Health Care Law

Supreme court will be hearing the case this coming week.
In the meantime:

FRI MAR 23, 2012 AT 02:30 PM PDT
Health care anniversary: the Affordable Care Act begins its third year
byJoan McCarter

President Obama's signature on the Affordable Care Act
The Affordable Care is two years old as of Friday, making it a good time to take stock of what it's done so far, and how its implementation is proceeding.
Among the biggest accomplishments:

Twenty million women have received preventive services like mammograms and Pap smears without having to pony up co-pays.
Expand that to the whole population, and 54 million Americans got preventative services without copays, services that do save lives.
More than 2.5 million young people have insurance, by being able to stay on their parents' plans until they are 26.
Nearly four million seniors saved almost $2.16 billion through discounts for their prescription medications in 2011.
The pre-existing insurance plan (PCIP) has extended insurance to 50,000 formerly uninsured and uninsurable people with pre-existing conditions.
Actually, that last one is both an accomplishment and a disappointment. For those it has helped, like Marlys Lenz Cox, it has been a "life-line." But, largely because of state interference in some instances, as well as barriers of cost and a 6-month waiting period mandated by Congress in the law, the program has drastically underperformed expectations.

Encouragingly, every state in the union but one are actively implementing laws and rules to make sure that insurance companies in their states provide preventative services without co-pays, and extend insurance to young people on their parents' plan. The one state that's not? Crazy Jan Brewer's Arizona.

Implementation of the state exchanges, which will be law beginning in 2014, is less encouraging with nearly half of states either continuing to explore their options in creating exchanges (many waiting for the outcome of the Supreme Court challenge to the law) or doing nothing.

Despite the states' resistance to begin setting up the exchanges pre-SCOTUS decision, the fact that 49 of them are actually implementing the market reforms expanding insurance coverage and preventative services without co-pays means that, at the very least, some of the provisions of the Affordable Care Act will remain in effect, even if the Court strikes down the individual mandate. Having implemented these popular programs, it will be very hard for states to backtrack.

The justices called on the lawyers for the White House and the Republicans to make the case that the Supreme Court has the requisite jurisdiction. Chief Justice John Roberts and Justices Samuel Alito and Anthony Kennedy were less vocal than the liberal-leaning justices. Justice Clarence Thomas, as expected, did not speak.

Notably, Roberts — who some court watchers believe may want to punt the ruling beyond an election year, to shield the Supreme Court from political attacks — only asked a handful of questions and did not seem to indicate that he believes the mandate is a tax.

“It’s a command,” Roberts said at one point. “A mandate is a command.”

http://www.washingtonpost.com/blogs/...adbS_blog.html

Wonkbook: Absolutely everything you need to know about health reform’s Supreme Court debut
Posted by Ezra Klein at 06:49 AM ET, 03/26/2012

Today's the day. The Supreme Court will begin hearing oral arguments as to the constitutionality of various provisions of the Affordable Care Act. Note that phrase: "Various provisions." The Supreme Court is not looking at the act as a whole. Rather, it’s considering four separate questions related to separate parts of the law. Here's my colleague Sarah Kliff with a primer of what they are, and why they matter. And after that, a special round-up of news, analysis, and opinion on the subject. And after that, your regularly scheduled Wonkbook:


As joggers pass, David Lebam, center, and Lucas Feurst take a smoking break at the Supreme Court. They are from Sweden where there is universal heath care. Earlier in the day several religious groups rallied near the steps of the Supreme Court to express their opposition to President Obama’s health care plan. (Michael S. Williamson - WASHINGTON POST) On Monday morning, at 10 a.m., the Supreme Court of the United States will open oral arguments on the health reform law. The hearing will last six hours and stretch over three days, the longest arguments in 45 years.

One reason these oral arguments will last so long has to do with the variety of the topics that the justices will address. The Court won’t consider the Affordable Care Act as one single issue, but rather has broken the case into four, separate issues. Here’s a Wonkblog guide to what those issues are, how each side will argue, when it happens, and why it matters. One quick programming note: While the Supreme Court’s arguments will not be broadcast live, C-Span has said it will make them available within a few hours of their conclusion each day here.

Anti-Injunction Act

What it is: The Court opens its oral arguments with a debate over whether it can even issue a ruling on the Affordable Care Act since its penalties for not carrying insurance have not come into effect yet. Under a law passed in 1867, the Anti-Injunction Act, a tax cannot be challenged until someone has actually had to pay it. Health reform’s penalties don’t start until 2015.

What they’ll argue: One weird quirk of this provision is that neither the defendants or plaintiffs think it applies: Both sides think the Court should be able to rule right now . So the court appointed an outside lawyer, Robert Long, to argue on their behalf. Long will likely look to the Fourth Circuit Court of Appeals for precedent. It ruled, in September, that the Anti-Injunction Act prevented it from issuing a ruling on the health law.

When it happens: Monday, March 26, 10-11:30 a.m.

Why it matters: The Anti-Injunction Act gives the Supreme Court an opportunity to put off its decision for at least three years, potentially diffusing the law slightly as a 2012 election year issue. This could be a mixed-bag for health care supporters: On the one hand, it gives the law three more years to be implemented. On the other, it would still make the law’s fate seem uncertain, and likely extend the national debate around the Affordable Care Act.

