Health Care

Anti-Abortion Measures Die with a Whimper

(Flickr/World Can't Wait)
Women's health and abortion access have dominated state legislatures across the country and, until recently, dominated the headlines as well. But as legislative sessions are wrapping up and final decisions get made, there's been less focus on the issues. Perhaps it's because, in several cases, the bills are dying with whimpers instead of bangs. This week, many of the measures look doomed. Idaho's pre-abortion sonogram bill died Tuesday, with pro-life activists accepting defeat—at least for this year. According to the Spokesman-Review , House State Affairs Chair Tom Loertscher worried that the controversy around the sonogram could threaten the state's other anti-abortion measures. The bill did not have any exemptions for rape or incest and would likely have required invasive, transvaginal sonograms—the kind that got Virginia so much attention. Right to Life of Idaho has said it plans to bring the bill back next year. In Pennsylvania, a similar sonogram measure has stalled after...

The Best Signs from Yesterday's Tea Party Rally

(Photo: Patrick Caldwell)
Tea Partiers descended on the Capitol Tuesday afternoon to voice their disapproval of Obamacare as the Supreme Court debated the constitutionality of the individual mandate, which will require citizens to purchase health insurance or else face a nominal fee once the bill has been fully implemented in 2014. Initially a conservative solution—originating at Bush's favorite think tank The Heritage Foundation—the mandate has come to symbolize conservative distaste with the bill that will expand coverage to millions of currently uninsured Americans. The rally on a lawn north of the Capitol was hosted by Americans for Prosperity, the Koch brothers' political arm that has funded many of the Tea Party's major gatherings. AFP president Tim Phillips kicked off the proceedings, leading the crowd in chants of "repeal the bill." A sea of over a thousand Tea Partiers—largely middle-aged or elderly, and almost all white—in red "Hands Off Health Care" t-shirts were in attendance from across the...

Verrilli's Courage Under Fire

(AP Photo/Evan Vucci)
On December 10, 1935, during oral argument before a hostile Supreme Court, then-Solicitor General Stanley Reed collapsed at the lectern. (He recovered and went on to serve on the Court himself.) Let history show that Solicitor General Donald Verrilli did not stagger yesterday under a Four Horseman-style onslaught of conservative questioning that seemed to leave the government without a path to victory in the “minimum coverage” phase of the Health Care Cases. Yesterday's argument concerned the centerpiece of the Affordable Care Act (ACA): the minimum-coverage, or individual mandate, provision. Under this rule, taxpayers who are not covered by employer or government health insurance will, after 2014, be required either to purchase an individual policy or pay a penalty on their tax returns. The requirement is designed to widen the insurance pool so that two other parts of the Act—one requiring companies not to discriminate on the basis of health risk, and the other forbidding them from...

The Unsurprising Possibility that the Court Could Strike Down the ACA

Wikimedia Commons.
I was somewhat surprised, prior to this week's oral arguments, how optimistic some of my favorite legal and political observers were about the outcome of the Affordable Care Act case being argued at the Supreme Court this week. The court, predicted Dahlia Lithwick , "will vote 6-3 or 7-2 to uphold the mandate, with the chief justice joining the majority so he can write a careful opinion that cabins the authority of the Congress to do anything more than regulate the health-insurance market." Linda Greenhouse foresees the Supreme Court upholding the law "by a wide margin." Kevin Drum also sees a 7-2 vote in favor of the ACA. Jon Chait argues that the law is clear, and acknowledges a chance the Supreme Court would simply ignore the law in the way they did in Bush v. Gore . I view things differently. I think there is a very real chance that the Court would strike down the law, and while I personally find these arguments exceedingly unpersuasive they're not "wrong" in the sense that they...

Americans Prefer Having Cake, Eating It

President Obama signs the Affordable Care Act.
The wise Harold Pollack has argued that health care reform is in some ways the best covered social policy story in the history of American journalism. That isn't to say there hasn't been plenty of crappy coverage, but there has never been the same volume of informed and insightful reporting and analysis available in so many places on a pressing policy debate. And yet it's easy to get depressed about the impact all that good work didn't have. From our perspective over here on the left, the arguments offered by reform's opponents are a collection of hypocrisy, faulty analysis, and outright lies. The public, unfortunately, hasn't really been persuaded. In the broadest terms, they mostly see health care reform through partisan lenses. In the particular, they want all the benefits without any of the responsibilities. I'm painting with a broad brush here, of course. But this morning the New York Times is out with a new poll on the Affordable Care Act that doesn't really show much that's new...

