Solicitor General Will Try, Again, to Keep Health Care Law Alive
By ADAM LIPTAK
WASHINGTON — Three years ago this month, Solicitor General Donald B. Verrilli Jr. stood before the Supreme Court to defend President Obama’s health care lawagainst a constitutional challenge that threatened to destroy its central provision. His oral argument drew harsh reviews, but in the end he managed to persuade five justices to accept his backup argument, saving the law.
Mr. Verrilli will return to the lectern on Wednesday morning to defend the law once again, and he has reason to be nervous. In 2012, four members of the court — Justices Antonin Scalia, Anthony M. Kennedy, Clarence Thomas and Samuel A. Alito Jr. – were ready to strike down the entire law, as they made clear in a bitter joint dissent.
It is certainly possible that Chief Justice John G. Roberts Jr. will again desert his usual allies to vote to save the law. But that is hardly a certainty.
Mr. Verrilli will again face Michael A. Carvin, who represented the plaintiffs last time. Mr. Carvin will argue that the law forbids the federal government from providing tax subsidies to help people buy insurance in the three dozen states that have refused to establish their own insurance marketplaces, known as exchanges.
A Supreme Court Rematch for a Lawyer Targeting the Health Care Act
WASHINGTON — In March 2012, a blunt-talking and rumpled lawyer named Michael A. Carvin told Supreme Court justices that President Obama’s health care lawwas an unconstitutional attempt to “regulate every activity from cradle to grave.”
He lost that case — and has never quite gotten over it.
“The operation was a success, but the patient died,” Mr. Carvin said then, insisting he had won at least a moral victory.
Now Mr. Carvin, 58, has a second chance to dismantle a law that conservatives despise. On Wednesday, he will again appear before the Supreme Court, this time on behalf of plaintiffs in King v. Burwell, a case that could cripple the Affordable Care Act — and, the White House says, deprive as many as 7.5 million Americans of their health coverage.
“The solicitor general will get up there and say, ‘Mr. Chief Justice, if you rule against us, people will lose their insurance and they may die,’ ” said Josh Blackman, the author of a book on the 2012 health care case and an assistant professor at South Texas College of Law. “No lawyer other than Michael Carvin could make the argument: ‘So what?’ ”
WASHINGTON — In March 2012, a blunt-talking and rumpled lawyer named Michael A. Carvin told Supreme Court justices that President Obama’s health care lawwas an unconstitutional attempt to “regulate every activity from cradle to grave.”
He lost that case — and has never quite gotten over it.
“The operation was a success, but the patient died,” Mr. Carvin said then, insisting he had won at least a moral victory.
Now Mr. Carvin, 58, has a second chance to dismantle a law that conservatives despise. On Wednesday, he will again appear before the Supreme Court, this time on behalf of plaintiffs in King v. Burwell, a case that could cripple the Affordable Care Act — and, the White House says, deprive as many as 7.5 million Americans of their health coverage.
“The solicitor general will get up there and say, ‘Mr. Chief Justice, if you rule against us, people will lose their insurance and they may die,’ ” said Josh Blackman, the author of a book on the 2012 health care case and an assistant professor at South Texas College of Law. “No lawyer other than Michael Carvin could make the argument: ‘So what?’ ”
The Supreme Court Has the Power to Deepen a National Health Divide
The Supreme Court has the potential to radically reshape the Affordable Care Act, creating a result profoundly different from that imagined by President Obama and the law’s drafters in Congress.
Three years ago, the court essentially limited the law’s ability to expand health insurance to low-income Americans in red states. A case it is considering on Wednesday might result in taking away insurance access for middle-income people, too.
Taken together, the two cases could lead to a sharp national division in access to health insurance, based on what state you live in. Instead of providing universal health insurance coverage to the country, the law would widen an existing rift in health care access.
Perversely, the states where the court could wind up reducing insurance coverage the most have the largest share of residents who would otherwise benefit. Many of the states with the largest number of uninsured residents could be shut out of the bulk of Obamacare’s insurance expansion while continuing to pay the law’s taxes and other costs. Meanwhile, richer states that had always insured more of their residents would reap the benefits of federal dollars to expand further.
