Friday, June 29, 2012

Health Care Reform Articles-JULY 3, 2012

Competing for Better Outcomes and Lower Costs

Victor R. Fuchs

Doctor as scientist, healer, magician, business entrepreneur, small shopkeeper, or assembly line worker — which is it? (Essay 30)

Doctor as scientist, healer, magician, business entrepreneur, small shopkeeper, or assembly line worker — which is it?

Bernard Lown, MD

June 26, 2012

Obama, for the Win!

Republicans are apoplectic. They’ve lost again.
The Supreme Court ruling on Thursday that largely found President Obama’s signature health care law to be constitutional left them floundering and fuming.
The conservative chief justice, John Roberts Jr., joined the liberal wing of the court in doing so, much to the ire of Republicans.
According to Politico, “Indiana congressman and gubernatorial candidate Mike Pence likened the Supreme Court’s ruling upholding the Democratic health care law to the Sept. 11 terrorist attacks,” during a closed-door House G.O.P. meeting. He later apologized.
Senator Rand Paul, a Republican from Kentucky and the son of former presidential candidate Ron Paul, issued a statement that seemed to suggest that the court doesn’t even have the authority to make the ruling. It read in part: “Just because a couple people on the Supreme Court declare something to be ‘constitutional’ does not make it so. The whole thing remains unconstitutional.”

Did John Roberts Give Mitt Romney A Gift?

By Marcia Angell, M.D.
The Huffington Post, June 29, 2012
The Supreme Court's decision to uphold the Affordable Care Act, aka Obamacare, puts me in mind of the old proverb: Be careful what you wish for. Democrats on a victory lap should watch their step, because John Roberts may have given Mitt Romney a gift. The impact on the health system will be much smaller than the political fallout, because with or without Obamacare, the American health system will continue to unravel -- quickly if Romney is elected, slowly if Obama is re-elected.
First the policy, then the politics:
Obamacare is simply incapable of doing what it is supposed to do -- provide nearly universal care at an affordable and sustainable cost. The problem is that three years ago, in his futile efforts to win over Republicans (remember the embarrassing courtship of Olympia Snowe?), Obama gutted the law before it was even passed. He made the private insurance companies the linchpin of the new system, and promised them millions of additional customers and billions of taxpayer dollars. He also did nothing to rein in the profit-oriented delivery system that rewards providers on a piecework basis for doing tests and procedures. So with all the new dollars flowing into the system and no restraints on the way medicine is practiced, the law is inherently inflationary.
Although there are some provisions to curb the worst abuses of the insurance companies, such as excluding people with preexisting conditions, there is nothing in the law that would stop insurers from raising premiums. A senior executive of the industry's trade association, America's Health Insurance Plans, told me privately that that's exactly what the companies will do if regulations cut into their profits. Thus, costs under Obamacare will almost certainly rise even faster than at present. No reform can work well or very long if its costs are unsustainable.
In fact, it is unlikely that Obamacare will ever be fully implemented as it stands. If Romney is elected, with a Republican Congress, it will be quickly overturned. If Obama is re-elected (and I hope he is, despite my disappointment in his health plan), it will come apart more slowly. But unravel it will, as costs rise and it becomes clear that there are still tens of millions of Americans priced out of the system.
Here's how the unraveling will look:

Next Battleground of Health Care Debate

WASHINGTON — Shortly after the U.S. Supreme Court’s historic health care decision, Barack Obama and Mitt Romney appeared before the cameras to offer their spin. Neither took questions.
For weeks, both men had methodically calibrated their response to what was the most eagerly anticipated pre-election high court decision ever. The ruling settles the law, not the politics.
The outcome poses challenges for both presidential contenders. Mr. Obama’s claim that it means the country “can’t refight” the law is a pipe dream. Mr. Romney will be held accountable for his strong inconsistencies on health care and his refusal to offer serious alternatives.
The 5-to-4 decision upholding the central tenet of Obamacare, as Republicans call it, was a better result for the Democrats. If things had gone the other way, Mr. Romney could have credibly charged that Mr. Obama wasted two years on an unconstitutional measure, instead of focusing on the economy.
Yet Chief Justice John G. Roberts Jr., while handing the White House an overall victory, created new problems for Mr. Obama’s re-election, declaring the l

