Tag: health insurance

Cross posted st The Stars Hollow Gazette

First, this morning House Majority Leader Eric Cantor (R-VA) made the rounds of talk shows spouting how the Affordable Health Care bill can be repealed with a simple majority in the House and Senate since the bill was passed under reconciliation. Without a filibuster proof majority in the Senate, Ryan Lizza at The New Yorker points out the obstacles for that to happen:

Many Republicans, especially in the blog and talk-radio swamps, would cry, “Use reconciliation!” Readers familiar with the congressional debates of 2009-2010 will remember that this procedure allows certain budgetary measures to pass through the Senate with a simple majority. [..]

But reconciliation wouldn’t work here-the process can only be used for policies that have budgetary effects and a C.B.O. score. Much of the A.C.A., such as the insurance exchanges and subsidies, would fall under these categories. But a lot of it, including the hated individual mandate, does not. Repealing the exchanges and subsides without repealing the mandate and the other regulations and cost controls in the law would create a health-care Frankenstein that a President Romney would be rather nuts to support.

That said, the SCOTUS ruling has some rather complex ramifications and Chief Justice Robert’s ruling was rather sly. First was there are the three bit from SCOTUSblog that Lambert Strether pointed out at Corrente:

First, here’s the reasoning:

   Essentially, a majority of the Court has accepted the Administration’s backup argument that, as Roberts put it, “the mandate can be regarded as establishing a condition — not owning health insurance — that triggers a tax — the required payment to IRS.” Actually, this was the Administration’s second backup argument: first argument was Commerce Clause, second was Necessary and Proper Clause, and third was as a tax. The third argument won.

Second, here are the implications for the role of the State as we have understood it from the New Deal onward; what Phillip Bobbitt would call a change a Constitutional Order:

   The rejection of the Commerce Clause and Nec. and Proper Clause should be understood as a major blow to Congress’s authority to pass social welfare laws.

Third, here is the new Constitutional Order:

   Using the tax code — especially in the current political environment — to promote social welfare is going to be a very chancy proposition.

Chancy or not — and it will be the precariat that suffers mischance, and not the elite, in any case — that’s what they’re going to do.

Next from Scarecrow at FDL News Desk who argues that Chief Justice Robert’s “incoherent decision” will “shackle congress” and “screw millions of uninsured:

In the process, he did violence to constitutional law and logic.  Consider, for example, Robert’s logic on the “mandate.”  In saving the “mandate,” Roberts essentially defined it as not a mandate.  You are not really required to purchase insurance, he noted; instead, you may choose not to purchase insurance and instead pay a minor tax.  As we know, taxing is just a way to collect revenues, a contribution to the common, aggregate costs of public programs.  In this case, the program is paying for many people’s health care through a system of risk/cost sharing.

But if the so-called mandate is not really a mandate but rather an option that can be avoided by paying a tax, and if a legitimate purpose of this tax, as government and amicus briefs argued, is to help cover aggregate costs across a pool of many insured and uninsured people, then what does that do to Robert’s argument about the Commerce Clause?  When arguing about the Commerce Clause, Roberts insists it’s a requirement to purchase a “product,” which forces you to take an action, and thus to engage in commerce when you would not otherwise have done that.  Regulating “inaction” is not permissible, Roberts argues.

But if, as Roberts concludes, the “mandate” is not a mandate, and the tax’s purpose is to help cover pooled costs, and not to buy a “product,” then there is no “mandate” to purchase a “product.”  So no one is forced to engage in commerce as Roberts framed it.  Indeed the “commerce” is already there in the risk sharing system across millions of people, all engaged in commerce by paying premiums into a pooled risk scheme.  Robert’s entire premise for striking down the Commerce Clause rationale is thus contradicted by his argument about how it’s permissible for Congress to enact a tax to support funding of collective health care costs.  That’s what the tax does; but it’s also what paying insurance premiums does.

Roberts’ reasoning on Medicaid is equally illogical. His premise is that Congress cannot expand an existing program administered by states that depends on shared state/federal funding by conditioning funding for the whole program on the states actually implementing the expansion.  As Brad DeLong observes, if Congress were just now creating a fully expanded Medicaid, to be implemented by states but mostly paid for by the feds, there would be no question that Congress could condition federal funding on the states actually carrying out the programs.  But if the program already exists for half the needy population, Congress cannot complete the program for the other half and use the same leverage to achieve the same degree of state cooperation.

