Health Care

States Lag on Health Exchanges

(Flickr/GenBug)
Once the law is fully implemented, health care exchanges will be the part of the Affordable Care Act we likely notice most. The exchanges were designed to turn health insurance into something approximating a real market—unlike the current system which creates a myriad of blocks that prevent the consumers from purchasing health insurance as they would any good, forcing families to either receive insurance through their employer, pay exorbitant costs for individual, or go without any coverage. The exchanges—along with subsidies for low and middle-income Americans—will ease that burden, allowing consumers to select a plan from a central hub without worrying about pre-existing conditions affecting their coverage. Liberals shouldered a number of defeats in 2009 and early 2010 as the Affordable Care Act snaked through the grind of congressional dysfunction. The failure of a public option ate up most of the attention at the time, but a minor shift in how the exchanges would operate might...

Repeal and Pretend to Replace

(Flickr/Gage Skidmore)
Maybe Republicans aren't so opposed to health care reform after all. After grandstanding against the Affordable Care Act for the past few years, Republicans aren't ready to let the entire bill die should the Supreme Court overturn the law later this summer. Congressional Republicans are crafting a contingency plan to reinstate some of the popular elements of the bill in that scenario, according to Politico . It's a clear indication that the GOP has learned the same lesson as Democrats: while the all-encompassing idea of Obamacare may fair poorly in the polls, voters typically support individual elements of the bill. The Republicans would reportedly like to maintain the provision that allows young people to stay on their parents' health insurance until they turn 26 and rules that close a donut hole on Medicare's prescription coverage. Most notably, they would also reinstate the ban on insurance companies denying coverage based on preexisting conditions. That last part reveals why these...

What Romney's Medicare Plan Actually Does

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DC journos have spent much of the 2012 election trying to answer the question of how exactly a President Romney would governor. On one side, there are the skeptics who never bought into Romney’s rhetoric during the Republican nomination. They argue Romney is, at heart, still a moderate northeastern governor, a businessman unsuited for the extremism that has come to dominate his party. Others are equally convinced that Romney must be taken at face value. Sure he might have positioned himself in the middle while he governed a state dominated by Democrats, but he has spent the past five years running for president full-time, aligning himself with every right-wing whim over the course of his two campaigns. He’s the Republican who sought the endorsement of Ted Nugent, discarded a gay spokesman, and calls corporations people. Lest we forget, it was Romney who was poised to run as the right-wing challenger to John McCain and Rudy Giuliani in 2008 before Mike Huckabee swooped in to steal the...

Striking Down the PPACA: Still Not A Desirable Outcome

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Jon Rauch has an imaginary dialogued with the late Ted Kennedy in which he argues that a Supreme Court decision striking down the Affordable Care Act (a k a the PPACA) might actually be good for liberals. "If the Supreme Court guts another important law and conservatives cheer even louder," Rauch argues, "their credibility as advocates of [judicial] restraint will be shot.” And, in addition, striking down the PPACA would put us on the path to national health insurance. Perhaps, then, striking down the PPACA is something that progressives should secretly wish for? Racuh's argument is a little bit different than contrarian arguments based on the legitimacy of the Supreme Court , but I don't find them any more convincing. First, Rauch's argument is a variant of the argument that judicial decisions produce a unique amount of backlash, which means an inevitable reference to Roe v. Wade : You bet. Remember Roe v. Wade, the 1973 case that made abortion a constitutional right? At the time, it...

Planned Parenthood Can't Catch a Break

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Planned Parenthood staffers might have been inclined to celebrate last Friday. That afternoon, the 5th Circuit Court of Appeals had ruled Texas could not exclude Planned Parenthood from its Women's Health Program . On Monday a district judge had granted an injunction, forcing the state to pay Planned Parenthood clinics that served the WHP clients—low-income women who are not pregnant. The injunction was short-lived—the state attorney general appealed the decision to the 5th Circuit, which granted an emergency stay, allowing state health officials to start kicking out the Planned Parenthood clinics. By Friday, the 5th Circuit had reversed the decision, granting a temporary injuction while Planned Parenthood's lawsuit against the state proceeds. While long-term fates are up in the air, this news was the best the organization has heard in quite a while. But any celebration would have been short-lived. By Friday night, the organization was already getting bad news. Texas may now have to...