Soda Makers Begin Their Push Against New York Ban

Lobbyists from Coca-Cola and other big soda companies have met with mayoral candidates and City Council members. Canvassers hired by the beverage industry are stopping New Yorkers on the street to solicit signatures on petitions. Facebook and Twitter pages tell readers to “say no to a #sodaban.”
Confronting a high-profile attack on its fizzy products, the American soft-drink industry is beginning an aggressive campaign to fight New York City’s proposed restrictions on large servings of sugary drinks.
Hoping for a debate about freedom, not fatness, the industry has created a coalition called New Yorkers for Beverage Choices to coordinate its public relations efforts in the city. On Thursday, the group introduced its first radio spot, a one-minute advertisement featuring “Noo Yawk”-accented actors proclaiming, “This is about protecting our freedom of choice.”
“This is New York City; no one tells us what neighborhood to live in or what team to root for,” says the narrator, as Yankees and Mets fans shout in the background. “So are we going to let our mayor tell us what size beverage to buy?” Adds one Brooklyn-tinged voice: “It’s unbelievable!”
The charge is being led by the industry’s leading trade group, the Washington-based American Beverage Association, which has retained several powerhouse political consultants for the cause, including the strategists responsible for the “Harry and Louise” television advertisements that helped defeat President Bill Clinton’s health care plan in the 1990s.

Consumer Questions on Health Care Act, and the Answers

Q. Now what? The law is upheld, so where does it go from here?
A. Now the scramble to enact the law continues. Unless the law is repealed by Congress, most of the major changes take effect on Jan. 1, 2014. By then, states must have set up health insurance exchanges, where people can buy coverage. Insurers will have to offer policies to anyone who applies, including people with expensive medical conditions. And people who do not qualify for exemptions based on income or religion will be required to have minimum insurance coverage or pay a penalty.
Q. In what way was the Medicaid expansion “limited”? What is the meaning of this portion of the decision?
A. The Supreme Court’s decision means that the Medicaid expansion is now an option for states, not a requirement. If states do not participate, experts have speculated that it could create a subset of people who earn too much to qualify for Medicaid — the exact threshold varies — but not enough to qualify for the tax credits that would help them pay for insurance. States will not have to pick up the added costs of the Medicaid expansion until 2016. After that, the federal government will gradually reduce its contribution until it reaches 90 percent of the costs by 2020.

On health care, it’s Romney vs. Romney

Republicans discredit their own health insurance overhaul with attack on Obama’s plan

Posted June 29, 2012, at 3:14 p.m.
Maine Republicans are assailing President Barack Obama’s health care law by saying it amounts to a tax increase. Not only are they wrong, but it appears their memories are a little selective.Their own health insurance overhaul last year, which they will continue to champion on their campaign trails, included a tax.
If Republicans are going to argue against the Patient Protection and Affordable Care Act, they should first make sure they’re not also delegitimizing their own law.
The Republican argument stems from the fact that five justices agreed on Thursday that the penalty people must pay if they refuse to purchase health insurance is a kind of tax. Because Congress has taxing power, the requirement that virtually all Americans buy insurance is constitutional.
But even though the swing vote came from a conservative — Justice John Roberts Jr. — and even though Maine Republicans last year passed a health insurance reform bill, LD 1333, that included a provision to add a $4 charge to the monthly premium of Mainers with private coverage, some in the GOP argue the health care act is wrong because its legality is based on tax law.
“This massive tax hike will only destroy the American economy as it forces us over the financial cliff,” reads a press release from Gov. Paul LePage’s office issued after the U.S. Supreme Court ruled Thursday that Obama’s health care law is constitutional.
Maine Senate President Kevin Raye, who is running for the U.S. House, called it “an unprecedented coercive new tax.” Olympia Snowe, Maine’s retiring Republican senator, said it will “impose an onerous tax.”
The law, however, is not projected to equate to a tax increase for the vast majority of Mainers or Americans. Most people already have insurance through their employers, Medicaid or Medicare. An Urban Institute study found that of the 26.3 million people currently uninsured, about 70 percent of them qualify for tax credits to help them pay for a qualified plan.

