Justin's Political Corner
The number of lawsuits challenging the Obama administration’s contraception coverage mandate climbed to 60 last week, and legal experts on both sides of the issue are predicting that the Supreme Court will take up the issue within the year.
Thirty-two nonprofit organizations, including religious hospitals and schools, have challenged the rule. The mandate is part of the Affordable Care Act, and it requires third-party insurance companies to provide contraception coverage to the nonprofits’ employees if they decide not to do so. While many of the lawsuits are either failing in court or moving slowly because they fall under President Obama’s one-year grace period for nonprofits, the 28 for-profit companies that are suing the administration are seeing their cases move much more quickly.
The most prominent of those cases — Hobby Lobby v. Sebelius — took a significant step forward last week, when the 10th Circuit Court of Appeals granted Hobby Lobby’s request to expedite the case and hear it en banc (by all judges on the court). Kyle Duncan, the attorney representing the Christian-owned Hobby Lobby against the Department of Health and Human Services, said he expects one or more of these cases to catch the Supreme Court’s attention soon.
“The action of the court on Friday really raises the prominence of what was already a prominent case even higher,” Duncan told HuffPost in a phone interview. “I think there’s a very good chance the Supreme Court takes this up. You’ve got a nationwide mandate and many different plaintiffs all suing at the same time—presumably you’re going to have courts going in different directions, so you’ve got very good conditions for Supreme Court review.”
According to the rules of the Affordable Care Act, religiously affiliated nonprofit organizations, such as schools and hospitals, can opt out of paying for contraception coverage for their employees by instructing the third-party insurer to absorb the cost of the coverage and provide it directly to women. For-profit companies, such as Hobby Lobby, are not exempt from covering contraception and face large fines if they refuse to do so.
So far, 21 companies have petitioned for preliminary injunctions against the mandate so as to avoid the fines. Of those cases, 16 have been granted injunctions and five have been denied.
The Becket Fund is arguing in court that the religious exemption is too narrow because it excludes people like the Christian owners of Hobby Lobby, who morally object to contraception. Reproductive rights groups, including the National Women’s Law Center, contend that “religious freedom” should be interpreted to allow women to decide for themselves whether to take contraception, rather than to allow their employers to decide for them.
Duncan said he thinks the Christian-owned Hobby Lobby is a perfect example of the dilemma that for-profit companies across the country face now that the government is requiring them to include birth control coverage in their insurance plans. “We think Hobby Lobby is an excellent vehicle for all these issues,” he said. “It’s the largest, most prominent business to have sued, and it’s got a lot on the line.”
h/t: Huffington Post
Now that Obamacare has survived at the Supreme Court and the ballot box, proponents and opponents of the law agree it’s here to stay. But Republicans remain committed to botching its implementation, which — along with inherent complexities in implementing parts of the law — leaves in place significant obstacles to achieving its key goals.
Although the GOP’s efforts to repeal, invalidate and defund the law have not succeeded, here are the four biggest obstacles the law faces in meeting its key goals:
1) Ongoing Disapproval Of The Law
Two leading health policy experts argue that the overarching threat to Obamacare is the fact that many Americans continue to disapprove of it.
“I would rank the number one obstacle to be ‘social acceptance,’” said Jonathan Gruber, a professor at MIT who helped craft the Affordable Care Act and the Massachusetts health care law that inspired it. “When we put in the mandate in Massachusetts we were worried that it would cause protests. None came. This was partly because we did a terrific job of advertising and promoting reform. The same is unlikely to be true in all other states. If folks are protesting, it undercuts the whole reform — if folks don’t sign up, then prices are higher, which leads to more protests, and so on.”
If the public doesn’t come around (supporters of the law are convinced it will), that could also encourage congressional Republicans to keep threatening to withhold funds for implementation, as they have been wont to do in recent years. In the future, with a Republican president or GOP-controlled Senate, they may seek to deny appropriating money for the ACA’s essential functions.
) States Declining To Expand Medicaid
Seventeen million Americans were projected to obtain coverage through the Medicaid expansion in the Affordable Care Act — until the Supreme Court made it optional for states. Even then, proponents believed the generous federal funding — 100 percent for the first few years and 90 percent after 2020 — would make the deal too good to pass up.
They miscalculated. Democratic governors are on board, but just six Republicans have said they’ll participate. Under pressure from the right, thirteen Republican governors have rejected the expansion, including blue staters like Scott Walker of Wisconsin and Tom Corbett of Pennsylvania. Ten GOP governors have yet to announce a decision.