The Supreme Court has the potential to radically reshape the Affordable Care Act, creating a result profoundly different from that imagined by President Obama and the law’s drafters in Congress.
Three years ago, the court essentially limited the law’s ability to expand health insurance to low-income Americans in red states. A case it is considering on Wednesday might result in taking away insurance access for middle-income people, too.
Taken together, the two cases could lead to a sharp national division in access to health insurance, based on what state you live in. Instead of providing universal health insurance coverage to the country, the law would widen an existing rift in health care access.
Perversely, the states where the court could wind up reducing insurance coverage the most have the largest share of residents who would otherwise benefit. Many of the states with the largest number of uninsured residents could be shut out of the bulk of Obamacare’s insurance expansion while continuing to pay the law’s taxes and other costs. Meanwhile, richer states that had always insured more of their residents would reap the benefits of federal dollars to expand further.
Hard Cases
BY JEFFREY TOOBIN
The great Supreme Court cases turn on the majestic ambiguities embedded in the Constitution. It is not a simple thing to define and apply terms like “the freedom of speech,” or “equal protection of the laws,” much less explain how much process is “due.” Still, the Justices, in their best moments, have explicated these terms in ways that ennobled the lives of millions. This week, the Court will hear arguments in a momentous case, King v. Burwell, a challenge to a central feature of the Affordable Care Act. But, in contrast to other landmarks in Supreme Court history, the King case is notable mostly for the cynicism at its heart. Instead of grandeur, there is a smallness about this lawsuit in every way except in the stakes riding on its outcome.
A Polarized Court, Weighing a Reversal of the Safety Net
by David Leonhardt
The Supreme Court has become a more partisan institution in recent decades, more closely resembling the other branches of government than it once did. This week will start to show just how partisan the court has become.
On Wednesday, it will hear arguments in the latest challenge to the health care law, a case that has received less attention than the 2012 challenge did but also is of great consequence. Of the 10 million people who have health insurance thanks to the law, the court could effectively take it from about five million of them.
There are few if any historical precedents for a rollback of the social safety net as large as this one would be. Social Security, Medicare and the minimum wage were never extended to millions of people and then withdrawn. This case, King v. Burwell, has the potential by next year to reduce the number of Americans with health insuranceby eight million — the equivalent of the entire population of Virginia.
If it happens, the decision is most likely to be along sharply partisan lines, with the five Republican-appointed justices voting one way and the four Democratic-appointed justices the other.
Lawyer Put Health Act in Peril by Pointing Out 4 Little Words
By ADAM LIPTAK
WASHINGTON — The first lawsuits challenging the Affordable Care Act were still in the early stages, but conservative lawyers were already working on a backup plan in December 2010 if the first line of attack failed.
It was Thomas M. Christina, an employment benefits lawyer from Greenville, S.C., who found a new vulnerability in the sprawling law. “I noticed something peculiar about the tax credit,” he told a gathering of strategists at the American Enterprise Institute.
With a rudimentary PowerPoint presentation, Mr. Christinasketched a new line of argument. He pointed to four previously unnoticed words in the health care law, enacted nine months earlier. They seemed to say its tax-credit subsidies were limited to people living where an insurance marketplace, known as an exchange, had been “established by the state.”
The Supreme Court will hear arguments on the implications of Mr. Christina’s theory on Wednesday. If a majority of the justices accepts it, more than six million Americans could lose health care coverage and insurance markets could collapse in about three dozen states where the federal government runs the exchanges, imperiling the health care law itself.
Employees not benefiting from slower growth in healthcare costs
erican workers already struggling with stagnant wages are being saddled with higher medical bills even as employers reap the benefits of a sustained slowdown in the growth of healthcare costs, a new report indicates.
While employees' insurance premiums and out-of pocket medical expenses shot up 21% from 2007 to 2013 to an average of $3,273 a year, employers' total healthcare costs rose only 14.5%.