Cranky Uncles, for Better or Worse, Will Lurk in More Exam Rooms

Money has always played a role in health care, even back in the good old days when Hippocrates charged a drachma or two for a second opinion. Back then it was the coin of the realm that healed the sick, and now, thanks to the upheld individual insurance mandate, it is going to be a little plastic card for all.
So nothing has really changed, right?
Health insurance is more than a cash equivalent. It is cash with strings attached, like a rich uncle with deep pockets but a volatile personality, munificent one minute and stingy the next. This is an uncle who takes you to the doctor but refuses to wait out front with a magazine: He is right there in the exam room with you, commenting on everything. Sometimes he peels the big bills out of his wallet with a smile, and sometimes he scowls, shakes his head and yanks you by the sleeve out the door.

The Price of Health Care

“IT is not our job,” Chief Justice John Roberts Jr. wrote in Thursday’s health care ruling, “to protect the people from the consequences of their political choices.” He might just as easily have written, “to protect politicians from the consequences of their political choices.” And now, with the Supreme Court parenthesis out of the way, we can get back to finding out exactly what those consequences will be.
For President Obama, the consequences of health care may still be fatal to his re-election hopes. The choice to go all-in on reform was the most important call of the Obama presidency, and from a purely political perspective it has proved the most disastrous one. Thursday’s decision won’t change this reality: Victory at the Supreme Court was obviously preferable to defeat, but the chief justice’s grudging imprimatur is unlikely to make a deeply unpopular piece of legislation suddenly popular instead.
Liberals have persuaded themselves that this unpopularity is largely the product of conservative misinformation and voter ignorance. But it’s really a result of the gulf that opened in 2009 between the public’s priorities and the president’s agenda. By turning from economic crisis management to sweeping social legislation before the crisis had actually abated, Obama made himself look more ideological than practical and more liberal than pragmatic. By continuing to push for the largest possible bill even after the public backlash had elected a Republican senator in Massachusetts, he made himself look wildly out of touch as well.

Health Care Reform Articles-June 29, 2012

Supreme Court Lets Health Law Largely Stand, in Victory for Obama

WASHINGTON — The Supreme Court on Thursday upheld President Obama’s health care overhaul law, saying its requirement that most Americans obtain insurance or pay a penalty was authorized by Congress’s power to levy taxes. The vote was 5 to 4, with Chief Justice John G. Roberts Jr. joining the court’s four more liberal members.
The decision was a victory for Mr. Obama and Congressional Democrats, affirming the central legislative achievement of Mr. Obama’s presidency.
“The Affordable Care Act’s requirement that certain individuals pay a financial penalty for not obtaining health insurance may reasonably be characterized as a tax,” Chief Justice Roberts wrote in the majority opinion. “Because the Constitution permits such a tax, it is not our role to forbid it, or to pass upon its wisdom or fairness.”
At the same time, the court rejected the argument that the administration had pressed most vigorously in support of the law, that its individual mandate was justified by Congress’s power to regulate interstate commerce. The vote was again 5 to 4, but in this instance Chief Justice Roberts and the court’s four more conservative members were in agreement.
The court also substantially limited the law’s expansion of Medicaid, the joint federal-state program that provides health care to poor and disabled people. Seven justices agreed that Congress had exceeded its constitutional authority by coercing states into participating in the expansion by threatening them with the loss of existing federal payments.
Justice Anthony M. Kennedy, who had been thought to be the administration’s best hope to provide a fifth vote to uphold the law, joined three more conservative members in an unusual jointly written dissent that said the court should have struck down the entire law. The majority’s approach, he said from the bench, “amounts to a vast judicial overreaching.”

Supreme Court upholds Obama’s health-care law

By Published: June 28

Chief Justice John G. Roberts Jr. on Thursday joined the Supreme Court’s liberals to save the heart of President Obama’s landmark health-care law, agreeing that the requirement for nearly all Americans to secure insurance is permissible under Congress’s taxing authority.
The court’s 5 to 4 ruling was a stunning legal conclusion to a battle that has consumed American politics for two years. Roberts’s compromise offered a dramatic victory for Obama and Democrats’ decades-long effort to enact a health-care law and a bitter defeat for Republicans and tea party activists, who had uniformly opposed the Patient Protection and Affordable Care Act.
The decision keeps in place the largest new social program in a generation, a major overhaul of the health-care system that could extend coverage to about 30 million Americans. It creates state-run insurance exchanges and eliminates what have been some of the most unpopular insurance practices.
The ruling did limit one significant portion of the law, which sought to expand Medicaid to cover millions more poor and disabled people. The program is a joint federal-state effort, and the court said the law’s requirement that states rapidly extend coverage to new beneficiaries or lose existing federal payments was unduly coercive.
Obama welcomed the justices’ decision, which he called “a victory for people all over this country whose lives will be more secure.”
At the core of the legislation is the mandate that Americans obtain health insurance by 2014.

