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Position Side :  Hanna Holland World Issues Mr. Towne  To begin with healthcare you have to fully look at everything and know what both sides see and how you are going to view it. I believe that ACA can be a beautiful thing if not used for the bad but yet the good. The benefits that ACA offers fo...

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ProHealth Care - Wisconsin health care system

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Millions Of People Have Gained Access To Health Care, But Republicans Still Say Obamacare Is Worse Than 9/11, Slavery, And The Holocaust

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Nine months after the official rollout of the Affordable Care Act (ACA), things are looking pretty good for the new health care law. In total, counting those who signed up for coverage via the state exchanges, healthcare.gov, and the Medicaid expansion, an estimated 17.2 million people have gained access to health insurance under the law.

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The main theme of today's oral arguments, considering whether or not the rest of the Affordable Care Act can stand if the Court finds that the individual mandate is unconstitutional, boiled down to what constitutes judicial restraint in this context. What is the most limited yet effective solution the Court can adopt?

Advocates today offered three potential outcomes for the Court to consider if the individual mandate fell: (1) Striking down the entire law to allow Congress to work from scratch, (2) Expunging the community rating and guaranteed coverage requirements (those obligating insurance companies to cover everyone regardless of preexisting conditions), but allowing the seemingly-unrelated aspects of the law to continue, or (3) Removing only the individual mandate so that Congress can determine and fix any problems that arise from the remaining provisions.

Normally judicial restraint is shown by the Court deferring as much as possible to elected officials (i.e. not striking down laws), which would imply that the opposite (occasionally referred to as judicial activism) is for the Court to declare more laws unconstitutional. Today the Justices wondered if stepping into the muddled territory of which provisions would effect each other and which ones could stand alone (and as Congress intended them to stand) would be an unwelcome intrusion, even if it meant more of the law would survive.

Justice Sotomayor argued that leveling any provisions beyond just those that the Court deemed unconstitutional would be an undemocratic, intrusive step outside the Court's traditional role.

Justice Sotomayor: What's wrong with leaving it to -- in the hands of the people who should be fixing this, not us?...Are you suggesting that we should take on more power to the Court?...Unless Congress tells us directly, it's not severable, we shouldn't sever. We should let them fix their problems.

Justice Scalia, on the other hand, indicated he supported a complete upending of the law to avoid any unnecessary complications that might occur by salvaging bits and pieces.

Justice Scalia: So you're just put to the choice of, I guess, bankrupting insurance companies and the whole system comes tumbling down, or else enacting a Federal subsidy program to the insurance companies, which is what the insurance companies would like, I'm sure. Do you really think that that is somehow showing deference to Congress and -- and respecting the democratic process? It seems to me it's a gross distortion of it.

Justice Kennedy, who is presumed by many to have the final say in the outcome of this case, appeared to side with Justice Scalia.

Justice Kennedy: When you say judicial restraint, you are echoing the earlier premise that it increases the judicial power if the judiciary strikes down other provisions of the Act. I suggest to you it might be quite the opposite. We would be exercising the judicial power if one provision was stricken and the others remained to impose a risk on insurance companies that Congress had never intended. By reason of this Court, we would have a new regime that Congress did not provide for, did not consider. That, it seems to me, can be argued at least to be a more extreme exercise of judicial power than to strike -than striking the whole. I just don't accept the premise.

But the lawyers came well prepared for these responses.

Paul Clement argued for the petitioner that each of the provisions relied on one another so that if the individual mandate fell, the Court's investigation would find that the periphery clauses would have to as well. The mandate is connected to the exchanges, which is connected to the tax credits, which is connected to the employer mandates and revenue offsets, and so on and so forth like dominoes.

H. Bartow Farr, appointed by the Court to argue that the rest of the law could stand without the mandate, argued that the mandate was just one of many tools that Congress relied on to fund the monetary fallout insurance companies would absorb. If the Court found the mandate unconstitutional, Congress would simply fill in the gap with a different mechanism.

By the end of the argument it appeared that, as expected, the liberal justices wanted as much of the act as possible to remain, while the more conservative justices were content with wiping the slate clean. Only Justice Roberts appeared willing to allow some of the periphery provisions to remain.

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The main theme of today's oral arguments, considering whether or not the rest of the Affordable Care Act can stand if the Court finds that the individual mandate is unconstitutional, boiled down to what constitutes judicial restraint in this context. What is the most limited yet effective solution the Court can adopt?

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The thermometer keeps inching upwards, though its hard to tell if its measuring heat or the rhetoric coming out of Washington. The recent Supreme Court decisions have done little to quell the debates on either side, and with a looming election in five months, no one seems interested in backing down.

