Tuesday, August 30, 2011
Friday, August 26, 2011
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Tuesday, August 23, 2011
Sunday, August 21, 2011
Friday, August 19, 2011
Thursday, August 18, 2011
Wednesday, August 17, 2011
AMA Chief to Congress: Deal With the Doc Fix
AMA Chief to
Congress: Deal With the Doc Fix
By Dena Bunis, CQ HealthBeat Managing
Editor
“Any serious proposal to confront our nation’s fiscal challenges must address the massive shortfall in funding for Medicare payments for physician services,”
The Medicare Payment Advisory Committee said in March that it will tackle this problem and could issue a recommendation to Congress in October.
“The final report released by the president’s National Commission on Fiscal Responsibility and Reform in December, as well as the recommendations of the Senate bipartisan ‘Gang of Six,’ included funding to permanently reform the SGR while also achieving a $4 trillion in overall deficit reductions. So it can be done,”
Physician groups had hoped that the debt deal would have included a remedy for the SGR, and soon after the law was passed, doctor lobbies made it clear that they would try to influence the panel to take up that issue.
Judge allows cuts to Arizona's Medicaid program
Judge
allows cuts to Arizona
A Maricopa County Superior Court judge on
Wednesday refused to block cuts to the state Medicaid program, saying a
voter-approved law
requiring health coverage for Arizonans below the poverty level doesn't force
the Legislature to pay for it.Judge Mark Brain's ruling means an enrollment cap for childless adults will remain in place, eliminating an estimated 110,000 people from the rolls in the coming year and freezing out an untold number of low-income Arizonans.
Lawyers representing people who have been denied health care since the freeze was imposed July 8 argued that it violated state law, passed by voters in 2000, and the state Constitution, which voters amended in 1998 to prevent legislative meddling with ballot measures.
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"The Voter Protection Act does not impose an enforceable duty on the Legislature to fund Proposition 204," he wrote in his seven-page ruling. "Simply put, the court lacks the authority to make the Legislature fund Proposition 204."
State lawmakers and Gov. Jan Brewer cut Arizona Health Care Cost Containment System, the state's Medicaid program, by more than $500 million to help balance the budget. AHCCCS won federal approval last month to cap enrollment for adults without dependent children, for savings estimated at $190 million.
Anne Ronan, an attorney with the
She said they will appeal the decision. In the meantime, she said, low-income, chronically ill Arizonans are at risk.
"People are calling us every day who are being denied, with very serious health problems," Ronan said.
Prop. 204 initially relied on tobacco settlement dollars as the primary source of funding but required that it "shall be supplemented, as necessary, by any other available sources."
Attorneys for Brewer and AHCCCS argued that the reference to "available sources" gave them authority to cut AHCCCS, which serves 1.3 million people and has seen dramatic growth since the recession took hold. The state's financial crisis meant there was no money "available," lawmakers argued, and freezing programs beyond minimal federal requirements was the only way to keep the rest of the AHCCCS intact.
They also argued that the judicial branch had no business telling the Legislature how to appropriate state funds. "
Thousands of people fall off the AHCCCS rolls every month. Community groups, including Don't Get Dropped, say phone calls and anxiety levels are increasing.
"People are asking, 'What am I going to do?' " said Allen Gjersvig, executive director of the Keogh Health Foundation, which is spearheading Don't Get Dropped. "There aren't a lot of good choices."
Among those who are losing coverage are parents whose children reach maturity or who lose custody. Gjersvig said some people also are having trouble getting through to the state Department of Economic Security to complete their re-enrollment paperwork and required phone interview. The agency handles AHCCCS eligibility.
Roughly 250,000 people are covered under Prop. 204, including about 6,100 people with serious mental illness, 1,200 with HIV/AIDS and 1,500 young adults poised to age out of Medicaid coverage for children. Those three groups are largely exempted from the freeze.
AHCCCS also is awaiting federal approval for a raft of other reductions, including freezing enrollment for some low-income parents, eliminating non-emergency medical transportation in urban areas, imposing mandatory copayments, eliminating emergency services funding for people who can't prove citizenship and requiring AHCCCS patients to re-enroll every six months instead of annually.
