Inventor of Paul Ryan Medicare Overhaul Says Plan Will Not Work

Paul Ryan's budget plan passed by a highly partisan House vote last month calls for sweeping changes to the Medicare program, reaching so far some analysts say to effectively destroy the program altogether. However, now the inventor of the plan adopted by Ryan's budget says the idea will not work.

Henry Aaron (not to be confused with the baseball great) came up with an idea in 1995, after Hilary Clinton's first attempt to overhaul the health care industry. It was called "premium support." It was simple: let consumers pick their health insurers in the private market, subsidize the premiums, and competition will drive down costs in the free market. It's the same theory in Ryan's plan. But Aaron, now with the Brookings Institute, no longer thinks the plan will work. In his testimony to Congress last week, Aaron says, "The conditions that recommended premium support in the mid-1990s no longer apply."

The relevancy here is important because Mitt Romney has campaigned to overturn the Affordable Care Act on Day-1 in office, yet he hasn't proffered an alternative to covering the tens of millions of Americans who are already uninsured or will be if the law is overturned. (Still waiting for the Supreme Court's ruling on this, so Romney might get off the hook.) Instead of having a new plan to cover the uninsured, Romney has endorsed Paul Ryan's budget (a potential VP pick), which looks to change Medicare substantially and pragmatically. But as Mr. Aaron's testimony points out repeatedly, the ACA will strengthen the Medicare system already in place and addresses its' so-called "insolvency."

"The [Medicare] Part A trust fund is currently in better shape financially than it has been for most of its history. If all provisions of the Affordable Care Act are enforced, its financial gap is small.

"Many are concerned over Medicare's long-term affordability. If provisions of the [ACA] are enforced, the added budget costs of Medicare over the next quarter century are modest and affordable...

"The conditions that recommended premium support in the mid-1990s no longer apply. The current Medicare program already fosters competition between publicly-administered, traditional Medicare and private plans. Current privately-administered plans raise costs."

Paul Ryan did not respond during the hearing, allowing Aaron's fellow Brookings Institute colleague, Alice Rivlin to defend the "premium support" measure.

"Bogus" Study Touted By The Washington Post

Last night, reports circulated that a new study showing the Affordable Care Act, pejoratively known as Obamacare, and more widely known as health-care reform, will actually increase the deficit. The study was completed by Republican Medicare trustee, and former Bush administration official, Charles Blahous. The Washington Post legitimized the study by pointing to Blahous' "trustee"signature, so surely it must be credible. Right? Unfortunately, as many have started to point out, Blahous' math is erroneous and it turns out that in fact the CBO analysis that the ACA will reduce the deficit is still correct. I'm still at a loss as to how this became such big news so quickly. It should not be incredibly shocking that a Republican and The Washington Post would argue against health-care reform.

The New Yorker's Jeffrey Toobin: "Heavy Burden"

Jeffrey Toobin doesn't think the 'heavy burden' of defending the Affordable Care Act should fall on Donald Verrilli Jr, Solicitor General, who argued for the government last week that the individual mandate in the bill was constitutional. Toobin believes the 'heavy burden,' in light of judicial precedent for the last 70 years, lies with the States in proving the mandate is unconstitutional.

"Consider, then, this question, posed to Verrilli by Justice Anthony M. Kennedy: “Assume for the moment that this”—the mandate—“is unprecedented, this is a step beyond what our cases have allowed, the affirmative duty to act to go into commerce. If that is so, do you not have a heavy burden of justification?” Every premise of that question was a misperception. The involvement of the federal government in the health-care market is not unprecedented; it dates back nearly fifty years, to the passage of Medicare and Medicaid. The forty million uninsured Americans whose chances for coverage are riding on the outcome of the case are already entered “into commerce,” because others are likely to pay their health-care costs.

"Kennedy’s last point, about the “heavy burden” on the government to defend the law, was correct—in 1935..."


