong medical treatment” and “may also lead to significant financial losses for the Medicare Trust Funds and taxpayers.”

Beatty also noted that given the millions — and perhaps billions — of Medicare transactions each year, some breaches are to be expected.

If the breaches are a concern, so was how federal officials’ reacted in wake of those breaches, according to the report. Medicare recipients at risk of having their medical information stolen were notified, but it appears those notifications left much to be desired.

From the report:

The notifications for these breaches often were missing required information. Notably, the notification letters for six of the breaches did not explain how the contractors were investigating the breach, mitigating losses, or protecting against further breaches. … Moreover, notification letters for half the breaches, including the largest breach [in Tennessee], were missing either the date the breach occurred or the date it was discovered.

Many times, the information inadvertently released included beneficiaries’ names, Medicare identification numbers, dates of birth, diagnoses and services received.

The Tennessee breach affected 13,412 beneficiaries. A printing error by a Medicare contractor caused the notices to be sent to incorrect addresses, according to the report.

Most of the breaches, including the one in Tennessee, were accidental, according to the report, but one of the 14 breaches was found to be criminal in nature.

“You can’t totally eliminate human error, although you strive to,” Angie Madden, the director of eHealth Service at the Tennessee Medical Association, said.

But Madden pointed out a silver lining. She said that the Centers for Medicare & Medicaid Services — the federal agency that oversees both those entities and was the subject of the report — “have done a fairly good job of education the public and beneficiaries” when it comes to fraud.

Click here to find out more about Medicare fraud.

Editor’s Note: This story was updated on Oct. 25 to make clear that the printing error leading to the data breach was made by a Medicare contractor.

Trent Seibert can be reached at Trent@TNReport.com or on Twitter at @trentseibert.

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Press Releases

TNDP: Questionable if TN GOP will Protect Senior Citizen Health Care Benefits

Press release from the Tennessee Democratic Party; August 30, 2012: 

NASHVILLE, Tenn. — Mitt Romney and Paul Ryan aren’t the only Republican politicians with a plan to end Medicare as we know it.

Earlier this year, Tennessee Republicans, including state Rep. Jim Gotto, co-sponsored the Health Care Compact bill (HB0369/SB0326), an extreme measure that endangers the health benefits of 800,000 Tennessee seniors enrolled in Medicare and shifts management of their health care plans to TennCare.

Tennessee seniors now want to know if Republican Senate candidate Steve Dickerson and House candidates Charles Williamson, Ben Claybaker and Robert Duvall will support controversial entitlement reforms such as turning Medicare into a privatized voucher program or the state Republican plan to have TennCare take over Medicare.

“Voters assume Dickerson, Williamson, Claybaker and Duvall will fall in line with party bosses, like Rep. Gotto, who want to end Medicare as we know it and hand the management of their health care plan over to TennCare,” said Brandon Puttbrese of the Tennessee Democratic Party. “If these candidates are supporting the Romney-Ryan ticket, which is pushing for vouchers and empty promises that will swamp Tennessee seniors with increased health care costs, voters have to expect that they won’t stray far from their party’s anti-senior policies.”

Romney, the Republican presidential nominee, has endorsed his running mate’s plan to privatize Medicare through vouchers. The non-partisan Congressional Budget Office found the Ryan plan would cut benefits and raise health care costs for seniors by $6,400 each year.

“Tennessee seniors won’t support an extreme plan that puts their current health care coverage at risk — whether it’s Mitt Romney, Paul Ryan or Republicans in Tennessee, there are consequences for endorsing plans that endangers Medicare’s guaranteed benefit or turns the program into a privatized voucher scheme,” said Puttbrese. “It’s time for Davidson County’s G.O.P. candidates — Steve Dickerson, Charles Williamson, Ben Claybaker and Robert Duvall — to be clear with voters and explain whether they support these extreme entitlement reforms that pose a threat to seniors by putting their guaranteed coverage at risk.

 

TENNESSEE REPUBLICAN COMPACT BILL COULD END MEDICARE’S GUARANTEED BENEFIT & FORCE MEDICARE RECIPIENTS INTO TENNCARE

Republican Health Care Compact Bill Would Force 800,000 Tennessee Seniors and 200,000 Disabled Tennesseans into TennCare or a Similar State Program. Under the Republican Health Care Compact Bill (HB0369/SB0326), beginning in FY13-14, the State of Tennessee would take over the federal Medicare program and force enrollees into TennCare or a similar state program. Not only would this be an unprecedented expansion of state government, this bill would increase the state budget by $11,505,596,700.[Capitol.TN.gov, accessed 8/15/12]

