Fix Health Care Policy

Another Victory on the Road to Repeal

“The unchecked expansion of congressional power to the limits suggested by the Minimum Essential Coverage Provision would invite unbridled exercise of federal police powers. At its core, this dispute is not simply about regulating the business of insurance—or crafting a scheme of universal health insurance coverage—it’s about an individual’s right to choose to participate.” So wrote Judge Henry Hudson of the United States District Court for the Eastern District of Virginia yesterday in striking down Obamacare’s individual mandate. Specifically, Judge Hudson found that Section 1501 of the act, which forces all Americans to buy government approved health insurance policies, “exceeds the Commerce Clause powers vested in Congress under Article 1.”

The White House and their leftist allies were quick to try and minimize this body blow to Obamacare, arguing that 14 previous court challenges have been dismissed by the courts. This desperate spin doesn’t even pass the laugh test. The 42-page decision is the first by a federal court this far along the litigation process and the first brought by a state (the case was filed by Virginia Attorney General Kenneth Cuccinelli). And soon Judge Roger Vinson of the United States District Court for the Northern District of Florida is expected to rule on an even larger challenge to Obamacare brought by 16 state attorneys general, four governors, two private citizens, and the National Federation of Independent Business.

In an early stage of that litigation, Judge Vinson wrote: “The individual mandate applies across the board. People have no choice and there is no way to avoid it. Those who fall under the individual mandate either comply with it, or they are penalized. It is not based on an activity that they make the choice to undertake. Rather, it is based solely on citizenship and on being alive.”

Judge Hudson used very similar reasoning in rejecting the Obama Administration’s claim that since “every individual in the United States will require health care at some point in their lifetime” the federal government has the power to force Americans to buy health insurance now. Hudson writes: “Of course, the same reasoning could apply to transportation, housing, or nutritional decisions. This broad definition of the economic activity subject to congressional regulation lacks logical limitation and is unsupported by Commerce Clause jurisprudence.” (more…)

Tags: Commerce Clause, Individual Mandate, Judge Henry Hudson, ObamaCare

Judge Rules Obamacare Mandate Goes Beyond Letter and Spirit of the Constitution

In the most significant decision to date involving the numerous challenges to Obamacare, a district court today ruled in favor of the Commonwealth of Virginia’s challenge, and declared the individual mandate portion of the Patient Protection and Affordable Care Act unconstitutional. The fact that the decision is based upon cross motions for summary judgment means among other things, in simple English, that the parties have had two major hearings and two sets of merit briefs before the Court, which has now issued its second major opinion (and this is leaving aside a slew of motions decided by the court). The decision, accordingly, is the most well-developed of any court yet to address the matter, and therefore should cause quite a bit of indigestion for defenders of Obamacare.

Judge Hudson first addressed the Obama administration’s claims that the law is constitutional under the Commerce Clause. After weighing the arguments and the case law, he found that the mandate’s scheme was without precedent in our country’s history: “Neither the Supreme Court nor any federal circuit court of appeals has extended Commerce Clause powers to compel an individual to involuntarily enter the stream of commerce by purchasing a commodity in the private market.” (more…)

Tags: Individual Mandate, ObamaCare, Supreme Court, unconstitutional, Virginia

Side Effects: Number of Waivers Grows As a Result of Obamacare Authors’ Sloppy Handiwork

Jamie Dupree recently reported for the Atlanta Journal-Constitution that the number of waivers granted by the Obama Administration for a certain provision in the new health care law has now reached 222. That’s double the amount of just three weeks ago.

The waivers apply to a provision of Obamacare prohibiting annual limits on health plans. For employers that currently provide their low-wage employees with so called “mini-med” health plans—which offer a limited benefit capped at a certain dollar amount—that provision presents a clear problem.