Read more http://www.newyorker.com/talk/comment/2012/04/09/120409taco_talk_toobin#ixzz1qvlrQc94

Supreme Court Hears Case Against the Affordable Care Act

The dust is still settling inside the Supreme Court. With all arguments now present before the nine justices in the case against the Affordable Care Act, pejoratively dubbed Obamacare by its opponents, and with still so many railing against it, including the activist conservative judges currently sitting on the Court, and a near-equal chorus in and out of Washington, it bears a moment to step back and look at where things now stand.

With so much media focus on the Affordable Care Act, there are still wide misperceptions of what exactly the law will do. Many of these misconceptions center around a simple premise: “I don’t want to pay for someone else’s health insurance.” Think of Rush Limbaugh’s vitriolic attack on a Georgetown law student two weeks ago, ignorantly claiming this woman a “slut” because she wants the university to pay for her contraception since they mandate that she purchase health insurance through the school. Limbaugh displayed a complete and total lack of understanding of how contraception works, as well as how insurance companies under the Affordable Care Act are supposed to cover these basic medical needs. And it stands to reason this ignorance extends to his listeners’ understanding of the implementation of the individual mandate in the Affordable Care Act, whether intended by Limbaugh and other opponents of the ACA or otherwise.

It is the individual mandate at the heart of the case heard before the Supreme Court. The mandate is that every individual would be forced to get insurance, and if the government is justified in compelling an individual to purchase health insurance, what is the ‘limiting principle’ stopping the government from compelling people to buy broccoli, GM cars, or something else. Those who brought the suit against the Department of Health and Human Services argue that compulsion by the government violates individual freedom and is thus unconstitutional. The government argues that this mandate is non-compulsory because every individual gets sick and is in essence already a participant in the health insurance industry and cannot be compelled to join a group they are inherently a part, and that by the powers vested in the Commerce Clause of the Constitution, Congress has a right to regulate this industry and those participants therein.

That’s the arguments for both sides in a nutshell, but it doesn’t necessarily address the premise that one person is paying for another’s health insurance, i.e. the well-off are subsidizing the poor. This, sadly, is a simple talking-point hounded and harped by those opposed to the bill, and is grounded with no factual basis. The truth is no one is paying for another’s health insurance under the law. The individual mandate forces the person without health insurance to purchase insurance from a private supplier. So, in essence, this is assisting the free market. If the person fails to purchase health insurance, the government retrieves a fee from them off their yearly tax return. Here’s the kicker in all this: without the law, you, me, and everyone else are already paying for other people’s health insurance. When someone without health insurance walks into an emergency room, those visits are paid by other taxes. The government spends over $100 billion per year to cover the uninsured. The additional revenue of mandating all individuals to have some form of health insurance far outweighs these costs.



So how did these arguments go over in the Court? Mostly in accordance with pregame analysis. Conservative judges hit hard against the bill. The Liberal Justices hit back hard against the States. There were moments of trepidation on Day Two of the hearings when Donald Verilli nearly collapsed beneath the pressure of arguing before the Court and many reporters in the room thought for sure the bill would be struck down that very day. Luckily, the Liberal Justices were there to bail Verilli out, and he gathered himself up for the third day of arguments and delivered a more forceful defense of the law. But the Court is tilted in Conservative favor and it seems likely the bill rests on the pen of Justice Kennedy alone. To paraphrase a Robert Reich tweet: how is it democracy when the fate of 30 million people’s health insurance rests in one man’s hands? But it’s not completely lost for the individual mandate, nor health care reform overall. Even if the individual mandate was struck down, many analysts believe most or all of the rest of the bill can stand. Then again, many think the Affordable Care Act hinges directly on the individual mandate and that if the mandate goes, the entire law crumbles after. Would this spell complete doom for President Obama, to repeal his signature social legislation before the 2012 election? Hardly. Thousands, if not millions, of Americans have already benefitted from aspects of the law that have gone into effect, from college graduates having the ability to stay on their parents’ insurance until age 26, to millions of Americans now with access to coverage because insurance companies can no longer deny someone with a pre-existing condition, to many other benefits. More and more Americans are beginning to understand that this bill serves to help, not to hinder. Also, if health reform should fall, many do not think the private insurance industry could last. It would almost certainly open the door to a single-payer system, or Medicare for everybody, and that’s a win for us all.

