GOP Leaders vs "Obamacare"/ Affordable Health Care (Negative Rhetoric vs Facts)

Political Parties duel on health law anniversary


The White House and congressional Republicans marked the two-year anniversary of President Obama's healthcare reform law with dueling messages Friday.

The administration released a new report — the fifth this week — highlighting the parts of the law that have taken effect. Many of the healthcare law's provisions, including insurance subsidies and Medicaid expansion to millions of Americans, have yet to begin, but Democrats are seeking to highlight the benefits that they say voters would lose now if the law were repealed or struck down by the Supreme Court.

The Republican National Committee attacked the law on the anniversary, releasing a Web video mocking the law's "lonely birthday" after Obama opted to keep a low profile ahead of Supreme Court arguments next week.
The RNC video features a bill, wearing a birthday hat, crying in front of well-known Washington landmarks.

"Nobody in America likes me," the bill says. "Even Obama won't celebrate my birthday now!"

The RNC also hung a banner outside its headquarters in Washington that reads: "Happy Birthday Obamacare! We didn't forget you."

The healthcare law has moved to the political forefront ahead of next week's oral arguments in the Supreme Court. Justices have blocked off three days to hear oral arguments over the law and its controversial insurance mandate, and a frenzy of demonstrations for and against the law are expected outside the courthouse.

The high court is expected to decide the fate of the healthcare law this summer, just months before the presidential election.

Surveys show the public remains sharply divided over the law two years after passage. An average of polls collected by Real Clear Politics found that 50.5 percent of Americans oppose the healthcare law. That's on par with the 50.4 percent who were opposed when Congress passed the law two years ago.


According to the administration's report, current effects of the law include:

• 2.5 million more young adults who have health insurance on their parents' plan;

• 5.1 million people with Medicare who saved an average of $635 on the cost of their prescription drugs, and 32.5 million Medicare seniors who received at least one preventive benefit without cost-sharing in 2011;

• 54 million people with private health plans had at least one new preventive service, such as mammograms, with no cost-sharing in 2011;

• people with private plans who benefited from new requirements that insurers spend at least 80 percent of premium dollars on healthcare and publicly justify rate hikes of more than 10 percent; and

• children with pre-existing conditions now can't be denied coverage.

"Today, two years after we passed health care reform, more young adults have insurance, more seniors are saving money on their prescription drugs, and more Americans can rest easy knowing they won't be dropped from their insurance plans if they get sick," Obama said in a statement. "The law has made a difference for millions of Americans, and over time, it will help give even more working and middle-class families the security they deserve."


Sources: CBS News, CATO Institute, The Hill, Youtube

"Obamacare"/ Affordable Health Care Act vs SCOTUS Arguments: 10 Key Areas To Watch For Discussion

10 Things to Watch During the Health Care Arguments

Welcome to America, the land of the free and the home of the brave, on the eve of the big Supreme Court arguments over the Affordable Care Act, where you cannot swing a reply brief without hitting a lawyer or a lobbyist or a medical "expert" willing (for some free publicity) to share with you his or her ponderous view of how it's all going to come out. I have received hundreds upon hundreds of emails pitching such knowledge and prescience-- and one of the best parts about the looming end of this case will be the end of these emails.

The truth is, dear reader, that the people who know how the case is going to turn out aren't talking. And the people who are talking about how the case is going to turn out don't really know. Since the justices alone are in the first group I happily acknowledge that I am squarely in the second group. After Bush v. Gore, after Citizens United a decade later, I have learned on this beat never to be too sure about anything. Instead, all I offer here are a few tips that I believe will help reasonably guide you through the three momentous days ahead.


1) Be prepared.

If you have somehow managed to avoid the ceaseless legal and political chatter over the Affordable Care Act, both before and after it's enactment almost exactly two years ago today, then congratulations! If you want to get caught up, however, start here, at the official website of the United States Supreme Court, for basic legal briefs and other material. From there, go to Scotusblog's indispensable coverage of the cases, the lawyers, and the issues. Then read this memorably candid piece by Dahlia Lithwick.

2) Be prepared for disappointment.

