Health Care Bill

[macrockett]

media.washingtonpost.com/wp-srv/politics/documents/03272010TrendSUNDAY.pdf?sid=ST2010032804111 (the poll on HC)



www.washingtonpost.com/wp-dyn/content/article/2010/03/28/AR2010032804094_pf.html
Washington Post poll finds split on health-care law remains deep

By Jon Cohen and Dan Balz
Washington Post Staff Writer
Sunday, March 28, 2010; A01

Americans overwhelmingly see the new health-care law as a major shift in the direction of the country, but they remain as deeply divided today over the changes as they were throughout the long congressional debate, according to a Washington Post poll.

In the days since President Obama signed the farthest-reaching piece of social welfare legislation in four decades, overall public opinion has changed little, with continuing broad public skepticism about the effects of the new law and more than a quarter of Americans seeing neither side as making a good-faith effort to cooperate on the issue.

Overall, 46 percent of those polled said they support the changes in the new law; 50 percent oppose them. That is virtually identical to the pre-vote split on the proposals and similar to the divide that has existed since last summer, when the country became sharply polarized over the president's most ambitious domestic initiative.

The health-care debate galvanized the country to a remarkable extent. About a quarter of all adults say they tried to contact their elected representatives in Congress about health care in recent months, including nearly half of those who say they are "angry" about the changes. In general, opponents of the measure were more than twice as likely as supporters to say they had made the effort.

But there are signs that Democrats have started to rally, with the party's base firming up after intense internal battles over a public insurance option and provisions covering abortion funding. Fifty-six percent of Democrats now "strongly support" the recently enacted health-care changes; last month, 41 percent were solidly behind the proposals. Eight in 10 Democrats now approve of the way Obama is handling health care, the most since last summer.

Obama's overall approval rating is at 53 percent in the poll, about the same as it has been in Post-ABC polls in the past several months; 43 percent disapprove.

Obama has renewed his effort to sell the legislation to the public ahead of the November midterm elections, with more rallies planned this week. His success could be crucial to Democratic fortunes in this fall's midterm elections, with about six in 10 saying the congressional votes on health care will be a factor in their choice at the ballot box.

At this point, Democrats hold a razor-slim edge (47 to 43 percent) on the "generic ballot," the question about which party's candidate people support in their local districts. Independents, who swung solidly for Democratic candidates in 2006 and 2008, now divide 42 percent for the GOP candidate and 39 percent for the Democrat.

Democratic officials have long argued that once the debate ended and health-care legislation was enacted, the public would begin to see the changes in a far-more-favorable light. The new poll suggests that the president and his party still face significant obstacles in this new phase of the debate.

Passions remain strongest among the plan's detractors, as 26 percent of all adults said they are angry about the changes enacted by Congress, up from 18 percent in August. That includes 54 percent of all Republicans. Fewer Americans, 15 percent, said they are enthusiastic about the new measure, including 40 percent of liberal Democrats.

Among opponents, there is near-universal support (86 percent) for efforts to cancel the changes either through a new vote in Congress or through the courts. Since passage, Republican leaders have called for repeal of the new law and replacement with more modest changes.

Many key provisions of the new law have been highly popular in recent polling, particularly insurance changes such as extending coverage to young adults and eliminating exclusions based on preexisting conditions. But the intensity of the overall opposition adds to the Democrats' challenge in pitching those benefits to voters, with just over seven months until the midterm elections.

More people see the changes as making things worse, rather than better, for the country's health-care system, for the quality of their care and, among the insured, for their coverage. Majorities in the new poll also see the changes as resulting in higher costs for themselves and for the country.

Most respondents said reform will require everyone to make changes, whether they want to or not; only about a third said they believe the Democrats' contention that people who have coverage will be able to keep it without alterations. And nearly two-thirds see the changes as increasing the federal budget deficit, with few thinking the deficit will shrink as a result. The Congressional Budget Office said the measure will reduce the deficit.

About half of all poll respondents said the plan creates "too much government involvement" in the health-care system, a concern that is especially pronounced among Republicans.

Senior citizens, who typically make up about one in five midterm voters, represent a particularly valuable but tough audience on this issue. More than six in 10 of those 65 or older see a weaker Medicare system as a result of the changes to the health-care system. Overall, seniors tilt heavily against the changes, with 58 percent opposed and strong opponents outnumbering strong supporters by a 2-to-1 ratio.

At the same time, seniors who say they understand the upcoming changes are much more apt to back the new law than those who say the plan is too complicated.

Support for the changes is significantly higher among Democrats and independents who say they understand the legislation than it is among those who do not. Republicans are solidly opposed, regardless of whether they think they understand the changes.

The overall political landscape continues to look favorable for Republicans to make gains in November, with six in 10 Americans seeing the country as pretty seriously off on the wrong track and that broad dissatisfaction likely to fall hardest on incumbents.

At this point, more poll respondents said they are likely to oppose a lawmaker who backed the president's health-care initiative than said they would support such a candidate (32 percent to 26 percent), with more passion again on the negative side. Forty percent said the health-care vote will make no difference in their decision this fall.

The Democrats hold a 13-point advantage over the GOP when it comes to dealing with health care in general. That's a significant, but far slimmer, lead than they carried into the 2006 elections, which returned them to the majority. Similarly, Democratic advantages on the economy, taxes, immigration and the deficit are all severely attenuated.

Republicans now have a six-point edge when it comes to handling terrorism, a historical GOP strong point that Democrats had neutralized. Democrats are favored on Afghanistan policy, an area that remains a strong point for the president.

The largest Democratic lead in the new poll is on energy policy, where the party holds a 49 to 32 percent advantage.

A big concern for both parties may be that significant numbers in the poll -- 10 percent or more -- see neither as more trustworthy on each of those major issues.

Public approval of Obama's handling of health care has rebounded somewhat, but a slim majority continues to disapprove of the way he is dealing with issue No. 1: the economy. About half of respondents (49 percent) said Obama won't be a factor in their vote in November. The rest split about equally between saying they would vote in part to express support for the president and saying it would be to show opposition.

The poll was conducted March 23 to 26 among a random national sample of 1,000 adults; the results have a margin of sampling error of plus or minus three percentage points.

[macrockett]

www.chicagotribune.com/health/ct-met-health-reform-illinois-impact-20100331,0,761261.story
chicagotribune.com

Health care bill’s impact on state will be delayed
Preliminary analyses show $200 million in extra Medicaid costs in 2020; other savings may be possible, officials predict

By Judith Graham, Tribune reporter

7:11 PM CDT, March 31, 2010

The health care overhaul isn't going to break the bank in Illinois any time soon, according to state officials and health care experts who have been scrambling to analyze the new federal law. On Wednesday, they gave a first glimpse at the impact on Illinois, while cautioning that many details aren't yet clear.

For example, more than 1.5 million Illinois children and adults could gain insurance coverage by 2019, according to rough estimates from the Illinois Hospital Association. Currently, more than 1.7 million Illinoisans are uninsured.

But will coverage be affordable as health care costs continue to climb? And will people comply with a mandate that everyone purchase insurance beginning in 2014, or will they risk a penalty?

Some other key issues:

Medicaid

New enrollees: Up to 650,000 childless Illinois adults will qualify for Medicaid for the first time in 2014, according to Theresa Eagleson, who runs the state program.

Childless adults will be eligible for Medicaid if they earn less than 133 percent of the federal poverty level ($14,400 annually for an individual).

The federal government will pick up 100 percent of the cost of the Medicaid expansion from 2014 through 2016. After that the state will start paying a small share and by 2020 will assume 10 percent of the cost — about $200 million a year, Eagleson said.

The state now spends about $5 billion annually on Medicaid's 2.3 million members, excluding federal stimulus payments.