The individual mandate

What it is: The most-contested part of the health reform law, the Affordable Care Act’s individual mandate requires nearly all Americans to carry health insurance. The legal question centers on whether such a regulation is permissible under the Commerce Clause, which allows the federal government to regulate interstate activity.

What they’ll argue: Health reform opponents contend that the decision not to do something — namely, not buy health insurance — is economic inactivity, rather than activity, and therefore not a behavior the federal government can regulate. Health reform supporters argue that the decision to not purchase health insurance has an economic effect. An individual without coverage, for example, may not have the money to pay for an emergency room visit, sticking hospitals or taxpayers with the bill.

When it happens: Tuesday, March 27, 10 a.m. - 12 p.m.

Why it matters: With no penalty for not purchasing health insurance, but a requirement for insurers to accept anyone still standing, many expect the costs of insurance would skyrocket. Congress could, theoretically, replace the individual mandate with another policy that doesn’t run afoul of the activity-inactivity distinction but it is unlikely that congressional Republicans would permit such a fix, at least in the near term.

Severability

What it is: The question of whether the health reform law can stand without the individual mandate — in legal parlance, whether the individual mandate is “severable” — is a pretty crucial one. The Supreme Court will hear arguments on if it could strike down that part of the law, while letting the rest of it stand.

What they’ll argue: The Department of Justice says that if the court strikes down the mandate, it should also repeal the health reform law’s guaranteed issue provision, which requires insurers to accept all customers regardless of their health-care status. The argument there is that the mandate is so integral to making insurance work - by getting the healthy people to sign up - that, without it, insurance markets could no longer accept all applicants. Opponents of the law go even further. They contend that because of how the law was written - without a clause that specifically noted that individual provisions could be severable - that the whole thing should fall with the mandate.

The Eleventh Circuit Court of Appeals came to an opposition conclusion: It overturned the mandate, but allowed the rest of the law to stand, even the parts that the Justice Department says should have fallen.

When it happens: Wednesday, March 28, 10 - 11:30 a.m.

Why it matters: If the Court finds the individual mandate unconstitutional, then severability will become a key issue in determining how much of the law falls with it. It could decide that just the mandate falls, leaving the insurance industry with a pretty big challenge. Or it could rule that the mandated purchase of health insurance is so critical to the health reform law that if it goes down, it takes other key parts of the Affordable Care Act with it.

Medicaid Expansion

What it is: The health reform law expands Medicaid to cover everyone under 133 percent of the federal poverty line (about $14,000 for an individual) in 2014. Medicaid is run as a state-federal partnership and, right now, states are only required to cover specific demographics, groups like low-income, pregnant women and the blind or disabled.

What they’ll argue: The states contend that this provision is too onerous: They’ll be responsible for footing part of the Medicaid expansion’s bill, and say they can’t afford the costs. The federal government, for its part, has centered its argument on the fact that states voluntarily participate in Medicaid. If they don’t like the new expansion, they could pull out of the program.

When it happens: Wednesday, March 28, 1-2 p.m.

Why it matters: Since states’ participation in Medicaid is voluntary, Supreme Court watchers widely expect the justices to find this part of the law constitutional. There is worry though, that if they were to strike down this part of the law, it could set sweeping new precedent for how state-federal partnership programs function.

Wonkbook's SCOTUS Obamacare Primer

Barnes previews: "The Supreme Court on Monday joins the nation’s vitriolic debate over the landmark health-care law and the limits of federal power. And though thousands of pages of legal arguments about the Constitution’s history and the court’s precedents have landed on justices’ desks, the outcome may also hinge on less tangible factors. Public opinion. The nation’s volatile political climate. The court’s self-consciousness about its own partisan divide. And the pivotal role it plays in deciding the nation’s thorniest social issues." Robert Barnes in The Washington Post.

This may be one of the most important cases in history. "American constitutional history has not moved in a straight line, from the Founding to the 21st Century. Its development is a wavering line, with twists and turns that were far from predictable. The amendment process under Article V has followed a meandering path -- in fact, the latest amendment, the 27th, dealing with congressional salaries and ratified in 1992, was actually one of the first proposed, in 1789. Meandering, too, have been the Supreme Court’s interpretations of what the Constitution ultimately means -- for any given day and time...By week’s end, America will have witnessed -- for most people, from afar, because only a couple of hundred seats are available for those who will see it actually happen -- a deeply serious and probably quite revealing conversation about the Constitution and what it might mean 225 years after it was written." Lyle Denniston in SCOTUSblog.

@chucktodd: This spin I'm hearing from both sides about how losing in Supreme Court on health care could be good for them politically I think is bunk

@conncarroll: if Court strikes down Ocare, Romney has easy line to separate himself from Obama: "My law is constitutional. Yours was not."

The story of how the legal challenge to Obamacare went mainstream. "When President Barack Obama signed the health care bill two years ago, the legal challenges to the law were widely belittled as long shots -- at best. But as the cases head to the Supreme Court this week, what looked to many like far-out legal arguments to undo 'Obamacare' don’t seem so zany anymore...Many legal scholars, including respected conservatives, pooh-poohed the idea that the courts might actually strike down the law or the individual mandate requiring most Americans to get health insurance or pay a fine. Yet on Monday, three days of oral arguments about the law begin at the high court -- the most time justices have devoted to a single law since 1966. The challengers’ journey from the near-fringe of legal thought to coming within striking distance of knocking out Obama’s signature legislative achievement has coupled an intense legal assault with a communications drive to convince elites and the public that the law violates the Constitution." Josh Gerstein in Politico.

