Posts Tagged ‘Republicans’

The Supreme Court Takes on the ACA

Tuesday, March 27th, 2012

As the Supreme Court begins three days of hearing about the constitutionality of the Patient Protection and Affordable Care Act (ACA), Americans have mixed feelings about President Barack Obama’s signature healthcare overhaul.  The individual mandate is extremely unpopular, despite the fact that approximately 80 percent of Americans have healthcare coverage through workplace plans or government insurance such as Medicare and Medicaid.  When the insurance obligation kicks in, the majority of Americans won’t need to buy anything new.  The bottom line appears to be that Americans object to being told how to spend their money, even if it solves the dilemma of the nation’s more than 50 million uninsured.  One critic dismissed the individual mandate by saying “If things were that easy, I could mandate everybody to buy a house and that would solve the problem of homelessness.”

Listen to Republicans describe the law as an attack on personal freedom, and you’d be surprised to learn that the idea originated with them.  Its model is the Massachusetts law enacted in 2006 when Mitt Romney was the governor.  Former House Speaker Newt Gingrich supported an individual mandate as an alternative to President Bill Clinton’s healthcare proposal, which put the burden on employers.  All four GOP candidates have promised to repeal the Affordable Care Act, which they describe as “Obamacare.”  Former Senator Rick Santorum (R-PA) terms it “the death knell for freedom.”

President Obama and congressional Democrats passed the mandate in 2010, without Republican support, in an effort to create a fair system that assures that all Americans — whether rich or poor, young or old — get the healthcare they need.  One thing that proponents point out is that other economically advanced countries have succeeded at it.  Congress determined that when the uninsured visit a clinic or the emergency room, the care they can’t afford costs roughly $75 billion a year.  A large percentage of that cost ends up adding $1,000 a year to the average family’s insurance premium.

In legal briefs challenging the law, opponents contend that the “minimum coverage requirement” — known as the individual mandate — would set a precedent that could apply to literally anything.  If it’s legal for Americans to be told to buy health insurance, Congress could try to impose “a broccoli mandate, a car-purchase mandate, really any other mandate that you’d want,” said Ilya Somin, a law professor at George Mason University.  “There are lots of interest groups that would love to lobby Congress to require people to buy their products.”

The mandate is intended to ensure that new insurance market reforms in the law work as intended.  Unless younger, healthier people — who often don’t purchase insurance until they get sick — are covered, the costs of those changes would be exorbitant.  In response to opponents’ admonitions that a mandate to buy insurance could lead to other government-required purchases, the Obama administration argued that no such examples exist.  “Respondents acknowledge that states do have the power to enact purchase mandates, but they identify no example of any state ever having compelled its citizens to buy cars, agricultural products, gym memberships or any other consumer product,” according to the Obama administration.

Not surprisingly, 73 percent of Americans believe that the Supreme Court will be influenced by politics when it rules on the constitutionality of the ACA.  The attitude crosses party lines and is particularly popular with independent voters, of whom 80 percent believe that the court will not base its ruling strictly on its legal merits, according to a Bloomberg National Poll.  Seventy-four percent of Republicans and 67 percent of Democrats believe that politics will be a determining factor in the court’s healthcare decision.

“I always worry when the court steps into the political thicket,” said Barbara Perry, a Supreme Court scholar and professor at the University of Virginia in Charlottesville.  “It does so at its peril.”  The justices themselves say that politics doesn’t impact their decisions.  “It is a very serious threat to the independence and integrity of the courts to politicize them,” Chief Justice John Roberts said at his 2005 Senate confirmation hearing.  Justice Stephen Breyer told Bloomberg News that politics doesn’t influence the court, even in cases with electoral implications.  “It would be bad if it were there,” he said.  “And I don’t see it.”