A Lift for the Mandate?

"The Supreme Court spent 91 minutes Wednesday operating on the assumption that it would strike down the key feature of the new health care law, but may have convinced itself in the end not to do that because of just how hard it would be to decide what to do after that. A common reaction, across the bench, was that the Justices themselves did not want the onerous task of going through the remainder of the entire 2,700 pages of the law and deciding what to keep and what to throw out, and most seemed to think that should be left to Congress. They could not come together, however, on just what task they would send across the street for the lawmakers to perform. The net effect may well have shored up support for the individual insurance mandate itself..." continue reading here.

Jonathan Cohn Worried in the Supreme Court

Jonathan Cohn, one of the leading voices covering the Health Care Reform debate, expresses his trepidation Wednesday afternoon after hearing the final arguments in the Affordable Care Act case before the Supreme Court.

"If there was one thing of which I was certain going into this week’s Supreme Court hearings, it was that, at worst, the justices would strike down the individual mandate and related coverage positions. In other words, they’d get rid of requirements that insurers cover everybody at a uniform price, on the theory those reforms don’t work without the mandate. But the other major pieces of the law – the expansion of Medicaid to cover 15 million people, the changes to the way Medicare pays hospitals, and so on – would stay..." continue readin here.

Obamacare in Trouble

Jonathan Cohn is nervous that after today, Day Two of arguments before the Supreme Court in the case against the Affordable Care Act, the individual mandate will be struck down and very likely the entire law will fall with it.

"My first impression from day two at the Supreme Court: I was more confident yesterday than I am today. With the caveat that I know health policy a lot better than I know law, I can still imagine the justices upholding the individual mandate. But, at this point, I can just as easily imagine them striking it down.

"Tuesday's hearing was energized and contentious, from start to finish. But while the justices hammered lawyers from both sides with difficult questions, Solicitor General Don Verrilli seemed to struggle more than Paul Clement, attorney for the states. And although the liberal justices were able, more or less, to carry the case on their own, there are only four of them – and the conservatives number five..." continue reading here.

Against Obamacare

The Weekly Standard has an exceptional and detailed piece up, "Without Precedent: The Supreme Court Weighs Obamacare," navigating not only the constitutionality of the Affordable Care Act, but addressing several other historical Court precedents at stake as the Supreme Court begins hearing arguments today on Obamacare. I certainly don't agree with everything here, but there is a compelling case why the Court should strike down the "individual mandate" in the Affordable Care Act, and by extension the entire bill itself.

"But to think of the Obama-care case (National Federation of Independent Business v. Sebelius, as the lead case is captioned) as just the latest Commerce Clause dispute is to deprive it of crucial context. NFIB v. Sebelius is much more than that. Obama-care entails an unprecedented reformation of the very structure of federal government, one that strains prior doctrines to their breaking point. The Roberts Court will have to make a judgment not just on the basis of legal text or precedent but on something more fundamental..." continue reading here.

Supreme Court Battle Over Health-Care Law Begins On Monday

Brett Smiley over at New York magazine dissects what is at stake as the Supreme Court begins hearing arguments on the Affordable Care Act today (Monday morning).

"But before argument about the actual legislation begins, the court must address whether the case, brought by opponents including 26 states and officially titled Department of Health and Human Services, et al., Petitioners v. Florida, et al., may be addressed at this time, i.e., is it "ripe." That's an issue because the so-called individual mandate, which would require Americans to buy health insurance, is not scheduled to take effect until 2014. There will be 90 minutes of argument on this point alone on Monday..." continue reading here.

Medicare and Obamacare

The New Republic's Jonathan Cohn last week questioned the notion put forth by the opposition to the President Obama's Affordable Care Act that the 'individual mandate' is an "unprecedented" over-reach of congressional power. Cohn argues that if Medicare is okay as law, the individual mandate must also be upheld in the Court.