Compact’s Block Grant Funding Gap Endangers Medicare’s Guaranteed Benefit at Current Levels and Would Pass Costs onto Seniors. In a release, AARP Utah — another state that has enacted the Health Care Compact law — summarized two of the major problems of the compact, problems that Tennessee would surely face. The AARP stated, “First, the block grant would not keep pace with medical inflation, meaning a loss of hundreds of millions of dollars in federal funding to the state, as medical inflation is much higher than ‘cost-of-living’ inflation… Third, the gap between the block grant funds and the actual cost of medical care for the hundreds of thousands of people who are served by Medicaid and Medicare would be shouldered by the low-income, disabled, and senior populations who are beneficiaries.” [AARP.org, 5/2012]

Indiana Republicans Excluded Medicare From Their Health Care Compact Law to Avoid Cuts to Seniors’ Benefits. Governor Mitch Daniels, a Republican, has a very complex position on Indiana’s “Health Care Compact.” Recognizing the that funding for the Health Care Compact is not designed to keep pace with medical inflation, as pointed out by AARP Utah, Indiana’s Republican-controlled legislature amended their “Health Care Compact” bill to exclude Medicare from their compact. [NWI Politics, 2/23/12]

PAUL RYAN’S BUDGET ENDS MEDICARE AS WE KNOW IT AND SHIFTS COSTS ON TO SENIORS

The Ryan Plan Would End Medicare As We Know It And Raise Seniors Health Costs By Thousands Of Dollars Per Year. “The budget resolution developed by House Budget Committee Chairman Paul Ryan (R-WI) would make significant changes to Medicare. It would replace Medicare’s current guarantee of coverage with a premium-support voucher, raise the age of eligibility from 65 to 67, and reopen the ‘doughnut hole’ in Medicare’s coverage of prescription drugs. Together, these changes would shift substantial costs to Medicare beneficiaries and (with the simultaneous repeal of health reform) leave many 65- and 66-year olds without any health coverage at all.” [Center for Budget and Policy Priorities, “Medicare in the Ryan Budget,” 3/28/12]

The Ryan Plan Raises The Eligibility Age For Medicare From 65 To 67, And Puts In Place Caps On Spending That Could Shift Costs To Seniors As Health Care Costs Rise. “Under Ryan’s blueprint, the Medicare eligibility age would rise over time beginning in 2023 from 65 to 67. In the future, seniors would be given government assistance to purchase private health-insurance plans or could continue to take part in the current fee-for-service model. Spending would be capped, meaning risks and costs could shift to seniors as health-care costs rise.” [Washington Post, 3/29/12]

The Affordable Care Act Preserves Medicare for the Future. Health reform found $716 billion in savings that didn’t cut Medicare benefits by a dime. These savings are extending the life of Medicare through 2024 by cutting unnecessary subsidies to insurance companies and rooting out waste, fraud and abuse. [FactCheck.org, 8/24/12]

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Featured Health Care Tax and Budget

TennCare Cuts Expected, Haslam Wants Feds To Release Funds

On a day when he met with his health and wellness task force, Gov. Bill Haslam on Monday lamented the predicament the federal government has put Tennessee in on $82 million in TennCare funds.

First, the feds said they goofed and owed the state the money due to an accounting error. Now, they say they owe the money but that it might take an act of Congress to release the funds, creating a delay.

Haslam isn’t happy.

“We were really disappointed,” Haslam said. “They had told us. They said, ‘We owe you that money.’ There was no question about that.

“The question was how they were going to refund it to us, and now they said, ‘Well, we do owe it to you, but we can’t pay it back to you without some specific legislation,’ which doesn’t seem right to me.”

The Haslam administration originally had planned for an 8.5 percent reduction for certain providers in TennCare in the state budget. But while a 4.25 percent reduction was put in place beginning this July 1, the rest was postponed to Jan. 1, 2012, since the state expected the funds to come from Washington. Paired with better-than-expected revenues at the time, the state was able to dodge a financial bullet when it amended the original budget plan this year.

But now, with the delay, the other 4.25 percent in cuts will apparently be applied. Haslam referred twice to the amount Monday as about “4 and a half percent,” but an aide pointed out it is the 4.25 percent.

“It’s just wrong that they say, ‘We owe that to you, but we can’t pay you ‘till we pass new legislation,'” Haslam said.

Further, Haslam isn’t confident the state will get its money.

“I’m really not. I wish I was,” he said. “What they had told us last spring was, ‘Definitely we owe it to you. We’ll figure out a way to get that money to you.’ And then the message came back last week, ‘Well, actually, we don’t think we can get it to you without specific legislation.’

