The time bomb in Obamacare?
By George F. Will,
A willow, not an oak. So said conservatives of Chief Justice John Roberts when he rescued the Affordable Care Act (ACA) — a.k.a. Obamacare — from being found unconstitutional.But the manner in which he did this may have made the ACA unworkable, thereby putting it on a path to ultimate extinction.
This plausible judgment comes from professor Thomas A. Lambert of the University of Missouri Law School, writing in Regulation, a quarterly publication of the libertarian Cato Institute.
The crucial decision, he says, was four liberal justices joining Roberts’s opinion declaring that the ACA’s penalty for not complying with the mandate to purchase health insurance is actually a tax on not purchasing it. With this reasoning, the court severely limited the ability of the new health-care regime to cope with its own predictable consequences.
What was supposed to be, constitutionally, the dispositive question turned out not to be. Conservatives said that the mandate — the requirement that people engage in commerce by purchasing health insurance — exceeded Congress’s enumerated power to regulate interstate commerce. Liberals ridiculed this argument, noting that since the judicial revolution wrought during the New Deal, courts have given vast deference to Congress regarding that power. The ridicule stopped when five justices, including Roberts, agreed with the conservative argument.
This did not, however, doom the ACA because Roberts invoked what Lambert calls “a longstanding interpretive canon that calls for the court, if possible, to interpret statutes in a way that preserves their constitutionality.” Roberts did this by ruling that what Congress called a “penalty” for not obeying the mandate was really a tax on noncompliance.
This must, Lambert thinks, have momentous — and deleterious — implications for the functioning of the ACA. The problems arise from the interplay of two ACA provisions — “guaranteed issue” and “community rating.”
http://www.washingtonpost.com/opinions/george-will-the-time-bomb-within-obamacare/2013/01/18/673a113c-6108-11e2-9940-6fc488f3fecd_print.html
State's health insurance exchange gets $674-million federal grant
Covered California will use part of the money to market itself to the estimated 5 million Californians who will be eligible to use the health exchange.
By Chad Terhune, Los Angeles TimesJanuary 18, 2013
Federal officials awarded California's new health insurance exchange a $674-million grant, providing money for a crucial marketing campaign aimed at millions of uninsured consumers.
The state-run insurance exchange, Covered California, is seeking to fundamentally reshape the health insurance market by negotiating with insurers for the best rates and helping consumers choose a plan.
Enrollment in the program starts in October for policies going into effect Jan. 1, when much of the federal healthcare law kicks in.
Although some states have resisted President Obama's massive insurance expansion, California has been forging ahead to set up its online marketplace.
One of the key challenges is getting the word out to an estimated 5 million Californians who will be eligible to buy coverage in the exchange. About half of those people are uninsured and will be eligible for federal premium subsidies, according to state officials.
Peter Lee, the exchange's executive director, said the agency will draw on the
federal grant announced Thursday for a two-year, $250-million marketing campaign statewide.
At an exchange board meeting in Los Angeles on Thursday, consumer advocates and community activists urged officials to offer
information in multiple languages and to make online enrollment as simple as possible.
“Covered California is part of reinventing the healthcare system,” Lee said. “But we will get things wrong along the way.”
http://www.latimes.com/business/la-fi-health-insurance-grant-20130118,0,6285921,print.story
Slowly Dying Patients, An Audit And A Hospice's Undoing
Why concierge medicine will get bigger
Practices could shield patients from health-care turmoil
If you’ve joined a concierge medical practice, recent trends in the worlds of health care and insurance may have you feeling good about your decision. If you haven’t signed up with one of these practices—also called “boutique,” “personalized” or “private-physician” practices—some of those same trends may lead you to consider it down the road.
Medicaid Expansion Is Delicate Maneuver for Arizona’s Republican Governor
By FERNANDA SANTOS
PHOENIX — Gov. Jan Brewer called it “one of the most difficult decisions” of her 30 years in public service.
If she chose to expand Medicaid, the federal and state program that provides health care to poor and disabled people, she risked antagonizing her conservative base, steadfast opponents of President Obama’s health care law. If she did not, she risked missing a solid chance of shifting the way she is viewed by a Latino population of increasing political influence, beyond her stern positions on immigration.
Ms. Brewer, who has become something of a conservative icon for her aggressive opposition to Mr. Obama’s policies, surprised many Legislature watchers at her State of the State address last week by saying she wanted to expand the state’s Medicaid program to include anyone who makes up to 133 percent of the federal poverty level, or $14,856 for an individual. The risk if Arizona does otherwise, she said, is losing the federal funds and the health care jobs that come with the changes.
