Posts Tagged ‘Congress’

Super Committee’s Failure Raises Questions About Healthcare Funding

Wednesday, December 7th, 2011

Now that the Super Committee has failed to identify $1.2 trillion in cuts from the federal budget, automatic cuts totaling billions for everything from Medicare to biomedical research, start in 2013.  Some healthcare sectors will fare better than others.  The primary health entitlement programs, Medicare and Medicaid, are protected under the law that created the Super Committee.  Automatic cuts will not impact Medicaid, the joint federal-state health program for the poor.  Medicare would be cut by two percent – all from payments to hospitals and other providers.

The bad news is that unless Congress reworks the legislation mandating the automatic cuts, a series of across-the-board reductions will begin in 2013.  The House and Senate appropriations committees must decide how to spread the cuts among various programs.  And some of the larger, better-financed lobbies may be able to influence what is cut and what is kept.

Even though the Medicare cuts are limited to hospitals and other medical providers and would not exceed two percent, they argue that is too much and that they sacrificed plenty in the Patient Protection and Affordable Care Act (ACA).  Rich Umbdenstock, president and CEO of the American Hospital Association, said sweeping cuts would hurt Medicare beneficiaries and their families and “also have an impact on the ability of hospitals to provide essential public services to the communities they serve given the impact that Medicare has on the entire healthcare system.”

Officially known as the Joint Select Committee on Deficit Reduction, the Super Committee was unable to meet its deadline to come up with $1.2 trillion of deficit reduction required by the law that created it, much less the $4 trillion that deficit hawks said was necessary to stabilize the finances of the U.S. government, whose debt has topped $15 trillion.  The failure ensures that the fiscal debate between Democrats who want to protect social programs and increase revenue by raising taxes on the wealthy; and Republicans who want smaller government and have pledged to reject tax increases will be a fundamental choice confronting voters in 2012.

“After months of hard work and intense deliberations, we have come to the conclusion today that it will not be possible to make any bipartisan agreement available to the public before the committee’s deadline,” Representative Jeb Hensarling,(R-TX), and Senator Patty Murray, (D-WA) said.  The co-chairs thanked committee members, staffers and “the American people for sharing thoughts and ideas and for providing support and good will as we worked to accomplish this difficult task.”

Writing for Politico, David Nather speculates on whether the Super Committee’s failure has harmed efforts to reform Medicare and Medicaid.  It would be easy to conclude that the Super Committee’s failure means the big, expensive health care entitlement programs — Medicare and Medicaid — are untouchable.  It also would be wrong.  The timing was off, coming too close to a presidential election.  The co-chairs weren’t powerful enough.  The work came too soon after a summer debt deal that Democrats hated.  Republicans couldn’t give the kind of concessions on taxes that Democrats needed.  And the alternative to a Super Committee deal on healthcare entitlements — the two percent automatic cuts in healthcare payments and defense funding that will now take place in 2013 — wasn’t harsh enough to force a deal on Medicare and Medicaid. In fact, it might even have been the easier way out.  All of which means Medicare and Medicaid are not off the table forever.”

The Hill’s Sam Baker offers a different perspective. “The Super Committee’s demise is a mixed bag for the American Medical Association and other groups that wanted the 12-member panel to tackle Medicare’s payment formula, known as the sustainable growth rate (SGR).  The AMA — with bipartisan support in Congress — pushed hard for the supercommittee to include in its deficit-cutting package a long-term fix to the SGR.  The formula calls for automatic annual cuts in doctors’ payments, which add up as Congress consistently delays each cut from taking effect.  Aspirations of a long-term SGR patch should be put to rest, healthcare lobbyists said. But they questioned whether the supercommittee push was ever realistic, because an SGR fix would add to the deficit.”

“I never once believed that the Joint Select Committee would be the one to do that,” said Julius Hobson, a senior adviser at the Washington, D.C.-based law firm Polsinelli Shughart and a former AMA official.

Can Marilyn Tavenner Save Medicare?

Monday, December 5th, 2011

President Barack Obama’s choice of Marilyn Tavenner as administrator of the Centers for Medicare and Medicaid Services – to replace Dr. Donald Berwick, whose recess appointment was set to expire at the end of the year – is more likely to survive the Senate confirmation process relatively unscathed.

A Harvard-educated pediatrician, Berwick won praise and the backing of major healthcare groups for his academic work, which focused on cutting the cost of care while improving quality and patient experience.  Republicans took exception to his praise of Britain’s National Health Service as an “example” for the United States to emulate.  Others accused him of supporting “rationing” healthcare services, a claim Berwick rejects.  “Every bone in my body, as a physician, even as a person, is to get everything (patients) want and need and to help them at every step,” he said.  “I have gone to the mat to get a last-ditch bone marrow transplant for a child with leukemia…and they are telling me I’m rationing?  They haven’t met me.”

White House officials said, “Before entering government services, Tavenner spent nearly 35 years working with health care providers in significantly increasing levels of responsibility, including almost 20 years in nursing, three years as a hospital CEO, and 10 years in various senior executive-level positions for Hospital Corporation of America.”