In reviewing the ACA, the Supreme Court is entering territory that it hasn’t approached since the days of Franklin Delano Roosevelt: ruling on a president’s signature legislative victory in the midst of his re-election campaign.  Justices are taking more time to listen arguments — six hours over three days — than any other case in the last 44 years.   “This is a central challenge to the modern Constitution, which was fashioned during the New Deal and then elaborated further during the civil rights revolution,” said Bruce Ackerman, a professor at Yale Law School in New Haven, Connecticut and author of The Decline and Fall of the American Republic.  “This goes to the very foundations of modern American government.”

The closest comparable was 76 years ago, involving Roosevelt’s New Deal, a response to the Great Depression.  It wasn’t a single piece of legislation and included the creation of Social Security.  The court ruled against parts of the New Deal, while leaving others in place.  The principal decision came when the court struck down much of the National Industrial Recovery Act, which allowed industries to create trade associations that set quotas and fixed prices.

Those wishing to tune in and watch the excitement are destined to be disappointed. The Supreme Court will make available same-day audio of the oral arguments.  In its announcement, the court said it is making the audio available because of the “extraordinary public interest” in the case.

Battle About Medicaid Block Grants Brewing in Congress

Wednesday, May 11th, 2011

Mississippi Governor – and possible presidential hopeful — Haley Barbour and other Republican governors recently demanded that Medicaid, the state-federal health program that covers 50 million poor and disabled, be transformed into block grants.  House Republicans have vowed to tackle expensive programs like Medicaid to cut federal spending.  Any attempt to turn Medicaid into block grants – federal lump-sum payments to states – raises many questions.  Democrats argue that a move of this type could result in loss of healthcare coverage for millions who are poor, sick and old.

Representative Fred Upton (R-MI), chairman of the House Energy and Commerce Health Subcommittee said to expect House bills on the Medicaid program’s maintenance-of-effort requirement and block grant funding to states.  Because Medicaid is an entitlement program, all Americans who are eligible are guaranteed coverage.  The federal government, which foots the bill for approximately 60 percent of Medicaid’s cost, is committed to helping the  states cover costs; in return, it requires them to cover certain groups of people and provide specific benefits.  For example, children, pregnant women who meet explicit income criteria and parents with dependent children must be given coverage.

“The governors have requested flexibility in the way they serve Medicaid patients,” Representative Joseph Pitts (R-PA), the Health Subcommittee’s chairman said.  “They maintain they can provide the service better and cheaper, so we’re looking to give them that flexibility and change this maintenance-of-effort provision.  I won’t be specific on the block grants, but we’re having discussions with governors.”  Pitts’ comments followed a Health Subcommittee hearing in which HHS Secretary Kathleen Sebelius answered extensive questions about the Obama administration’s fiscal 2012 budget and the Patient Protection and Affordable Care Act.

Why are the block grants important?  When the new healthcare law goes into full effect in 2014, approximately 16 million additional people will become eligible for Medicaid.  The debate, which cuts to the heart of the social contract between the government and its citizens, has implications for the other large entitlement programs — Social Security and Medicare.  In 2010, the federal government spent $1.5 trillion on those programs, or approximately 43 percent of the federal budget, according to the Congressional Budget Office.  Speaker of the House John Boehner (R-OH) said House Republicans’ upcoming budget proposal would cut Social Security and Medicare, despite the political risk of taking on such popular programs.  Democrats are skeptical.  Changing Medicaid into a block grant means “you have no guarantee that people who are now covered will continue to be covered, or whether (the states) will simply cut back on their Medicaid program,” said Representative Henry Waxman, (D-CA), who is a primary defender of the program.

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.”

Republicans Vow to Take on Healthcare Entitlement Programs

Wednesday, March 23rd, 2011

With the power shift in the House of Representatives, Medicare, Medicaid and Social Security are being targeted in proposed budget cuts designed to bring down the deficit. “It will likely be the first time you see a House have a prescription for Social Security, Medicare and Medicaid,” House Majority Leader Eric Cantor (R-VA) said at the Federation of American Hospitals’ annual public policy conference and business exposition in Washington.

