Health Care

Science versus the Courts

What role should government play in how doctors administer treatment?

Flickr / rad(ish)labs
This month, two California courts issued differing opinions deciding whether California could ban gay conversion therapy based on evidence of harm to minors. On the same day the Oklahoma Supreme Court struck down two laws requiring abortion providers to practice in accordance with the right wing-dominated state legislature. Immediately after, I was asked if these two decisions were essentially the same, protecting the free speech rights of health-care professionals and stopping the government from interfering in the patient–provider relationship. But, these issues don’t fit so neatly into a box. Let me begin by acknowledging that I am not a fan of the argument that health-care providers should be allowed to practice their trade unfettered by “government” intrusion. Rather, I believe that evidence-based regulation of health care should be the standard, and sometimes that means government action. But the burden is high, the science must be high quality, and the branch of government...

It’s a Mad, Mad Michigan

Right-to-work legislation was only the beginning. State Republicans have an entire docket full of legislation set to limit rights.

(AP Photo/The Detroit News, Elizabeth Conley)
Sure, lame-duck legislatures are bound to be a bit mad. But the session that just closed in Michigan was one for the ages. Aflush with the flurry of bills sent to the desk of Governor Rick Snyder—not so much speaking to his opinion on their quality—a politics-loving friend of mine in Detroit exclaimed, “It’s like Christmas in … well, in December.” The swift passage of right-to-work in Michigan picked up national and international headlines last week. But that overhaul of labor law is only one piece of the expansive legislative plan for the state that now awaits Snyder’s go-ahead. The lame-duck session was the final and powerful display of influence by GOP and Tea Party lawmakers that had a total and triumphant win in the 2010 election. Even as Michigan’s reputation as a “swing state” is diminishing—it’s voted Democratic for president since 1992, and both its U.S. senators are Democrats—local politics remain fractious. Not only does the GOP dominate both chambers in the state...

While You Weren’t Looking, Michigan Turned Into Texas

Flickr/CedarBendDrive
The Michigan legislature’s lame duck session is only three weeks long, but the state house didn't need more than 18 hours to move the state sharply to the right. During a marathon session Thursday and Friday, the state house passed a variety of very conservative bills on issues from abortion to gun control to taxes. You can’t say they’re not efficient. The state, which favored Obama by 9 points and has long been home to a moderate-progressive movement, may now have a set of laws that puts it on America’s more conservative end. Perhaps most shocking for pro-choice advocates was the effort to restrict abortion rights—or, as Mother Jones put it, “ the abortion mega-bill. ” Assuming the governor signs the bill into law, women in Michigan will now have to buy separate insurance policies to cover abortion. Otherwise, even in cases of rape or miscarriage, the abortion will not be covered. Clinics that provide more than 120 abortions a year will now face significantly more stringent licensing...

The Obama Administration Plays Hardball On Medicaid

President Obama signing the Affordable Care Act.
When the Supreme Court upheld the Affordable Care Act, it also gave Republican states a gift by saying they could opt out of what may be the ACA's most important part, the dramatic expansion of Medicaid that will give insurance to millions of people who don't now have it. While right now each state decides on eligibility rules—meaning that if you live in a state governed by Republicans, if you make enough to have a roof over your head and give your kids one or two meals a day, you're probably considered too rich for Medicaid and are ineligible—starting in 2014 anyone at up to 133 percent of the federal poverty level will be eligible. That means an individual earning up to $14,856 or a family of four earning up to $30,657 could get Medicaid. Republican governors and legislatures don't like the Medicaid expansion, which is why nine states—South Dakota, plus the Southern states running from South Carolina through Texas—have said they'll refuse to expand Medicaid (many other states have...

What Raising the Medicare Eligibility Age Means

President Johnson signing Medicare into law in 1965.
After a campaign in which Republicans attempted to pillory Barack Obama for finding $716 billion in savings from Medicare (via cuts in payments to insurance companies and providers but not cuts to benefits), those same Republicans now seem to be demanding that Obama agree to cuts in Medicare benefits as the price of saving the country from the Austerity Trap, a.k.a. fiscal cliff. Oh, the irony! You'd almost think that they weren't really the stalwart defenders of Medicare they pretended to be. And there are some hints that the Obama administration is seriously considering agreeing to raise the Medicare eligibility age from 65 to 67 as part of this deal. It's a dreadful idea, and as we discuss this possibility, there's one really important thing to keep in mind: Medicare is the least expensive way to insure these people. Or anybody, for that matter. In all this talk of the bloated entitlement system, you'd be forgiven for thinking Medicare was some kind of inefficient, overpriced big...

Who Wants Moar Medicaid?