Unknowns: What will it cost the state to execute this expansion? Who will supply medical care to new Medicaid members? Will the feds continue to pick up 90 percent of the cost beyond 2020?

Existing enrollees: Illinois may try to lessen the financial impact by shifting some Medicaid members to a new state health insurance exchange to be created in 2014.

"The exchange may end up subsidizing people we're currently covering," Eagleson said.

Here's how that might work: Illinois would move Medicaid members with household incomes equaling at least 133 percent of the federal poverty level to the exchange. There, the federal government would pick up the tab for their coverage; low-income individuals are set to get hefty subsidies.

The plan could generate savings of about $53 million by transferring financial responsibility for about 93,000 children and adults to the federal government, according to figures supplied by the Illinois Department of Healthcare and Family Services.

The state now pays about half of the cost of Medicaid coverage for adults and slightly less for children covered under the State Children's Health Insurance Program, known here as All Kids.

Unknowns: Will federal health regulators allow this maneuver? How much will it cost the state to create and oversee the insurance exchange? How many Illinois families will enroll and qualify for subsidies?

Seniors' drug plans

Illinois will save about $20 million a year starting in fiscal 2012 as the federal government bolsters financial assistance for seniors who purchase prescription drugs.

Specifically, the government has committed to narrowing and then closing the coverage "doughnut hole" in Medicare prescription drug plans.

The savings will come from Illinois Cares Rx, a program that helps low-income seniors pay for prescription medications.

State employees

The health insurance benefits Illinois provides to 110,000 workers are good — but not generous enough to be taxed under the new health overhaul, according to Michael Gelder, top health care adviser to Gov. Pat Quinn. A new analysis indicates that Illinois falls under the limits set for high-cost, soon-to-be-taxed "Cadillac" health plans, he said.

Hospitals

Illinois hospitals will lose $8 billion in anticipated Medicare funding over the next 10 years. U.S. hospitals expect a $155 billion reduction in Medicare funding over the next decade.

Medical centers will adapt by better managing care and becoming more efficient, said Maryjane Wurth, president of the Illinois Hospital Association.

Especially hard hit could be Illinois hospitals in indigent communities that serve large numbers of low-income and uninsured patients. These hospitals rely on special "disproportionate share" payments totaling several hundred million dollars a year. Those federal payments are to be slashed.

Unknowns: What rules will be set for limiting disproportionate share payments to Illinois hospitals? Will Illinois' Medicaid program cut payments to hospitals and other medical providers? Will efforts to cut costs prove successful?

[e-mail]

Copyright © 2010, Chicago Tribune

[macrockett]

www.chicagotribune.com/health/la-na-constitutionality27-2010mar27,0,291118.story
chicagotribune.com

States fighting healthcare law don't have precedent on their side
A 2005 Supreme Court ruling citing the authority to regulate commerce poses a problem for suits claiming it's unconstitutional for the federal government to force individuals to have insurance.

By David G. Savage

March 27, 2010

Reporting from Washington

Lawsuits from 14 states challenging the constitutionality of the new national healthcare law face an uphill battle, largely due to a far-reaching Supreme Court ruling in 2005 that upheld federal restrictions on home-grown marijuana in California.

At issue in that case -- just like in the upcoming challenges to the healthcare overhaul -- was the reach of the federal government's power.

Conservative Justices Antonin Scalia and Anthony M. Kennedy joined a 6-3 ruling that said Congress could regulate marijuana that was neither bought nor sold on the market but rather grown at home legally for sick patients.

They said the Constitution gave Congress nearly unlimited power to regulate the marketplace as part of its authority "to regulate commerce."

Even "noneconomic local activity" can come under federal regulation if it is "a necessary part of a more general regulation of interstate commerce," Scalia wrote.

The decision throws up a significant hurdle for the lawsuit filed last week in federal court by 13 state attorneys -- all but one a Republican. The Virginia attorney general filed a similar, but separate suit.

The suits claim that the federal government has no right to force individuals to have health insurance -- a central provision of the new healthcare law.

"By imposing such a mandate, the act exceeds the powers of the United States under Article I of the Constitution," according to the suit from the 13 states.

But this week, Obama administration lawyers pointed to Scalia's opinion as supporting the constitutionality of broad federal regulation of health insurance, and most legal experts agreed.

In the healthcare legislation, signed by the president Tuesday, Congress required virtually all Americans to have health insurance beginning in 2014. Those who fail to do so could be assessed a tax penalty of up to $750 per year.

Legislators argued that the "individual mandate" was necessary because it would undercut the insurance market if individuals could just opt out of having health insurance. Freeloaders could wait until they were hurt in an accident or contracted a disease and then demand insurance coverage for their "preexisting condition."

The court's ruling in the 2005 case, Gonzales vs. Raich, "is an enormous problem" for those who contend that the healthcare mandate is unconstitutional, said Simon Lazarus, a lawyer for the Washington, D.C.-based National Senior Citizens Law Center.

"It clearly says Congress has vast regulatory authority over interstate commerce," he said.

David B. Rivkin, a Washington lawyer who is representing the 13 states, said the legal challenge rests on the principle that the federal government has limited powers.

"It is a matter of fundamental principle in the Constitution," he said. "Ours is a government of limited and enumerated powers. And there has to be a limit."

He also argued that the Constitution did not permit Congress to regulate health insurance, which has been traditionally under state control.

While the Bill of Rights put clear limits on the government's power to interfere with an individual's freedom of speech or free exercise of religion, the Constitution does not put clear limits on Congress' power.

Article I says, "Congress shall have the power to lay and collect taxes . . . [to] provide for the common defense and general welfare of the United States . . . [and] to regulate commerce."

Since the New Deal era of the 1930s, the Supreme Court has repeatedly said that the federal government can regulate almost anything that involves economic or commercial activity.

Several constitutional law experts said this week that it is somewhere between unlikely and hard-to-imagine that the Supreme Court would strike down the new healthcare law.

"In my view, there is a less than 1% chance that the courts will invalidate the individual mandate," said George Washington University law professor Orin Kerr, a former clerk to Justice Kennedy.

But some said the high court's conservatives could decide that the Obama administration and congressional Democrats had gone too far.

"When it comes to the hot-button, partisan issues that divide Americans, precedent rarely dictates how the court will rule," said Adam Winkler, who teaches constitutional law at UCLA.

The "court has already shown itself to be willing to break from long-standing precedent in major cases, and it won't likely be deterred by such case law in a challenge to healthcare reform," he said.

Critics of the new health insurance mandate often claim the Founding Fathers could never have envisioned the federal government telling individuals that they must take an action or buy a private product.

That, however, is not quite correct, experts said.

As one of its earliest actions, Congress passed the Militia Act of 1792, which was signed by President George Washington. It mandated that "each and every able-bodied white male citizen" must "be enrolled in the militia."

Hardly shy about imposing federal regulations on private citizens, the militia law said that each new recruit must show up within six months carrying "a good musket or firelock, a sufficient bayonet and belt, two spare flints, a knapsack [and] a pouch to contain not less than 24 cartridges suited to the bore of his musket or firelock."

Winkler also dismissed the argument that Congress cannot penalize someone for "doing nothing," such as not buying health insurance.

"If you don't believe me, just 'do nothing' this April 15 when your tax bill is due," he said.

[e-mail]

Copyright © 2010, The Los Angeles Times

[macrockett]

Well the Health Care Bill ("HCB") is now law so I guess it ok to start telling the truth about the cost. The HHS, just released a report that shows, not only will the HCB not save money, but it will cost at least $300 billion more over the next ten years. I expect this number to be revised upward many times over in the years to come.

cbs2chicago.com/national/health.care.reform.2.1651675.html

Apr 23, 2010 8:25 am US/Central
Report: Costs Will Increase Under Health Reform
Government Economists' Analysis Suggests Possible Rise In Public's Tab Of 1 Percent Or More Over Next Decade
WASHINGTON (CBS News) ―

CBS News
President Obama's health care overhaul law will increase the nation's health care tab instead of bringing costs down, government economic forecasters concluded Thursday in a sobering assessment of the sweeping legislation.