It could be simply a case of math trumping ideology: In 2014, the first full year of the expansion, Arizona stands to gain $1.6 billion in federal matching funds, Ms. Brewer said. (The federal government would cover the full cost of the new beneficiaries in the early years and 90 percent of the cost after 2020.)
Her fellow Republican governors in the Southwest, Susana Martinez of New Mexico and Brian Sandoval of Nevada, used a similar argument to justify their decisions to do the same thing. But it was Ms. Brewer whom National Review Online, the conservative publication, singled out for criticism in an editorial, saying she exemplified “that unfortunately common strain of Republican leadership that is uncompromising in rhetoric but opportunistic in reality.” Americans for Prosperity, the conservative advocacy group, also circulated a paragraph-by-paragraph rebuttal of the arguments she used to support her choice.
Expanding Medicaid is a central element in Mr. Obama’s plan to provide health coverage for virtually every American, as it could add as many as 17 million people to the rolls. Last month, his administration made it an all-or-nothing proposition, saying it would not cover partial expansions, a move that left many Republican governors who were hoping for such a middle-of-the-way option looking for a different way.
Congress is once again hard at work - but for who? :
-SPC
Fiscal Footnote: Big Senate Gift to Drug Maker
By ERIC LIPTON and KEVIN SACK
WASHINGTON — Just two weeks after pleading guilty in a major federal fraud case, Amgen, the world’s largest biotechnology firm, scored a largely unnoticed coup on Capitol Hill: Lawmakers inserted a paragraph into the “fiscal cliff” bill that did not mention the company by name but strongly favored one of its drugs.
The language buried in Section 632 of the law delays a set of Medicare price restraints on a class of drugs that includes Sensipar, a lucrative Amgen pill used by kidneydialysis patients.
The provision gives Amgen an additional two years to sell Sensipar without government controls. The news was so welcome that the company’s chief executive quickly relayed it to investment analysts. But it is projected to cost Medicare up to $500 million over that period.
Amgen, which has a small army of 74 lobbyists in the capital, was the only company to argue aggressively for the delay, according to several Congressional aides of both parties.
Supporters of the delay, primarily leaders of the Senate Finance Committee who have long benefited from Amgen’s political largess, said it was necessary to allow regulators to prepare properly for the pricing change.
But critics, including several Congressional aides who were stunned to find the measure in the final bill, pointed out that Amgen had already won a previous two-year delay, and they depicted a second one as an unnecessary giveaway.
“That is why we are in the trouble we are in,” said Dennis J. Cotter, a health policy researcher who studies the cost and efficacy of dialysis drugs. “Everybody is carving out their own turf and getting it protected, and we pass the bill on to the taxpayer.”
The provision’s inclusion in the legislation to avert the tax increases and spending cuts that made up the so-called fiscal cliff shows the enduring power of special interests in Washington, even as Congress faces a critical test of its ability to balance the budget.
Rethinking Medicare
Healthcare reform's fail-safe
Letting independent experts help rein in costs is not un-American. It's pragmatic.
January 20, 2013
Medicare's budget is expanding rapidly in part because medical costs are rising faster than inflation and in part because the number of beneficiaries is growing as masses of baby boomers retire. The Patient Protection and Affordable Care Act tries to slow that expansion with a slew of pilot projects and other initiatives aimed at increasing Medicare's quality and efficiency. The new payment advisory board is the act's fail-safe: If the cost per beneficiary grows faster than a formula set by the law, the board will recommend changes to the program to bring it back under the spending target. Those changes must be considered by Congress on a fast-track basis, and will go into effect automatically unless lawmakers adopt an alternative that achieves the same savings.
House Republicans took a new tack in their fight against the board when they convened for the first day of the 113th Congress on Jan. 3. In the procedural rules they passed for the coming two years, they declared that the requirement that Congress consider the board's recommendations simply does not apply to the House. That's ridiculous, but it's likely to be more of a symbolic protest than a substantive one because the rules can't trump the statute itself. Besides, the Congressional Budget Office projects that spending per Medicare beneficiary won't grow fast enough to provoke action from the board until much later in the decade.
The first real battle over the board is more likely to take place in the Senate, where the 15 presidential appointees will have to be confirmed. President Obama hasn't nominated anyone yet, and the White House has offered no timetable for doing so.
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