Washington Post
At Wonkblog, Sarah Kliff has a revealing map of the states that have agreed to the Obamacare Medicaid expansion, are undecided, or have rejected it. Take a look: Eighteen states will accept the Affordable Care Act's Medicaid expansion—or are leaning towards it—17 are undecided, 7 are leaning "no," and 9 will not expand it. It's worth emphasizing how important this is: Of the 32 million people slated to receive health-care coverage under the ACA, just over 21 million will receive it by way of the Medicaid expansion. If states like Texas, Florida, Georgia, and Virginia decide to reject it, millions of people will go uninsured for no reason other than political pique. My hunch is that conservative states will be able to avoid the Medicaid expansion in the short run, but that longer-term pressure will force them to yield. Remember, the federal government is offering to cover 90 percent of the cost of the expansion, meaning—in effect—that states are receiving a huge award of free money...

Getting Away with Wage Theft

The 1938 Fair Labor Standards Act (FLSA), which ushered in many of the worker protections we enjoy today, was a major progressive victory. But as the century that followed it shows, it was by no means the end of the struggle to get workers treated fairly. Employers, aided by conservatives in the executive and judicial branches, have often found ways of ensuring these laws are not fully enforced. Symczyk v. Genesis Healthcare Corp. , which the Supreme Court considered yesterday at oral argument, presents another case in which conservatives on the Supreme Court might erect a barrier making FLSA harder to enforce. The case involves a lawsuit filed by Laura Symczyk, who alleged that Genesis Healthcare had committed wage theft against her and her co-workers. According to Symczyk, Genesis routinely docked the pay of workers (including herself) for lunch breaks that were not taken. Reflecting the strength of her claim, Genesis offered her $7,500 plus associated fees to settle. Symczyk,...

Will the Contraception Mandate Survive Judicial Review?

Yesterday's court order blocking the Obama administration's ruling on health-care plans is by no means the end of the road.

Yesterday, the Eighth Circuit Court of Appeals issued a stay blocking the Obama administration's requirement that employer health-insurance plans cover contraception. The related suit was filed by Frank O'Brien, a Roman Catholic business owner who claimed that the mandate violated his rights under the free exercise clause of the First Amendment. It's not clear whether the stay indicates a real chance that the mandate will ultimately be ruled unconstitutional. It was granted in a one-line order , with one of the judges in a three-judge panel dissenting. The stay order indicates that the two other judges consider the suit non-frivolous, but this does not necessarily mean that O'Brien will ultimately prevail. Still, the appeals court would have been better not to issue the stay, because the free exercise argument being made against the contraception mandate is i ndeed frivolous. The key precedent, Oregon v Smith , makes it clear that generally applicable laws do not violate the First...

The Great Society's Next Frontier

(AP Photo/Susan Walsh)
(AP Photo/Susan Walsh) A copy of H.R. 3200, America Affordable Health Choices Act of 2009, sits on the desk of House Energy and Commerce Committee Chairman Henry Waxman, a Democrat from California. A s The Washington Post ’s Ezra Klein declared shortly after voters re-elected President Barack Obama, one of the major winners last week was health-care reform. With Democrats holding on to the Senate and the White House, Republicans will be unable to repeal the law before all of its provisions go into effect in 2014—after which, the theory goes, the public will come to accept that government has the responsibility to ensure health care is available for all. This is the end of a long battle for progressives: Health care has been the major missing piece of our welfare state for nearly a century, and for decades making it part of our system of social insurance has been a primary goal of politicians, think tanks, and activists. With this piece of the progressive puzzle in place, the natural...

The Moral Question of the Medicaid Expansion

Uninsured people getting medical care at an event in Los Angeles earlier this year. (Flickr/Neon Tommy)
In the last four years, we've seen a lot of reflexive, frankly dickish anti-Obamaism from Republicans at all levels. Much of it is relatively harmless; when some knuckle-dragging congressman goes on talk radio to air his suspicions that Obama's birth certificate is a forgery, there may be some chipping away at the President's legitimacy, but no one's life is affected directly. But there are some cases where Republicans are willing to do direct, substantial, even life-threatening harm to thousands or even millions of people, for no other reason than to demonstrate their unflagging hatred for the man in the Oval Office. I'm talking here about the coming expansion of Medicaid, which didn't get discussed much during the campaign, but which is the most profound effect of the passage of the Affordable Care Act. As you'll recall, when the Supreme Court upheld the individual mandate, it gave a gift to Republicans too, saying states could opt out of the law's expansion of Medicaid, under which...