@BuzzFeedAndrew: Imagine a 2008 debate between Obama and Romney with Romney arguing for a mandate and Obama arguing against one. Parallel Universe.

MEET THE SOLICITORS: Donald Verrilli and Paul Clement.

SYMPOSIUMS: The New York Times and The National Review.

CHART: What happens if the individual mandate falls, in one chart.

PROFILE: Meet Justice Anthony Kennedy, the Supreme Court's swing vote.

Five myths about the health-care law: http://wapo.st/GRphTa .

Many lined up for a chance to attend the arguments. "Heading into the first of three days of Supreme Court arguments on Monday, the pavement occupied by the approximately 15 people in line Sunday morning was among the most coveted real estate in Washington. Tickets are scarce even for those connected to the case. And for everyone else, there’s the line. It started with two people who were in line by 9:30 a.m. on Friday, waiting to score one of at least 60 seats made available to the general public for each day of arguments, said Kathy Arberg, a Supreme Court spokeswoman...In Washington, anyone who wants to attend a judicial or Congressional hearing and can afford to spend $36 to $50 an hour can hire professional 'line standers' through companies like Washington Express to do the waiting for them. LineStanding.com, which had people waiting outside the court over the weekend, lets customers choose how early they want their surrogate to arrive, including an option labeled 'please put us at the front of the line.'" Emmarie Huetteman in The New York Times.

GREENHOUSE: The legal question is clear. "Free of convention, and fresh from reading the main briefs in the case to be argued before the Supreme Court next week, I’m here to tell you...The constitutional challenge to the law’s requirement for people to buy health insurance — specifically, the argument that the mandate exceeds Congress’s power under the Commerce Clause — is rhetorically powerful but analytically so weak that it dissolves on close inspection. There’s just no there there." Linda Greenhouse in the New York Times.

SOMIN: The individual mandate is unconstitutional. "The federal government claims that this is a special case because everyone eventually uses health care. But this argument relies on shifting the focus from health insurance to health care. A similar ploy can justify any other mandate, including even the much-discussed 'broccoli purchase mandate.' Not everyone eats broccoli. But everyone surely participates in the market for food. Many also argue that health insurance is special because producers are sometimes required to give free services to the uninsured. But why is this fact relevant to Congress’ commerce power? The usual answer is that failure to purchase insurance thereby has adverse economic effects on producers. But any time someone fails to purchase any product, producer profits are lower than they would be otherwise. The government’s other justifications for the mandate are also essentially rationales for unlimited federal power." Ilya Somin in The New York Times.

BLOOMBERG VIEW: Health care is not broccoli. "Here is where they invoke broccoli. If Congress can force me to buy health insurance, they ask -- and this analogy has actually appeared in a federal judicial opinion -- can’t it also force me to eat broccoli?
In a word (or two): Yes and no. Congress could certainly pass a law requiring the consumption of broccoli. And the courts would certainly invalidate it. Without disputing the point that the Constitution grants the U.S. government only limited powers, it is easy to conclude that Congress is well within its authority to enact the individual mandate. Every American, by virtue of his or her existence, is a consumer of health care. The same, sadly, cannot be said for broccoli. Health care accounts for about 18 percent of the economy, and an even larger share of the federal budget. Hospitals and insurance companies and their affiliates operate and treat patients on a national scale and across state lines. Precise figures are unavailable, but broccoli’s role in the U.S. economy is considerably smaller." The editors at Bloomberg View .

LITHWICK: This is about politics, not law. "The law is a completely valid exercise of Congress’ Commerce Clause power, and all the conservative longing for the good old days of the pre-New Deal courts won’t put us back in those days as if by magic. Nor does it amount to much of an argument. So that brings us to the really interesting question: Will the Court’s five conservatives strike it down regardless? That’s what we’re really talking about next week and that has almost nothing to do with law and everything to do with optics, politics, and public opinion. That means that Justice Antonin Scalia’s opinion in the Raich medicinal marijuana case, and Chief Justice John Roberts’ and Anthony Kennedy’s opinions in Comstock only get us so far. Despite the fact that reading the entrails of those opinions suggest that they’d contribute to an easy fifth, sixth, and seventh vote to uphold the individual mandate as a legitimate exercise of Congressional power, the real question isn’t whether those Justices will be bound by 70 years of precedent or their own prior writings on federal power. The only question is whether they will ignore it all to deprive the Obama of one of his signature accomplishments." Dahlia Lithwick in Slate .

EMANUEL: Even if the Court strikes down the mandate, it won't be the end of health care reform. "What if the Supreme Court declares unconstitutional the Affordable Care Act’s requirement that everyone buy health insurance? What if it strikes down all the act’s insurance provisions, including the requirement that insurance companies cover everyone, regardless of pre-existing illnesses? Would this totally put an end to the health care reforms we have passed in the last three years? Absolutely not. The essence of the case the Supreme Court will begin hearing on Monday is whether, invoking its powers in the commerce clause of the Constitution, Congress can require individuals to purchase health insurance or pay a penalty. I believe the mandate is constitutional, but no matter how the court rules, many health care reforms that were approved by Congress through the Affordable Care Act and other recent bills -- like those to promote electronic health records, encourage coordinated care, reduce medical errors and cut costs -- will proceed." Ezekiel Emanuel in The New York Times.

