Newsletter, What's Going On, February 1, 2011
Judge Vinson in Florida has struck down the entire Affordable Care Act. (The full text of Judge Vinson’s decision is contained in that hyperlinked article). An interesting sentence from the Judges ruling: “It is difficult to imagine that a nation which began, at least in part, as the result of opposition to a British mandate giving the East India Company a monopoly and imposing a nominal tax on all tea sold in America would have set out to create a government with the power to force people to buy tea in the first place. “ Ezra Klein considers the opinion extreme, and describes good reasons why. He’s also written about what might happen if the law is overturned…a scenario that we single-payer enthusiasts would really like. (Both of Klein’s posts are well worth reading.) Igor Volsky identified a central portion of Judge Vinson’s ruling that is nearly identical to text in an amicus brief filed by an organization sometimes branded as a hate group. And many more opinions. Still more.
Judge Vinson ruled the law unconstitutional, but did not issue an injunction forbidding further implementation. Jonathan Cohn describes why an injunction wouldn’t have mattered much, anyway.
This is the response to the judicial ruling from the White House.
Health Care Appeal Moved Up. The Fourth Circuit Court last Wednesday moved up the schedule for its review of two cases testing the constitutionality of the new federal health care law, and set them for back-to-back hearing in May. That indicates that the cases are likely to produce rulings at the same time, in an appeals court that is known for moving with dispatch. Lyle Denniston, SCOTUSBlog, via Ezra Klein’s Wonkbook.
The Intrade web site now indicates an 8% chance of the individual mandate being declared unconstitutional by the Supreme Court by Oct 31, 2011. However, the same site quotes much greater probability of the mandate being invalidated by December 2012 or 2013.
Vermont’s single payer proposal, developed by Harvard’s Dr. William Hsiao, continues to generate a great deal of attention on health policy blogs.
- The two-week period for comments closes in the middle of this week. The schedule calls for a two-week period for Dr. Hsiao and his team to consider the comments they’ve received, then to release a final report. There are indications that the final report could have significant changes from the just-released draft. Vermont single payer advocates, in particular, have voiced a number of suggestions and concerns. In interviews, Dr. Hsiao has acknowledged that some of his proposals reflect substantial compromise between what might be desirable and what’s politically possible. He also reported that his draft was a bit rushed to completion because of difficulties his team experienced getting cooperation…and data…from some of the state’s insurers.
- Purists have complained that the Hsiao proposal isn’t really single-payer, and it isn’t…it leaves Medicare untouched, at a minimum. Leadership at PNHP has discussed the question, concluded unanimously to back the physicians in Vermont who back Hsiao’s proposal…not as ideal, but as a giant step in the right direction
- Vermont Gov. Shumlin has released a budget proposal that calls for significant cuts in the Medicaid program and other economies. Those cuts have led to more complaints from the Vermont Medical Association than have been reported in the wake of the Hsiao proposal. In fact, there’s been unexpectedly little opposition Hsiao’s draft…so far.
- Blue Cross of Vermont is not in favor of what Hsiao has proposed…but it has made it known that it would sure like to be the fiscal intermediary (as it is for Medicare payments in the state) if the plan is adopted.
- There are preliminary plans for a medical student rally in support of Hsiao’s proposal, scheduled for late March. 40+ doctors…in white coats…came to the Vermont Capitol in support of the proposal in the middle of a workday, one day last week. The Governor invited them into his office to make their case.
Senator Bernie Sanders summarized Vermont’s position: “What Vermont is asking for is to be able to use the Federal Money, not a penny more, and have their own single-payer.”
The Oregon legislature will shortly have a single-payer bill to consider. This is a draft (from Health Care for All – Colorado.) More than 400 people attended a single payer rally in downtown Portland last Saturday to discuss the bill; conference organizers had expected 75-100. This is a report from the conference. The bill will probably be introduced in the next week or so.
