Health Care Reform – k and k Health Care

The health care reform bills being debated in Congress threaten to shut out millions of immigrants. But Congress’ exclusionary policies toward immigrants will not simply leave immigrants worse off. They will inevitably jeopardize the nation’s economy and the health of all of us.

President Obama has prioritized health care reform to ensure that millions of Americans have a fair, affordable and efficient health care system. For immigrants, this vision is far from a reality. First, the current health care reform bill treats legal immigrants unfairly. Individuals who have waited years to come to the United States will be required to wait years in order to obtain affordable health care.

Immigrants are generally younger and healthier than the U.S. population at large. However, no one is immune to falling ill or having an accident. The current health care bill would require recently arrived, legal immigrants to wait five years to obtain the only option for affordable health care coverage, Medicaid. While low-income citizens will have access to Medicaid, the most vulnerable among us will continue to wait for affordable health care despite the fact that they pay taxes for the very programs from which they are excluded. There is no sound reason for Congress to discriminate against these individuals and prevent them from receiving basic medical care.

Congress and the White House also took an unprecedented step to prohibit individuals from buying — with their own hard-earned money — an American good that could help their families. The Senate version of the health care bill forbids undocumented immigrants from purchasing private insurance at full cost in the newly created insurance marketplaces. As a result, undocumented immigrants as well as their family members, who are often U.S. citizens or legal immigrants, will likely remain uninsured and will be forced to seek care in the emergency room.

Massachusetts Election of Senate Republican Recasts Debate: Following the election of Republican Scott Brown to the Massachusetts Senate seat Tuesday night, Democratic leaders have been scrambling to revive what could now be a dying bill. The loss of the Democrat’s 60th vote in the Senate opens up the legislation to a Republican filibuster – something the Democrats have managed to avoid thus far in the debate.

House and Senate Democrats met this week to discuss how to move forward with the reform legislation in light of this election and promised Wednesday that they would push ahead. There are a number of options that Democrats are considering, but at this point they have not charted their course.

On Wednesday, Speaker of the House Nancy Pelosi (D-CA) attempted to rally House Democrats around a strategy to push the Senate bill through the House and onto President Barack Obama’s desk so as to avoid the need to again secure 60 Senate votes. However, the Speaker indicated on Thursday morning that she did not believe she has the needed 218 House votes necessary to move forward. This option would have allowed lawmakersto then propose additional modifications to the approved legislation through a process called “reconciliation,” which only requires 51 votes in the Senate.

Currently, the path to health care reform is unclear. Democrats seek a way to secure the necessary votes to pass the legislation, and some now question the value of pushing such a large bill. President Obama had hoped to see a final bill prior to his State of the Union address, which has been scheduled for January 27; however, it appears this goal is likely out of reach.

More than 20 separate challenges to the law, including lawsuits by conservative groups and individuals, have been filed in federal courts throughout the country. And most legal experts agree that both sides raise valid questions.

“This case could be decided either way without overturning any existing Supreme Court precedents,” Coan said.

So far, federal judges have dismissed two of the lawsuits – one filed in Virginia by Liberty University, founded by Jerry Farwell, and the other filed in Michigan by the Thomas More Law Center, a public interest law firm that focuses on defending the religious freedom of Christians, family values and other issues.

But federal judges in Florida and Virginia have denied the federal government’s motions to dismiss the lawsuits by the states.

Van Hollen, a Republican, wanted to challenge the health care law immediately after it was passed but needed Democrat Gov. Jim Doyle’s approval – and the governor in a strongly worded letter made clear that wasn’t going to happen.

“The State of Wisconsin will not enter into litigation intended to deny health care for tens of thousands of residents,” Doyle wrote in March.

The state also has estimated that the law would save Wisconsin 5 million to 0 million from January 2014 through June 2019 as the federal government picks up a larger share of the cost of insuring residents with limited incomes.

While the disease spread, and hundreds or even thousands died, would you thank the judge for his fidelity to the pre-1937 vision of the Commerce Clause? Or would you think that, no matter what was written in the judge’s order, the irretrievable spread of the epidemic really had affected commerce and should have been stopped?

These reflections were spurred by the decision Monday in the case of Virginia v. Sebelius, the lawsuit brought by Ken Cuccinelli, Virginia’s right-wing zealot attorney general, to spare the uninsured of his state the indignity of government-funded health care. Judge Henry Hudson of the United States District Court for the Eastern District of Virginia agreed with Cuccinelli that the so-called “individual mandate” provision of the Act exceeds the Commerce Clause because it seeks to “compel an individual to involuntarily enter the stream of commerce by purchasing a commodity in the private market.”

For those of you scoring at home, currently it’s Affordable Health Care Act 2, right-wing opponents 1. Two federal district courts have upheld the program; Judge Hudson is the first district judge to hold against it. That’s neither here nor there–the final score will almost certainly be a best-of-nine championship series played here in Washington at the Supreme Court. But it does underline that the issues in the case are close. The weight of academic opinion so far supports the Act, but some of the very brightest (and perhaps not coincidentally most conservative) of my colleagues disagree.