@sarahkliff: Even puppies want to hear SCOTUS argue health reform. http://pic.twitter.com/7MPFaL17

This may be one of the most important cases in history. "American constitutional history has not moved in a straight line, from the Founding to the 21st Century. Its development is a wavering line, with twists and turns that were far from predictable. The amendment process under Article V has followed a meandering path -- in fact, the latest amendment, the 27th, dealing with congressional salaries and ratified in 1992, was actually one of the first proposed, in 1789. Meandering, too, have been the Supreme Court’s interpretations of what the Constitution ultimately means -- for any given day and time...By week’s end, America will have witnessed -- for most people, from afar, because only a couple of hundred seats are available for those who will see it actually happen -- a deeply serious and probably quite revealing conversation about the Constitution and what it might mean 225 years after it was written." Lyle Denniston in SCOTUSblog.

Obama’s health law proving successful
By Juan Williams - 03/26/12 05:00 AM ET
Just in time for the two-year anniversary of the passage of the Patient Protection and Affordable Care Act, the Supreme Court will hear oral arguments on the law’s constitutionality this week.

This is a political column. So let’s leave the litigation and questions of constitutionality to the lawyers.



In my world of people and politics there are two relevant issues. First, does the law provide better medical care for Americans? And is it reducing the cost of healthcare?
While the new law will not be fully implemented until 2014, the parts that have been enacted show that the indisputable, factual answer to both questions is “yes.” But at the moment, the facts do not seem to matter in the court of public opinion. Republican opposition remains as solid today as the day the act was signed into law.

Overall, a March 11 Bloomberg poll found that 37 percent of Americans say it should be repealed, 46 percent want to wait to see how it works and 11 percent think it should be left just the way it is.

The Wall Street Journal reported last week that 50.5 percent of all Americans oppose the law. That is almost exactly the same level of opposition as there was in 2010. One aspect of that opposition that needs to be highlighted is that more than 20 percent of Americans are opposed because they want the law to do more. Specifically, they want it to include a public option for insurance coverage to put more pressure on insurance companies to lower their rates and requirements for coverage.

http://www.washingtonpost.com/nation...y.html?hpid=z1

Health-care provision at center of Supreme Court debate was a Republican idea

By N.C. Aizenman, Monday, March 26, 6:41 PM

As the Supreme Court moves Tuesday to the heart of the challenge to President Obama’s signature health-care law, there is a curious twist: The case largely rests on the constitutionality of a provision that originated deep in Republican circles.

The individual insurance mandate, which requires virtually all Americans to obtain health coverage or pay a fine, was the brainchild of conservative economists and embraced by some of the nation’s most prominent Republicans for nearly two decades. Yet today many of those champions — including presidential hopefuls Mitt Romney and Newt Gingrich — are among the mandate’s most vocal critics.



A guide to health-care law challenges by day:
10 AM MONDAY | Is it premature for the Supreme Court to rule on the challenge to the law's insurance requirement? View details »
10 AM TUESDAY | Is the law's insurance requirement constitutional? View details »
10 AM WEDNESDAY | If the insurance requirement is ruled unconstitutional, should the rest of the health care law stand? View details »
1 PM WEDNESDAY | Is the law's expansion of Medicaid to cover a greater share of the poor constitutional? View details »

Meanwhile, even as Democratic stalwarts warmed to the idea in recent years, one of the last holdouts was the man whose political fate is now most closely intertwined with the mandate: President Obama.

“The ironies to this story are endless and everywhere,” said John McDonough, a professor at the Harvard University School of Public Health who, as a Senate Democratic staffer, played a key role in drafting the law.

The tale begins in the late 1980s, when conservative economists such as Mark Pauly, a professor at the University of Pennsylvania’s Wharton School of business, were searching for ways to counter liberal calls for government-sponsored universal health coverage.

“We wanted to find an alternative that was more consistent with market-oriented economic ideas and would involve less government intervention,” Pauly said.

His solution: a system of tax credits to ensure that all Americans could purchase at least bare-bones “catastrophic” coverage.

Pauly then proposed a mandate requiring everyone to obtain this minimum coverage, thus guarding against free-riders: people who refuse to buy insurance and then, in a crisis, receive care whose costs are absorbed by hospitals, the government and other consumers.

Heath policy analysts at the conservative Heritage Foundation, led by Stuart Butler, picked up the idea and began developing it for lawmakers in Congress.

By 1993, when President Bill Clinton was readying his major health-care overhaul bill, the Heritage approach — subsidizing and facilitating the purchase of private health plans, while using the individual mandate to maximize participation — had gelled as the natural Republican alternative.

Then-Sen. John H. Chafee (R-R.I.) formally proposed it in a bill that attracted 20 Republican co-sponsors; the bill foundered once Clinton’s effort unraveled. But the idea of the mandate gained currency in the ensuing years as Democrats chastened by the failure of the Clinton plan began considering new solutions more likely to attract bipartisan support.

