Fix Health Care Policy

If the individual mandate is the blockbuster issue before the Court, Medicaid and severability may be sleeper hits that ultimately have tremendous impact.

If the Court strikes down the mandate, then what is to be done with the Russian novel-length ObamaCare? Should the Court just tear out the few pages that contain the mandate, or the mandate plus related sections (whatever that means), or is the mandate so central to the law that the Court should throw out the whole thing? This is what in legal jargon is known as “severability.” To answer this question, the Court looks to what Congress intended—namely, would Congress have preferred a health care bill without a mandate to no health care bill at all, or would ObamaCare work as Congress intended stripped of the mandate. Here’s what to watch for at today’s oral arguments:

First, what do the justices think about the convoluted legislative maneuvering that led to Obamacare’s passage with hardly a vote to spare? Recall that Congress repeatedly tweaked the legislation to arrive at a favorable (if fictional) budget score, meaning that nearly all provisions are (at least in terms of Congress’s budgetary goal) interrelated. The final bill squeaked through the House with the President lobbying furiously to save the whole enterprise. There were votes traded in exchange for the “Cornhusker Kickback” and the “Louisiana Purchase,” and the whole deal was capped off with a dubious use of a budget reconciliation maneuver to avoid a filibuster. Will the Court really believe, given all of this, that Congress would have been happy to pass ObamaCare without the mandate, or that given this delicate budget scoring, that ObamaCare will work as Congress intended with the mandate excised?

Read the rest on The Foundry…

Tags: coercion, Medicaid Expansion, oral arguments severability, Supreme Court challenge

Rare is the occasion when the nine justices of the U.S. Supreme Court gather to hear three days of arguments, and rarer still is when it is for a case like Obamacare — one that cuts to the core of the Constitution and whose outcome could fundamentally alter the role of the federal government and its power over the people. But today the Court will do just that when it open its doors and begins weighing the arguments on the constitutionality of President Barack Obama’s seminal health care law.

Were the American people to vote on the issue, they would fall decidedly against Obamacare, as recent polls have shown. But for the Court, the decision is not as cut and dried as an up or down vote, but one that involves the interplay of a series of issues raised by those who are challenging Obamacare — more than half the States of the Union and a collection of interested organizations and private parties — and those brought by the Obama Administration, which is defending the law. And they come to the Supreme Court after conflicting appellate court rulings which have left undecided the question of whether Obamacare is permissible under the Constitution.

Read the rest on The Foundry…

Tags: Anti-Injunction Act, Individual Mandate, Medicaid Expansion, ObamaCare, oral arguments, severability, Supreme Court challenge

Obamacare increases unaffordable government spending, which ultimately comes out of taxpayers’ pockets. Here, we summarize three of the most costly provisions of Obamacare:

1. Medicaid Expansion: Beginning in 2014, Obamacare expands Medicaid to include all non-elderly individuals with income below 133 percent of the federal poverty level. The expansion of Medicaid accounts for more than half of the newly insured population under Obamacare. The Congressional Budget Office (CBO) estimates, “By 2022, federal outlays for Medicaid are expected to total $605 billion, more than twice the 2012 amount,” and “about 95 million people will be enrolled in Medicaid at some point in the year.”

As Heritage analysts point out, the expansion will significantly impact both state and federal budgets. Heritage estimates the expansion will “increase state tax obligations by just under $33.5 billion for federal fiscal years (FY) 2014 through 2020. Of that amount, $21.5 billion will be the states’ share of the benefit costs, and just under $12 billion will be the states’ share of the added administrative costs.”  (Read the rest on The Foundry…)

Tags: budget busters, government spending, Medicaid Expansion, ObamaCare, state tax obligations, unaffordable health care

Last March, Virginia and Florida (joined by 12 other states) filed suit against Obamacare, challenging its constitutionality. Since that time, many other states have joined in, recognizing the threat posed by the legislation to both the Constitution and their own state budgets. As we reported on Friday, more than half of all states are now suing over Obamacare.

In Friday’s post, several commenters asked for a complete list of the states involved with the various lawsuits, which we have compiled below. The following list contains all 27 states that have started or joined in a lawsuit against Obamacare. Those highlighted gray are in the process of joining a suit or, in the case of Oklahoma, preparing to sue on their own. (Read the rest at The Foundry…)

Tags: Medicaid Expansion, ObamaCare, state budgets, states suing, unconstitutional mandates

Because of Obamacare, states are considering dropping out of Medicaid, the federal-state health program for the poor, rather than deal with the additional fiscal strain resulting from the health law.

One of the main drivers behind health care reform was to reduce the nation’s number of uninsured. Under the new law, this will be partially achieved by adding 18 million Americans to the Medicaid program.

This expansion will strain already hurting state budgets. By expanding a program for which states share the cost, the federal government is able to hide the true cost of the expansion while draining state coffers, at the expense of other state spending priorities.

