Bottom Line Insurance Announces Help for Consumers Confused by Healthcare Reform
Bottom Line Insurance
Atlanta, GA (PRWEB) September 15, 2011
Georgia Health Insurance Broker, Atlanta based Bottom Line Insurance Consultants, announces free assistance for consumers who have questions about how Health Care Reform is going to affect their new health insurance plan purchase.
Because of a new requirement legislated as part of the Patient Protection and Affordable Care Act (PPACA), known to some as “Obamacare”, many Americans are already facing several changes in their health insurance premiums, health insurance benefits, and ability or inability to obtain health insurance.
One part of the health reform bill that has already caused confusion among some consumers mandates that insurance companies selling health insurance plans accept an applicant for health insurance regardless of their pre-existing health conditions. This provision applies only to those ages 19 and under.
According to this health insurance story on CBS News.com, the insurers have decided to no longer market health insurance policies to those ages 19 and under unless accompanied by an adult family member. Even then, the insurers can increase the premiums significantly for up the age 19 and under applicant.
The insurance companies have asked that all Americans be required to pay something into the health insurance system to help offset the costs of these new changes. Whether or not all Americans will be required to purchase health insurance coverage is a ruling that has yet to be determined, and has been the subject of various lawsuits in several District Courts throughout the country. More than likely this issue will be decided by the Supreme Court.
It remains to be seen how Health Care Reform will affect the cost of health insurance or the benefits offered, but consumers don’t have to try and navigate the new requirements on their own. If a consumer is currently evaluating an individual health insurance plan, family health insurance plan, a small business or group health insurance plan and they are confused about their options, consumers can call the health insurance experts at Bottom Line Insurance for advice.
The Georgia licensed health insurance agents at Bottom Line Insurance are ready to provide free assistance, answer consumer questions about Health Care Reform, and provide guidance to help consumers make the best possible choice at the best possible rates for their individual, family or group health insurance plan.
Foster was asked to judge claims that the health law would “hold down costs.” Foster said he thought the claim was “false … more than true.” Critics of the overhaul seized on his comments as proof that they have been right — and proponents have been wrong — about the law’s fiscal impact.
It’s a legitimate argument. Unlike the controversy over death panels, the issue of how much health reform will ultimately cost is both complicated and open to honest differences of opinion. And unlike, say, the right-wing scare-monger Betsy McCaughey, Rick Foster is a bona fide expert with a record of intellectual integrity. Remember those stories about the government official who, in 2003, challenged the Bush Administration’s optimistic projections about what the Medicare drug bill would cost? Foster was that official.
But if we’re going to take Foster seriously, it’s important to be clear about what he said, what he didn’t say, and what it all it means.
Keep in mind, first, that it’s not clear exactly what question Foster was answering in that snippet of testimony. After all, “cost” can mean different things. It can mean the health costs that individuals, businesses or government bear, and it can mean costs in the near future or costs in the many years beyond that. It’s possible that Foster was simply saying that, 10 years hence, the government will have spent roughly the same amount on health care as it would have if the law were not in effect.
If so, that’s neither surprising nor particularly worrisome. The idea behind the Affordable Care Act is to strengthen health insurance and give it to more people, which will cost the government money. At the same time, though, it will make the health care system as a whole more efficient, which will save the government money. Over the course of a decade, the costs and savings should be about equal, which means the net cost to the government would be roughly zero — even as we’d made insurance both more reliable and much more available. That would be a pretty good deal.
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Now, if you’re worried about the government’s long-term fiscal future — and you should be! — the key question is what happens after those 10 years. The big worry is that the budgetary burden of health care will become staggeringly heavy in 2030, 2040 and beyond. The only way to avoid that scenario is to slow down the growth of federal health care spending — that is, to make sure it doesn’t keep going up as fast as it’s been for the last few decades.
This is the key area of dispute and what Foster, most likely, had in mind. The official government projections, including the ones Foster made, suggest the health law will reduce that rate of growth, albeit modestly. But in his reports, and then again in his recent testimony, Foster suggested those projections might be unrealistic. The problem is that they include some automatic, annual reductions in what the Medicare program will pay hospitals — scheduled reductions, according to Foster, that future lawmakers are not likely to allow when they actually come due.
