Some patients walked away when they learned that the hospital would be charging them hundreds of dollars for treatment because they couldn’t prove their enrollment in the federal health care system.
“They had no idea if my insurance was active or not,” one woman, Maria Galvez, said to The Daily Mail, outside the Inova Healthplex facility in Springfield, Va. So instead of paying the $500 or more for her needed chest x-ray, she left – untreated, the paper reported.
“The people in there told me that since I didn’t have an insurance card, I would be billed for the whole cost of the x-ray,” she said. “It’s not fair. You know, I signed up last week like I was supposed to.”
Ms. Galvez said she had enrolled in Carefirst Blue Cross three days before Christmas, for $450 per month.
At the same time, she said, in The Daily Mail, “no one has sent me a bill.”
Ms. Galvez’s experience was shared by others.
A woman who asked to be published only by the name Mary said she couldn’t receive emergency services at the Inova Alexandria Hospital down the road, in Alexandria, Va., for the same reason.
“I had chest pains last night,” she said to The Daily Mail, on Thursday. “They took me in the emergency room. They told me they were going to admit me, but when I told them I hadn’t heard from my insurance company since I signed up, they changed their tune.”
She said that a nurse told her that her hospital bill would be at least $3,000 a day if she stayed, due to her inability to prove insurance coverage.
Rather than stay and pay, she left.
“Should I be in the hospital? Probably,” she said, The Daily Mail reported.
“Maybe it’s one of those borderline cases. I have to think that if I were really in danger, they wouldn’t give me the choice. But what if I think I’m covered and I’m really not? The emergency room bill is going to bad enough.”
Everybody is talking about how Obamacare will look on January 1, 2014.
But how will things look on January 1, 2015?
We put that question to eight smart people who follow health policy.
They represent different political perspectives and come by their expertise in different ways.
There's an economist, three trained physicians, plus a longtime consumer advocate and organizer. Two of them worked for Republican presidents, one served a Democrat.
One frequently criticizes Obamacare from the right, another from the left.
But their predictions have more in common than you might suspect:
1) ****HAROLD POLLACK:
In 2014, the most interesting political and policy stories will shift from Washington to the fifty states. States face a mammoth implementation challenge. They also provide the terrain in which we will see whether bipartisan health policy is actually possible. In some parts of the country, we’ll see some fascinating negotiations as Republican governors and the Obama administration each seek a dignified path to make this thing work.
I hope that we see something else, too: An end to the politics of impunity toward the poor and the uninsured.
It’s sobering to think that the same inequalities that make universal coverage a moral imperative pose the chief political obstacles to universal coverage itself. Those with the most to gain from the Affordable Care Act’s Medicaid expansion are economically marginal, disorganized, alienated from the levers of politics, distrusted or disliked by many other Americans. This reality produces a striking sense of impunity among governors and legislators who deny Medicaid coverage to five million people, even as the federal government stands ready to foot virtually the entire bill.
As Medicaid expansion becomes real, Republican politicians who embrace it will begin to profit. Hospitals, cities and counties, and other interest groups in non-expansion states will ask hard questions about why their states chose a different path. Poor people themselves, in campaigns such as texasleftmeout.org, will increase the pressure, too.
It’s important that these recalcitrant officials pay some price—not just to smooth the way for expanded coverage, but to debunk a particularly toxic assumption in American life. Too many politicians assume that poor people just don’t matter, politically. On many issues from the sequester to unemployment insurance, the practical consequences of this assumption are only too obvious.
This assumption is being put to the test. In 2014, I’m betting that some governors will be surprised.
2) ***GAIL WILENSKY:
As expected, 2014 was a tumultuous year for the Affordable Care Act. It started in January with many people who thought they had enrolled not actually being insured--either because the information hadn't been accurately transmitted back to their insurance companies or because they hadn't paid their premiums by January 10. After a lot of pressure from the Administration to cover people retroactively if necessary, people newly insured began receiving services.
Access to health services was less problematic than many had feared because of the smaller-than-predicted numbers enrolling in private insurance. Only 4.5 million got coverage, even after the March surge in sign-ups. And there were the many "red" states that hadn't expanded their Medicaid coverage. Some states reported challenges getting primary care services provided to the newly insured--California having the most significant problems.
Some of the smaller regional insurance companies participating in 2014 decided not to participate again in 2015. Some larger companies that had only selectively participated in 2014 increased their participation only modestly for 2015, still concerned about the significant adverse selection that had occurred in 2014 and their difficulty to price properly.
The biggest uproar occurred when many smaller/mid-sized employers received notices that their existing policies didn't meet ACA standards and weren't being renewed. As expected, the Administration provided a variety of accommodations to these employers.
The best news is that the majority of states that had not previously expanded Medicaid announced intentions to do so for 2015. The bad news is that the newly elected Congress is even less likely to pass any legislative "fixes" than the previous Congress.
(Gail Wilensky has served as director of Medicare and Medicaid and she has chaired the Medicare Payment Advisory Commission. She is now an economist and senior fellow at Project HOPE.)
3) ***ANTHONY WRIGHT:
By the end of 2014, more than 2 million Californians will be enrolled in new coverage options under the Affordable Care Act. A million will have coverage through our exchange, Covered California, following its second open enrollment period. More will be getting coverage through our Medicaid program. Already 700,000 newly covered people have insurance through an early expansion of Medicaid; by February it will be more than 1 million.
Washington-based media will continue to hyperventilate about Obamacare, mistakenly using every website glitch or early enrollment figure as a binary barometer of the law’s success or failure. But even in a state like California—where the website (mostly) works, premiums came in below expectations, and enrollments are on target—officials aren't putting up a “Mission Accomplished” banner yet. Just as rollout problems were never indications of the ACA’s demise, progress to date is not proof the job is finished.
As elections are about the future, not the past, I predict Obamacare itself won't be a major factor in future contests. The debate will be “What’s Next?”