The Massachusetts plan

That process came to a head in 2004 when Mitt Romney, then governor of Massachusetts, turned to then-Sen. Edward M. Kennedy (D-Mass.) for help adopting a health-care overhaul for the state that was largely based on providing residents with government subsidies to buy private insurance.

The plan, signed into law in 2006, regulated insurance companies to a degree beyond anything Pauly had envisioned: For instance, they were barred from excluding or charging higher premiums to people with preexisting health conditions.

Irony at the Supreme Court
First Read: "Yesterday's oral arguments were simply the opening act in the Supreme Court's consideration of President Obama's signature health-care law. But today's discussion -- over whether or not the individual mandate to purchase health insurance is constitutional -- is the main event. And there's plenty of irony (and even hypocrisy) on this issue. After all, it was then-candidate Barack Obama who railed against the individual mandate, which was supported by Hillary Clinton. What's more, the individual mandate was once a conservative-leaning idea (championed by the Heritage Foundation, Newt Gingrich and, yes, Mitt Romney)."

"The final bit of irony: Only a small percentage of the public would even be subject to the individual mandate, if it's found to be constitutional. A new Urban Institute study finds, per Huffington Post, that 98% of Americans 'would either be exempt from the mandate -- because of employer coverage, public health insurance or low income -- or given subsidies to comply.' So there you have it, folks: The central issue before the Supreme Court was once opposed by Obama, supported by conservatives and Republicans, and won't even affect most Americans."

"If the government can do this, what is left? What else can it not do?" asked Scalia. "All bets are off," Roberts agreed.

Supreme Court justices challenge Obama administration over health care law

http://news.yahoo.com/blogs/ticket/s...170042500.html

Liberals would love this to pass as they can then use the all powerful federal government to move their statist agenda forward agaisnt the will of the people.

Do you want to know why?

http://www.youtube.com/watch?v=KRgB2eeHZEw

Carville: A Supreme Court loss will help Democrats

Posted by
CNN Political Unit
(CNN) - While the Obama administration fights to protect the constitutionality of the Affordable Care Act, Democratic strategist and CNN contributor James Carville said a Supreme Court overruling may not be such a bad thing for the president, politically.

"I think this will be the best thing that has ever happened to the Democratic Party," Carville said Tuesday on CNN's "The Situation Room with Wolf Blitzer."

He added: "You know, what the Democrats are going to say, and it is completely justified, 'We tried, we did something, go see a 5-4 Supreme Court majority'."

Carville, who gained fame working on Bill Clinton's 1992 presidential campaign, predicted health care costs will only increase in the future, in which case Republicans will be to blame for leading the drive to expel a federal program designed to help Americans cover those costs.

"Then the Republican Party will own the healthcare system for the foreseeable future. And I really believe that. That is not spin," Carville said.

Republican and RedState.com editor Erik Erikson, meanwhile argued that an overruling would represent more mainstream sentiments than not.

"Both sides, not just the Democrat side, even if the laws were upheld or struck down, there is a 5-4 conservative majority, and historically you see Republicans picking justices who have a greater propensity to gravitate to the left than you see Democrat judges propensity to gravitate to the right," Erikson, also a CNN contributor, said. "This will be an undercurrent issue for both sides, though."

3/28/12 at 12:16 PM 122Comments
Frank Rich on the National Circus: Why the Supreme Court Can Only Help Obama
By Frank Rich


If the Supreme Court overturns Obamacare, how does Obama respond?
Just keep moving. The decision is scheduled to come down in June. The election will be more than four months away — an eternity in politics.
But everyone says the Affordable Care Act is Obama’s signature achievement so far. How can he just walk away?
He can take credit for the provisions that Americans love: coverage for the young up to age 26 on their parents’ policies; lowered drug costs for the elderly; and, most of all, the ban on insurance companies either raising premiums or denying coverage to those with preexisting conditions. He can also point out that the Romney-Ryan budget will maim Medicare, another hugely popular health-care provision created by Democrats.
The popular parts of the health-care law could be unsustainable if the Court strikes down the mandate, however. Premiums will skyrocket.
By then it will be 2014, and, as James Carville correctly pointed out this week, the GOP “will own the healthcare system for the foreseeable future.” The Democrats can heap the blame for rising costs and every other health-care ill on the Republicans, who to this day have not offered a plausible alternative to Obamacare. Indeed, Carville argues that a court decision against Obama “will be the best thing that has ever happened to the Democratic Party.” That’s hyperbole, but he’s onto something.
Then where does that leave Romney? Can he Etch A Sketch away from his own support of an individual mandate?
Rick Santorum is right about at least one thing: Romney is the worst possible Republican candidate to debate Obama about health care. If the mandate survives in court, and the GOP base goes ballistic, the Democrats can keep reminding voters that Romney was “the godfather” of the mandate (as David Plouffe put it last weekend) in Massachusetts and can keep replaying that “I like mandates” Romney clip from that 2008 GOP debate. But it gets even worse for Mitt. He revealed (in a Tuesday night interview with Jay Leno, yet) that he is even against the Obamacare provision favored by 85 percent of the public, according to a recent poll — the requirement that insurance companies cover those who are already sick. Here’s how Romney put it to Jay: “If they are 45 years old and they show up and say I want insurance because I have heart disease, it's like, hey guys — we can't play the game like that.” Turns out he has no more empathy for that middle-aged man with heart disease than he does for the workers he shredded in his lucrative games at Bain.
So who would a repeal of Obamacare hurt most?
The biggest victims will be the some 30 million Americans who have no health insurance. The rest of us, who one way or another will keep picking up the bill for their medical care, will also pay a price. In the political arena, the court’s decision, up or down, is a win-win for Obama and a lose-lose for Romney, who at this late date hasn’t figured out how to answer health-care questions on the Tonight Show, let alone in a debate with the president.
The Obama administration pushed to get this case on the docket before the election. Are they going to regret that?
For all the reasons above, no. It was a shrewd move. Whatever happens, it diffuses the issue well before November 6.
A hot mike caught Obama telling Russian president Dmitri Medvedev that he would have "more flexibility" to negotiate missile defense after the elections. Can the Romney camp make political hay out of that?
Karl Rove is already on record saying that this supposed gaffe could have “a big negative impact on Mr. Obama’s reelection.” But the impact, if there was any, has already dissipated because (a) what Obama said to Medvedev had the virtue of being actually true; (b) America’s nuclear strategy with Russia, though a 24/7 obsession to the neocons Rove pals around with, is no more determinative an issue in the 2012 election than any other foreign policy matter, the war in Afghanistan included; (c) Romney has already muffed his response, by vilifying not only Obama but Russia — in hysterical terms more appropriate to the Khrushchev era. Memo to Mitt: The Cold War is over. Few Americans care that the Pope is currently frolicking with the Castro brothers in Havana.
Until this week's polls, Santorum had been trouncing Romney in Wisconsin. Now Romney is ahead. Is the GOP nomination battle over?
You betcha. And the big winner remains Obama, who is ahead in the three battleground states of Florida, Ohio, and Pennsylvania in the new Quinnipiac poll out this week, thanks to the wholesale desertion of women from the GOP. A new national Washington Post-ABC News poll finds Obama’s approval rating at 53, Romney’s at 34.

