A Federal Budget Crisis Months in the Planning
By SHERYL GAY STOLBERG and MIKE McINTIRE
Urging Patience, Obama Says Problems With Health Care Sites Reflect Demand
By JACKIE CALMES
Why Obamacare isn’t ‘settled’
By Gerard Magliocca,
Gerard Magliocca is a professor of constitutional law at Indiana University. His latest book is “American Founding Son: John Bingham and the Invention of the Fourteenth Amendment.”
The Affordable Care Act was passed by Congress, signed by President Obama, upheld by the Supreme Court and reconfirmed by the president’s reelection. Many of its provisions have gone into effect. As Democrats have taken to saying, it is the law of the land.
But contrary to what the president suggested in the Rose Garden this past week, that does not mean Obamacare is “settled, and it is here to stay.” And it is not illegitimate for Republicans to use every lawful means at their disposal to stand in its way.
Lawyers use the term “settled law” to describe court decisions that clearly establish a rule or a doctrine. Yet settled law also refers to legal actions that are accepted by society. Consider two of the most famous Supreme Court decisions: Brown v. Board of Education, which desegregated public schools, and Roe v. Wade, which created the constitutional right to have an abortion. Both of these cases are “the law of the land.” They are binding on all courts in the United States. Only one of them, though, is settled in the broader sense of that phrase. It is perfectly acceptable for politicians, judges and ordinary citizens to attack Roe and call on the Supreme Court to overturn it. It is totally unacceptable to criticize Brown in 2013.
A statute or court opinion becomes settled law when there is a broad consensus that it is just. But a more practical rule of thumb is that both political parties must agree on its legitimacy. Roeremains unsettled after 40 years primarily because Republicans refuse to accept it.
Once both parties agree that something is untouchable, however, only a truly extraordinary effort by citizens can bring about change. In this sense, the parties serve as formidable guardians for the rule of law.
The Affordable Care Act is not settled law because the public remains deeply divided over it: More than half of Americans are opposed. But even more critically, congressional Republicans have withheld their stamp of approval. Many Republican lawmakers refuse even to call it a law; they keep referring to it as a “bill.”
Republicans offer several explanations for their rejection of the act’s validity. Most often, they note that the law was passed entirely with Democratic votes. This is in contrast to other major legislation, including the Civil Rights Act of 1964, which was enacted with overwhelming bipartisan support and thus became settled much more quickly.
Beginning of the End for Major Health Insurers
By Wendell Potter, OpenMike
05 October 13
've often said that the Affordable Care Act is the end of the beginning of reform. Starting October 1, 2014, that law will signify the beginning of the end of the health insurance industry as we know it.
As I've noted previously, my former CEO at Cigna said at a leadership retreat that what kept him up at night was the fear that big health insurance corporations might someday be viewed as unnecessary middlemen, that their "value proposition" would come under scrutiny and found to be wanting. That insurance companies would, to use his term, be disintermediated.
That day has arrived.
Most of the attention this week will be focused on the glitches that will inevitably occur when the switch is flipped and the long-awaited health insurance marketplaces (also called exchanges) finally go live.
Yes, there will be technological snafus, just as there will be some people upset to find that the relatively cheap policies they have now will be unavailable next year because they don't meet the Affordable Care Act's standards. As of January 1, 2014, the law outlaws policies pretty much guaranteeing that people will be underinsured if they get sick or injured - underinsured because those policies have inadequate benefits and outrageously high deductibles.
So expect to hear plenty of squawking, especially from those who have made a career out of opposing "Obamacare." But before long, the snafus will be resolved and people will realize that the newly available coverage in the marketplaces will provide better protection and actually cost them less after the tax credits and subsidies are factored in.
A Federal Budget Crisis Months in the Planning
By SHERYL GAY STOLBERG and MIKE McINTIRE
WASHINGTON — Shortly after President Obama started his second term, a loose-knit coalition of conservative activists led by former Attorney General Edwin Meese III gathered in the capital to plot strategy. Their push to repeal Mr. Obama’s health care law was going nowhere, and they desperately needed a new plan.
Out of that session, held one morning in a location the members insist on keeping secret, came a little-noticed “blueprint to defunding Obamacare,” signed by Mr. Meese and leaders of more than three dozen conservative groups.