This argument is more sophisticated and reasonable than the erroneous claim, made by many critics, that the federal government is simply incapable of reducing Medicare spending. Foster’s worry is that hospitals can’t adjust to lower reimbursements by increasing productivity, the way the law assumes they will; instead, he fears, they will just lose money and, in some cases, face the prospect of closing. In response to this threat, Foster says, lawmakers would likely cancel the reductions.
Is he right? Foster admits he isn’t sure. Among other things, he assumes that the law’s reforms of the way we organize and pay for care — everything from developing electronic records to financial incentives for coordination among doctors — won’t help them reach those productivity goals. But many experts with just as much experience and integrity disagree, citing the hospital sector’s well-known waste and the fact that these reforms have never been tried so extensively, particularly in combination with one another. These experts also point out, respectfully, that Foster has been wrong before: His projections for the 2003 Medicare drug benefit turned out to be considerably inflated.
Even if some hospitals do lose money, that might not be a bad thing. Currently, lots of smaller hospitals offer services like advanced cardio-vascular surgery or cancer treatment because those fields are lucrative. But this practice tends to drive up costs, since the availability of such services encourages more doctors and to use them. (It’s called “supply-driven demand.”) And it’s not even good for the patients, since most of those hospitals can’t do the procedures as effectively or safely as the intensive, high-level hospitals that specialize in them.
Still, suppose Foster is right about the law’s ultimate outcome — that the cuts prove too harsh and, as a result, the hospitals successfully lobby to eliminate them. What then? Well, we’d have to admit defeat, because if it’s impossible to reduce spending on hospitals then it’s also impossible to reduce government spending across the health care system. Taxpayers would be stuck writing larger and larger checks on government health programs, making the ability to balance budgets contingent on our future willingness to raise taxes or cut spending elsewhere.
In other words, we’d be in the same basic fiscal place we are now, with one key difference: We would have universal health insurance and its protections. It wouldn’t be an ideal situation, but it’d still be better than what we’d have without the law.
ILLINOIS: Governor Pat Quinn has announced that Department of Insurance Chief Deputy Director Jack Messmore will serve as the agency’s Acting Director. Messmore steps into the role following the departure of Michael McRaith, who will become the first director of the U.S. Federal Insurance Office. Messmore has been with the agency for 25 years and previously served as Deputy Director, Assistant Deputy Director and Examiner-in-Charge.
MISSOURI: Senate President Pro Tem Rob Mayer has appointed an interim committee to study whether the state should follow federal guidelines and enact a health insurance exchange as mandated by the ACA. The exchange would be a quasi-governmental body through which individuals and small business could compare and buy health insurance plans. A bill creating the “Show-Me Health Insurance Exchange” cleared the House this year, with unanimous support, but died in the state Senate. Republican state Sen. Jane Cunningham denounced the legislation as a violation of Missouri law and a repeal of the will of the voters. Missourians voted in 2010 to prohibit government from forcing individuals and businesses to purchase health insurance, as required under the federal health reform law. The Senate Interim Committee on Health Insurance Exchanges will research Missouri’s options regarding the establishment of a health insurance exchange. Mayer named state Sen. Scott Rupp, as chairman of the committee. Other senators named to the committee include Cunningham, Jack Goodman, Brad Lager, Rob Schaaf, Kiki Curls, and Joe Keaveny. The committee’s meetings will be held in locations across the state, including St. Louis, Kansas City and Jefferson City. Dates for the meetings have yet to be announced.
NEW JERSEY: With one week remaining before summer recess, the General Assembly passed legislation last week that Governor Chris Christie has been requesting for months to reform health and pension benefits for public employees. Thousands of union employees have filled the halls of the State House and the streets outside the building during the past week in protest but were unsuccessful in stopping the bill’s progress. The reform measure will impact the state’s more than 500,000 government workers and retirees. The legislation will increase public employee contributions for health insurance and pensions, create additional plan options for the State Health Benefits Plan (SHBP), suspend cost-of-living increases to retirees, raise retirement ages, and temporarily curtail unions’ contract bargaining rights. To obtain the necessary Democratic votes in the Assembly, a provision that would have prohibited SHBP members from seeking medical care at out-of-state facilities was removed. The legislation requires a final concurrence vote by the Senate before moving to the governor’s desk. Governor Christie indicated he will sign the bill upon final passage.