The problem: Even though some Republican governors say they’ll look for other ways to expand coverage, it’s an open question how — or whether — Americans below 133 percent of the poverty line will obtain insurance in the states that do not participate.
3) States Refusing To Build Insurance Marketplaces
The law encourages states to set up and run their own one-stop marketplaces to connect sellers and buyers of health insurance — the central mechanism through which its subsidies and coverage guarantees are actualized. Although states had the ability to opt out, it seemed like a no-brainer because if they decline to set one up, the federal government is required to craft and operate one for them. Building and operating the exchanges in according with the complex regulations in the statute was never going to be easy, but this unanticipated political hurdle adds a new dimension of problems.
Conservatives are working to portray any governor who sets up an exchange as pro-Obamacare, despite the irony that refusing to do so would relinquish power over their health care to Washington. As a result, most Republican governors have refused to build a state-run exchange under the law. Others are looking for a way around some of the rules.
The problem: The ACA lacks a funding mechanism for Department of Health and Human Services to set up exchanges for states that decline to do so themselves — and congressional Republicans are unlikely to appropriate additional money for that. HHS, already stretched thin with the law’s implementation, must find the money within its budget.
4) Nullification Of The Medicare Cost-Cutting Board
The centerpiece of President Obama’s plan to save Medicare from bankruptcy in the long-haul is already law under the Affordable Care Act. Set to take effect in 2015, the Independent Payment Advisory Board will be tasked with cutting Medicare reimbursements to providers if per-beneficiary spending rises above per-capita GDP plus 1 percent. It cannot cut seniors’ benefits. IPAB will be composed of 15 Senate-confirmed experts.
H/T: Sahil Kapur at TPM
The vast majority of part-time workers in the U.S. don’t have employer-based health insurance, according to a new study from the ADP Research Institute — an issue the health care reform law will help address once it is fully in effect.
The majority of Americans access health insurance through their jobs. But the results from ADP’s study highlight the fact that the current employer-based model often leaves low-wage workers, and particularly those who work fewer than 40 hours a week, in a coverage gap. Only a small percentage of part-time employees are offered health insurance through work, and many of them can’t afford to pay into those plans — but they also typically can’t afford to purchase insurance plans on their own, either.
Fortunately, several Obamacare provisions — including extending Medicaid coverage to additional low-income Americans, providing Americans with subsidies to help them purchase health care on state-based insurance markets, and requiring employers with more than 50 workers to provide health insurance — will start to eliminate some of those coverage gaps and help part-time workers better afford health coverage.
But as Clifford noted, that hasn’t stopped several extremely profitable companies from trying to get around Obamacare and continue denying their workers basic health benefits. Therestaurant industry, which often employs low-wage and part-time workers, has been particularly resistant to Obamacare’s regulation that requires businesses to ensure their employees will be able to afford health care.
On Monday, the GOP will convene an “emergency” meeting in the Rules Committee so they could hold a vote on The “Repeal of Obamacare Act” as early as Wednesday July, 11. The seven page messaging bill compiles the best Republican talking points against the law since it passed in 2010, but offers only the smallest hint of how the party plans to extend coverage to the millions who would lose it. “The path to patient-centered care and lower costs for all Americans must begin with a full repeal of the law,” the bill says on page six.
This free market mantra may resonate with the GOP base, but it does nothing to improve the economy or solve the health care crisis. Below are 5 consequences of the GOP’s repeal legislation:
1) Millions without coverage. A Congressional Budget Office analysis of the GOP’s repeal measure from 2011 found that “32 million fewer nonelderly people would have health insurance in 2019, leaving a total of about 54 million nonelderly people uninsured. The share of legal nonelderly residents with insurance coverage in 2019 would be about 83 percent, compared with a projected share of 94 percent under current law (and 83 percent currently).”
2) Health insurance costs increase. The same analysis concluded that “many people would end up paying more for health insurance— because under current law, the majority of enrollees purchasing coverage in that market would receive subsidies via the insurance exchanges, and [repeal] would eliminate those subsidies.” What’s more, “Premiums for employment-based coverage obtained through large employers would be slightly higher.”
