KHN Original Reporting & Guest Opinion
Kaiser Health News contributor Stuart Taylor, Jr., tells Jackie Judd the conservative justices were especially skeptical on Tuesday, asking sometimes-hostile questions of Solicitor General Donald Verrilli. Watch the video or read the transcript.
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Inside the Supreme Court building this week, the nation's highest court is hearing oral arguments in a case that seeks to overturn the 2010 health law. This Kaiser Health News
photo gallery, with pictures taken by Jessica Marcy, details happenings outside the building, where Americans gathered to express their support or opposition to the law -- or just to see history being made (Marcy, 3/27). Check out the photos
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Now on Kaiser Health News blog, Phil Galewitz reports on Wednesday's scene at the Supreme Court: "A smaller and more subdued crowd gathered outside the Supreme Court Wednesday for the third and final day of the historic hearings over President Obama’ health care law. About 100 supporters of the law, many carrying signs saying, "Protect our Health, Protect the Law," marched in front of the Court, while about 30 opponents stood nearby with their own placards" (Galewitz, 3/28).
Yesterday, Galewitz filed this report: "The second day of the momentous Supreme Court hearing on President Obama’s health law ended almost exactly at noon. By 12:03, many conservative lawmakers and television commentators who had been in the packed chambers stood on the marble steps outside, saying the health insurance mandate at the heart of the law appeared to be in deep trouble" (Galewitz, 3/27). Check out what else is on the blog.
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Kaiser Health News
provides excerpts of some of the most compelling parts of Tuesday's oral arguments at the high court (3/27). Read selections
highlighting how conservative justices aggressively challenged the government's position on the individual mandate.
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Wednesday's Supreme Court oral arguments are split between two topics -- first, severability, which is scheduled to last 90 minutes; and then the Medicaid expansion, which has been allotted 60 minutes. The severability arguments will focus on whether some or all of the health law's other provisions should stand if the mandate is overturned. The Medicaid arguments will answer this question: "Apart from those issues, does the law's expansion of Medicaid violate the sovereignty of the states by effectively requiring them to spend more of their own money or forfeit all of the federal Medicaid money they now receive?" (Taylor, 3/26). For more information about the arguments, read KHN's Primer For The Upcoming Oral Arguments.
Also, check out Kaiser Health News resource page, The Supreme Court Decides: Health Law At The High Court, for our complete coverage. It includes KHN's scorecard, which tracks the course the legal challenges followed to arrive at the high court; as well as anaylsis, news, briefs and other documents. KHN also has a collection of its coverage related to the law's second anniversary and the high court's review, and will update the web site throughout the day with the latest information and news summaries.
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Kaiser Health News provides a fresh take on health policy developments with "Spring Forward, Fall Back?" by Chris Weyant.
Meanwhile, here's today's health policy haiku:
Inside marble walls
nine wealthy lawyers dither
while poor people die.
-Johnathon Ross MD
If you have a health policy haiku to share, please send it to us at http://www.kaiserhealthnews.org/ContactUs.aspx and let us know if you want to include your name. Keep in mind that we give extra points if you link back to a KHN original story.
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In the final day of debate, the justices consider whether the entire law must be thrown out if the mandate is overturned. That issue will get 90 minutes, while the challenge to the expansion of Medicaid is on for 60 minutes.
The Washington Post: On Last Day Of Health Care Hearing, Supreme Court Considers Severability, Medicaid Expansion
The Supreme Court will complete its review of President Obama's health care law Wednesday by considering whether all of the law must fall if part of it is found unconstitutional, and whether the law's proposed Medicaid expansion violates the federal-state partnership. The Medicaid expansion decision might have the most lasting impact on the federal government's ability to use its spending power to pressure state action (Aizenman and Barnes, 3/28).
The Associated Press/Washington Post: On Final Day Of Health Care Hearings, 26 States Tell Justices They Can't Afford More Medicaid
States are complaining that the U.S. government made them a health care offer they can't refuse — but they'd sure like to. And on a doubly busy Wednesday ending three days of hearings, the Supreme Court has another issue to consider: If justices throw out a key piece of the health care law, should they keep the rest of it? (3/28).
The Associated Press: Court: What's Left Of Health Law Without Mandate?