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NEW YORK: The legislative session concluded late last week, four days late, without a vote in the Senate on the insurance exchange bill. The Senate declined to take up the bill despite a message of necessity from the governor, but it is not necessarily a dead issue. It is likely that an additional session will be scheduled days before the end of the year, possibly before the end of the summer. Last week, state leaders struck a compromise on a health exchange that would serve as a marketplace for individuals and small-business employees to access insurance. The Assembly approved a compromise bill that combines aspects of a state Senate proposal (a “bare bones” bill) and Gov.Cuomo ‘s proposal (a more extensive bill). The new bill would have put off major policy decisions, including whether the exchange would actively purchase and negotiate benefits for consumers and whether public health programs, such as Medicaid, would be part of the exchange.
In other action, the Senate passed legislation that would allow physicians to bargain collectively. The Assembly, however, did not take action, making the bill unlikely to move forward this year. A diverse coalition formed around the issue, with consumer advocates, hospitals, employers and health plans all opposed to what ultimately amounts to price-fixing. Only the State Medical Society supported the bill. The bill passed by a divided vote in the Senate, but was not taken up in the Assembly. A number of other bills passed both houses, including an amendment to the recently passed autism mandate. Under the amendment, coverage for applied behavioral analysis therapy would be limited to ,000 per year, and the effective date of the act would be delayed one year. Also passing was legislation requiring parity coverage of orally administered chemotherapy treatments (with an Rx coverage rider) and parity for non-mail-order fertility medications. It is likely that Governor Cuomo will sign both the autism mandate and its amendment, the oral chemotherapy bill and the exchange legislation, if and when it passes the Senate. The Senate and House also passed legislation conforming New York law to many of the ACA’s market reforms, including annual and lifetime dollar limit restrictions and new requirements for external appeals. The governor is expected to sign the legislation.
OHIO: State Republicans said last week that a group collecting signatures needed to put a constitutional amendment challenging federal health care reform on the November ballot has reached the threshold required to qualify for the ballot. Initially, the initiative was that of the Tea Party, but the Ohio Republican party decided to help get the issue on the ballot and, to this end, a joint resolution was introduced and passed in the State Senate. The initiatives are aimed at getting Republicans out to vote in November.
CentraState Health System, UCSF Medical Center, MyHealthDirect, & More Discuss Healthcare Delivery Reform
New York, NY (PRWEB) August 24, 2011
The Institute for Health Technology Transformation announced the speakers for their panel session entitled, “A Comprehensive Look at Healthcare Delivery Reform: From ACO’s to PCMH and Beyond” at the Institute’s Health IT Summit in New York City taking place September 20-21, 2011 at The Westin New York at Times Square.
The panel will be moderated by Lynn Nace, Publisher & Editor, Executive Insight. Speaking will be Neal Ganguly, Chief Information Officer, CentraState Health System; Joshua Adler, MD, Chief Medical Officer & Professor of Clinical Medicine, UCSF Medical Center & UCSF Benioff Children’s Hospital; Lyle Berkowitz, MD, FHIMSS, Medical Director of Information Systems, Northwestern Memorial Physicians Group & Founder and Director, Szollosi Healthcare Innovation Program; and Jay Mason, CEO & Founder, MyHealthDirect.
This session will engage a diverse group of healthcare leaders for a candid discussion about the challenges, and potential solutions, we face in the months ahead. “Reorganizaiton of health care delivery will require substantial flexibility in the health IT markets,” said Dr. Joshua Adler.
The iHT2 Health IT Summit in New York City is the premier executive summit focused on the strategies and tools that are re-defining customer care, collaboration, and efficiency in the health care provider markets. The summit will bring together over 200 CIOs, VPs, and Directors of IT from hospitals, health systems, and larger physician practices to discuss the latest trends and challenges in topics including: Telehealth, mHealth, Meaningful Use, Accountable Care Organizations, Privacy & Security, Interoperability, Health Information Exchange, Cloud Computing, and more.
Sponsors and Partners for the 2011 iHT2 Health IT Summit in New York City include: Apixio, Axway, Availity, BoxTone, Catalyst Solutions, Verilogue, EDIMS, EXACT, ICA, ICW, Intel, Intermec, MEDSEEK, Microsoft, MMR Information Systems, MyHealthDirect, Presidio Networked Solutions, MedPlus, SAGO Networks, Vidyo, VMware, AMDIS, CMIO, Continua Health Alliance, DOTmed, eHealth SmartBrief, Executive Insight, Frost & Sullivan, Healthcare IT News, IDC Health Insights, Manhattan Chamber of Commerce, MarketsandMarkets, Massachusetts Health Data Consortium, Mobile Healthcare Today, NYHIMA, ReportsandReports, and SearchHealthIT.com.