3) Americans with pre-existing conditions will lose access to coverage.Republicans have said that they would not replace the Affordable Care Act’s federal rules prohibiting insurers from discriminating against people with pre-existing conditions. Instead, they would encourage states to form expensive high-risk pools to cover the sick or, alternatively, leave them to find their own coverage in the individual market — where many will likely go uninsured.
4) Medicare in disarray. Approximately 100 million Medicare claims are processed each month using a formula that was altered by the Affordable Care Act. Should the law be repealed, new rates could not be calculated under the old, pre-ACA formula until after a rulemaking process that can take months before is completed. The result would be that Medicare would not be able to pay doctors for what could be many months.
5) Deficits increase by billions. The CBO predicts that “as a result of changes in direct spending and revenues is likely to be an increase in the vicinity of $230 billion.” Repeal would also “increase federal deficits in the decade after 2019 by an amount that is in a broad range around one-half percent of GDP.”
This is just another GOP stunt to appease their base.
Think Progress: GOP Governors May Turn Down $258 Billion In Obamacare Funds, Leave 9.2 Million Americans Uninsured
Despite the Supreme Court ruling that the Affordable Care Act is constitutional, Republican governors are considering refusing billions in Medicaid funds which promise to insure millions of lower-income Americans without health care. The Court found that while the Medicaid provision is constitutional, the federal government cannot take away federal funds from states that refuse to open the program to more residents.
A ThinkProgress survey reveals that ten GOP governors have said definitively that they will not accept the funds, while 19 are still considering other options. Sixteen states, all with Democratic governors, have committed to expanding their programs.
Not a single Republican governor has pledged to accept the new Medicaid funds and three Democrats are also considering turning down the money. In total, these states would give up $291.4 billion in federal funds and leave 10,297,221 Americans uninsured.
![Via George Zornick at The Nation: If the Supreme Court Strikes Down the Mandate—What’s Next? |
What should be done if the Supreme Court strikes down the Affordable Care Act’s individual mandate?
If the Court does anything—which, of course, it should not—it would likely only remove the mandate and possibly the associated insurance company regulations and subsidies for purchasing insurance. Striking down the entire law would be a dramatic and unlikely step, even for this conservative bench.
So where would the law stand if the mandate disappears, and what could be done to patch it?
Many Democrats and their political allies have been publicly and privately talking up the benefits of the Affordable Care Act outside the mandate—like the Medicaid expansion, the ongoing creation of state exchanges for buying health insurance, the various cost-control measures in the bill—and downplaying the severity of losing it.
“There’s been entirely too much attention paid to the mandate, and not enough attention paid to what the law will do and the ways that it’s already benefiting millions and millions of Americans,” Ethan Rome, executive director of the progressive coalition Health Care for America Now, which was instrumental in getting the law passed, told me in a phone interview. “The sport of speculation about what the Court will do is in overdrive, and as part of that, people are overthinking how to make the law work if one thing or another about it is changed.”
Here’s a quick look at some policy options to move the ball forward on healthcare reform if the mandate is struck down:
Helping the uninsured to buy coverage. The idea behind a mandate was that by increasing the number of people buying insurance, it would lower the costs for everyone else—both by broadening the base of premium payments, and reducing the external costs of the uninsured seeking treatment in emergency rooms. More urgently, since the ACA required insurance companies to provide coverage to people with pre-existing conditions, it had to have a mechanism to ensure that people wouldn’t just wait until they got sick and then purchase insurance.
But if the mandate is gone and you can’t force people to buy coverage, there are several ways you might be able to entice them to do so:
Subsidies. In the House version of the Affordable Care Act, a surcharge on the wealthy would help fund subsidization of health insurance for people who couldn’t afford it. Annual household income in excess of $350,000 but less than $500,000 would be have a 1 percent surcharge attached; annual household income in excess of $500,000 and less than $1 million would have a 1.5 percent surcharge; and annual household income in excess of $1 million would have a 5.4 percent surcharge. Thursday on Capitol Hill, House minority leader Nancy Pelosi said that in the event the mandate is struck down, “there could be something passed in the Congress, similar to what we had originally in the House bill, which was a surcharge on the wealthy to pay for aspects of [coverage].”
Age rating. The government could entice young and healthy people to buy coverage by allowing health insurers to charge them less, which is known as age rating. The ACA allows insurance companies to charge the elderly only a maximum of three times more than the young, but if that ratio were revised upward, it could make health insurance more attractive to the healthy. But the flipside is that it would necessarily make coverage for the elderly even more expensive, and as Ezra Klein notes, age rating hasn’t done much for affordability of coverage in New Jersey, where it’s been in place since 2008.
