Paul Ryan is Right! (Even Though He’s Wrong!)

Roger Collier

Posted 10/11/11 on Health Care Reform Update

Having cost the Republican Party a Congressional seat earlier this year with his plan to turn Medicare into a voucher program, House Budget Committee Chair Paul Ryan is back with an even more sweeping health care proposal.

Ryan’s latest offering, unveiled in a speech a week ago at Stanford University’s conservative Hoover Institution, is nothing less than a blueprint for replacing the Affordable Care Act with a consumer-driven model that would eliminate the current tax-exempt treatment of employer-paid health insurance. Is Ryan right? Or wrong?

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It’s Not Just About The Money: Cost Control in Cancer Care

Harold Pollack

First published 7/17/11 on Kaiser Health News

Health reform raises central ideological questions about the size and scope of government, about progressive taxation, about the individual mandate and more. It’s easy to forget that cost control will be a huge challenge, no matter how these ideological matters are resolved, indeed under any health system. Finding the right combination of humanity and restraint will be particularly hard in addressing life-threatening or life-ending illness. Economic incentives, American culture, a changing doctor-patient relationship and fundamental uncertainties at the boundaries of clinical care conspire against our efforts to provide more humane, more financially prudent care.

Health Insurance Exchange Regs Are Out, And They Make Me Feel Like A Visitor From The Future

David Harlow

First posted 7/12/11 on Health Blawg

Health Insurance Exchange regulations were released by HHS yesterday — in a DC hardware store, for local color and homespun truths — with a go-live date of January 1, 2014, per the Affordable Care Act, and a key interim approval deadline of January 1, 2013, by which date each state needs to demonstrate that it has its act together and are on a glide path to the go-live date.  Despite the rancorous opposition to the ACA (consider, for example, the views of the Virginia Attorney General — who is leading a multi-state charge against the individual mandate — expressed at the American Health Lawyers Association Annual Meeting last month, where he was an invited keynote speaker, and later tweeted a tone-deaf assessment of the audience and an unkind skewering of a questioner who didn’t share his perspective), 49 states, D.C. and four territories have accepted health insurance exchange planning grants.  Thus, it seems unlikely (for now) that the federales will have to make use of the “Do I have to do everything for you?” clause which would allow HHS to step in and set up an exchange for a state.

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The Appeals Court’s Decision

Allen Bradford

From the start, I have believed and have said, publicly and privately, that the U.S. Supreme Court’s eventual ruling on the constitutionality of the Affordable Care Act’s individual mandate could be forecast with an eye on political leanings at least as much as legal analyses.  Specifically, I have predicted that because 5 members of the 9 member Supreme Court were Republican appointees, it is more likely than not that the individual mandate would be nullified as an unconstitutional exercise of Congressional power.

The 6th Circuit U.S. Court of Appeals yesterday issued a decision that throws my presumption and therefore my prediction into serious doubt. Not only because 2 or the 3 Appellate judges upheld the individual mandate.  But because of the powerful concurring opinion written by Judge Jeffrey Sutton, a once controversial appointee of President George W. Bush.

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Is the Mandate Penalty a Penalty?

Jim Hufford

First published 5/26/11 on Organon

Neal KatyalArguments for the constitutionality of the individual mandate as an exercise of the taxing power often start by noting that the penalty is reported on income tax returns, calculated as a percentage of income (with a flat minimum and a cap), and codified in the Internal Revenue Code. They go on to detail the ways the ACA’s penalty differs from typical penalties: there is no scienter requirement (one’s state of mind is irrelevant to assessment of the penalty); criminal punishments are not available to enforce payment; the amount of the penalty is reasonable, not exorbitant, and limited to the actual cost of qualifying coverage; and it is imposed in proportion to the frequency of noncompliance, month by month. These points have been fixtures of the United States’ briefs throughout the ACA litigation.

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FAQs on Accountable Care Organizations

Jenny Gold

First published 3/31/11 on Kaiser Health News

Accountable care organizations take up only seven pages of the massive new health law yet have become one of the most talked about provisions. This latest model for delivering services offers doctors and hospitals financial incentives to provide good quality care to Medicare beneficiaries while keeping down costs. A cottage industry of consultants has sprung up to help even ordinary hospitals become the first ACOs on the block.

ACA Turns One

Jim Hufford

First published 3/23/11 on Organon

The good news is that it’s the Affordable Care Act’s first birthday. The bad news is that the ACA is sick and unloved, and its long-term prognosis is grim.

Nobody ever thought the ACA was perfect, and health reformers have by and large defended it on the grounds that it was a good start towards tackling the real problems in our healthcare system. Once the political storm surrounding the legislation subsided, the thinking went, we would be able to get down to the real, technocratic work of crafting evidence-based reforms that addressed the underlying crisis of escalating costs. As Don Taylor has written, we were “obviously wrong about that, and politically, the ACA remains toxic.”

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