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Newsletter, What's Going On, December 14, 2010

Judge rejects key part of Obama healthcare law. "This dispute is not simply about regulating the business of insurance -- or crafting a scheme of universal health insurance coverage -- it's about an individual's right to choose to participate," Hudson wrote, adding the provision invites an "unbridled exercise of federal police powers."  And…”Legal Analysis, Implementation Predictions And Political Posturing Abound In The Wake Of Yesterday's Decision”  Kaiser Health News.   And…Op-Eds

A Washington Post staff writer wrote: And conservatives may come to regret this line of attack: "The individual mandate was created by conservatives who realized that it was the only way to get universal coverage into the private market. Otherwise, insurers turn away the sick, public anger rises, and, eventually, you get some kind of government-run, single-payer system, much as they did in Europe, and much as we have with Medicare. If Republicans succeed in taking it off the table, they may sign the death warrant for private insurers in America: Eventually, rising cost pressures will force more aggressive reforms than even Obama has proposed, and if conservative judges have made the private market unfixable by removing the most effective way to deal with adverse selection problems, the only alternative will be the very constitutional, but decidedly non-conservative, single-payer path."  The Wonkbook.  The hyperlinked article is worth reading in its entirety.

Another viewpoint: What if the Supreme Court Strikes Down the Insurance Mandate?  There are alternatives to accomplish what the individual mandate seeks to accomplish.  Wonkbook.

LIBERALS SEE SILVER LINING – New York Times editorial board and the Washington Post’s Ezra Klein repeat the refrain we heard all Monday: The ruling was way better than it could have been. NYT praises Hudson for bending "over backward to limit the scope of his ruling." NYT Editorial  POLITICO Pulse.

Tuesday morning, Intrade’s odds that the individual mandate would be declared unconstitutional had risen to 16 chances in a hundred. 

As you plan your year-end giving, please keep us in mind.

Austin Frakt and Aaron Carroll have written a thoughtful article for the Kaiser Health News, titled How the Health Reform Game has Changed.  Two (of the nine) paragraphs in the article:

“It shouldn't be a surprise that hospitals, insurers, large employers, and the pharmaceutical industry do not favor repeal. The health law took the shape it did for a reason: interest groups were reasonably successful in achieving their goals with respect to the fundamental structure of the law. Insurers and hospitals like the mandate (even if Americans oppose it) because it promises greater revenue and a more attractive risk pool for the former and a reduction in uncompensated care for the latter. The pharmaceutical industry is pleased that the Medicare doughnut hole will be closing because it will lead to increased drug sales. Large employers also favor Medicare reforms that will reduce costs and increase quality, both for Medicare and for the supplements that large employers sponsor for their retirees.”   And…

“However, just because health reform won't be repealed, that doesn't mean there might not be significant changes during implementation, or that Republicans won’t have influence over those changes. Many of the key implementation decisions won't be made at the federal level because insurance is regulated to a large extent by states. State insurance commissioners are not appointed by the president or by Congress; they are generally appointed by governors. In the November mid-term elections, Republicans picked up nine governorships, and will, as a result, control that office in 29 states. And, in the states where insurance commissioner is an elected position, the GOP also made gains."

There’s been substantial debate whether the compromises in the Affordable Care Act so emasculated it that it isn’t worth supporting.  Maybe so, but compare the history of Social Security.  Steve Benen wrote in the Washington Monthly: “Social Security, however, is another story.

“No self-respecting liberal today would support Franklin Roosevelt's original Social Security Act. It excluded agricultural workers -- a huge part of the economy in 1935, and one in which Latinos have traditionally worked. It excluded domestic workers, which included countless African Americans and immigrants. It did not cover the self-employed, or state and local government employees, or railroad employees, or federal employees or employees of nonprofits. It didn't even cover the clergy. FDR's Social Security Act did not have benefits for dependents or survivors. It did not have a cost-of-living increase. If you became disabled and couldn't work, you got nothing from Social Security.

John Judis noted earlier this year that the original Social Security Act ‘was a bare shell of what it became in the 1950s after amendment. Benefits were nugatory. And most important, coverage was denied to wide swaths of the workforce.’

“And why was it so limited? Because Franklin Delano Roosevelt had to cut deals with conservatives -- many of whom were motivated by nothing more than racism -- in order to get the legislation passed. FDR knew he was betraying his principles and even some of his own supporters at the time, but he considered the goal of getting Social Security in place paramount, even if it was incomplete, even if it left Americans in need out.