G.O.P. Vowing to Take Battle Over Health Care Law Into November

WASHINGTON — Mitt Romney and other Republicans who oppose the health care law are looking ahead to one remaining avenue of appeal: the ballot box in November.
Taken aback by the Supreme Court ruling on Thursday that upheld the constitutionality of the law, Mr. Romney and Congressional Republicans pledged to intensify their efforts to repeal it, an argument that will be a crucial element of the party’s quest to galvanize conservative activists and win control of the White House and the Senate.
Republicans swiftly sought to turn the court’s reasoning against President Obama, recasting the legislation as a tax increase. Mr. Romney, who as governor of Massachusetts signed a similar health care law, was one of the few in his party who did not join in that argument. Instead, he criticized the ruling and called the federal law a job killer that inserted the government between patients and their doctors.
For Mr. Obama, the Supreme Court victory blunted efforts by his opponents to brand him as a feckless and failed leader who invested too much time trying to overhaul the health care system as the economy foundered.
In an example of the conservatives’ determined drive against the president, the House voted just hours after the Supreme Court decision to hold Attorney General Eric H. Holder Jr. in contempt of Congress.
Still, the health care ruling validated, for now, the president’s gamble in pushing through the most ambitious domestic legislation of his administration, and it energized his re-election campaign at the close of an otherwise frustrating stretch.

Roberts Shows Deft Hand as Swing Vote on Health Care

WASHINGTON — Chief Justice John G. Roberts Jr. has a favorite quotation from one of the giants who preceded him on the Supreme Court. Assessing the constitutionality of a law passed by Congress, Justice Oliver Wendell Holmes Jr. once wrote, “is the gravest and most delicate duty that this court is called on to perform.”
In finding a way to uphold President Obama’s health care overhaul law on Thursday, Chief Justice Roberts performed the task with exquisite delicacy. That he did was a surprise from a judge whose rulings and background, including legal work in the administrations of President Ronald Reagan and the first President George Bush, suggested a conventionally conservative worldview.
To be sure, the chief justice considers himself the custodian of the Supreme Court’s prestige, authority and legitimacy, and he is often its voice in major cases. There was reason, then, to think he might have provided a sixth vote to uphold the law had Justice Anthony M. Kennedy joined the court’s four-member liberal wing. That would have allowed Chief Justice Roberts, the thinking went, to write a narrow, grudging majority opinion. But almost no one thought that he would provide the fifth vote, joining only the liberals, to uphold a Democratic president’s signal legislative achievement.
The court Chief Justice Roberts leads is not leaving the national spotlight. The next term already includes a major case on affirmative action in higher education, and cases on voting rights and same-sex marriage are likely to follow. All will test the chief justice’s leadership, and the novel alignment in Thursday’s case is unlikely to be repeated. In cases concerning the role of race in admissions and voting, he is likely to take his usual place with the court’s conservatives. In cases on gay rights, Justice Kennedy is likely to be the swing vote.

A Vindication, With a Legacy Still Unwritten

WASHINGTON — For Barack Obama, who staked his presidency on a once-in-a-generation reshaping of the social welfare system, the Supreme Court’s health care ruling is not just political vindication. It is a personal reprieve, leaving intact his hopes of joining the ranks of Franklin D. Roosevelt, Lyndon B. Johnson and Ronald Reagan as presidents who fundamentally altered the course of the country.
For all its weight, however, the judgment does little to settle the bitter debate, spanning decades, over the proper role of government in American life. That debate rages on, with the next acid test only four months away — an election that will give voters the chance to render their verdict on Mr. Obama’s ambitious legacy.
What the Supreme Court’s decision does do is preserve Mr. Obama’s status as the president who did more to expand the nation’s safety net than any since Johnson. It preserves a bill intended to push back against rapidly rising income inequality. And for a self-consciously historic figure, it allows Mr. Obama to argue that he has delivered on the most cherished goal of his 2008 campaign: “Change we can believe in.”
“Historians will compare this to F.D.R.’s Social Security and Lyndon Johnson’s Medicare,” said the historian Robert Dallek, who has written about both presidents. “This is another step in humanizing the American industrial system.”
In political terms, said Douglas G. Brinkley, a professor of history at Rice University, “It’s the cornerstone of what could turn out to be one of the most extraordinary two-term presidencies in American history.”
Beyond his legislative agenda — not just on health care, but on education and Wall Street regulation — Mr. Obama has sketched out a view of government as a force for good, a great leveler and a protector of the middle class. That view stands in stark contrast to the Republican mantra, articulated by Reagan, who headed in the opposite direction in his first inaugural address, saying that “government is not the solution to our problem; government is the problem.”