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A fight might break out between feds and the states on Medicaid cuts, report Marilyn Werber Serafini and Julie Appleby: "Financially strapped governors, Congress and the Obama administration could be headed for a showdown over the Medicaid health care program that covers 48 million poor, disabled and elderly people nationwide. Arizona's governor has already asked for permission to drop people from the joint federal-state program, which states say is eating up huge portions of their budgets. But to do so, they need the green light either from Congress or the Obama administration...The new health care law requires states to maintain their Medicaid eligibility levels for adults until 2014, when much of the law kicks in. In the meantime, federal funds that helped most states maintain their Medicaid programs - part of the 2009 stimulus package --comes to an end in June, even as enrollment remains at an all-time high while the nation struggles to recover from the recession. " Ezra Klein’s Wonkbook.
House Republicans are considering a push to privatize Medicare, reports Ricardo Alonso-Zaldivar: "Months after they hammered Democrats for cutting Medicare, House Republicans are debating whether to relaunch their quest to privatize the health program for seniors. House Budget Committee Chairman Paul Ryan, R-Wis., is testing support for his idea to replace Medicare with a fixed payment to buy a private medical plan from a menu of coverage options. Party leaders will determine if the so-called voucher plan will be part of the budget Republicans put forward in the spring. 'No decisions have been made on the details of our House GOP budget,' Michael Steel, a spokesman for Speaker John Boehner, R-Ohio, said Thursday." Ezra Klein’s Wonkbook.
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Simply Put: Introduction. Austin Frakt, one of the Incidental Economists, posts: “I’ve been challenged by Aaron (his partner Economist) to put basic concepts that underlie our health system into simple terms that everyone can understand. I think this is a great idea. It’ll test my understanding of ideas from health economics and my ability to strip away the math and jargon while retaining conceptual accuracy. (This was an implicit challenge, but I’ll take it up anyway.) The first question is: what are the concepts? I can think of some off the top of my head (listed in the original post). But I’ll bet you can think of many I’ve overlooked. As you request them, I’ll add them to the list. When I have time I’ll put out a “Simply put” post. I’d like to say I’ll do one per week, but I shouldn’t make an explicit commitment.”
I’ll plan to reprint the Simply Put posts in this digest as they appear. jwr
CT Mirror: In Attack On Health Reform, Republicans Target Medicare Advisory Board This week, a half-dozen House Republicans unveiled a one-paragraph piece of legislation (HR 452) to dismantle the Independent Payment Advisory Board well before it ever gets going. And unlike most other Republican repeal initiatives, this GOP effort might attract some Democratic company (Shesgreen, 1/28). Kaiser Health Report.
Commonhealth: The Associated Press: Medicare official doubts health care law savings “Two of the central promises of President Barack Obama's health care overhaul law are unlikely to be fulfilled, Medicare's independent economic expert told Congress on Wednesday. The landmark legislation probably won't hold costs down, and it won't let everybody keep their current health insurance if they like it, Chief Actuary Richard Foster told the House Budget Committee. His office is responsible for independent long-range cost estimates.” (google.com)
Have you noticed that the health insurance industry, the pharmaceutical industry, the American Medical Association and the American Hospital Association are not actively campaigning for repeal of the Affordable Care Act? However, all is not peaceful among health insurers.
Republicans on Thursday said insurers do not offer new child-only plans in 20 of the 48 states that participated in their survey due to health reform law requirements. HHS Secretary Kathleen Sebelius said many insurers are "reconsidering" their offerings and stressed that other options exist for children such as enrollment in the Children's Health Insurance Program. The Hill/Healthwatch blog (1/27) From AAP SmartBrief. The state by state report.
Alabama, State Sen. Scott Beason (R) "A lot of people say, if the Supreme Court decides that it is constitutional, you have to live with it. My feeling is, the people should have the final say. Frankly, the only recourse people have is for the states to try to flex some sovereignty muscle." Arguing for "nullification," Thomas Jefferson's late 18th-century doctrine that purported to give states the ultimate say in constitutional matters. Herndon’s Health Care Media Summary.