In states that have been more hostile to the law, at least some officials will change their minds about the Medicaid expansion, allowing it go forward.
In states like California that have embraced the law, officials and supporters of reform will focus on improving the law. Among the questions they will address:
1. How can we ensure a safety-net that survives and thrives—to provide primary and preventative care to the remaining uninsured, including undocumented immigrants that were excluded from the ACA?
2. How can we further regulate the insurance market—beyond basic steps like banning pre-existing condition exclusions—so that insurers compete not on avoiding sick people, but on cost, quality, customer service and prevention? How else can we make the health industry more accountable for improved quality and reduced cost of care? California is likely to debate (through bills, the budget, and the ballot box) more oversight of networks, transparency of health spending, rate regulation, investments in prevention and public health, and more.
While we will concentrate on the unfinished work of implementing the law in 2014, the work to fulfill the full promise of the law will be just beginning.
(Anthony Wright is director of Health Access California, a consumer advocacy organization.)
4) ***SEAN PARNELL:
Although it’s unlikely that 2014 will be as bad for the ACA as the initial rollout was, the law still faces significant challenges in the New Year.
The biggest hurdle will be enrollment, particularly among the young and healthy. Deductibles are high, premium subsidies generally aren’t available except to the poorest, the tax for being uninsured is low, and the young have always been overrepresented among the uninsured. This will continue to be the case in 2014 and beyond.
Late in 2014, insurers will announce premiums for 2015. They will be higher, inflicting a political price on Democrats. Expect more creative interpretations and regulatory flexibility out of the Obama administration in order to smooth over more unintended consequences of the ACA.
There will be more Americans who pay directly for more of their health care. The ACA is projected by the Congressional Budget Office to leave 30 million people uninsured, and tens of millions more will get high-deductible plans through exchanges or their employers. These self-pay patients will demand price transparency and discounts for paying in full at the time of treatment, and innovative entrepreneurs will step up to cater to them while ignoring the traditional third-party payment system.
At the end of 2014, I expect to see many advocates of the ACA look back and conclude that while it’s too early to call the law a failure, the meager results fall far short of what was hoped for.
(Sean Parnell is author of The Self-Pay Patient and a writer at www.theselfpaypatient.com)
5) ***DAVID BLUMENTAL:
The most recent CBO projections for ACA coverage, from May 2013, suggested there would be 7 million new privately insured Americans and 9 million new enrollees in Medicaid/CHIP by the end of 2014.
Through December 30, 1.9 million Americans had enrolled in private coverage through the federal and state marketplaces. As of December 20, 627,000 had enrolled in Medicaid/Chip. Let’s assume that by January 1 the numbers stand at about 2.0 million for private insurance (30 percent of the CBO 2014 target) and 1 million for Medicaid (11 percent).
The real deadline, however, for the first ACA open enrollment period is March 31, 2014, when penalties kick in. It would be reasonable to expect enrollment during February-March, 2014 to equal the 2013 numbers, bringing the total for private enrollees to about 4.0 million or 60 percent of CBO projections
Medicaid/CHIP numbers are harder to predict because enrollment can proceed continuously over the year. Assuming 1.5 million Americans enroll in Medicaid/CHIP during 2014, participation in public plans would come to 2.5 million or about 28 percent of projected.
Including the 3 million young people under 26 who have gained coverage under their parents’ plans in 2013, these projections would mean that a minimum of 10 million Americans would have become newly insured under provisions of the Affordable Care Act by the end of 2014.
As for costs, the ACA is given some credit (deserved or not) for keeping growth in overall health care costs below historical rates. However, times of rising personal wealth have always been times of rising health care spending. If the economy experiences strong GDP growth in 2014, growth in health spending is also likely to increase beyond the 2012 level of 0.8 percent per capita. A reasonable prediction: both GDP and health care will grow in the 2-3 percent range.
As a percent of GDP, health care expenses would remain unchanged at the 18 percent level.
This would have been viewed as a big accomplishment only a few years ago, but that was then.
(David Blumenthal, who has been a professor of medicine at Harvard and the National Coordinator for Health Information Technology, is now president of the Commonwealth Fund.)
6) ***TEVI TROY:
One year from now, the Affordable Care Act will be hobbled but still there. The hangover from the botched rollout will continue to haunt the program, but the website will be in better shape, and an increasing number of people will be getting subsidized insurance via the exchanges. At the same time, sticker shock will continue, especially among those without access to subsidized rates, and take-up rates will continually be lower than the administration predicted.
This will lead to a situation where Democrats are touting the number of covered individuals and calling the ACA a success, while Republicans will highlight the increased costs, lower than expected numbers of covered individuals, and the roll out problems to determine that the plan is a failure. The answer to the question of whether the law is a success or a failure will come from the employer-based market. If employer-based plans continue without significant disruptions, the ACA will weather the storm; but if individuals in the employer-based market lose their insurance or see major changes in their plans, the ACA’s political troubles will worsen.
In addition, one year from now, Republicans will be pleased with their election gains in the House and Senate, but will also realize that, even with their political victory, they cannot repeal the ACA while a lame duck President Obama remains in office.
This will set up the 2016 election as yet another do-or-die test for the ACA.
(Tevi Troy is a former Deputy Secretary of HHS and the author of What Jefferson Read, Ike Watched, and Obama Tweeted: 200 Years of Popular Culture in the White House.)
7) ***JOHN Z. AYANIAN:
The most notable change will be 12 million newly insured Americans. In May, 2013 the Congressional Budget Office (CBO) projected 9 million low-income adults would gain coverage in states opting to expand Medicaid during 2014, and another 7 million Americans would obtain private insurance through new federal and state health insurance exchanges. However, because of incomplete ACA awareness among eligible adults and early technical problems with the exchanges, I expect overall enrollment gains in 2014 will be 12 million instead of 16 million Americans.
A second major change over the next year will be much better functioning insurance exchanges. Major problems faced by HealthCare.gov and many new state exchanges will be essentially resolved through effective technical solutions.