About Institute for Health Technology Transformation:
The Institute for Health Technology Transformation is the leading organization committed to bringing together private and public sector leaders fostering the growth and effective use of technology across the healthcare industry. Through collaborative efforts the Institute provides programs that drive innovation, educate, and provide a critical understanding of how technology applications, solutions and devices can improve the quality, safety and efficiency of healthcare. http://www.ihealthtran.com
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.
The costs of providing health care for undocumented immigrants will not disappear after passing health care reform. It is unlikely that millions of immigrants, whose contributions keep up our standard of living and our economy functioning, will be deported. Instead, the cost of care will become the financial responsibility of the patient, the provider, the local and state governments, and every single taxpayer. Moreover, in order to exclude a few, there will be additional forms, documents, and bureaucrats that the rest of us will be subjected to. Buying the mandated health insurance could feel like a trip to the Department of Motor Vehicles. Taxpayers will have to pay millions for this additional red tape and delay, all to keep a few people from buying health insurance with their own money.
Providers, employers, consumers, religious leaders, and state and local governments recognize that these policies are short-sighted and will cost all of us more in the long-run. Policies that attempt to exclude and ostracize immigrants also disproportionately harm all communities of color and immigrant-rich states like California and New York, further widening existing inequities in our nation. Yet because immigrants live in all 50 states, the intended and unintended consequences and costs of these restrictions will be far-reaching.
Ending discriminatory and exclusionary policies in this final round of negotiations is not only a matter of fundamental fairness and sound economics. It is required in order to not leave all of us worse off. Congress has a short window of opportunity to remove the restrictions on legal and undocumented immigrants in the health care reform bill. Doing so will not jeopardize the passage of the bill. Failing to doing so, however, will leave all of us, immigrant or not, worse off and wondering what happened to the promise of health care reform.
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After months of public debate and private negotiations, health care reform discussions stalled following Tuesday’s Senate vote in Massachusetts. The Democratic Senate lost its 60th vote supermajority when Republican Scott Brown was elected to the United States Senate in the Massachusetts special election.
Health Care Reform Negotiations Post-Massachusetts Special Election
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.
Other remaining options:
1. House and Senate Democrats could also quickly complete the merging of the two bills and vote on the combined package before Mr. Brown is sworn in. 2. Democratic leaders could attempt to re-engage Sen. Olympia Snowe (R-ME), the only Republican who voted for the Senate Finance Committee’s bill passed in October. Democrats would need to allow her to amend the bill so that she could support its passage and give Democrats the needed 60th vote; or, 3. House and Senate Democrats could essentially start over in their respective chambers and propose scaled-back versions of the bill under “reconciliation” procedures or regular order. Reconciliation procedures would greatly limit the scope of the legislation to issues only related to raising or spending federal funds; therefore, many provisions, such as creating new insurance exchanges and an individual mandate, might be excluded.
President Obama seemed to indicate that he favors having House and Senate lawmakers start over again and produce a scaled-back bill. In addition, more moderate Senate Democrats – hesitant to push through such a huge partisan bill in light of the Massachusetts election – urged leaders to slow down. Sen. Jim Webb (D-VA) has called on Senate leaders to suspend voting on health care reform until Mr. Brown is sworn into office. President Obama and Senate Majority Leader Harry Reid (D-NV) have iterated this same message. Further, Sen. Joe Lieberman (D-CT) called for a bipartisan effort as the best way to achieve health care reform legislation.
Health Care Reform Negotiations Prior to Massachusetts Special Election
Senators Urge Guarantee of Government Savings: In a letter sent last Thursday to Sen. Reid, five Democratic Senators asked for the inclusion of a “fail-safe mechanism” in the final bill. This mechanism would give Congress “the tools to keep costs under control should the current savings estimates fail to materialize.”
Both the Senate and House versions of the bill rely heavily on reductions in government spending, particularly around Medicare, to help pay for reform. Republicans and some nonpartisan analysts believe the government will not follow through on these spending reductions, which will lead to soaring costs.