Mississippi Governor Haley Barbour, a Republican, said that members of Mississippi’s Medicaid program saw its enrollment drop approximately 23 percent to 580,000 beneficiaries from 750,000 after the state started requiring beneficiaries to establish their eligibility in person.  Barbour began this practice in his first year as governor in 2004.  Senator Orrin Hatch (R-UT), the ranking Republican on the Senate Finance Committee, slammed the Patient Protection and Affordable Care Act (ACA), noting that its expansion of Medicaid will “bankrupt” the states, which already have strained budgets.  Hatch also cited Congressional Budget Office figures that say the ACA’s Medicaid expansion will cost taxpayers $435 billion over the next decade.

President Barack Obama said his proposed 2012 budget was a “down payment,” on cutting the federal budget deficit, and said that more work is needed to address “long term challenges”. Cantor said that on “individual items” there were “probably some areas of agreement” between the President and Republicans.  “But we can’t keep taking the savings and going to spend it,” he said.  “The object here is to cut.”  According to Cantor, the President’s plan “just misses the mark of living up to the expectations” Obama laid out in his State of the Union speech in January.  Asked if Cantor expected adjustments to Social Security and Medicare, Cantor said he was “hopeful that we can get some cooperation from [Senate Majority Leader] Harry Reid [D-NV] and the President, because these are programs that touch the lives of every American and we don’t want, nor can we, make these changes by ourselves.”

Writing on the Huffington Post, Richard Eskow took an alarmist tone, saying that “entitlement reform” is a euphemism for allowing the elderly to die if they become ill. “’The President’s budget punts on entitlement reform,’ reads a statement by House Republicans.  ‘Our budget will lead where the President has failed, and it will include real entitlement reforms.’  ‘You have to do entitlement reforms if you are serious about this budget,’ according to Representative Paul Ryan (R-WI).”  Eskow counters “Reality check: Nobody’s proposing ‘entitlement reform.’ That term is a cloaking device for some very ugly intentions.  It’s a meaningless manufactured phrase cooked up by some highly-paid consultant, and it diminishes the sum total of human understanding every time it’s used.  The phrase is a euphemism for deep cuts to programs that are vital and even life-saving for millions of elderly and poor people, but it’s politically unpalatable to say that.  So it became necessary to come up with yet another cognition-killing term designed to numb us from the human toll of our political actions.  ‘Entitlement reform’ is the new ‘collateral damage.’”

The Washington Post’s Ezra Klein is more diplomatic in his assessment of the possibility of entitlement reform. “We’ll see.  I wouldn’t be surprised if Obama has his name on a broader deficit-reduction bill at this time next year.  If he takes the deficit away from Republicans before 2012, his reelection campaign becomes considerably easier.  And on a less cynical level, his administration is stocked with deficit hawks — the same folks who actually balanced the budget under Bill Clinton.  And similarly, Republicans want to deliver on the deficit-reduction promises they’ve made to their base.  In theory, everyone’s incentives and ideologies are pointing in the same direction.  That’s a good sign for progress.”

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).

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).

Nearly 50 Percent of Americans Think the Healthcare Law Has Been Repealed – They’re Wrong!

Wednesday, March 9th, 2011

Defying the odds – and facing President Barack Obama’s veto pen – the Republican-controlled House of Representatives voted to repeal the Patient Protection and Affordable Care Act (ACA); a move that was DOA in the Senate.

Despite considerable evidence to the contrary, approximately 50 percent of Americans are convinced that the healthcare law has been successfully repealed.  A poll by the Kaiser Family Foundation found widespread public confusion about the law, with 22 percent of Americans incorrectly believing it has been repealed and another 26 percent unsure or unwilling to say. Even after extensive media coverage of the repeal effort, only 52 percent of Americans accurately responded that the healthcare law remained intact.  According to the Kaiser Family Foundation, “There remains no consensus about whether to keep, expand, replace or repeal the law.  Forty-eight percent are opposed to the law, while 43 percent favor it.  Sixty-one percent of those polled oppose Congress cutting off funding of the law in order to block it, as many Republican lawmakers are considering.”