Americans are evenly divided on the overall law, with 47 percent supporting it, according to Pew Research. And a New York Times/CBS News poll finds that many of the law's key provisions are backed by large majorities: the law's popular features include the requirement that insurance companies cover people with pre-existing conditions (85 percent), letting children stay on parents' policies until age 26 (68 percent) and cutting the cost of prescription drugs for seniors (77 percent).
Here's a breakdown of what is at stake if the Supreme Court strikes down the law:
BENEFITS ALREADY IN PLACE: Although key benefits of the ACA won't be implemented until 2014, significant changes are already in place. For example, 2.5 million young adults age 19 to 25 are now covered on their parents' policies. For Medicare, the first steps to close the gap in prescription drug coverage -- the notorious "donut hole" -- saved $2.1 billion for nearly 3.6 million seniors last year, according to the U.S. Department of Health and Human Services.
STATE EXCHANGES: State insurance exchanges, which are being set up now and will fully launch in 2014, will open up access to insurance for anyone who can't access group healthcare coverage through the workplace -- a crucial, growing problem in an economy characterized by volatility and stubbornly high levels of structural unemployment.
For example, nine million Americans age 50 to 64 were uninsured as of 2010 -- up from 5.3 million in 2002, according to The Commonwealth Fund. Too young for Medicare, their only option now is the individual insurance market, where premium prices are high, coverage is partial and many can't buy policies at all due to pre-existing conditions. Nine million individuals were turned down for coverage in the individual market over the past three years due to pre-existing conditions, Commonwealth says.
Starting in 2014, the law will ban charging higher premiums or denying coverage based on health or age, and insurance companies will no longer be permitted to disqualify applicants based on pre-existing conditions. And applicants will be eligible for federal subsidies on the cost of coverage if they make less than 400 percent of the federally defined poverty level -- currently $92,000 for a family of four. For this group, the subsidy uses a sliding scale to hold costs as a share of income between 2 percent and 9.5 percent.
The Congressional Budget Office (CBO) projects that 23 million Americans will gain coverage through the state exchanges by 2019. "That's a very sweeping change for people who need to retire early, are unemployed, or have a job that doesn't offer health care benefits," says Sara Collins, vice president for affordable insurance at The Commonwealth Fund.
The process will start with an application for insurance submitted to your state exchange; depending on your income, you'll be eligible to buy a policy in the exchange -- or receive coverage under Medicaid.
MEDICAID EXPANSION: Medicaid primarily serves parents with very low incomes, and few states cover adults who do not have children. The ACA provides federal funding for a dramatic expansion of Medicaid. The new program will serve all households that are living around the federal poverty level -- about $30,000 in annual income for a family of four. Fifty-seven percent of adults in that income range were uninsured for at least part of 2011, and 41 percent were uninsured for one year or longer.
So that's what's at stake if the healthcare reform law is struck down by the Supreme Court. All told, 31 million Americans who otherwise would have health insurance won't be covered at the end of this decade, and we'll be back to the drawing board on healthcare reform.
(Editing by Beth Pinsker Gladstone and Andrea Evans)

http://finance.yahoo.com/news/whats-...133908100.html

So Obama will look good if the Supreme Court strikes down his "landmark" legislation? Great spin. The Supreme Court strikes it down and the Republicans now own it? Carville, he's a funny guy.