This Should Be Good News for Texas Planned Parenthood (But Isn't)

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A judge today ruled that the state of Texas cannot exclude Planned Parenthood from its Women's Health Program, which offers basic reproductive health care for poor women. It's seemingly good news for the organization; last session, conservative lawmakers barred Planned Parenthood from the federal program because of its ties to abortion. (For the record, in Texas the program only serves women who aren't pregnant and public dollars do not fund abortion services.) Because of the decision, the state has lost federal support for the program , a big loss since the feds paid 90 percent of the program costs. Since then, Governor Rick Perry has promised to find funding for the program—a challenge given the state's serious budget troubles—and officials have outlined a plan for a state-run version . But even if there's money, without Planned Parenthood clinics, there's simply a capacity shortage. So Planned Parenthood might actually get its way, and become part of the program, the state could...

Dworkin on Why the PPACA is Constitutional

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Ronald Dworkin has an article defending the constitutionality of the Patient Protection and Affordable Care Act in the New York Review of Books that offers an excellent primer on the relevant issues. There are two sections I'd recommend in particular. First, in Section II Dworkin does the most lucid job I've seen so far in explaining why the "activity/inactivity" distinction made by the challengers is so weak: The rhetorical force of their examples, about making people buy electric cars or broccoli, depends on a very popular but confused assumption: that it would be tyrannical for any government to force its citizens to buy what they do not want. In fact both national and state governments steadily coerce people to do just that through taxation: they make them buy police and fire protection and pay for foreign wars whether they want these or not. There is no reason in political principle why government should not make people pay directly for its services through insurance rather than...

Six States, Six Fates for Pro-Life Bills

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As states around the country consider legislation to limit access to abortion and reproductive rights, the outlook isn't bright for women's health advocates. Here's the latest from five states: Through a tied-vote, the Iowa Senate defeated a measure that would stop public dollars from funding abortions in rape and incest cases. Iowa currently allows tax dollars to fund abortion procedures for low income women if there's a danger to the life of the mother or if the pregnancy came through rape or incest. The House already approved the bill earlier in the week. In Tennessee, the state House has approved a measure that creates criminal penalties for harming embryos. The state can already prosecute someone for harming a fetus, but those laws don't include the first eight weeks of pregnancy. Of course that may be because, in the first eight weeks, many don't know they're pregnant yet and many embryos die from a variety of natural causes. The bill passed 80-18 Thursday in the House and now...

Relax, Ladies! The Texas GOP Has Your Back

(Flickr/ Planned Parenthood Federation of America)
Texas health officials are telling low-income women not to worry. The Women's Health Program, the Medicaid program serving 130,000 women, will still be there for them. Of course, how it will be paid for and whether enough clinics will be left providing services are still subjects up for debate. The Republican-dominated Texas Legislature cut funding for the program—which offers poor women basic reproductive health services like birth control and cancer screenings—by two-thirds last year. The cuts came out of fear that the health-care providers were too linked with the so-called abortion industry. Just to be safe, conservative lawmakers barred Planned Parenthood from participating in the program. Of course, since the beginning of the program, no public dollars could go to abortions, and women could only participate if they were not pregnant. The results were swift. The budget cuts resulted in clinic closings around the state , and the decision to exclude Planned Parenthood violated...

ALEC Gives In, But There's No Reason to Celebrate

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After weeks of pressure, the American Legislative Exchange Council (ALEC) appears to be backing away from long-term efforts at creating barriers to voting (voter-ID laws) and pushing "Stand Your Ground" legislation. The latter allows those who feel threatened in public places to use force; Florida's version is currently at the center of the Trayvon Martin case. Giving in to public pressure, ALEC announced Tuesday that it was disbanding its Public Safety and Elections Task Force, which promoted such legislation and helped see it proliferate. The organization is now "reinvesting these resources in the task forces that focus on the economy." ALEC's spokesperson did not respond to interview requests nor did Public Safety Task Force Chair Jerry Madden, a Texas state representative. ALEC, which proudly calls itself "the nation's largest, non-partisan, individual public-private membership association of state legislators," has operated as a largely secret arena in which corporate sponsors...

What Does an Abortionist Look Like?