“And I think in today’s Washington, specific legislation to send money away out of the federal government to us, even though it’s owed to us, I think will be difficult.”

TennCare officials announced last week they believed it is “highly improbable” the legislation could be introduced and passed in Congress by Jan. 1. So the cuts, which would affect nursing homes, managed care administrative rates, transportation providers, lab and X-ray providers, dentists and home health providers, are expected.

Haslam was asked if the state had any recourse.

“I don’t know that. That’s a really good question. We don’t know that we do,” he said.

The funds are caught in a mix-up involving two federal programs, Medicaid and Medicare. Over 35 years, about 300,000 people applying for disability payments were involved. Federal officials had mistakenly considered the applicants under Medicaid when they should have been covered by Medicare. States have to pay for a share of Medicaid coverage while Medicare is covered by the federal government. TennCare is Tennessee’s version of Medicaid.

But while the state grapples with the federal government, a group tasked with coming up with a plan to improve Tennesseans’ health had its first meeting Monday.

Haslam welcomed his health and wellness task force to Conservation Hall at the Tennessee Residence and formally issued a release announcing the 16 members, who are health care leaders from across the state.

The governor made the case that health is related to education and economic development, and the state has a lousy record on health and wellness in national rankings.

“We have to face facts,” Haslam said. “In Tennessee, we rank 42nd in terms of health and well-being. Some of those are preventable, addressable issues.

“We’ve brought together, I think, some of the finest people from across the state who work on this every day, from different aspects, to see if we can address this.”

Haslam said he wanted a clear strategy that has “measurable outcomes” from the group. He noted that about one-third of the state budget goes to health care costs.

“When we bring back up this budget next year you’ll see again how much involvement we have in health care,” he said.

The task force is chaired by Dr. John Lacey III, chief medical officer for the University of Tennessee. Haslam said he would like to see an outline of a plan from the group in the first half of 2012.

Haslam did say the state has made some recent progress but that the state is still in the 40s when ranked nationally. In a slideshow presentation, Ben Leedle Jr., CEO of Healthways, headquartered in Franklin, said the state had climbed from the ranking of 42nd in 2009 that Haslam mentioned to 40th in 2010.

“To your point, we’re making progress,” Leedle said. “But I want to point out something really important in this data.

“The mid-year 2011 well-being data shows Tennessee has slipped from 40th to 45th. Anybody see what’s probably driving that? Look at the ‘healthy behavior’ line. Dead last in the U.S.”

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Press Releases

Beavers to File Legislation Calling for States to Gain Control of Health Care

Press Release from State Senator Mae Beavers, Jan. 19, 2011:

(NASHVILLE, TN), January 19, 2011 – State Senator Mae Beavers (R-Mt. Juliet) said today she will file legislation calling for Tennessee to join an interstate compact with the express purpose of returning the responsibility and authority for regulating health care to the states. There are also plans to file the “Health Care Compact” in a number of state legislatures during their 2011 sessions.

“An interstate health care compact is a powerful vehicle for states to confront the federal health care law mandated by Washington directly,” said Senator Beavers. “The federal health care law is one of the biggest oversteps of federal authority in our nation’s history. It forces states into a ‘one size fits all’ approach to public policy, and is in direct contradiction to state’s rights and the personal liberties guaranteed by our federal Constitution.”

The Health Care Compact provides a legal framework in which states can create their own healthcare systems. It essentially provides a permanent waiver to each member state to create whatever healthcare regulations the legislature deems best for the citizens of that state. The structure protects Medicare and Medicaid funding by allowing member states to access federal tax revenues directly and without strings attached. Beavers said the combination of a secure funding stream and maximum flexibility for state legislators will create the conditions for multiple solutions to emerge to the health care crisis.

“One size does not fit all,” Beavers added. “States have different needs which are not recognized in the federal mandates passed by Congress last year. The Health Care Compact does not mandate how each state will handle health care within their boundaries. It leaves them to decide how to create a system that fits their needs, providing greater accountability and more flexibility in delivering citizens a more efficient and effective system.”

A Thomson Reuters poll released January 18, 2011 shows that 65 percent of doctors believe that the federal health care law will cause health care quality to deteriorate, while only 18 percent predict that it will improve.

Beavers said she will begin the process of moving the proposal through the legislature when lawmakers return to Nashville in February.

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Business and Economy Health Care News Tax and Budget Transparency and Elections

Stable for Now, TennCare Demands Future Attention

Gov. Phil Bredesen has no illusions about the longterm manageability of TennCare, saying this week, “I think the stuff we did with TennCare bought the state a decade but not more than that.”

The governor’s take on the state’s version of the Medicaid program may come as a surprise to those who assumed TennCare’s major problems were over as a result of major reductions Bredesen made in the program that slowed what had become a runaway train.