Monday, on, our political pundits--Kansas City Star reporter Dave Helling, University of Kansas political science professor Burdett Loomis, Washburn University political science professor Bob Beatty, and St. Louis Beacon reporter Jo Mannies-- return to impart some clarity to the issues that are heating up politics on both the national and local level.

Whether its tax cuts, health care, or the race to the White House, listen in for the latest on Up to Date.

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Political Pundits: Taxes, and Health Care, and Elections, O My!

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The thermometer keeps inching upwards, though its hard to tell if its measuring heat or the rhetoric coming out of Washington. The recent Supreme Court decisions have done little to quell the debates on either side, and with a looming election in five months, no one seems interested in backing down.

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In the latest leg of their endless journey to find bad news about the Affordable Care Act, conservative analysts and websites have seized on some ambiguous figures to declare that enrollment is " plummeting," " shrinking," "sinking rapidly"--choose your headline.

The most charitable interpretation of this claim is that it's based on extreme cherry-picking. The most accurate interpretation is that it's wrong.

And the most important underlying points are that (1) some attrition is inevitable and normal, and (2) the most aggressive interpretation of the statistics places the attrition rate about where experts expected it to be--at somewhere in the 2-3% range per month.

That figure recognizes that the individual health insurance market, which is the segment addressed by the ACA exchanges, is extremely volatile, with a sizable proportion of people moving in and out every month. Here's how the assiduous statistics-tracker Charles Gaba recently described why people might have dropped their exchange plans after signing up:

"Maybe they got a job with benefits and didn't need the [plan] anymore. Maybe they got married to someone who was already covered. Maybe they moved out of the country. Maybe they turned 65 and moved over to Medicare. Maybe they fell on hard times and moved onto Medicaid. Maybe their spouse or child passed away. Maybe they passed away. Who the hell knows?"

For these people, he observes, the law is working exactly as planned, giving them "the peace of mind of decent healthcare coverage for however long they need it before they move onto some other coverage. For some this may only be a month or two; for others it may be years. This is a good thing." (Emphasis in the original.)

What about the evidence, though? The ur-source for it appears to be an article in the resolutely anti-Obamacare Investors Business Daily. The piece, which is based on figures from the large insurers Aetna and Cigna, was cited by, among others, Tucker Carlson's conservative Daily Caller.

The IBD piece says Aetna "had 720,000 people sign up" for ACA exchanges by May 20, according to an Aetna spokesman. IBD continues: "At the end of June, it had fewer than 600,000 paying customers. Aetna expects that to fall to 'just over 500,000' by the end of the year." IBD's math places the attrition rate at 30% (720,000 falling to 500,000).

But according to an earlier IBD piece--flagged by Gaba--Aetna actually had only 580,000 paid enrollees as of May 20. Exactly how many fewer than 600,000 paying customers did Aetna have at the end of June? IBD doesn't say. But a drop from 580,000 at the end of May to 500,000 at the end of the year works out to a decline of roughly 2% a month. "Plummeting"? Hardly.

In any event, IBD may be treating the Aetna figures as more concrete than Aetna does. During a July 29 conference call with securities analysts, the firm's CEO, Mark Bertolini, cautioned that because two-thirds of its individual enrollments came in April and May, the company doesn't have "a whole lot of experience" with the ACA segment--and it wouldn't have a good sense of its pattern and pricing until the end of September.

IBD also quotes Cigna CEO David Cordani saying on a conference call that "it expects its individual market customers, including more than 100,000 in the exchanges, to 'move from 300,000 down to 280,000 in that range.'"

But Cordani gave more detail than that. He explained that most of Cigna's individual customers were in states that allowed grandfathered health plans--those that didn't comply with Obamacare's 2014 standards--to remain temporarily in effect. The vast majority of those customers are expected to transition into ACA plans or out of the market. So Cordani wasn't actually making a specific prediction about Cigna's exchange enrollments, a subset of that larger total. But he did say that "we're not flagging a big trend down for the year."

Over the years, the anti-ACA crowd has moved from one dire prediction to another. As each freakout turns out to be unwarranted, they seamlessly and shamelessly tee up the next. This week, it's "plummeting" enrollments and frightful attrition. Since this picture is also askew, what will be the next freakout? Stay tuned; you know there will be something.