President Obama Pushes for Less Protection for Biologic Drugs: Last Thursday President Obama pushed for a change in the health care reform legislation that would reduce the number of years that biologic drugs were patent protected from generic competition, previously set at 12 years. White House officials and Rep. Henry Waxman (D-CA) were negotiating for 10 years protection or less.
Members of the news media speculated that the move to reduce biologic drug protections could be a leverage point for President Obama to pressure the drug industry to increase contributions to pay for health care reform. In fact, the Wall Street Journal reported that Congressional Democrats had already asked drug companies to contribute an additional billion or more, over and above the billion which the industry agreed to early on in the reform negotiations.
President Obama Strikes Deal with Unions: Last week Democratic negotiators struck a deal with union officials and conceded to union demands to scale back a tax on high-end insurance plans. The deal would exempt union workers from having to pay the tax until 2018, five years after the tax would apply to other workers. While the deal would help gain union support for the bill, it would also reduce the amount of tax revenue generated by about 40 percent, to billion. As such, Democratic leaders would need to find other sources of revenue to make up the difference.
Public Opinion
Exit Poll Indicates Health Care Reform as Hot Button Issue: As the ballot polls closed on Tuesday night’s Massachusetts Senate election, an exit poll conducted by Frabrizio, McLaughlin & Associates indicated that 52 percent of voters said that they oppose the federal health care reform measure and 42 percent said they cast their ballot to help stop President Obama from passing this legislation. In addition, 48 percent said that health care was the single issue driving their vote.
Polls Show Discontent: The latest Wall Street Journal/NBC News poll indicated that almost half of Americans believe the health care reform bill in Congress is a bad idea (46 percent). This figure is up dramatically from April when only 26 percent believed the plan was a bad idea. Further, just 33 percent say the plan is a good idea. Nearly half of those surveyed (48 percent) believe that passing the current legislation would be a “step backward.”
In addition, a new Quinnipiac University poll showed that public support for health care reform continues to decline. Thirty-four percent mostly approve, while 54 percent mostly disapprove. At the end of December, 53 percent of Americans mostly approved, while 36 mostly disapproved.
Looking Ahead
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.
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Imagine for a moment a sudden outbreak of smallpox (weaponized smallpox, if your taste runs to Jack Bauer-style scenarios). Airborne, highly contagious, deadly, it has the capability of spreading across the country and beyond in weeks, if not contained with a program of vaccination–vaccination not for a few, but for everybody, as soon as possible. Easy To Insure ME has the answers
If Congress passed emergency authorization for the program, would you want a judge to block it? What if some citizens preferred not to be vaccinated? What if they promised Scout’s honor not to get smallpox, or if they did, not to give it anyone else?
Would you want the judge to halt the program on the grounds that not getting vaccinated was “inactivity,” and thus beyond Congress’s power over “to regulate commerce with foreign nations, and among the several states, and with the Indian Tribes?” Those who refused vaccination might act as reservoirs of the disease, and thus affect commerce. What if the judge conceded that point, but said Congress still couldn’t reach them because they weren’t voluntarily in the stream of commerce?
What if the judge blocked the program because Congress relied on private medical personnel to administer the vaccine? Congress could have created a program by which thousands of full-time federal employees would give the inoculations–that would be constitutional–but using non-employees made the program unconstitutional. Would that make sense?
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.
I do think, however, that Judge Hudson’s opinion is wrong. Grievously wrong. Threat-to-the-nation-from-rampaging-smallpox wrong.
Here’s why I think so. The argument that “inactivity” is beyond the reach of the Commerce Clause sounds reasonable. That’s because, like most serious fallacies, it’s half true. Last summer, Sen. Tom Coburn asked Supreme Court nominee Elena Kagan whether Congress could require individuals to eat vegetables three times a day.
The cheeky Kagan responded, “Sounds like a dumb law.” And a law that requires eating vegetables (or joining a gym, or subscribing to a newspaper) really is a dumb law. There is no overarching national necessity behind it. It’s hard to imagine Congress claiming with a straight face that vegetable portions were an emergency, or that they needed to be regulated as part of a comprehensive scheme.
That’s the answer to those who will shortly post below that “‘Professor Epps, if that is really what he is, clearly believes Congress can regulate all human activity.” (Good to see you guys again, by the way.) Congress can’t regulate everything; what it can regulate is everything that needs to be reached as part of a comprehensive scheme required by a necessity that affects the nation.
