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Newsletter, What's Going On, February 18, 2011

Representative John Conyers has introduced H.R. 676 again in the present session of Congress.  The Bill is renamed this year: The Expanded and Improved Medicare for All Act.   Don McCanne’s Comment:  The "Expanded and Improved Medicare for All Act," H.R. 676, sponsored by Rep. John Conyers Jr., D-Mich., would replace today’s private health insurers – and the Obama law's individual mandate, which is being challenged as unconstitutional – with a single, streamlined public agency that would pay all medical claims, much like Medicare works for seniors today.  The immediate task for all of us who support an expanded and improved Medicare for all is to begin to recruit more cosponsors. Remind your Representatives that this does not eliminate the important beneficial measures of the Affordable Care Act. What it does instead is it replaces the highly flawed financing structure of ACA with a proven model that both makes health care affordable and includes everyone - the paramount goals of health care reform that have remained elusive until now.

House Republicans begin efforts to defund health-care overhaul.  Republicans launched this week the first of what they vow will be a series of attempts to use their control of the House of Representatives to defund the health-care overhaul law.  Rep. Denny Rehberg (R-Mont.) offered an amendment to the pending bill to fund the final seven months of this year's budget - an amendment that would prohibit administration officials from using any of the money to implement the health-care law. The proposal appears likely to make it into the final version of the budget bill that the House is about to vote on.  But the defunding effort faces two major obstacles: Democrats control the Senate and the White House, and nearly all funds the federal government will need to implement the law were appropriated in the law itself.  The only way to halt the administration's access to those implementation funds is for Congress to enact legislation rescinding them - a virtually impossible task as long as the GOP's majority is limited to the House.  Washington Post. 

The GOP spending request includes cuts meant to bar implementation of health care reform, reports David Nather: "The House Republican spending bill to fund the government for the rest of the year would bar funding for the director of the White House Office of Health Reform and for enforcement of the 1099 reporting requirement that Congress is already trying to repeal. It also ratchets back funding for preventive services under the new Prevention and Public Health Fund, community health centers, and National Health Service Corps to 2008 levels -- wiping out any increases provided under the health care law. The spending measure cuts $360 million from the Centers for Medicare and Medicaid Services, under a program management account that mainly pays for Medicare operations, and $65 million from the Administration on Aging."  POLITICO Pulse.

Poll: Most Americans Don't Want To Defund Health Law.  Kaiser Daily Health Report. 

RYAN VOWS TO TARGET MEDICARE, MEDICAID - The top House budget writer vowed this week to craft a blueprint for the nation's fiscal future that proposes significant reforms to Medicare and Medicaid - but not necessarily to Social Security - as he criticized President Barack Obama for choosing not to address entitlement spending in his fiscal 2012 budget.  POLITICO Pulse. 

The White House is temporarily exempting insurers in four states from health-care reform's care requirements, reports Robert Pear: "The Obama administration said Wednesday that it had granted broad waivers to four states allowing health insurance companies to continue offering less generous benefits than they would otherwise be required to provide this year under the new federal health care law. The states are Florida, New Jersey, Ohio and Tennessee, the administration told Congress. Lawmakers said that many other states, insurers and employers needed similar exemptions from some of the law’s requirements and would seek waivers if they knew of the option. Steven B. Larsen, a top federal insurance regulator, said the waivers would allow many consumers to keep the coverage they had, a goal often espoused by President Obama."  Ezra Klein’s Wonkbook. 

Indiana Gov. Mitch Daniels wants Republicans to get serious about health care reform, writes Peter Suderman: "Besides jettisoning the PPACA and starting over, Daniels says that it is time both parties recognize that Medicare is 'completely unsustainable,' and will need to be pared back accordingly... He argues instead that the GOP should get specific with the public about what the country can and cannot afford to do--and push policy accordingly. For starters, he wants to make Medicaid look more like his Healthy Indiana Program. He also favors 'rigorous' means testing of all entitlement programs and a shift toward 'concentrating resources on people who are the most vulnerable.'...But the biggest change he says he’d make is to delink insurance from employment--a change that has been politically impossible because it would require many individuals to let go of their current health insurance." Ezra Klein’s Wonkbook.  There’s chatter this week proposing Governor Daniels as a prospective Republican candidate for President.

Health care reform in Massachusetts was always intended to be a two-stage process.  The first was to get everyone covered by insurance.  The second phase is to get health care costs under control.  Yesterday, Massachusetts governor Deval Patrick was to introduce a proposal to accomplish phase two. He “plans to file long-awaited legislation…that would give him authority to scrutinize the fees paid to hospitals and doctors, part of a proposal to transform how providers are compensated and to curb rising health care costs, according to high-level administration officials. The legislation also underlines the administration’s plan to shift most Massachusetts employees, Medicaid recipients, and other residents with state-subsidized health insurance — about 1.7 million people, or 1 in 4 residents — to a new cost-conscious health care payment system, in which doctors and hospitals are put on a budget for each patient’s care. Liz Kowalczyk, the Boston Globe.  Consumer groups were impressed

Is the Blue Cross Blue Shield of Massachusetts “Alternative Quality Contract” the wave of the future?  Physicians will find this is really worth reading.  Incidental Economist.  

Aaron Carroll at the Incidental Economist reviews the economics of Medicaid.  Alabama has no reason to be proud.  And Dr. Carroll provides a nice, reasoned assessment of the likelihood of success of the Vermont single payer initiative.

A new Health Policy Brief from Health Affairs and the Robert Wood Johnson Foundation describes efforts to repeal the so-called 1099 provision in the Affordable Care Act. That provision was designed to help finance the expansion of health insurance coverage by making certain that businesses reported and paid tax on certain income.  The provision has drawn the ire of the business community, which views the new requirement as an excessive paperwork burden. President Obama has called for repealing it; the Senate has voted to do so; and the House is likely to do so in coming weeks.

