health law


Needling The Anti-Vaccine Crowd: Who Gets Blamed When Kids Get Sick?

Dr. Shapero/Flickr

Dr. Shapero/Flickr

Art Caplan’s view on vaccinations and civic responsibility initiated an infectious response on the Harvard Law School blog where it first appeared and among WBUR’s Here & Now listeners who tuned into the show earlier this week.

Caplan, the founding head of the Division of Bioethics at New York University Langone Medical Center, argues that parents who veto vaccinations should be held legally responsible to any party that gets sick because of that decision.

Now, as anyone who has ever written about vaccines and parenting knows, when you touch on these topics, the comments can get pretty emotional.

Here’s Paloma Smith:

…stop looking for excuses for your reckless behavior. Your child should be vaccinated, period. That is why diseases in this country are much less of a concern than in third-world countries. Continue reading

Altman To Chair Board Of New Cost-Control Health Policy Commission

Stuart Altman of Brandeis University

The Patrick administration just announced that Prof. Stuart Altman, a Brandeis economist who advised President Nixon on health policy, will chair the Health Policy Commission, the new board overseeing the sweeping cost-control law.

The board will monitor progress toward keeping health care spending in line with state economic growth overall. Altman says he’s hopeful the state can meet this goal.

WBUR’s Martha Bebinger asked Altman a few questions about the post.

Bebinger: How do you see this new role?

Altman: Massachusetts has put together the best kind of balanced program that I could think of in the country, where it is relying at one level on the many changes that are going on in the private sector, both at the delivery system and at the payment system. But it also has put together an overarching public assessment of what’s going on to make sure that it works, and it actually brings cost down without hurting quality.

If the changes that are currently in place don’t do that, this commission is responsible for giving an early warning sign that the system is not working and makes recommendations on how to make the system work. So we don’t have direct regulatory power to force the system to change, but we do have a monitoring role to make sure that it is working and if it’s not, first to direct the delivery system and the payers to change, and if that doesn’t work, we could also recommend back to the Legislature that the state needs more authority.

What is your sense going in about whether things will proceed without too much intervention, or whether you will need to be directive?

One level I’m pretty optimistic. The level of changes that are occurring in the state are really very substantial. And I would say that both at the delivery system and including our very big delivery systems they really are seriously trying to restructure their care delivery and really trying to live within a tighter budget than they had in the past. And the payers too, Blue Cross, and Tufts, and Harvard also, are tightening up the reins and not giving big increases. Continue reading

Celebrating Major Health Cost-Control Plan, Though Some Still Wary

Gov. Deval Patrick is expected to sign the new health care cost-cutting bill soon.

WBUR’s Martha Bebinger sums up the new health cost bill now awaiting Gov. Deval Patrick’s signature:

A sweeping health care cost-containment bill is heading to the desk of Governor Deval Patrick.

“This is more than a good bill, a really great bill,” Patrick said. “This is a commonwealth that has shown the nation how to extend coverage to everybody… and we’re going to crack the code now on cost control.”

The Governor and legislature are celebrating a bill that has broad support but is being received with more wariness and trepidation than recent major health care efforts, including the landmark coverage law. As we’ve heard again and again, tackling health care costs is going to be hard.

Trying to hold down health care costs is one of those third-rail issues that many politicians won’t touch. As he introduced the bill, House lead author Steve Walsh stressed that while it’s projected to saved $200 billion dollars over 15 years, that’s not the only goal.

“What should be important to us is our son or daughter, or our husband or wife, or our mother or father,” Walsh said. “And making sure that the health care that they need, that they deserve, is available to you, your constituents and your families in time of need. And there’s nothing that we have done in any way, shape or form here today that will inhibit that.” Continue reading

Report: States That Most Need ACA Medicaid Cash Likely Won’t Take It

An update on which states are most likely to opt out of the Medicaid expansion under the newly-energized Affordable Care Act tells a sad story. The states that most need the federal money to cover their poor, sick residents are the ones most likely to snub it, according to a report in The Incidental Economist.