As per the CBO, if the states actually implement the expansion and make an effort to get those eligible to sign up, 16 to 17 million more people will have health care coverage. But without that leverage to get the states to accept Medicaid expansion it leaves the poor between around 50% and 133% of the poverty line in a real no man’s land, because they would both be ineligible for Medicaid AND the coverage subsidies in the exchanges.

As for the states voluntarily opting in for the Medicaid expansion, David Dayen doesn’t think that will happen either, even though the cost for the states would only be responsible for less than 10% of the costs.

And being on the hook for even a small amount of funds isn’t going to make any of these governors happy. Heck, here’s a Democrat, former West Virginia Governor and current Senator Joe Manchin, making the argument for them:

   We should all recognize that the health care challenges that many West Virginians and Americans face are not going to go away unless Congress takes additional action to repair this bill. Now that the Court has ruled, we can move forward with fixing what is wrong with this bill and saving what is right. I have always been determined to reduce the burden on states from the Medicaid expansion, and this ruling affirms my position – and makes clear that states must have the flexibility to live within their means by determining Medicaid eligibility as each state sees fit. I have always said one size doesn’t fit all.

That’s going to be a compelling set of logic for a non-trivial number of governors. They’ll also distort how much the expansion would put their states “on the hook.” 26 states sued to eliminate the Affordable Care Act entirely, and they almost got there. Why wouldn’t they jump at the chance to eliminate the portion that creates half of the coverage benefits?

This isn’t going to be universal. New Mexico’s Republican Governor Susanna Martinez, for example, certainly sounds like she’ll take the money. But Southern states in particular, who paradoxically house the citizens most in need of the Medicaid expansion coverage, will be likely resisters at the outset. And it’s not like a lot of success in modern America comes from rallying at the grassroots level for poor and disenfranchised people.

As was noted by Ezra Klein of the Washington Post, opponents of the ACA see this as a win:

“We won,” said Georgetown law professor Randy Barnett, who was perhaps the most influential legal opponent of the Affordable Care Act. “All the arguments that the law professors said were frivolous were affirmed by a majority of the court today. A majority of the court endorsed our constitutional argument about the Commerce Clause and the Necessary and Proper Clause. Yet we end up with the opposite outcome. It’s just weird.”

Yes, it’s weird but so was the whole ACA bill from the very start.

Cross posted from The Stars Hollow Gazette

It would seem that there really are rational Republicans in elective office. Thank you to Louisiana Attorney General Buddy Caldwell who recognized that the Patient Protection and Affordable Care Act neither protects the patient or makes health care affordable. The only thing that will do that is single payer and that isn’t in the bill. Single payer health care spreads the cost of health care across the spectrum, covering everyone, and insures access to care from birth to death. So, AG Caldwell is suing the Obama Administration because he trusts the government more than the greedy, profit driven insurance companies.

ThinkProgress spoke with Louisiana Attorney General Buddy Caldwell outside the Supreme Court on Wednesday. Caldwell opposes Obamacare and the individual mandate, but for a different reason than most of his fellow litigants: it props up the private health insurance industry. “Insurance companies are the absolute worst people to handle this kind of business,” he declared. “I trust the government more than insurance companies.” Caldwell went on to endorse the idea of a single-payer health care system, saying it’d “be a whole lot better” than Obamacare:

   KEYES: You don’t think the subsidies for low-income people are going to be helpful?

   CALDWELL: No, no. The worst thing you can do is give it to an insurance company. I want to make my point. All insurance companies are controlled in their particular state. If you have a hurricane come up the east coast, the first one that’s going to leave you when they gotta pay too many claims is an insurance company. Insurance companies are the absolute worst people to handle this kind of business. I trust the government more than insurance companies. If the government wants to put forth a policy where they will pay for everything and you won’t have to go through an insurance policy, that’d be a whole lot better.

I don’t know about the rest of Mr. Caldwell’s politics but I wish there was a Democrat in the White House that agreed with him on this.