The Republican-sponsored repeal bill, curiously named the “Repealing the Job-Killing Health Care Law Act,” passed 245 – 189 with assistance from three Democrats.  Majority Leader Harry Reid (D-NV) has refused to bring repeal to the Senate floor for a vote.  President Obama has vowed to veto any repeal effort.  Republicans have not introduced an alternative bill, although Speaker of the House John Boehner (R-OH) said Republicans will ask congressional committees to make “common-sense reforms” to expand coverage and cut costs, but told reporters no “artificial deadlines” were needed.

“As has been true since early in the debate, individual provisions of the new law are more popular than the law itself, complicating the debate over repeal,” the study notes. “So while the public in general is divided over whether to keep or repeal the legislation, if they could pick and choose, the large majority (roughly eight in 10 Americans) would keep the provisions providing tax credits to small businesses, and upward of seven in 10 would keep the provisions that close the Medicare doughnut hole, provide coverage subsidies to those of low and moderate income, institute the new voluntary long-term care insurance program known as the CLASS Act, and prohibit insurance companies from denying coverage based on pre-existing conditions.”

According to a USA TODAY/Gallup Poll, 32 percent of Americans would like to see the law repealed; 13 percent want to see the bill left as it stands. The poll found that 29 percent of Americans want to see minor changes and that 24 percent want major changes.  Representative Ben Chandler, (D-KY), who voted against the law last year, said he voted against repeal because he thinks the law’s “bad” parts should be repealed piece by piece.  “I will not vote to repeal parts of the law that protect central Kentuckians by preventing insurance companies from dropping people if they get sick, ending lifetime caps on coverage and eliminating pre-existing condition exclusions,” Chandler said.

Implementation of the law is continuing as planned, according to Health and Human Services Secretary Kathleen Sebelius.  “I want the people who are benefiting from the Affordable Care Act — including families, seniors and small business owners — to know that this vote does not change the law and that this department will continue to work every day to implement this vital law.”

2012 Budget Has Funds to Reform Medical Liability Laws

Wednesday, March 2nd, 2011

In a move that builds on the healthcare reforms contained in the Patient Protection and Affordable Care Act – and one that will make physicians very happy — President Barack Obama’s fiscal 2012 budget includes $250 million in grants over the next three years to subsidize efforts to help the states overhaul their medical liability laws. If the budget passes, the grants will be administered by the Justice Department in consultation with the Department of Health and Human Services (HHS).  As much as $100 million will be disbursed in fiscal 2012, with $50 million in each of the succeeding three years.  According to the Justice Department’s budget outline, the grants will fuel reforms that “fairly compensate patients who are harmed by negligence, reduce providers’ insurance premiums, weed out frivolous lawsuits, improve the quality of healthcare, and reduce medical costs associated with defensive medicine.”  The grants build upon $25 million in grants HHS awarded last June through the Agency for HealthCare Research and Quality safety and medical liability demonstration projects by states and health systems.

“I think the president is very serious about following up on this,” HHS Secretary Kathleen Sebelius,  whose agency would advise the Justice Department on awarding the grants, told the Senate Finance Committee.  Specific reforms might exclude caps on jury awards that the American Medical Association and Republican lawmakers have wanted for years.  At the same time, they include measures unacceptable to trial lawyers, a group that contributes heavily to Democratic candidates.

Philip K. Howard, chairman of Common Good, described the budget item as “A very significant moment for controlling healthcare costs.” Based in New York, Common Good has taken the lead in supporting special courts in which judges with healthcare backgrounds would resolve medical liability cases.  “With this budget item, President Obama is moving beyond bipartisanship and, in effect, saying that the country can no longer afford the rising healthcare costs that defensive medicine unnecessarily fuels,” Howard said.  President Obama also called for tort reform legislation in his 2011 State of the Union address.