"I’m speaking, of course, about Social Security and Medicare. Each program is a form of “social insurance” and each serves the same basic function: To protect us from financial shocks that we cannot anticipate or avoid. With Social Security, the shock is reaching retirement without enough income. With Medicare, the shock is high medical bills during old age. During our working years, we pay into these programs by handing over portions of our incomes, in the form of payroll taxes. And we don't have a choice about it, unless we want to start evading taxes..." continue reading here.

Jonathan Chait: "Barbarism" to Repeal Health Reform

New York magazine's Jonathan Chait examines the crusade against the Affordable Care Act and delves into the deeper question of whether health care is a right or a privilege. This is something my friends and I debated over Facebook last week.

"It is one thing to simply ignore the problem of the uninsured, by failing to act on it when you have power. But to actively crusade to throw vulnerable people off their newly-won health insurance is a higher sin, a sin of commission rather than omission..." continue reading here.

White House Releases Affordable Care Act Accomplishments

From a study released today from the White House regarding the Affordable Care Act:

Health reform is already making a difference. Thanks to the Affordable Care Act:

•2.5 million more young adults have health insurance on their parent’s plan.

•In 2010 and 2011, over 5.1 million seniors and people with disabilities on Medicare have saved over $3.1 billion on prescription drugs. These savings include a one-time $250 rebate check to seniors who hit the "donut hole" coverage gap in 2010, and a 50 percent discount on brand-name drugs in the donut hole in 2011. And everyone with Medicare can get key preventive services like mammograms and other cancer screening tests for free.

•Insurance companies can no longer drop your coverage when you get sick because of a mistake on your application, put a lifetime cap on the dollar amount of coverage you can receive or raise your premiums with no accountability.

•Insurance companies can no longer deny coverage to children because of a pre-existing condition. And in 2014, discriminating against anyone with a pre-existing condition will be prohibited.
Even as some Republicans refuse to except the basic accomplishments of the law, the White House is adament to show how important this law has become for many Americans. You can read the rest of the study here.

Affordable Care Act: Two-Year Anniversary

Today marks the two-year anniversary of President Obama's signature legistlative accomplishment, the Affordable Care Act, the health care reform package still wrapped in controversy, and coincidentally, the Supreme Court begins hearing arguments about the constitutionality of the law. With so much opposition against the Affordable Care Act, it's easy to lose sight of what the law is actually supposed to achieve. But, over the course of the law's first two years of life, it's really easier to point to the things the law has achieved rather than the fear-mongering of how it will deteriorate this country. This piece highlights some of the key accomplishments of the health care law and seeks to delineate some common misconceptions.

"Here are a few simple questions to test your knowledge. TRUE or FALSE?
1) The U.S. Supreme Court has ruled that the Affordable Care Act is unconstitutional.
2) Health care costs have gone up because of health reform.
3) Preventive benefits no longer require co-pays or deductibles.
4) The state health care exchanges are not going to be implemented.
5) Insurance companies can no longer deny coverage to children because of pre-existing conditions."

Continue reading here...

Sandra Fluke Reflections on the Affordable Care Act

With the 2nd anniversary of the passage of the Affordable Care Act on Friday, there's been much reflection and enumeration on what exactly the Affordable Care Act has thus far accomplished, and will accomplish in the next two years as full implementation of the law goes into effect. Sandra Fluke, the victim of Rush Limbaugh's heinous character assassination, reflects on what the Affordable Care Act has meant to her and other women like her.

"This law, also known as health reform, will benefit over 45 million women in our country through increased access to preventive care services without copays and deductibles. Thanks to the Affordable Care Act's new requirements that private insurance and Medicare cover these services without cost-sharing, by the time the law is fully implemented in 2014, women will benefit from, among other services: mammograms, cervical cancer screenings, pre and post natal care, flu shots, regular well-baby, well-child and well-woman visits, domestic violence screening, and the full range of Food and Drug Administration-approved contraceptives..." continue reading here.