“At the time, The Nation ran scathing pieces against Roosevelt and the Social Security, condemning the ‘betrayal,’ and accusing FDR's White House of possibly dealing ‘a death blow’ to social-insurance movement ‘for many years.’

“Under the circumstances, this history seems relevant.”  From Ezra Klein

Houston Chronicle: Insurers Sell Products To Fill The Gap 
As employees face higher co-pays, deductibles and health care premiums.  A relatively new insurance product has become increasingly popular. It's known as "gap" or "bridge" insurance, and it covers some of the out-of-pocket health care costs that are becoming more difficult for employees to shoulder, such as annual deductibles that are rising to $1,000, $2,500 or even $5,000 (Sixel, 12/8).   Yes.  You read that right.  Insurance companies sell insurance policies with bigger and bigger deductibles.  Now they’re selling more insurance to cover the deductibles.  Don McCanne sputters with precision.  “Gap” policies for private insurance is available in Alabama.  I’m told that some employers provide high-deductible insurance for their employees who are then encouraged to buy the “gap” coverage on their own. 

Bob Doherty, writing as the ACP Advocate, asks, “What Happens if Universal Coverage is Allowed to Slip Away?”  In part: “One of the things about the health care reform debate that has bothered me the most is how little of it has been about the uninsured. The Republicans have not offered a plausible plan to cover the uninsured, and the Democrats have mostly emphasized the benefits for people who already have insurance (while assuring them that they can keep their doctor and their health plan). But the Affordable Care Act makes only modest improvements (like better coverage of preventive services) for people with insurance. Instead, most of its benefits will go to subsidize coverage for people who otherwise couldn’t afford health insurance.

This makes the law a harder sell for the 80% of U.S. residents with health insurance, and may help explain why support for the law seems stuck in the mid-to-high 40s in most polls. (Seniors, for instance, are the least supportive of the ACA. Could this be because they already have universal government-run health coverage – Medicare – and don’t see much to gain by extending coverage to others?)”

Children's hospitals are losing money for "orphan drugs", reports Robert Pear: "Over the last 18 years, Congress has required drug manufacturers to provide discounts to a variety of health care providers, including community health centers, AIDS clinics and hospitals that care for large numbers of low-income people. Several years ago, Congress broadened the program to include children’s hospitals. But this year Congress, in revising the drug discount program as part of the new health care law, blocked these hospitals from continuing to receive price cuts on orphan drugs intended for treatment of diseases affecting fewer than 200,000 people in the United States...Children’s hospitals say the change is costing them hundreds of millions of dollars."  However, The Boston Globe: Health Law Fix To Save Children's From Added Costs The Senate voted last night (last Wednesday night) to fix an error in the federal health care law that could cost Children's Hospital Boston and others like it millions of dollars in added drug costs to treat children with rare diseases. The change was included in a broader bill that would extend through next year a Medicare physician payment formula (Viser, 12/9).

As presently written, the Comparative Effectiveness studies commissioned under the Affordable Care Act must not take comparative cost into account.  Rep. Darrell Issa, a powerful Republican who’s been selected by his colleagues to be the next chairman of the House Committee on Oversight and Government Reform, indicated in an interview that maybe studies of the most cost-effective therapy are in order, after all.

Firedoglake: Health Care Reform Reminder: Democrats Could Still Pass Public Option through Reconciliation.   You  wish. 

The Patient-Centered Medical Home.  Greatest thing since sliced bread?  Or, “the PCMH/EMR (Patient Centered Medical Home/Electronic Medical Record) movement will be just another government/big business/bureaucratic top-down unfunded mandated boondoggle that will further waste healthcare resources and further delay the most fundamental reform that has yet to happen: primary care physicians should be fairly paid for the work they do.”  Dr. Richard Young, writing at KevinMD, gives his reasons for believing it’s the latter.  He has some facts to back up his opinion. 

The New York Times had an editorial Sunday pointing out (again) the need to control health care cost.  From the editorial: “This year, Medicare, Medicaid and a related children’s health insurance program will account for more than 20 percent of all federal spending — higher than Social Security or defense. Unless there are big changes, by 2035 federal health care spending — driven by rising medical costs and an aging population — is projected to account for almost 40 percent of the budget.”

Stat of the week: States and insurance coverage: levels of coverage vary widely. Massachusetts has near universal coverage, with an uninsured rate of less than 5% due to landmark health reform legislation enacted in 2006. Uninsured rates in states such as New Mexico, Florida, and Texas exceed 25%. Source: Kaiser Family Foundation, The Uninsured: A Primer.