Since the new law doesn’t specify whether those plans count as major medical insurance or supplemental coverage, businesses have applied for waivers to ensure that the benefit limits on their mini-med plans aren’t increased or eliminated. Otherwise, employers would no longer be allowed to offer those plans, resulting in more than a million low-wage workers losing their current coverage. Without the option of a mini-med plan, most of those workers would likely go uninsured until 2014, when they would then be able to obtain a health plan paid for by new federal subsidies through the new state health exchanges. (more…)

Tags: low-wage workers, mini-med health plan, ObamaCare, waiver

Doctors Avoid Medicare Pay Cut for Another Year—but Then What?

Senate leaders reached an agreement Monday to delay cuts to physician reimbursement rates under Medicare for one year. The details of the negotiations have yet to be ironed out, but if the deal makes it through Congress, doctors will avert a 23 percent pay cut scheduled for January 1.

Heritage health policy expert Bob Moffit explains in a recent post that the Sustainable Growth Rate (SGR) formula, enacted in 1997, arbitrarily ties Medicare physician reimbursement to the overall performance of the economy, meaning that when payments grow faster than the economy, automatic reductions go into effect.

In theory, that is. Congress has continually delayed the reductions to avoid reducing seniors’ access to health care. (This delay is known as the “doc fix.”) As reimbursement rates drop, more physicians become inclined to limit the number of Medicare patients they see. Some are even forced to stop accepting Medicare altogether. As Congress continues to stop the cuts from going into effect, they accumulate, so failure to act now would serve doctors a crippling 23 percent pay cut in 2011. (more…)

Tags: doc fix, Medicare, ObamaCare, Ryan Roadmap, Senate deal, Sustainable Growth Rate

Side Effects: What Doctors Have to Say About Obamacare

No one is more familiar with the health care system than doctors. So what do they have to say about Obamacare? Nothing good, according to a recent survey.

The Physicians Foundation found that “rather than a sign of progress, the survey suggests that most physicians view health reform as a further erosion of the unfavorable conditions with which they must contend.” Furthermore, Obamacare “has further disengaged doctors from their profession, with potentially negative consequences for both the medical profession and for the quality and accessibility of medical care in the United States.”

Sixty-seven percent of respondents initially held a “very negative” or “somewhat negative” impression of Obamacare. When asked how their feelings had changed months after passage of the law, 51 percent said they felt the same, while 39 percent felt more negative. Furthermore, 86 percent of respondents said physicians’ perspectives were not adequately taken into account during the reform process. (more…)

Tags: Medicaid, Medicare, ObamaCare, The Physicians Foundation

One More Step toward the Right Medicare and Medicaid Reforms

The President’s National Commission on Fiscal Responsibility and Reform is not set to release its final recommendations on how best to tackle deficit spending and entitlement reform until December 1. However, several of its members have already gone public with proposals to reduce runaway spending and put Medicare and Medicaid, two of the fastest-growing entitlement programs, on the road to solvency.

The commission co-chairs, Alan Simpson and Erskine Bowles, released a report that takes several positive steps in reforming Medicare, including opting to repeal the Sustainable Growth Formula. Alice Rivlin and Representative Paul Ryan (R–WI), also members of the commission, released transformative, long-term solutions to Medicare and Medicaid that would better serve patients and reduce the tremendous upward pressure these programs place on federal spending. (more…)

Tags: debt commission, entitlement spending, Medicaid, Medicare, sustainable growth rate formula, unfunded obligations

Time to Clean Up the Medicare Doctor Payment Mess

Congressional Quarterly is reporting that the United States Senate is going to enact a one-month reprieve for Medicare physicians, saving them once again from a draconian reduction in Medicare payment.

This entire system is a mess. Under the existing Medicare payment formula (the Sustainable Growth Rate, or SGR) for doctors that the Senate and their House colleagues enacted in 1997, physician reimbursement is tied to the performance of the general economy. If in any given year Medicare physician payment outpaces the growth in the general economy, there is an automatic proportional reduction.