Frank Rich is funny too? lol. I quess we will know in the not too distant future how this will turn out for both President Obama and the Republican Party. There will be lots of objective evidence so we will know whether Mr. Carville or Mr. SeriouslyWrong is the more accurate.

http://tpmdc.talkingpointsmemo.com/2...nt.php?ref=fpa

Conservatives Struggle With Key Anti ‘Obamacare’ Argument
Justice Antonin Scalia

BRIAN BEUTLER MARCH 30, 2012, 5:02 AM 8997 60
For the challengers’ constitutional attack against the individual mandate in President Obama’s health care law to withstand scrutiny, they need to maintain two key questionable arguments.

The first is the plaintiffs’ claim that the law’s mandate and the penalty enacted to enforce the mandate are fully distinct. Their challenge depends on the court viewing the mandate as a command, and not part of a more general incentive.

Relatedly, they claim that the command itself is meant to draw non-participants into a market they may not want to enter. For this to fly, they have to contend that the market the government is regulating — or that Congress intended to regulate — is the market for health insurance and not the much broader market for health care services.

This has become a central point of contention, and it could be an issue on which the court’s decision turns. And yet squaring the challenger’s argument with the history and purpose of the health care law presents opponents of the law with a question they’ve had a very hard time answering.

“The commerce is not the health insurance market,” former Reagan Solicitor General Charles Fried told the Washington Post. “The commerce is the health-care market, as Verrilli said a million times. And it’s very hard to deny that.”

Paul Clement — the challengers’ attorney — tried his best. But this was one line of argument he, and his conservative fellow travelers on the Supreme Court bench, had a hard time sustaining.

“This statute undeniably operates in the health insurance market,” he told the court Tuesday. “And the government can’t say that everybody is in that market. The whole problem is that everybody is not in that market, and they want to make everybody get into that market.”

Enter Justice Elena Kagan with the obvious counterpoint. “Well, doesn’t that seem a
little bit, Mr. Clement, cutting the baloney thin?” she asked rhetorically. “I mean, health insurance exists only for the purpose of financing health care. The two are inextricably interlinked. We don’t get insurance so that we can stare at our insurance certificate. We get it so that we can go and access health care.”

Here’s Clement’s attempt to break that link.

“Well, Justice Kagan, I’m not sure that’s right. I think what health insurance does and what all insurance does is it allows you to diversify risk. And so it’s not just a matter of I’m paying now instead of paying later. That’s credit. Insurance is different than credit. Insurance guarantees you an up-front, locked-in payment, and you won’t have to pay any more than that even if you incur much great expenses. And in every other market that I know of for insurance, we let people basically make the decision whether they are relatively risk averse, whether they are relatively non-risk averse, and they can make the judgment.”

His argument, though, drew him directly into the analogy that conservatives like to avoid: car insurance. State governments mandate that car owners carry insurance. There’s little doubt the federal government could issue a similar mandate if needed.

Here’s his exchange with Justice Sonia Sotomayor.

JUSTICE SOTOMAYOR: But we don’t in car insurance, meaning we tell people, buy car — not we, the states do, although you’re going to — I’ll ask you the question, do you think that if some States decided not to impose an insurance requirement, that the federal government would be without power to legislate and require every individual to buy car insurance?
MR. CLEMENT: Well, Justice Sotomayor, let me say this, which is to say — you’re right in the first point to say that it’s the states that do it, which makes it different right there. But it’s also -*

JUSTICE SOTOMAYOR: Well, that goes back to the substantive due process question. Is this a Lochner era argument that only the States can do this, even though it affects commerce? Cars indisputably affect commerce. So are you arguing that because the states have done it all along, the federal government is no
longer permitted to legislate in this area?

MR. CLEMENT: No. I think you might make a different argument about cars than you would make about health insurance, unless you tried to say — but, you know, we’re -*

JUSTICE SOTOMAYOR: Health insurance — I mean, I’ve never gotten into an accident, thankfully, and I hope never. The vast majority of people have never gotten into an accident where they have injured others; yet, we pay for it dutifully every year on the possibility that at some point, we might get into that accident.

MR. CLEMENT: But, Justice Sotomayor, what I think is different is there is lots of people in Manhattan, for example, that don’t have car insurance because they don’t have cars. And so they have the option of withdrawing from that market. It’s not a direct imposition from the government. So even the car market is different from this market, where there is no way to get outside of the regulatory web. And that’s, I think, one of the real problems with this because, I mean, we take as a given -*

JUSTICE SOTOMAYOR: But you’re — but the given is that virtually everyone, absent some intervention from above, meaning that someone’s life will be cut short in a fatal way, virtually everyone will use health care.

MR. CLEMENT: At some point, that’s right.

It breaks down pretty quickly. But that doesn’t mean conservative justices aren’t sympathetic to the argument anyhow.

“I don’t agree with you that the relevant market here is health care,” said Justice Antonin Scalia. “You’re not regulating health care. You’re regulating insurance.”

Chief Justice John Roberts tried a different tack. “You say health insurance is not purchased for its own sake, like a car or broccoli; it is a means of financing health care consumption and covering universal risks,” he noted. “Well, a car or broccoli aren’t purchased for their own sake, either. They’re purchased for the sake of transportation or, in broccoli, covering the need for food. I don’t understand that distinction.”

“The difference, Mr. Chief Justice, is that health insurance is the means of payment for health care, and broccoli is not the means of payment for anything else,” objected Solicitor General Donald Verrilli Jr.

