Posts Tagged ‘healthcare reform law’

Will the ACA Survive the Supreme Court, 2012 Election?

Wednesday, February 1st, 2012

The 26 states that have challenged President Barack Obamas healthcare law face several dilemmas as they try to convince the Supreme Court to declare the law’s Medicaid expansion unconstitutional   The two lower courts that heard the Medicaid challenge ruled in favor of the Obama administration, even as those judges struck down the healthcare law’s individual mandate. Legal experts on both sides of the mandate debate were surprised that the Supreme Court agreed to also hear the Medicaid piece of the state’  lawsuit.  The healthcare law’s supporters claim that the states erred in their initial brief on the Medicaid expansion, which was filed with the Supreme Court.

According to the states involved in the lawsuit. the ACA’s Medicaid expansion is “coercive.” Although state participation in the program is strictly voluntarily, the brief argues, the healthcare law makes it impossible for states to opt out of Medicaid.  The brief tries hard to link the Medicaid expansion to the individual mandate, arguing that states won’t be able to exercise their legal right to leave Medicaid because it’s the only way for Medicaid-eligible residents to fulfill the mandate.

“While the (Affordable Care Act) purports to leave states’ participation in Medicaid nominally voluntary, multiple aspects of the Act evince Congress’ keen awareness that, in fact, no state will be able to reject its new terms and withdraw from the program,” the brief says. “Most obviously, the ACA’s individual mandate requires Medicaid-eligible individuals to obtain and maintain insurance.”  But most Medicaid-eligible people would be exempt from the mandate, said Timothy Jost, a law professor at Washington and Lee University and a supporter of the health law.

Then there’s the Supreme Court case, which will be heard in the spring and a verdict announced prior to the November presidential election. According to Kurt Mainwaring, a ksl.com contributor, “Far-reaching consequences of the court’s ruling will likely impact both the cost of healthcare and the outcome of the 2012 elections.  If the Supreme Court rules that ACA is constitutional, healthcare costs will likely continue to rise — although at a slower rate than if the law were determined to be unconstitutional.  At present, healthcare costs make up approximately 18 percent of GDP. If expenditures continue on their current trajectory, “the share of GDP devoted to healthcare in the United States is projected to reach 34 percent by 2040.”  Translated to real numbers, the Department of Health and Human Services (HHS) notes that Americans paid approximately $1,000 annually in healthcare costs in 1960; more than $7,000 per year in 2007; and are projected to pay more than $13,000 per year by 2018.  This kind of increase in healthcare costs is not sustainable — and these kinds of projections are part of the reason ACA was enacted in the first place.

Beach Conger, a Vermont internist writing in the Burlington Free Press believes that “Medicare for All” — a possibility that was raised during the lengthy debate over the ACA — should be reconsidered.  According to Conger, “Medicare and I were born in the same year. Professionally speaking, that is. We were raised together, and we have been married to each other for what seems an eternity. As with any long-term relationship, we have had our ups and downs, but we have both matured over the years, and I believe we are both the better for it. Without being too vain, I have to say I have done a better job at providing health care, and I have to admit that Medicare has helped me do it.  At first, it just made sure that those retired people who wished to pay me the fees to which those in my line of work have become so accustomed, could actually do so. But eventually it realized that there was more to the business than just money, and it began to keep an eye over my shoulder, making sure I was not leaving undone those things which ought to be done and not doing those things which I ought not.  So I can’t help but think, why not Medicare for everyone? It would be so simple. And that’s when I realized.  It was too simple.”

Dr. Conge, it should be pointed out, lives in Vermont, to date the only of 50 states to enact a single-payer public option — Green Mountain Care.