The justices will have plenty of many different ways to resolve these cases without giving a complete victory to either side in the fight. For example, the Court could declare that the Care Act contemplates a "tax" and not a "penalty"-- even though it doesn't say so-- and that would mean that the challenges are premature. Can you imagine the political furor if that's the result here? I can. It would mean a whole new generation of lawsuits in two years-- if the statute itself isn't amended or repealed first.


3) Action/inaction.

Opponents of the health care law say that Congress may not constitutionally regulate "inaction"-- the voluntary choice not to buy health insurance. In response, the Obama Administration and other Care Act supporters say there is no such thing as "inaction." Notably, 6th U.S. Circuit Court of Appeals Judge Jeffrey Sutton, an appointee of George W. Bush and a former law clerk to Justice Antonin Scalia, wrote last year that "inaction is action." If the Court agrees with that formulation, the law likely will survive.


4) Drinking games!

If, like hundreds of millions of your fellow citizens, you cannot see the arguments live, then consider having an "audio release" party. Invite your friends over to listen to the justices and lawyers cogitate. And you can play drinking games. For example, everyone can take a shot if someone in court mentions the phrase "broccoli mandate" to connote overreaching federal power. Or, if you are a heavier drinker, you can just take a shot every time someone mentions Wickard v. Filburn, the 1942 case so vital to both sides.


5) The mind of Justice Clarence Thomas.

He hasn't asked a question at oral argument in more than six years. Starting on Monday, he'll likely sit in court in total silence for six hours over three days on a subject, the Affordable Care Act, which we know is so near and dear to his wife Ginny's heart. What will he be thinking during those long public hours? What good questions will be raised in his mind that he won't ask aloud? And what will the Thomases' dinner table conversation be like early next week? Maybe that's where we need the cameras!


6) The words of Justice Elena Kagan.

Speaking of justices whose participation in these health care cases has been marked by political controversy, there is the former Solicitor General of the United States. In her brief tenure on the Court, less than two full Terms, she already has distinguished herself for her writing and her cogent questions during argument. Unlike Justice Thomas, she likely will speak in court. What does she think of the Commerce Clause and the aforementioned "broccoli mandate"? Watch this from her 2010 confirmation hearing.


7) Everything old is new again.

Opponents of the Affordable Care Act say it represents an "unprecedented" expansion of federal power. Supporters of the law say the political and legal assault upon the measure is "unprecedented." Baloney. Folks, we've been here before. If you want some context and perspective on the arguments, read Jeff Shesol's masterful "Supreme Power," about the Court and Franklin Roosevelt. If you really want to go old-school, and make your grandparents proud,. read the classic The 168 Days by Joe Alsop and Turner Catledge.


8) Watch Breyer.

Justices often delight in torturing at oral argument even those attorneys whose positions they ultimately endorse. So all eyes his coming week will be on Chief Justice John Roberts and Justice Anthony Kennedy. But it might also make sense to keep an eye on Justice Stephen Breyer to see where his eyes are. Justice Breyer frequently asks questions of the lawyers while looking directly at one of his colleagues on the bench as if to say: "Lawyer, please answer my question so I can convince my fellow justice of a particular point."


9) Ahead? A full season of waiting.

By my calculations, we'll have to wait three full months before we will likely get some answers to the questions raised by the oral arguments. I reckon it's 93 days from Wednesday, March 28 at noon, when the oral arguments finally end, to Thursday, June 28th at 10 a.m., when the Court is expected to release its final opinions of the current Term. Of course, the justices could issue their ruling sooner-- a few days earlier, perhaps-- but don't bet on it.


10) Behave in court.

Because the great public interest in the issues surrounding the new law, the courtroom will be packed-- and there are likely to be plenty of first-time viewers of a High Court oral argument. Here are some helpful rules: 1) don't start the "Wave" after an attorney finishes an argument; 2) don't try to sneak in a flask of whiskey to brace yourself for the tedium of the Anti-Injunction Act; 3) don't fist-pump when a justice asks a good question or when an attorney offers a good answer, and; 4) whatever you do, don't do this.


Sources: CBS News, CNN, Emory University, Newsbusters, The Atlantic, Youtube

"Obamacare"/ Affordable Health Care Act Changed The American Health Care System Forever

Pres. Barack Obama signed the Health Care Reform bill into Law on March 23, 2010.


Health reform at 2: Why American health care will never be the same

In February 2009, Michael Zucker told a group of high-paid surgeons something they did not want to hear: The way they earned a salary was about to change.

