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Newsletter, What's Going On, March 4, 2011

POLITICO Pulse earlier this week: WAITING FOR VINSON, STATES IN LIMBO- Alaska has a governor that says the state doesn't have to implement - but a state Senate arguing that they do. The Washington state attorney general wants the law enjoined; his boss, Gov. Chris Gregoire, doesn't. The differences of opinion raise a lot of questions about how much regulators can do on implementation and whether states should be party to the lawsuit in the first place. "It creates a challenging question: who speaks for the state?" George Washington University's Jonathan Turley, tells PULSE. "You're dealing with a massive government regulation that affects each of these states. A lawsuit with those kinds of implications is less common."  (This discusses the reach of the judge’s ruling dispassionately).  

Then, yesterday… Brian Beutler, TPMDC: Florida Judge Stays Decision Voiding Health Care Law. Roger Vinson, the Florida district court judge who voided the entire health care law has issued a stay of his own ruling, giving the Obama administration just a week to file an appeal.  His decision had sown confusion -- sometimes opportunistic confusion -- about whether states were required to implement the law during the appeal process. The Department of Justice sought clarification from Vinson last month to ease that confusion. In his clarification, Vinson also stayed his own decision, on the condition that the DOJ file its appeal with a higher court within seven days.  He was emphatic that the confusion be speedily resolved.  A Department of Justice spokesman indicated the DOJ would file an expedited appeal. 

POLITICO Pulse: ACTUARIES: EVERYONE ASKING ABOUT MANDATE ALTERNATIVES- Members of the American Academy of Actuaries, in town for Hill and agency meetings, tell PULSE that one of the hottest questions they've gotten is what can be done if the individual mandate falls. The answer? "There's no real silver bullet," says Tom Wildsmith, the group's vice president for health issues. But the alternative is likely a package of ideas: open enrollments, waiting periods and penalties for late enrollment, or perhaps only allowing non-covered persons to buy bronze plans, versus the gold plans.

No silver bullet?  Robert Laszewski.  The Health Care Blog: Defined Contribution Health Care – The Conservatives’ Silver Bullet.   

David Nathan, POLITICO: Put aside the questions of the constitutionality of the individual mandate.  It’s distinctly possible that the penalties for not getting insurance are so low, they wouldn’t induce many people to buy insurance they wouldn’t otherwise buy.  In other words, they just might not work.  

Matthew Yglesias: Or, if the individual mandate is unconstitutional, won’t the move toward national single-payer legislation return, stronger than ever? 

For states to do their own, state-level single-payer legislation or any other state-level health care reform, they need waivers of several provisions in federal laws.  Presently they aren’t allowed to apply for those waivers till 2017.  President Obama went on record this week supporting states that would like the application date moved up to 2014.  Initial Republican response was cautiously supportive, but that didn’t last long…for instance, POLITICO Pulse: “HERBERT WALKS BACK ON WYDEN-BROWN- The Utah governor fell more in line with Congressional Republicans while testifying Tuesday before Energy and Commerce. 'That really is not flexibility,' Gary Herbert said of the now POTUS-endorsed proposal. In a Monday interview with POLITICO, Herbert had described the legislation as a 'step in the right direction.'” There are now other posts pointing out Republican contention that the change to an earlier date is essentially meaningless.  Here.  And here.  And here.   Problems with the Republican position.  (POTUS = President Of The United States.)  And spokesmen for PNHP, Physicians for a National Health Program, have made it clear that organization still favors a national single-payer bill in preference to state-level legislation.  The American College of Physicians is supportive of the President’s position. 

Steve Kemble, Hawaii. One payer states blog: In 2009, the Hawaii legislature passed a bill (Act 11 2009) to create a Hawaii Health Authority (HHA) to design a "universal health care system covering everyone in the state," reporting to the Legislature with actionable legislation by January 2011. Our then Republican Governor vetoed the bill but her veto was overridden. She refused to appoint the HHA Board and the law was never implemented.

This session, both the House and Senate have introduced identical bills to extend the reporting date for the HHA to January 2012, and as of yesterday, both have passed out of all the committees to which they were assigned. The original bill is law, so our new Governor Abercrombie is free to appoint the Board any time he wants to. He was previously in the US House where he was a longstanding single-payer advocate and a co-sponsor of HR 676. 

The only testimony in opposition to the bills extending the reporting date for the HHA was from HMSA, the major BCBS health insurer in Hawaii. They favor alternative bills creating a separate Board charged with implementing a Hawaii version of the health insurance exchange called for in the PPACA. Those bills are also still alive and have passed all the committees they were assigned to. Crossover is next week. The HHA bills could either be merged and sent to the House and Senate as a whole for voting, or they could be crossed over and have to be reviewed again in committees in both houses, with more opportunities for the health insurance lobby to kill them. 

Section 1099 of the PPACA is the unpopular provision that requires businesses to notify the IRS of significant payments made to suppliers each year.  The intent is to capture taxes from companies not presently reporting all their income.  The proposal is unpopular because of the paperwork it will create.  Both parties are agreeable to repealing the provision, but disagree on how to offset the tax revenue the provision was expected to generate.   Judy Solomon, Off the Charts: The House (was to vote yesterday) on a (Republican) bill that would seriously weaken health reform by imposing large tax penalties on many people who received subsidies to buy coverage in the health insurance marketplaces (“exchanges”) the law will set up.  That would discourage many people from applying for subsidies in the first place, leaving more Americans to remain uninsured.  It also could create a public backlash against health reform among people who bought coverage and then found themselves owing large sums to the IRS.  Democrats consider the Republican proposal to be “another middle-class tax.” 