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Latest Obamacare freakout: enrollment 'plummeting' (Spoiler: not so)

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In the latest leg of their endless journey to find bad news about the Affordable Care Act, conservative analysts and websites have seized on some ambiguous figures to declare that enrollment is " plummeting," " shrinking," "sinking rapidly"--choose your headline. The most charitable interpretation of this claim is that it's based on extreme cherry-picking.

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1) There is a free choice of doctors and hospitals.

2)No exclusions for preexisting conditions.

3)No bankruptcy due to medical bills.

4) Lower cost of government health care will cause insurance coverage to be more accessible.

5) Doctor can focus on individual patient.

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"Government healthcare" refers to government funding of healthcare services via direct payments to doctors, hospitals and other providers.

In U.S. government healthcare, doctors, hospitals and other medical professionals are not employed by the government. Instead, they provide medical and health services, as normal, and are reimbursed by the government, just as insurance companies reimburse them for services.

An example of a successful U.S. government healthcare program is Medicare, established in 1965 to provide health insurance for people aged 65 and over, or who meet other criteria such as disability.

The U.S. is the only industrialized country in the world, democratic or non-democratic, without universal healthcare for all citizens provided by government-funded coverage.

50 Million Uninsured Americans in 2009

In mid-2009, Congress is working to reform U.S. healthcare insurance coverage which presently leaves more than 50 million men, women and children uninsured and without access to adequate medical and health services.

All healthcare coverage, except for some low-income children and those covered by Medicare, is now provided only by insurance companies and other private-sector corporations.

Private company insurers, though, have proven quite ineffective at controlling costs, and actively work to exclude healthcare coverage whenever feasible.

Explains Ezra Klein at the Washington Post:

"The private insurance market is a mess. It's supposed to cover the sick and instead competes to insure the well. It employs platoons of adjusters whose sole job is to get out of paying for needed health care services that members thought were covered."

In fact, multi-million bonuses are awarded annually to top healthcare executives as incentive to deny coverage to policy holders.

As a result, in the United States today:

"Over a third of families living below the poverty line are uninsured. Hispanic Americans are more than twice as likely to be uninsured as white Americans while 21% of black Americans have no health insurance.

More than 9 million children lack health insurance in America.

Eighteen thousand people die each year because they are uninsured."

Slate.com reported in 2007, "The current system is increasingly inaccessible to many poor and lower-middle-class people... those lucky enough to have coverage are paying steadily more and/or receiving steadily fewer benefits."

(See Page Two for specific Pros & Cons of Government Healthcare.)

Latest Developments

In mid-2009, several coalitions of Congressional Democrats are heatedly crafting competing healthcare insurance reform legislation. Republicans have generally not offered substantive healthcare reform legislation in 2009.

President Obama has voiced support for universal healthcare coverage for all Americans which would be provided by selecting among various coverage options, including an option for government-funded healthcare (aka a public plan option or public option).

However, the President has stayed safely on the political sidelines, thus far, forcing Congressional clashes, confusion, and setbacks in delivering on his campaign promise to "make available a new national health plan to all Americans."

Healthcare Packages Under Consideration

Most Democrats in Congress support universal healthcare coverage for all Americans which offers various options for insurance providers, and includes a low-cost, government-funded healthcare option.

Under the multi-option scenario, Americans satisfied with their present insurance can opt to keep their coverage. Americans dissatisfied, or without coverage, can opt for government-funded coverage.

Republicans complain that the free-market competition offered by a lower-cost public-sector plan would cause private-sector insurance companies to cut their services, lose customers, would inhibit profitability, or go entirely out of business.

Many progressive liberals and other Democrats believe strongly that the only fair, just U.S. healthcare delivery system would be a single payer system, such as Medicare, in which only low-cost government-funded healthcare coverage is provided to all Americans on an equal basis.

Americans Favor Public Plan Option

Per the Huffington Post about a June 2009 NBC/Wall Street Journal poll, "... 76 percent of respondents said it was either 'extremely' or 'quite' important to 'give people a choice of both a public plan administered by the federal government and a private plan for their health insurance.'"

Likewise, a New York Times/CBS News poll found that "The national telephone survey, which was conducted from June 12 to 16, found that 72 percent of those questioned supported a government-administered insurance plan - something like Medicare for those under 65 - that would compete for customers with private insurers. Twenty percent said they were opposed."

Background

Democrat Harry Truman was the first U.S. President to urge Congress to legislate government healthcare coverage for all Americans.

Per Healthcare Reform in America by Michael Kronenfield, President Franklin Roosevelt intended for Social Security to also incorporate healthcare coverage for seniors, but shied away for fear of alienating the American Medical Association.