According to Ezra Klein, “Tavenner’s healthcare experience lies much more in management than policy.  Former colleagues describe her as a patient-centered manager, a hands-on medical professional equally comfortable in the board room and the emergency room.  And in contrast to Berwick, Tavenner isn’t associated with a grand vision for health reform, or a particular policy agenda for Medicare and Medicaid.  ‘With Marilyn, you present the information, then she makes a decision, and you move on,’ said Patrick Finnerty, who served as Virginia’s Medicaid director under Tavenner.  ‘She doesn’t make promises she can’t keep.  There are differences of opinions, and she would try to work through those.  She’s straight with folks but always respectful.’”

Tavenner started her career as a nurse at Virginia hospitals owned by the Hospital Corporation of America (HCA).  Tavenner met with success, rising from chief nursing officer to CEO.  In 2004, she was again promoted to HCA’s president of outpatient services, her first national position with the firm.  She resigned two years later, when then-Virginia Governor Tim Kaine tapped her to head the state’s Health and Human Resources department.

Tavenner has already won the American Medical Association’s (AMA) backing. “We have worked extensively with her in her role as deputy administrator, and she has been fair, knowledgeable and open to dialogue,” AMA President Peter Carmel said.  “With all the changes and challenges facing the Medicare and Medicaid programs, CMS needs stable leadership, and Marilyn Tavenner has the skills and experience to provide it.”

Senator Orrin Hatch (R-UT), the ranking Republican on the Senate Finance Committee, said that the panel would thoroughly scrutinize Tavenner, but did not say he opposes her nomination.  Despite Hatch’s mild comment, Tavenner is expected to face some difficult questioning because Senate Republicans have not overtly endorsed her.  According to a Republican healthcare lobbyist, “I can’t imagine a lot of support for her,” noting that the high-profile CMS role “always gets sucked into the controversy of the day.”  Ultimately, Tavenner is likely to be confirmed for the CMS post.

Tavenner is widely seen as a pragmatic administrator who will not rock the CMS boat. “The only way to stabilize costs without cutting benefits or provider fees is to improve care to those with the highest health care costs,” she said.  Tavenner also said she opposed Republican efforts to turn Medicaid into a block grant that would limit the amount of federal funding states can receive for the program.  “That approach would simply dump the problem on states and force them to dump patients, benefits or make provider cuts or all the above,” she said.  Tavenner “brings continuity in terms of implementing the mission,” said Len Nichols, director of George Mason University’s Center for Health Policy Research and Ethics.

Showdown As Opposing Medicare Ads Debut

Wednesday, November 30th, 2011

A coalition of advocacy groups such as the Americans United for Change, Service Employees International Union, American Federation of State, County, the Municipal Employees and Service Employees International Union and Moveon.org recently started running a series of ads telling lawmakers not to cut Medicare benefits.  In particular, the ads target Representative Denny Rehberg (R-MT), Senator Dean Heller (R-NV) and Senator Scott Brown (R-MA).

“If you vote to cut Medicare, Representative Rehberg, I will remember it every time I visit my doctor.  I’ll remember you cut Medicare and Medicaid every time I fill my prescription,” says an elderly woman narrator in one of the ads.  “I’ll remember you cut Medicare every time I fall or get hurt. I’ll remember you protected millionaires over protecting my health. My friends will remember it, too — all of them.  Call Senator Heller.  Tell him to protect Medicare and Medicaid.”

Brian Walsh, the National Republican Senatorial Committee communications director, made light of the Democratic message, arguing that the half-trillion dollars they shifted out of Medicare to pay for healthcare reform makes their argument hollow.  “The irony of this pathetic attack ad is that in each of these three races, it’s actually the Democrat candidates who are all firmly on record supporting the $500 billion in Medicare cuts that were included in their massive healthcare overhaul,” said Walsh.  “The big labor unions funding this ad know that, but yet they are doing everything they can to mislead voters in Montana, Nevada and Massachusetts.”

In the meantime, the United States Chamber of Commerce is running commercials attacking Senators Sherrod Brown (D-OH) and Jon Tester (D-MT).  Friends of the U.S. Chamber criticize Tester for supporting “government-run healthcare” and challenges Brown on energy taxes.  The business community has been under unprecedented threat,” Rob Engstrom, part of a two-man team running the chamber’s political operation, said.  The trade group plans to break its previous political spending record — $50 million — to try to elect a more business-friendly Congress.  The Montana ad reminds viewers about Tester’s votes for “government-run healthcare” then urges voters to “call Senator Tester and tell him to stop supporting big government and start fighting for Montana’s families.”