Medicare, Medicaid Costs Rising More Slowly

Tuesday, January 24th, 2012

Healthcare spending nationally grew slowly for the second successive year in 2010, bringing it in line with growth in the U.S. economy as a whole, according to the Department of Health and Human Services (HHS).  Spending rose by 3.9 percent in 2010, to $2.6 trillion, while the GDP rose 4.2 percent, according to HHS, which published its findings in the journal Health Affairs.  In 2009, spending increased nearly the same by 3.8 percent, but in contrast it’s growth rate was twice that by 7.6 percent in 2007.  Spending increases frequently hit double digits in the 1980s and 1990s.  While spending growth in general remained slow, premiums for people in private insurance plans grew faster for the first time in seven years than what was spent on their care, according to the Centers for Medicare and Medicaid Services (CMS).  Premiums in 2010 rose 2.4 percent, slightly less than the 2.6 percent increase in 2009, although private health insurers’ spending on actual benefits rose only 1.6 percent in 2010, down from 3.7 percent in 2009.

Healthcare represents 17.9 percent of the U.S. economy, the same proportion as in 2009, according to a government report. “Persistently high unemployment, continued loss of private health insurance coverage and increased cost sharing led some people to forgo care or seek less costly alternatives than they would have otherwise used,” the report said.

The report showed that the federal government paid 29 percent of the nation’s healthcare bill in 2010, up from 23 percent in 2007. Some of that increase reflects a transitory increase in federal aid to states to enroll more uninsured people in Medicaid. The percentage of spending by private businesses and state and local governments fell.

The recession played a large role in impacting spending, CMS officials said.  Because fewer people were insured, and private insurers generally picked up less of the cost, patients went to the doctor and hospital less frequently.  The answer may go beyond the recession.  “The utilization slowdown is at least in part structural, and not just cyclically driven by the economy, and the adoption of higher cost sharing plan designs will result in some level of permanent slowdown in trend,” said Ana Gupte, a senior analyst at Sanford Bernstein, which conducts research for investors.

“Premiums grew faster than benefits for the first time in seven years, and benefits grew at their slowest rate in the history of the accounts, according to Anne Martin, a CMS economist.  Martin said this was because private health insurance companies lost enrollees as people were laid off, moved to cheaper health insurance plans as a result, cost-sharing increased.

Karen Ignagni, president of America’s Health Insurance Plans, said that the portion of premiums “allocated to health plans administrative costs was among the lowest in recent years, despite the fact that health plans have been in compliance with the healthcare reform law.”

Additionally, spending on prescription drugs declined in 2010.  Not only did individuals buy fewer drugs, but there were also more switches from brand to lower-cost generic medications. According to CMS, fewer new drugs came onto the market.

Paul Ginsburg, president of the Center for Studying Health System Change, a Washington research group, said the report didn’t address the biggest question: “When the economy gets strong again, do we just return to the old business as usual?  Probably,” he said. “But there’s a chance that the experience of people economizing may have longer-lasting effects.”

The Obama administration was pleased with the report and called it good news for the healthcare law, although some researchers found the law had a less than 0.1 percent impact on national health spending in 2010.  “These numbers do not take into account all of the cost-saving provisions in the Affordable Care Act that are still being implemented.  But they do show why the Affordable Care Act is so important,” senior White House adviser Nancy-Ann DeParle said. According to DeParle, the insurance regulations in the law will keep insurance companies “in check.”

The phasing in of the patient Protection and Affordable Care Act (ACT) which will expand insurance coverage to as many as 32 million people, will incur larger cost increases later in this decade. National health spending is expected to increase by 8.3 percent in 2014, when the most ambitious coverage expansions take effect, according to CMS projections.  “The law will control the growth of healthcare spending through fraud prevention, better coordination of care, disease prevention and overhauling insurance markets,” DeParle said.

According to DeParle, “Starting in 2011, insurance companies were required to publicly disclose and justify any premium increases larger than 10 percent. Many states have the authority to reject unreasonable premium increases and the Affordable Care Act gives states $250 million to strengthen their rate review programs. Additionally, insurers are required to spend at least 80 percent of your premium dollars on healthcare expenses instead of overhead and profits.”

Vermont Taking the Public Option

Wednesday, April 13th, 2011

Vermont – the nation’s second smallest state with a population of just 625,741, according to the 2010 Censusis moving toward adopting a single-payer healthcare system. The House in the Green Mountain State recently passed a bill by a 92 – 49 vote that would set up a five-member board to design a benefits package that would be available to all Vermonters through a state insurance exchange.  According to the legislation, “All Vermont residents shall be eligible for Green Mountain Care, a universal healthcare program that will provide health benefits through a single-payment system.”