Zucker is the chief development officer at Baptist Health System, a five-hospital network in San Antonio. For 37 common surgeries, such as hip replacements and pacemaker implants, it would soon collect “bundled” Medicare payments. Traditionally, hospitals and doctors had collected separate fees for each step of such procedures; now they would get a lump sum for treating everything related to the patient’s condition.

If a hospital delivered care for less than the bundled rate, while hitting certain quality metrics, it would keep the difference as profit. But if costs were high and quality was too low, Baptist would lose money. For the first time in their careers, the doctors’ paychecks depended on the quality of the care they provided.

Four surgeons quit in protest.

“I’d describe the reception as lukewarm at best,” Zucker says. “There was a lot of: ‘How could you do this?’ and ‘I’m not going to participate.’ ”

The program launched in June 2009 with a checklist of quality metrics. To earn a bonus, surgeons would, among other things, need to ensure that antibiotics were administered an hour before surgery and halted 24 hours after, reducing the chances of costly complications.

Only three doctors hit the metrics that first month, but their bonuses caught the attention of others. “There was a lot of, ‘Why are those doctors getting more, and I’m not?” Zucker says. Eight doctors got bonus payments in July; two dozen got them in August. Compliance with certain quality metrics steadily climbed from 89 percent to 98 percent in three months.

Two-and-a-half years later, Baptists’ surgeons have earned more than $950,000 in bonuses. Medicare, meanwhile, has netted savings: Its bundled rate is about 5 percent lower than all the fees it used to pay out for the same services. “It wasn’t a home-run,” says Zucker, noting the start-up costs in administering the program — not to mention a handful of lost employees. “But I’d call it a solid triple.”

The Affordable Care Act is mostly known for its mandate to expand health insurance to 30 million more Americans within a decade. That’s the side of the legislation Democrats touted last week, when the law hit its two-year anniversary. It’s also the point that has roused the most ire from opponents. Insurance expansion is at the heart of legal challenges the Supreme Court will take up on Monday, which argue that forcing people to buy insurance coverage is unconstitutional.

But much of the law’s 905 pages are dedicated to an effort that’s arguably more ambitious: an overhaul of America’s business model for medicine. It includes 45 changes to how doctors deliver health care — and how patients pay for it. These reforms, if successful, will move the country’s health system away from one that pays for volume and toward one that pays for value. The White House wants to see providers behave more like Baptist Health Systems, rewarding health care that is both less costly and more effective.

The health-care industry was moving toward value-based payments even before health reform passed. But the Affordable Care Act has played an important role, economists say, by signalling that America’s biggest health-care spender — the federal government — is also headed in that direction.

“The Affordable Care Act is like two laws in one,” former Medicare administrator Don Berwick said. “There’s the coverage piece, and I think that’s proceeding well. On the other side, there’s health-care delivery reform.”

Even as Congress was debating the Affordable Care Act, economic and demographic trends were steering the industry’s business model off a cliff. As costs ticked higher, Americans were losing insurance coverage. They were making fewer trips to the doctor, which meant less revenue. Baby Boomers landed in Medicare, which pays less than private insurance, further shrinking health-care providers’ income. Health systems reevaluated their volume-dependent bottom lines.

“There was a patient mix shift happening that, unless hospitals changed, they were going to be losing money in about five years,” says Chas Roades, chief research officer at consulting firm the Advisory Board Co.

In Washington, the Obama administration was facing a different problem: Medicare was eating up a growing share of the federal budget. The program’s costs had more than doubled in a decade, from $212 billion in 1999 to $499 billion in 2009. Since it started in 1965, the program has paid providers based on volume. Most private insurance works this way, too: In 2008, 78 percent of health plans paid for coverage on a fee-for-service basis. That system, economists argued, was driving up costs: It pushed doctors to provide as much care as possible, regardless of whether it was effective.

Across the country, however, a few health-care systems had made high-profile moves in another direction. Places like Kaiser Permanente in California and the Mayo Clinic in Minnesota were setting strict budgets for their patients and demonstrating, in study after study, that they could deliver higher quality outcomes at a lower cost than other hospitals and doctors.