The ACA’s future hinges on the U.S. Senate elections in 2014. If Democrats retain control of the Senate, ACA implementation will continue largely as planned. In contrast, if Republicans control both the Senate and House in 2015, Republicans and moderate Democrats in Congress will agree to change several features of the ACA. Essential benefit requirements for insurers will be loosened, financial penalties for uninsured individuals will be lightened, insurance subsidies will be reduced or eliminated for some currently eligible households (those at 300-400% of the federal poverty level), and the medical device tax will be eliminated. Because President Obama will veto a full ACA repeal, its two core components—Medicaid expansion in 25 or more states and subsidized private coverage for most currently eligible households—will be preserved until the 2016 Presidential election.
(John Z. Ayanian is a professor of internal medicine and director of the Institute for Healthcare Policy and Innovation at the University of Michigan.)
8) ***DON MCANNE:
There is no doubt that, in 2014, we will see enough individuals enrolled in Medicaid, in the exchange plans, and some new enrollment in employer-sponsored plans (to avoid the penalty, though small this year), that the Affordable Care Act will be considered a success. But success is not measured by enrollment in insurance plans but rather by the ability to obtain access to affordable health care.
Not only will tens of millions remain uninsured, those insured that need health care will face financial barriers of high deductibles and other cost sharing, and many will face lack of choice due to narrow provider networks. Unavoidable care provided out of network could result in catastrophic expenses. We will continue to hear stories of people facing excess costs and network problems that will prevent them from accessing care of their choosing.
Already, from both the left and the right, there is much discussion of single payer (improved Medicare for all) as an inevitability once it is realized how poorly functioning will be our fragmented, dysfunctional system of financing health care. We will not see the threshold for action in changing to single payer reached this year, but within a few years, demand for change will occur.
The feeble recommendations from the right would only make things worse, partly by diminishing what little protection we do have, so there isn’t much left other than single payer. Once enough people understand that all of us can have free choice of care that is affordable through equitable public funding, they will demand single payer.
(Don McCanne is a senior health policy fellow with Physicians for a National Health Plan.)
Responding to Thursday’s Supreme Court decision upholding the constitutionality of the Affordable Care Act, Congressional Republicans have scheduled a vote in the House to repeal the law and Mitt Romney pledged to undo the measure if he’s elected president in November.
But unless the GOP wins a super majority in the Senate — a scenario no one thinks is plausible — it can do little more than weaken Obamacare’s regulations and defund some of its provisions.
Here is why:
1) Romney has no authority to issue waivers.
Romney has promised to expand a provision of the Affordable Care Act that allows states to opt out of certain sections of the law to permit states to ignore it entirely. But the executive branch and the Department of Health and Human Services (HHS) likely don’t have the authority to grant such broad waivers.
According to the law, HHS (together with the IRS) have waiver authority, but only if the states meet very specific requirements.
Neither have blanket waiver authority, which would have to come from Congress.
Sen. Ron Wyden (D-OR) — the author of the waiver provision — has challenged Romney’s claims, saying, “Anybody who tries to move outside the standards of the bill — which is the coverage and costs and the like — well I’ll certainly fight that. But I think lots of other people will too.”
2) Congress can’t repeal the full law through reconciliation.
Without the necessary 60 votes in the Senate for full repeal, Republicans are pledging to use a budget reconciliation bill to undo the ACA.
But this process would only apply to the budget-related elements of the law and would thus leave many portions — including the mandate — intact.
As health care expert Robert Laszewski put it, “Romney could end up creating a chaotic environment driven by enormous uncertainty over just which parts of the new health care law would be implemented–for consumers, health care providers, and insurers.”
3) Republicans have nothing to replace it with.
David Frum explains that since the expansion of coverage provisions go into effect in 2014, Romney would have just one year to both repeal and replace the law.
Republicans haven’t even coalesced around a single plan — and many in the party believe that the federal government should leave health care alone and want to leave the entire reform process to the states.
Thus, “if replacement does not happen in the first 100 days, it won’t happen at all—that is, it won’t happen as a single measure, but rather will take the form of dozens of small incremental changes adopted episodically over the next 20 years.”
4) Americans support Obamacare’s provisions.
While Americans may not like “Obamacare” — and the political process of passing it — they do support its major provisions and are likely to resist any effort by Republicans to take away their benefits.
A recent Reuters/Ipsos poll found that while 56 percent of Americans oppose the law as a whole, 61 percent of respondents favored allowing young adults to stay on their parents’ insurance plans until age 26, 72 percent wish to maintain the requirement that companies with more than 50 workers provide health insurance for their employees, and 82 percent of respondents favored banning insurance companies from denying coverage to people with pre-existing conditions.
As more benefits roll out in 2014, it will be increasingly difficult for Republicans to argue for their repeal.
Mitt Romney, speaking just before noon today, declared that on his first day in office, “I will act to repeal Obamacare.” I think he chose his words carefully. As President, he may indeed “act” to repeal it on Day One, but I don’t believe he will actually be able to overturn the law.
If Romney were to win in November, the first matter he’d have to deal with would be the fallout from the so-called fiscal cliff of December 31st, the day when some five hundred billion dollars worth of tax increases and spending reductions take effect, which could put the economy into another recession (if it’s not already in recession by then).
This moment would perhaps be Romney’s greatest chance at repeal.
Because the fiscal-cliff negotiations will be an enormous fight over the size and scope of the federal government, every government policy will theoretically be open to debate—including, Romney might insist, repeal of the A.C.A.
But it’s a fantasy.
The negotiations would be dead before they started if Republicans demanded repeal as a price for a Grand Bargain on taxes, spending, and entitlements. The fiscal-cliff negotiations will undoubtedly include a great deal of horse-trading that will infuriate and cheer partisans on both sides.
But there is literally nothing Republicans could offer Democrats in return for repealing the Party’s greatest achievement since the Johnson Administration.