The heart of the Obama administration's health care overhaul hanging in the balance, the Supreme Court is turning to whether the rest of the law can survive if the crucial individual insurance requirement is struck down. The justices also will spend part of Wednesday, the last of three days of arguments over the health law, considering a challenge by 26 states to the expansion of the Medicaid program for low-income Americans, an important feature toward the overall goal of extending health insurance to an additional 30 million people (Sherman, 3/28).
Stateline: Justices Consider Severability And Medicaid
The health care law calls on states to expand their Medicaid programs to cover all individuals with incomes at or below 133 percent of the federal poverty line — an estimated 16 million uninsured people. Under the law, the federal government pays 100 percent of the cost of coverage for newly eligible individuals through 2016. After that, the federal share gradually decreases to 90 percent in 2020 and remains at that level. In addition, the federal government pays for 90 percent of states’ administrative costs for the expansion (Vestal, 3/28).
Fox News (Video): Supreme Court Sets Up Doubleheader Finale On "ObamaCare" Hearing
The closing act to the Supreme Court's three-day examination of President Obama's health care law will be a doubleheader covering two distinct issues. Wednesday's hearing comes after the justices held an intense two-hour session a day earlier on the law's requirement that Americans buy health insurance. At the final session, the justices will examine whether other parts of the law are invalid if the Court votes to strike down the individual mandate. The afternoon finale will then look at one specific provision of the 2,700-page law involving the expansion of the Medicaid program that the 26 states challenging the law claim is coercive (Ross, 3/28).
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In exploring the severability question, the justices will ponder whether other parts of the health law can go forward if they void the individual mandate, considered the measure's central element. News outlets examine the "contingency plans" being explored by the law's supporters in case the mandate falls.
NPR: Court Looks At Whether Mandate Can Separate From Rest Of Health Law
In its second-to-last argument over the Affordable Care Act Wednesday, the Supreme Court Wednesday ponders a what-if. Specifically, if it decides that Congress exceeded its Constitutional authority in enacting the part of the law that requires most Americans to either have health insurance starting in 2014 or pay a penalty, does that invalidate the rest of the law? And if not, how much, if any, of the rest of the law should it strike down? (Rovner, 3/28).
Reuters: Supreme Court Weighs All-Or-Nothing On Healthcare Law
The fate of President Barack Obama's healthcare overhaul will be on the line on Wednesday when the Supreme Court considers whether the entire law must fall without its centerpiece insurance mandate. Completing three days of historic arguments, the nine justices will hear arguments on whether the rest of the law, Obama's signature domestic accomplishment, can survive should the court decide Congress exceeded its powers by requiring all Americans buy insurance by 2014 (Vicini and Biskupic, 3/28).
Bloomberg: Court Considers Health Law Fate If Coverage Rule Voided
The U.S. Supreme Court today will consider how much of President Barack Obama's health-care law must be thrown out if the justices decide Congress can't require Americans to buy medical insurance.The debate on so-called severability took on added significance after questions from justices yesterday indicated a majority might strike down the insurance requirement. Today’s session will conclude three days of hearings, six hours in all, the longest in 44 years (Stohr and Drummond, 3/28).
The Washington Post: Could The Health-Care Law Work Without The Individual Mandate?
If the Supreme Court were to invalidate the 2010 health-care law's requirement that virtually all Americans obtain insurance, would the rest of the law become unworkable? Even among supporters of the statute, opinions vary widely about the practical impact of a decision to strike down the mandate but leave everything else intact — one of several options available to the court (Aizenman, 3/27).
CBS: Court To Mull Health Care Law Without Mandate
The heart of the Obama administration's health care overhaul hanging in the balance, the Supreme Court is turning to whether the rest of the law can survive if the crucial individual insurance requirement is struck down. The justices also will spend part of Wednesday, the last of three days of arguments over the health law, considering a challenge by 26 states to the expansion of the Medicaid program for low-income Americans, an important feature toward the overall goal of extending health insurance to an additional 30 million people (3/28).