But Bredesen, now nearing the end of his term, said the fundamental issues involving health coverage remain.

Apart from the cost pressures already involved in health care, another enormous storm is headed the state’s way with the expansion of Medicaid in the new federal Patient Protection and Affordable Care Act, the law that has become known, for better or worse, as ObamaCare.

Bredesen famously referred to the expansion of Medicaid as “the mother of all unfunded mandates” on states when the bill was being debated in Congress. Now that the bill has become law, Bredesen has taken a different tack, basically saying it’s the law and must be followed, somehow.

Yet through all the concern about what the future holds on the state health care program, for the moment a consensus appears to have formed that the current leadership at TennCare has adroitly managed the operation. Bredesen says so, and so do some people currently running for Bredesen’s job.

“I think one of the issues the new governor is going to have to deal with is basically how do you deal with Medicaid,” Bredesen said. “You know my feelings about using Medicaid as part of President Obama’s expansion. I don’t think it’s the right thing to do. I think it will put a huge amount of pressure on states in the future.

“But that’s something the governor’s got to do. It’s done. It’s the law. It’s over. It’s something the future governor is going to have to deal with.”

The new law calls for establishing health insurance “exchanges,” which will serve as a government-regulated marketplace for buying health insurance. While some aspects of the law have a more immediate impact — such as helping fill the “doughnut hole” in coverage of the Medicare prescription drug plan or extending coverage of children under their parents’ plans until age 26 (due to go into effect in September) — the bulk of the law is scheduled to kick in in 2014.

The time delay has given some who dislike the law an expectation that the law can be changed, so its full impact won’t be known for awhile. But as it stands, the burden will be falling on states to figure out how to follow through on the new law.

“This is not something the federal government can execute. They’re going to need the states to set up the exchanges,” Bredesen said. “Obviously a lot of new people will be coming into Medicaid, and that produces a whole bunch of issues, from rates we’re paying to physicians to other things. So I think there is a whole set of things to be dealt with in terms of implementing the act.”

Bredesen feels good about TennCare’s current leadership, which includes director Darin Gordon.

“We have some good expertise in the state right now, particularly in the form of Darin and his staff over there,” Bredesen said. “I think we’ll get through it but that’s going to take a lot of work.”

One of the candidates for governor, U.S. Rep. Zach Wamp, a Republican from Chattanooga, said this week he, too, is impressed with TennCare’s current leadership, and Wamp gives Bredesen credit for managing the state budget in broad terms, as well as specifically on TennCare.

“Darin Gordon has done an excellent job,” Wamp said. “In fact, the last 24 months at TennCare the program is trending better than it has at any time in its existence. When I had my full briefing with him and asked a slew of questions, I was highly impressed. I think they’re focusing now on more preventive care and wellness, which is something I’m really strong on.

“Frankly, short of the Obama mandate kicking in, I believe TennCare is going in a good direction, but if the Obama mandate kicks in without some relief, if we can’t change that, TennCare is going to get buried with federal mandates. We don’t have the money to pay for those mandates.”

The days of total upheaval at TennCare seem to have subsided, for now.

“We’ve got a good team at TennCare now. It’s been stable,” Bredesen said. “They know what they’re doing. They’re doing a good job. They’re making their budgets. In fact they’re helping us solve some of our other budgets. But that’s going to be a real issue.”

Bredesen was elected in 2002 in great part on his perceived management skills, just as TennCare was spiraling out of control. A key report by consultant McKinsey & Company showed TennCare putting the state on a path to financial ruin. Bredesen responded by cutting more than 170,000 people from the TennCare rolls in 2005. He also put limits on the amount of prescription medications that would be covered, a politically controversial move.

Now, the concern has become that with strides made over a number of years, Medicaid expansion in the new federal law threatens to wipe out previous gains.

Bredesen’s point, as he moves through his final year in office, is that while the state bought time with its changes, the problem of health care costs has not been solved. The new governor will find that waiting for him.

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Business and Economy Featured Health Care Liberty and Justice

Lawsuit Seeks to Make Medicare Opt-Out a Real Option

During recent state legislative debates on Tennessee challenging the new federal health care policy mandates, an auxiliary issue that’s come up is Medicare: What kind of penalties do people face who opt out of the U.S. government’s health insurance plan for the elderly?

The question has arisen in committee discussions on the “Health Freedom Act,” which has already passed in the Senate.

Some House Democrats who oppose the act say its language directing the state attorney general to defend Tennessee citizens against involuntary federal health care directives might give people the impression they can also avoid participating in Medicare without fear of federal government retaliation, or with the backing of state legal resources.