Assuming that Romney comes through this period of his transition and Presidency with a deal that settles the tax and spending issues brought about by the fiscal cliff (and the related debt-ceiling vote that will likely happen weeks later), he could then return to his domestic agenda, which, he declared today, includes repeal of the A.C.A. as the first priority.
But he would immediately face a set of political circumstances similar to the ones that made health care such a difficult issue for Obama in 2009.
Absent the Senate Democratic Caucus being found to be running a crack house or chid-prostitution ring, there is no prospect whatsoever of the Republicans winning a sixty-vote, filibuster-proof majority in the Senate this year.
The most likely outcome is the Democrats narrowly retaining control, though Republican control is certainly within the realm of possibility.
Assuming that Romney comes to Washington without a sixty-vote majority in the Senate, the task of repeal will be nearly insurmountable.
First of all, the Congressional Budget Office, which “scores” all legislation—and which so frustrated Obama in 2009 that he refused to mention its name in White House meetings, demanding instead that aides call it “banana”—would now be the A.C.A.’s best friend.
The last time the C.B.O. weighed in on the matter, it reported that repeal of the A.C.A. would cost the government almost three hundred billion dollars.
Republicans dispute that, but they’d still be under pressure to explain where they would come up with that money. The bigger problem, of course, would be in the Senate.
Remember the weeks that the Senate Finance Committee spent arguing over health care?
The committee would need to return for a repeat performance.
If Democrats still controlled the committee, Republicans would have to somehow force it to debate repeal and find at least one Democratic vote to send repeal legislation to the full Senate.
This is unlikely to happen.
But if it does, in order to become law, Romney’s repeal of the A.C.A. would face a battery of three separate tests requiring sixty Senate votes: one to bring the legislation to the floor, one to start the debate, and one to end the debate.
The filibuster, the G.O.P.’s favorite parliamentary device of the Obama era, would now be the Party’s great enemy.
Many Republicans, especially in the blog and talk-radio swamps, would cry, “Use reconciliation!” Readers familiar with the congressional debates of 2009-2010 will remember that this procedure allows certain budgetary measures to pass through the Senate with a simple majority.
(After Ted Kennedy died and was replaced by the Republican Scott Brown, Obama and congressional Democrats used the reconciliation process to make some final, crucial changes to the health-care law.)
But reconciliation wouldn’t work here—the process can only be used for policies that have budgetary effects and a C.B.O. score. Much of the A.C.A., such as the insurance exchanges and subsidies, would fall under these categories.
But a lot of it, including the hated individual mandate, does not. Repealing the exchanges and subsides without repealing the mandate and the other regulations and cost controls in the law would create a health-care Frankenstein that a President Romney would be rather nuts to support.
If the Supreme Court had gutted the law today by throwing out the mandate and the regulations and several of the other “non-scoreable” items, a President Romney with a G.O.P. Congress might have had a relatively easy time finishing the job of killing Obama’s law, even without sixty votes in the Senate.
But today the Court did two things that make repeal of the A.C.A. nearly impossible now: it has given its not-inconsequential stamp of legitimacy to the law, and it has made the parliamentary path of repeal through Congress highly unlikely and probably impossible, at least in the near future.
Far-sighted conservatives always thought that their great hope for toppling Obama’s most important legislative achievement was through the courts.
They were correct.
Sources: CBS News, Face The Nation, Fox News, New Yorker, Think Progress, Youtube
He Trusted Olympia Snowe an Experienced, Seasoned Legislator who he thought really Cared More about helping people than about Politics.
He was Wrong!
Olympia Snowe cared more about Politics and about helping her party (GOP) Win.
This is So Sad.
What about the Millions of Uninsured People?
Do GOP Leaders care about those people?
If Pres. Obama's Health Care law is Struck down he should Shout it from the 4 Corners of America about the Good things his Law Offered.
The GOP has NO Replacement at ALL!
Thus Millions of Children & Adults with Pre-Existing Conditions will Suffer.
If I were Pres. Obama I would NOT let the American People forget this harsh reality.
While its true Pres. Obama's Affordable Health Care Law was NOT Perfect, it was most certainly necessary.
An Adverse Ruling by the SCOTUS will most certainly cause Political Implications for the GOP and help to Sink Mitt Romney's Ship come November.
I again ask GOP Leaders, what do you have to Replace the Affordable Health Care Act?
Especially for Millions of Children & Adults with Pre-Existing Medical Conditions??
WHAT??
Senator Snowe if the Affordable Health Care Act is Struck down by the High Court, I hope you can Sleep peacefully at night knowing Millions of Children & Adults with Pre-Existing Medical Conditions will NOT be eligible for Health Insurance.
If Your Political Party (GOP) Wins this battle, was it worth it??
Late on Tuesday, March 27, halfway around the world, President Obama began one of the most suspenseful waits in recent presidential history.
After a blur of nuclear security meetings in South Korea, Mr. Obama settled into the Air Force One conference room to read a summary aides had written of that day’s arguments before the Supreme Court back in Washington. The justices had asked deeply skeptical questions about his health care law.
Mr. Obama’s most profound policy achievement was at much higher risk of defeat than his aides had expected, vulnerable to being erased by the margin of a single justice’s vote.
Since then, Mr. Obama and the White House have put on brave faces, insisting that the law and the mandate at its center will be upheld when the court rules this month. In private conversations, they predict that the bulk of the law will survive even if the mandate requiring Americans to buy health insurance does not.
But even if the White House is a fortress of message discipline, it cannot disguise the potential heartbreak for Mr. Obama, who managed to achieve a decades-old Democratic dream despite long odds and at steep cost.
If he loses both his law and re-election, many will conclude “that he bet on his major reform, and the Supreme Court defeated it, and he lost his hold on the presidency,” Robert Dallek, the presidential historian, said in an interview.
On the day the ruling comes out, one Obama adviser joked, “I might have to clean out my sock drawer.”