A report by economic experts at the Health and Human Services Department (HHS) said the health care remake will achieve Obama's aim of expanding health insurance - adding 34 million Americans to the coverage rolls.

But the analysis also found that the law falls short of the president's twin goal of controlling runaway costs, raising projected spending by about 1 percent over 10 years. That increase could get bigger, however, since the report also warned that Medicare cuts in the law may be unrealistic and unsustainable, forcing lawmakers to roll them back.

The mixed verdict for Obama's signature issue is the first comprehensive look by neutral experts.

In particular, the warnings about Medicare could become a major political liability for Democratic lawmakers in the midterm elections. The report projected that Medicare cuts could drive about 15 percent of hospitals and other institutional providers into the red, "possibly jeopardizing access" to care for seniors.

The report from Medicare's Office of the Actuary carried a disclaimer saying it does not represent the official position of the Obama administration. White House officials have repeatedly complained that such analyses have been too pessimistic and lowball the law's potential to achieve savings.

CBS Radio News correspondent Peter Maer reports the White House was referring questions about the report Friday morning to the HHS.

"The analysis by the independent Office of the Actuary reaffirms what the Congressional Budget Office has already said: the Affordable Care Act will cover more Americans and strengthen Medicare by cracking down on waste fraud and abuse, modernizing payment systems and improving benefits by providing free preventive services, supporting innovations that help control chronic disease and closing the prescription drug donut hole," HHS Secretary Kathleen Sebeilus said in a written statement."

"The Affordable Care Act will improve the health care system for all Americans and we will continue our work to quickly and carefully implement the new law," the statement concluded.

The report acknowledged that some of the cost-control measures in the bill - Medicare cuts, a tax on high-cost insurance and a commission to seek ongoing Medicare savings - could help reduce the rate of cost increases beyond 2020. But it held out little hope for progress in the first decade.

"During 2010-2019, however, these effects would be outweighed by the increased costs associated with the expansions of health insurance coverage," wrote Richard S. Foster, Medicare's chief actuary. "Also, the longer-term viability of the Medicare ... reductions is doubtful." Foster's office is responsible for long-range costs estimates.

Republicans said the findings validate their concerns about Obama's 10-year, nearly $1 trillion plan to remake the nation's health care system.

"A trillion dollars gets spent, and it's no surprise - health care costs are going to go up," said Rep. Dave Camp, R-Mich., a leading Republican on health care issues. Camp added that he's concerned the Medicare cuts will undermine care for seniors.

Congress in the past has enacted deeper Medicare cuts without disrupting service, and HHS Secretary Kathleen Sebelius issued a statement that sought to highlight some positive findings for seniors. For example, the report concluded that Medicare monthly premiums would be lower than otherwise expected, due to the spending reductions.

"The Affordable Care Act will improve the health care system for all Americans and we will continue our work to quickly and carefully implement the new law," the statement said.

Passed by a divided Congress after a year of bitter partisan debate, the law would create new health insurance markets for individuals and small businesses. Starting in 2014, most Americans would be required to carry health insurance except in cases of financial hardship. Tax credits would help many middle-class households pay their premiums, while Medicaid would pick up more low-income people. Insurers would be required to accept all applicants, regardless of their health.

A separate Congressional Budget Office analysis, also released Thursday, estimated that 4 million households would be hit with tax penalties under the law for failing to get insurance.

The U.S. spends $2.5 trillion a year on health care, far more per person than any other developed nation, and for results that aren't clearly better when compared to more frugal countries. At the outset of the health care debate last year, Obama held out the hope that by bending the cost curve down, the U.S. could cover all its citizens for about what the nation would spend absent any reforms. The report found that the president's law missed the mark, although not by much. The overhaul will increase national health care spending by $311 billion from 2010-2019, or nine-tenths of 1 percent. To put that in perspective, total health care spending during the decade is estimated to surpass $35 trillion.

Administration officials argue the increase is a bargain price for guaranteeing coverage to 95 percent of Americans. They also point out that the law will decrease the federal deficit by $143 billion over the 10-year period, even if overall health care spending rises.

The report's most sober assessments concerned Medicare.

In addition to flagging the cuts to hospitals, nursing homes and other providers as potentially unsustainable, it projected that reductions in payments to private Medicare Advantage plans would trigger an exodus from the popular program. Enrollment would plummet by about 50 percent, as the plans reduce extra benefits that they currently offer. Seniors leaving the private plans would still have health insurance under traditional Medicare, but many might face higher out-of-pocket costs.

In another flashing yellow light, the report warned that a new voluntary long-term care insurance program created under the law faces "a very serious risk" of insolvency.

(© 2010 CBS Broadcasting Inc. All Rights Reserved. This material may not be published, broadcast, rewritten, or redistributed. The Associated Press contributed to this report.)

[macrockett]

In addition:

CBO: 4 Million People To Pay Fine In 2016 For Lacking Health Coverage

By Martin Vaughan, Of DOW JONES NEWSWIRES

WASHINGTON -(Dow Jones)- About 4 million people will pay penalties in 2016 for failing to purchase health insurance as required by the new health care law, the Congressional Budget Office estimates.

That projection is a fraction of the 21 million non-elderly people that CBO estimates will remain uninsured by that time. It takes into account that many low-income uninsured will be exempt from the penalty.

The estimate also takes into account non-compliance -- people that will simply refuse to pay the penalty and hope to avoid detection.

Penalties for not having insurance under the new law will be assessed when a person files their tax return. By 2016, they will start at $695 per uninsured person per household, or 2.5% of household income, whichever is greater.

The estimate, released Thursday, is the first time CBO has attempted to quantify the number of Americans who will actually pay the health mandate penalty.

CBO estimates that the law will reduce the number of uninsured by 32 million by 2019, raising the share of legal nonelderly residents with insurance coverage from 83% to 94%.

Two-thirds of those paying the health insurance penalty will be eligible for subsidies under the new law, because their income will be less than 400% of the federal poverty level -- or less than $96,000 for a family of four by 2016.

This suggests that despite being eligible for subsidies, 2.5 million taxpayers will still choose to pay penalties rather than purchase health insurance -- which Republican critics of the bill claimed shows the subsidies are ineffective.

"The individual mandate tax will fall hardest on Americans who can least afford to pay it, many of whom were promised subsidies by the Democrats and who the President has promised would not pay higher taxes," said Rep. Dave Camp of Michigan, the senior Republican on the House Ways and Means Committee.

-By Martin Vaughan, Dow Jones Newswires; 202-862-9244; martin.vaughan@ dowjones.com

Read more: www.nasdaq.com/aspx/stock-market-news-story.aspx?storyid=201004221356dowjonesdjonline000708&title=cbo-4-million-people-to-pay-fine-in-2016-for-lacking-health-coverage#ixzz0m1zU38B9

[macrockett]

Here we go again. CBO has revisited the Health Care Bill yet again. Due to possible discretionary costs... well here is what they said:

The May 11 letter identified possible discretionary spending of at least $115 billion over the 2010-2019 period. Whether that spending will ultimately occur will depend on future appropriation actions.

www.cbo.gov/ftpdocs/114xx/doc11490/LewisLtr_HR3590.pdf (the letter)

www.cbo.gov/ftpdocs/114xx/doc11493/Additional_Information_PPACA_Discretionary.pdf

(the details)

www.cbo.gov/ (the website)

Bottom line? Our government has no idea what the health care bill will cost the taxpayer. I expect it to be on par with Medicare, as in large unfunded liability.

