Laboratories of Democracy

Merrill Goozner

First published 3/1/11 on Gooz News

Experimentation in how states would move toward universal health care coverage was written into the DNA of the Affordable Care Act. The law allowed any state to petition for a waiver that would enable it to enact its own brand of reform — including versions that did not include an individual mandate to purchase coverage or penalize employers who didn’t provide it – as long as their plans met the basic criteria of the law in terms of covering most people, providing comprehensive coverage, being affordable, and not increasing the federal deficit.

President Obama yesterday offered to move up the date for states that want to pursue their own visions of reform from 2017 to 2014. Stories in today’s press billed this as an effort by the administration to assuage conservative critics who’ve filed suit against the law and governors from both political parties who fear its economic impact. Medicaid expansion accounts for about half of the newly covered people under reform. Even with the feds picking up 90 percent of the tab, many states in today’s fiscal environment are wary of any new obligations — even one where they’re only on the hook for 10 percent.

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An Open Question

JIM HUFFORD

When Jonathan Cohn looks at the legal challenges to the ACA, he doesn’t see judicial restraint:

What bothers me (well, one of the things that bothers me) is that so many critics of the Affordable Care Act act as if it is the individual mandate itself, not their interpretation of the constitution, that represents a radical break with the past. I just don’t see that and neither, apparently, do a lot of other people who follow the law more closely than I do.

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Logical Bare Necessities

JIM HUFFORD

Originally published 2/7/11 on Organon

Andrew Koppelman at Balkinization calls Judge Vinson’s opinion a “bizarre collection of non sequiturs.” I’ve also noticed instances of the opposite: super-sequiturs—conclusions which logically follow from any premise whatsoever because they are necessarily true. Here’s one:

[T]he record seems to strongly indicate that Congress would not have passed the Act in its present form if it had not included the individual mandate.

(p. 66-67 of the opinion [pdf])(oomphasis added). I don’t know about the record, but the law of material equivalence strongly indicates that Vinson is right: if Congress had passed the ACAwithout the individual mandate, Congress would not have passed the ACA in its present form—with the individual mandate.

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Is Richard Foster Right About Health Care Costs

JONATHAN COHN

Originally published 2/2/11 on Kaiser Health News

Last week, before a lower federal judge in Florida declared the Affordable Care Act unconstitutional, another relatively obscure government figure generated news about health care reform. It was Richard Foster, the chief actuary at the federal agency that runs Medicare and Medicaid.

During a Capitol Hill hearing, Foster was asked to judge claims that the health law would “hold down costs.” Foster said he thought the claim was “false … more than true.” Critics of the overhaul seized on his comments as proof that they have been right — and proponents have been wrong — about the law’s fiscal impact.

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It Will Be Democratic Senators Leading The Charge To Fix Or Improve The New Health Law

ROBERT LASZEWSKI

Originally published 1/31/11 on Kaiser Health News

When the House of Representatives roll was called Jan. 19, only three Democrats joined with House Republicans in voting to repeal the new health law. This development was notable in that it meant most of Democrats who voted against the overhaul the first time around, and were reelected to Congress in November, voted not to repeal it this time — evidence that they may be sensing that support for the health overhaul hardening. A quick examination of public opinions offers evidence as to why this idea might be taking hold.

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Has the Florida Judge Stopped the Health Care Law in its Tracks

ROBERT LASZEWSKI

Originally published 2/1/11 on Health Policy and Marketplace Review

Reading page 75 of today’s Florida opinion it sounds like that is his intent:

(5) Injunction

The last issue to be resolved is the plaintiffs’ request for injunctive relief enjoining implementation of the Act, which can be disposed of very quickly.

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Fixing the Failure At Physician Compare

MICHAEL MILLENSON

Originally published 1/28/11 on Kaiser Health News

The launch of Medicare’s Physician Compare website at year-end should have been a watershed event in the long campaign for health care transparency and patient empowerment. Instead – and it pains me to write this – Physician Compare is a case study in how the interests of the average citizen can be shunted aside by indifferent government, lazy journalists and solipsistic special interests. That remains true despite all of those involved being Good People Trying To Do The Right Thing.

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The House Health Care Repeal Vote, the National Debt, and the Imperative for Democrats and Republicans to Compromise

ROBERT LASZEWSKI

Originally published 1/17/11 at Health Policy and Marketplace Review

This week’s House health care repeal vote is little more than a political stunt–everyone knows the effort will die in the Senate.

But, when the day is done the only way for the Republicans to do anything with the new health law will be to work out a compromise—repeal before the 2012 elections is impossible and it isn’t very likely after the 2012 elections. Even if the Republicans sweep the White House and both houses of Congress in 2012, it is highly unlikely they will have the 60 Senate votes needed for a full repeal.

So, in the end, a compromise will be needed.

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U.S. employers put health care cost containment at the top of reform priorities

JANE SARASOHN-KAHN

Originally published 1/4/2010 on Health Populi

1 in 5 among all U.S. employers (22%) would likely drop health insurance coverage and let workers buy a plan through a health insurance exchange. However, most employers would expand wellness programs driven by incentives in health reform.

1 in 2 employers will continue to offer health insurance even if HIEs are competitive in 2014

JANE SARASOHN-KAHN

Originally published 12/16/2010 on Health Populi.

Just over one-half of U.S. employers plan to maintain their health plans in 2014 even if health insurance exchanges (HIEs) offer competitive priced health plans for individual employee health coverage, according to a survey of 1,400 employers by Willis and Diamond Management & Technology Consultants. 1 in 3 employers is not sure whether they’ll maintain their own health plan or shift employees toward an HIE.

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‘Don’t Litigate, Innovate.’ How To Implement A Fully Funded Alternative To The New Health Care Overhaul — And It’s Already In The Law

ROBERT LASZEWSKI

Originally Published 11/22/10 here on Kaiser Health News

Scott Brown (R-MA) and Ron Wyden (D-OR)

What if a Republican governor and a Republican legislature had the ability to implement their version of health insurance reform and the federal government would have to pay for it? It’s a great idea. And I’m thrilled to say that a bi-partisan bill has already been introduced in the Senate by Ron Wyden, D-Ore., and Scott Brown, R-Mass., that would help facilitate exactly this end.

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What Would Happen If You Were To Pass a Big Health Care Bill Without Bipartisan Support?

ROBERT LASZEWSKI

Originally Published on Health Policy and Marketplace Review here.

During the recent health care debate I heard many people on both sides of the debate worry out loud about passing a heath care bill that did not enjoy broad support.

I guess this question is no longer a theoretical one.

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