The Senate is expected to approve the legislation and send it to Governor Peter Shumlin, who campaigned to reform the state’s healthcare system. At that point, Vermont would need a federal waiver to implement the plan, something that cannot be provided until 2017 under provisions of the Patient Protection and Affordable Care Act (ACA).  Nationally, single-payer healthcare, also known as Medicare for All, has proven popular in polls, but was rejected during the healthcare reform debate.

“This bill takes our state one step closer to a system that ensures that all Vermonters have access to the care they deserve and contains costs,” House Speaker Shap Smith said. According to Shumlin, passing a state-funded healthcare system would make Vermont “the first state in the country to make the first substantive step to deliver a system where healthcare will be a right and not a privilege, where healthcare will follow the individual, not be a requirement of the employer, and where we’ll have an affordable system that contains costs.”  The so-called RomneyCare system in Massachusetts is the framework for the Affordable Care Act.

We have a historic opportunity to fix a broken health care system,” said Representative Mark Larson (D-Burlington) and chairman of the House Health Care Committee.  He said the goal is to “provide healthcare security to Vermonters” and decelerate the growth of healthcare costs.  Supporters say the bill is designed to provide health insurance to the 47,000 Vermonters who don’t have coverage, provide better insurance to the more than 160,000 underinsured residents and cut costs.  Opponents say that the state is moving too fast into uncharted territory.  They say the proposed health system’s ultimate cost and how it would be funded aren’t made clear in the legislation.

One of Vermont’s leading opponents to Green Mountain Care is the Ethan Allen Institute, which describes itself as a free-market think tank.  John McClaughry, the institute’s president, argues that public option supporters rely on three arguments — that healthcare is a human right and that there is significant unhappiness with the operation and financing of the current system.  The third reason, he said, “is political and rarely stated.  It will put the government in control of all employers, medical providers, insurers (if any), and patients.  That will mean many more jobs for (unionized) government bureaucrats.  It will require unionization of doctors and other professionals who will have to bargain with the public body over their compensation and working conditions.  It will mean more campaign contributions and votes for politicians who will work to rig the system in favor of their particular group of ‘stakeholders.”

The Connecticut Coalition for Universal Health Care disagrees.  “Healthcare providers would be in a fee for service practice, and would not be employees of the government, which would be socialized medicine,” according to the Coalition.  One model of socialized medicine is the Veterans Administration’s (VA) network of hospitals, paid for by the government and managed by federal employees.  Many veterans feel they receive better healthcare outcomes through the VA than at for-profit hospitals.  Another model is TriCare, which administers the worldwide healthcare plan for 9.6 million eligible beneficiaries of the uniformed services, retirees and their families, also a superior system.

Wisconsin a Model for Creating Healthcare Insurance Exchanges

Tuesday, April 12th, 2011

Wisconsin is a national model for implementing the Patient Protection and Affordable Care Act (ACA).  The state has accepted $37.7 million in federal funding to begin designing the state’s health insurance exchange as required by the law.  But it remains unclear how the funding will be used under the administration of Governor Scott Walker, who opposes the law.  Earlier this year, the Department of Health and Human Services (HHS) announced that Wisconsin, along with Kansas, Maryland, New York, Oklahoma and Oregon, had been selected as “early innovators”, meaning they received $241 million in federal grants to design IT systems for their exchanges.  The systems developed will ultimately be used as models by other states, according to the department.  Wisconsin applied to become an “early innovator” under former Democratic Governor Jim Doyle, who supports the new federal healthcare reform law.

Early innovator states will play a critical role in developing a consumer-friendly marketplace where insurers must compete to deliver the best deal,” said HHS Secretary Kathleen Sebelius.  She noted that the grants will lay the groundwork to “ensure consumers in every state will be able to easily navigate their way through health insurance options.”  Although states must begin operating the exchanges only in 2014, they are required to declare their intent to form them by January 1, 2013.  The federal government will run the exchanges in states that refuse to comply.