[macrockett]

Remember, payment cuts for doctors was one of the items that would bust the HC savings if it wasn't passed by Congress. So far they have put off that vote.

JUNE 16, 2010 Wall Street Journal

Doctors Chafe As Medicare Cuts Loom

By JANET ADAMY And GREG HITT

For more than two decades, internist Lee Antles has treated Medicare patients at his practice in Olympia, Wash. Last month, he started turning them away.

What pushed him over the edge was Congress's failure to end the looming threat—which no one expects to be carried through—of a 21% payment cut for doctors who participate in the seniors' insurance program. Last year, he and his wife, Margie, who manages the office, took home $55,000 before taxes, he said.

Dr. Antles is considering quitting medicine and moving to Chicago, so his wife can return to a sales job that pays at least twice that much. "It just causes me such angst," he said, who would become a stay-at-home father to the couple's six-year-old daughter. "It leaves 1,000 Medicare patients. Where do they go?"

The Senate could vote as soon as Wednesday to end debate on a bill to delay the cuts. But lawmakers are considering postponing them just through the year's end. A House bill that passed last month would delay the cuts through the end of 2011.

Repeated short-term fixes of the problem in recent years have left doctors frustrated and some, like Dr. Antles, are refusing to take new Medicare patients. Since the latest "doc fix" expired May 31, doctors have been holding off on submitting claims until Congress approves another patch. On Saturday, President Barack Obama used his weekly radio address to urge Congress to fix the problem.

The battle comes amid a broader struggle in the Senate over a more than $120 billion bill extending long-term unemployment benefits, which lapsed earlier this month, and renewing several popular business tax breaks. The measure is running into headwinds, as many centrist Democrats, joined by Republicans, say the bill is only partially funded and will add $80 billion to the federal budget deficit.

Senators have begun closed-door talks aimed at finding a compromise that would pull back the bill's overall cost, perhaps by tens of billions of dollars. In addition to a shorter window for staving off the Medicare payment cuts, lawmakers are considering reducing money that would help states meet their Medicaid obligations and paring back the extension of jobless benefits, said people familiar with the discussions.

Republican Sen. Susan Collins of Maine said Tuesday the price of the bill was "still too high."

For seniors, the tussle in Washington could make it more difficult to find a doctor, especially if they're switching doctors. Medicare pays physicians at a lower rate than private insurers, and they complain of too much paperwork.

Grace Leach, a 69-year-old retired nurse, said she called four gynecologists in Naples, Fla., who all refused to accept her Medicare plan. "I was getting desperate," she said. Ms. Leach had to drive 45 minutes for a doctor to give her an ovary exam.

The percentage of doctors participating in Medicare is 97%, about flat from 2009, according to the Centers for Medicare and Medicaid Services. But a survey by the American Medical Association last month found that 17% of doctors say they are restricting the number of Medicare patients in their practice. Among primary care physicians, the figure is 31%. Many cited the constant threat of payment cuts.

"This cut is basically the last straw," said J. James Rohack, president of the AMA, which represents thousands of doctors. "This is no way to run a major health insurance program."

The AMA was an early supporter of President Barack Obama's health overhaul in part because it hoped the doc fix would be made permanent.

The issue dates to 1997, when Congress passed a budget law that set up formulas to reduce doctor payments if broad spending targets were exceeded. When the formula began seriously eating into doctor reimbursements in 2002, Congress put it off and let it compound until the next year. Now that the cut adds up to 21%, no one in Washington thinks Congress would actually impose it.

Doctors say the back-and-forth is just one of many frustrations that have caused them to limit patients on Medicare. Craig Heigerick, an osteopathic physician in Lilburn, Ga., stopped accepting new Medicare patients two years ago because the payment rates were too low. Medicare patients "tend to take the most amount of time," he said, making them even less cost-effective to treat.

At Dr. Antles's practice in Olympia, Medicare pays him $95 for a visit that covers six organ systems. By comparison, Aetna Inc. pays $129 and Uniform Medical Plan, which covers state workers, pays $140. To bridge the patchy reimbursements, Margie Antles has taken out four loans and borrowed money from her parents.

She says the financial pressures of the practice reached a breaking point after Memorial Day, when the Senate left town without passing another delay in the payment cuts. "We said, 'We have to sit down over the kitchen table and talk about this. We cannot ignore this anymore,' " she said.

Write to Janet Adamy at [e-mail] and Greg Hitt at [e-mail]

[macrockett]

Massachusetts, remember, was held up by President Obama as the model for the federal health care system just enacted Massachusetts has a population of about 6.5 million people. If the state of health care in a state with so few people is spiraling out of control what does that mean for a system for 300 million people?

JULY 7, 2010

The Massachusetts Health-Care 'Train Wreck'
The future of ObamaCare is unfolding here: runaway spending, price controls, even limits on care and medical licensing.

By JOSEPH RAGO

President Obama said earlier this year that the health-care bill that Congress passed three months ago is "essentially identical" to the Massachusetts universal coverage plan that then-Gov. Mitt Romney signed into law in 2006. No one but Mr. Romney disagrees.

As events are now unfolding, the Massachusetts plan couldn't be a more damning indictment of ObamaCare. The state's universal health-care prototype is growing more dysfunctional by the day, which is the inevitable result of a health system dominated by politics.

In the first good news in months, a state appeals board has reversed some of the price controls on the insurance industry that Gov. Deval Patrick imposed earlier this year. Late last month, the panel ruled that the action had no legal basis and ignored "economic realties."

Senior Editorial Page Writer Joe Rago on why Obama is using a recess appointment to install the new head of Medicare and Medicaid.

In April, Mr. Patrick's insurance commissioner had rejected 235 of 274 premium increases state insurers had submitted for approval for individuals and small businesses. The carriers said these increases were necessary to cover their expected claims over the coming year, as underlying state health costs continue to rise at 8% annually. By inventing an arbitrary rate cap, the administration was in effect ordering the carriers to sell their products at a loss.

Mr. Patrick has promised to appeal the panel's decision and find some other reason to cap rates. Yet a raft of internal documents recently leaked to the press shows this squeeze play was opposed even within his own administration.

In an April message to his staff, Robert Dynan, a career insurance commissioner responsible for ensuring the solvency of state carriers, wrote that his superiors "implemented artificial price caps on HMO rates. The rates, by design, have no actuarial support. This action was taken against my objections and without including me in the conversation."

Mr. Dynan added that "The current course . . . has the potential for catastrophic consequences including irreversible damage to our non-profit health care system" and that "there most likely will be a train wreck (or perhaps several train wrecks)."

Sure enough, the five major state insurers have so far collectively lost $116 million due to the rate cap. Three of them are now under administrative oversight because of concerns about their financial viability. Perhaps Mr. Patrick felt he could be so reckless because health-care demagoguery is the strategy for his fall re-election bid against a former insurance CEO.

The deeper problem is that price controls seem to be the only way the political class can salvage a program that was supposed to reduce spending and manifestly has not. Massachusetts now has the highest average premiums in the nation.

In a new paper, Stanford economists John Cogan and Dan Kessler and Glenn Hubbard of Columbia find that the Massachusetts plan increased private employer-sponsored premiums by about 6%. Another study released last week by the state found that the number of people gaming the "individual mandate"—buying insurance only when they are about to incur major medical costs, then dumping coverage—has quadrupled since 2006. State regulators estimate that this amounts to a de facto 1% tax on insurance premiums for everyone else in the individual market and recommend a limited enrollment period to discourage such abuses. (This will be illegal under ObamaCare.)

Liberals write off such consequences as unimportant under the revisionist history that the plan was never meant to reduce costs but only to cover the uninsured. Yet Mr. Romney wrote in these pages shortly after his plan became law that every resident "will soon have affordable health insurance and the costs of health care will be reduced."

