health care law

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What The Supreme Court Ruling On Obamacare Means: A Student’s Perspective

By Marina Renton
CommonHealth Intern

As a public health major at Brown University, I’ll admit I’m biased: When the King v. Burwell decision was handed down this week, I was absolutely elated. The decision felt exactly right to me; people were not going to lose their health care coverage, and more might even have the chance to gain it.

But the case is complicated, so to really understand the take-home messages, I consulted a couple of health care policy experts.

One is Ira Wilson, professor of Health Services, Policy and Practice at Brown University, who taught my “Health Care in the United States” class last semester.

The other is Michael Doonan, assistant professor at the Heller School for Social Policy and Management at Brandeis and executive director of the Massachusetts Health Policy Forum

Their responses are lightly edited:

MR: What background do we need to understand the Supreme Court decision?

IW: One of the core tenets of health care reform is that people who can’t afford insurance get subsidies so that they can buy it.

The ACA:

• Reforms insurance by doing things like preventing denials due to pre-existing conditions. So it requires that insurance do certain things that it hasn’t always done in the past.

• Requires that everybody get insurance. That’s the individual mandate, and that was covered in the 2012 challenge and then upheld in the 2012 case.

• Requires that affordable insurance be available to everyone. And this King case threw into question that third leg of the stool, as it were. Or at least it brought it into question for the states that, rather than deciding to develop their own exchange, used a federal one. So without this, the entire framework for health care reform in those states that have a federal exchange begins to fall apart. And as we know because we’ve seen lots of articles about estimating how many people would lose insurance if those subsidies were taken away (estimates were in the six million range), it would have a devastating impact on people who are now insured who would lose it.

What does the ruling say about Obamacare?

MD: If the Supreme Court had ruled against the government and said that the subsidies could not be available in the 34 states that have federally run exchanges, it might not have been the death of Obamacare, but it certainly would have put it on life support. So this decision is really critical in helping root and solidify the Affordable Care Act. And the more it gets rooted in each of the states, the harder it’s going to be to repeal.

IW: So this actually was a 6-3 decision, not a 5-4 decision. And it does seem to me the fact that both Justice Roberts and Justice Kennedy — who were the two that one might have imagined might have been on the other side of this issue — came down on the side of upholding these subsidies is a bit of a statement.

What if the ruling had gone the other way?

MD: Think about Texas. Now, in Texas, there are about 1.1 million people who are enrolled in that exchange, that marketplace. Well, 90% of them — over 900,000 people — are receiving those subsidies, and they could have lost their insurance.

And it’s not only important that people lose their insurance, which is the most critical thing, but hospitals would see many, many more uninsured patients. So even people adamantly opposed — I think that even Republican governors who are opposed to this are secretly saying, “Oh my gosh; thank goodness.” This would have caused them a tremendous, tremendous burden, because they would have seen more uninsured.

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Mitt Romney: Then And Now

Romney: In 2006, he signed the state's health insurance law. Today he plans to announce he's running for president.

Later today at a farm in Stratham, New Hampshire, Mitt Romney plans to announce he’s running for president, again.

Five years ago, in Boston, Romney signed into law Massachusetts’ landmark health reform legislation requiring every citizen in the state buy health insurance. And that, as we’ve heard, is both his signature achievement and, potentially, his most devastating political baggage.

In its inimitable way, The New Yorker lays out Romney’s conundrum better than anyone else. In the current issue, Ryan Lizza opens his story with a familiar scene: Romney at an elaborate bill-signing ceremony at Faneuil Hall. But he embellishes the portrait of the Governor with perfect detail. (The full story is behind a pay wall now, but here’s a taste):

Romney signed the bill at a wooden desk using fourteen different pens, which he later distributed to the dignitaries on hand. “It’s law!” he shouted after the final stroke. On cue, the sounds of the fife-and-drum corps filled the hall with Colonial-era music. Behind Romney stood the people most responsible for passing the plan, among them Senator Ted Kennedy and Salvatore DiMasi, the Speaker of the Massachusetts House of Representatives. In one photograph, the Governor is looking over his shoulder at DiMasi, laughing, and Kennedy is smiling at Romney. Kennedy died in 2009, and DiMasi is currently on trial for extortion and corruption and may go to jail. Romney, who did not seek reelection in 2006, is running for the 2012 Republican Presidential nomination. Early this spring, as his campaign was foundering, a morbid joke about the photo circulated among Massachusetts political insiders: “The funny thing about that picture is that there’s three dead men, but only one is in the ground.”