"Almost everyone in the health system is realizing savings, but employees' costs are rising," noted the new report from the Center for American Progress, a left-leaning Washington think tank.
Public opinion surveys regularly show affordability as a top healthcare concern for Americans. That is one of the reasons many policymakers hoped the slowdown in healthcare costs would bring some relief.
Overall healthcare spending in the U.S. has risen at the slowest pace on record in recent years.
The Center for American Progress report, provided exclusively to the Los Angeles Times, offers additional evidence this slowdown is not helping workers, however.
Researchers analyzed national survey data from the federal Agency for Healthcare Research and Quality that measure how much employers and employees pay for health plans that workers get through their jobs.
They also looked at data gathered from major health plans by the Health Care Cost Institute on how much employees pay in co-pays, deductibles and other out-of-pocket health spending.
Employers still pick up the lion's share of workers' health costs, paying more than two-thirds of the average worker's insurance premium in 2013, or $7,238, according to the report.
But the employer share is shrinking.
At the same time, workers' out-of-pocket costs are rising as employers boost deductibles and co-pays in the health plans they offer.
From 2007 to 2013, the average worker's annual out-of-pocket medical spending rose to $800 from $665, researchers found.
This trend is particularly troublesome at a time when paychecks are stagnating, said Topher Spiro, the center's vice president for health policy and lead author of the report. "This issue is critically important to address the squeeze middle-class families are facing," he said in an interview.
Challenge to health law stokes fears
mantha Allen always dreamed of being a photographer.
But struggling with asthma and a painful neurological disorder called fibromyalgia, she needed a job that offered health insurance. That put a freelance career out of reach.
Last year, though, Allen was able to get a health plan through the Affordable Care Act with help from a $100 monthly premium subsidy made available by the law. She quit her job at a bank and started a photography business.
"It's made all the difference in the world," she said recently. "I want to do this forever."
Allen, 30, is one of millions of Americans who have come to rely on the insurance aid in the law. Few of them will be in the courtroom Wednesday when the Supreme Court takes up a legal challenge to the subsidies, but perhaps no one has more at stake. An estimated 7 million people could lose assistance if the court backs the challengers.
The lawsuit — spearheaded by conservative and libertarian activists — argues that a strict reading of the statute makes subsidies available only in the handful of states like California that established their own insurance marketplaces through the law.
Thirty-seven states, including New Hampshire, elected instead to have the federal government fully or partially operate their marketplaces using the HealthCare.gov website.
The marketplaces, a central pillar of the law, allow Americans who don't get health benefits at work to shop online among plans that must all offer basic benefits and cannot turn away customers, even if they're sick.
Consumers making less than four times the federal poverty level — about $24,000 for a single person or $94,000 for a family of four — qualify for subsidies to offset the cost of their premiums.
http://www.latimes.com/business/la-fi-0303-court-obamacare-people-20150303-story.html
What the Hell Is Concierge Medicine?
By Alison Prelusky / Daily Kos
March 2, 2015
Recently, I was dumped.
It seemed to come out of nowhere. As far as I knew, everything was fine, and I honestly had no reason to think otherwise. She dropped the axe by way of a letter, with plenty of flowery language to dress up the usual clichés: "I feel like I'm giving and giving, but getting little in return." "I'm just not happy with the way things are working out." "We both deserve better."
Then came the real shocker: "We can still see each other, but you'll have to start paying for my services out-of-pocket."
The letter was written by my primary care doctor, announcing an upcoming switch from a traditional medical practice to a new model: Concierge Medicine. This was a term I had never heard before, and I'm guessing most of her other patients hadn't either. (According to the US News & World Report, only 6% of practicing physicians in the USA ran concierge or cash-only practices in 2013.) It's a trend that's been taking hold in pockets and patches across the United States over the past few years, but it's still relatively unknown.