The Real Winners

So the Supreme Court — defying many expectations — upheld the Affordable Care Act, a k a Obamacare. There will, no doubt, be many headlines declaring this a big victory for President Obama, which it is. But the real winners are ordinary Americans — people like you.
How many people are we talking about? You might say 30 million, the number of additional people the Congressional Budget Office says will have health insurance thanks to Obamacare. But that vastly understates the true number of winners because millions of other Americans — including many who oppose the act — would have been at risk of being one of those 30 million.
So add in every American who currently works for a company that offers good health insurance but is at risk of losing that job (and who isn’t in this world of outsourcing and private equity buyouts?); every American who would have found health insurance unaffordable but will now receive crucial financial help; every American with a pre-existing condition who would have been flatly denied coverage in many states.
In short, unless you belong to that tiny class of wealthy Americans who are insulated and isolated from the realities of most people’s lives, the winners from that Supreme Court decision are your friends, your relatives, the people you work with — and, very likely, you. For almost all of us stand to benefit from making America a kinder and more decent society.

Modesty and Audacity

Washington is full of arrogant people who grab power whenever they get the chance. But there is at least one modest minimalist in town, and that’s John Roberts Jr.
In his remarkable health care opinion Thursday, the chief justice of the Supreme Court restrained the power of his own institution. He decided not to use judicial power to overrule the democratic process. He decided not to provoke a potential institutional crisis. Granted, he had to imagine a law slightly different than the one that was passed in order to get the result he wanted, but Roberts’s decision still represents a moment of, if I can say so, Burkean minimalism and self-control.
Roberts and six colleagues also restrained the power of the federal government to sanction the states. And, perhaps most important, he restrained future Congressional power.
Over the years, the commerce clause in the Constitution has been distorted beyond recognition, giving Congress power to regulate all manner of activity (or inactivity). Roberts redefined the commerce clause in a way that limits the power of Washington. Congress is now going to have to be very careful when it tries to use the tax code and other measures to delve into areas that have, until now, been beyond its domain.
Roberts’s modest stance is generally consistent with how he has behaved over the last several years. There’s been a lot of overwrought and misleading liberal commentary on the supposed ideological activism of this court. In fact, with a couple obvious exceptions, this court has been remarkably modest. According to a 2010 analysis by The Times, the Warren, Burger and Rehnquist courts overturned an average of nine laws a term, while the Roberts court has overturned an average of three laws a term.

A Justice in Chief

The title "chief justice of the United States" is not in the Constitution, and neither was it in the first Judiciary Act by which Congress organized the federal courts. It came into use only casually and gradually, by the late 19th century replacing the favored "chief justice of the Supreme Court of the United States." Even today, people often mangle the title as "chief justice of the Supreme Court."
The mangled title is one that John G. Roberts Jr. would have had trouble claiming on Thursday. In his controlling opinion in the health care case, he spoke largely for himself. In 42 of his 59 pages, he spoke for none of his fellow justices. He led no one.
But the title that he actually goes by, chief justice of the United States, seemed a good fit. He spoke for the country.
His decision to call the mandate a tax and to provide a clearly reluctant fifth vote for upholding it as within the Congressional taxing power was a deeply pragmatic call that saved the Affordable Care Act. Certainly by no coincidence, it also saved the Supreme Court from the stench of extreme partisanship that has hung over the health care litigation from the moment more than two years ago that Republican state officials raced one another to the federal courts to try to erase what they had been unable to block.
There is much to parse in the 193 pages of opinions in National Federation of Independent Business v. Sebelius. In its treatment of Congress's power under the Commerce Clause (only the four most liberal justices would have upheld the law on commerce grounds) and its limited view of federal power to place conditions on states' receipt of federal money, the decision may have implications that extend well beyond this case.