Americans United for Change explains why it is running ads about protecting Medicare and Medicaid.  “For decades, seniors have relied on Medicare being a guaranteed benefit and those less fortunate have depended on Medicaid to provide long-term care and coverage for children.  These programs need to be strengthened to ensure they remain available for future generations, which means not gutting and decimating benefits, leaving low-income children, seniors, and people with disabilities out in the cold.  The key to making Medicare sustainable is reining in costs, not dumping more expenses onto seniors.  We are working to set the right priorities for an economically secure future while continuing to protect healthcare coverage for those who can least afford it.”

Writing for the Huffington Post, Sam Stein describes the Democratic ads as “Not exactly the most visually stimulating videos, the ads warn lawmakers that they will pay a political price for cutting Medicare or Medicaid.  That may prove to be popular politics — certainly, polls show that voters want the two healthcare programs protected — but the notion that cuts won’t ultimately be pursued is highly unlikely.  Aides on the Hill from both political parties have long agreed that there is room to trim down Medicare’s provider-side components.  Reforms to Medicaid, whether in the form of decreased help to the states or something more structural, have also been discussed.”

Half of Americans Support Obamacare Repeal

Monday, November 28th, 2011

A recent Gallup poll found that 47 percent of Americans support the repeal of the Patient Protection and Affordable Care Act (ACA), compared with the 42 percent who want the law kept in place.  The remaining 11 percent offered no opinion.  In an ironic twist, the survey also determined that half of Americans believe the federal government has a responsibility to make certain that all citizens have healthcare coverage, compared with 46 percent who do not.

“Views on this issue are highly partisan, with Republicans strongly in favor of repeal and the large majority of Democrats wanting the law kept in place,” according to Gallup.

Republicans claim that the healthcare law is unconstitutional because of the individual mandate that requires all Americans to purchase health insurance.  Approximately eight in 10 Republicans think Congress should repeal the healthcare law, including 54 percent who want the entire law thrown out.  Democrats have an opposing view: 60 percent support keeping the healthcare law as is.  Independents are split.

Fully 80 percent of Republicans support repeal, while a mere 10 percent support the law.  Democrats, not surprisingly support the healthcare law by 64 – 21 percent.  The intensity of the issue on both sides is also striking.  Among those who favor repeal of the so-called Obamacare, 66 percent say it is a “very important” issue.  Fully 60 percent of the ACA’s supporters described it is a “very important” issue.

Another finding of the survey is that 56 percent of respondents prefer an insurance system run by private companies; while 39 percent prefer a government-run system.

Writing for CBS News, Jennifer De Pinto says that “Even though overall support for the healthcare law is mixed, majorities have favored some individual elements of the law, including requiring health insurance companies to cover people with pre-existing conditions and allowing children to stay on their parents’ healthcare plan until age 26.  However, the provision that requires all Americans get health insurance is not as popular.  A CNN/ORC Poll conducted this past summer found 54 percent of Americans oppose that provision.”

In a poll taken by the Kaiser Foundation, 34 percent said they view the law either “very” (12 percent) or “somewhat” (22 percent) favorably while 51 percent saw it in either as “somewhat” (20 percent) or “very” (31 percent) unfavorably.  In April 2010, the favorable view of the law was 50 percent only one time (July 2010).  With the exception of the October dip, support has generally been between 39 and 43 percent since the start of this year.  Even as the overall bill remains consistently unpopular, parts of it — including the individual mandate, which would require all Americans to carry health insurance — are viewed more positively.

Even if the Supreme Court overturns the ACA or it is repealed, President Barack Obama said that the healthcare law he signed in 2010 represents “a reform that will finally make sure that nobody goes bankrupt in America just because they get sick.”  Obama said the law assures coverage for people with preexisting medical conditions and is the kind of change he promised during the 2008 presidential campaign.  “Everything we fought for in the last election is now at stake in the next election,” Obama said.  “The very core of what this country stands for is on the line.”

Supreme Court to Decide Healthcare Reform

Wednesday, November 23rd, 2011

The Supreme Court has agreed to rule on the fate of President Barack Obama’s Patient Protection and Affordable Care Act (ACA) healthcare law, with an election-year ruling due by July on the most comprehensive overhaul in nearly a half century.  The decision had been widely expected because the Obama administration asked the nation’s highest court to uphold the landmark legislation and 26 states asked that the law be ruled unconstitutional.

President Obama expressed confidence that the court would uphold the law when the decision is handed down, just four months prior to the 2012 election.  “Thanks to the Affordable Care Act, one million more young Americans have health insurance, women are getting mammograms and preventive services without paying an extra penny out of their own pocket and insurance companies have to spend more of your premiums on healthcare instead of advertising and bonuses,” said Dan Pfeiffer, the White House communications director.  “We know the Affordable Care Act is constitutional and are confident the Supreme Court will agree,” Pfeiffer said.  The administration pointed out that other landmark legislation, such as the Social Security Act, the Civil Rights Act and the Voting Rights Act, all faced similar legal challenges that failed.

Republicans have vowed to repeal “Obamacare,” but that promise will have to be modified if the high court undercuts the law as written.  A Supreme Court victory would make President Obama even more confident that the law is the major accomplishment of his first term.