The cost of defensive medicine to American healthcare consumers is not easy to estimate. Conservative estimates place the cost at approximately $50 billion a year.  The Obama debt commission estimated that its recommendations could save government programs $17 billion through 2020, calling for an aggressive effort to rewrite malpractice laws.

Gibson Vance, president of the American Association for Justice, described the proposal as “bad policy and bad for patients.”  The president’s proposal also got a chilly reception from congressional Republicans, who contend that he has promised more on malpractice than he has been able to deliver.  Obama initially voiced an interest in the issue during the lengthy healthcare reform debate.  He has opposed another malpractice alternative: capping the amount a patient can receive in a medical liability case.  This alternative is favored by many physicians and Republicans, but opposed by the majority of Democrats.

“These grants will help states reform their laws to pursue innovative approaches that will improve the quality of healthcare, fairly compensate patients who are harmed by negligence, reduce medical costs and liability, and protect patient safety,” said Justice Department spokeswoman Tracy Schmaler.

Healthcare Law Repeal DOA in Senate; Likely Headed to the Supreme Court

Monday, February 14th, 2011

The Republican House of Representatives’ attempt to repeal the Patient Protection and Affordable Care Act was DOA — as expected — in the Democratic-controlled Senate.  Voting along strict party lines, all 50 Democratic Senators who were present and one Independent gave the repeal a thumbs down.  All 47 Republican Senators voted in favor of repeal.  Two Senators – one a Democrat and the other an Independent – were not present to vote.

Senator Barbara Mikulski (D-MD) delivered a scornful speech during the heated debate, saying the Republicans are offering “one more hollow, symbolic pander-to-the-masses amendment.  If you want to rewrite the bill, keep your promise, Republican Party, that if you want to repeal, then let’s go replace.  I want to hear their ideas for replacement.  I challenge them right here, right now, today on this amendment.”  Not surprisingly, Republican Senate leaders disagree with Senator Mikulski’s stance. “We think it is just the beginning,” Senate Republican Minority Leader Mitch McConnell (KR-KY) said Wednesday after the Senate voted to reject an amendment he offered to repeal the law.  “This issue is still ahead of us and we will be going back at it in a variety of ways,” McConnell noted.  “We’ll be looking at it in every different way to revisit it.”

The Republicans can claim a small victory as the Senate voted to repeal the 1099 requirement that was a highly unpopular inclusion in the healthcare reform law. Many perceived this as a tax on healthcare consumers and small businesses because it required anyone performing a transaction equaling $600 or more to file a 1099 form with the IRS.  The cost of the requirement had the potential to add up to 40 percent for some small businesses, which could have resulted in closures or layoffs.  The amendment passed the Senate by an 81 – 19 vote and has President Barack Obama’s support. Opponents of the amendment, such as Senator Carl Levin (D-MI), said that Congress, not the White House, should wield the budget-cutting ax.

The Senate’s actions come on the heels of a decision by Florida Federal District Court Judge Roger Vinson that it is unconstitutional for Congress to pass a healthcare law that requires Americans to obtain insurance coverage.  Judge Vinson’s decision created a 2 – 2 tie in lower courts. According to Judge Vinson’s decision, “The act, like a defectively designed watch, needs to be redesigned and reconstructed by the watchmaker.”

Judge Vinson’s decision increases the likelihood that the Affordable Care Act will end up in front of a Republican-dominated Supreme Court. “A year ago, it was a long shot,” said Randy Barnett, a law professor at Georgetown University.  “Now, it’s seen as a 5 to 4 case.  And nobody’s sure which way the 5 – 4 will come down.”  The stakes are enormous for the defining achievement of the Obama presidency.  The decision also has the potential to define the limits of federal power for generations.  “This case could define federalism for the next 100 years,” said Jonathan Turley, a George Washington University constitutional law professor.  “This is a very difficult case for the Supreme Court as an institution.  You have a slight majority of the states opposing it.  You have a national law that’s affecting hundreds of billions of dollars and services.  This is the type of case the justices do not relish.”