One junior senator from Illinois agreed. In a February 2006 interview on NBC, Mr. Obama praised the "bold initiative" in Massachusetts, arguing that it would "reduce costs and expand coverage." A Romney spokesman said at the time that "It's gratifying that national figures from both sides of the aisle recognize the potential of this plan to transform our health-care system."

An entitlement sold as a way to reduce costs was bound to fundamentally change the system. The larger question—for Massachusetts, and now for the nation—is whether that was really the plan all along.

"If you're going to do health-care cost containment, it has to be stealth," said Jon Kingsdale, speaking at a conference sponsored by the New Republic magazine last October. "It has to be unsuspected by any of the key players to actually have an effect." Mr. Kingsdale is the former director of the Massachusetts "connector," the beta version of ObamaCare's insurance "exchanges," and is now widely expected to serve as an ObamaCare regulator.

He went on to explain that universal coverage was "fundamentally a political strategy question"—a way of finding a "significant systematic way of pushing back on the health-care system and saying, 'No, you have to do with less.' And that's the challenge, how to do it. It's like we're waiting for a chain reaction but there's no catalyst, there's nothing to start it."

In other words, health reform was a classic bait and switch: Sell a virtually unrepealable entitlement on utterly unrealistic premises and then the political class will eventually be forced to control spending. The likes of Mr. Kingsdale would say cost control is only a matter of technocratic judgement, but the raw dirigisme of Mr. Patrick's price controls is a better indicator of what happens when health care is in the custody of elected officials rather than a market.

Naturally, Mr. Patrick wants to export the rate review beyond the insurers to hospitals, physician groups and specialty providers—presumably to set medical prices as well as insurance prices. Last month, his administration also announced it would use the existing state "determination of need" process to restrict the diffusion of expensive medical technologies like MRI machines and linear accelerator radiation therapy.

Meanwhile, Richard Moore, a state senator from Uxbridge and an architect of the 2006 plan, has introduced a new bill that will make physician participation in government health programs a condition of medical licensure. This would essentially convert all Massachusetts doctors into public employees.

All of this is merely a prelude to far more aggressive restructuring of the state's health-care markets—and a preview of what awaits the rest of the country.

Mr. Rago is a senior editorial writer at the Journal.

Also, watch the video about the new head of health care.

online.wsj.com/video/opinion-journal-the-new-health-care-administrator/F8895601-EF7E-4081-9E00-967D1EF13C86.html?KEYWORDS=massachusetts+health+care

[macrockett]

Below are the comments from the Director of the CBO:

cboblog.cbo.gov/

Long-Term Budget Outlook
June 30th, 2010 by Douglas Elmendorf

Recently, the federal government has been recording the largest budget deficits, as a share of the economy, since the end of World War II. As a result of those deficits, the amount of federal debt held by the public has surged. At the end of 2008, that debt equaled 40 percent of the nation’s annual economic output (as measured by gross domestic product, or GDP), a little above the 40-year average of 36 percent. Since then, large budget deficits have caused debt held by the public to shoot upward; CBO projects that federal debt will reach 62 percent of GDP by the end of this year—the highest percentage since shortly after World War II. The sharp rise in debt stems partly from lower tax revenues and higher federal spending related to the recent severe recession and turmoil in financial markets. However, the growing debt also reflects an imbalance between spending and revenues that predated those economic developments.

This morning CBO released the latest in its series of reports on the long-term budget outlook. (Addendum: I presented the key findings of the report to the National Commission on Fiscal Responsibility and Reform.) The report examines the pressures on the federal budget by presenting our projections of federal spending and revenues over the coming decades. Under current laws and policies, an aging population and rapidly rising health care costs will boost outlays for Social Security benefits and sharply increase federal spending for health care programs. Unless revenues increase at a similar pace, such spending will cause federal debt to grow to unsustainable levels. If policymakers are to put the nation on a sustainable budgetary path, they will need to let revenues increase substantially as a percentage of gross domestic product, decrease spending significantly from projected levels, or adopt some combination of those two approaches.

The Outlook for Major Health Care Programs and Social Security

Growth in spending on health care programs remains the central fiscal challenge facing the nation. CBO projects that if current laws do not change, federal spending on major mandatory health care programs will grow from roughly 5 percent of GDP today to about 10 percent in 2035 and will continue to increase thereafter. (Mandatory programs are those that do not require annual appropriations; the major mandatory health care programs include Medicare, Medicaid, the Children’s Health Insurance Program, and the subsidies that will be provided through the insurance exchanges that will be established as a result of the new health care legislation.)

That estimate includes all of the effects of the recently enacted health care legislation. Although, CBO expects the legislation to reduce federal budget deficits over the first 10 years and in subsequent decades (through its effects on both revenues and spending), it is expected to increase federal spending in the next 10 years and for most of the following decade; by 2030, however, that legislation will slightly reduce federal spending for health care if all of its provisions are fully implemented, CBO projects. (The estimates for the health care legislation that are used in this report are unchanged from the ones that CBO and the staff of the Joint Committee on Taxation published in March, when the legislation was being considered.)

Under current law, spending on Social Security is also projected to rise over time as a share of GDP, albeit much less dramatically—from 5 percent to 6 percent of GDP. (Later this week, CBO will release a report on a number of different policy options for changing Social Security.)

All told, CBO projects, the aging of the population and the rising cost of health care will cause spending on the major mandatory health care programs and Social Security to grow from roughly 10 percent of GDP today to about 16 percent of GDP 25 years from now if current laws are not changed. (By comparison, spending on all of the federal government’s programs and activities, excluding interest payments on debt, has averaged 18.5 percent of GDP over the past 40 years.)

Budget Outcomes Under Two Long-Term Scenarios

In the report, CBO presents the long-term budget picture under two scenarios that embody different assumptions about future policies governing federal revenues and spending. Budget projections grow increasingly uncertain as they extend farther into the future, so this report focuses largely on the next 25 years.

One scenario, the extended-baseline scenario, adheres closely to current law. That set of policies would result in steadily higher average tax rates because they incorporate the assumptions that most of the tax cuts enacted in 2001 and 2003 expire and that the alternative minimum tax applies to more and more people each year—and because the combination of economic growth and the structure of the tax system generates additional tax revenues as a percentage of income. Those rising rates, combined with the tax provisions of the recent health care legislation, would push total revenues to 23 percent of GDP by 2035—much higher than has typically been seen in recent decades—and to larger percentages thereafter. At the same time, government spending on everything other than the major mandatory health care programs, Social Security, and interest on federal debt—activities such as national defense and a wide variety of domestic programs—would decline to the lowest percentage of GDP since before World War II. Despite those substantial revenue increases and constrained spending for a portion of the budget, the rising costs of health care programs and Social Security would lead to continued budget deficits, and federal debt held by the public would grow from an estimated 62 percent of GDP this year to about 80 percent by 2035.

The budget outlook is much bleaker under the alternative fiscal scenario, which incorporates several changes to current law that are widely expected to occur or that would modify some provisions of law that might be difficult to sustain for a long period. In this scenario, CBO assumed that Medicare’s payment rates for physicians would gradually increase (which would not happen under current law) and that several policies enacted in the recent health care legislation that would restrain growth in health care spending would not continue in effect after 2020. In addition, under the alternative scenario, spending on activities other than the major mandatory health care programs, Social Security, and interest would fall below the average level of the past 40 years relative to GDP, though not as low as under the extended-baseline scenario.

More important, CBO assumed for this scenario that most of the provisions of the 2001 and 2003 tax cuts would be extended, that the reach of the alternative minimum tax would be kept close to its historical extent, and that over the longer run, tax law would evolve further so that revenues would remain at about 19 percent of GDP, near their historical average.