Politico: Health Care Reform: Coverage For Sickest May Hinge On Court's Decision
Lawyers for President Barack Obama made a high-stakes gamble on the way to the Supreme Court: If you strike down the individual mandate, they told the justices, you've also got to kill the guarantee of coverage for people with pre-existing conditions. All of a sudden, that’s looking like a bad bet (Millman, 3/27).
The New York Times: Contengency Plans Are Few If Court Strikes Down Insurance Requirement
If the court invalidates the insurance requirement, the White House and a divided Congress would be left to pick up the pieces. Their first steps toward finding alternatives to reduce the number of uninsured in the country — nearly 50 million, or one in six Americans — would depend heavily on how far the Supreme Court goes, and on the balance of power in Washington after the November elections (Sack, 3/27).
Kaiser Health News: If Mandate Is Overturned, Obama Could Need Help To Salvage The Health Law
When Barack Obama ran for president in 2008, he insisted the nation could fix its health care system without requiring everyone to carry insurance. As the Supreme Court weighs in on the health law, Obama is facing the possibility that he may have to make good on his campaign claim. During the March 27 oral arguments at the Supreme Court, conservative justices – who are in the majority – aggressively challenged the mandate. ... There are ways that Obama—if he’s re-elected — might be able to salvage the law even if the court strikes down the individual mandate but leaves the rest intact, health policy experts say (Rau, updated 3/28).
The Associated Press: Loss Of Insurance Mandate Wouldn't Kill Health Law
President Barack Obama's health care law would not automatically collapse if the Supreme Court strikes down the unpopular requirement that most Americans carry medical insurance or face a penalty. The overhaul could still lurch ahead without that core requirement, experts say. But it would be more like a clunky collection of parts than a coherent whole. That would make an already complicated law a lot harder to carry out, risking repercussions for a U.S. health care system widely seen as wasteful, unaffordable and unable to deliver consistently high quality (Alonso-Zaldivar, 3/28).
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A ruling against Medicaid could touch a variety of federal statutes and reshape the federal-state legal framework.
NPR: Supreme Court's Medicaid Decision Could Reach Far Beyond Health Care
After Tuesday's judicial fireworks, the Supreme Court wraps up arguments on the new health care law Wednesday by focusing on two questions. The first involves what would happen if the "individual mandate" — the core of the law that requires most people to have health insurance — is struck down. Would the rest of the law fall, too, or could some provisions stay? But it's the second argument the court will hear about the Affordable Care Act that could potentially have the most far-reaching consequences. At issue is whether the health law's expansion of the Medicaid program for the poor unfairly forces the states to participate (Rovner, 3/28).
Politico: Medicaid Ruling Could Have Far-Reaching Impact
The court is spending most of its health law oral arguments on questions pertaining to the individual mandate. Later, the court will devote the sixth and final hour to Medicaid expansion. And even though court-watchers are not expecting a precedent-shattering ruling on the question, the fact that the court is addressing this element of the health law signals that the justices are taking it seriously. A broad ruling by a conservative majority in June against Medicaid could shake the shared legal foundation of landmark legislation, including unemployment benefits, the Civil Rights Act and the Clean Air Act (Feder, 3/27).
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In yesterday's oral arguments, the grilling aimed at the Obama administration's lawyer by the court's conservatives raised the prospect that the law's centerpiece could be overturned.
The Washington Post: Supreme Court Expresses Doubts On Key Constitutional Issue In Health Care Law
In an intense interrogation of the government's lawyer, Solicitor General Donald B. Verrilli Jr., the justices posed repeated and largely unanswered questions about the limits of federal power. At the end of two hours, the court seemed split on the same question that has divided political leaders and the country: whether the Constitution gives Congress the power to compel Americans to either purchase health insurance or pay a penalty (Barnes and Aizenman, 3/27).
The Wall Street Journal: Justices Question Health Law
The Supreme Court's conservative justices sharply challenged the Obama administration's health care overhaul Tuesday, raising clearly the prospect that the president's signature domestic achievement could be struck down. The court's liberal and conservative wings seemed inclined to split evenly over the question of whether the "individual mandate" requiring Americans to carry health insurance or pay a fine is constitutional (Bravin, 3/27).