Wisconsin Department of Health Secretary Dennis Smith said his state will fulfill that commitment.  “Wisconsin has a bit of a head start,” Smith said, noting how the state began developing an automated eligibility system for its state-based health insurance programs.  “That’s one thing that makes this state a leader.  Part of what we believe is important with this exchange is to demonstrate that it should not be used in a regulatory manner that would disrupt our competitive market.”  Wisconsin applied for the innovator grant while Doyle still was still the state’s governor.  The chosen states were selected based on their technical expertise, readiness to develop information technology to operate the exchanges, the adaptability of their systems to other states and a demonstration that planning already was underway.

Through the exchange, Wisconsin wants to deliver affordable care to as many as 160,000 individuals in the non-group market, 770,000 BadgerCare Plus and Medicaid clients, and one million small-business employees.  “Wisconsin’s proposal envisions a single, intuitive portal through which residents can access subsidized and non-subsidized healthcare and other state-based programs,” according to HHS.  “The exchange will integrate across health and human services programs to promote efficiency and lower overall administrative cost.”

Finding affordable health insurance has long been a challenge for rural Americans, but the Affordable Care Act presents new opportunities for Wisconsin’s farmers and rural residents by creating health-insurance exchanges. Jon Bailey, director of research and analysis for the Center for Rural Affairs, says the new law is ideal for them.  “The groups that the exchange marketplace is meant for, in large numbers, are more predominant in rural areas than in urban areas.  So the small businesses, the people who buy through the individual market, the uninsured, these are the people the exchange marketplace is meant for.  Those who get health insurance through their work probably aren’t going to be involved in this at all.”

The Affordable Care Act gives states multiple options on how to set up the insurance marketplaces, Bailey said.  “Every state is just kind of making that basic decision right now: Do we want to run our own exchange or do we want the federal government to come in and do it?  There’s some other basic questions: Do we want to cooperate with other states?  Have a regional exchange?  Things like that.”

Nine Million Americans Lost Healthcare Coverage During the Recession

Monday, April 4th, 2011

The financial crisis not only robbed nine million Americans of their jobs – but also their healthcare insurance. According to a new study by The Commonwealth Fund, only 25 percent of Americans who lost employer-sponsored healthcare coverage succeeded at finding another source.  As a result, an estimated 52 million Americans did not have healthcare coverage in 2010.  Even though the federal government provides a subsidy, just 14 percent of people who lost their jobs continued their coverage through COBRA.

According to The Commonwealth Fund Biennial Health Insurance Survey of 2010, “Using data from The Commonwealth Biennial Health Insurance Survey of 2010 and prior years, this report examines the effect of the recession on the health insurance coverage of adults between the ages of 19 and 64 and the implications for both their finances and their access to healthcare.  The survey of 3,033 adults, conducted by Princeton Survey Research Associates International from July 2010 to November 2010, finds that in the last two years a majority of men and women who lost a job that had health benefits became uninsured.  Adults who sought coverage on the individual insurance market over the past three years struggled to find plans they could afford and many were charged higher premiums, had a health condition excluded from their coverage, or were denied coverage altogether because of a pre-existing condition.  Meanwhile, Americans with health insurance had higher deductibles and consequently greater exposure to medical costs.  And millions were struggling to pay medical bills, facing cost-related barriers to getting the care they need, or skipping or delaying needed care, including prescription medications, because of the cost.”

Just 50 percent of adults aged 64 or less are current with preventive care.  Fully 49 million employed Americans spent 10 percent or more of their yearly income on out-of-pocket costs and insurance premiums, a sharp increase from the 31 million reported in 2001.  Once the Patient Protection and Affordable Care Act (ACA) goes into full effect in 2014, the situation is likely to improve dramatically.  “These reforms have enormous potential to begin solving the problems identified in this report,” said Sara Collins, vice president of The Commonwealth Fund, a private foundation that promotes a high performing healthcare system that achieves better access, improved quality, and greater efficiency, particularly for society’s most vulnerable, including low-income people, the uninsured, minority Americans, children, and the elderly.