It articulated a take-no-prisoners legislative strategy that had long percolated in conservative circles: that Republicans could derail the health care overhaul if conservative lawmakers were willing to push fellow Republicans — including their cautious leaders — into cutting off financing for the entire federal government.
“We felt very strongly at the start of this year that the House needed to use the power of the purse,” said one coalition member, Michael A. Needham, who runs Heritage Action for America, the political arm of the Heritage Foundation. “At least at Heritage Action, we felt very strongly from the start that this was a fight that we were going to pick.”
Last week the country witnessed the fallout from that strategy: a standoff that has shuttered much of the federal bureaucracy and unsettled the nation.
To many Americans, the shutdown came out of nowhere. But interviews with a wide array of conservatives show that the confrontation that precipitated the crisis was the outgrowth of a long-running effort to undo the law, the Affordable Care Act, since its passage in 2010 — waged by a galaxy of conservative groups with more money, organized tactics and interconnections than is commonly known.
With polls showing Americans deeply divided over the law, conservatives believe that the public is behind them. Although the law’s opponents say that shutting down the government was not their objective, the activists anticipated that a shutdown could occur — and worked with members of the Tea Party caucus in Congress who were excited about drawing a red line against a law they despise.
A defunding “tool kit” created in early September included talking points for the question, “What happens when you shut down the government and you are blamed for it?” The suggested answer was the one House Republicans give today: “We are simply calling to fund the entire government except for the Affordable Care Act/Obamacare.”
Urging Patience, Obama Says Problems With Health Care Sites Reflect Demand
By JACKIE CALMES
WASHINGTON — President Obama urged Americans who have flocked to the new government-run Web marketplaces for health insurance policies not to give up because of the technical problems attributed to greater-than-anticipated demand. Fixes are under way, he said.
Mr. Obama, in an interview with The Associated Press released on Saturday, said he did not have any figures to counter scattered reports that just a very small number of people have succeeded in signing up for insurance coverage since state and federal Web sites began enrollment on Tuesday for the so-called insurance exchanges. Those are a central part of Mr. Obama’s health care law, which was passed in 2010 to extend coverage to those who do not get insurance benefits on the job.
People “definitely shouldn’t give up,” Mr. Obama said. Citing the slow start to a similar program for Massachusetts residents several years ago, the president predicted that when the six-month window for enrollment ends in March, “we are going to probably exceed what anybody expected in terms of the amount of interest that people had.”
House Republicans — who forced a shutdown of the federal government, which also started on Tuesday, by demanding that the health care law be defunded or delayed as a condition for their approving financing for the government in the new fiscal year — were quick to jump on the snags as validation of their opposition to the program.
Yet Mr. Obama and other Democrats have countered that public demand caused technical problems with the new state and federal Web sites, evidence of the popularity of what the health care program has to offer.
“The interest way exceeded expectations, and that’s the good news,” Mr. Obama said in the interview. “It shows that people really need and want affordable health care” from insurers that have bid to compete in the insurance exchanges.
Why Obamacare isn’t ‘settled’
By Gerard Magliocca,
Gerard Magliocca is a professor of constitutional law at Indiana University. His latest book is “American Founding Son: John Bingham and the Invention of the Fourteenth Amendment.”
The Affordable Care Act was passed by Congress, signed by President Obama, upheld by the Supreme Court and reconfirmed by the president’s reelection. Many of its provisions have gone into effect. As Democrats have taken to saying, it is the law of the land.
But contrary to what the president suggested in the Rose Garden this past week, that does not mean Obamacare is “settled, and it is here to stay.” And it is not illegitimate for Republicans to use every lawful means at their disposal to stand in its way.
Lawyers use the term “settled law” to describe court decisions that clearly establish a rule or a doctrine. Yet settled law also refers to legal actions that are accepted by society. Consider two of the most famous Supreme Court decisions: Brown v. Board of Education, which desegregated public schools, and Roe v. Wade, which created the constitutional right to have an abortion. Both of these cases are “the law of the land.” They are binding on all courts in the United States. Only one of them, though, is settled in the broader sense of that phrase. It is perfectly acceptable for politicians, judges and ordinary citizens to attack Roe and call on the Supreme Court to overturn it. It is totally unacceptable to criticize Brown in 2013.