Romney’s Supreme Burden

Congratulations to Mitt Romney! His signature contribution to American life, devising a health plan that became a model for the only major Western democracy without medical care for nearly all of its citizens, has been upheld. If Romney accomplishes nothing else in life, he will go down in history as the man who first proved, in the laboratory of Massachusetts, where he once governed, that an individual mandate could work.
Jeers to Mitt Romney! As the presumptive Republican nominee for president, he stood in front of the Capitol just after the Supreme Court ruling on Thursday and promised to fight in the coming campaign against one big idea - his own.
Now Romney has no choice but to run against himself. It was Rick Santorum who put it in blunt political terms during the Republican primary. Romney, he said, "is the worst Republican in the country to put up against Barack Obama" because he is the intellectual godfather of the most consequential act of the Obama presidency.

If Romney was honest, and his party less locked in the grip of its far-right base, he could point with pride to the progress that Massachusetts has made. In the Bay State, compliance with the law is high, and nearly two-thirds of the people support it. The cost of insurance fell significantly in the first year after the law took effect. And fewer than 1 percent of the people chose to pay the penalty - or tax, as Chief Justice John G. Roberts Jr. helpfully clarified for Obamacare - rather than sign up for health insurance.
But the days of Romney praising his plan, which he did as recently as 2009, are long gone. Remember, it was in a moment of debate candor that Romney turned to Newt Gingrich and acknowledged the free-market, Republican origins of the mandate.
"We got the idea from Newt," said Romney. "And Newt got it from the Heritage Foundation." And the idea is a simple one: freeloaders cost the system billions and indirectly raise insurance for those who do the right thing.
JUNE 28, 2012, 5:20 PM

The Two Big Questions on Health Care

THERE are two great mysteries about the Supreme Court's ruling on the Affordable Care Act that befuddle commentators. First, why was Chief Justice John G. Roberts Jr. the crucial fifth vote upholding the requirement that individuals buy health insurance? And what will be the impact of declaring unconstitutional the penalty for states that decide not to expand their Medicaid programs to everyone who earns less than 133 percent of the income defined as the poverty level?
Obviously there are other considerations that may have motivated the ruling from Chief Justice Roberts, like not wanting his court to be tarred with another very controversial, politicized decision, but we should not overlook the role his health might have played.
Chief Justice Roberts has a pre-existing condition but is just 57, and thus not eligible for Medicare. Remember his unexplained seizure soon after he became chief justice? If he did not have employer-provided insurance and had to get his own coverage on the individual market, he would be denied health insurance coverage at almost any price. Maybe the appreciation for his precarious insurance status made Chief Justice Roberts more sensitive to the need for the Affordable Care Act and its requirement that insurance be available to all of those with pre-existing conditions.
In a 7-to-2 decision, with Justices Elena Kagan and Stephen G. Breyer joining the five conservatives, the court ruled that the new provisions of the act giving coverage to all Americans under 133 percent of the poverty level constituted not an expansion of the program but actually a new Medicaid program. Threatening states that did not adopt this provision with termination of all their matching federal Medicaid money, the court said, constituted "a shift in kind, not merely degree." The court viewed this Medicaid provision as coercion - "withholding of 'existing Medicaid funds' is 'a gun to the head' " - that would force states to acquiesce.
How are states likely to respond? For ideological reasons some states, like Texas or Florida, may decide not to expand their Medicaid programs. But for most states, the Medicaid expansion contained in the act is simply too good a deal to pass up.

Ruling frames Obama battle with Romney

The battle over the nation’s health care law shifted from the courtroom to the ballot box Thursday, with President Obama praising the Supreme Court’s decision as a landmark that will help all Americans, and Mitt Romney, his presumed opponent, pledging to make repeal his first priority as president.
“The highest court in the land has now spoken. We will continue to implement this law. And we’ll work together to improve on it where we can,” Obama said in brief remarks at the White House.
Minutes earlier, Romney excoriated the 5-4 decision.
“If we want to get rid of Obamacare,” Romney said, “we’re going to have to replace President Obama.”

