Arriving at the Beginning

Brian Klepper

Posted 11/12/12 on Medscape Connect’s Care & Cost Blog

The most striking aspect of the election was that it decisively clarified the philosophical preferences of most Americans. And because the outcome was largely determined by minorities, women, and the young, it appeared to be a much broader and more independently-minded vision than most pundits have given the electorate credit for. That unexpectedly portends big changes.

Peggy Noonan’s analysis in the Wall Street Journal quotes a brutal summation by conservative activist Heather Higgins:

A majority of the American people believe that the one good point about Republicans is they won’t raise taxes. However they also believe Republicans caused the economic mess in the first place and might do it again, cannot be trusted to care about cutting spending in a way that is remotely concerned about who it hurts, and are retrograde to the point of caricature on everything else.

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The Game’s Not Over, and It May Not Even Be The Real Game

Brian Klepper

Posted 6/29/12 on Medscape Connect’s Care and Cost Blog

Like most health law watchers, I was surprised by yesterday’s decision. I’m sure that on this issue, as with everything else, zealous responses will rationalize the result and split the country down the middle.

I expected the Court to be purely partisan, but apparently Chief Justice John Roberts acknowledged the gravity of his role and saw his way clear to support the law with some constraints. Here’s the comment from SCOTUS (Supreme Court of the United States) Blog:

Salvaging the idea that Congress did have the power to try to expand health care to virtually all Americans, the Supreme Court on Monday upheld the constitutionality of the crucial – and most controversial – feature of the Affordable Care Act. By a vote of 5-4, however, the Court did not sustain it as a command for Americans to buy insurance, but as a tax if they don’t. That is the way Chief Justice John G. Roberts, Jr., was willing to vote for it, and his view prevailed. The other Justices split 4-4, with four wanting to uphold it as a mandate, and four opposed to it in any form.

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Day Three – The Wrap Up

Merrill Goozner

Posted 3/29/12 on Gooz News

This is what conservative justices will do if they strike down or cripple the health-care law … A court that gave us Bush v. Gore and Citizens United will prove conclusively that it sees no limits on its power, no need to defer to those elected to make our laws. A Supreme Court that is supposed to give us justice will instead deliver ideology. now – E.J. Dionne, The Washington Post

The insurance mandate was effectively reduced to a bumper sticker by the opponents in their constitutional challenge, and the entire law reduced to little more than an appendage to the mandate. . . The fate of the mandate should not determine the survival of the other elements of the law — like prohibiting insurers from denying coverage to people with pre-existing conditions or charging them higher fees — which can operate without the mandate. – New York Times editorial

Overturning the whole law would be an act of judicial restraint. – The Wall Street Journal editorial

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Health Reform: An Amicus Brief for the Court of Public Opinion

C. Eugene Steuerle

Posted 3/23/12 on the The Government We Deserve

The Supreme Court will consider the constitutionality of the Affordable Care Act at the end of the month. We the public should be appalled.

It’s not that each side can’t come up with some good constitutional arguments. It’s that the suit is totally unnecessary, caused largely by the unwillingness of the major political parties to work together on anything. Like a divorce between two parties more invested in their fight than in the effect on those around them, it belongs in a domestic relations court that would refer the parties to a mediator.

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The Right Rx for Better Health Care: Rise Up to Challenge the Industry’s Lobbying Power

Brian Klepper and Shannon Brownlee

Published 3/29/12 in the New York Daily News

Obamacare had its days in the Supreme Court this week, and the justices’ decision could have sweeping consequences for the individual mandate provision in the Patient Protection and Affordable Care Act, and maybe even for the fate of the law itself.

Yet whatever the court decides, we will still be stuck with a problem that this contentious law was not likely to solve on its own: an out of control health care industry that threatens the stability of the U.S. economy and the federal government’s ability to deal with our long-term debt.

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ObamaCare and Jobs

Joe Paduda

Posted 2/22/12 on Managed Care Matters

Will the health reform bill kill jobs? Devastate small businesses? Push us back into recession?

According to several organizations and and anti-reform politicians, it’s the worst thing to hit the economy since the Depression.

But it turns out those doomsayers are mostly wrong.

Here’s what FactCheck.com says about these claims:

“this is health-care hooey, aimed at exploiting public concern over continuing high unemployment, with little basis in fact.

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Dismantling the Affordable Care Act: The Obama Supreme Court Argument + 51 Republican Senators

Robert Laszewski

Posted 2/9/12 on Health Care Policy and Marketplace Review

I have no idea which way the Supreme Court will rule this year on the Affordable Care Act. Let me go out on a limb and predict a 5-4 vote on the question of whether the individual mandate is Constitutional. Just don’t ask me which way the vote goes.