Limbaugh Controversy a Big Win For Dems

A recovering economy is bad news for Republicans in 2012. If Republicans address social issues as virulently as they have the ‘contraception controversy,’ it will be a long, sad election season for them. Provisions in the Affordable Care Act made it so all employers had to cover contraceptive care. Republicans cried foul on infringing religious freedoms. This seemed a win-win for republicans: attack an already unpopular legislative bill, at least with conservatives, and pin the bill to a social issue they care deeply about.

But it didn’t really turn out that way. President Obama compromised. This consolation by the administration seemed a straight-forward alternative, but many still argued insurance companies would pass the costs of contraceptive care to the institutions through higher premiums, but this simply isn’t true. Furthermore, it’s in the insurance companies’ best interest, i.e. benefits their bottom-line, to offer free contraceptive care for ALL women.

The controversy should have died there, but, republicans kept on it. At a Congressional hearing, Darrell Issa actually barred a woman named Sandra Fluke, a Georgetown law student, from giving testimony. Democrats, days later, held a congressional forum where Ms. Fluke finally gave her testimony. Republicans responded by letting Rush Limbaugh do the talking.

Limbaugh’s tirade has only served to help President Obama and the Democrats this fall. First of all, Limbaugh’s idiocy only proved how little he understands contraception and how women use it. Rachel Maddow expressed this brilliantly on her show Friday night. Limbaugh, and many other conservatives, do not seem to have a basic grasp of how contraceptive coverage works, and almost universally think contraception is solely used as an abortifacient, and ignore hormonal contraceptive use as a therapeutic drug, evidenced by Ms. Fluke’s testimony. Nobody is paying for somebody else’s contraceptive care. The taxes paid through your employer cover the health care benefits that YOU receive. If your employer objects to contraceptive coverage, or maybe they don’t like the diet pills you’ve been taking, or maybe the painkillers that you’re prescribed are too costly, and you have to go out of network to get those drugs then you’re essentially paying TWICE for medical insurance. As the Fluke testimony shows, going out of network can have disastrous consequences for women.

The right’s draconian furor against contraception will only further secure the women’s vote in 2012, especially the independent vote. Limbaugh, personally, is suffering. At least 9 advertisers, including AOL, Sleep Number, and a tax services company, have pulled their ads from his show. Limbaugh’s half-hearted (and now “left-blaming”) apology has been almost universally condemned as “insincere.” Even Ron Paul thinks it was all about ad revenue: "I don't think he's very apologetic. It's in his best interest, that's why he [apologized].” When a majority of Americans support the contraceptive requirement and conservative blowhards make such inexcusable comments, republicans are not only hurting their chances of winning the White House, but damage any chance to take the Senate or hold the House.

Obama and the Contraceptive Accommodation

I guess one of the things I find most appealing about Facebook is the access to information and opinion from my friends that I don’t find elsewhere. And I think the impersonal dialogue that exists through the site gives people incentive to write things they might not normally say during a conversation. For me personally it provides a gateway to my friends’ point-of-view that normally I do not think I would know. The contraception “controversy” dogging President Obama through the last couple of weeks has again provided a basis for some personal introspection on my part, some friendly banter on Facebook, and some evolving perspective on the issue.

It started with a link of mine to an article on Truthout.Org describing how this contraception issue is mostly being drummed by a partisan right-wing agenda to shift the upcoming presidential election towards social issues rather than the economy. The reason being this issue of having employers (including religious institutions) provide birth control care in their insurance plans has been law since 2000 and the Bush administration coming into office did absolutely nothing to appeal the decision of the Equal Employment Opportunity Commission’s ruling that denying contraceptive care is in violation of Title VII of the 1964 Civil Rights Act, which prevents discrimination based on sex. So, clearly, this was never a problem until a democrat was in office and then it became an ‘example’ of “government overreach by this administration”.