Why "Obamacare" (the Name) Won't Matter

barackobama.com
I don't know about you, but every time I read the term "Obamacare," I can't help but hear Michele Bachmann's voice saying it, in that singsongy Minnesota accent. But I guess Team Obama thinks I'm in the minority, because they've decided to go ahead and embrace the term. As David Axelrod wrote in an email to supporters, "Can you imagine if the opposition called Social Security 'Roosevelt Security'? Or if Medicare was 'LBJ-Care'? Seriously, have these guys ever heard of the long view?" Which is fine. There's nothing inherently pejorative about "Obamacare," unless you react with an involuntary retch every time you hear the name "Obama." The people who have used the term most enthusiastically up until now certainly do, so they thought that everyone else would be repelled by it. But the thing is, in the long run it doesn't really matter what we call the Patient Protection and Affordable Care Act. That's because unlike Social Security or Medicare, Obamacare isn't actually a program. Which...

A Decision Is Coming

A crowd of protesters outside the Supreme Court on the first day of ACA hearings (Photo: Patrick Caldwell)
The Supreme Court opened hearings today on the Patient Protection and Affordable Care Act—PPACA if we're going to be technical—but more commonly known as Obamacare. The six hours slotted for oral arguments are spread out across three days, and while the constitutionality of the individual mandate is the main issue at stake, there will be a host of other topics discussed, ranging from severability (whether the rest of the law can stand if the mandate is struck down) to whether Congress was within its bounds when it redefined Medicaid eligibility to include swaths of new people currently uninsured. I was outside the court this morning talking with protesters rallying for and against the bill (more on that to come later) but Prospect alum Adam Serwer was inside for Mother Jones listening to the judges debate the first issue at hand: can they even decide on the qualms with the law or do they need to wait until after 2014 when ACA is fully in effect? According to the 1867 Tax Anti-...

Will the Supreme Court Duck Health Care?

Wikimedia commons
The great legal theorist Alexander Bickel advocated that courts use "passive virtues"—that is, using invented jurisdictional reasons to not hear politically contentious cases. The political scientist Mark Graber has tweaked this concept to describe passive-aggressive virtues —the tendency of the great Chief Justice John Marshall to expound on his theories of constitutional law while deciding cases on grounds that left opponents no means of opposing the Court (usually because they ended up with the policy they wanted.) In an intriguing article for Slate, David Franklin argues that the Roberts Court could duck the constitutional challenge to the Affordable Care Act using these methods. The Court, Franklin notes, could simply decide not to decide by holding that the legal challenge to the ACA is prohibited by the Tax Anti-Injunction Act . This would keep the court out of the political firestorm for the time bring while refusing to give Obama a political victory by clearly declaring the...

The Supreme Court, Health Care Reform, and Electoral Politics

(Flickr / TimmyGUNZ)
Last week I participated in a roundtable that on these issues, along with other GW faculty from public health and law—Sara Rosenbaum, Peter Smith, and Katherine Hayes—as well as former U.S. Senate Finance Committee staffer Mark Hayes and former House Commerce Committee Health Subcommittee Counsel Andy Schneider. You can find a synopsis here and the video here . My remarks centered on implications of health care reform for the 2012 election (as I previously wrote about here ). How might the Court’s decision affect the politics of the issue for the election? First, it’s likely that the Court’s decision—no matter what it is—won’t much affect overall public support or opposition to the Affordable Care Act. Court decisions often simply polarize approval—as in this study of Roe v. Wade. There are already early indicators that this will happen. In a March 2012 Kaiser Family Foundation poll , respondents were asked how they would feel if the court rules the individual mandate unconstitutional...

The Affordable Care Act On Trial

Flickr/DonkeyHotey
Today the Supreme Court begins hearing oral arguments to determine the constitutionality of the Affordable Care Act. It's the timid (or maybe wise) pundit who fears making predictions, so I'll go ahead and say this: the Court is going to uphold the ACA, by a vote of 6-3. Chief Justice John Roberts will join the four liberal justices and Anthony Kennedy in the majority, and Roberts will write the decision. Justices Scalia, Thomas, and Alito will offer a vigorous and at times comically overstated dissent, in which they will decry the end of the freedom that universal health coverage will bring. That may just be optimism talking; I've certainly allowed my hopes to outrun good sense before. There's a voice inside me that says "Don't forget Bush v. Gore !" In other words, the Court is perfectly capable of acting in a nakedly partisan manner if it so chooses, so the five conservatives could well decide that the opportunity to undo a Democratic president's signature domestic policy...