What these systems had in common was a model called integrated care, where doctors, hospitals and insurers work together to deliver the most cost-effective treatments. In integrated care systems, doctors are often paid a flat salary, rather than charging for each procedure they perform. They often receive incentive payments for hitting certain quality metrics.

Alongside a handful of success stories, there were dozens of cautionary tales. Health-care costs did decrease in the mid-1990s, when Health Maintenance Organizations limited patients’ access to more costly, speciality providers, but patients left such payment plans in droves, which encouraged providers to stick with a volume-driven system.

For the Obama administration, this represented an opportunity. Insurance premiums had grown by 131 percent between 1999 and 2009. If Congress was going to extend insurance to millions more Americans, it wanted a guarantee that those benefits would be affordable. The integrated-care model, they hoped, could control those costs even as it improved the quality of care. No “rationing” needed.

Payment reforms became “massively and unstoppably important,” says Bob Kocher, a former White House health-care adviser. “There was a sentiment among the Democrats that the problem is spending, and a real desire to finance the coverage expansion, as much as possible, from delivery system reforms.”

It was unclear how quickly the federal government could move. Medicare’s whole infrastructure, from its billing software to its reimbursement levels, is built around paying doctors a fee for each service. Kocher remembers suggesting that the law should require that 20 percent of Medicare’s payments be bundled by 2015. A senior Medicare official, he recalls, nearly had an “allergic reaction” to that timeline.

The Affordable Care Act ultimately included 45 delivery system reforms. Fifteen of those change how Medicare doctors and hospitals are paid, according to an analysis by Sen. Sheldon Whitehouse (D-R.I.). The six that have rolled out thus far are largely voluntary, allowing those who think they can deliver more cost-efficient care to opt-in to new payment models.

But the remaining changes will be mandatory. Beginning in October, hospitals stand to lose 1 percent of their Medicare revenue if they can’t hit key metrics on “preventable readmissions” — patients who turn up at the hospital with a complication from an earlier procedure. That’s a big change from the current, volume-based system in which those readmissions generate additional revenue for a hospital.

Although it’s not fully implemented, some say the Affordable Care Act has already significantly catalyzedthe health-care system. Leaders know where Medicare wants to go, even if they didn’t chart an especially aggressive path for how it would get there. “Forever and a day, everybody had been saying we had to change the way we paid for health care,” Roades says. “Now, we have a sense of direction of where the country’s biggest payer is headed. And that provides cover for everybody else to move in that direction.”

Roades calls the past two years ones of “breathtaking change.” When the Advisory Board Co. surveyed 69 hospital executives in November, just 16 percent said they had bundled payments in place. But of those who didn’t, 75 percent expected to within two years. Two-thirds expected they would have such payment arrangements with Medicare.

The health-care system has become increasingly integrated, with hospitals and insurance plans buying up doctors’ offices. Consulting firm Irving Levin Associates saw health-care merger activity shoot up 11 percent, from $205 billion in 2010 to $227 billion. Their analyst, Stanford Steever, attributed that largely to the Affordable Care Act.

Others, however, point out that it’s too early to see any data on health-care outcomes, as only a handful of the payment reforms have come online. And there are signs that the industry may not be ready to leave the payment model it’s depended on for decades.

The Obama administration stumbled in launching its most sweeping effort, the Accountable Care Organization program. The hope was to get health-care providers to band together and accept a flat fee for all the care provided to a set population of Medicare patients. That way, different providers would have an incentive to coordinate the care a given patient was getting by different specialists. Currently, individual patients can be treated by many different doctors who aren’t full aware of what the others are doing, much less working in close cooperation with them.

“Initially, there was a lot of euphoria about the ACO concept,” says Anders Gilberg, senior vice president of government affairs at the Medical Group Management Association.

When draft regulations came out, providers balked, contending in thousands of comment letters that it was too much of a gamble. If patients’ care costs didn’t decrease, health systems would find themselves in the red.

“There’s a lot of risk, and it’s frankly for an unknown reward,” Gilberg says.“So I’d question, as this is structured, whether it will fundamentally change our health-care system.”

The White House revised the rule, and eventually attracted 32 health systems to kick off the program, as so-called ACO Pioneers. But those systems, so far, report little change in how they deliver care: The ones who felt confident enough to participate were already delivering integrated care and, with the start up costs of administering the program, are not certain they’ll see significant savings.