“It’s the means of satisfying a basic human need,” Roberts rebutted. “[J]ust as insurance is the means of satisfying [a basic human need].”

......Another $17 trillion surprise found in Obamacare

By Neil Munro - The Daily Caller | The Daily Caller – Fri, Mar 30, 2012

Senate Republican staffers continue to look though the 2010 Obamacare law to see what’s in it, and their latest discovery is a massive $17 trillion funding gap.

“The more we learn about the bill, the more we learn it is even more unaffordable than was suspected,” said Ala. Sen. Jeff Sessions, the Republican’s budget chief in the Senate.

“The bill has to be removed from the books because we don’t have the money,” he said.

The hidden shortfall between new Obamacare spending and new Obamacare taxes was revealed just after Supreme Court judges grilled the law’s supporters about its compliance with the constitution’s limits on government activity. If the judges don’t strike down the law, Obamacare will force taxpayers find another $17 trillion to pay for Obamacare’s spending.

The $17 trillion in extra promises was revealed by an analysis of the law’s long-term requirements. The additional obligations, when combined with existing Medicare and Medicaid funding shortfalls, leaves taxpayers on the hook for an extra $82 trillion over the next 75 years.

The federal government already owes $15 trillion in debt, including $5 trillion in funds borrowed during Obama’s term.

That $82 billion in unfunded future expenses is more more than five years of wealth generated by the United States, which now produces just over $15 trillion of value per year.

The $82 trillion funding gap is equal to 28 years of the the current federal budget, which was $3.36 trillion for 2011.

The new $17 trillion funding gap is five times the current federal budget.

Currently, the Social Security system is $7 trillion in debt over the next 65 years. Medicare will eat up $38 trillion in future taxes, and Medicaid will consume another $2o trillion of the taxpayer’s wealth, according to estimates prepared by the actuarial office at the Centers for Medicare and Medicaid Services.

The short-term cost of the Obamacare law is $2.6 trillion, almost triple the $900 billion cost promised by Obama and his Democratic allies, said Sessions.

The extra $17 billion gap was discovered by applying standard CMMS estimates and models to the law’s spending obligations, Sessions said.

http://news.yahoo.com/another-17-tri...133210667.html

Just remember this: http://www.youtube.com/watch?v=hV-05TLiiLU

http://www.miamiherald.com/2012/04/0...re-reform.html

Uphold healthcare reform

OUR OPINION: A workable solution for a pressing national problem

BY THE MIAMI HERALD EDITORIAL
HERALDED@MIAMIHERALD.COM
Something has to be done about healthcare in the United States. As the president of Blue Cross (now Florida Blue) told The Herald’s Editorial Board last week: “The costs are rising at a rate the private market won’t accept, and which the public sector — the government — can’t pay for.”

The indispensable need for change — to cut costs, provide universal coverage, increase efficiency and eliminate waste and unfair practices — will exist regardless of whether the Patient Protection and Affordable Care Act that Congress passed two years ago is upheld.

Last week’s three-day debate over the merits of the act before the Supreme Court gave the nation a valuable civics lesson. Lawyers for both sides engaged in a passionately argued yet respectful debate, and the justices eagerly jumped in with pointed questions and observations that steered the argument toward the most pressing issues.

The court should uphold the law. But whatever decision it makes, there can be no denying that reform in one form or another is coming our way because healthcare is too important to ignore.

In many ways, reform is already here. The linchpin of the Affordable Care Act is the so-called “individual mandate,” requiring everyone to buy healthcare insurance or pay a penalty in order to make universal coverage a fiscally sound reality. Ironically, that was the focus of much of the debate the justices heard, yet it doesn’t kick in until 2014, whereas many other provisions already have.

Thanks to the Affordable Care Act, some 2.5 million young people can stay on their parents’ insurance — today — until they reach 26. At least 250,000 small businesses have been able to claim a tax deduction to cover the healthcare of their employees. Prescription-drug discounts have saved seniors an estimated $3.2 billion. No one today can be turned down for insurance because of a pre-existing condition and insurance companies must devote at least 80 percent of premiums to medical care instead of profits or administrative costs.

In short, thanks to ACA, American healthcare is changing for the better. If the “individual mandate” survives the Supreme Court test, as it should, it will enshrine a basic principle of insurance, casting the net wide enough so that healthy patients balance those who are ill. But even if it doesn’t, other parts of the law are worth keeping — and must be paid for with a formula that allows insurance providers to offer services without going bankrupt.

Questions during last week’s debate made it clear that some judges are aware of this reality.

• If they deny the individual mandate, but keep the rest of the law, an uproar will ensue as insurance companies demand to know how they’re supposed to comply with the remaining provisions without an expanded premium base. The justices rightly seemed concerned about the consequences of going down this road.

• If the entire act is thrown out, the court will have upended a law whose beneficial effects are self-evident and which was enacted to remedy an intolerable situation — a broken healthcare system that excluded nearly 50 million Americans from insurance and whose costs were soaring out of control.

There is another fundamental reality that the court cannot ignore. The Obama administration devised an imperfect but workable and comprehensive solution to a pressing national problem. The Republicans offered none. Unless the court has a solution of its own, it should not turn back the clock.



Read more here: http://www.miamiherald.com/2012/04/0...#storylink=cpy