During a Commerce Committee hearing last week, Rep. Craig Fitzhugh, a Ripley Democrat, asked the Health Freedom Act’s sponsor, Mike Bell, if the act’s language “is…broad enough to say that I could quit paying my Medicare taxes, and there would be no penalty for doing that if I just opted out of Medicare.”

Bell, a Riceville Republican, answered that current law already allows one to opt out of Medicare. However, in order to do so, a person must also forfeit entitlement to federal Social Security benefits.

Bell went on to indicate that the Health Freedom Act’s intent isn’t to shield Tennesseans from paying federal taxes of any kind already in existence — just that they not be punished for refusing to buy health insurance or participate in new federal health programs going forward.

In fact, the question of just how mandatory Medicare is — and whether the government can indeed withhold Social Security benefits from those who choose to opt out — is a legal dispute that may be coming to a head.

Congress has in reality never stipulated that, as a condition of dropping out of Medicare, Americans must also forfeit their Social Security entitlements, argues Kent Masterson Brown, a Kentucky-based attorney currently suing the federal government on the issue.

There is indeed an active and operative bureaucratic directive to Medicare and Social Security administrators, nearly two-decades old now, that says citizens who opt out of Medicare must forfeit Social Security benefits. Part of the Social Security Program Operating Systems Manuals, it furthermore declares that people must return any Social Security payments they’ve accepted should they choose to ditch Medicare.

Those policies were instituted by the Department of Health and Human Services in 1993, at the height of then-First Lady Hillary Clinton’s effort to overhaul the country’s health care system.

But while Mrs. Clinton’s effort ultimately fizzled, the policy lives on — even though it is a clear violation of both the intent and language of federal statutes governing Medicare and Social Security, Brown said. Brown and five clients he represents who are challenging the policy are arguing that because the directive was illegally promulgated, it should be nullified.

“Making Medicare mandatory is totally contrary to the statute,” Brown told TNReport. “It is an entitlement — you shall be entitled. Entitlement doesn’t mean you have to take it. It just means you have a right to it. Social Security and Medicare both read the same way — ‘shall be entitled.’

“Historically, the secretary of Health and Human Services and the commissioner of Social Security have always interpreted Social Security to be voluntary — you can take it or not,” Brown added. “If you want to leave all your money in there, fine. If you want to take it you can take it.”

Just last week, over the objections of the U.S. Justice Department, Brown and his five clients were given the go-ahead to proceed with their case from a U.S. District Court judge in Washington, D.C. “(N)either the statute nor the regulation specifies that Plaintiffs must withdraw from Social Security and repay retirement benefits in order to withdraw from Medicare,” wrote Judge Rosemary Collyer of the District of Columbia.

Brown’s clients want out of Medicare but don’t want to give up the Social Security benefits they’ve paid into all their lives. All five — one of whom is former U.S. House Republican Majority Leader Dick Armey, now the chairman of the conservative activist group FreedomWorks — say they prefer their own health plans. The policies belonging to the plaintiffs — who in addition to Armey include four others, two of them former federal employees — range from high-deductible insurance coupled with health savings accounts, to standard Federal Employee Health Program benefit packages, said Brown.

Brown attributes the fact that the government’s punitive policy has gone unchallenged for so long to the prohibitive costs associated with legal challenges against the federal government on health care issues. Also, the administrative appeals processes people must typically exhaust before they’re allowed to use the courts to settle their federal regulatory grievances is extremely long and grueling, he said.

“Litigation like this is vastly expensive — it takes a tremendous amount of resources,” he said.

Brown said that in his dealing with federal attorneys on the matter, they’ve mostly justified the government’s actions by arguing that agency decision-makers are deserving of much latitude and deference when it comes to interpreting federal laws as they go about implementing or administering programs.

Brown added that it is unclear how Clinton administration officials determined they had the authority to make such sweeping policy shifts contrary to the statutes. For his purposes, Brown said he doesn’t really care what they did to rationalize their actions; that he can prove the bureaucrats did indeed promulgate unlawful rules is all that really matters.

And while Brown, who occasionally writes for and speaks on behalf of free-market organizations like the Cato Institute, is quick to point out that his clients’ Medicare case is far removed, legally speaking, from the ongoing debates over the federal health care overhaul, he also believes it serves as a warning that where vast and powerful agencies are concerned, policies are often executed very differently manner than that promised not just by politicians, but the law itself.

Brown worries the agency officials who will administer the health reforms signed into law last month could promulgate “the most onerous rules imaginable.”

His case “illustrates the power these people will wield,” said Brown. “It’s absolutely frightening to think what they could do.”