Cross posted from The Stars Hollow Gazette

Today the Supreme Court heard arguments about the severability of the individual mandate in the Affordable Health Care bill  and the expansion of Medicaid.

The day after the Supreme Court suggested that President Obama’s health care law might be in danger of being held unconstitutional, the justices on Wednesday turned their attention to the practical consequences and political realities of such a ruling.

The justices seemed divided on both questions before them: What should happen to the rest of the law if the court strikes down its core provision? And was the law’s expansion of the Medicaid program constitutional?

The two arguments, over almost three hours, were by turns grave and giddy. They were also relentlessly pragmatic. The justices considered what sort of tasks it makes sense to assign to Congress, what kinds of interaction between federal and state officials are permissible and even the political character of the lawsuits challenging the law. One justice dipped into Senate vote counting.

The court had in other words, on the third and final day of a historic set of arguments, moved from the high theory of constitutional interpretation to the real-world consequences of what various rulings would entail.

The arguments on severability, which hinged totally on whether the mandated stays or goes, boiled down to three points:

1. sever only the mandate, allow the rest of the law to stand and let Congress sort it out;

2. sever the mandate along with insurance regulations like guaranteed issue and community rating, to prevent what the government argues would be an insurance death spiral;

3. or throw out the whole law, which did not include a standard severability clause.

The Justices seemed divided over point #2 and #3 rather than #1. For the most part, the discussions and comments were reflective of the consequences of overturning the entire law or any part of it:

[..] A common reaction, across the bench, was that the Justices themselves did not want the onerous task of going through the remainder of the entire 2,700 pages of the law and deciding what to keep and what to throw out, and most seemed to think that should be left to Congress.  They could not come together, however, on just what task they would send across the street for the lawmakers to perform.  The net effect may well have shored up support for the individual insurance mandate itself.

The dilemma could be captured perfectly in two separate comments by Justice Antonin Scalia – first, that it “can’t be right” that all of the myriad provisions of the law unrelated to the mandate had to fall with it, but, later, that if the Court were to strike out the mandate, “then the statute’s gone.”  [..]

Justice Anthony Kennedy, who is considered the swing vote on the individual mandate, expressed concern “possible unintended consequences in the form of huge costs to insurance companies if the mandate – which would bring millions of healthy young people into the healthcare system and spread out costs – was invalidated alone”:

“We would be exercising the judicial power if one … provision was stricken and the others remained to impose a risk on insurance companies that Congress had never intended,” Kennedy said. “By reason of this court, we would have a new regime that Congress did not provide for, did not consider.”

The four liberal justices expressed deep reservations about tossing out the sweeping law that has hundreds of other provisions, some of them already in effect.

Justice Sonia Sotomayor, one of the four and an Obama appointee to the court, asked whether the court should allow Congress to decide what to do next. “What’s wrong with leaving it in the hands of people who should be fixing this, not us?”

Justice Ruth Bader Ginsburg went further. She said many parts of the law had not been challenged in court. “Why make Congress redo those?”

On the matter of Medicaid expansion a majority of the justices were inclined to support the government’s role in prodding states to expand the state-federal Medicaid healthcare program for the poor, providing coverage for an estimated 17 million Americans:

The court’s more liberal justices all expressed puzzlement about why there should be a problem with the expansion in light of the fact that it is almost entirely to be paid for by the federal government. The states say they are being coerced into participating because a decision not to may cause them to lose not only the new money but also existing funds.

Justice Elena Kagan described a hypothetical program only slightly different from the real one. “It’s just a boatload of federal money for you to take and spend on poor people’s health care,” she said to a lawyer for the states, Paul D. Clement. “It doesn’t sound coercive to me, I have to tell you.” [..]

He (Chief Justice John G. Roberts Jr) said the court’s decision on the Medicaid expansion should be informed by the reality that the states have “since the New Deal” cheerfully accepted federal money.

“It seems to me that they have compromised their status as independent sovereigns because they are so dependent on what the federal government has done,” the chief justice said.

Justice (Antonin) Scalia addressed the political realities of the litigation itself, asking Mr. Clement whether there was “any chance that all 26 states opposing it have Republican governors, and all of the states supporting it have Democratic governors?”