“We’re not projecting this to be a windfall,” says Mark Eustis, president of Fairview Health System in Minnesota, an ACO site. “We’re hopeful we’ll cover the revenue lost that we would have received in a fee-for-service plan. We’re not expecting big increases in what we’re actually paid.”

Other providers who like the idea of more value-based reimbursement also question its limits. Baptist Health Systems managed to net $8 million in savings when it started accepting flat fees. But most of that came from negotiating lower prices on the medical devices it used. Only about 10 percent of savings came from making the hospital’s care model more efficient. “What we got first was the low-hanging fruit,” Zucker says.

Value-based reimbursement comes with a bevy of logistical challenges. A health-care system must figure out what counts as quality care, the metrics by which it ought to judge its doctors and hospitals. It also has to decide who gets what share of the savings. At Baptist, surgeons have questioned how the hospital divvies up its own savings (which is, in some ways, constrained by the terms Medicare set).

“The hospital got $8 million, and the surgeons got $1 million,” says Ty Goletz, a orthopedic surgeon at Baptist. “That’s not necessarily looked on favorably by physicians.”

The obstacles likely explain why, for its part, Medicare does not expect volume-driven medicine to disappear overnight. “For the time being and the future, we’re going to have a large proportion of Medicare who are paid through fee-for-service,” Medicare’s deputy administrator Jonathan Blum said.

But the system, he says, is shifting away from it. “The goal, quite simply, is to improve our quality metrics and bring down per-capita costs,” Blum continued. “That’s going to be the ultimate success.”

When Baptist Health Systems started down this path in 2008, it had little idea where it would lead or whether the doctors would revolt. Now that 78 percent of his doctors have received bonus checks, Zucker is more confident.

“It’s created a different relationship between us and our physicians,” he says. “For a long time, we’ve kept each other at arm’s length. And this really changed how we looked at physicians.”

Baptist Health System recently applied for the Affordable Care Act’s new bundled-payment program, which will shift more procedures to flat fees. That program will also expand the amount of cost savings that doctors are allowed to receive. It’s another step in the right direction, says Goletz, who has operated at Baptist for three decades.

“The way I look at it, Medicare used to pay a bunch of money into a bunch of little buckets, and some were ours, and some were theirs,” he says. “We decided that rather than paying into those little buckets, we should pay into one big bucket. We cleaned up the waste, saved money and lowered our costs.”


Sources: C-Span, Washington Post, White House.gov, Youtube

Health Care Law Forces Some To Change Coverage? Broken Promise Or No? (Videos)

Health-Care Rules May Force Some To Change Health Care Coverage, Leaked Document Suggests



President Barack Obama said repeatedly during the health-care debate that people who like their current coverage would be able to keep it. But an early draft of an administration regulation estimates that many employers will be forced to change their health plans under the new law.

In just three years, a majority of workers -- 51 percent -- will be in plans subject to new federal requirements, according to midrange projections in the draft.

Plans that predate the health-care law are exempt from many, but not all, of its consumer protections. Types of changes could include offering preventive care without co-payments and instituting an appeals process for disputed claims that follows new federal guidelines. The law already requires all health plans to extend coverage to young-adult children until they turn 26.

"What we are getting here is a clear indication that most plans will have to change," said James Gelfand, health policy director for the U.S. Chamber of Commerce. "From an employer's point of view, that's a bad thing. These changes, whether or not they're good for consumers, are most certainly accompanied by a cost."

The Obama administration said the draft regulation is an early version undergoing revision, but the leaked document was drawing wide interest Friday.

Senate Minority Leader Mitch McConnell (R-Ky.) said it showed that Obama's assurance that Americans would be able to keep existing plans was "a myth."

"Since its passage, Republican arguments against the bill have been repeatedly vindicated, even as the administration's many promises about the bill have been called into question again and again," McConnell said.

An administration official, speaking on condition of anonymity because the rules are still being written, said the final version will uphold Obama's promise, accommodating employers' desire for flexibility while protecting consumers from runaway costs.






View Larger Map



Sources: CBS News, TPMtv, Washington Post, Youtube, Google Maps

Kathleen Sebelius Warns Insurers: Beware! You Won't Succeed In Blocking Health Care Reform!