I found the recent Obama administration brief submitted to the Court on the mandate question somewhat ironic. Not surprisingly, the Obama Justice Department argued that a finding by the Court that the individual mandate is unconstitutional should not jeopardize the vast majority of the new health law.

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Romney Jumps on the Waiver Bandwagon–And Creates Even More Uncertainty Over the New Health Care Law

Robert Laszewski

Posted 10/26/11 on Health Policy and Marketplace Review

Republican presidential frontrunner Mitt Romney has pledged to end “Obamacare.” Upon taking office, he would immediately begin the process by granting the states waivers from having to implement it:

“I’ll grant a waiver on Day One to get repeal started. On Day One, granting a waiver for all 50 states doesn’t stop it in its tracks entirely. That’s why I also say we have to repeal Obamacare, and I will do that on Day Two, with a reconciliation bill [requiring only 51 votes in the Senate] because as you know, it was passed by reconciliation with 51 votes.”

Romney appears to be on thin ground in making his waiver promise and his promise to use reconciliation to stop “Obamacare” could lead to chaos in the market and among consumers.
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Quick Medicare Factoids

Joe Paduda

First posted 9/08/11 on Managed Care Matters

There’s going to be a LOT coming out in the next two months about Medicare, so it may help to know a few things about the program to help put it in context.

– We spent over a half-trillion dollars on Medicare in 2010.

– That’s fifteen percent of total Federal expenditures.

– 48 million people were covered in 2010.

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Another Legal Round – With A Major Mis-Step?

Roger Collier

First published 6/13/11 on Health Care Reform Update

The past week’s appellate court hearing in Atlanta on the constitutionality of the Affordable Care Act, one of a series along the inevitable road to the Supreme Court, showed that the opposing legal arguments are beginning to be firmly established—with each seeming to confuse the purchase of health insurance with the purchase of health care.

The Atlanta panel of three judges, with both Republican and Democratic appointees, heard arguments for and against the earlier ruling by Judge Roger Vinson in Pensacola that the individual mandate was unconstitutional and so central to the ACA that the entire act should be invalidated, and specifically that while the Commerce Clause of the Constitution gave the government authority to regulate interstate commerce, it did not allow Congress to penalize people for the “inactivity” of declining to buy a commercial product.

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Why Health Care Reform Is Here To Stay

Joe Paduda

First published 6/10/11 on Managed Care Matters

It’s pretty simple, really.

Once people gain actual real-life experience with a government program, they abandon their fear of the unknown, see its benefits more clearly, and become invested in its future.

We’ve seen that with Medicare, which consistently pleases its beneficiaries. Part D has similar traction, and now we’ve learned that the citizens of Massachusetts are increasingly happy with that state’s health reform.

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Is the Mandate Penalty a Penalty?

Jim Hufford

First published 5/26/11 on Organon

Neal Katyal Arguments 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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Average Annual Health Costs for a US Family of Four Approach $20,000, With Employees Bearing 40%

Jane Sarasohn-Kahn

First published 5/11/11 on Health Populi

Health care costs have doubled in less than nine years for the typical American family of four covered by a preferred provider health plan (PPO). In 2011, that health cost is nearly $20,000; in 2002, it was $9,235, as measured by the 2011 Milliman Medical Index (MMI). To put this in context,

The 2011 poverty level for a family of 4 in the 48 contiguous U.S. states is $22,350
The car buyer could purchase a Mini-Cooper with $20,000
The investor could invest $20K to yield $265,353 at a 9% return-on-investment.

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Reform At Year One: The Economist’s View

Roger Collier

First published 3/31/11 on Health Reform Update

Sometimes, in the middle of a hotly-argued partisan battle, it can make sense to look at the opinions of more distant and possibly more objective observers. When the battle involves American politics, the international press sometimes offers valuable—and possibly more realistic—perspectives than those available to readers and viewers of domestic media.

Accordingly, on the first anniversary of the enactment of the Affordable Care Act, it was particularly interesting to look at health care reform’s coverage in the influential Economist magazine.The Economist, in its March 19-25 edition, was less than positive about the present status of reform or either the hopes of its backers or the allegations of its opponents.

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Health Reform’s Next Act: A Focus On Achieving Health Equity

Brian Smedley

First published 3/21/11 on Kaiser Health News

When President Barack Obama met with the nation’s governors last month and offered to allow states to establish their own plans to reform health care in place of the Patient Protection and Affordable Care Act, he insisted that states meet or exceed the same goals established in the health overhaul to expand insurance coverage, improve the quality of care and contain rapidly escalating healthcare costs.

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