Mr. Clement responded, “There’s a correlation, Justice Scalia.”

In her last article on Wednesday’s sessions, Slate‘s Dahlia Litwick gives her assessment of the last three days:

Amid all the three-day psychodrama, it’s easy to get confused about what’s happened and what hasn’t. Court watchers seem to generally agree that the individual mandate is in real peril and will rise or fall with Chief Justice Roberts and Justice Kennedy. Court watchers also agree that 19th-century tax law-while generally adorable-will not prevent the justices from deciding the case by July. And they also agree that they may have counted five justices who appear willing to take the whole law down, along with the mandate, and the Medicaid expansion as well.

But the longer they talked, the harder it was to say. A lot of today’s discussion started to sound like justices just free-associating about things in the law they didn’t like. That doesn’t reveal all that much about the interplay between the four separate challenges-what happens when they all have to be looked at together-or anything at all about what will happen at conference or in the drafting of opinions. Could the five conservative justices strike down the entire health care law, and take us into what Kagan described this morning as a “revolution”? They could. Will they? I honestly have no idea anymore. As silent retreats go, this one was a lot less enlightening than I’d hoped.

Constitutional law professor Jonathan Turley discussed the hearings with Keith Olbermann on Countdown, calling this case a “game of chicken” that “can be deadly.”

Cross posted from The Stars Hollow Gazette

House of Representative Democratic women walked out of House oversight hearing on access to birth control when the Republican majority’s refused to allow minority female witnesses at a hearing on the Administration’s birth control access rules. Rep. Carolyn Maloney (D-NY) and Rep. Eleanor Holmes Norton (D-DC) left accusing Chairman Darrell Issa (R-CA) of manipulating committee rules to block female witnesses from testifying.

In a letter yesterday, Rep. Elijah Cummings (D-MD) sent a letter (pdf) to Issa yesterday objecting to the lack of minority witnesses and those who supported President Obama’s compromise:

   When my staff inquired about requesting minority witnesses for this hearing, we were informed that you would allow only one. Based on your decision, we requested as our minority witness a third-year Georgetown University Law Center student named Sandra Fluke. I believed it was critical to have at least one woman at the witness table who could discuss the repercussions that denying coverage for contraceptives has on women across this country.

   In response, your staff relayed that you had decided as follows:

   “As the hearing is not about reproductive rights and contraception but instead about the Administration’s actions as they relate to freedom of religion and conscience, he believes that Ms. Fluke is not an appropriate witness.”

   It is inconceivable to me that you believe tomorrow’s hearing has no bearing on the reproductive rights of women. This Committee commits a massive injustice by trying to pretend that the views of millions of women across this country are meaningless, worthless, or irrelevant to this debate.

Only one witness who supported the compromise, Barry Lynn of Americans United for Separation of Church and State was invited to testify. The other eleven witnesses over the two days of testimony would be all male religious leaders or professors, including a Catholic bishop. Issa argued that “the hearing is not about reproductive rights and contraception but instead about the Administration’s actions as they relate to freedom of religion and conscience.”

I agree this is about the 1st Amendment but it has nothing to do with religious freedom, it has to do with establishing religious doctrine as government policy.

Cross posted from The Stars Hollow Gazette

President Barack Obama presented a compromise addressing the objections of the religious right, so-called pro-lifers and extremest conservatives to the provision in Affordable Care Act requiring religiously affiliated employers to provide contraceptive coverage to women. Women will still be guaranteed coverage for contraceptive services without any out-of-pocket cost, but will have to seek the coverage directly from their insurance companies if their employers object to birth control on religious grounds. Insurers will absorb the cost insuring that access to birth control as well as cancer screening, mammograms and check ups would remain free to all women.

Planned Parenthood and the Catholic Health Association both expressed pleasure about the new plan, however, there were still objections from the Catholic Bishops and right wing politicians who vowed to continue the war on women.

Many of those voicing objections to this provision have cited the 1st Amendment stating that forcing churches to provide something that is opposed by their tenets violates their 1st Amendment right to freely practice their religion. But does it? The First Amendment

Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof; or abridging the freedom of speech, or of the press; or the right of the people peaceably to assemble, and to petition the Government for a redress of grievances.