Defending the Right to Treat Your Employees Like Dirt

Papa Johns? More like Papa Jerk's! Thank you, I'll be here all week. (Flickr/jumbledpile)
Getting tired of eating at Chick-Fil-A every day to express your hatred of liberals? Well, now you have a couple more options. You can chow down at Applebee's, where the CEO of their New York franchises went on TV to declare that he won't be doing more hiring because of the costs Obamacare would impose. Or you can head over to Papa John's, whose CEO, John Schnatter, has said that Obamacare could add as much as—brace yourself—10 cents to the cost of a pizza, and since obviously customers would never tolerate such price gouging, he'll just have to cut back employees' hours. In our new era of corporate political activism, we're goin to be seeing a lot more of this kind of thing. So let's make sure we all understand exactly what it is these chieftains are complaining about: They don't want to give their employees health insurance . That's it. They'd prefer to talk about "regulation" in some general sense, so you might get the impression that Obamacare is making them needlessly remodel...

Nancy Pelosi, Same Job, Different Coalition

(Flickr/Talk Radio News Service)
(AP Photo/Pablo Martinez Monsivais) House Minority Leader Nancy Pelosi holds a news conference with newly elected Democratic House members on Capitol Hill. N ancy Pelosi has confounded expectation before. Following the 2010 midterm elections, when Republicans recaptured the House on a wave of Tea Party indignation, Pelosi was widely, and unjustly, criticized for leading House Democrats to debacle. She had played a key role in enacting Obamacare, a program that the Obama administration chose not to defend as Election Day drew nigh. She had not paid enough attention to solving the recession, critics argued, though in fact House Democrats had passed additional stimulus measures that failed to surmount Senate filibusters. It was time, the critics said, for her to go. But Pelosi disagreed, and her House colleagues turned out to be in no mood to challenge her decision. Now, once again, she has surprised the Washington conventional wisdom by signing on for another two years atop the House...

When It Comes to Lady Politicians, We've Got a Long Way to Go

(Flickr/Leader Nancy Pelosi)
(AP Photo/Michael Dwyer) Democrat Elizabeth Warren takes the stage after defeating incumbent GOP Senator Scott Brown in the Massachusetts Senate race, during an election night rally at the Fairmont Copley Plaza hotel in Boston, Tuesday, November 6, 2012. I t's made for a great narrative: Tuesday night, female candidates prevailed in nearly all the tightest, most-watched Senate races around the country. A historic number of women will now serve in the upper chamber, once the boysiest of boys' clubs. If that wasn't enough to prompt some girl-power cheering, there was the news out of New Hampshire that, with the election of Maggie Hassan to the state's top executive spot, the governor, senators, and congressional representatives now all carry XX chromosomes. Several commentators have noted there's still a long way to go. But perhaps, more notably, there's little evidence that these wins are part of a wider trend for female candidates. The political gains were most notable in the Senate,...

Will Massachusetts Voters Legalize Assisted Suicide?

This is the ninth in the Prospect's series on the 174 measures on state ballots this year. Six years ago, Mesfin Nega was attacked outside a nightclub. He suffered a broken neck and a damaged spinal cord that transformed the previously healthy 32-year-old into a quadriplegic. As The Washington Post later reported , Nega had made a pact with his friend Shimelis Yegazu: If one were ever to suffer an injury that required him to be connected to life-sustaining equipment, the other would take it upon himself to disconnect the equipment. Nega and Yegazu made the news last week when Yegazu followed through with this pact, administering a lethal dose of phenobarbital to Nega, and then taking a fatal dose himself. Nega’s story raises a question that has been off the political radar for some time: Should a patient who wants to end his or her own life have the right to receive a physician’s assistance doing so? Debate here doesn't fall along usual partisan lines—there is no party orthodoxy for...

Anti-Obamacare Ballot Measures: Purely Symbolic, Sometimes Ironic

(Flickr/Fibonacci Blue)
This is the seventh in the Prospect's series on the 174 measures on state ballots this year. Ever since the Affordable Care Act (ACA) passed, Republicans have been desperate for ways to gut it. They hoped the Supreme Court might do the dirty work, but the Court ruled this summer that the law was constitutional. They hoped to pass new legislation, but as long as Democrats have the White House and the Senate, that's a non-starter. So instead, for the time being, they are turning to purely symbolic acts of defiance. Four states have ballot measures on November 6 that, if passed, would directly conflict with the ACA. In Alabama, Florida, Montana, and Wyoming, voters can ostensibly decide to ban any and all mandates that residents get health insurance. But these "bans" would exist in name only. That's because the measures would violate Obamacare, which requires that the state's residents get health insurance or pay a fine (which the Supreme Court calls a tax). These measures will have no...

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