Readers would do well to discount the importance of Judge Hudson’s decision, which is about as significant as an early NBA playoff game. And partisans might nurture the Christmas spirit by refraining either from the right-wing spike dance or the progressive chant of “You’re blind, ump!” These are hard issues; federal judges, by and large, don’t ask for these cases to land in their courtrooms. Having read the opinion, I see nothing in it to suggest that Judge Hudson is not doing his duty to construe the statute as he reads it, compare it with the Constitution as he understands it, and announce whether the two go together. His opinion was respectful to both sides and–in stark contrast to the intemperate earlier interim decision of Senior Judge Robert Vinson of a Florida district court–devoid of inflammatory rhetoric, judicial triumphalism, or talk-radio style taunting. No one can seriously argue that the judge did not earn his salary.

The Patient Protection and Affordable Care Act became the law of the land in 2010, but debate over its existence and implementation will rage on in the New Year.  The law’s serious policy flaws are already impacting health insurance and costs, but these are part of a deeper and broader issue: the proper role for the federal government in Americans’ health care.  The public’s stance on this issue has been anything but settled in the wake of the new law’s passage. Easy To Insure ME has the answers

As ramifications of Obamacare continue to play out, it becomes clearer that the changes made are the wrong ones. The new law cuts 5 billion from Medicare, but uses the savings to fund a new health entitlement, rather than deal with the financial insolvency that Medicare faces. “Bending the cost curve” was one of Obamacare’s original goals, but Medicare’s actuary reports that while the the new law indeed bends the curve, it is in the wrong direction: up, not down.

Furthermore, countless employers have said Obamacare accelerated increases in their health insurance premiums, prompting them to consider dropping coverage or pass more of the cost onto employees and their families. Mandates and new regulations are likely to further inhibit businesses’ ability to offer health insurance to employees, and also threaten to negatively affect the economy at large. Finally, when the law comes fully online and the true costs are accounted for, Obamacare is expected to significantly increase the nation’s deficit spending.

The White House last week continued to rail against rising health insurance premiums to help build popular support for his health care reform package. But the effort to focus the blame for rising costs on insurers was questioned, in particular, by state insurance experts and economists quoted in a New York Times story last week. Insurance commissioners said that trying to hold down premiums before costs were under control would be very risky. This approach could mean solvency issues in some cases, they told the Times. To help educate Americans about the true drivers of rising health care costs, America’s Health Insurance Plans, the industry trade association, last week launched a new national ad campaign. The ad demonstrates that health insurance company costs represent a small slice of the overall health care cost pie.

Federal

With a cadre of staff operatives searching for the right health insurance reform provisions among those previously discarded from the House, Senate and the President’s proposals, Democratic leadership has been relentlessly pursuing every possible pathway to pass a final bill. The expected process would have: 1) the House pass the Senate-adopted reform bill (which most House members hate), 2) the House passing a bill to “fix” all the things it hates using a reconciliation legislative vehicle, followed by 3) the Senate passing the very same reconciliation bill — requiring only 51 votes in the Senate. The House Budget and Rules Committees are expected to start the review, hearing and mark-up process of the reconciliation bill this week. The Senate commitment to using reconciliation was made official in a scathing letter from Leader Harry Reid to the Minority Leader. Along the way the two Chambers will need to see the latest CBO “scores” on the bill before voting, and 216 House Democrats will have to resolve policy disagreements over abortion, federal health insurance rate review and authority, and other substantive issues. Additionally, the House will have to trust that the Senate can pass the reconciliation measure without changing one comma. Partisanship has blossomed into open hostility over health reform. Whether Congress can overcome these policy, process and political mine fields remains as murky as ever, but Democrats have chosen to try and will push for resolution by the Easter recess.

Several of the bills are generating controversy. A bill that would set up California’s health insurance exchange, the virtual marketplace of health insurance options required in 2014 under the federal law, passed the Assembly on Friday. The bill, authored by Sen. Elaine Alquist, D-Santa Clara, is scheduled to go back to the Senate and be voted on with a companion bill.

Insurers are against both bills, as are several Republican lawmakers, without amendments that would limit taxation on insurers and require more legislative oversight. They argue that the bills set up a new bureaucracy with broad powers to tax them and create disadvantages for smaller health plans in the exchange.

“Our concern is that (the bill) sets up very broad authority and powers,” said Charles Bacchi, executive vice president of the California Association of Health Plans. “We believe if they make wrong decisions, it could result in fewer choices for consumers.”

Health insurers are also fiercely opposed to several bills that propose various forms of rate regulation, an issue that gained traction earlier in the year after Anthem Blue Cross proposed a 39 percent rate increase on 800,000 individual California policyholders.
Power over rate increases

The rate-hike proposals include a bill by Sen. Mark Leno, D-San Francisco, that would require insurers to justify rate increases, and one by Assemblyman Dave Jones, D-Sacramento, that would give state regulators the power to approve or deny rate hikes.

Gov. Arnold Schwarzenegger has proposed a separate plan that would require health care insurers to hire actuaries to review their proposed premium increases.

Bacchi, referring to the Jones bill, said rate regulation diverts attention from the need to curb medical costs. “Health care costs are going up enough,” he said, “without having to create overly burdensome and expensive new government bureaucracies to handle this.”

The California Medical Association and the California Hospital Association join the insurers in their opposition, arguing that if the insurers are squeezed, they’re likely to turn around and squeeze doctors and hospitals through lower reimbursement rates.