A statute or court opinion becomes settled law when there is a broad consensus that it is just. But a more practical rule of thumb is that both political parties must agree on its legitimacy. Roeremains unsettled after 40 years primarily because Republicans refuse to accept it.
Once both parties agree that something is untouchable, however, only a truly extraordinary effort by citizens can bring about change. In this sense, the parties serve as formidable guardians for the rule of law.
The Affordable Care Act is not settled law because the public remains deeply divided over it: More than half of Americans are opposed. But even more critically, congressional Republicans have withheld their stamp of approval. Many Republican lawmakers refuse even to call it a law; they keep referring to it as a “bill.”
Republicans offer several explanations for their rejection of the act’s validity. Most often, they note that the law was passed entirely with Democratic votes. This is in contrast to other major legislation, including the Civil Rights Act of 1964, which was enacted with overwhelming bipartisan support and thus became settled much more quickly.
Beginning of the End for Major Health Insurers
By Wendell Potter, OpenMike
05 October 13
've often said that the Affordable Care Act is the end of the beginning of reform. Starting October 1, 2014, that law will signify the beginning of the end of the health insurance industry as we know it.
As I've noted previously, my former CEO at Cigna said at a leadership retreat that what kept him up at night was the fear that big health insurance corporations might someday be viewed as unnecessary middlemen, that their "value proposition" would come under scrutiny and found to be wanting. That insurance companies would, to use his term, be disintermediated.
That day has arrived.
Most of the attention this week will be focused on the glitches that will inevitably occur when the switch is flipped and the long-awaited health insurance marketplaces (also called exchanges) finally go live.
Yes, there will be technological snafus, just as there will be some people upset to find that the relatively cheap policies they have now will be unavailable next year because they don't meet the Affordable Care Act's standards. As of January 1, 2014, the law outlaws policies pretty much guaranteeing that people will be underinsured if they get sick or injured - underinsured because those policies have inadequate benefits and outrageously high deductibles.
So expect to hear plenty of squawking, especially from those who have made a career out of opposing "Obamacare." But before long, the snafus will be resolved and people will realize that the newly available coverage in the marketplaces will provide better protection and actually cost them less after the tax credits and subsidies are factored in.
Doctors’ Bad Habits
By DANIELLE OFRI
RECENTLY I was talking with a patient about her glucose levels, which have been inching their way toward diabetes. She was honest that she was eating too much junk and knew perfectly well that her diet was not doing her health any favors.
We talked about the circumstances of her daily life, and together came up with the plan: she would try to eat one fruit or vegetable every day, while cutting out one serving of junk food. It was a modest goal, but seemed obtainable. A perfect example of shared decision making.
But after she left, I glanced back at my previous notes and saw that we’d negotiated the exact same compromise during her last appointment. Scrolling back, I could see that at every visit we covered the same nutritional territory, and each time I must have congratulated myself on the excellent patient-centered care.
Unfortunately, it wasn’t getting us anywhere. Her diet hadn’t budged.
We doctors constantly lament how difficult it is get our patients to change their behavior. We rant about those who won’t take their meds, who won’t quit smoking, who never exercise. But the truth is, we are equally intransigent when it comes to changing our own behaviors as caregivers.
Clinical practice guidelines are a common way of summarizing the standard recommendations for medical conditions. There are thousands of guidelines, for everything from genetic screening to bedsore prevention. Most doctors and nurses think that well-researched guidelines are an excellent idea. Most agree with their recommendations.
The problem is, most of us are just like our patients — we often ignore good advice when it conflicts with what we’ve always done.
I thought about this as I read the latest recommendations from the Choosing Wisely campaign — a project led by the American Board of Internal Medicine to inform doctors and patients about overused and ineffective tests and treatments. Medical groups were asked to list five things in their field that are often overutilized but don’t offer much benefit.
State: Anthem can’t force customers to leave Central Maine Healthcare
Yesterday at 7:46 PMThe decision applies to customers in southern and western Maine.
Anthem Blue Cross and Blue Shield cannot force existing customers to stop seeing their current physicians in the Central Maine Healthcare system, state Superintendent of Insurance Eric Cioppa has decided.