(AP Photo/Richmond Times-Dispatch, Joe Mahoney)
She’s a single, unemployed mother with three children who finds out that she’s pregnant—just after the father has been sent to prison. She says she is distraught at the idea of hurting her kids by adding another child to the family, giving each of them less money, time, and attention, dragging them further into poverty. But she lives in rural southeastern Idaho, a two-and-a-half-hour drive from the nearest clinic in Salt Lake City—and getting an abortion would require two round trips there, because of the mandatory waiting period. So she takes RU-486, ordered online, self-supervised. She freaks out at the fetus’s size, stashes it on her back porch, tells a friend, and gets reported to the police. And, is promptly arrested for inducing her own abortion. To put it mildly, Jennie Linn McCormack doesn’t sound like the world’s most responsible person—except that she apparently had the good sense to realize she was not going to be a good parent to another child. I haven’t interviewed her...

Mapping the ACA

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Via Sarah Kliff, here's a great graphic from Kaiser Family Foundation laying out how funds from the Affordable Care Act are being distributed across the country: In total, over $12 billion has been handed out to state governments and private entities to implement the provisions of the ACA. Breaking it down by state, California—the first state to setup their own health exchange—has received the lion's share of funding, taking in over $1.1 billion. Other population heavy states such as New York, Texas, Michigan, and Ohio have taken in large sums as well. These funds aren't just being channeled to state governments; rather the lion's share has been directed to assist private entities. In Michigan, for example, $184 million in federal funds have gone to the state government but $630 million has been directed to private entities, mostly business to help with the costs of providing care. You can look at the full breakdown of funds on Kaiser's interactive map here .

What's in a Name?

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Liberals often complain about the Democrats’ seeming inability to message their ideas with the same consistency and verve as conservatives. It just never seems like the party has the same discipline in its talking points. Congressional Dems' messaging during the health-care reform legislation in 2009 is a case in point. Rather than taking their cues from Republicans (despite the atrocious polices it entailed, naming a bill the PATRIOT Act immediately after 9/11 was a genius tactic), Democrats went for the unmemorably named "Patient Protection and Affordable Care Act." It’s not like Democrats are clueless to such tricks—the campaign finance disclosure bill they’ve proposed after Citizens United had the fitting acronym DISCLOSE—they just didn’t bother in this instance. The party soon paid the price, as Republicans called it "Obamacare" and said it was the living symbol of a tyrannical president imposing his socialist visions for the rest of the country. It was a term Democrats battled...

Of Course a Decision Striking Down the ACA Would Be "Judicial Activism"

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Orin Kerr outlines a five-part test for whether a decision can be called "judicial activism" as a means of assessing whether the label could be fairly applied to a decision striking down the Affordable Care Act. Roughly, the criteria are: 1) whether the decision was motivated by the policy preferences of judges; 2) whether it expands judicial power for future cases; 3) whether it was inconsistent with past precedents; 4) whether it struck down a "law or practice"; and 5) whether the decision was "wrong." On three of the first four criteria, Kerr essentially agrees that a decision striking down the ACA would be "activist." On points No. 3 and No. 4, he concedes explicitly (while arguing, plausibly enough, that No. 4 isn't a useful criterion in a country with firmly established judicial review). On No. 1, he all but concedes, arguing that "if the votes line up in the predictable political way, then claims of activism based on argument #1 will be common." Given this, we can go ahead and...

Judicial Review Doesn't Mean What You Think It Means

(AP Photo / J. David Ake)
Last night while I was asleep, highly placed sources whom I cannot identify (because they don’t exist) assured me that Attorney General Eric Holder originally wrote this first draft of a letter he was ordered to submit to Judge Jerry Smith of the Fifth Circuit. The final letter has quite a different tone. But those of us who cherish the rule of law can dream that he might have actually sent Judge Smith the following instead. Judge Jerry E. Smith Circuit Judge Fifth Circuit Court of Appeals Dear Judge Smith, Lawyers tell an anecdote about a psychiatrist who finds himself in heaven. St. Peter says, “We’re so glad you’re here, we have a psychiatric emergency!” The psychiatrist is puzzled. “How can that be?” he asks. “Surely the souls of the blessed are free from all pain and torment. Why would they need a psychiatrist?” “It’s not the blessed,” says the saint. “It’s God. He has terrible delusions of grandeur—he thinks he’s a federal judge!” This story came to mind when I learned that on...

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