“The report tells the story of the continuing deterioration of healthcare accessibility, efficiency, safety and affordability over the past decade,” said The Commonwealth Fund president Karen Davis. “All this despite the fact that the United States spends more than any other country on healthcare.  Most recently it has failed the millions of Americans who lost their jobs during the recession and lost health benefits as well, leaving them with no place to turn for affordable healthcare coverage.  The silver lining is that the Patient Protection and Affordable Care Act has already begun to bring relief to families,” Davis said.  “Once the new law is fully implemented, we can be confident that no future recession will have the power to strip so many Americans of their health security.”

Of those people who attempted to buy an individual plan during the study’s timeframe — 19 million individuals – or 71 percent found it difficult or impossible to locate a plan they could afford and met their needs, were denied coverage or charged extra because of a pre-existing medical condition.  Adults with family incomes of less than $22,050 for a family of four were hardest hit with 54 percent having no healthcare insurance.  An additional 41 percent of families with incomes of between $22,050 and $44,100 had no coverage.  Of higher-income families, just 13 percent lacked healthcare coverage in 2010.

Conservative groups such as the Heritage Foundation are critical of the healthcare reform law.  The Washington, D.C.-based think tank wants changes made to the healthcare system to make it less reliant on government and to have individuals “own and control their own healthcare policies.”  Additionally, Heritage believes that the healthcare law will increase government spending.  “Of course there’s some people who will benefit from the law, but just focusing on individuals with benefits is misleading,” said Brian Blase, a policy analyst in health studies.  “You have to look at the law in its totality.”

Affordable Care Act Under Siege As It Celebrates Its 1st Birthday

Wednesday, March 30th, 2011

As the Patient Protection and Affordable Care Act (ACA) celebrates its first birthday, the future of the law is still unclear, but its effects have been enormous.  The debate over the law likely created the “tea party” movement.  Last November, Republicans took control of the House of Representatives and strengthened their numbers in the Senate.  Potential contenders for the 2012 Republican presidential nomination need only say one word, “Obamacare,” to get a negative reaction from a crowd.  President Obama at times himself has struggled to ensure that his first term isn’t defined solely by this legislation.

Public opinion over the ACA remains divided, despite the efforts of Democrats to showcase how it will provide healthcare insurance to millions of uninsured Americans.  Additionally, most Americans remain confused about what the healthcare overhaul actually accomplishes.  Republicans considering a 2012 presidential race for the most part stand united in their opposition to the legislation.  Former Minnesota Governor Tim Pawlenty is using his opposition to the law to gain a national following.  “If courts do not do so first, as president, I would support the immediate repeal of Obamacare and replace it with market-based healthcare reforms,” Pawlenty said.  Former Massachusetts Governor Mitt Romney is in a different position because he supported a similar law during his tenure.

Representative Steve King (R-IA), the Iowa Congressman who is in the vanguard to repeal the ACA, says that “America will never become the nation it can be if were saddled with Obamacare“, “I have a deep conviction that this is unconstitutional, that this is unsustainable, and I have a duty.  And that doesn’t mean I sit back and wait for the Supreme Court to save America from itself.  It’s my job to step up and lead.”

Taking a difference stance, Carmela Coyle, president and chief executive of the Maryland Hospital Association, said her group strongly supports the reform law and will work to assure that the effort translates into better and cost-effective care.  “We support healthcare reform because hospitals see every day what happens when patients don’t have the healthcare coverage they need and can’t get their care at the right time and in the right setting.  Expanding coverage was necessary, and it was right.  We must ensure that the health coverage now guaranteed to many Marylanders is meaningful coverage.”

What’s the future of the Affordable Care Act? House Republicans, who say the law gives the federal government too much control and doesn’t cut costs, passed a repeal bill after they became the majority in January.  Full repeal is unlikely unless Republicans successfully take control of the Senate and the presidency in the 2012 presidential elections.  The current Democratic-led Senate will not vote to repeal and President Obama would certainly veto a repeal bill.  Democrats argue the law’s reforms will slow the growth of healthcare costs while improving care and reducing the ranks of the uninsured.  Republican efforts to withhold funds to block the law’s implementation will be DOA in the Senate.  That leaves Republicans the option of picking apart the law regulation by regulation, a strategy that could prove more successful.