Additionally, Virginia Attorney General Ken Cuccinelli has asked the Supreme Court to fast track his state’s challenge to the healthcare law, saying he thinks the legal dispute has become so important that the nation’s highest court should take it up immediately. “We want to eliminate the uncertainty in both our governmental budgets and in the private sector,” he said.  “We want to eliminate at least the uncertainty associated with health care.” The Obama administration opposed the move, saying the case should follow the regular process.  This would put off until 2012 a Supreme Court ruling on the law that aims to provide more than 30 million uninsured Americans with medical coverage and cracks down on unpopular insurance industry practices.

Pre-Existing Medical Conditions Impact As Many As Half of All Americans

Wednesday, February 9th, 2011

A Department of Health and Human Services (HHS) study reveals that as many as half of all Americans under the age of 65 have pre-existing medical conditions, which could mean rejection by insurance companies or having to pay more for coverage.  According to HHS Secretary Kathleen Sebelius, that totals approximately 169 million people.  The report says that, of those Americans who are uninsured, 17 to 46 percent have pre-existing medical conditions, depending on the definition used. Such health problems are particularly common among adults aged 55 to 64 – a group long recognized as a problem spot in the healthcare system, because people of that age tend to have higher medical expenses but are too young to qualify for Medicare.

A Democratic analysis, released last fall by Representative Henry A. Waxman (D-CA), then the chairman of the House Energy and Commerce Committee, said that between 2007 and 2009, the nation’s four largest private health insurers denied coverage to about 650,000 people based on their medical history.

“Not surprisingly, as people age, their likelihood of having – or having had – a health condition increases,” according to Sebelius.  “Looking only at pre-existing conditions used in determining eligibility for high-risk pools, the percentage of Americans with these health conditions ranges from five percent of children to 48 percent of people ages 55 to 64.  Adding in common conditions that major insurers generally use in medical underwriting raises the risk to 24 percent for children, increasing to 86 percent for people ages 55 to 64.”

Robert Zirkelbach, a spokesman for America’s Health Insurance Plans (AHIP), the industry’s lobbying group, offers a different opinion, noting that “We’ve long supported reforming the individual insurance market so that everybody can have access to health-care coverage, regardless of their preexisting medical conditions.  But this report exaggerates the number of people who are impacted.”

Rick Ungar, who writes for Forbes, offers another perspective and asks if pre-existing conditions are an indication that the American Dream is dead.  According to Ungar — who is an attorney in Southern California, and a frequent writer, speaker and consultant on healthcare policy and politics – his initial reaction to the government report was “Yeah…it made me suspicious too.  Go figure that this extraordinary government revelation would surface on the very day the House is taking up debate on the repeal of healthcare reform.”

Ungar’s suspicion eased when he read this additional quote from Zirkelbach.  “Most of the Americans included in the figures currently have insurance. They would be at risk,” he said, “only if they needed to change coverage and buy it on their own.  People who get insurance through their jobs are guaranteed coverage.” Alter+Care Inspire notes that an additional reason might be people losing their jobs – something to consider at a time when the private sector has been so sluggish.

“And there it was,” according to Ungar.  “This spokesman for the nation’s pre-eminent health insurance lobby was not only acknowledging that there are millions upon millions of people with pre-existing conditions who could be denied healthcare coverage, he was actually telling us that we need not worry about them because – so long as they continue to get their insurance through their job – it’s all good.  But what if they want to leave their job to engage in some good, old-fashioned American entrepreneurialism?  Did Mr. Zirkelbach inadvertently direct our attention to the depressing reality that up to one-half of all Americans may not be free to pursue their futures and fortunes as they see fit because they are trapped in their jobs by their healthcare benefits?  You bet he did.”