Senate Minority Leader Mitch McConnell, (R-KY) said “this misguided law represents an unprecedented and unconstitutional expansion of the federal government into the daily lives of every American.”  The majority of Americans agree,” McConnell said.  “In both public surveys and at the ballot box, Americans have rejected the law’s mandate that they must buy government-approved health insurance, and I hope the Supreme Court will do the same.”

Despite Republicans’ insistence that the ACA is unconstitutional, only one of the four federal appeals courts that have heard cases on healthcare reform has struck down even a part of the law.

One of the ACA’s most vocal opponents is Karen Harned of the National Federation of Independent Business, who said: “We are confident in the strength of our case and hopeful that we will ultimately prevail.  Our nation’s job-creators depend on a decision being reached before the harmful effects of this new law become irreversible.”

Legal experts believe that the healthcare vote will be close on the nine-member court, which is comprised of five conservatives and four liberals.  Moderate conservative Justice Anthony Kennedy, who often is the swing vote, and could well cast the decisive vote.  Paul Heldman, senior analyst at Potomac Research Group, which provides Washington policy research for the investment community, said he still leaned toward the view that the law’s requirement that individuals buy insurance will be upheld.  “We continue to have a high level of conviction that the Supreme Court will leave much of the health reform law standing, even if finds unconstitutional the requirement that individuals buy coverage,” he wrote.

An impressive 5 ½ hours of oral arguments will be held in late February or March. The primary issue is whether the “individual mandate” section – which requires virtually all Americans to buy health insurance by 2014 or face fines — is an improper exercise of federal authority.  According to the states, if that linchpin provision is unconstitutional, the entire law must be also be overturned.  Joining Florida in the challenge are Alabama, Alaska, Arizona, Colorado, Georgia, Idaho, Indiana, Iowa, Kansas, Louisiana, Maine, Michigan, Mississippi, Nebraska, Nevada, North Dakota, Ohio, Pennsylvania, South Carolina, South Dakota, Texas, Utah, Washington, Wisconsin and Wyoming.  Virginia and Oklahoma have filed their own challenges, along with other groups and individuals opposed to the law.

According to USA Today’s Joan Biskupic, “The leading question before the justices is whether in requiring most Americans to buy insurance, Congress exceeded its power to regulate interstate commerce.  The case is on track to be heard by March, and a ruling would come by the end of June, just before the Republican and Democratic conventions for the 2012 presidential election. The law known as the Affordable Care Act, intended to extend medical care nationwide, is the centerpiece of the Obama domestic agenda, and all major GOP presidential candidates oppose it.  The legal challengers, including a group of 26 states, say the law went beyond federal power and, if allowed to stand, would hurt small businesses and compromise individual choices on medical care.”

Writing in The Hill, Sam Baker says that “As they weigh the mandate, the justices will have to consider how it affects other parts of the law.  If they find the coverage requirement unconstitutional, they will have to decide whether to strike it down on its own or instead strike down the entire law.  The justices also will determine whether a separate federal law bars them from reaching a decision on the mandate before it takes effect.  People can’t challenge a tax before they have to pay it, and the Obama administration has defended the mandate by invoking Congress’s taxing power.  But it has also said the court should bypass procedural issues and rule directly on the mandate.”

Obama to Sign Executive Order Releasing $1 Billion to Cut Medical Fraud

Wednesday, November 23rd, 2011

President Barack Obama will once again sidestep a fractious Congress and sign an executive order designed to cut fraud from Medicare and Medicaid.  The Department of Health and Human Services (HHS) will administer the changes, such as testing changes to obsolete hospital billing systems to prevent overbilling, administration officials said.

The billion-dollar initiative will reward the “most compelling new ideas” for cutting costs and improving care of Medicare and Medicaid patients with rewarding federal grants.  Called the Health Care Innovation Challenge, the initiative will provide between $1 million and $30 million over three years to individual organizations or coalitions that develop sustainable, new approaches to improving healthcare quality and efficiency.  “We’ve taken incredible steps to reduce healthcare costs and improve care, but we can’t wait to do more,” said HHS Secretary Kathleen Sebelius.  “Both public and private community organizations around the country are finding innovative solutions to improve our healthcare system, and the Health Care Innovation Challenge will help jump-start these efforts.”

Centers for Medicare and Medicaid Services (CMS) administrator Dr. Donald M. Berwick, M.D. said, “When I visit communities across the country, I continually see innovative solutions at the very ground.  By putting more programs like this in place and more ‘boots on the ground,’ these types of programs can truly transform our healthcare system.”

This program is part of the Obama Administration’s “We Can’t Wait” initiative, which is a series of legal Executive Branch steps designed to move America forward while Congressional Republicans block critical and necessary legislation.

To demonstrate that its campaign to cut government waste is working, the White House said the administration cut improper payments by nearly $18 billion in 2011, largely in such programs as Medicare, Medicaid, Pell Grants and food stamps.  Budget chief Jack Lew ordered federal agencies to tighten their oversight of contractors and grant recipients to reduce the potential for taxpayer waste.