Penalties for not buying coverage. Aside from helping people buy coverage, you can penalize them for not doing so. That’s what the individual mandate does, instituting penalties ranging from $695 for poor Americans to $12,500 for wealthy ones for not obtaining health insurance. You can create penalties in other, smaller ways without a mandate—though we should note that these aren’t particularly progressive options. If you think of the uninsured as being all free-riders, then penalties make sense. But again, a majority of the uninsured are either too poor to afford insurance or don’t have a job that offers it, and are often both. So penalizing them further isn’t terribly helpful.
Thinking progressively and outside the box. After considering how regressive penalties for not buying insurance can be, you might realize a dirty little Democratic secret, if you haven’t already: the individual mandate isn’t all that progressive. Yes, it makes the Affordable Care Act work better, and should be preserved. Yes, the Supreme Court would unmistakably enter into a new period of activist overreach if it strikes it down. But remember this was originally a Republican idea.
So what are some truly progressive alternatives to the mandate?
An obvious answer is single-payer health insurance. Former Labor Secretary Robert Reich wrote in March that if the Supreme Court strikes down the individual mandate but leaves the pre-existing condition requirement in place, “Obama and the Democrats should say they’re willing to remove that requirement—but only if Medicare is available to all, financed by payroll taxes.”
The political will for a single-payer system almost certainly doesn’t exist right now, however. (Though Democrats could start nudging towards it, for example by lowering the Medicare eligibility rate to 55).
In the meantime, the public option might be the best viable option for a progressive improvement of the healthcare system—and one that would seem much more attractive if the Supreme Court guts all or part of the ACA.](http://25.media.tumblr.com/tumblr_m5zys7Ga0I1r1vqpco1_500.jpg)
Via George Zornick at The Nation: If the Supreme Court Strikes Down the Mandate—What’s Next? |
What should be done if the Supreme Court strikes down the Affordable Care Act’s individual mandate?
If the Court does anything—which, of course, it should not—it would likely only remove the mandate and possibly the associated insurance company regulations and subsidies for purchasing insurance. Striking down the entire law would be a dramatic and unlikely step, even for this conservative bench.
So where would the law stand if the mandate disappears, and what could be done to patch it?
Many Democrats and their political allies have been publicly and privately talking up the benefits of the Affordable Care Act outside the mandate—like the Medicaid expansion, the ongoing creation of state exchanges for buying health insurance, the various cost-control measures in the bill—and downplaying the severity of losing it.
“There’s been entirely too much attention paid to the mandate, and not enough attention paid to what the law will do and the ways that it’s already benefiting millions and millions of Americans,” Ethan Rome, executive director of the progressive coalition Health Care for America Now, which was instrumental in getting the law passed, told me in a phone interview. “The sport of speculation about what the Court will do is in overdrive, and as part of that, people are overthinking how to make the law work if one thing or another about it is changed.”
Here’s a quick look at some policy options to move the ball forward on healthcare reform if the mandate is struck down:
Helping the uninsured to buy coverage. The idea behind a mandate was that by increasing the number of people buying insurance, it would lower the costs for everyone else—both by broadening the base of premium payments, and reducing the external costs of the uninsured seeking treatment in emergency rooms. More urgently, since the ACA required insurance companies to provide coverage to people with pre-existing conditions, it had to have a mechanism to ensure that people wouldn’t just wait until they got sick and then purchase insurance.
But if the mandate is gone and you can’t force people to buy coverage, there are several ways you might be able to entice them to do so:
Subsidies. In the House version of the Affordable Care Act, a surcharge on the wealthy would help fund subsidization of health insurance for people who couldn’t afford it. Annual household income in excess of $350,000 but less than $500,000 would be have a 1 percent surcharge attached; annual household income in excess of $500,000 and less than $1 million would have a 1.5 percent surcharge; and annual household income in excess of $1 million would have a 5.4 percent surcharge. Thursday on Capitol Hill, House minority leader Nancy Pelosi said that in the event the mandate is struck down, “there could be something passed in the Congress, similar to what we had originally in the House bill, which was a surcharge on the wealthy to pay for aspects of [coverage].”