Anthem and MaineHealth, the state’s largest owner of hospitals and other medical facilities, have partnered to offer insurance on the health care exchange – or marketplace – created in Maine under the federal Affordable Care Act.
Their network will include 32 of the state’s 38 hospitals, excluding only Parkview Adventist Medical Center in Brunswick, York Hospital in York, Mercy Hospital in Portland and the three hospitals owned by Central Maine Healthcare of Lewiston.
http://www.pressherald.com/news/State__Anthem_can_t_force_customers_to_leave_Central_Maine_Healthcare_.html
Leaders of three associations fault Maine’s failure to expand Medicaid
Posted:TodayUpdated: 2:27 AM
The AARP, Maine Medical Association, and American Medical Association speak out.
Maine’s failure to accept federal dollars to expand Medicaid under the Affordable Care Act will damage the health of thousands of residents, deny the state’s economy millions of dollars in tax revenue and forgo more than 3,000 jobs that otherwise would be created, representatives of the Maine Medical Association, American Medical Association and AARP said Saturday.Leaders of the three organizations spoke at a joint press conference as part of Maine Medical Association’s annual meeting, held Friday through Sunday at Holiday Inn by the Bay in Portland.
They described the decision not to accept millions of federal dollars for additional Medicaid benefits as a missed opportunity to expand affordable health care in the state and boost Maine’s economy.
“It’s our money, we’ve paid into it, and the feds want to give it back to us,” said Rich Livingston, AARP’s Maine volunteer state president. “So far, we haven’t said yes.”
http://www.pressherald.com/news/Leaders_of_three_associations_fault_Maine_s_failure_to_expand_Medicaid_.html
EMHS chief: Mercy merger not about competing for patients with MaineHealth
Posted Oct. 04, 2013, at 5:30 p.m.
PORTLAND, Maine — The CEO of Brewer-based Eastern Maine Healthcare System, which is entering the southern Maine market for the first time, on Friday said she’s not interested in competing for patients with MaineHealth, the parent of Portland’s Maine Medical Center.
Though industry watchers claim EMHS’ merger with Portland’s Mercy Health Systems of Maine will place it in direct competition with MaineHealth, the largest health care system in the state, M. Michelle Hood, EMHS’ CEO, said the Mercy merger is “not intended to bring patients out of Portland and take them to Bangor.
“We believe in care close to home,” Hood told the Bangor Daily News on Friday. “If it was my mom who lived in Portland and got her primary care at Mercy and needed something that Mercy didn’t have, but MaineHealth had, I’d say go to MaineHealth. They’re a quality provider. So it’s not about moving patients.”
In fact, Hood said she hopes to grow EMHS’ existing collaborative relationship with MaineHealth.
EMHS, parent of Eastern Maine Medical Center in Bangor and six other hospitals in northern and eastern Maine, announced in December it would seek to absorb Mercy Health System of Maine, parent of Mercy Hospital in Portland, into its system. The state approved the health care systems’ Certificate of Need this week, which was the last significant hurdle to cross. EMHS and Mercy held an event at Mercy’s Fore River campus on Friday to celebrate.
Regardless of intention, however, competition is a reality. When pushed on the question of whether EMHS entering the southern Maine market will increase competition with MaineHealth, Hood said: “I don’t know. We’ll see what happens. Health care today … you don’t know one day to the next what the landscape will look like, but it’s certainly not the intent.”
EMHS was not looking to move into southern Maine before Mercy approached the company about a merger, according to Hood. Currently, the most southern hospital in EMHS’ network is the 48-bed Inland Hospital in Waterville, located 74 miles from Mercy Hospital.
When Mercy, which was a member of Pennsylvania-based Catholic Health East, reached out to larger health care systems in Maine to advertise the fact it was searching for a new parent, MaineHealth was included on the list, according to Eileen Skinner, Mercy’s CEO.
“The difficulty with MaineHealth is that the antitrust aspect and the Federal Trade Commission approval of that would have been almost impossible,” Skinner told the BDN.
Mercy negotiated briefly with Steward Health Care System, a for-profit Massachusetts hospital chain, before those talks fell through in late 2012.
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