In the meantime, implementation is underway.  “As we look forward with implementation of the health reform law, the states really become the focus now,” said Jennifer Tolbert, a principal policy analyst at the Kaiser Family Foundation.  “When thinking about the coverage expansions in particular because it is going to be up to the states to implement the expansion of the Medicaid program for lower-income individuals and to create the new health-insurance exchanges that will provide access to private insurance for moderate and middle income individuals.”

HHS Giving Waivers to Small Health Plans

Tuesday, March 22nd, 2011

The Department of Health and Human Services (HHS) has okayed 94 percent of requests – primarily from sponsors of “mini-med” and other limited healthcare plans – for waivers that excuse them from meeting a key requirement of the Patient Protection and Affordable Care Act (ACA). According to HHS Secretary Kathleen Sebelius, the waivers are needed because most mini-med plans do not meet federal rules mandated by the healthcare reform law, which establishes a minimum yearly dollar limit on essential benefits that plans must provide in 2011, 2012 and 2013. For 2011, the minimum is $750,000, rising to $1.25 million in 2012 and $2 million in 2013.  To date, 919 of 975 waiver applications have been approved by HHS, according to Representative Henry Waxman (D-CA), the ranking Democrat on the House Energy and Commerce Committee.

“We are committed to making the waiver process transparent to the public and to make sure workers with mini-med plans are informed about the limited nature of their coverage,” said Steve Larsen, director of oversight in HHS’s Office of Consumer Information and Insurance. “For example, we have required plans that receive waivers to inform their enrollees that their coverage is limited.  HHS also helps to ensure transparency by posting a list of the plans that have been granted waivers, so stakeholders understand how they are affected.”  To date, waivers have been granted in Florida, New Jersey, Ohio and Tennessee.  Members of Congress said that in several other states, insurers and employers will need similar exemptions from some of the law’s requirements.

Not surprisingly, House Republicans slammed HHS for granting the waivers, claiming that they are proof that the Affordable Care Act is deeply flawed. “I think it is an understatement to say that these waivers have been controversial,” said Representative Cliff Stearns (R-FL).  “Obamacare was sold as all benefit — no downside.”  Plans that were granted waivers represent about 2.4 million people, or about one percent of the employer-based coverage market overall, according to HHS.

Additionally, House Republicans expressed concern that power over public and private health insurance programs was concentrated in the Centers for Medicare and Medicaid Services, led by an official, Dr. Donald M. Berwick, who has not been confirmed by the Senate. “He is in charge of almost all insurance coverage in the United States,” said Representative Michael Burgess, (R-TX).

Healthcare Reform May Not End Medical Bankruptcies

Monday, March 21st, 2011

Is healthcare reform a cure-all for the issue of medical bankruptcy?  Depends.  Bankruptcies occur when a person has a serious illness and cannot keep up with paying the bills.  Since RomneyCare became law n Massachusetts, the number of medical-related bankruptcies fell from 59.3 percent to 52.9 percent between 2007 and 2009, according to a recent study.

“Health costs in the state have risen sharply since reform was enacted.  Even before the changes in health care laws, most medical bankruptcies in Massachusetts — as in other states — afflicted middle-class families with health insurance.  High premium costs and gaps in coverage — co-payments, deductibles and uncovered services — often left insured families liable for substantial out-of-pocket costs.  None of that changed.  For example, under Massachusetts’ reform, the least expensive individual coverage available to a 56-year-old Bostonian carries a premium of $5,616, a deductible of $2,000, and covers only 80 percent of the next $15,000 in costs for covered services,” according to the researchers.  According to the authors, an insured couple earning more than $44,000 a year – a level that is higher than the eligibility requirement for subsidies – might pay as much as $20,512 a year for medical services.  “Massachusetts’ health reform, like the national law modeled after it, takes many of the uninsured and makes them underinsured, typically giving them a skimpy, defective private policy that’s like an umbrella that melts in the rain: the protection’s not there when you need it,” lead author Dr. David Himmelstein said in a Physicians for National Health Reform news release.  The organization’s goal is a national single-payer healthcare system.