Routinely, Congress has blocked the annual payment reductions, but then, under the congressional formula, the payment reductions accumulate. Yet another flaw of the Patient Protection and Affordable Care Act is that it did not fix the physician payment problem. The result: This December, Medicare doctors will face a 23 percent cut in pay. A one-month extension of the reprieve would guarantee that the cuts next month would be even greater, requiring another congressional intervention. (more…)

Tags: Medicare "doc fix", ObamaCare, Patient Protection and Affordable Care Act, physician payments, Sustainable Growth Rate

Breaking Health Care Research: Repealing Obamacare and Getting Health Care Right

As newly elected lawmakers prepare for the hard work to be done in the next Congress, the future of the hugely unpopular Patient Protection and Affordable Care Act hangs in the balance.

In recent analysis, Heritage expert Nina Owcharenko makes the case for the full repeal of the PPACA and provides a framework for replacement with reform that will transform the system to focus on doctors and patients, not government. She writes that:

“Beyond the unprecedented mandates, new taxes, massive entitlement expansion, unworkable and costly insurance provisions, and its failure to control costs, the new law concentrates enormous power in the U.S. Department of Health and Human Services (HHS). It creates a giant network for the federal micromanagement of health plans, benefits, insurance markets, and unprecedented intervention into the details of health care financing and the delivery of medical care.” (more…)

Tags: failure control costs, massive entitlement expansion, new taxes, ObamaCare, unprecedented mandates

Who Should Control Your Health Care, You Or The Government?

After President Barack Obama installed Dr. Donald Berwick as head administrator of Medicare and Medicaid by recess appointment, Press Secretary Robert Gibbs was asked at the daily press briefing if “it would have been politically troublesome in an election year to have all these comments aired out about rationing, redistribution that Dr. Berwick had talked about in the past.”

Gibbs was ready for this question, though, and shot back: “Did he say things like, ‘rationing happens today; the question is who will do it’? Did he say that?” The bait laid, the reporter responded: “That was one comment.” The trap sprung, Gibbs pounced: “Actually that was Paul Ryan. That was Paul Ryan. He’s a Republican in Congress.” The White House press corps roared with laughter.

Gibbs may have won that round, but today Berwick is scheduled to testify before the Senate Finance Committee, and conservatives will have their first chance to question the bureaucrat in charge of implementing Obamacare’s many changes to the Medicare system. Hopefully Berwick’s past statements will not dominate the hearings but instead serve as a jumping-off point to shine light on the vast new powers Obamacare granted the federal government.

For starters, in June 2009, Berwick told Biotechnology Healthcare: “The decision is not whether or not we will ration care—the decision is whether we will ration with our eyes open. And right now, we are doing it blindly.” For comparison sake, here is the full version of the Gibbs-truncated Ryan quote from a 2009 interview with The Washington Post: “Rationing happens today! The question is who will do it? The government? Or you, your doctor and your family?” (more…)

Tags: CMS Administrator Dr. Donald Berwick, federal bureaucracy, Medicare, ObamaCare, Robert Gibbs, Senate Finance Committee

The Berwick Hearing’s Best Focus: Obamacare’s Effects on Doctors and Patients

The Centers for Medicare and Medicaid Services (CMS) Administrator Dr. Donald Berwick this morning is expected to testify before Congress in his first appearance since a controversial recess appointment in June. He will talk before the Senate Finance Committee.

President Barack Obama’s controversial decision to sidestep protocol and appoint Berwick has been magnified by media coverage of Berwick’s publications and speeches that supported highly centralized health-care systems. While a respected health policy analyst, Berwick has what he calls “romantic” views on the United Kingdom’s National Health Service, which rations care based on the cost-effectiveness of treatments. Likening Britain’s system to a “global treasure” has many senators concerned that Berwick will take the same viewpoint while implementing the new health law. (more…)

Tags: CMS Administrator Dr. Donald Berwick, Independent Payment Advisory Board, Medicaid, Medicare, National Health Service, ObamaCare