Politico: 1099 Repeal Foiled Again Another day, another failed attempt at 1099 repeal. Republicans rebuffed a Democratic effort to repeal health reform's universally-panned 1099 IRS reporting requirements as a piggyback in the tax cut deal, congressional aides on both sides of the aisle confirm to Politico (Kliff and Haberkorn, 12/13).  Kaiser Daily Health Policy Report.

Boston’s Beth Israel hospital is about to sign a revolutionary contract with that state’s Blue Cross, moving from fee-for-service toward ‘global’ reimbursements.  An interview with its chief of staff.

Modern Healthcare: 'Mini-Med' Plans Must Spell Out Coverage Limits 
The HHS said it is requiring health insurers that offer bare-bones coverage, known as "mini-med" plans, to notify consumers in plain language that their benefits are extremely limited. Mini-med plans, typically offered to low-wage retail workers, often have annual coverage limits of just $2,000 and small monthly premiums (Vesely, 12/9).  Kaiser Daily Health Policy Report.  These are the ‘junk insurance’ that McDonalds offers to its employees, for example. 

The government's dependence on the American Medical Association drives up health costs, writes Uwe Reinhardt: "The RUC is a group of 29 physicians drawn from a variety of medical specialties. It was established by the A.M.A. in 1991 to advise the C.M.S. on recalibrations of the relative value scale underlying the Medicare fee schedule...As it happens, however, the C.M.S. tends to accept the RUC’s recommendations on RVU changes more than 90 percent of the time, which effectively makes the RUC the final arbiter in these matters. I do not believe that slavish acceptance of the RUC’s recommendations is a good thing, if only because the physicians on the RUC do labor under at least the appearance of a conflict of interest."  The Wonkbook.

Stateline: In Vermont, Single-Payer Health Care In A Single State Congress never really considered a single-payer health plan run by the government. Vermont is planning for one. This isn't some liberal fantasy. Vermont lawmakers are serious. To understand how serious, you only have to look at the resumes of William Hsiao and Jonathan Gruber (Goodman, 12/14).  Kaiser Health News. 

Arizona continues in the news because of its decision to deny organ transplants to some Medicaid recipients without which they will die.  The denial will save the state an estimated 1.4 million dollars in an overall state budget of 9 billion.  Several lawmakers said “funding for organ transplants for Medicaid patients should have taken priority over a recent $20 million renovation to roof of the Arizona Veterans Memorial Coliseum or a $2 million grant for algae research"  The Arizona governor has declined to call a special session of the legislature to deal with the Medicaid problem.

Fox News Boss Ordered Staffers To Echo GOP Talking Point About Public Option In Health Care CoverageHuffington Post.  The term ‘public option’ is forbidden on Fox News.  The terms ‘Government-run health insurance’ or ‘government option’ or ‘so-called public option’ are to be used instead.

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Thursday, December 16, 2010.  @5:30 PM.  Third Thursday happy hour (social gathering), at 801 Franklin (Huntsville).   Rescheduled this month.   Wednesday, December 22.  5-7 PM.  Happy hour, Westin Hotel, Bridge Street, Huntsville to greet Linda Haynes Loeb and Tom Loeb who’ll be in town for a brief visit. 

Thursday, December 16, 8 PM CDT.  PNHP’s monthly activist phone call.  Please call me for the phone number and access code. 

Wednesday, December 29, 2010.  Lunch, (social gathering) Nothing but Noodles, Village on Whitesburg Shopping Center, 4800 Whitesburg Drive, Huntsville.  Wednesday before each monthly meeting. 

Sunday, January 2 (?),  7PM CDT.  Healthcare-NOW monthly activist phone call. Please use this Dial-in Number 1-218-862-1300 and Conference Code 441086. To mute and unmute the line, please hit *4. 

Monday, January 3, 2011 @ 5:30 PM.  North Alabama Healthcare for All Monthly Meeting —Huntsville/Madison County Public Library, 901 Monroe Street  (downtown).  The meeting is in Room AB, on the first floor. After you enter the library’s front door, turn right towards the auditorium. 

Thursday , January 6, 2011, 7 PM.  Debate: “That the US Supreme Court will Declare the Individual Mandate Unconstitutional by midnight October 31, 2011.”  David Carpenter vs. (to be determined…where are Republican attorneys when we need them?)  Main meeting room, Emmett O’Neal Library, 50 Oak Street, Mountain Brook.  Brief business meeting precedes the debate, at 6:30 PM, same place.  

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