Justices John Roberts and Samuel Alito aren't certain to rule against health care reform, reports Robert Barnes: "Some of those who watch the court most closely say it might actually be a little different this time. They believe the court's four liberals...have little trouble accepting that Congress has the power to mandate that individuals either secure health insurance for themselves or pay a fine. They think there is more play among some of the court's most consistent conservatives, most particularly Chief Justice John G. Roberts Jr. and Justice Samuel A. Alito Jr... The chief justice, in U.S. v. Comstock , agreed that the Necessary and Proper Clause gave the government the right to detain sexually dangerous federal prisoners even after their sentences were completed, although even the power to imprison is not explicit in the Constitution."  POLITICO Pulse.

The Justice Department wants a judge who declared health care reform unconstitutional to okay its implementation, reports Jennifer Haberkorn: "The Justice Department on Thursday asked the Florida judge who struck down the health care overhaul to declare that the law must still be obeyed...Vinson last month struck down the entire health care reform law as unconstitutional, which has caused confusion for the states and federal government about whether they have to proceed with implementation. Some legal scholars and opponents of the law, including the governors of Alaska and Florida, believe the ruling has the effect of an injunction against the law, though Vinson declined to issue one."  Ezra Klein’s Wonkbook.

InsureBlog’s Mike Feehan adds to the debate surrounding the constitutionality of the individual mandate in the PPACA.  He points out that in the recent Florida ruling that found the mandate to be unconstitutional, the judge noted that the government’s position during the preceding court battle in Virginia was that “although people are required to buy health insurance under the act, they are not yet required to use it.”  Mike brings up an excellent point when he asks why they would use the word “yet”.  The possibility that the government could one day compel people to seek preventive care against their will is a disconcerting idea indeed.  Health Wonk Review. 

New England Journal Of Medicine: Can Congress Regulate "Inactivity" (And Make Americans Buy Health Insurance)? Judge Vinson believes that the federal government is far too powerful and that he has discovered a limiting principle. But the line he draws is not grounded in, and ignores the reasoning of, governing Supreme Court precedent. Courts, like doctors, must make judgments on a case-by-case basis. In law, as in medical diagnosis and treatment, simple rules are often misleading and inappropriate. That does not mean that there are no rules. It simply means that the governing rules are complicated and contextual (Timothy Stoltzfus Jost, 2/16).  Kaiser Daily Health Report.

National Journal: Senators Introduce Bill To Expand Medicare Mental Health Coverage 
In a bipartisan effort to bring equality to mental illness coverage for Medicare beneficiaries, Sens. John Kerry, D-Mass., and Olympia Snowe, R-Maine, introduced a bill eliminating psychiatric care caps. Under current Medicare regulations, beneficiaries are offered up to 190 days of inpatient psychiatric treatment in a hospital through the lifetime of the policy. Under Kerry and Snowe's bill the limitation will be eliminated and Medicare mental health coverage would be equal to that offered in private insurance (Fung, 2/17).  Kaiser Daily Health Policy Report.

Retiree health care costs are a tremendous strain on state and local governments, but public employee unions counter they’ve given up wages to secure the promise of full health benefits on retirement.   

Kaiser Family Foundation Primer on Medicare Financing.  The costs of administering the Medicare program have remained low over the years – less than 2 percent of program expenditures. As such, program administration is not a contributing factor to Medicare’s expenditure growth. Administrative costs include all expenses by government agencies in administering the program (HHS, Treasury, the Social Security Administration, and the Medicare Payment Advisory Commission). Also included are the cost of claims contractors and other costs incurred in the payment of benefits, collection of Medicare taxes, fraud and abuse control activities, various demonstration projects, and building costs associated with program administration.  Don McCanne’s Quote of the Day.  

Sebelius Clears the Way for Arizona to Shed Adults From Medicaid.  Kevin Sack, New York Times. 

Leanne Townsend, the Alabama field representative of Organizing for America, is looking for stories of people helped by the Affordable Care Act.  Contact her here

Ezra Klein Justin Bieber talks health care: The Canadian-born Bieber never plans on becoming an American citizen. "You guys are evil," he says with a laugh. "Canada's the best country in the world. We go to the doctor and we don't need to worry about paying him, but here, your whole life, you're broke because of medical bills. My bodyguard's baby was premature, and now he has to pay for it. In Canada, if your baby's premature, he stays in the hospital as long as he needs to, and then you go home."  Yet Canadian medicine is not without problems.

Did you know that there is a provision in the Affordable Care Act that guarantees working new mothers break time to express milk?  

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Thursday, March 17, 2011.  @5:30 PM.  Third Thursday happy hour (social gathering), at The Scene, restaurant and lounge, upstairs at Monaco, 370 The Bridge Street, Huntsville.  Rob Kilpatrick would appreciate knowing you’re coming.  rob2020@mac.com 

Wednesday, March 2, 2011. Please join NAHA (North Alabama Healthcare for All), for a fun lunch with no agenda, just some good discussion. 

Location in March to be determined.  .  Wednesday before each monthly meeting.

Sunday, March 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, March 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, March 10, 7:00 PM.  Health Care for Everyone-Alabama meeting, Community Meeting Room, Emmet O’Neal Library, 50 Oak Street, Mountain Brook.  Subject to be announced. 

Thursday, March 17, 2011.  @5:30 PM.  Third Thursday happy hour (social gathering), at The Scene, restaurant and lounge, upstairs at Monaco, 370 The Bridge Street, Huntsville.  Rob Kilpatrick would appreciate knowing you’re coming.  rob2020@mac.com


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