Health care is such a necessity. Before Republicans hit upon the argument that health care isn’t part of commerce, they harped for years on the dangers of regulating “one-sixth of the economy.” After years of debate (more than half a century in fact) and extensive fact-finding, Congress decided that health care could only be provided effectively through a nationwide program.
Ironically, Republican opponents concede that if Congress had passed a mandatory program funded by payroll and income taxes–a kind of Medicare for all ages–their challenge would have no merit. (In case the supple Cuccinelli later decides to reverse field, I personally saw him say this on October 21, 2010, at the Washington Legal Foundation.) Those taxes would of course be no less compulsory than the “mandate.” But Congress’ partial reliance on the private market (which in other contexts Republicans rhapsodically defend) somehow guts the nation’s power to solve its health care problem.
Well, everybody’s got to have an argument, and the right has settled on this one. But conservatives should be careful what they wish for. Every constitutional decision is to be weighed not only (or even primarily) by the specific facts at issue, but by the potential mischief of the precedent that will be set. A decision voiding the health care act would strike at the heart of our nation’s ability to deal with situations like my smallpox hypothetical.
Wait a minute, you say, health care regulation isn’t like a smallpox epidemic. No? Certainly health care is a life-or-death issue for millions of Americans, including many who will be insured under the Act but will fall through the cracks in the current system. Who could seriously claim that the 50.7 million people who currently have no health care do not constitute an emergency?
A judge, to strike down the Act, must conclude that no reasonable Congress could have concluded that the situation needed nationwide, comprehensive regulation. And that no reasonable Congress could have concluded that the “mandate” is a key part of a comprehensive scheme to ensure near-universal coverage. Because if both those things are true, then the “inactivity” of refusing to take prudent care to prepare for an individual’s health care needs is as potentially damaging as the “inactivity” of refusing needed vaccination at a time of epidemic.
What if these “inactive” individuals promise will really never, never, contract a catastrophic sickness or suffer a devastating injury, that neither they nor their children will ever, ever appear in an emergency room as uninsured patients? That rings as hollow as my hypothetical objectors’ promise not to get or spread smallpox. These things aren’t voluntary; taxes, sickness, death–you can’t opt out, no matter how you try. And, I’m sorry to the hard-core libertarians out there, you cannot agree to waive life-saving care for your children. That argument was over long ago.
The “inactivity” argument depends on the idea that the Constitution prohibits the United States from running a modern economy, in which all of us are involved by virtue of our membership in the nation. As in any highly industrialized nation, we’re all in this together. And if we adopt an old-fashioned minimal view of national authority, we will have confirmed that 21st century America has chosen decline over economic leadership.
I make no predictions. Judge Hudson’s logic may very well prevail–especially if the conservative majority of the Supreme Court, a year or two hence, cannot resist the temptation to deliver a knockout blow to a president they despise. But such a decision would sow mischief in at least two ways. First, stripping this country of its first modern health care system would deform the Constitution, set back the cause of effecting legislative self-government, and spread suffering over decades or even generations.
That may not matter so much to those who make the decision. Federal judges, like state attorneys general, are covered by generous health-insurance programs, and may not feel the whole thing is such a big deal. And our current Justices make no secret of their seething contempt for America’s legislature.
But if history teaches us anything, it teaches that emergencies come like thieves in the night, and that when they do, we look to government to step in. A strong nation preserves the tools it may need to avert disaster. Throwing those tools away would be an even greater mischief.
If the United States finds Congress’s powers gutted because of this partisan dispute, we will one day have reason to regret it.
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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.
But the debate extends beyond these policy errors and into the realm of the federal government’s rightful role in health care. Obamacare significantly increases Washington’s influence over every aspect of the U.S. health care system—not just in the insurance market, but right down to the patient’s bedside. Medicare beneficiaries will be especially affected by the creation of new bureaucratic entities and top-down, cost-containing mechanisms included in the law.
Meanwhile, Americans continue to oppose parts or all of the new health reform law. Pollsters like Rasmussen show that Americans’ support for repealing Obamacare has ranged from 50 percent to 63 percent since the law’s passage. In November, American voters chose to send a wave of new lawmakers to Congress, many of whom campaigned in support of repealing the law. The provisions in Obamacare are not consistent with what Americans want, strengthening the case for repeal and a new direction for health care reform.