The Advisory Board (see their map above) says these five states won’t participate in the expansion of the federal program:

Florida: Gov. Rick Scott (R) said, “Florida will opt out of spending approximately $1.9 billion more taxpayer dollars required to implement a massive entitlement expansion of the Medicaid program.” In addition, the governor said the state will not establish an insurance exchange (Pear, New York Times, 7/2).
Louisiana: In an interview on NBC’s “Meet the Press,” Gov. Bobby Jindal (R) said, “Every governor’s got two critical decisions to make. One is do we set up these exchanges. And, secondly, do we expand Medicaid. And, no, in Louisiana, we’re not doing either one of those things” (Barrow, New Orleans Times-Picayune, 7/2). Continue reading

Mass. Reacts To Supreme Court Ruling Upholding Health Law

WBUR’s Martha Bebinger reports that the U.S. Supreme Court’s 5-4 decision to uphold the Affordable Care Act won’t have much impact in Massachusetts, where many of its provisions are already under way as part of the state’s own health law, signed by then-Gov. Mitt Romney. Still, the political and long-term implications of today’s court ruling are huge. Here are some early reactions:

Prof. Kevin Outterson, co-director of the health law program at Boston University, offers a powerful metaphor to sum up what the court did legally. He says that Obamacare was dancing on a tightrope by arguing that Congress had the power to impose insurance under the “Commerce clause,” and it fell off. But to everyone’s surprise, Chief Justice John Roberts ended up holding a net.

Prof. Outterson says:

“Obamacare was dancing on a high wire, which was the commerce clause, and they fell off — losing that vote 5 to 4 — but we were surprised to find a taxing power net manned by Chief Justice Roberts that saved the entire ACA. The other four conservative justices made it clear as a bell that if they had prevailed on the individual mandate, they would have struck down every word of the ACA.

On the Medicaid issue, a strong majority of 7 Justices said the Medicaid expansion was unconstitutional if HHS threatened states with the loss of existing Medicaid funds for non-compliance. But Roberts, Breyer and Kagan saved Title II by interpreting the statute narrowly to give states a choice: whether they accept the Medicaid expansion or not, all existing funds are safe. I call this the “Red State Veto.”

Continue reading

Bulletin: Individual Mandate Survives As A Tax, 5-4 Ruling Upholds ObamaCare

Chief Justice John Roberts Saves The ACA. Who knew?

Read the full opinion here.

So, the mandate is constitutional. Chief Justice Roberts joins left of court. Medicaid provision is limited but not invalidated, says Scotusblog.

Bottom line: “The entire ACA is upheld, with the exception that the federal government’s power to terminate states’ Medicaid funds is narrowly read,” says Scotusblog. “Roberts saved the ACA.”

Amy Howe blogs: “The money quote from the section on the mandate: Our precedent demonstrates that Congress had the power to impose the exaction in Section 5000A under the taxing power, and that Section 5000A need not be read to do more than impose a tax. This is sufficient to sustain it.”

Howe: “The Court holds that the mandate violates the Commerce Clause, but that doesn’t matter b/c there are five votes for the mandate to be constitutional under the taxing power.

(Thank you Scotusblog!)

More from Kennedy’s dissent, from Scotusblog: “In opening his statement in dissent, Kennedy says: “In our view, the entire Act before us is invalid in its entirety.”

For a laugh between all this serious talk, check out tumblr’s “When Scotus Upheld ObamaCare.”

Amy Howe summarizes the ruling in plain English:

The Affordable Care Act, including its individual mandate that virtually all Americans buy health insurance, is constitutional. There were not five votes to uphold it on the ground that Congress could use its power to regulate commerce between the states to require everyone to buy health insurance. However, five Justices agreed that the penalty that someone must pay if he refuses to buy insurance is a kind of tax that Congress can impose using its taxing power. That is all that matters. Because the mandate survives, the Court did not need to decide what other parts of the statute were constitutional, except for a provision that required states to comply with new eligibility requirements for Medicaid or risk losing their funding. On that question, the Court held that the provision is constitutional as long as states would only lose new funds if they didn’t comply with the new requirements, rather than all of their funding.

Howe notes Roberts’ rationale for his opinion here:

From the beginning of the Chief’s opinion: “We do not consider whether the Act embodies sound policies. That judgment is entrusted to the Nation’s elected leaders. We ask only whether Congress has the power under the Constitution to enact the challenged provisions.”