Not surprisingly, there was some immediate opposition to the initiative, with Republican critics calling it a “$1 billion experiment.”  “On the day the Supreme Court decided to review the constitutionality of ‘Obamacare,’ the president is asking for another $1 billion in taxpayer dollars to pay for another healthcare experiment that will continue taking us in the wrong direction,” said RNC spokeswoman Kirsten Kukowski.  “We already spent $2.6 trillion on his job-killing health care bill.  Another $1 billion Executive Order is just more words for a president more interested in campaign talking points than creating jobs.”

With the Supreme Court preparing to hear arguments for and against the Patient Protection and Affordable Care Act (ACA) next March, it is important to note that even the 26 states suing to have the law overturned are hedging their bets.  Only four states have refused all federal money to plan for the changes that are scheduled to take place.

Several healthcare industry leaders expressed their support for the ACA. “The system is transforming itself,” said Charles N. Kahn III, president of the Federation of American Hospitals.  “But the success of these changes depends a lot on whether there is sufficient funding.”  Nationally, hospital systems are anticipating an influx of federal funds and patients as the law goes into full effect.  “If the law is struck down, healthcare reform will have to continue one way or another,” said Patricia Brown, president of Johns Hopkins HealthCare.

Medicare Bundling Payments to Save Money

Wednesday, September 21st, 2011

The Centers for Medicare and Medicaid Services (CMS) has a new program that would bundle insurance payments for multiple procedures with the goal of improving patient care while saving money.  CMS invited providers to help develop four models to bundle payments.  The program encourages hospitals, doctors and other specialists to coordinate in treating a patient’s specific condition during a single hospital stay and recovery.  “Today Medicare pays for care in the wrong way,” Health and Human Services Secretary Kathleen Sebelius said.  “Payments are based on the quantity of care, and not on the quality of that care.  There is little financial incentive for the kind of care coordination that can help patients from returning to the hospital.” 

The models give providers flexibility regarding how they get paid and for which services, and provides financial incentives to avoid needless or duplicate procedures.  “Hospitals and other providers recognize that they have to accommodate the current (fiscal) environment,” said Nancy Foster, vice president for quality at the American Hospital Association. 

“From a patient perspective…you want your doctors to collaborate more closely with your physical therapist, your pharmacist and your family caregivers,” CMS Administrator Donald Berwick said.  “But that sort of common sense practice is hard to achieve without a payment system that supports coordination over fragmentation.  We’re taking steps that will save Medicare, seniors and taxpayers $28 billion over 10 years. Medicare is paying much more than the private sector for equipment like wheelchairs and walkers.  By expanding our successful competitive bidding program, we can ensure that Medicare pays a fair rate for these goods.”

According to CMS, the initial round of competitive bidding has added up to savings of 35 percent compared to the fee schedule.  Questions in the 1st quarter of 2011 totaled less than 0.9 percent of calls to Medicare’s call center; Medicare received just 45 complaints during that time.  CMS will conduct the second phase of the program for a similar set of products in 91 major cities.  Competition begins this fall; the new prices go into effect on July 1, 2013.  “The success we’ve had in the first phase tells us that we can achieve these savings with no disruption for patients’ access and no negative effect on patients’ health,” said Jonathan Blum, deputy CMS administrator and director of the Center for Medicare. “We remain confident in our bidding methodologies that will produce tangible savings while ensuring adequate choice of qualified suppliers.”

The CMS Innovation Center, created under President Barack Obama’s Patient Protection and Affordable Care Act (ACA), has been investigating bundling payments as part of a larger effort to both improve patient care and reduce costs.

There is some disagreement over whether the CMS bidding program is successful.  Economists, consumer groups and some in Congress are on record opposing the program.  They cite reduced access to care, flaws in the program design and impact on local jobs.  “There’s a reason why more than 30 patient advocacy groups, 244 economists and auction experts and 145 members of Congress oppose this program: it undermines quality of care and it increases costs,” said Tyler J. Wilson, president of the American Association for Homecare.  “Because of this bidding program, beneficiaries will spend more time in expensive institutions, rather than in the far more cost-effective setting for care – their own homes.” 

Tim Size, executive director of the Rural Wisconsin Health Cooperative, is concerned about the impact on rural hospitals.  “Washington has created a new ‘super committee’ to find more cuts.  Some call it a super Congress to remind us this is a small group given powers usually kept by Congress.  Most economists say Washington needs a coherent policy for both additional cuts and additional revenue.  But politics seems to have taken new revenue off the table.  Most people believe the super committee will deadlock.  If Congress fails to act, cuts will be implemented across the board.  Most federal programs will be cut.  Across-the-board cuts harm efficient programs along with the inefficient.  Across-the-board cuts harm necessary along with the less necessary. The country deserves better than bulldozers driven by blindfolded drivers.  Most rural hospitals are financially just holding their heads above water.  Under-payment by government programs has left them vulnerable.  A sluggish economy and an increasingly competitive healthcare marketplace are taking their toll.  Medicare and Medicaid are rural hospitals’ largest payers. Additional cuts are likely to tip many rural hospitals into the red and eventual closure.”