Contraception is not about freedom of religion, as Scarecrow at FDL so eloquently explains:

What’s happening here is that the government has chosen to adopt a rule relating to health care.  Proponents often say this, and some media may dismiss this as ducking the religious issue, but it’s not.  It’s consistent with what we’ve done for decades.  Contraception is about health care, mostly women’s health care, and sometimes life-saving health care; but it’s clearly health care.  When government addresses contraception, it does so for health reasons, not religious reasons.  Government can adopt rules to protect women’s health and safety without violating the First Amendment.

What about the “establishment clause”?  This is how the bait and switch happens.  The Catholic Bishops do not believe contraception should be used; it shouldn’t be available at all.  They don’t mean just unavailable to Catholics; they mean not available to anyone. They want the legal rule to be: no contraceptives for anyone, so no insurance coverage for contraception services for anyone.

Religious freedom says they are free to believe contraception is wrong, that it violates their religion.  Government can’t force them to believe otherwise; it can’t force them to exercise a religion they don’t believe, except that government can, for health and safety reasons, require everyone to obey reasonable rules to protect peoples’ health and safety, even if some believe such regulations are inconsistent with their religious beliefs.

Religious freedom doesn’t mean the Catholic Bishops, or any other religious leaders, have the right to impose what they believe on everyone else.  When we cross over to the realm of what the rules should be for everyone, and the pushing is coming from a religious purpose, it’s more likely we’re talking about that other clause, the establishment clause.  And that’s exactly where the Bishops are.

Those who oppose any contraception insurance coverage want to prevent the government from having a rule that requires contraception, or have it adopt a rule prohibiting the coverage of contraception.  And they want this not for health/safety reasons, but for declared religious ones.  In other words, they want a government rule that imposes their religious beliefs on everyone else.  That’s not about the “free exercise” clause; that’s “establishment of religion.”

Constitutional lawyer David Boies, who represented VP Gore and successfully opposed California’s Prop 8. appeared with Lawrence O’Donnell on The Last Word, explaining the constitutionality of the birth control mandate.

Around the same time that the health care reform act was being hotly debated, several months back, I wrote extensively about my own experiences.  I’ve struggled with chronic illness the whole of my life, and so not having health insurance was not exactly any bargaining chip for me.  The no-insurance option shouldn’t have to be anyone’s experience, yet this is still true for many I know.  Many people my age (thirty) and younger who have had to endure extended periods of unemployment due to the economy must depend on benevolent parents, should they be young enough, or instead beg for whatever available government coverage can be achieved.  At worst, they must make do with no coverage, hoping and praying that they don’t get seriously sick.  My sister is a prime example of the risk you take when you don’t have health insurance.  An injury, followed in rapid succession by an illness, required extensive care, depleting what little savings she had and leaving her in debt.  She always worked somewhere, but only managed to find jobs in the service industry, low-wage endeavors that did not provide insurance to employees.      

December 7, 1964  from a newspaper in the national archives

Says Medicare Bill Will Be Passed

Newark – Speaking at a meeting of the New Jersey Association of Health Underwriters at the Military Park Hotel here Friday, Joseph J. Sear, president and chairman of the board of the Progressive Life Insurance Company of Red Bank, said the outcome of the recent election makes it virtually certain that the 89th Congress, meeting in January, will pass a Medicare bill, and that it will be signed by the President.

“We, in the accident and health insurance business,” he said, “should have no fears that the passage of such a bill will hurt our business unless it becomes the opening wedge for a socialized medicine program such as in Great Britain, which includes everyone from cradle to the grave. The bill before Congress is generally restricted to providing medical aid for persons 65 years of age and older under the Social Security Program, and we are still insuring primarily persons below the age of 65.

“Since I last spoke to you 13 years ago, (note: 1951) the people cared for by hospital expense policies increased from $85 million to $145 million and the people cared for by medical expense policies increased from $28 million to $102 million, and the trend is still upward.”