Investors take health care ruling in stride

It isn’t every day that the Supreme Court gives a jolt to 18 percent of the American economy.
Of course I’m talking about the health care industry, and maybe it’s a stretch to use a word like jolt to describe the impact of any decision that essentially upholds an enacted law.
But the court news caught me by surprise, and I had plenty of company. The ruling altered conventional wisdom on health care, even if the law still faces another challenge in the presidential election this fall.
Anyone who believes that the cost and complexity of the health care law would deal a serious blow to the nation’s economy didn’t see that concern reflected in the stock market Thursday. Big market indexes fell moderately on news of the ruling, but stocks were already down. Investors were much more worried about banking-sector problems and the latest economic waffling in Europe.
interesting activity. Overall, those stocks lost modest ground on Thursday.

Supporters remember, hail Kennedy’s influence

WASHINGTON — In the anticipation before and subsequent tumult after the Supreme Court’s ruling, one memory repeatedly flowed from the lips and signs of supporters of the health care law.
“Now he can rest in peace,’’ House Democratic leader Nancy Pelosi said, referring to Edward M. Kennedy. “His dream for America’s families has become a reality.”
Kennedy had frequently alluded to the long struggle for health care coverage for all Americans as the fight of his life. In the early 1970s, he crisscrossed the country, holding a series of forums on the issue. Upon returning to the capital, Kennedy proposed a far-reaching bill that would essentially provide coverage for all Americans, as Medicare does for seniors.

A victory for Obama — and for Roberts

By Published: June 28

The Supreme Court’s decision upholding the health-care law is not only a huge victory for President Obama, but also a moment of leadership for Chief Justice John Roberts. The court’s mixed verdict could create problems, notably in its weakening of the law’s Medicaid provisions in the name of states’ rights. While the impact of this part of the ruling is not fully clear yet, the court may have effectively denied health-care coverage to a large number of poorer Americans.
But the headline victory for the law was of enormous importance to Obama. Had the court knocked the Affordable Care Act down, all the spin in the world would not have undone the damage this would have been inflicted on the president, his political standing and his legacy. Thanks to this ruling, the broad structure of the largest domestic achievement of the Obama legacy remains intact. It gives him bragging rights in the campaign, and in history. And for those who support universal coverage, the fact that the law remains on the books offers an opportunity to build on it in the future.
Obama was wise to use his address to the nation on the court’s decision to restart the effort to explain what the Affordable Care Act actually does and the benefits it offers to Americans who already have health insurance, those who are worried about losing it and those who would like to get it but cannot now afford it. By putting the health-care law at the center of the news, the court case gave the president and other supporters a second chance to do what they should have done more effectively in the first place. It was a nice touch for Obama to try to turn the law’s low rating in the polls to his benefit. “It should be pretty clear by now,” he said, “that I didn’t do this because it was good politics.” He was also smart to speak briefly, and to avoid triumphalism.

Dana Milbank: The umpire strikes back

By Published: June 28

John Roberts was the first justice to appear from behind the curtains when the buzzer sounded in the Supreme Court chamber at 10 a.m. sharp. He forced a tight grin and scanned the audience, which, on this historic day, included several members of Congress and retired Justice John Paul Stevens. The only hint of what was afoot came from Justice Antonin Scalia, who, taking his place at the chief justice’s right, bowed his head as if in mourning.
“I have the opinion in NFIB v. Sebelius ,” Roberts announced matter-of-factly, as if stating that he was about to admit a new crop of lawyers to the Supreme Court Bar. His words were so measured and his delivery so calm that 14 minutes elapsed before he signaled which way the decision had gone — by answering those who wanted to declare the Obama health-care law unconstitutional with these two dreaded words: “we disagree.”
In the audience, Sen. Orrin Hatch (R-Utah), an opponent of the law, folded his arms across his chest, his mouth slightly agape. Sen. John Barrasso (R-Wyo.) put his chin in his hand. Rep. Tom Price (R-Ga.), a leader of House conservatives, shook his head. Scalia was reclining in his chair, staring blankly. Justice Clarence Thomas was practically horizontal.