Single-Payer and the Supreme Court

(Flickr/surroundsound5000)
When the Supreme Court begins its extraordinary three days of hearings on the constitutionality of the Affordable Care Act, one of the oddities will be an amicus brief challenging the act’s individual mandate from 50 doctors who support national health insurance. They point out the inconvenient truth that, contrary to the administration’s representations, the government did not need to require citizens to purchase insurance from private companies in order to meet its goals of serving the health-care needs of the populace. Congress could have enacted a single-payer law. Since the Constitution unambiguously gives Congress the power to tax, there has never been a serious constitutional challenge to our tax-supported systems of health insurance, Medicare, and the services of the Veterans Health Administration system. In the words of the brief: Amici thus submit this brief for the purpose of disputing the primary tenet of the Government’s position, that Congress cannot regulate the...

Now Is the Law of Their Discontent

(Flickr/S.E.B.)
To paraphrase Ecclesiastes, of the making of many briefs there is no end, and much study is a weariness of the flesh. My flesh is weary after weeks of poring over the party and amicus briefs in the Affordable Care Act cases, which (in case you haven’t heard) will be argued next week. There are four overall issues in the case: (1) is the minimum-coverage requirement (or “individual mandate”) a permissible use of the Commerce Power? (2) If not, should the Court strike down the entire Act or only the minimum coverage requirement? (3) Is the bill’s requirement that states receiving Medicaid funds expand eligibility for low-cost health-care “coercive” to state governments? And (4) is the entire lawsuit against the “minimum coverage” provision barred by the federal Tax Anti-Injunction Act until after the provision takes effect in 2014 and some taxpayer has been forced to pay the tax penalty for not carrying health insurance? If those don’t seem to flow in logical order, they don’t—(4)...

GOP Senator Defends Planned Parenthood

(Flickr/JRockefellerIV)
The last time Texas Senator Kay Bailey Hutchison took on Rick Perry, things didn't go so well. Hutchison, among the most popular politicians in the state at the time, was the favorite to win the Republican nomination, and instead Perry rode into the general with overwhelming support. Among Hutchison's key problems—besides simply running a bad campaign—a nagging reputation as a moderate, who was at least somewhat pro-choice and who'd voted for the bank bailout. After the disappointing finish, she later announced she wouldn't run for re-election in the Senate. This may be her last year in politics. And evidently, she's decided that it's no time to back down from her political rival. On MSNBC Thursday morning, the senator openly criticized Perry's decision to defund Planned Parenthood and jeopardize the state's federal funding for the Women's Health Program. "We cannot afford to lose the Medicaid funding for low income women to have health care services," she said. "We cannot." Hutchison...

On Medicare, Republicans Continue to Be Admirably Foolish

Flickr/Gage Skidmore
Today, House Budget Committee chairman and GOP heartthrob Paul Ryan will release his latest budget proposal, and all right-thinking Republicans will line up to express their support (you may remember what happened to Newt Gingrich in May when he criticized a previous version of Ryan's plan and was punished for his heresy, then quickly backtracked). And I have to say, Republicans deserve some credit for this. Not because their plan to privatize Medicare will actually be good for seniors (it won't) or for the budget (it won't). But because in the face of nearly inevitable political damage, they forge right on ahead. It isn't often you see politicians suffer politically for a position they take, then come right back and try it again. And it wasn't like they didn't know it was coming. After all, Democrats have been gleefully accusing them of trying to dismantle Medicare for decades, and so when they put forward a plan to actually dismantle Medicare, everybody knows what will happen:...

The Difference Between Contraception and Mainlining Heroin

(Flickr/romana klee)
Last week, I mentioned two state legislatures had passed abstinence-only sex education bills . While Wisconsin's governor was already supportive of the measure, in Utah, Governor Gary Herbert was less certain. The measure would have banned any discussion of contraception, or for that matter, homosexuality. The current law in Utah already requires parents to "opt-in" if the course includes discussion of contraceptives, but this measure would have actually removed even the option for students to learn about more than simply abstinence. It had passed overwhelmingly in both chambers, despite protests and opposition from the state PTA and teachers' groups. Late Friday, after protests, phone calls, and significant pressure from both sides, Herbert announced he had vetoed the measure . In his statement , he said he was unwilling to say "the State knows better than Utah's parents," noting a majority of parents choose to have their children learn about contraception. Herbert described himself...

Pages