The study’s results, which were published in the American Journal of Medicine, suggest “that reducing medical bankruptcy rates in the United States will require substantially improved – not just expanded – insurance.” http://www.latimes.com/health/boostershots/la-heb-obamacare-insurance-costs-03082011,0,7832154.story To determine if RomneyCare had cut the number of bankruptcies, the research team examined a random sample of Massachusetts bankruptcy filings from July of 2009.  After sending surveys to 500 households, they compared the results to national and Massachusetts data assembled during 2007.  The Massachusetts healthcare law went into effect in 2008. According to Dr. Steffie Woolhandler, one of the study’s authors, health insurance in Massachusetts has risen since RomneyCare was implemented.  “It’s really too much money for the average family – especially if the breadwinner is the one who gets sick,” she said.  “We need to reduce limits on deductibles and out-of-pocket costs.”

“People think they have reasonable insurance until they try and use it,” said Dr. David Himmelstein, another study author.  “You are carrying an umbrella and it starts to rain and you put it up and it’s full of holes.  For most people, it just hasn’t rained yet.”  High premiums, large co-payments and deductibles mean that even families with insurance have to pay substantial out-of-pocket costs, said Himmelstein, a professor of public health at City University of New York.  Himmelstein said his survey’s findings suggest that the national health overhaul — which was modeled on the Massachusetts law and takes full effect in 2014 – is unlikely to ease the number of medical bankruptcies, either.

Sally Pipes, a conservative healthcare expert, is a long-time critic of the Massachusetts healthcare law.  “In fact, a substantial portion of Massachusetts’ newly insured still can’t afford to purchase even basic medical services, and are effectively no better off than before the law’s passage. Meanwhile, government health spending is spiraling out of control, adding to the state’s already massive public debt.  Nearly 30 percent of Massachusetts residents report that their medical costs have increased since MassCare’s implementation.”

Healthcare Reform – 3; Opponents – 2

Wednesday, March 16th, 2011

The score on legal challenges to the Affordable Care and Patient Protection Act is now 3 – 2 – with the Obama administration and healthcare reform in the lead. Nor surprisingly, the three judges who have voted to uphold the law are Democratic appointees, while those who struck down the law are Republican appointees.

The law survived a challenge in federal court in Washington, D.C., the third win in a series of lawsuits attempting to overturn the legislation. U.S. District Judge Gladys Kessler threw out a lawsuit brought in June by five individuals who claimed the requirement that people obtain minimum insurance coverage starting in 2014 is unconstitutional.  Judge Kessler said Congress was acting “within the bounds” of its constitutional Commerce Clause power when it imposed the insurance requirement.  “The individual decision to forgo health insurance, when considered in the aggregate, leads to substantially higher insurance premiums for those other individuals who do obtain coverage,” Kessler wrote.  “Thus, the aggregate effect on interstate commerce of the decisions of individuals to forgo insurance is very substantial.”

A right-wing group called the American Center for Law and Justice (ACLJ) is appealing Judge Kessler’s ruling.  The group maintains that it is unconstitutional for the law to require that each person purchase insurance; they perceive it as a move towards adopting socialized medicine.  According to the appeal, the group wants to spare Americans “all of the horrors you have heard coming out of Canada (and) Europe, where it is a bureaucrat who decides — not your doctor — what care you have.”  According to Edward White, an attorney with the ACLJ, “That does not mean that Congress cannot fix the healthcare problem we have in this country.  It’s just the way they’re going about it now by requiring people to act and buy a product and using its Commerce Clause power to an extent that is beyond what Congress has ever done in the 200 some odd years of this country.”

Judge Kessler could not disagree more strongly: “To put it less analytically, and less charitably, those who choose — and Plaintiffs have made such a deliberate choice — not to purchase health insurance will benefit greatly when they become ill, as they surely will, from the free healthcare which must be provided by emergency rooms and hospitals to the sick and dying who show up on their doorstep,” she said.  “In short, those who choose not to purchase health insurance will ultimately get a ‘free ride’ on the backs of those Americans who have made responsible choices to provide for the illness we all must face at some point in our lives.”