So what’s the alternative? Reform should transform the health care system to strengthen individuals’ control over their health care spending and decision-making. Patients, including those covered by Medicare and Medicaid, should have the opportunity to choose health care plans in the private insurance market that best suit their needs.
Market-based reforms would foster greater competition among insurers and more choices for consumers, enabling them to seek out the best value for their dollar. This bottom-up approach to reducing health care costs would maintain the quality of care available in the United States. It would put doctors and patients, not Washington bureaucrats, in charge of decisions relating to individuals’ care.
As the conversation continues, plans that embody these principles are gaining greater traction. U.S. Rep. Paul Ryan’s “Roadmap for America’s Future” would drastically change Medicare, Medicaid, and the health care system at large, to put patients in the driver’s seat. Ryan and Alice Rivlin, both members of the National Commission on Fiscal Responsibility and Reform, together offered a similar plan for Medicare and Medicaid that would replace the highly centralized, bureaucratic system with a defined-contribution program, offering beneficiaries greater autonomy.
In 2011, repeal must remain a priority for the new Congress, not only to undo the disastrous consequences of Obamacare, but as the first step to reform that will fix the health care system in ways that empower patients, not bureaucrats.
The health-care law of 2010 is, as Vice President Biden put it, a “big [expletive] deal.” It sets us on the road to universal health insurance. It is a favorite target for Republicans gunning to take over Congress. Lawmakers who supported it could lose their jobs. And it will remain a central focus after the midterms, as Democrats defend it against legal and political challenges through 2014, when it takes full effect. Easy To Insure ME
But the Democrats’ effort to sell the law to the public may be undermined by what even some ardent supporters consider its biggest shortfall. The overhaul left virtually untouched one big element of our health-care dilemma: the price problem. Simply put, Americans pay much more for each bit of care — tests, procedures, hospital stays, drugs, devices — than people in other rich nations.
Health-care providers in the United States have tremendous power to set prices. There is no government “single payer” on the other side of the table, and consolidation by hospitals and doctors has left insurers and employers in weak negotiating positions.
“We spend fewer per capita days in the hospital compared with other advanced countries, we see the doctor less frequently, and we swallow fewer pills,” said Jon Kingsdale, who oversaw the implementation of Massachusetts’s 2006 health-care law. “We just pay a lot more for each of those units than other countries.”
The 2010 law does little to address this. Its many cost-control provisions are geared toward reducing the amount of care we consume, not the price we pay. The law encourages doctors and hospitals to join “accountable care organizations” that have financial incentives to limit unnecessary care; it beefs up “comparative effectiveness research” to weed out inefficient treatments; and it will eventually tax the most expensive insurance plans to restrain consumers’ superfluous use of health care.
Such measures could reduce redundant tests, emergency room visits and hospital readmissions, which would help control the costs of Medicare, where the government sets rates. But they are less likely to lower prices outside Medicare and stem the growth of private insurance rates.
The main reason for this is politics. Remember how drawn-out the health-care battle was? It started in the spring of 2009 and was waged for a full year. The bill’s proponents in the White House and in Congress had some inkling of how tough the fight with the insurance companies would be. Taking on hospitals, doctors, and drug and device manufacturers as well — the people you’d face in a showdown over prices — might have been fatal.
So there was no price fight. The law will go on to face a likely post-midterm Republican onslaught — and dismantling it may be easier if Americans think it does little to restrain costs. It is one of those fine political ironies: The law derided as socialism may have had an easier time winning favor from a skeptical public if it was, well, a little more socialist.
It’s pretty far from socialist as it stands. The administration decided not to seek lower drug rates for Medicare, and it didn’t press for a “public option,” a government-run insurance plan that people under 65 could buy into. While supporters of the public option sold it as a way to compete with insurers, the real target was hospitals and doctors. A public option would have created a nationwide purchaser of health care that could have exerted leverage on providers to cut prices. This would have lowered the law’s costs by reducing the subsidies needed to make insurance affordable.
To avoid the wrath of hospitals and doctors, proponents of the bill rarely emphasized this cost-control argument. Nonetheless, when conservative “Blue Dog” Democrats weakened the public option in committee, they cited opposition from providers. And when the bill’s supporters floated a close alternative to the public option — letting people over 55 buy into Medicare — the reaction from Sen. Olympia Snowe, the moderate Maine Republican, said it all: “I am talking to a lot of my providers . . . and I know they are mighty unhappy.” Snowe exposed where the lobbying strength lay: No senator ever spoke of listening to “my insurers.”