In grappling with what the court may do, Mr. Obama and his advisers now appear to be far past the denial stage (when they dismissed constitutional challenges) but nowhere near acceptance (they still believe the law will be upheld.) Instead, they have quietly entered a surprising new state that might be called Learning to Live Without Universal Coverage.
Former advisers are emphasizing the many aspects of the bill that are not connected to the mandate, like the subsidies to buy insurance. Some aides even argue privately that losing the mandate could be a political boon, because it would rob Republicans of their core complaint against the law.
But that position has a not-small problem: it directly contradicts the argument the administration so strenuously made to the court, which is that the law cannot work without the mandate.
It is also uncomfortable for a deeper reason, one that goes to the core of who Mr. Obama wanted to be as president. Earlier in his term, he refused every chance to settle for the more limited health care overhaul that the Supreme Court may now effectively deliver, making epic sacrifices to win something far broader.
Before he became president, critics said that Mr. Obama’s greatest achievement was his own rise, that he played it safe — sometimes voting “present” in the Illinois State Senate — rather than taking risks for what he really believed. “What’s he ever done?” Representative Bobby L. Rush, Democrat of Illinois, asked repeatedly in 2000 when he crushed his upstart Congressional challenger, and opponents later echoed the question.
Early in the presidential race, Mr. Obama summoned the historian Doris Kearns Goodwin for a conversation about Abraham Lincoln. He was only an upstart candidate, but he was already talking about leaving a legacy, about accomplishing vast things.
In the White House, many of his top advisers, including Vice President Joseph R. Biden Jr. and his first chief of staff, Rahm Emanuel, counseled Mr. Obama against a sweeping health care overhaul. By summer 2009, with the country still stunned by economic crisis and Republicans falsely raising the specter of death panels, some aides practically begged the president to scale back, take interim steps and move on to other issues.
Mr. Obama did not relent. He had an economic rationale for stabilizing a dysfunctional health system, but he also “saw what Teddy called the moral issue,” Victoria Reggie Kennedy, Senator Edward M. Kennedy’s widow, said in an interview, referring to her husband. For those who wondered what Mr. Obama really believed in, universal health coverage seemed to be the answer.
As the brutal fight continued, the president sacrificed more and more in its name: an overhaul of energy and environmental laws, greater focus on economic issues, some of his own popularity and that of House Democrats, who eventually lost their hard-won majority. “Michelle and I are perfectly comfortable if we’re only here one term if we feel like we really accomplished something,” he told aides.
That declaration sounds different today. Mitt Romney, the presumptive Republican presidential nominee, uses “Obamacare” as an epithet and applause line, promising outright repeal if he wins. A few years ago, the health care law seemed a reason for Mr. Obama to risk losing re-election, former aides said. Now, it is a reason he feels he must win re-election.
As he awaits the decision, Mr. Obama has no more knowledge of or influence on it than any of the other lawyers handicapping the odds in Washington bars and boardrooms.
The former law professor turned president is scathing about the argument that the mandate violates the Constitution, saying it has no merit whatsoever. Sometimes, to the nervousness of advisers, he says as much in public; a few days after oral arguments, he laid down a gauntlet for the Supreme Court, all but saying that striking down the law would be politically motivated judicial activism. (He later softened his statement.)
“To have a voice as profound as the Supreme Court say it’s unconstitutional,” said Jonathan Gruber, an economist at the Massachusetts Institute of Technology who was an adviser on the law, would be “bad news all around.”
But there are clues that Mr. Obama is privately grappling with both the potential loss of universal health care and how much of it he might be able to restore. At a recent fund-raiser in Manhattan, he rattled off a second-term agenda, and along with tax reform and immigration, he mentioned coming back to health care, to work around a negative ruling. His tone was matter-of-fact, one attendee said.
If the court strikes down the mandate and Mr. Obama wins in November, he could face one last version of his perpetual choice on health care: would he settle, learning to live with a sharply edited law? (Given that Republicans see the bill as a signature piece of big-government overreach, he might have no choice.) Or would he expend yet more precious capital on health care?
Ezekiel Emanuel, Rahm’s brother and a former health adviser to the president, predicted the second path. “Too much of the president’s legacy — and the good of the country — is tied up with this,” he said.
The final result on health care, then, will help determine whether Mr. Obama is the game-changing president he aspired to be.
“This is his singular policy achievement,” said Barry Friedman, a law professor at New York University who wrote a brief supporting the law. “So there’s a palpable pain in having this go down.”
Though the White House continues to maintain official silence on contingency plans, Mr. Obama hinted at his thinking a few weeks ago. “In my first term, we passed health care reform,” he began a joke at the White House Correspondents Dinner in April. “In my second term, I guess I’ll pass it again.”
Politico’s Pulse reports that Maine Sen. Olympia Snowe (R) “is inviting people to send a ‘thank you’ note to the 11th Circuit Court of appeals for deeming the individual mandate unconstitutional.
“I applaud you and your efforts for standing up for the constitution and for defending my individual liberties,’ reads the note on her reelection website, conveniently omitting the fact the Snowe was the only Republican to vote in favor of the mandate when she supported moving the health reform legislation out of the Senate Finance Committee:
In fact, she did not publicly oppose the individual requirement to purchase coverage — which the 11th Circuit found unconstitutional — until October of 2009. Earlier that year, she had indicated that she could support an individual requirement if coverage became more affordable. “I understand the rationality behind the individual mandate,” Snowe said during the committee’s mark-up hearings. “Certainly we shouldn’t pay for those who don’t have health insurance.”
But this isn’t the first time Snowe has attempted to cloud her role in moving forward the health care legislation. In March, Snowe issued a press release announcing that she is co-sponsoring an amendment “to repeal the employer mandate imposed by the new health reform law.” The “mandate” she was referring to, however, is actually a “free rider” compromise provision that she helped broker in her effort to draft a bipartisan health care law.
A House Republican said Saturday his party would work to repeal President Obama's health care law if the Supreme Court upholds it next week.