Although I was a bit skeptical, I tried to keep an open mind while reading the letter. The beginning seemed pretty reasonable, with statements that could get anybody nodding along:
Maintaining a private practice in the current managed care climate has become increasingly difficult... Regrettably, the current system is disease-focused as opposed to wellness-focused. Doctors are reimbursed for seeing ill patients frequently... There are no incentives for maintaining a patient's health and preventing the development of chronic disease
Any informed person would be hard-pressed to disagree with these statements. We've all heard about medical insurance companies working to maximize profits in backhanded, unethical ways. A significant portion of America's healthcare spending goes toward treatment of preventable diseases, instead of ways to help stop people from getting those diseases in the first place. Most doctors in the U.S. are reimbursed for tests and procedures rather than for helping people take steps toward healthier living. Of course this is a terrible way to go. Who could argue otherwise?
I fear that the system is going to worsen as the primary care physician shortage grows (approximately 50,000 short by 2025) and 30 million newly insured Obamacare patients seek treatment.
I understood her point - the thought of a doctor shortage in America is pretty terrifying - but couldn't help but notice an unsettling implication lurking below the surface. I'm fortunate enough to have had medical insurance before the Affordable Care Act was put into place, but I tried to imagine my reaction to this part of the letter if I had just gained insurance because of the ACA. I would probably feel portrayed as a parasite, a stupid newbie who's ruining everything for the people who were in The Health Insurance Club first. Besides, what's the alternative? Would it be better for less people to have access to affordable healthcare?
The gap will likely be filled by doctors with poor English language skills, nurse practitioners, physician assistants, and urgent care centers.
Ah yes, what good is fearmongering without a dash of dogwhistle racism? Beware, patients - if you thought non-Americans were scary before, just wait until you have to press 1 for English in a doctor's exam room.
What does Pelosi’s “You have to pass the bill” comment have to do with Obamacare suit?
Obamacare is increasingly lowering the number of Americans without health insurance, but it faces a threat by a lawsuit before the Supreme Court today.
This case (King v Burwell) would take away subsidies from millions who purchased their insurance through a federally run exchange. It’s based on the absurd argument that the Congress didn’t mean for subsidies to be available unless one’s state set up an exchange — something the Congressional Budget Office never assumed in its many estimates of the ACA’s cost.
Some analysts argue that Republicans would face enormous backlash if those millions suddenly lose their insurance.
In the Washington Examiner, conservative pundit Byron York quotes an unnamed GOP aide fretting about “ads saying cancer patients are being thrown out of treatment, and Obama will be saying all Congress has to do is fix a typo.” [source]
Indeed, the possibility of tens of thousands of Mainers having the rug pulled out from under them motivated Rep. Poliquin to vote against a flat out repeal and pundit Matt Gagnon (who wants you to know he really, totally, definitely doesn’t think the law is “working”) to explain that Poliquin’s vote was reasonable because, Gagnon says, it “would negatively impact tens of thousands of Mainers.”
Former House Speaker Nancy’s Pelosi’s famous comment — and its misinterpretation — help make sense of the absurdity of this case.
For years, the strongest opponents of Obamacare will sometimes throw in something like this: “Well, you know Pelosi said you had to pass the law to find out what’s in it.”
This has even been used by lawyers trying to gut the law in one of their briefs. It’s their fall back from saying the law actually meant to limit subsidies to state exchanges, to a position that maybe this wasn’t known but, in any case, the limit is in the text. (That latter claim runs into trouble because it conflicts with the Court’s doctrine that particular parts of laws are understood in the law’s broader context, but that’s another story.)
When Pelosi’s comment is used by ACA opponents, the implication is that the ACA was rushed through, “shoved down our throats,” and no one had a chance to read it. And they say that Pelosi even admitted that.
But that interpretation is not only false, but also demonstrates the utter fiction that underlies this lawsuit.
Posted March 03, 2015, at 12:10 p.m.
The Supreme Court hears arguments Wednesday on the latest legal challenge to the Affordable Care Act. However the nine justices rule on a challenge that hinges on four words in the expansive health care reform law, there will be clear and significant personal and policy consequences.