Nearly one year after President Obama signed the healthcare reform bill, more than half of the states have challenged the legislation in the courts. In comments filed in a Florida federal court, representatives of the 26 states that successfully challenged the healthcare reform law asked the judge to halt the healthcare law’s implementation, according to The Hill. The comments are a response to the Obama administration’s request that U.S. District Judge Roger Vinson explain his January 31 ruling that the healthcare reform law is unconstitutional.  Of five federal court rulings on the reform law so far, Judge Vinson’s is the only one that strikes down the entire law.

Additionally, Florida and Alaska have declared the reform law effectively dead unless an appellate court reverses the decision.  Court comments by the 26 states – which were backed by the National Federation of Independent Business — said the Obama administration should have requested a stay, pending appeal, rather than request a clarification.  “If the Government was not prepared to comply with the Court’s judgment, the proper and respectful course would have been to seek an immediate stay, not an untimely and unorthodox motion to clarify,” the plaintiffs wrote.

Senate Republicans Refusing to Confirm Dr. Donald Berwick

Monday, March 14th, 2011

Senate Republicans are trying to block the nomination of Harvard-educated pediatrician Dr. Donald Berwick to serve a full term as the administrator of the Centers for Medicare and Medicaid Services.  Led by Senators Orrin Hatch (R-UT), the ranking member of the Senate Finance Committee, and Mike Enzi (R-WY), the ranking member of the Senate Health, Education, Labor and Pensions Committee, the senators contend that President Barack Obama’s recess appointment last year was completed before a hearing was held.  The senators contend that this hindered the 111th Congress’ ability to fully consider Berwick’s nomination.

“This abrupt and unilateral action meant that no senator — Democrat or Republican — was given the opportunity to ask Dr. Berwick a single question before he was placed in charge of an agency with a budget larger than the Department of Defense; which controls four percent of our nation’s gross domestic product; and, most importantly, directly impacts more than 100 million American lives every single day,” according to the Senators’ letter.  The senators say that Berwick’s “past record of controversial statements, and general lack of experience managing an organization as large as complex as CMS should disqualify him” from the post.  “Once you have withdrawn his nomination, we are confident we can all work together to find a nominee for administrator we can support and confirm after appropriate hearings are held,” the letter stated.

Even some Congressional Democrats are urging the Obama administration to find another Medicare chief after concluding that the Senate is unlikely to confirm Dr. Berwick. The most-favored nominee is Dr. Berwick’s principal deputy, Marilyn B. Tavenner, a nurse and former Virginia secretary of health and human resources who has extensive management experience and would likely be confirmed.  President Obama bypassed Congress and named Dr. Berwick to his post while the Senate was in recess last summer.  The current appointment allows him to serve to the end of 2011.

Despite the vocal opposition to Dr. Berwick, President Obama is refusing to withdraw his nomination. “The president nominated Don Berwick because he’s far and away the best person for the job, and he’s already doing stellar work at CMS: saving taxpayer dollars by cracking down on fraud, and implementing delivery system reforms that will save billions in excess costs and save millions of lives,” White House spokesman Reid Cherlin said.  Unfortunately for the president, even some Senate Democrats believe that Berwick cannot be confirmed.  Senate Finance Committee Chairman Max Baucus (D-MT) has said that he would not commit to a confirmation hearing, and other Democrats have acknowledged that the nomination is in trouble.  “I think it would be very tough in this environment.  If we can get some bipartisan products moving forward, then the answer is yes. If you can’t get some bipartisan products moving forward, it’s going to be difficult,” said Senator Ben Cardin, (D-MD).

The Medicare administrator’s job involved significant responsibilities under the healthcare law, such as establishing new insurance markets, expanding Medicaid, and overhauling the way Medicare pays providers to reward quality instead of volume. Republicans need 41 votes to block Berwick’s confirmation in the full Senate; their letter indicates they have more than enough.  The loss of Berwick, a respected medical innovator and patient advocate, would be a blow to the administration as it moves ahead in its implementation of the healthcare reform law.

Five Republican senators did not sign Hatch’s letter.  They are Scott Brown (R-MA), Susan Collins (R-ME),  Olympia Snowe (R-ME), Lisa Murkowski (R-AK), and Rob Portman (R-OH).