Tuesday, August 16, 2011
Monday, August 15, 2011
Legal Fight Over Health Care Law Jolted by Appeals Court Decision in Favor of States
Legal Fight Over Health Care Law Jolted by Appeals Court
By Jane Norman, CQ HealthBeat
Associate Editor
The turmoil and uncertainty that surround
the implementation of the health care law increased Friday with an appeals
court ruling in a multistate legal challenge striking down the heart of the
law: its requirement that all Americans have health insurance. While every
court decision so far has been a jolt, the 304-page opinion affirmed the view
of a majority of the very bodies putting the law in place — the states.
The decision that the individual mandate is
unconstitutional also means that federal appeals courts now are split on the
law, appearing to increase the likelihood that the U.S. Supreme Court will take
up the case. The speed with which that might happen, and whether it will come
during the 2012 campaign, will depend on how quickly the Justice Department
wants to move.
Not all was a victory for the 26 states
that brought the suit, Florida v. Department of Health and Human Services
. They lost their argument that the expansion of the Medicaid program was
unconstitutional because it is so costly for them to bear their share of the
federal-state program. The court said the expansion to an estimated 16 million
additional beneficiaries “is not unduly coercive,” especially considering that
the federal government will bear nearly all of the costs.
The White House downplayed the 2-1 decision
by the U.S. Court of Appeals for the 11th Circuit. Aides stressed that four
other federal courts, including one appeals court, already have found the law (
PL 111-148 , PL 111-152 )
constitutional. “We strongly disagree with this decision, and we are confident
it will not stand,” said Stephanie Cutter, assistant to the president and
deputy senior adviser.
Ron Pollack, executive director of the
group Families USA, which supports the law, said the ruling will help
implementation. “Today’s court ruling allows the Affordable Care Act to move
forward,” he said. “All of the provisions of the act — save possibly for one,
the personal responsibility provision — will be implemented in states across
the country. On the personal responsibility issue, the appellate courts are now
split.”
But the ruling was a victory for the
states, many of which were prodded to the challenge by Republican lawmakers
elected in 2010 and tea party activists. Earlier this week, Kansas Gov. Sam Brownback , a
Republican, returned a $31.5 million grant from the federal government to set
up an “early innovator” exchange, citing the uncertainty over the future of the
health care law and its cost. Exchange planning in other states has been slowed
by conservative objections.
Two of those suing — Mississippi and Nevada
— had just hours earlier on Friday been awarded multimillion-dollar grants by
the Department of Health and Human Services for the development of their health
insurance exchanges, which will be used in the law to provide insurance for
individuals and small businesses.
After a district court decision earlier
this year that the entire law was unconstitutional, states hesitated on
implementation. It wasn’t clear by Friday night if that would happen again,
especially since it was just the mandate found unconstitutional, but state
officials said they were heartened by the ruling and looking toward the likely
next phase in the Supreme Court. “Today we have prevailed in preventing
Congress from infringing on the individual liberty protected by the U.S.
Constitution,” said Florida Attorney General Pam Bondi.
In addition, a judge appointed by President
Bill Clinton was one of the two 11th Circuit judges ruling that the individual
mandate is unconstitutional. Judge Frank M. Hull joined with Chief Judge Joel
Dubina, who was appointed by President George Bush. Dissenting was Judge
Stanley Marcus, another Clinton
This was a twist on a ruling earlier this
summer by the 6th Circuit, where conservative judge Jeffrey S. Sutton upheld
the law, much to the joy of the law’s advocates. That case was brought by the
conservative Thomas
More Law
Center
Still pending is a decision from the 4th
Circuit in Richmond , Va. ,
which is considering two cases: one by Virginia
and a second by Liberty
University
House Speaker John A. Boehner ,
R-Ohio, called for a speedy resolution by the Supreme Court. “The costly
mandates, regulations, and taxes that are hanging over small businesses are adding
to our economic uncertainty and joblessness,” Boehner said.
Celebrating was the National Federation of
Independent Business Small Business Legal Center, a party to the suit with the
states. Elizabeth Milito, senior executive counsel, said the group was
disappointed that the entire law wasn’t struck down but nonetheless it was a
“good day for small business.”