Reuters: Skeptical Justices Question Obama Health Care Law
The Obama administration faced skeptical questioning from a U.S. Supreme Court dominated by conservatives on Tuesday during a tense two-hour showdown over a sweeping health care law that has divided Americans. A ruling on the law's key requirement that most people obtain health insurance or face a penalty appeared likely to come down to Chief Justice John Roberts and Justice Anthony Kennedy, two conservatives who pummeled the administration's lawyer with questions (Biskupic and Vicini, 3/27).
The New York Times: In Court, Sharp Questions On Health Care Law's Mandate
With the fate of President Obama’s health care law hanging in the balance, a lawyer for the administration faced a barrage of skeptical questions on Tuesday from four of the Supreme Court’s more conservative justices, suggesting that a 5-to-4 decision to strike down the law was a live possibility (Liptak, 3/27).
Reuters: Broccoli, Cellphones And The Obama Health Care Law
If Congress has the power to require that Americans obtain health insurance, U.S. Supreme Court justices on Tuesday asked hypothetical questions on what would be next -- insisting that people eat broccoli, buy a cellphone or get burial insurance? During a second day of arguments over President Barack Obama's 2010 health care law, conservative Chief Justice John Roberts likened health care services for the sick to such emergency services as police, fire and ambulance assistance (Vicini, 3/27).
Kaiser Health News: Day 2: Justices Grill Obama Administration On Health Law
Kaiser Health News contributor Stuart Taylor, Jr., tells Jackie Judd the conservative justices were especially skeptical today, asking sometimes-hostile questions of Solicitor General Donald Verrilli (3/27). Read the interview transcript or watch the video.
NPR: Mandate's Fate Seems To Rest On Kennedy, Roberts
At the U.S. Supreme Court Tuesday, hostile questioning from key justices seemed to imperil the individual mandate, the central provision of the Obama health care overhaul. … But for supporters of the law, the worrisome questions came from Justice Anthony Kennedy, the justice who most often swings the court in 5-4 decisions (Totenberg, 3/27).
The Philadelphia Inquirer: Looking For Signs Of How Justices Will Rule
The law's supporters had pinned their hopes on Justice Anthony Kennedy, who has often cast the swing vote in decisions that split on ideological lines. But Kennedy seemed just as skeptical of the mandate as the other conservatives. He described it as "unprecedented" and saw a "heavy burden of justification" to uphold it under the Constitution. Without Kennedy's vote, the law's supporters face long odds (Field, 3/28).
NPR: Supreme Court Cheat Sheet: A Quick Guide To The Day 2 Arguments
In contrast to Monday's dense and technical arguments, Tuesday's session was filled with sharp rhetorical volleys and clever analogies. Here are some of the more telling exchanges between the lawyers and the high court justices (Halloran, 3/27).
Market Watch: Justices Show Split Over Health-Insurance Mandate
Supreme Court justices appeared to be split largely along ideological lines after hearing arguments over whether U.S. citizens should be made to buy insurance or pay a penalty -- the central issue in the health-care-reform debate -- in a second day of hearings Tuesday. Transcripts of the day's proceedings, however, indicated that there may be two swing votes in Chief Justice John Roberts and the court's perennial ideological straddler, Justice Anthony Kennedy (Britt, 3/27).
Modern Healthcare: Administration Attorney Strains For Answers On Insurance Mandate
Solicitor General Donald Verrilli Jr. faced a withering barrage of questions Tuesday from Supreme Court justices about what limits would remain on congressional power if federal lawmakers can force Americans to perform an act such as purchasing health insurance. All three attorneys supporting and opposing the individual mandate in the Patient Protection and Affordable Care Act faced skeptical justices and tough questions during the two hours of arguments, but Verrilli, arguing for the Obama administration, struggled to come up with a precise definition of the principle that would limit Congress' powers (Carlson, 3/27).
Politico: Did Verrilli Choke? And Does It Really Matter?
Tuesday may have been the biggest day in Solicitor General Donald Verrilli's career, when he went before the Supreme Court to defend the central tenet of the health care reform law. To many who were watching, it looked like he choked. "He was passive. He was stumbling. He was nervous," CNN legal analyst Jeffrey Toobin told POLITICO. "I was just shocked.” His halting delivery was so pronounced that BuzzFeed mercilessly edited together 40 seconds of coughing, throat clearing and water-drinking. "I've seen him argue under pressure," said Arnold and Porter's Lisa Blatt, a former assistant to the solicitor general who's argued 30 cases before the Supreme Court. Blatt, who listened to audio of the argument, said, "That's not the way he usually sounds" (Feder, 3/27).