POLITICO Pulse: As the talks begin on how to fund the government for the rest of the year, there's a very real math problem that Harry Reid faces. There won't be 60 votes to end a filibuster on any spending agreement that includes the House language to defund the health care law, because Senate Democrats would never go for it. But if it's all stripped out, he might not be able to get 60 votes either - because most or all of the Senate Republicans would vote against a bill that funds the law. 

But Speaker Boehner may have problems of his own in getting the next continuing resolution through the House.  TPMDC: A number of the members of his own party pledge to vote against the resolution extending funding unless the legislation includes strong anti-abortion provisions.  The Speaker may need Democrats to get the continuing resolution passed.  

Marilyn Sarafini.  Kaiser Health News: GOP House Budget Chairman Ryan Pushes Medicare Vouchers. House Budget Committee Chairman Paul Ryan vowed Thursday to include aggressive reforms of Medicare in the budget proposal he is beginning to craft. Ryan reiterated his controversial idea to issue vouchers to beneficiaries.  Ryan, R-Wis., said he wants to "protect" people who are currently 55 or older by giving them Medicare exactly as it exists today. "We don’t want to pull the rug out from people on their way to retirement," he said.  Those now younger than 55 would get a voucher to buy private insurance when they become eligible. He likens this idea to the health insurance program for federal employees – including members of Congress – who can choose from a menu of federally certified health plans. 

Suzy Khimm, Mother Jones: House Speaker John Boehner has promised that GOP will tackle entitlement reform in the near future.  Of the three major entitlements, Social Security and Medicare have strong defenders in Congress and in the country.  Medicaid ‘only’ affects the poor.  It’s much more vulnerable to political attack, and Republicans have that program squarely in their sights.  

Maggie Mahar: Primary Care and the National Health Service Corps: Finding Physicians “Who Will Go Where No One Else Will Go”  Useful discussion of the problem of finding primary care physicians for patients who will be scratching to find doctors to care for them, once the Affordable Care Act kicks in, especially in underserved areas.  

Jon Walker, Firedoglake: The Illinois’s health care reform implementation panel has released its initial recommendations. They concluded that the private insurer exchanges created by the new health care law are likely to be a relatively bad deal for low-income residents, and that the state would be able to provide them better and cheaper coverage through a new public Basic Health Plan, at less cost to the federal government. 

Kaiser Daily Health Policy Report: The Hill: Dueling Reports On Health Law's Costs Issued As Governors Testify On Capitol Hill Dueling reports on the health care reform law's impact on states surfaced Tuesday as governors testified on Capitol Hill. A new bicameral report from Republicans on the Senate Finance and House Energy and Commerce panels estimated that the law's Medicaid expansion would cost $118 billion over 10 years, almost twice the Congressional Budget Office's score. Simultaneously, the Robert Wood Johnson Foundation issued a report saying states would get $82.3 billion from the federal government in Medicaid and state exchange subsidies (Pecquet, 3/1).

The Daily Camera: Miss Colorado’s story. “It seems that any time we plunge the depths of unexpected poverty or homelessness -- the family with two working parents, who still need food assistance, the beauty queen without a home -- there's a trail of medical bills at its core.  Beauty pageant contestant Blair Griffith, a sunny 23-year-old department store employee, is this year's Miss Colorado USA. She'll be competing for a national crown in June, and her platform is a most personal one: She and her sick mother are currently homeless.  As beauty queen narratives go, this one is perfectly timely. Even the fact that her job, at Saks Fifth Avenue, will soon draw to a close as that store falls victim to the ailing economy.  But a kernel of her story isn't as mired in the 2011 economy; it's a part of countless stories and studies about poverty, hunger and homelessness in America. It's about health care costs.  According to Griffith, her mother had a heart attack. The insurer declared it was the result of a pre-existing condition, leaving the widow to pay for medical care -- including $800 a month in medicine -- out of pocket. Unable to pay for it all, the family was evicted from their apartment.” One Payer States Google Group. 

Kaiser Daily Health Policy Report:  PBS Newshour: In California, Rising Health-Insurance Premiums Spark Outcry People got angry when Blue Shield of California announced recently it would raise health insurance rates for some individuals as much as 59 percent. It was the fourth major insurance company to announce sharp increases for those buying their own insurance and the third round of rate hikes by Blue Shield since last fall (Michels, 3/3). 

Sara Rosenbaum.  Healthcare GPS.  There are provisions within the Affordable Care Act that permit expansion of a state’s Medicaid program to allow family planning and services for low income women, women who would not otherwise qualify for financially supported care.  

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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.  We’ll combine a drop-in health care study group, this month starting with the ‘Individual Mandate’; talk about recent goings on in health care reform and plans for what to do next.  All invited. 

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 

Thursday, March 24, 2011. 8 PM. CST  PNHP Leader/Activist Conference Call.  Call me for the number and access code. 

Wednesday, March 30, 2011. Please join NAHA (North Alabama Healthcare for All), for a fun lunch with no agenda, just some good discussion. 

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

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