The List Of ACA Programs That May Never Be Funded |
As former CMS head Bruce Vladeck explains, “Since the law was passed, the budgetary picture in Congress has changed dramatically. So stuff (Obama administration officials) were interested in doing when health reform passed, they now have a realistic sense that…they are never going to get an appropriation to do it.” Kaiser Health News has the list of the endangered programs.
Brian Beutler catches this exchange from yesterday’s oral arguments over the constitutionality of the Affordable Care Act before Atlanta’s Eleventh Circuit Court of Appeals: Judge Hull, a Clinton appointee, suggests that the plaintiffs central contention that the Constitution’s commerce clause does not allow the federal government to regulate “inactivity” is just not very convincing:
Specifically, Hull cast aside the plaintiff’s claim that by compelling non-participants in the insurance industry to buy health insurance, it regulates “inactivity.”
“[T]his case comes down somewhat to whether or not the decision — because you are making a decision, and let me put aside activity and inactivity. Don’t call my economic decisions I’m making inactivity. I consider it inactivity. The activity/inactivity [distinction] doesn’t help me personally,” she said.
It’s worth pointing out that some legal scholars have long dismissed this distinction. Washington and Lee law professor Timothy Jost contends that “the commerce clause nowhere contains the word activity” but rather focuses on “economic decisions.” And those decisions — for healthy people to stay out of the insurance market — can be regulated by the government because they result in $43 billion in cost shift to taxpayers, employers, and the government who pick up the tab for uncompensated, uninsured care.
ThinkProgress has been documenting the push by radical anti-abortion groups to outlaw common forms of contraception, like birth control pills, based on the medically inaccurate view that they are equivalent to abortion.
More evidence (as if it were needed) that these fringe views are seeping into the conservative mainstream came at last week’s Faith and Freedom Conference in Washington, DC, which was attended by almost every GOP presidential candidate. Marjorie Dannenfelser, president of the influential anti-abortion group the Susan B. Anthony List, made an extraordinary claim to defend her support for defunding Planned Parenthood: contraception, which Planned Parenthood provides, goes hand-in-hand with abortion.
During a Catholic activism panel she declared, “Every year that contraception and family planning increases, the abortion rate also increases in direct proportion. [...] This is an undeniable fact.”
Despite her protestation, Dannenfelser’s claim flies in the face of common sense — and the facts. Increasing women’s access to safe, effective forms of contraception is the single best way to reduce the number of abortions. Birth control reduces the likelihood of unplanned, unwanted pregnancies.
Planned Parenthood spokesman Tait Sye correctly points out that maintaining funding for the group is actually the best thing lawmakers could do to prevent abortions: “Planned Parenthood, the largest provider of family planning, birth control, and sex education, does more than any other organization in the United States to help women avoid unintended pregnancies and reduce the need for abortion.” Faith in Public Life notes that Dannenfelser’s views “don’t have much relevance to the 99% of American women of child-bearing age who have used contraception or the 80% of self-identified pro-lifers who support access to contraception.”
Nevertheless, in an attempt to help congressional Republicans further eviscerate funding for Planned Parenthood, the Susan B. Anthony List recently launched a vicious ad campaign attacking the group through heavily edited video footage. SBA bought $90,000 worth of TV airtime in the DC-area market for the ads, which “depict Planned Parenthood as a profit-driven abortion factory with little concern for its low-income patients.”
The Affordable Care Act (ACA) requires most Americans to either carry insurance or pay slighty more income taxes for a simple reason. The act also forbids insurance companies from denying coverage to patients with preexisting conditions, and this ban cannot function if patients are free to enter and exit the insurance market at will. If patients can wait until they get sick to buy insurance, they will drain all the money out of an insurance plan that they have not previously paid into, leaving nothing left for the rest of the plan’s consumers.
There is also a ton of evidence proving this point. Seven states attempted to protect people with preexisting conditions without also enacting an insurance requirement, and it ended in disaster. Kentucky, Maine, New Hampshire, and Washington each lost most or all of their individual market insurers, and the cost of some New Jersey health plans more than tripled after that state enacted a similar law. A couple of states had slightly less awful results, but they still saw premiums shoot up between 15 and 20 percent immediately after their laws went into effect. Massachusetts, by contrast, enacted a law much like the ACA, and its premiums declined by 40 percent.
Moreover, this essential link between the two provisions is more than enough to justify the insurance coverage requirement under the Constitution. As conservative Justice Antonin Scalia explains, “where Congress has the authority to enact a regulation of interstate commerce,” such as a law protecting people with preexisting conditions, “it possesses every power needed to make that regulation effective.”