The New York Times front page declares: Victory For Obama

No Health Law Ruling Today, But Scotus-Watchers Remain On Edge


From about 10 am until 10:26 today, I though I might have some kind of bad cardiac event, or maybe even a stroke.

My heart raced, I felt dizzy and slightly nauseous. I couldn’t move. I emailed a colleague citing my rising anxiety level.

I hadn’t just eaten a vat of fried dough, nor was I experiencing a post-strenuous-exercise collapse.

Along with tens of thousands of others (70,000 according to CoverItLive), I was glued to the Scotusblog, the Bloomberg Law-sponsored live blog of the U.S. Supreme Court. Snapping to attention with each new audio type-writer click, we wanted to be right there (or as close to there as possible sitting at home in front of a screen) if the high court ruled on the health law this morning. Of course, they didn’t. Continue reading

Happy Birthday Health Law (With Cake For Romney)


Sometimes a birthday is more than just a birthday. Just ask Mitt Romney.

On the 6th anniversary of the signing of the Massachusetts health reform law, Gov. Deval Patrick (who also serves as a co-chairman of President Obama’s re-election campaign) took the opportunity to stick it to the likely GOP presidential nominee in remarks at Fanueuil Hall yesterday, The Wall Street Journal reports. There was even talk by national health law advocates of sending Romney (who signed the state health law on April 12, 2006 when he was governor of Massachusetts) a delicious gift to mark to occasion.

“I think he has a lot to be proud of, he contributed ideas, the individual mandate was one of them…why not be proud?” said Gov. Deval Patrick, a co-chair of President Barack Obama’s national re-election committee, referring to Mr. Romney’s support for the state’s requirement that individuals purchase insurance or pay a fee…

The event underscored how Democrats are trying to turn Mr. Romney’s health-insurance expansion into a political liability as he looks toward the general election. Activists who support the federal health law will delivery grocery-store-bought sheet “birthday” cakes with six candles in honor of the Massachusetts health law to two of Mr. Romney’s campaign stops in Pennsylvania on Thursday, said Eddie Vale, a spokesman for the Protect Your Care coalition of campaigners.

To underscore the politics of the day, here’s video from the folks at

For a bit more substance, see The Washington Post’s Wonkblog on “Charts: Six Ways RomneyCare Changed Massachusetts.”

Post-Supremes: Deconstructing The Health Law Arguments

Webcast Replay: Health Reform And The Court (Kaiser Health News)

Screenshot of the Kaiser Health News' webcast "Health Reform And The Court." Click the above image to link to the full webcast replay.

If, for some reason, you haven’t had enough parsing of this week’s judicial thrashing of the national health care law, listen to this thoughtful Kaiser Health News analysis by a panel of smart reporters and observers who covered the past three days of oral arguments on the health law before the U.S. Supreme Court.

Asked what happens to the provisions of the law that are already in effect if the entire law is invalidated, Tom Goldstein, publisher of the Scotusblog said he’s not sure of the legal term but, basically “God only knows.”

Massachusetts Keeps A Close Eye On Supreme Court


The Supreme Court Justices (DonkeyHotey/Flickr)

The Supreme Court Justices (DonkeyHotey/Flickr)

Martha Bebinger reports that “the unprecedented combination of health care policy, legal theory and broccoli before the U.S. Supreme Court this week has kept many Boston area residents glued to their computers, radios, TVs and phones for updates.”

This barrage of coverage has an air of inevitability to it: there’s an overall sense that the individual mandate will be invalidated and much, if not all, of the health law may go down with it. (The government’s case is being called, alternatively, “a train wreck” and a “plane wreck,” the U.S. solicitor general’s performance has been panned as he came off as nervous and awkward even while the Obama administration says it remains confident that the law will be upheld.)

So, Martha writes: “Many Massachusetts residents are surprised at how the individual mandate was described this week in and outside the Supreme Court.”

“One thing we’re hearing a lot in Washington, particularly from people who are opposed and would like to see it overturned, is how draconian the mandate is and what an extreme overreach of government it is, and it’s the death of freedom and all of that,” says David Kravitz, co-founder of the left leaning blog Blue Mass Group. Continue reading