This cost shift strategy to the states is pushing some states to consider dropping Medicaid altogether. The New York Times reports that Texas is already considering this route. Texas Rep. Warren Chisum (R-District 88) said the state will be restricted in how it can otherwise cut costs. “With Obamacare mandates coming down, we have a situation where we cannot reduce benefits or change eligibility,” he said in the article. “This system is bankrupting our state.” (more…)

Tags: dropping coverage, Medicaid Expansion, ObamaCare, state budgets, uninsured

In passing Obamacare, Congress has put the states in quite a pickle. To sharply expand health coverage, Obamacare flung wide the gates of Medicaid eligibility. It envisions a massive expansion of the federal-state health program that, historically, delivers low-quality care to low-income Americans.

Not a smart move.

States were already struggling to meet their share of Medicaid program costs—even though Medicaid payments to providers often don’t even cover the cost of care. And, due to the inadequate reimbursement rates, more and more doctors were already refusing to accept new Medicaid patients.

How fiscally shaky is Medicaid today? Well, last year Congress used the stimulus bill to give states $87 billion to help them cover rising Medicaid costs. And that doesn’t seem to be enough.

A recent letter from House Democrats encourages their colleagues to give states another $24 billion to help them cover Medicaid costs for another six months. “Without this funding,” the letter says, “our states will be forced to make severe cuts to Medicaid providers and benefits, and the ensuing budget shortfall would have grave consequences for school funding and other essential state programs.” (more…)

Tags: deficit, federal-state program, low-quality care, Medicaid Expansion, ObamaCare, Side Effects

The negative effects of Obamacare will impact every American. However, it is those who are the very backbone of the United States’ high-quality health care system who will be most severely affected: physicians. In a recent paper, Heritage’s health policy expert Robert Moffit, Ph.D., details the changes American doctors can expect to see in the way they practice medicine as a result of the recently-passed law.

Moffit outlines the following as being most detrimental to the practice of medicine:

Medicaid Expansion and Payment. As it is, doctors receive heavily reduced pay for treating Medicare patients, and reimbursement for Medicaid is even lower. In many areas, doctors who accept Medicaid do so at their own loss, as reimbursement rates do not even cover the expense of seeing the patient. Writes Moffit, “Medicare payment

has resulted in sporadic access problems for Medicare patients, and the lower Medicaid payments have already contributed to serious access problems for low-income persons and worsened hospital emergency room overcrowding.” By adding an estimated 18 million people to this system, Obamacare will aggravate these existing dilemmas.

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Tags: Medicaid Expansion, more bureacracy, ObamaCare, physicians, sustainable growth formula

In the depressing aftermath of Congress’s passage of the Democratic health-care legislation, there has been an understandable temptation among conservatives to think that all their effort over the last year to derail what was coming down the tracks may have been for naught. After all, the bill did pass. The president and his allies got their signing ceremony and their victory lap, as well as a barrage of premature but predictable pronouncements from the national media that we are now witnessing a historic moment of irreversible liberal progress.

And there’s no use sugarcoating what has happened. It’s a debacle from every possible vantage point. The Democrats have created another massive entitlement program while expanding federal power and reach in a manner not seen since the heyday of Franklin D. Roosevelt. If allowed to stand, the new health-care law will tether America’s middle class to the federal government in ways that will fundamentally alter — and not for the better — the relationship between citizens and the state. The result will be worse health care, distorted politics, less medical innovation and economic vitality, and depleted wealth.

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Tags: $1.2 trillion cost, conservative opposition, doctor-patient relationship, massive entitlement program, Medicaid Expansion, Medicare cuts, ObamaCare, Public Opinion, public option, repeal

The Senate’s health care bill became law earlier this week, but the fight against a government overhaul of our nation’s health system continued in the Senate. Senators voted on many amendments to the reconciliation bill passed by the House as a “fix” to the massive Senate health bill, H.R. 3590.

This process proved extremely important, since it underscored some very key policy issues that have surfaced in the national debate. Forget what lawmakers say; look instead on how they act. Votes on key issues tell a big story. Consider the following policy issues:

Medicaid For Congressmen: CBO and other experts estimate that more than 30 million Americans will secure health care coverage under the recently enacted health care legislation. But there is one little problem: Roughly half of those will be covered, not under private health insurance, but under Medicaid, a poorly performing welfare program that indisputably delivers low quality care. Even though Medicaid is a mess, Congress voted to extend Medicaid coverage to 16 million more Americans by 2019. If Congress thinks Medicaid is the right option to cover millions of their fellow citizens, then House and Senate members should not mind enrolling in it themselves.

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Tags: Amendments, entitlement growth, Federal Employees Health Benefits Program, government overhaul, House "fix", Medicaid Expansion, senate health care bill