Which is why one of the most bizarre aspects of an incredibly bizarre Eleventh Circuit argument yesterday was the fact that the acting solicitor general faced a bevy of questions forcing him to cite more and more specific studies proving that the insurance coverage requirement actually is necessary to thwart disaster. Consider this exchange between Katyal and Judge Frank Hull:
KATYAL: What Congress found was that you couldn’t ban preexisting condition discrimination…without a minimum coverage provision. They had eight states that tried to do this, and ban these forms of discrimination.
HULL: And that’s because the insurers left that state and left that market? [...] I tried to find a study in the record by an economist — anybody — that tries to analyze the national market based on whether insurers will or will not leave the market. There did not seem to be a study in the record on that point, is that correct?
KATYAL: Well, I think that there are several studies. The American [Association of People] with Disabilities brief shows that, for example, that when the seven states reformed the insurance markets without a minimum coverage provision the insurers did leave the states. And Congress made a specific finding saying that the Massachusetts experience worked precisely because it coupled the insurance reforms to the minimum coverage provision.
It’s not entirely clear what Judge Hull is getting at here, but if she is suggesting that the many studies showing that state insurance markets strain until they break without an insurance coverage requirement aren’t enough for her court to simply accept that fact and move on, than she is departing wildly from decades of settled law. As the Supreme Court has said time and time again, Congress does not have to prove by utterly incontestable evidence that its economic regulations are justified; it only has to prove that its economic assumptions aren’t completely irrational. A pile of studies showing the impact of health care regulations in the states are more than sufficient to clear this very low bar, as should be a CBO study finding that premiums would spike substantially if the court sides with the plaintiffs.
Moreover, there are is a very good reason why courts are not supposed to second-guess Congress’ economic policy assumptions except in the most extreme and absurd cases. Members of Congress are elected; judges are not. Both supporters and opponents of the ACA were able to muster an army of economists supporting their position on this law. Someone has to make the call as to which side is right, and that someone will either be an elected official accountable to the public, or it will be an appointed judge with lifetime tenure.
If the Eleventh Circuit decides that Congress’ judgment wasn’t good enough, it will not only be a massive departure from settled law, it will be a minor coup wrestling power away from the voters and giving it to three officials in black robes.
Yesterday, Texas lawmakers in the state house passed a 142-page measure in special session that could drastically change how 6.6 million Texans benefiting from Medicare, Medicaid, and SCHIP programs receive their care. The bill — which includes two controversial amendments that have yet to be adopted by the state Senate — strongly mirror the reforms offered in Rep. Paul Ryan’s (R-WI) budget, but would have to be approved by the federal government:
– Convert Medicaid into a block grant: The state will apply for a waiver that would convert the existing Medicaid financing structure — under which the federal government reimburses Texas for a certain percentage of its Medicaid spending — into a capped block grant that would increase only for population and the general rate of inflation, not medical inflation.
– Privatize Medicare: Texas would enter a compact that would exempt the state from the federal eligibility and benefit rules in the Medicaid program and from all Medicare rules, allowing lawmakers to “possibly sweep Texas seniors on Medicare into private health insurance policies.”
State medical providers are already raising concerns, arguing “the proposals are too vague about what would happen to existing services and eligibility rules” and that it could lead the state to lower its rock-bottom reimbursement rates. The medical groups note that the proposals would bring less federal dollars into the state and prevent Texas from receiving more funds during economic downturns. “Only federal stimulus money balanced the Medicaid budget two years ago, and lawmakers this year have punted a $4.8 billion Medicaid IOU to 2013,” they say.
But Rep. Lois Kolkhorst (R), who sponsored the measures, promised that the state would be able to use “innovation” to stretch the more limited federal contribution. She did not provide any further details. A recent analysis of the effects of the GOP’s budget on the states from the Kaiser Family Foundation concluded that Texas could lose 38.4 percent of its federal dollars and may have to cut enrollment in Medicaid by up to 52 percent.
Last year, Gov. Rick Perry (R-TX) suggested that Texas may opt out of the Medicaid program entirely, but walked back the idea after a state report concluded that 2.6 million Texans would be left uninsured. Texas currently has the highest uninsurance rate in the nation.
Experts Don’t Expect More Insurers To Cap Profits |
“Blue Shield of California’s surprising announcement that it will cap profits at 2 percent and issue millions in policyholder refunds sparked hopes that other health insurers would follow suit, but many experts said yesterday that was unlikely” because Blue Shield is “better positioned than most to make that move.”
Rick Santorum has seized on Mitt Romney’s health care law in Massachusetts to distinguish himself from the GOP governor and likely front-runner for the 2012 nomination, arguing that the Bay State’s reform very closely resembles the Affordable Care Act. “When Governor Romney is Massachusetts went along with a government top-down system of how to make sure everybody has insurance. [...] I think it violated those fundamental principles [of individual freedom] and it’s very similar in orientation to what President Obama did with Obamacare,” Santorum told Fox News’ Greta Van Susteren earlier this week.