"Not only is President Obama's health care law not working, it makes things worse by driving up health care costs, making it harder for small businesses to hire workers," said Rep. Bill Cassidy, R-La., during the Republican weekly radio address.
The Supreme Court is expected to rule next week on the constitutionality of the law that Obama signed in 2010.
Regardless of the ruling, health care figures to play a major role in the fall election between Obama and Republican Mitt Romney, as well as races for control of the U.S. House and Senate.
Cassidy, a doctor, said that if the GOP wins full control of Congress, it should repeal any existing parts of Obama's law, and replace it with a more gradual approach to health care policy.
"It's now clear, if it wasn't already, that containing costs step-by-step -- not expanding government in one fell swoop -- is the right approach to health care reform," Cassidy said.
The Republican radio address:
"Hello, I'm Bill Cassidy, a doctor and United States Congressman from the State of Louisiana.
As you know, the U.S. Supreme Court will soon rule on the constitutionality of the president's health care law, a law which continues to hurt job creation and damage our economy. Not only is President Obama's health care law not working -- it makes things worse by driving up health care costs, making it harder for small businesses to hire workers. The only way to change this is by repealing ObamaCare entirely.
So, unless the Court throws out the entire law, we should repeal what is left and implement common-sense, step-by-step reforms that protect Americans' access to the care they need, from the doctor they choose, at the lowest cost.
In this tough economy, the top health care concern of families and small businesses is out-of-control costs. Health care coverage has become too expensive for too many people. Two years ago, Washington Democrats pushed through ObamaCare and its 2,700 pages with promises that it would fix all this. It did not have popular support. It did not have bipartisan support. But its authors insisted that ObamaCare would make health care more affordable, and of course Americans hoped that would be true.
Instead, ObamaCare has turned out to be the wrong medicine for out-of-control health care costs. The law, as an example, is going to cost nearly twice as much as we were told, people are already paying more for their health care than they were before, and because of health insurance expenses, employers are canceling plans to expand their businesses, which is to say they will not be hiring new workers. With costs going up and too much uncertainty, this two trillion dollar takeover will result in more people being pushed out of the plan they enjoy today.
The Obama administration has tried all kinds of run-of-the-mill Washington tactics to distract from ObamaCare's failures -- issuing hundreds of waivers to selected businesses and unions and spending millions of taxpayer dollars on public relations campaigns.
None of this has worked, and now the vast majority of Americans want the Supreme Court to overturn all or part of ObamaCare. If that happens, it's important to know that Republicans will not repeat Democrats' mistakes. We will not rush through a massive bill the American people don't support or won't even have time to read to figure out whether they do support it. And we won't take our focus off jobs and the economy.
I have practiced medicine for nearly three decades primarily treating the uninsured ... I still see patients almost weekly. Good health care starts in a doctor's office, not a Washington backroom. It's now clear, if it wasn't already, that containing costs step-by-step -- not expanding government in one fell swoop -- is the right approach to health care reform. Families should be able to make their own health care choices, visit the doctor of their choosing, and receive the health care they and their physician feel is best. That means implementing patient-centered solutions that lower costs and restore Americans' freedoms over their health care decisions.
Again, Republicans continue, as promised, to focus on helping small businesses create jobs. The most recent jobs report pegged unemployment at 8.2 percent -- much higher than what White House officials said it would be by now with the 'stimulus' in effect. ObamaCare, with its fees, tax hikes, and costly mandates, makes this worse. We should seize this opportunity to protect jobs and work together on a step-by-step reform that does what ObamaCare did not do, which is to lower the cost of health care for families and small businesses. This is what Republicans hope to achieve, and we hope to have your support.
Thank you for listening, and God bless the United States of America."
Alarmed by a shortage of primary care doctors, Obama administration officials are recruiting a team of “mystery shoppers” to pose as patients, call doctors’ offices and request appointments to see how difficult it is for people to get care when they need it.
The administration says the survey will address a “critical public policy problem”: the increasing shortage of primary care doctors, including specialists in internal medicine and family practice. It will also try to discover whether doctors are accepting patients with private insurance while turning away those in government health programs that pay lower reimbursement rates.
Federal officials predict that more than 30 million Americans will gain coverage under the health care law passed last year. “These newly insured Americans will need to seek out new primary care physicians, further exacerbating the already growing problem of P.C.P. shortages in the United States,” the Department of Health and Human Services said in a description of the project that it submitted to the White House.
Plans for the survey have riled many doctors because the secret shoppers will not identify themselves as working for the government.
“I don’t like the idea of the government snooping,” said Dr. Raymond Scalettar, an internist in Washington. “It’s a pernicious practice — Big Brother tactics, which should be opposed.”
According to government documents obtained from Obama administration officials, the mystery shoppers will call medical practices and ask if doctors are accepting new patients and, if so, how long the wait would be. The government is eager to know whether doctors give different answers to callers depending on whether they have public insurance, like Medicaid, or private insurance, like Blue Cross and Blue Shield.
Dr. George J. Petruncio, a family doctor in Turnersville, N.J., said: “This is not a way to build trust in government. Why should I trust someone who does not correctly identify himself?”
Dr. Stephen C. Albrecht, a family doctor in Olympia, Wash., said: “If federal officials are worried about access to care, they could help us. They don’t have to spy on us.”
Dr. Robert L. Hogue, a family physician in Brownwood, Tex., asked: “Is this a good use of tax money? Probably not. Everybody with a brain knows we do not have enough doctors.”
In response to the drumbeat of criticism, a federal health official said doctors did not need to worry because the data would be kept confidential. “Reports will present aggregate data, and individuals will not be identified,” said the official, who requested anonymity to discuss the plan before its final approval by the White House.
Administration officials said the survey would yield an enormous benefit to the government while imposing an extremely limited burden on doctors.
The new health care law includes several provisions intended to increase the supply of primary care doctors, and officials want to be able to evaluate the effectiveness of those policies.
Federal officials said the initial survey would cost $347,370. Dr. Hogue said the money could be better spent on the training or reimbursement of primary care doctors.