Some 8.6 million people signed up for individual health insurance plans for 2015 using HealthCare.gov. They live in the 37 states, including Maine, that opted not to set up their own online health insurance marketplaces under the Affordable Care Act.
Preliminary numbers showed that 87 percent of those 8.6 million people qualified for assistance from the federal government to pay their monthly insurance premiums. That assistance, on average, lowered the cost of insurance by 72 percent, to about $105 per month.
That federal assistance is what is in jeopardy depending on the outcome of the case before the Supreme Court, King v. Burwell. The plaintiffs, namely the conservative Competitive Enterprise Institute, argue that those 37 states’ residents shouldn’t be eligible for federal premium assistance because the text of the Affordable Care Act provided for tax credits only for those who purchased insurance through exchanges “established by the state.”
In Maine, nearly 75,000 people had signed up for insurance under Obamacare through the Feb. 15 end of the open enrollment period. Earlier numbers showed 89 percent of them had incomes low enough to make them eligible for federal assistance. The value of that assistance was $337 per month on average, or 78 percent of the cost of their full monthly premiums.
Mainers, on average, can buy individual insurance now for $97 per month. Before the Affordable Care Act, according to the Kaiser Family Foundation, Maine residents buying insurance in the individual market paid $282 on average.
The Congressional Budget Office projects that the number of people signing up for health insurance through Obamacare’s insurance exchanges will only grow as time goes on — meaning the number of people who depend on federal assistance to afford that insurance will continue to grow as well. The Supreme Court’s ruling could preserve critical assistance for a growing number of people, or it could throw it out.
The consequences wouldn’t stop with federal assistance, though. Since the elimination of it would put the cost of insurance out of reach for so many, fewer people would purchase insurance, meaning fewer healthy people would subsidize the costs of caring for the very ill, destabilizing the entire insurance system in the affected states. This would essentially put us back where we were before the ACA, with high numbers of people without insurance and their care (usually expensive emergency room care) subsidized by those with health insurance.
But it’s not the Supreme Court’s job to issue a ruling based solely on its potential consequences. It’s not even the court’s job this time to weigh in on the law’s constitutionality. (The justices, after all, have already done that.) In this case, the court’s job is merely to interpret a statute.
And when it comes to interpreting statutes, Supreme Court justices — including those on the court’s conservative wing — are on record advocating for statutory interpretations that take into account a law’s full context and meaning and not a few words in isolation, The New York Times’ Linda Greenhouse pointed out in a February column. In King v. Burwell, the Affordable Care Act is full of the context needed to set up a system in which residents of states that don’t set up insurance exchanges can still qualify for premium assistance. The crux of the plaintiffs’ case, on the other hand, is four words that, in isolation, would seem to undermine the full Affordable Care Act.
Of course, the law could survive a negative ruling by the Supreme Court. Congress could make a simple fix to the law. States could also set up work-around solutions that allow their residents to benefit from federal assistance and still be able to afford health coverage.
That, however, depends on policymakers who have been working to undermine Obamacare suddenly becoming cooperative. In our estimation, the likelihood is greater that the Supreme Court will rule the plaintiffs in King v. Burwell have no case.
By Jonathan McKane, Special to the BDN
Posted March 03, 2015, at 12:27 p.m.
An iconic liberal dream quietly died in Vermont recently.
The proposed single-payer health care system for the Green Mountain State ran headlong into reality.
Gov. Peter Shumlin, longtime proponent of the government health care plan, finally realized its phenomenal costs and associated tax increases and reluctantly announced he could no longer support it.
“The potential economic disruption and risks would be too great to small businesses, working families and the state’s economy,” said Shumlin at a press conference. He was referring to the projected doubling of all taxes in Vermont to fund it.
He can’t say they weren’t warned. Conservatives in the Vermont legislature — the few that there are — repeatedly warned of the unaffordability of the proposed gigantic program, laying out in black and white the fiscal impossibility of providing “free” health care to all.