RomneyCare: Big Speech On U.S. Health Law Coming Soon

Romney signed the state's health reform law in 2006

The Boston Globe reports that Mitt Romney will offer his own vision of a national health care plan tomorrow at a speech in Michigan.

The campaign provided The Globe with a scant outline of what RomneyCare might look like. (Hopefully the speech will be a little more fleshed out.) Here are the bullet points:

–Restore to the states the responsibility and resources to care for their poor, uninsured, and chronically ill.

–Give a tax deduction to those who buy their own health insurance, just like those who buy it through their employers.

–Streamline the federal regulation of healthcare.

–Reduce the influence of lawsuits on medical practice and costs.

–Make healthcare more like a consumer market and less like a government program.

Romney, a likely presidential candidate, has been forced to walk a fine line whenever he delves into the topic of health care. As the governor who signed Massachusetts’ landmark health overhaul into law (the same law that later served as a model for national health reform) Romney can’t escape his eternal connection to the 2006 reforms. Yet, he’s bashed Obama’s national health reform law on the campaign trail, saying what may work pretty well in Massachusetts won’t fit every state.

The speech will surely get a lot of attention. Look for market-based fixes and schemes to reduce medical malpractice cases.

Health Law Repeal Debate Begins

Kaiser Health News posts the text of the GOP proposals to repeal and replace Obama’s health care overhaul, which Republicans have officially named: “The Job-Killing Health Care Law.” So much for a new civility taking hold in Washington.

For a reality check after you read the bills, here’s Ezra Klein envisioning two worlds: one if the law is repealed, aka, the status quo, and another if the reforms in the Patient Protection and Affordable Care Act are allowed to unfold.

The choice Congress is debating today is not between the vision of progress in the Affordable Care Act and some other vision for how we move forward. It’s the progress in the ACA or the status quo. And when you compare those two, there’s no contest: Under the ACA, coverage is more universal, deficits are lower, cost control experiments are more numerous, and the insurance market is more competitive and humane than under the status quo.

Gazing Into The Crystal Ball: How Will The Supremes Rule On Health Overhaul?

Wanted: Clues On Health Reform Law From The U.S. Supreme Court

Legal experts are scouring a recent Supreme Court decision to see if it might offer clues on how the justices might rule on the constitutionality of the health reform law, Kaiser Health News reports.

A story in the L.A. Times concludes that the decision not to hear a recent case that challenged a federal ban on felons possessing body armor does not bode well for opponents of the law. Here’s the lede of the story, headlined: “Supreme Court ruling hints of difficulty for Obama insurance law foes:”

The Supreme Court may not be so anxious to rein in Congress’ broad power to pass regulatory laws under the Constitution’s commerce clause, the key point of dispute in the pending court battles over President Obama’s health insurance law.

By a 7-2 vote, the justices turned down a constitutional challenge to a 2002 law that makes it a federal crime for a felon to have body armor or a bulletproof vest.

The majority’s decision, rendered without comment, could make it more difficult for those challenging health insurance reform to win court orders overturning parts of the new law.

But an article on the same case that appeared in The Wall Street Journal law blog, “Does Dissent In Body Armor Case Bode Ill For Health Care Law?” doesn’t exude such certainty.

Those reading the tea leaves on how the Supreme Court will judge the health-care overhaul may want to examine a dissent filed by two conservative justices this morning in a case involving the Constitution’s Commerce Clause.

Over the dissent of Justices Clarence Thomas and Antonin Scalia, the court declined to hear the appeal of Cedrick Alderman, an ex-convict from Washington state who challenged a 2002 federal law making it a crime for former felons to possess body armor. Mr. Alderman was sentenced to 18 months in prison after he was found with body armor during a police stop…

Justice Thomas, joined by Justice Scalia, wrote that the court should have heard Mr. Alderman’s appeal. He recalled the court’s 1995 decision striking down a portion of the Gun-Free School Zones Act, which used a similar rationale to make possession of a firearm within 1,000 feet of campus a federal crime. That precedent provides ammunition for the argument that the body armor act exceeds the congressional commerce power, they wrote.

They called for the Supreme Court to reaffirm its “commitment to proper constitutional limits on Congress’ commerce power.”