Under that combination of policy assumptions, federal debt would grow much more rapidly than under the extended-baseline scenario. With significantly lower revenues and higher outlays, debt would reach 87 percent of GDP by 2020, CBO projects. After that, the growing imbalance between revenues and noninterest spending, combined with spiraling interest payments, would swiftly push debt to unsustainable levels. Debt as a share of GDP would exceed its historical peak of 109 percent by 2025 and would reach 185 percent in 2035.

Neither of those scenarios represents a prediction by CBO of what policies will be in effect during the next several decades—but these projections, encompassing two very different sets of policy assumptions, provide a clear indication of the serious nature of the fiscal challenge facing the nation.

The Impact of Growing Deficits and Debt

In fact, CBO’s projections understate the severity of the long-term budget problem because they do not incorporate the significant negative effects that accumulating substantial amounts of additional federal debt would have on the economy:

* Large budget deficits would reduce national saving, leading to higher interest rates, more borrowing from abroad, and less domestic investment—which in turn would lower income growth in the United States.
* Growing debt would also reduce lawmakers’ ability to respond to economic downturns and other challenges.
* Over time, higher debt would increase the probability of a fiscal crisis in which investors would lose confidence in the government’s ability to manage its budget, and the government would be forced to pay much more to borrow money.

Keeping deficits and debt from growing to unsustainable levels would require raising revenues as a percentage of GDP significantly above past levels, reducing outlays sharply relative to CBO’s projections, or some combination of those approaches. Making such changes while economic activity and employment remain well below their potential levels would probably slow the economic recovery. However, the sooner that long-term changes to spending and revenues are agreed on, and the sooner they are carried out once the economic weakness ends, the smaller will be the damage to the economy from growing federal debt. Earlier action would require more sacrifices by earlier generations to benefit future generations, but it would also permit smaller or more gradual changes and would give people more time to adjust to them.

Posted in Budget Projections, Long-Term Budgetary Issues | Comments Off

[macrockett]

Finally, someone on the inside tells the truth about the new health care bill. None other than the Chief Actuary of Medicare (for the last 12 years)

www.cms.gov/ReportsTrustFunds/downloads/tr2010.pdf (the report)

Wall Street Journal AUGUST 8, 2010

Richard Foster for President
Medicare's chief actuary vs. President Obama on the ObamaCare facts.

There probably isn't a worse job in Washington than Medicare trustee, unpaid Capitol Hill interns included. Every year the trustees issue the gravest warnings about entitlement spending and at best prompt a moment of brow-furrowing before the political class returns to its default state of indifference.

This year's report, issued last week, has more than the usual political meaning because Democrats are hailing it as validation of their claims that ObamaCare will save taxpayers money. The trustee report shows "how the Affordable Care Act is helping to reduce costs and make Medicare stronger," the White House said in a statement.

One problem: That spin ignores the extraordinary companion analysis by chief Medicare actuary Richard Foster that repudiates this conclusion and is the most damning fiscal indictment to date of the Affordable Care Act.

The trustees do estimate the Medicare hospital trust fund will run out of money in 2029, some 12 years later than they estimated last year. (Keep in mind that the trust fund is a meaningless accounting artifact because Medicare was long ago financed in part by general tax revenues.) It's also true that, thanks to ObamaCare's changes under current budget rules, Medicare's unfunded 75-year liability has fallen to about $30.8 trillion from nearly $37 trillion in the previous audit.

Even in Washington, $6.2 trillion is real money. Yet this is a strange excuse for celebration. Democrats wrung about a half-trillion dollars from Medicare over the next decade, but then they turned around and plowed these "savings" into their new middle-class health-care entitlement. It's akin to paying off one credit card with another—while still being deeply in hock on the first.

But then comes the report's final appendix, where Mr. Foster disowns the previous 280-odd pages. Mr. Foster has been Medicare's chief actuary for 15 years, and as such he is required to evaluate the law as written. But as he notes in his appendix, the law as written bears little if any relation to the real world—and thus, he says, the trustee estimates "do not represent a reasonable expectation for actual program operations in either the short range . . . or the long range." In an unprecedented move, he directs readers to a separate "alternative scenario" that his office drew up using more realistic assumptions.

Mr. Foster shows that the Medicare "cuts" that Democrats wrote into ObamaCare exist only on paper and were written so they could pretend to reduce the deficit and perform the miracles the trustees dutifully outlined. With the exception of cuts in Medicare Advantage, those reductions will never happen in practice.

One of the fictions Mr. Foster highlights is the 30% cut in physician payments over the next three years that Democrats have already promised to disallow. Republicans would do the same, we hasten to add.

Another chunk of ObamaCare "savings" are due to cranking down Medicare's price controls for hospitals and other providers that Mr. Foster says are also "extremely unlikely to occur." In the absence of "substantial and transformational changes in health-care practices"—in other words, a productivity revolution in medicine that has never happened—costs will simply rise for private patients, or hospitals will refuse to treat seniors insured by Medicare. Congress will never allow that to happen either.

In other words, under ObamaCare the "cost curve" will not be bent as the White House has advertised.

Under his more plausible outlook, Mr. Foster notes that Medicare's share of the economy will rise 60% between now and 2040, while under the trustees report that Democrats are crowing about it would "only" rise by 35%. Didn't President Obama tell us that health-care reform is entitlement reform?

Politicians have deliberately written the ObamaCare rules, as they have for all entitlements, so the real costs are disguised and hard for taxpayers to figure out. During the ObamaCare debate, Mr. Foster was honest enough from his Medicare perch to expose the plan's true costs, and his new Medicare demarche continues this public service. He ought to receive the Presidential Medal of Freedom, or at least some media attention. But in Barack Obama's Washington, his honesty will be rewarded with obscurity.

[macrockett]

Soon, the Federal District Court in Virginia will hear the arguments concerning the Constitutionality of the new Health Care Law. This particular suit was brought by the State of Virginia and centers on the Commerce Clause and whether it extends to the new law. Virginia contends that it does not. The Obama administration contends that it does.

If you want to bone up on some of the issues, Cornell University Law School has a summary of key cases concerning the Commerce Clause: topics.law.cornell.edu/wex/Commerce_Clause

At the bottom of the Cornell summary, the Morrison and Lopez cases, used by the State of Virginia to support their case are mentioned. You can click the links to see the actual case law.

A motion for summary judgment is scheduled for October 18 according to the States website:
www.oag.state.va.us/PRESS_RELEASES/Cuccinelli/07110_Health_Care.html

Virginia's case is summarized here: www.oag.state.va.us/PRESS_RELEASES/Cuccinelli/Comm%20v.%20Sebelius%20-%20Complaint%20filed%20with%20Court%20_323_10.pdf

Various Briefs filed in the case can be viewed here:

scribd.asterpix.com/cy/2437661/?q=Briefs+Filed+In+Commonwealth+Of+Virginia+V.+Kathleen+Sebelius

dockets.justia.com/docket/virginia/vaedce/3:2010cv00188/252045/

US governments brief re motion to dismiss that was rejected by the District Court: www.oag.state.va.us/PRESS_RELEASES/Cuccinelli/22%20Virginia%20-%20memo%20in%20support%20of%20motion%20to%20dismiss.pdf



www.nytimes.com/2010/08/03/us/03virginia.html
August 2, 2010
Virginia Suit Against Health Care Law Moves Forward
By JOHN SCHWARTZ

A federal judge has refused to block a challenge to the Obama administration’s health care law brought by the Commonwealth of Virginia.

The administration had asked the judge, Henry E. Hudson of Federal District Court, to dismiss the challenge by Virginia’s attorney general, Ken T. Cuccinelli II.

Mr. Cuccinelli had argued that Congress, in passing a measure that requires people to buy insurance or face a penalty, exceeded its limits under the Constitution’s Commerce Clause and tax powers. Mr. Cuccinelli had also argued that the federal law violated a state law, the Virginia Health Care Freedom Act, which declares that residents cannot be forced to buy health insurance.