Virginia Appeal Confirms the ACA’s Individual Mandate

Monday, September 19th, 2011

The Obama administration won a round in the legal battle over the Patient Protection and Affordable Care Act (ACA) when a federal appeals court tossed out two lawsuits in Virginia.  The 4th U.S. Circuit Court of Appeals ruled in both lawsuits — one filed by Virginia Attorney General Kenneth Cuccinelli, the second by Liberty University – that the plaintiffs did not have legal standing to sue.  This is a rejection of the first case that ended with a ruling that the healthcare reform law was unconstitutional.  Additional cases remain active, including the lawsuit filed by 26 other states, which means that the issue has by not gone away.

Virginia argued that it had the right to challenge the individual mandate – a key proviso of the law that requires people to buy health insurance by 2014 or pay a tax penalty – because it interferes with a state law that says residents can’t be forced to purchase health insurance.  According to the court, “To permit a state to litigate whenever it enacts a statute declaring its opposition to federal law” would “convert the federal judiciary into a forum for the vindication of a state’s generalized grievances about the conduct of government.”  During oral arguments, a lawyer for the Obama administration said that the case “fails at the outset” because the mandate is applicable to individuals and not the state.  After the decision was handed down, Cuccinelli expressed “disappointment” that the case was thrown out.  According to Cuccinelli, “the Court did not even reach the merits on the key question of Virginia’s lawsuit – whether Congress has a power never before recognized in American history: the power to force one citizen to purchase a good or service from another citizen.”

In the case brought by Liberty University — a private Christian school — the court said in a 2 – 1 ruling that it was blocking the case because a federal tax law stripped it of jurisdiction to decide the issue.  The Court was the first to rule that the individual mandate is essentially a tax.  Because the mandate cannot be enforced until 2014, the Court ruled that the Anti-Injunction Act “strips us of jurisdiction” from hearing a pre-enforcement challenge.  “What the Court said is that the penalty for not complying with the mandate functions as a tax that cannot be challenged until it has been assessed,” said Kevin Walsh, a law professor at the University of Richmond School of Law.

Virginia Governor Bob McDonnell reacted to the ruling, saying “Today, a three judge panel, consisting of two judges appointed by President Barack Obama and one by former President Bill Clinton, found that Virginia lacks standing to challenge the individual mandate provision of the federal healthcare law.  We respectfully disagree with the panel’s reasoning.  To conclude that a state has no standing to challenge an expensive and burdensome federal mandate on its citizens that the state has banned in its law, might cause James Madison and George Mason, Virginia’s principal drafters of our nation’s founding documents, to promptly roll in their graves.  To dismiss a Virginia statute as a basis for standing, declaring it to be ‘quintessentially political,’ and asserting that a state cannot be a ‘constitutional watchdog’ undermines our precious principles of federalism.  This decision must be promptly appealed.

“As federal courts across the country continue to come to differing conclusions on the merits of cases arguing the unconstitutionality of the federal healthcare law, today’s decision further exemplifies why these cases should be expedited to the nation’s highest court.  It is the Supreme Court that will ultimately determine whether the federal mandate on every citizen to purchase health insurance violates the U.S. Constitution.  States and businesses continue to expend time and money and languish in uncertainty as they try to come into compliance with a law that may ultimately be ruled unconstitutional.  It is exasperating that the President and the Justice Department oppose a prompt resolution of this case through an expedited appeal.  America needs finality in this case,” according to McDonnell.

Judge Diana Gribbon Motz, who was appointed to the bench by President Clinton, wrote that the only apparent function of the state law was “to declare Virginia’s opposition to a federal insurance mandate.”  The state law was enacted just days after President Obama signed the ACA into law.

Writing in U.S. News & World Report, Scott Galupo says that “Cuccinelli and co. follow a long trail from the 18th century British jurist William Blackstone to the Dred Scott case to the New Deal to the present day.  The conservative team, at first, makes a tight, prudential case against the Obamacare mandate that I, in my nonprofessional capacity, happen to favor.”  Parsing Cuccinelli’s statement about the decision, Galupo notes that “In plainer, get-to-the-point English: We grant you the social safety net established under the ‘Roosevelt Settlement.’  We recognize Congress’s power to regulate interstate commerce.  We even grant that this power could conceivably deliver universal healthcare.  But for Pete’s sake, don’t try to include ‘inactivity’ — that is, not buying a health insurance plan on the private market — under its purview.  Because, once you regulate the act of doing nothing, what’s left to regulate?  Er, nothing.  Thus, does the state’s power to tax and police become theoretically unlimited?  But, later in the body of the piece, Team Cuccinelli begins to play other, more presently familiar cards.  Glenn Beck fans will recognize the faces in the rogue’s gallery: Justice Oliver Wendell Holmes, progressive philosopher John Dewey, and others who, this argument goes, created the post-New Deal legal and philosophical edifice.  Wouldn’t you know it, this welfare-state stuff constitutes a violation of natural law — which, ipso facto, means economic laissez-faire — and a lurch into moral chaos.  Echoing the newly popular Hayek, Cuccinelli’s article asserts the primacy of economic rights while characterizing as relativistic the not-exclusively-liberal jurisprudential argument that personhood and dignity precede the marketplace.  (Last I checked, I’ve never seen an unborn baby sign a contract.)”