My point in linking the article was to highlight this GOP hypocrisy, but a friend commented about the ruling itself, having also fallen into the trap that the government is only now overstepping its bounds (and never did in the previous 8 years of the Bush presidency). He mocked that toothpaste will be the next thing the government will require employers to cover in their insurance plans. I responded that that was ridiculous because toothpaste is over-the-counter, and further tried to make my point that I was not addressing the contraception issue per se (for my views on it were initially that I think religious organizations should be allowed to deny birth control coverage based on freedom of religion), but, again, the hypocrisy of the GOP to make this an issue now. My friend then posted this:

“Here’s what I think. I read an article about how England lost their right to own firearms. It started slowly and pitted gun owners against each other. The government first outlawed automatic firearms. This only affected persons who owned automatic firearms so everyone else who owned semi-autos, bolt actions, handguns, etc. said, 'Oh well, this doesn’t affect me.' Next the government outlawed semi-autos. So everyone that owned bolt actions, handguns, etc. said, 'Oh well, this doesn’t affect me.' Then they outlawed bolt actions and so on and so forth. In England, all firearms owners should have stood together to fight the bans whether it affected them of not, but they didn’t and the government was able to break them down piece by piece. I see this contraception deal as the same thing. Non-Catholics are saying, 'Why do we care? We believe in contraception and preventative pregnancy.' What non-Catholics should be saying is, 'We do not share the Catholic Church’s belief on contraception, but we stand behind them in their Constitutional right to believe and practice their religious views.' This isn’t about me being Republican and you being Democrat. This is about a slippery slope. This is the first step toward the Government impeding the free exercise of religion. This isn’t some conspiracy theory,[sic] it’s just what governments eventually do.”

After pointing out that my friend should read Martin Niemoller’s “First They Came...” quote on the rise of Nazi Germany, I dove into an argument showing how I think President Obama’s shift to exempt religious organizations/businesses from this Affordable Care Act requirement was a “slippery slope” inclined the other way. (Note: the administration is now shifting the burden of covering contraception to insurance companies.) In my view, offering this accommodation to businesses with religious affiliations creates the opportunity for other businesses to deny contraceptive coverage, not only because they might have a moral/religious objection to contraception, but because they might want to save a little money instead of provide care to their employees. What were to happen if one of the largest insurance companies in the country decided that they had moral objections to contraception because some of their top executives suddenly became devout 'Catholics'? And when businesses are granted special privileges, why can’t a state or local government not be offered these same exemptions to discriminate against women for contraceptive use? And the current GOP front runner for the presidential nomination is Rick Santorum, who has been running on a staunchly evangelical platform and wants a Constitutional Amendment banning all contraceptives. This outcome seems like the next step in accommodating one religious group, or in reality what we should classify the Catholic Church as, this one business. The more I think about this issue, the more I side with President Obama’s initial take on this (and the one the EEOC deemed in 2000) is that no one group should be allowed to discriminate from any one group.

And I think it bears to mention, that Ron Paul, who has a strong backing all over the country for the GOP nomination, believes the Civil Rights Act was itself unconstitutional and should be repealed, and by extension would disagree with the EEOC’s ruling. Paul, a long-serving Texas Congressman, seems to me a very dangerous individual to have in office. Congressman Paul thinks that if a business, a person, or really anybody, wants to discriminate against a race, a sex, or any other group they have it within their rights to do so. Paul does not seem to understand that one individual’s freedom cannot be limitless. According to Immanuel Kant, the famous German philosopher, individual freedom extends only to the cusp of infringing on another’s freedom. Sure, you have the right to own a gun, but if your right to have that gun to kill me infringes on my right to life, then you should have to relinquish that right. Such are the basis for laws. Such balance is the basis for the Civil Rights Act, and the mandate in the Affordable Care Act to require employers to cover contraception. Government has an obligation to protect the citizenry no matter of race, religion, or creed. It has an obligation to thwart any person or entity who wishes to restrict the autonomy of another.