New England Journal Of Medicine: Perspective: The States' Next Challenge -- Securing Primary Care For Expanded Medicaid Populations In the coming years, the United States must address both an expansion of Medicaid coverage and an expected shortage of primary care physicians (Leighton Ku, 1/26). Kaiser Health News.
Physician Compare is a government-run web site, mandated under the ACA, intended to make it easier for patients to find physicians. The site is supposed to have names, addresses and some information about qualifications. Instead, it’s a mess. Michael Millinson, President, Health Quality Advisors, in Kaiser Health News.
Louisiana Wants to Cover Medicaid Patients with Private Plans Innovations in the Louisiana Medicaid system are of natural interest to Alabamians ever since Carol Steckel, our highly-regarded Medicaid Commissioner, left our state to join Bobby Jindal’s administration. This week there’s a report of an interesting modification proposed for Louisiana Medicaid. CNBC via AAP SmartBriefs.
Massachusetts Gov. Deval Patrick’s new $30.5 billion budget proposal, unveiled last Friday, presents a sobering future for poor patients and hospitals, who will face higher costs while the state scrambles for ways to rein in the price of medical care, reports The Boston Globe.
And every so often someone comes along and explains…again…abut the crippling costs of medical care, and how they’re getting worse, and what’s proposed to do something about them…and writes something new and fresh about the problem.
Maggie Mahar has another thoughtful assessment, laced with appropriate skepticism, of the stampede now going on into electronic medical records.
Selling Insurance Across State Lines: Frequently Asked Questions. Phil Galewitz and Lexie Vedon. Kaiser Health News. Via the Incidental Economist.
The Congressional Research Service has an analysis (.pdf) of the CLASS act provisions of the Affordable Care Act. Worth knowing about, for there are credible analyses of the Act that conclude that it isn’t fiscally self-sustaining.
DEM POLLSTER: PROVIDERS "CYNICAL" ON REFORM - At the Herndon Alliance annual meeting on Saturday, Democratic pollster Celinda Lake encouraged activists and advocates to educate health care providers about health care reform. In a not-yet-finished study, Lake found that doctors and nurses were "pretty cynical about health care reform right now." Lake: "Doctors and nurses are very popular with the public; they trust them. But many nurses have no clue what is actually in the bill. Nurses tend to react more like real people, they want to know how health care is going to affect them. Emphasize popular insurance reforms with providers like pre-existing conditions, these people are getting care, as well as giving it. ... One of the strongest messages we found was to remind providers how bad the current system is, how we got here, and how this may help." POLITICO Pulse.
Daily Kos raised over $20,000 to run radio ads targeting Republican health care hypocrisy...specifically, “House Republicans who have railed against the scourge of “government health care,” but who have no problem accepting government-subsidized health insurance for themselves.”
Why high deductibles don’t work for the sick. They force folks with marginal incomes to put off care and skip medications until they get really sick. Ezra Klein, quoting Atul Gewande.
The Affordable Care Act is supposed to extend mental health parity to millions more Americans. Maybe…or is this just a pipe dream? Maggie Mahar.
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Wednesday, February 2, 2011. Please join us at Shea's Express, for a fun lunch with no agenda, just some good discussion. The address for Shea's Express is 415 Church St., Huntsville (in the plaza right behind Bryant Bank, over by the old Huntsville Depot).. Wednesday before each monthly meeting.
Sunday, February 6, 2011 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, February 7, 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, February 10, 2011, 7PM. Health Care for Everyone – Alabama Meeting. “What’s Going On In Vermont?” We’ll review the presentation that Dr. Hsiao made to the Vermont legislature recommending a single payer health system, and discuss what’s happened since. Main meeting room, Emmet ONeal Library, 50 Oak Street, Mountain Brook.
Thursday, February 17, 2011. @5:30 PM. Third Thursday happy hour (social gathering), at Brickhouse Café, 7 Town Center Drive, (Huntsville). Rob Kilpatrick would appreciate knowing you’re coming. firstname.lastname@example.org
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