Forty Six Years Later

March 23, 2010. Patient Protection and Affordable Care Act (PPACA), aka Dole/Nixon/RomneyObamaCare, signed into law by “Democratic” President.   2009 Bill passed by Senate still lacks universal coverage and the option of purchasing government insurance, but contains universally loathed tax mandate and excise tax pushed by “Democratic” Senator from Massachusetts and WH “Economist” consultant from MIT.  Bill not designed to add more Medicaid coverage until 2014.   http://en.wikipedia.org/wiki/P…

September 17, 2010. Number of uninsured Americans now rises to 50.7 million, or 1 out of 6, or 16%.   Workers now paying 47% more for family health insurance coverage than in 2005, while employers pay 20% more.

http://www.usatoday.com/news/n…

January 3, 2011 New Republican Majority leader Eric Cantor introduces bill to rules committee called “Repealing the Job Killing Health Care Law Act”   “Effective as of the enactment of Public Law 111- 148, such act is repealed, and the provisions of law amended or repealed by such Act are restored or revived as if such act had not been enacted.”

pdf download text here: http://rules-republicans.house…

January 4, 2011  from Kaiser Health News-

House Republicans have scheduled a Jan. 12 vote to repeal the health care law. While the measure is expected to pass the House, Democrats in the Senate have pledged to stop the bill.

http://www.kaiserhealthnews.or…

January 5, 2011 Shuffle the Deck Chairs on the Titanic

The Office of Consumer Information and Insurance Oversight, created just after the law passed, is about to be folded into the federal Medicare agency, signaling a major organizational shift just months after the office was created, administration officials said.

In addition, Michael Hash, who has been serving as a top White House health adviser, has taken the reins of the Office of Health Reform at the Department of Health and Human Services. Hash succeeds Jeanne Lambrew,  who has been director of the office since May 2009 and has played a central role on the health law. Lambrew, a former aide to President Bill Clinton, will stay on at HHS as an adviser to Secretary Kathleen Sebelius.

The insurance oversight office was headed by Jay Angoff, who battled with insurance companies both as a Missouri official and a class-action litigator. He’ll become a senior adviser to Sebelius.

The office will become part of the Centers for Medicare and Medicaid Services, and will be managed by Marilyn Tavenner, deputy administrator of CMS.

http://www.kaiserhealthnews.or…

January 5, 2011.   Blue Shield of CA seeks rate increases of up to 59% for customers by March 1st. They blame costs of hospitals

http://www.latimes.com/health/…

Hospitals treat the un insured when their health descends into the most expensive crisis mode,  and pass the markup, make it up prices along to the insured, while charging the uninsured the highest rates, so they can still have their debts “sold.”

And nothing has changed the basic dynamic of leaving a portion of the population uncovered to act as a price lever on the rest.

Nothing.

A million and a half people filed for bankruptcy last year.  The leading cause is uncontrolled medical debt.

Blue Shield spent $16 million on federal lobbyists in 2010.  The top recipient was “Democrat” There Will Be No Public Option Blanche, the former Sen. Lincoln of Arkansas.  Eric Cantor got $22,500.

http://www.opensecrets.org/org…

They have a PAC, too, for their executives to use.

http://www.campaignmoney.com/p…

There’s more – each of those executives will be making other, individual donations.

But in CA, the real action is at the state level.  How they loved Schwarzenegger, the ex governator.  And the Republicans. And the Democrats.  Last year’s money bomb:

http://cal-access.ss.ca.gov/Ca…

http://cal-access.ss.ca.gov/Ca…

most complete list of donations in 2009 – 2010 election cycle:

http://cal-access.ss.ca.gov/Ca…

Poor Jerry Brown only got $2,500 out of all of that ?  

 

Something not particularly well known about Social Security Disability is that after two years, a disabled person, regardless of age, is eligible for Medicare.  An eligible person isn’t just given the option, he or she is automatically moved to the program unless he or she specifically declines it.  Until that point, a disabled person usually has to make do with Medicaid and all of its maddening restrictions and budget shortfalls.  One would think that the ability to transition to a better program for health insurance would be reason for celebration.  In some ways, it is, but in unexpected ways, it has not proven to be been appreciably better.

This is huge in so many ways, to many for a non medical professional like myself to break it all down.

New Insurance Rules: Free Preventive Health Care