This morning, Santorum went a step further, likening Romney’s law to that of “every socialized” country and claiming that it was rationing care:
SANTORUM: Medicare is already being changed. There are going to be cuts in Medicare, there is going to be lines, there is going to be rationing of care simply because the 15-member commission is required under Obamacare to reduce reimbursement rates for doctors and hospitals which of course — we see it in Massachusetts, you see it in every socialized medicine country, where government run health care system, when they do that, it leads to lines, which leads to rationing.
Despite Santorum’s claims, a new poll from Harvard School of Public Health and the Boston Globe released just this week “found that 63 percent of Massachusetts residents support the 2006 health law, up 10 percentage points in the past two years.” More than 98 percent of Massachusetts residents now have health care coverage, including 99.8 percent of children — the highest in the nation.
The Problem With The McKinsey ‘Employers Will Drop Coverage’ Survey |
The GOP has been making a lot of the McKinsey survey, which found that 30 percent of employers could drop coverage as a result of the Affordable Care Act, so Time’s Kate Pickert did the sensible thing and called up McKinsey “to ask about the methodology behind the employer survey.” They declined to comment on how the study was conducted, but Pickert picked up on this key nugget which may suggested that the group “may have primed respondents to say they would keep or drop coverage”: “…Our survey educated respondents about [employer sponsored insurance] implications for their companies and employees before they were asked about post-2014 strategies.”
The American Hospital Association has written a letter urging President Obama to extend health care coverage to undocumented immigrants, noting that “hospitals shoulder a disproportionate burden” in providing emergency services to the community:
Hospitals shoulder a disproportionate burden in providing EMTALA-mandated emergency services to undocumented immigrants. And, in those communities where the number of undocumented immigrants is greatest, the strain has reached the breaking point. In response, many hospitals have had to curtail services, delay implementing services, or close beds. The most recent statistics shows that America’s hospitals provided nearly $40 billion in uncompensated care in 2009.
In today’s unpredictable environment, hospitals need adequate reimbursement to ensure that our patients – both documented and undocumented – and the communities we serve receive the care they expect and deserve. Hospitals should not have to bear the burden of uncompensated care for undocumented immigrants.
While some conservatives have suggested barring immigrants from accessing medical assistance — including emergency care — hospitals themselves think the solution is just the opposite. A health care policy that excludes undocumented workers will never fully control health care spending, fulfill the moral obligations of society, or get to true universal coverage. The fact is that extending access to preventive services and other primary care needs would likely go a long way to reducing emergency care use and the costs of uncompensated care.
Generally, immigrants tend to be healthier than U.S. citizens, use less medical care, use less expensive care, and do not impose a disproportionate financial burden on the US health care system. For instance, per capita total health expenditures of immigrants were 55 percent lower than those of U.S. born persons. “Even after controlling for the effects of race, ethnicity, income, insurance status and health status, immigrants are much less likely to use primary and preventive medical hospital emergency and dental services than citizens,” a recent report found.
Welcome to The Morning CheckUp, ThinkProgress Health’s 7:00 AM round-up of the latest in health policy and politics. Here is what we’re reading, what are you?
Planned Parenthood funding is the new litmus test: “Abortion rights opponents describe Planned Parenthood’s public funding as a new ‘litmus test’ for Republican candidates — and an easy way to draw a distinction with President Barack Obama — while abortion rights supporters are eagerly eyeing the debate as an attack on contraceptives that could mobilize the Democratic base.” [Politico]
Health reform’s day in court: The 11th circuit judges gave the law mixed reviews, “but the actual substance of those questions – and some side comments that the judges made – suggested they were ready to reject essential pieces of the legal challenge.” [Jonathan Cohn[
Lifting the ban against abortion services on military bases: Sen. Kirsten Gillibrand (D-NY) and Rep. Louise Slaughter (D-NY) recently introduced legislation that would "allow servicewomen to use private funds to obtain abortion care at military health facilities and lift the ban that denies U.S. servicewomen and dependents insurance coverage for abortion services in cases of rape or incest. [RH Reality Check]
North Carolina House approves waiting period for abortion: lawmakers in the House “voted 71-48 to approve the Women’s Right to Know Act, which requires women to get specialized counseling and wait 24 hours before having an abortion.” [Citizen Times]
Iowa House bans abortions after 18 weeks: “The Iowa House of Representatives passed a bill Wednesday that would establish the toughest abortion restriction in the country, banning the procedure after 18 weeks.” [Reuters]
Bipartisan group of lawmakers say NIH funding is key to curbing health costs: “A bipartisan group of Senate and House lawmakers are urging the chairs and ranking members of their respective chambers’ appropriations subcommittees to support funding for the National Institutes of Health, which they say is essential to keeping the country competitive in biomedical research and offers one of the best hopes in helping contain the increasing costs of health care.” [Inside Health Policy]