The government is almost certain to appeal
the decision to the Supreme Court, and Milito said the NFIB wants that to
occur as soon as possible so as to eliminate uncertainty for businesses and
states in whether and how to implement the law. “A decision from the Supreme
Court in the next term would be a good thing for the country,” she said.
But she said opponents also are worried
that the Justice Department will ask for an “en banc” review from the 11th
Circuit, which would mean a review by all of the judges on the appeals bench
rather than just the three who heard oral arguments. That could mean a delay of
a final decision by the high court.
The uncertainty must be resolved quickly,
said James A. Klein, president of the American Benefits Council, a trade
association representing those who administer or sponsor health and retirement
plans for 100 million Americans.
“The fact that today’s decision upheld the
rest of the law, while striking down the mandate, does not make the situation
any clearer,” Klein said. “Knowing whether people must obtain health coverage
is critical for individuals and for the employers from whom most Americans get
their coverage. Citizens, employers and all stakeholders deserve the clarity
that only the Supreme Court can provide.”
The ruling did not kill the entire law but
just the individual mandate. The appeals court judges were considering a
federal district court ruling by Judge Roger Vinson that declared the entire
law unconstitutional. Hull
This was highlighted by the law’s
supporters. “This decision makes clear that the courts will not undo health
care reform and that insurance company abuses like discrimination against
people with pre-existing conditions will not be tolerated,” said Ethan Rome,
head of the advocacy group Health Care for America Now.
But the judges said that the individual
mandate is an overreach by Congress and violates the Commerce Clause of the
Constitution. “We have not found any generally applicable, judicially
enforceable limiting principle that would permit us to uphold the mandate
without obliterating the boundaries inherent in the system of enumerated
congressional powers,” the judges wrote.
Another tussle has been over whether the
individual mandate is a penalty, as described in the law, or a tax, as
described by supporters. Hull
The mandate “represents a wholly novel and
potentially unbounded assertion of congressional authority: the ability to
compel Americans to purchase an expensive health insurance product they have
elected not to buy and to make them re-purchase that insurance product every
month for their entire lives.” Supporters argue that the health insurance
market is unique and so must be regulated, but “uniqueness is not a
constitutional principle in any antecedent Supreme Court decision,” the judges
said.
Appeals Judges Strike Down Individual Mandate, but Medicaid Expansion Remains
Appeals Judges Strike Down Individual Mandate, but Medicaid
Expansion Remains
By Jane Norman, CQ HealthBeat
Associate Editor
Judges for the 11th U.S. Circuit Court of
Appeals on Friday declared the individual mandate in the health care law to be
unconstitutional. But they left the rest of the law intact, including a key
component — the expansion of Medicaid to millions of uninsured Americans.
The 2-1 ruling from the Atlanta-based court
came in a suit filed by 26 states led by Florida
This is the second federal appeals court
ruling on the law. The administration prevailed in the first, filed by the Thomas More Law Center
in Ann Arbor , Mich.
The 11th Circuit judges said that “Congress
exceeded its commerce power in enacting its individual mandate” and that “its
tax power does not provide an alternative constitutional basis for upholding
this unprecedented individual mandate.”
The decision was written by Chief Judge
Joel Dubina, an appointee of President George Bush, and Judge Frank M. Hull,
who was appointed by President Bill Clinton. Dissenting was Judge Stanley
Marcus, another Clinton
Earlier this year, U.S. District Court
Judge Roger Vinson had ruled the entire law unconstitutional. But the appeals
court said just the requirement that all Americans hold insurance is
unconstitutional.
The 26 state plaintiffs are Alabama, Alaska,
Arizona, Colorado, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Louisiana,
Maine, Michigan, Mississippi, Nebraska, Nevada, North Dakota, Ohio,
Pennsylvania, South Carolina, South Dakota, Texas, Utah, Washington, Wisconsin,
and Wyoming.
Late Friday, another health care lawsuit
was thrown out of a federal court in California
Friday, August 12, 2011
Thursday, August 11, 2011
Wednesday, August 10, 2011
Tuesday, August 9, 2011
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Thursday, August 4, 2011
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