Shumlin and Vermont Democrats had charged ahead, however, led by Shumlin’s special counsel for health care reform, Anya Rader-Wallack, who famously stated, “We can move full speed ahead with what we need without knowing where the money’s coming from.”
Jonathan Gruber, genius and Affordable Care Act creator, helped design “Green Mountain Care” and promised billions in savings over the next decade. What could go wrong?
Thankfully for Vermont taxpayers, much of the potential damage was averted as leaders realized their folly and aborted their mission to liberal health care utopia before too much “economic disruption.” Federal taxpayers, however, had already shelled out $45 million in planning grants.
Maine Democrats who either haven’t heard of the Vermont implosion or don’t care are still not ready to give up on the vision of a single-payer plan for Maine. They have submitted several bills this year proposing as much — just as they have in every Maine Legislature over the past 15 years. Rader-Wallack would approve.
They do this despite the fact that all of their previous single-payer bills failed, even when the Democrats held large legislative majorities and the governor’s office. With Republicans in control of the Senate and the governor’s office, these new single-payer bills don’t have even a dim ray of hope.
Combine that with the news that Vermont, the bluest of blue states, just had a fiscal epiphany and came to the same conclusion that conservatives reached long ago — that single-payer is unaffordable — and even a left-wing visionary should see that these bills are a waste of time.
Court Battle Puts Health Coverage of Tens of Thousands of Mainers at Risk
By PATTY WIGHT
This week, the U.S. Supreme Court will consider a case that could eliminate health insurance subsidies and potentially unravel the Affordable Care Act. Plaintiffs in King versus Burwell argue that the health care law only allows the federal government to provide subsidies to those who purchase insurance from state-run exchanges. The decision could affect tens of thousands of customers in Maine.
Health insurance was always expensive for Dave Clannon's family. He's a self-employed property manager in Litchfield, so he and his daughter got coverage through his wife's employer-based plan at a cost of $1,100 a month. But when she was laid off in January, the family went to the Affordable Care Act's online Marketplace and got coverage for $52 a month, after subsidies.
Clannon says now they have one less thing to worry about. "I would hate to see the subsidy go away," he says, "because I don't know if we would be able to afford the premium on our own. That would be out of reach once again."
The Urban Institute and the Robert Wood Johnson Foundation estimate that 60,000 Mainers will lose their subsidies, and 50,000 will become uninsured, if plaintiffs in the King versus Burwell case are successful. The lawsuit points to a sentence in the federal health law that says subsidies will go to consumers who buy insurance "through an exchange established by the state." This, plaintiffs argue, makes subsidies in federally-run marketplaces null and void.
"The consequences of this case are potentially devastating. I can't think of another situation where the Supreme Court has heard a case where people's benefits would be taken away in such a stark manner," says Andrea Irwin, of the group Consumers for Affordable Health Care.
Irwin says plucking one sentence out of a 2,000-page law fails to look at the whole picture. "Really, the whole intent of the law was to increase access of affordable coverage to people."
Irwin says the ACA does that in three key ways: by eliminating pre-existing condition exclusions, widening the insurance pool through the individual mandate, and providing subsidies to make coverage affordable. "If you look at whole law, if you take away any three legs of that stool, the whole law fails," she says.
Health policy consultant Mitchell Stein says if the subsidies are eliminated in states with federally-facilitated marketplaces, lots of people will drop coverage. Most will likely be healthy people. That leaves sicker people in the insurance pool, which costs more and will increase premiums.
And Stein says that will drive even more people out. "And the more - it's only the very sickest in the health system, and they need to be charged ever-escalating premiums, leading to what's called the premium death spiral."
Stein says eliminating subsidies would also, in effect, eliminate the employer mandate to provide affordable insurance, because employers are only penalized when workers can get subsidies on the Marketplace.
The end result, Stein says, is if the Supreme Court finds in favor of the plaintiffs, the country will be split in two: between the haves, and the have-nots, of health coverage. "It's undeniable there will be a huge human cost immediately if some sick people have to stop their treatment," he says. "Many people will lose their coverage."
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