The Obama administration remains optimistic about the ACA.  “When it ends, we are confident we will prevail,” White House adviser Stephanie Cutter said.

Social Security Disability Income Under Fire From Budget Cutters

Wednesday, September 7th, 2011

Although some people are convinced that federal Supplemental Security Disability Income (SSDI) program for severely disabled children is a boondoggle, a four-year-old boy diagnosed with severe ADHD is an excellent example of how the program works.  The boy’s case workers said there wasn’t much they could do for him.  “We were at a standstill,” said the boy’s mother, who was barely scraping by as a single parent of two.  When doctors recommended she enroll her son in the SSDI program, her situation quickly improved.   A $674 monthly payment helps pay for her son’s day care, a private tutor and medications.  Most importantly, SSDI made the boy eligible for Medicaid, which provided access to the doctors he needed. 

“I can see a light in his eyes again,” according to the mother.  “He just looks so much happier.”  The SSDI program for children is expanding rapidly, with the largest increase among kids with mental, behavioral and learning disorders, including ADHD, speech delays, autism, and bipolar disorder.  

Even though the program benefits children in need, it is generating Congressional criticism.  The Boston Globe created a backlash that called the children’s SSDI program “The Other Welfare” and followed several families whose children’s eligibility for the program was open to discussion.  Several of the families believed that they had to medicate their children with psychotropic drugs in order to qualify for the benefit.  The series spurred Representative Geoff Davis, (R-KY), Representative Richard E. Neal, (D-MA), and Senator Scott Brown, (R-MA), to ask for an investigation by the Government Accountability Office (GAO), which is expected to be released by the end of the year.  In a letter to the GAO, the three lawmakers expressed concern about “recent reports in the media and elsewhere” that “have identified potentially alarming practices…(that raise) numerous concerns, including the potential for fraud and abuse in the program.”  Some Congressmen are not waiting for the GAO study results and have twice proposed limiting SSDI benefits.  The House budget resolution proposed that the government could save $1.4 billion over 10 years by reducing incentives in the SSDI program “for parents to place their children on medication solely to receive SSI benefits.”  

Advocates for children have rallied against the potential cuts.  The largest advocacy groups, including the Bazelon Center for Mental Health Law, the American Psychiatric Association, the American Academy of Pediatrics, and Children and Adults with Attention Deficit/Hyperactivity Disorder, have formed a coalition to protect the SSDI program for kids and are lobbying Congress.

 At present, SSDI provides cash assistance and Medicaid to the families of 1.2 million low-income kids who have severe disabilities, at a cost of $10 billion a year.  The program has grown by nearly 40 percent over the last nine years.  “Cutting the SSI program could have disastrous consequences for families, many of which already are struggling well below the poverty line,” according to Rebecca Vallas, a lawyer with Community Legal Services, a non-profit that is part of the coalition.  Vallas says the increase in the SSDI program is due to a national increase in child poverty and improved access to healthcare for kids, who get diagnosed earlier and more frequently with disabilities that might otherwise be ignored.

It’s not only kids who benefit from SSDI.   Recently, the Social Security Administration added 12 new conditions to its “compassionate allowances list,” including several heart ailments.  Applicants who have any of the 100 conditions  on the list are fast-tracked and can have a decision as quickly as two weeks.  For other people, the length of the disability process can be measured in months — or even years.  “When you have a catastrophic experience and you lose 50 percent of your income, it can mean that you’re selling your house, that you may not be able to support yourself. That’s so depressing for the patient,” said Karla Robeson.  Social Security is in the process of determining new conditions to add to the compassionate allowances list, though they’re getting more difficult to pinpoint, said Social Security Commissioner Michael Astrue.

Not everyone is supportive of the SSDI program.  Writing on Slate, James Ledbetter, a widely respected financial journalist, says that “They are the recipients of Social Security’s Disability Insurance, a somewhat obscure federal program that nonetheless eats up nearly $200 billion a year.  SSDI began in 1956 and was intended to provide benefits for people between 50 and 64 who’d been in the workforce but had developed ‘any medically determinable physical or mental impairment which can be expected to result in death or to be of long-continued and indefinite duration.’  At the end of the first year, there were 150,000 Americans receiving SSDI benefits.  As Congress serially widened the eligibility criteria — by age, by type and duration of impairment — that number began to grow.  Enrollment hit one million adults in 1966; by the end of 1977 it was 2.8 million; and today it’s more than eight million ex-workers, plus another million disabled adult offspring and disabled widows and widowers.  SSDI represents, as the authors of a 2006 economics journal paper put it, a ‘fiscal crisis.’  Equally distressing, it also represents public policy run amok.  Over the last few decades, a program that was designed to help a relatively small group of people who were fatally sick or permanently unable to work has evolved into a backdoor welfare program in which a huge number of people are paid not to get jobs.  How huge?  Nationwide, we’re talking about well over four percent of the adult population.  In some states — Alabama, Arkansas, Kentucky, Maine, Mississippi, and West Virginia — the rate exceeds six percent.  These millions of workers extricated from payrolls represent untold billions in tax lost revenues and all manner of desperately needed economic activity (consumption, home purchases, etc.).”