Most doctors accept Medicare patients, who are 65 and older or disabled. But many say they do not regard the government as a reliable business partner because it has repeatedly threatened to cut the fees paid to doctors treating such patients. Congress usually steps in at the last minute to avert such cuts.
In many parts of the country, Medicaid, the program for low-income people, pays so little that many doctors refuse to accept Medicaid patients. This could become a more serious problem in 2014, when the new health law will greatly expand eligibility for Medicaid.
Access to care has been a concern in Massachusetts, which provides coverage under a state program cited by many in Congress as a model for President Obama’s health care overhaul.
In a recent study, the Massachusetts Medical Society found that 53 percent of family physicians and 51 percent of internal medicine physicians were not accepting new patients. When new patients could get appointments, they faced long waits, averaging 36 days to see family doctors and 48 days for internists.
In the mystery shopper survey, administration officials said, a federal contractor will call the offices of 4,185 doctors — 465 in each of nine states: Florida, Hawaii, Massachusetts, Minnesota, New Mexico, North Carolina, Tennessee, Texas and West Virginia. The doctors will include pediatricians and obstetrician-gynecologists.
The calls are to begin in a few months, with preliminary results from the survey expected next spring.
Each office will be called at least twice — by a person who supposedly has private insurance and by someone who supposedly has public insurance.
Federal officials provided this example of a script for a caller in a managed care plan known as a preferred provider organization, or P.P.O.:
Mystery shopper: “Hi, my name is Alexis Jackson, and I’m calling to schedule the next available appointment with Dr. Michael Krane. I am a new patient with a P.P.O. from Aetna. I just moved to the area and don’t yet have a primary doctor, but I need to be seen as soon as possible.”
Doctor’s office: “What type of problem are you experiencing?”
Mystery shopper: “I’ve had a cough for the last two weeks, and now I’m running a fever. I’ve been coughing up thick greenish mucus that has some blood in it, and I’m a little short of breath.”
In separate interviews, several doctors said that patients with those symptoms should immediately see a doctor because the symptoms could indicate pneumonia, lung cancer or a blood clot in the lungs.
Other mystery shoppers will try to schedule appointments for routine care, like an annual medical examination for an adult or a sports physical for a high school athlete.
To make sure they are not detected, secret shoppers will hide their telephone numbers by blocking caller ID information.
Eleven percent of the doctors will be called a third time. The callers will identify themselves as calling “on behalf of the U.S. Department of Health and Human Services.” They will ask whether the doctors accept private insurance, Medicaid or Medicare, and whether they take “self-pay patients.” The study will note any discrepancies between those answers and the ones given to mystery shoppers.
The administration has signed a contract with the National Opinion Research Center at the University of Chicago to help conduct the survey.
Jennifer Benz, a research scientist at the center, said one purpose of the study was to determine whether the use of mystery shoppers would be a feasible way to track access to primary care in the future.
The government could survey consumers directly, but patients may not accurately recall how long it took to get an appointment, and their estimates could be colored by their satisfaction with the doctor, researchers said.
I suggest the Obama Administration STOP listening to Rahm Emanuel and instead listen attentively to Dr. Howard Dean.
If we as a nation are going to reform our Health Care System why not do it right?
If we are NOT going to do it correct, GOP fairy tales of "Death Panels" will in fact become a reality.
Whether we like it or not, wish to admit it not Uninsured people who can't afford Health Care Insurance die!
This current version of Health Care Reform is not REAL Reform.
Since its been stripped down to nothing effective, the only population it will benefit are Health Care Executives.
Pres. Obama & Congress please lay aside your egos and listen to Dr. Dean's voice of reason.
History won't give us another shot at this effort so why not get it right once and for all?
Democrats what's more important? Your Political Careers or the lives of Human Beings?
Isn't it better to do it correct now than hurt millions of American Voters later with a crappy, non-effective bill?
If this crappy bill is pushed through just to score Political points or create a "Presidential Legacy", in 2010 & 2012 Democrats will pay a huge price at the Polls.
Giving free health care to all. Nicole Lamoureux of the National Association of Free Clinics, reports on Kansas City’s two day clinic which started Wednesday.
Have your checkbooks and credit cards ready. There's a price for health care security.
President Barack Obama's overhaul — now looking like it really will happen — should give uninsured Americans options they've never had before. But it won't be a free ride.
As with the Medicare prescription drug benefit that passed when Republicans ran Washington, consumers will face a dizzying lineup of health plan choices — with different costs and benefits.
"People who need to buy coverage as individuals and small employers are going to have a lot more in the way of attractive health insurance options, and they won't have to worry about whether their medical condition precludes them from being covered," said policy expert Paul Ginsburg, who heads the nonpartisan Center for Studying Health System Change.
The downside: "Sticker shock is going to come to some."
Get ready for a whole new set of trade-offs.
For example, people in their 50s and early 60s, when health problems tend to surface, are likely to pay less than they would now. Those in their 20s and 30s, who get the best deals today, will face higher premiums, though for better coverage.
Obama on Wednesday hailed a tentative deal by Democratic senators to give millions of Americans the option of signing up for private plans sponsored by the federal employee health system, which covers some 8 million including members of Congress. The compromise, which also offers people age 55 to 64 the option of buying into Medicare, appears to have given Democrats a way around the deal breaker issue of a new government plan to compete with private carriers. Senators continued to debate for a 10th day, with Democrats pushing to pass the bill by Christmas.
The 2,074-page Senate bill will grow even longer as amendments are considered, but the basic outlines of the legislation most likely to pass are becoming clearer.
The overhaul will be phased in slowly, over the next three to four years. But eventually all Americans will be required to carry coverage or face a tax penalty, except in cases of financial hardship. Insurers won't be able to deny coverage to people with health problems, or charge them more or cut them off.