“The public hates the insurance industry and trusts doctors and hospitals,” said Richard Kirsch, head of the liberal coalition Health Care for America Now. “But what killed the public option was the hospitals, not the insurance industry.”
Politicians wanted to avoid a confrontation over providers’ prices. So a different policy argument took hold: The real reason everything cost so much was the overuse of health care, not the actual prices of treatment. This argument came primarily from Dartmouth College researchers who had amassed data showing wide disparities in Medicare spending among different regions. Hospitals in the lower-spending areas, mostly in the Upper Midwest and the Northwest, seized on the study to argue that the key to controlling costs was to reward providers like them. The case was popularized by Atul Gawande’s widely read New Yorker article in June 2009 focusing on McAllen, Tex., one of the highest spenders in the Dartmouth rankings. If health-care delivery in places such as McAllen could be brought in line with lower-spending places such as the Mayo Clinic’s home town, Rochester, Minn. — through the formation of integrated networks of salaried doctors — costs could be reined in.
The theory caught fire at the White House. It gave President Obama and his then-budget guru Peter Orszag a way to talk about costs without taking on doctors and hospitals; instead, the White House could simply differentiate between providers that offer “value” and those that don’t.
But the Dartmouth rankings, and the concept they supported, did a “disservice” to the debate, said Robert Berenson of the Urban Institute. For one thing, he and others say, the figures overstate regional differences in Medicare spending, which shrink when socioeconomic factors are taken into account. Second, rates of Medicare spending are not necessarily representative of health-care spending for people under 65. Some of the places that do well in the Dartmouth rankings charge high prices for non-Medicare patients — and were, not surprisingly, among those pushing hardest against a public option.
More broadly, the skeptics argue that merely providing care in smaller quantities will not sufficiently lower costs. They note that Americans already have shorter hospital stays and fewer doctors’ visits than people in other advanced countries. What sets us apart is our high prices for these health-care “units” — a finding trumpeted in a landmark 2003 paper by Princeton’s Uwe Reinhardt and others titled “It’s the Prices, Stupid.” The price problem is only getting worse, researchers and antitrust investigators have found, because of consolidation among providers, and it could be exacerbated by goading them to form even bigger networks.
But the notion that we pay more, despite using health care less, never caught on during the long march to reform. The main culprits driving our health-care costs were deemed to be inefficient doctors in a few corners of the country and demanding consumers — say, people seeking unnecessary surgery or patients with unhealthy habits and chronic conditions.
The camp that believes volume is the main problem disputes the idea that bigger networks of hospitals and doctors would make the price problem worse. “The more we’re able to encourage integrated systems of care, the better,” the new Medicare director, Donald Berwick, a Dartmouth data champion, told me before his nomination by Obama.
Berwick and his allies say they never meant for overuse of care to become the sole focus. Elliott Fisher, the lead Dartmouth researcher, said he did not intend for his data to be “interpreted as letting off the hook” those providers that kept overuse in check but charged high prices. “We clearly need to do both” prices and volume, he said.
But we didn’t do both in the health-care law, which raises the question of what will happen once the overhaul proves inadequate to the price problem. Perhaps the public option will be reconsidered, as many liberals hope. Perhaps there will be a new push for lower drug prices. Or maybe there will be a return to the rate-setting that prevailed decades ago, when hospitals, insurers and state officials worked together to agree on prices. Maryland is the only state that still does this, and data suggests that it has kept its cost growth lower than average. Massachusetts is considering a similar approach.
Would such measures have a chance? Perhaps. For one thing, as skeptical as insurers are of government intervention, they are glad to discuss reform that aggressively goes after providers. “We have a major cost problem, and we have to get on with the job of attacking it — with every stakeholder who is responsible for that,” said Karen Ignagni, the insurance industry’s chief lobbyist.
And the public? The Brookings Institution’s Henry Aaron predicts that there may be support for tougher action on high prices once the principle of universal health coverage is established, since taxpayers will be on the hook for more of the cost of insurance. “If we attacked costs right at the front end, [the legislation] would have died,” he said. “Now, we’ll have a mechanism that will force us to address it. There are only so many fronts you can fight a war on at the same time.”
That’s assuming, of course, that the law survives long enough to enjoy any embellishment.
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