Court ruling leaves deep MaineCare cuts in question

Posted June 28, 2012, at 7:08 p.m.
The U.S. Supreme Court’s decision to let states opt out of the federal health reform law’s sweeping expansion of Medicaid revived uncertainty Thursday over the LePage administration’s planned cuts to health coverage for poor Mainers.
MaineCare, the state’s Medicaid program, provides health insurance to low-income residents. President Barack Obama’s landmark health reform law expands Medicaid by using the program to cover 17 million Americans who earn less than 133 percent of the federal poverty line, or about $14,500 for an individual.
Under the Patient Protection and Affordable Care Act, states would get substantial additional federal dollars to help cover the costs of the expansion. States that didn’t extend Medicaid coverage to the poor risked losing all federal funding.
The justices ruled that the federal government cannot pull existing Medicaid funding from states that opt out of the law’s call to greatly expand the program. That frees states to skip the expansion — or even reduce some Medicaid services — without penalty.
What remains unclear is whether states can cut some Medicaid spending without federal permission, which Gov. Paul LePage proposed and the Legislature approved earlier this year.
Typically, states split the bill for Medicaid with the feds, but under the ACA, the federal government will pay for all new beneficiaries through 2016. The match starts to drop in 2017, settling at 90 percent after 2020, which may not be enough to entice some states to accept the financial burden of new patients.

Now it’s up to Congress

Posted June 28, 2012, at 4:20 p.m.
The battle over the nation’s health care system now shifts to Congress. The Republican-controlled U.S. House, as expected, promises to continue to try to repeal the 2010 reform that the U.S. Supreme Court has now largely upheld.
But the present U.S. Senate, with a Democratic majority, is most unlikely to agree on repeal.
Party leaders promptly laid down their positions. Majority Leader Sen. Harry Reid said that the matter is settled and both parties should now turn to job creation and securing the economy.
Republican leader Sen. Mitch McConnell said the decision “makes one thing clear: Congress must act to repeal this misguided law.”
With Congress divided on the issue, the outcome may depend on the November election. If Mitt Romney wins the presidency and Republicans control both houses, they will most likely attempt to repeal Obamacare, as the new law is often called. But it could hinge on whether Republicans are able to prevent a filibuster, which is very unlikely.
When Romney learned of the decision, he said: “If we want to get rid of Obamacare, we are going to have to replace President Obama.” But the Republicans then would have to come up with something to take its place.
If Obama wins re-election and the Democrats keep or extend their control of the Senate, they will carry out the current and future terms of the law and may refine some of its provisions. A win for the Democrats might even lead to converting the system into a single-payer plan, which would cover all Americans instead of leaving out a substantial number. It would be something like extending Medicaid from the elderly and disabled to all Americans.

Supreme Court health care ruling supreme indeed

The decision on President Barack Obama’s most important domestic policy is in: Requiring people to purchase health insurance is constitutional.
The U.S. Supreme Court ruled Thursday that Congress was correct in requiring nearly every American to purchase health insurance before 2014 or else pay a financial penalty with their tax returns.
The decision in National Federation of Independent Business, et al., v. Sebelius, secretary of Health and Human Services, et al., is an enormous and historic step to repair our health care system and provide coverage to the uninsured. Though it is just that: a step.
Five justices agreed that the fee someone must pay if he or she refuses to purchase health insurance is a kind of tax. Since Congress has taxing power, the individual mandate stands. That’s why it doesn’t matter that the justices didn’t uphold the law on the ground that Congress could use its power in this instance to regulate commerce between states.
The court also held that the part of the Patient Protection and Affordable Care Act that requires states to impose new eligibility requirements for Medicaid, or risk losing funding, is constitutional — as long as states only potentially lose new funding, not all their funding.
The decision was possible because of the swing vote of conservative Chief Justice John Roberts Jr.
According to the U.S. Department of Health and Human Services, so far the law has benefited Mainers by doing the following:

For Maine, ruling will be felt almost immediately

Maine was one of 26 states to challenge the Obama administration’s health care reform law all the way to the Supreme Court.
But Mainers are just as passionately divided about the Affordable Care Act as other Americans. 
As news of the historic decision swept through the state Thursday, it brought joy and relief to some and frustration and disgust to others.

Heart of health law still beating

Roberts leads way in ruling that upholds Obama's law

By ROBERT BARNES The Washington Post
WASHINGTON - Chief Justice John Roberts on Thursday joined the Supreme Court's liberals to save the heart of President Obama's landmark health care law, agreeing that the requirement for nearly all Americans to secure insurance is permissible under Congress' taxing authority.
1:00 AM 

Our View: Decision moves reform back into political arena

Controversy over the health care law is far from over as Romney and Obama head into November.

If you'd been thinking that the Supreme Court's ruling on President Barack Obama's controversial health care law would settle the argument once and for all, well, think again.
If anything, Thursday's 5-4 decision upholding the constitutionality of the Affordable Care Act added fuel to the fire that has burned so intensely since the law was passed more than two years ago.