Most of the uninsured will be covered, but not all. As many as 24 million people would remain uninsured in 2019, many of them otherwise eligible Americans who still can't afford the premiums. Lawmakers propose to spend nearly $1 trillion over 10 years to provide coverage, most of the money going to help lower-income people. But a middle-class family of four making $66,000 would still have to pay about 10 percent of its income in premiums, not counting co-payments and deductibles.
No dramatic changes are in store for most people who get coverage through their jobs — about 60 percent of those under age 65. The Congressional Budget Office says the bill wouldn't have a major effect on premiums under employer plans, now about $13,000 a year. Parents would be able to keep dependent children on their coverage longer, age 27 in the House bill.
One benefit for people with employer coverage is hard to quantify: It should be easier to get health insurance if they're laid off.
The real transformation under the legislation would come for those who now have the most trouble finding and keeping coverage: people who buy their own insurance or work for small businesses. About 30 million could pick from an array of plans through new insurance supermarkets called exchanges.
Some people's taxes would go up.
To pay for expanded coverage, the House bill imposes a 5.4 percent income tax surcharge on individuals making more than $500,000 and families earning more than $1 million. The Senate slaps a 40 percent tax on insurance plans with premiums above $8,500 for individual coverage, and $23,000 for family plans, among other levies.
The rest of the financing would come mainly from cuts in federal payments to insurers, hospitals, home health care agencies and other medical providers serving Medicare.
Preventive benefits for seniors would be improved. So would prescription coverage. But people enrolled in private plans through the Medicare Advantage program are likely to see higher out-of-pocket costs and reduced benefits as overpayments to insurers are scaled back.
The latest big wrinkles in the debate involve intriguing opportunities for consumers. But even there, it may be less than meets the eye.
Lawmakers have been talking for years about giving average Americans the option of coverage through the federal employee system, "just like members of Congress." The compromise among Senate Democrats would make plans certified by the federal employee system available nationwide, bringing competition to states in which one or two large insurers now control the market.
The other big new idea is to allow people age 55 to 64, one of the groups now most at risk for losing coverage, to buy into Medicare.
Yet from the inside, the federal employee health benefits plan isn't looking all that great these days. Federal workers do have a wide choice of insurance plans, but they're looking at hefty premium increases next year. Individual coverage under the most popular plan is going up 15 percent.
"I don't think you'll ever find someone satisfied with the price," said Jacqueline Simon, policy director for the American Federation of Government Employees. "And you've got people who are priced out." The union estimates that 250,000 federal workers are uninsured, mostly because they can't afford the premiums.
And what about Medicare? It is widely accepted, with 74 percent of doctors saying in a recent survey that they're taking most or all new Medicare patients. But buying into Medicare won't be cheap, about $7,600 a year not counting out-of-pocket costs for deductibles and copayments.
Ginsburg, the policy expert, says he's puzzled as to why anyone in their late 50s would want to buy into Medicare instead of picking a plan offered in the new exchanges, the insurance supermarkets. His reasoning: The exchange plans should have lower premiums since they would also include younger people who don't go to the doctor that often.
"The legislation already solved the problem by offering them coverage through the exchange," he said. "A Medicare buy-in based on the older age group is going to cost a lot more."
Organizers of a free health clinic for uninsured residents of Louisiana on Saturday said they're pleased with its success.
Not only did the clinic see 1,000 patients, it may have saved the lives of some sick individuals. Many of the patients had not seen a physician since Hurricane Katrina struck the Gulf Coast in 2005.
Volunteer physicians and other medical providers tended to the health care needs of over 1,000 patients who attended the C.A.R.E. (Communities Are Responding Everyday) Clinic at the Ernest N. Morial Convention Center in New Orleans. The clinic was organized by the National Association of Free Clinics and Louisiana Free Clinic Association (NAFC).
“We saw a number of very sick patients today who have not had medical care for many years,” Doctor Corey Hebert, a New Orleans physician and one of the clinic’s medical directors said. “This clinic was a life saver for many people who have no way to pay for their healthcare needs.”
Corey went on to say, “It is important that this is the same facility where people were dying four years ago and today we are giving them life.” His remarks were in reference to the aftermath of Katrina and the human crisis that occurred at convention center.
“It was wonderful to provide free care to so many people in one day,” Nicole Lamoureux, executive director of the NAFC, said. “But it also was important that we were able to connect a large number of these patients with free clinics and other health care providers who can provide them with care on a day-to-day basis.”
The NAFC and the Louisiana Free Clinic Association sponsored the event. The 727 volunteers who participated included physicians, nurses, other medical providers and non-medical individuals.
“I am very moved by all the physicians and other medical providers who volunteered to make this C.A.R.E. Clinic such a success,” Dr. Rani Whitfield, M.D., said. Whitfield, a Baton Rouge physician, served as co-medical director for the clinic. “The dedication to helping those need help was moving.”
The clinic operated from 8:00 a.m. to 5:00 p.m. today at no cost to patients or taxpayers. Most of the patients registered before the event, but walk-ins were seen on a first-come-first-served basis.
“We did good work today,” Whitfield added. “It was good to connect many people in need of medical care with doctors, nurses and others who can help them on an ongoing basis.”
This was the second massive free clinic the NAFC has sponsored. Over 1700 patients received treatment at the first one, which was held in Houston in September. Two more C.A.R.E. Clinics are planned in Little Rock on Nov. 21 and Kansas City on Dec. 9-10.
“I’m looking forward to building on the successes in Houston and New Orleans to help even more people,” NAFC President Sheri Wood, who is based in Kansas City, said.
More information about the NAFC and the Little Rock and Kansas City events is available online at Freeclinics.us
New Orleans CARE Clinic Preliminary Numbers:
# 68 percent of patients seen seek medical care in the emergency room or do not seek care when ill
# 53 percent of those seen have not seen a doctor in more than one year with many not seeing a doctor since Katrina
# 90 percent of patients seen have more than one diagnosis -- hypertension and diabetes being the most prevalent
# 55 percemt of those seen were women and 45 percent were men
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