MSNBC----

The insurance lobby won't be able to block a public health plan because most Americans realize they would be better off if the industry had competition, Health and Human Services Secretary Kathleen Sebelius said Tuesday as congressional committees worked to shape legislation.

In an interview with The Associated Press, Sebelius said that President Barack Obama does not want to drive health insurers out of business, but make them more competitive by offering working families and small businesses the option of a public plan without the high overhead costs of marketing, administration and profits.

"I think there is a lot of understanding that the private market has really failed to provide affordable coverage to Americans," Sebelius said. The industry has had "a lot of opportunities" to get rid of coverage restrictions and other unpopular policies, Sebelius said, and really "hasn't served Americans very well."

However, Sebelius stressed that Obama is open to compromise on the shape of the public plan, which doesn't have to be run by the government. She spoke positively of a compromise idea that envisions consumer-owned nonprofit cooperatives, like rural electricity or agriculture co-ops. They would get started with seed money from taxpayers but then compete without government control. The plan by Sen. Kent Conrad, D-N.D., may end up in a health overhaul bill to be unveiled by the Senate Finance Committee this week.

In the end, the insurance industry will blink first in any showdown over a public plan, Sebelius predicted.

"I think they understand there's a lot of momentum both in the House and in the Senate for something to pass, and they'd much rather be inside the room, having those discussions, and helping to shape it as much to their liking as they possibly can," she said.

Sebelius, the former Kansas governor and insurance commissioner, is taking on an increasingly upfront role as a spokeswoman for Obama's effort to overhaul the health care system to provide coverage for nearly 50 million uninsured and restrain costs.

The massive department she heads, Health and Human Services, is working on plans to expand coverage by signing up more people who are eligible for existing government programs such as Medicaid and children's health insurance.

A years-long process:

In the interview, Sebelius also said that covering the uninsured could take years, even if Congress passes a bill and Obama signs it into law this fall.

Stretching out the phase-in period could make it easier to handle the costs of the bill, estimated at $1 trillion over 10 years at least, a sum that already is prompting second thoughts from some key lawmakers.

Qualming concerns:

The idea of a public plan has drawn sharp opposition from the insurance industry, which sees it as a step toward a government-run system like in Canada or the United Kingdom. Business groups, doctors and hospitals also have concerns. Republicans have made the issue the cornerstone of their opposition to Obama's health care push. And while liberals enthusiastically support a government plan, conservative Democrats are leery.

Sebelius said that Obama is not trying to run insurers out of town.

The notion that a public option "is really the stalking horse" for a government-run system "is not accurate," Sebelius said.

A public plan would be offered along with private ones through a new kind of insurance purchasing pool called an 'exchange.' The exchanges would be open to individuals and small businesses, and maybe even some large companies. Sebelius said a public plan would provide a standard for affordable coverage against which private insurance can be measured, especially in undeserved areas of the country.

Underestimated costs:

Sebelius' comments came after disappointing cost estimates for health care legislation by Sen. Edward M. Kennedy. The Congressional Budget Office released estimates that his bill would cost about $1 trillion over 10 years and only cover about one-third of the nearly 50 million uninsured. Budget officials cautioned that these were early estimates of a bill that's only partly written.

Sebelius discounted the early estimates, while saying the administration wants to keep the cost at about $1 trillion over 10 years, with about two-thirds of that coming from shifting funds from existing health programs like Medicare and Medicaid.

While Sebelius said the "ballpark" cost for providing full coverage seems to be about $1 trillion, the budget office estimates suggested the price tag could get even bigger.

Costs are becoming a big worry for moderate Republicans the administration is hoping to win over.

Sen. Olympia Snowe, R-Maine, on Tuesday said the process that produced Kennedy's bill is "broken."

"We have a fundamental obligation to ensure this legislation does not increase the deficit and, sadly, current congressional health care reform efforts fall woefully short," Snowe said in a statement. Obama also says he wants the bill to be fully paid for.

Stretching out the length of time for providing benefits under the bill could be one way to deal with the cost crunch.

"Will something probably be phased in? You bet," Sebelius said in a question-and-answer session with The Associated Press. "It won't start the day after the bill passes." It could take until sometime during the next presidential term, which starts in 2013, she said.


View Larger Map

Sources: MSNBC, Google Maps