Mr. Cuccinelli is one of 21 state officials fighting the health care law, and this is the first ruling by a federal court on the important question of whether states have the standing to sue.

Monday’s opinion does not address the merits of the health care law. It has no direct effect on the other state challenges, but it may influence the other judges.

In its briefs, the federal government argued that “this court would have to make new law and ignore decades of settled precedent” and “step beyond the proper role of the judiciary” to claim jurisdiction and block the legislation. Case after case has shown that the government’s powers to regulate interstate commerce and to create taxes reach far.

The federal government argued that Virginia had no standing to sue over the law, and that it had not stated a case it could win.

Judge Hudson, who was appointed to the federal bench by President George W. Bush, disagreed. In a 32-page opinion, he wrote that the law “radically changes the landscape of health insurance coverage in America.”

The case, he wrote, “raises a host of complex constitutional issues”; the notion that the government’s authority could include “the regulation of a person’s decision not to purchase a product” was new to the federal courts, the judge concluded, and so the state’s protest could not be dismissed outright.

A Justice Department spokeswoman, Tracy Schmaler, played down the ruling as “merely a procedural decision by the court to allow this case to move forward,” and predicted that the law would withstand court scrutiny.

“We are confident that the health care reform statute is constitutional and that we will ultimately prevail,” Ms. Schmaler said in a statement.

Stephanie Cutter, a Democratic consultant working with the White House, posted an entry on the White House blog attacking the opponents of the law.

“Having failed in the legislative arena, opponents of reform are now turning to the courts in an attempt to overturn the work of the democratically elected branches of government,” Ms. Cutter wrote. “This is nothing new. We saw this with the Social Security Act, the Civil Rights Act and the Voting Rights Act.”

“All of those challenges failed,” she said. “So, too, will the challenge to health reform.”

In a statement, Mr. Cuccinelli said he was “pleased” with the decision.

Randy Barnett, a professor at Georgetown University Law Center who was an early critic of the health care law on constitutional grounds, said, “This decision establishes the seriousness of the constitutional challenges to the individual mandate.” Lower courts, he added, “should be striking the law down” until the challenges reach the Supreme Court, which alone has the authority “to expand Congress’s power, if it wants to.”

Jack Balkin, a professor at Yale Law School who has expressed skepticism over challenges to the health care law, argued on his blog that “it is still very likely that the Supreme Court will uphold the individual mandate,” if the case gets that far.

“This is the very beginning of the very beginning of a process that will go on for a long time,” Mr. Balkin said in an interview.

Judge Hudson, in his opinion, recognized that the ruling was narrow and preliminary, and that there was much more to come. “While this court’s decision may set the initial judicial course of the case,” he wrote, “it will certainly not be the final word.”

[sam2]

While I continue to hope that a court will find that the health care law, as passed, is unconstitutional, deep down my cynicism bubbles to the surface to quash those hopes.

I won't pretend to understand the constitutional issues, I think that ultimately, this is a case where "justice will be that which is in the interest of the stronger" and the federal government will ultimately prevail. First, the feds have unlimited resources to fund the litigation and hire the best minds to frame their arguments. Second, and possibly most important, health care is Obama's, and the Democrats, signature issue. If it is overturned, the stars will never be aligned again to allow it to be passed a second time. The administration realizes that the entire concept remains immensely unpopular, people are beginning to understand that it never could provide more services for less money. We are beginning to realize that even if we liked our old health care, we really won't be able to keep it.....in short, the administration cannot allow it to be overturned -- it would be too big a blow to accept. So, in my opinion, there is no limit to the effort the government will expend in order to win the legal challenge. In the end, the government will prevail and we will have a new legal precedent to cite the next time government attempts to interfere in what should be private issues.

Not convinced? Remember one of the characteristics Obama wanted in his first supreme court justice was "empathy" Sotomayor apparently embodied enough to be nominated. I'd prefer that justices rule based on law and precedent, not empathy. To me it is code for legislating from the bench. She'll be voting in favor of expanding the commerce clause as will most of the liberal members of the bench. The court has changed. Many decisions that had been 5-4 in favor of more conservative interpretations of the constitution will now be decided 4-5 in favor of more expansionist interpretation of government's power.

[macrockett]

Sept 9, 2010 10:06:10 GMT -6 sam2 said:

While I continue to hope that a court will find that the health care law, as passed, is unconstitutional, deep down my cynicism bubbles to the surface to quash those hopes.

I won't pretend to understand the constitutional issues, I think that ultimately, this is a case where "justice will be that which is in the interest of the stronger" and the federal government will ultimately prevail. First, the feds have unlimited resources to fund the litigation and hire the best minds to frame their arguments. Second, and possibly most important, health care is Obama's, and the Democrats, signature issue. If it is overturned, the stars will never be aligned again to allow it to be passed a second time. The administration realizes that the entire concept remains immensely unpopular, people are beginning to understand that it never could provide more services for less money. We are beginning to realize that even if we liked our old health care, we really won't be able to keep it.....in short, the administration cannot allow it to be overturned -- it would be too big a blow to accept. So, in my opinion, there is no limit to the effort the government will expend in order to win the legal challenge. In the end, the government will prevail and we will have a new legal precedent to cite the next time government attempts to interfere in what should be private issues.

Not convinced? Remember one of the characteristics Obama wanted in his first supreme court justice was "empathy" Sotomayor apparently embodied enough to be nominated. I'd prefer that justices rule based on law and precedent, not empathy. To me it is code for legislating from the bench. She'll be voting in favor of expanding the commerce clause as will most of the liberal members of the bench. The court has changed. Many decisions that had been 5-4 in favor of more conservative interpretations of the constitution will now be decided 4-5 in favor of more expansionist interpretation of government's power.

You may be right Sam2. There is a lot at stake in this case. The cases that I mentioned, however, Lopez and Morrison, were also federal cases. Each of these cases dealt with the scope of the commerce clause and the limitation upon it.

In my opinion, should the Supreme Court validate the Federal Bill, the 10th Amendment to the Constitution no longer has any real legal significance. The fact that the Federal government is requiring action on the part of every citizen, again in my opinion, goes well beyond the scope of the commerce clause as currently contemplated (being used to prohibit manifest behavior in the interest of interstate commerce.)

But then again, the Supreme Court chose not to hear a Bondholder case, concerning bankruptcy priority law, in the Chrysler Bankruptcy. Anything is possible.

[doctorwho]

Sept 9, 2010 10:06:10 GMT -6 sam2 said:

While I continue to hope that a court will find that the health care law, as passed, is unconstitutional, deep down my cynicism bubbles to the surface to quash those hopes.

I won't pretend to understand the constitutional issues, I think that ultimately, this is a case where "justice will be that which is in the interest of the stronger" and the federal government will ultimately prevail. First, the feds have unlimited resources to fund the litigation and hire the best minds to frame their arguments. Second, and possibly most important, health care is Obama's, and the Democrats, signature issue. If it is overturned, the stars will never be aligned again to allow it to be passed a second time. The administration realizes that the entire concept remains immensely unpopular, people are beginning to understand that it never could provide more services for less money. We are beginning to realize that even if we liked our old health care, we really won't be able to keep it.....in short, the administration cannot allow it to be overturned -- it would be too big a blow to accept. So, in my opinion, there is no limit to the effort the government will expend in order to win the legal challenge. In the end, the government will prevail and we will have a new legal precedent to cite the next time government attempts to interfere in what should be private issues.

Not convinced? Remember one of the characteristics Obama wanted in his first supreme court justice was "empathy" Sotomayor apparently embodied enough to be nominated. I'd prefer that justices rule based on law and precedent, not empathy. To me it is code for legislating from the bench. She'll be voting in favor of expanding the commerce clause as will most of the liberal members of the bench. The court has changed. Many decisions that had been 5-4 in favor of more conservative interpretations of the constitution will now be decided 4-5 in favor of more expansionist interpretation of government's power.