HHS Moves Forward to Create Healthcare Insurance Exchanges

Tuesday, August 30th, 2011

The Department of Health and Human Services (HHS)  has given $185 million to 13 states and Washington, D.C. to help them build Affordable Insurance Exchanges –one stop shopping that lets consumers choose a private health insurance plan that is virtually identical to insurance choices offered to members of Congress.  Since President Barack Obama signed the Affordable Care Act (ACA), more than half of the states have moved forward on building insurance exchanges.  The ACA creates Affordable Insurance Exchanges that will allow eligible individuals, families, and small businesses to shop for coverage beginning in 2014.  HHS plans to make more grant awards over the next several months.

According to HHS Secretary Kathleen Sebelius, “Too many American families have been priced out or locked out of the health insurance market.  Exchanges will give them control and could save them thousands of dollars a year.  I am encouraged by the progress states have made to date and am excited to give them more resources to continue their work.”

One state that is seeking guidance on how to set up its healthcare exchange is Nebraska,  which has questions about implementing this provision of the ACA.  According to state health insurance analyst Michael Sciullo, officials still haven’t learned the precise details of how the health insurance exchange could be established.  Sciullo is uncertain about whether a Nebraska-run program would carry over to other states, which option is the most cost-effective and how many participants would meet income requirements to join an exchange.  “There seems to be a lot of challenges with the concept,” Sciullo said.  “I think initially it was a concept that sounded great, particularly when we talk about the pooling aspect.  But with all the other challenges facing states as they prepare for the exchange process…it’s been one of those things that sounded a lot better in theory than has worked out practically.” 

Nebraska officials face the challenge of deciding whether the state will join the federal exchange, participate in a regional exchange with other states or create its own exchange.  A regional exchange In Nebraska is not likely because each state has different regulations governing healthcare insurance.  

HHS is encouraging states to set up their own exchanges because a peculiarity in the ACA is that while it gives HHS the authority to create a federal exchange for states that don’t set up their own, it doesn’t have the authority to provide any funding to achieve this goal.  The irony is that the law appropriates virtually unlimited dollars to help states create their own exchanges.  The federal exchange will have the same authority as the states to impose fees on insurance sold through the exchange once it is open for business.  No money is coming in until people start purchasing insurance, and there is significant work to be done in preparing to create federal exchanges.  “It’s very clear that (the HHS) secretary should ‘use such sums as may be necessary’” for supporting states in setting up exchanges, but it’s “sort of silent” on the federal fallback exchange, said Jon Kingsdale, founding director of the Massachusetts Connector, who advises HHS on setting up the federal exchange. 

The recent announcement that HHS, The Department of Labor, and the Treasury  proposed new rules that will help consumers easily understand their health coverage and determine the best options for themselves and their families.  Additionally, these proposed rules will help employers find the best coverage for their business and their employees.  Under the proposed rule alterations, health insurers and group health plans will give consumers clear, consistent and comparable information about their health plan benefits and coverage.  The new forms, scheduled to be available next year, will be a vital resource for more than 180 million health insurance consumers with private coverage.  “Today, many consumers don’t have easy access to information in plain English to help them understand the differences in the coverage and benefits provided by different health plans,” Sebelius said.  “Thanks to the Affordable Care Act, that will change.”  According to Sebelius, the simplified options have been sent to the nation’s governors for their input and approval. 

“Workers and their families need clear and understandable information regarding their health coverage,” said Secretary of Labor Hilda L. Solis.  “Today’s proposal is a common-sense step that will help workers quickly and easily compare different coverage options, in order to make more informed decisions.”  

Writing on the White House blog, Dr. Donald Berwick, administrator of the Centers for Medicare and Medicaid Services, says that “Having affordable, quality health insurance is incredibly important.  But how can you pick the plan that is best for you and your family if insurance plans are written in words you cannot understand or in type so small you can barely read it?  And how can you take advantage of the health benefits you have if you don’t know what your plan covers?  You’re not alone in your confusion.  Too many Americans don’t have access to information in plain language to help them understand the health coverage they have.  Now, thanks to the Affordable Care Act, every American consumer will receive an important new tool to understand their coverage.  Under proposed rules, health insurers and employers who offer coverage to their workers must provide you with clear and consistent information about your health plan.”