Age rating. The government could entice young and healthy people to buy coverage by allowing health insurers to charge them less, which is known as age rating. The ACA allows insurance companies to charge the elderly only a maximum of three times more than the young, but if that ratio were revised upward, it could make health insurance more attractive to the healthy. But the flipside is that it would necessarily make coverage for the elderly even more expensive, and as Ezra Klein notes, age rating hasn’t done much for affordability of coverage in New Jersey, where it’s been in place since 2008.
Penalties for not buying coverage. Aside from helping people buy coverage, you can penalize them for not doing so. That’s what the individual mandate does, instituting penalties ranging from $695 for poor Americans to $12,500 for wealthy ones for not obtaining health insurance. You can create penalties in other, smaller ways without a mandate—though we should note that these aren’t particularly progressive options. If you think of the uninsured as being all free-riders, then penalties make sense. But again, a majority of the uninsured are either too poor to afford insurance or don’t have a job that offers it, and are often both. So penalizing them further isn’t terribly helpful.
Thinking progressively and outside the box. After considering how regressive penalties for not buying insurance can be, you might realize a dirty little Democratic secret, if you haven’t already: the individual mandate isn’t all that progressive. Yes, it makes the Affordable Care Act work better, and should be preserved. Yes, the Supreme Court would unmistakably enter into a new period of activist overreach if it strikes it down. But remember this was originally a Republican idea.
So what are some truly progressive alternatives to the mandate?
An obvious answer is single-payer health insurance. Former Labor Secretary Robert Reich wrote in March that if the Supreme Court strikes down the individual mandate but leaves the pre-existing condition requirement in place, “Obama and the Democrats should say they’re willing to remove that requirement—but only if Medicare is available to all, financed by payroll taxes.”
The political will for a single-payer system almost certainly doesn’t exist right now, however. (Though Democrats could start nudging towards it, for example by lowering the Medicare eligibility rate to 55).
In the meantime, the public option might be the best viable option for a progressive improvement of the healthcare system—and one that would seem much more attractive if the Supreme Court guts all or part of the ACA.
Throughout his campaign, Mitt Romney has continued to claim that the Affordable Care Act hurts small businesses. But a new study on small businesses contradicts Romney’s (and the Conservative community’s) claims. Conducted by a business advocacy group, Small Business Majority, an opinion poll surveyed 800 businesses owners across the country. And the results show that over half of the respondents – who were all small business owners – strongly support the law.
Key findings from the study indicated that 50 percent of small business owners want the health care reform law to be upheld by the Supreme Court, in its entirety or with just minor changes. Only one-third of the respondents wanted the Supreme Court to overturn the law. However, after learning more about the law’s details, support for keeping the law intact grew to 56 percent.
The Affordable Care Act expands health insurance to the millions of uninsured Americans by making it more affordable and regulating the abusive practices of health insurance companies. But conservatives have attacked it as government overreach, with Rep. Michele Bachmann (R-MN) as one of theloudest critics. After the last day of Supreme Court hearings about the health care reform law, Bachmann told Fox News’ Sean Hannity that people are uninsured not because they can’t afford insurance, but because they simply choose to be uninsured:
BACHMANN: One argument that the government was trying to make is that somehow health care is uniquely different. That government can regulate it because everyone participates. Health insurance is not uniquely different. It’s still an opportunity that some people choose to engage in, but 40 million people do not. And the premise was made that people don’t buy insurance because they can’t afford it. That’s not true. There are people who just decide they want to roll the dice and take their chances that they won’t need insurance.
Bachmann’s assumption that 40 million people “choose” to not have health insurance downplays the plight that people can face trying to find affordable health insurance in the face of rising costs.
Newt Gingrich told CNN’s Wolf Blitzer yesterday that uninsured Americans should receive health care coverage through charity organizations and “free clinics,” rather than government-sponsored programs. The former speaker of the House answered Blitzer’s question from Monday’s CNN/Tea Party debate about how the government should treat a 30-year-old uninsured man who needs months of intensive treatment:
GINGRICH: Historically, we had charity. We had places that say, if you are down on your luck, if you failed to be responsible, we will take care of you, but that doesn’t mean that you’re necessarily going to get a private room, that you’re necessarily going to get everything somebody would get who’s been prudent and who has taken care of themselves. […] Yes, we’re going to make sure they’re taken care of, but they ought to understand that’s charity.
BLITZER: But that money should come from charitable organizations, not from taxpayers? Is that what you’re saying? […]
GINGRICH: I would prefer to see it come from charitable organizations.
h/t: ThinkProgress Health