In 1965, President Lyndon Johnson signed into law the Medicare program, which is a single payer, government healthcare plan. After signing the bill, President Johnson issued the first Medicare card to former President Harry Truman.

In 1993, President Bill Clinton appointed his wife, well-versed attorney, Hillary Clinton, to head a commission charged with forging a massive reform of U.S. healthcare. After major political missteps by the Clintons and an effective, fear-mongering campaign by Republicans, the Clinton healthcare reform package was dead by Fall 1994.

The Clinton administration never tried again to overhaul healthcare, and Republican President George Bush was ideologically opposed to all forms of government-funded social services.

Healthcare reform was a top campaign issue among 2008 Democratic presidential candidates. Presidential candidate Barack Obama promised that he will "make available a new national health plan to all Americans, including the self-employed and small businesses, to buy affordable health coverage that is similar to the plan available to members of Congress." See the entirety at Obama Campaign Promises: Health Care.

Pros of Government Healthcare

Iconic American consumer advocate Ralph Nader sums up the positives of government-funded healthcare from the patient's perspective:

Free choice of doctor and hospital;

No bills, no co-pays, no deductibles;

No exclusions for pre-existing conditions; you are insured from the day you are born;

No bankruptcies due to medical bills;

No deaths due to lack of health insurance;

Cheaper. Simpler. More affordable;

Everybody in. Nobody out;

Save taxpayers billions a year in bloated corporate administrative and executive compensation costs.

Other important positives of government-funded healthcare include:

Cons of Government Healthcare

Conservatives and libertarians oppose U.S. government healthcare mainly because they don't believe that it's a proper role of government to provide social services to private citizens.

Instead, conservatives believe that healthcare coverage should continue to be provided solely by private-sector for-profit insurance corporations or possibly by non-profit entities.

In 2009, a handful of Congressional Republicans have suggested that perhaps the uninsured could obtain limited medical services via a voucher system and tax credits for low-income families.

Conservatives also contend that lower-cost government healthcare would impose too great of a competitive advantage against for-profit insurers.

The Wall Street Journal argues, "In reality, equal competition between a public plan and private plans would be impossible. The public plan would inexorably crowd out private plans, leading to a single-payer system."

From the patient's perspective, negatives of government-funded healthcare could include:

A decrease in flexibility for patients to freely choose from among the vast cornucopia of drugs, treatment options, and surgical procedures offered today by higher-priced doctors and hospitals.

Existing patient confidentiality standards, which would likely be diluted by centralized government info that would necessarily be maintained.

Less potential doctors may opt to enter the medical profession due to decreased opportunities for highly compensated positions. Less doctors coupled with skyrocketing demand for doctors could lead to a shortage of medical professionals, and to longer waiting periods for appointments.

Where It Stands

As of late June 2009, the struggle to shape healthcare reform has only begun. The final form of successful healthcare reform legislation is anyone's guess.

The American Medical Association, which represents 29% of U.S. doctors, opposes any government insurance plan mainly because doctors' reimbursement rates will be less than those from most private sector plans. Not all doctors oppose government-funded healthcare, though.

Political Leaders on Healthcare Reform

On June 18, 2009, Speaker of the House Nancy Pelosi told the press, "I have every confidence that we will have a public option coming out of the House of Representatives -- that will be one that is actuarially sound, administratively self-sufficient, one that contributes as to competition, does not eliminate competition."

Senate Finance Committee Chair Max Baucus, a centrist Democrat, admitted to the press, "I think a bill that passes the Senate will have some version of a public option."

Moderate Blue Dog Democrats of the House "say the public plan should occur only as a fallback, triggered if private insurers aren't doing a good enough job on access and costs," per Rob Kall at OpEd News.

In contrast, Republican strategist and Bush advisor Karl Rove recently penned a harshly dire Wall Street Journal op-ed in which he warned that "... the public option is just phony. It's a bait-and-switch tactic... Defeating the public option should be a top priority for the GOP this year. Otherwise, our nation will be changed in damaging ways almost impossible to reverse."

The New York Times wisely summed up the debate in a June 21, 2009 editorial:

"The debate is really over whether to open the door a crack for a new public plan to compete with the private plans. Most Democrats see this as an important element in any health care reform, and so do we."

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Government Healthcare - Analysis of Pros & Cons

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"Government healthcare" refers to government funding of healthcare services via direct payments to doctors, hospitals and other providers. In U.S. government healthcare, doctors, hospitals and other medical professionals are not employed by the government. Instead, they provide medical and health services, as normal, and are reimbursed by the government, just as insurance companies reimburse them for services.