Chicago politics has reached the White House- God help us all

[macrockett]

The promises about savings in health care under the new law just keep slipping. Yesterday economists at the Center for Medicare and Medicaid Services projected the average yearly cost of health care will go up more the previously thought. My thought? They have no idea what it will be. Remember in the late 60s when Medicare came on line it was projected that by early 1990 the cost would be around $9 billion. The actual cost? Over $100 billion.

online.wsj.com/article/SB10001424052748704362404575480161749608830.html?mod=WSJ_hpp_LEFTTopStories#printMode
SEPTEMBER 8, 2010

Health Outlays Still Seen Rising
By JANET ADAMY

The health-care overhaul enacted last spring won't significantly change national health spending over the next decade compared with projections before the law was passed, according to government figures released Thursday.

The report by federal number-crunchers casts fresh doubt on Democrats' argument that the health-care law would curb the sharp increase in costs over the long term, the second setback this week for one of the party's biggest legislative achievements.

The Wall Street Journal reported Wednesday that insurance companies have proposed rate increases ranging from 1% to 9% nationwide that they attribute specifically to new health-law coverage mandates.
Access thousands of business sources not available on the free web. Learn More

Democrats signaled they would ratchet up pressure on the companies. "Insurers are using the consumer protections in health reform as a cover for their own greed," said Rep. Pete Stark (D., Calif.), chairman of the House Ways and Means health subcommittee.

Michigan Rep. Dave Camp, the top Republican on that committee, said the rate increases underscore why lawmakers should repeal the legislation and replace it with changes that make care more affordable.

Regardless of the health law, national health spending has been rising in recent years and economists expect that to continue. In February, the federal Centers for Medicare and Medicaid Services projected that overall national health spending would increase an average of 6.1% a year over the next decade.

The center's economists recalculated the numbers in light of the health bill and now project that the increase will average 6.3% a year, according to a report in the journal Health Affairs. Total U.S. health spending will reach $4.6 trillion by 2019, accounting for nearly one of every five U.S. dollars spent, the report says.

"The overall net impact is moderate," said lead author Andrea Sisko, an economist at the Medicare agency. "The underlying impacts on coverage and financing are more pronounced."

The White House said the law will lower costs for insured consumers by removing the hidden price they pay to subsidize the uninsured.

In the next year, spending from private health insurance is expected to grow while out-of-pocket medical costs decline because more people will stay on Cobra insurance coverage for the unemployed, the report said.

The law's early provisions will increase overall health-care spending, the report says, while adding to benefits for consumers. The creation of new high-risk insurance pools, a requirement that children can stay on their parents' insurance plans until age 26 and other early provisions will increase U.S. health expenditures by $10.2 billion through 2013, the report says.

The new projections take into account other factors, including a delay in payment cuts to doctors who treat Medicare patients.

Insurers say they plan to raise premiums on some Americans due to the health overhaul, complicating Democrats' efforts to trumpet their signature achievement before elections. Janet Adamy and Evan Newmark discuss. Also, Justin Lahart discusses the two-track economy for American business, with global players getting boosts from fast-growing foreign markets, while companies focused on the U.S. market are hamstrung by recession-scarred consumers.

U.S. health spending is projected to rise 9.2% in 2014, up from the 6.6% projected before the law took effect. New mechanisms kick in that year to expand insurance coverage. The report estimates 92.7% of U.S. residents will have health insurance by 2019, up from 84% this year.

Once the insurance expansion begins, U.S. health spending is expected to grow slightly more slowly. Between 2015 and 2019, the report predicts, it will increase 6.7% a year on average, down from the 6.8% projected before the overhaul passed.

Out-of-pocket spending is expected to fall sharply starting in 2014 when more people gain insurance coverage through new tax credits and an expanded Medicaid federal-state insurance program. But an excise tax on high-cost plans that takes effect in 2018 will increase out-of-pocket spending as insurance providers reduce their plan benefits to stay below the tax threshold. The law is expected to slow growth in Medicare spending by 1.4 percentage points because it contains lower payments to health-care providers.

Write to Janet Adamy at [e-mail]
-----------------------------------------------------------------------------------------



Gov't: Spending to rise under health care overhaul

By RICARDO ALONSO-ZALDIVAR (AP) – Sep 9, 2010

WASHINGTON — The nation's health care tab will go up — not down — as a result of President Barack Obama's sweeping overhaul. That's the conclusion of a government forecast released Thursday, which also finds the increase will be modest.

The average annual growth in health care spending will be just two-tenths of 1 percentage point higher through 2019 with Obama's remake, said the analysis. And that's with more than 32 million uninsured gaining coverage because of the new law.

"The impact is moderate," said economist Andrea Sisko of Medicare's Office of the Actuary, the nonpartisan unit that prepared the report.

Factoring in the law, Americans will spend an average of $13,652 per person a year on health care in 2019, according to the actuary's office. Without the law, the corresponding number would be $13,387.

That works out to $265 more with the overhaul. Currently, Americans spend $8,389 a year per person on health care.

The new bottom line is guaranteed to provide ammunition for both sides of a health care debate that refuses to move offstage. Republicans are vowing repeal if they win control of Congress this fall, although they are unlikely to have enough votes to override an Obama veto.

For critics, the numbers show that the law didn't solve the cost problem, although Obama repeatedly said he wanted to bend the spending curve down.

The analysis found that health care spending will grow to nearly 20 percent of the economy in 2019. That siphons off resources that could be invested in education, research, transportation or other areas. Medical costs now account for about 17 percent of the economy, and some experts think that's already too much.

For advocates of the law, the numbers show that expanding coverage to 93 percent of eligible Americans comes at a relative bargain price. Moreover, if Congress sticks to cost controls in the legislation, there's potential beyond 2020 to rein in the growth of health care spending. The new projections show a slowdown starting around 2018.

"By the end of the projection period, we estimate (costs) will grow more slowly," said John Poisal, who worked on the forecast.

It's a long way off, but under the health care law, the big coverage push doesn't start until 2014.

That's when the government will offer tax credits to help middle-class people buy private coverage through new insurance markets in their states. At the same time, Medicaid will be opened up to millions more low-income people. Insurers will have to accept all applicants, regardless of health problems. And most Americans will be required to carry coverage or face a fine from the IRS.

The study also showed:

_Government is becoming the dominant player in health care even without Obama's law. Federal, state and local government spending will overtake private sources in 2011, three years before the main provisions of the overhaul take effect. The biggest programs are Medicare and Medicaid.

_Even after the health care overhaul is fully phased in, three out of five people under age 65 will still have private coverage, with most continuing to get benefits through their employer.

_Two federal-state programs, Medicaid and children's health insurance, will grow dramatically under the overhaul. Enrollment will jump 34 percent between 2013 and 2014, to more than 85 million people. States will be bigger players in health care — and face new pressures over the long run.

The White House released its own analysis of the report, calculating that total health care spending per insured person would be more than $1,000 lower under the law.

A White House blog post from health reform director Nancy-Ann DeParle said that by 2019 overall health care spending per insured person would average $14,720 under the law, compared with $16,120 if Congress and the president had not acted, or $1,400 less.

The White House average was not part of the Medicare analysts' projections, and there was no official response from the actuaries to the White House estimate. DeParle acknowledged that spending would rise in the short run as uninsured people gain coverage, but noted the rate of growth would slow in the second half of the decade. "A close look at this report's data suggest that for average Americans, the Affordable Care Act will live up to its promise," she said.

The Medicare analysts' report is available online from the journal Health Affairs.

content.healthaffairs.org/cgi/reprint/hlthaff.2010.0788v1
(When the above page opens on Health Affairs, hit the download link to see the study)