Bloomberg: Some Justices Question Health Law's Constitutionality
U.S. Supreme Court justices hinted they might strike down President Barack Obama’s health care law as the court's Republican appointees suggested Congress went too far by requiring Americans obtain insurance or pay a penalty. On the second of three days of arguments in the historic case, justices' questions indicated they might split 5-to-4, with the court's five Republican appointees joining together to overturn the law (Stohr and Asseo, 3/27).
San Francisco Chronicle: 5 Conservative Judges Tough On Health Care Law
The Supreme Court's conservative justices tore into the Obama administration's signature health care law Tuesday, posing the question: If the government can make individuals buy health insurance, why can't it make them buy cell phones or even burial insurance? When they vote together, the five conservatives are a majority of the nine-member court. President Obama's legal team went into the second day of oral arguments on the Affordable Care Act knowing they needed to win over at least one conservative justice to join the four justices who appeared more sympathetic to upholding the law (Freedman, 3/28).
The Fiscal Times: High Court Heads for High Noon on Health Care Act
[Justice Ruth Bader Ginsburg] asked about what will likely be the step for liberal reformers should health care reform be struck down: pursuit of a single-payer health care system. "You need a group to subsidize" people who need health care, she told Clement. "You're saying the only way that can be done is if the government does it itself. It has to be a government takeover. Is that your position?" (Goozner, 3/27).
Boston Globe: Court's Conservatives Question Health Law's Mandate
The Supreme Court's conservative justices raised concerns Tuesday that President Obama's health care law could open the door for the government to compel Americans to participate in all sorts of commerce, including the mandated purchase of cellphones, gym memberships, even burial insurance. The justices' probing questions during the second day of hearings over the constitutionality of Obama's signature health care overhaul served to jolt the law's supporters from any certitude that the court would find the requirement to have health insurance does not trample on individual rights (Jan, 3/27).
Kaiser Health News: Transcript: Highlights Of The Lively Arguments At The Supreme Court, Day 2
Kaiser Health News provides excerpts of some of the most compelling parts of Tuesday's oral arguments at the high court. Read selections highlighting how conservative justices aggressively challenged the government's position on the individual mandate (3/27).
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In Massachusetts, reforms are proceeding with an individual mandate, while Washington state and New Jersey faced hardships when they overhauled their health insurance markets without one.
The New York Times: In Massachusetts, Insurance Mandate Stirs Some Dissent
Massachusetts offers a real-world laboratory of how such a mandate might work. Roughly 48,000 people in the state were subject to penalties for not having coverage in 2009, the latest year for which figures are available, down from 67,000 in 2007. The maximum penalties range from $228 to $1,212 a year, depending largely on income. (Anyone with an annual income of less than 150% of the federal poverty line pays no penalty.) The penalties are paid on state tax returns (Goodnough, 3/27).
The Seattle Times: Washington’s ’93 Health Overhaul Faltered With Loss Of Mandates
[Some] remember 1993, when state lawmakers passed a comprehensive state law aimed at insuring everyone and spreading the health-care expenses of the sickest throughout a large pool of policyholders. But the law, which relied on both mandates and incentives, was soon dismembered, leaving only popular provisions, such as prohibiting insurers from denying coverage to sick people or making them wait many months for coverage. Without any leverage to bring healthy people onto insurance rolls, insurers, left with the priciest patients, began a financial death spiral (Ostrom, 3/27).
Earlier, related KHN coverage: The New Jersey Experience: Do Insurance Reforms Unravel Without An Individual Mandate? (Cohn, 3/20).
Meanwhile, a study explores the eventual reach of the federal mandate -
CQ HealthBeat: Study: Relatively Few Would Have To Buy Coverage Under Mandate
Relatively few Americans would be affected by what polls show is the most controversial part of the health law ... That's the finding of a new study by the Urban Institute, which estimates that just six percent of the U.S. population, 18 million people, would have to "newly purchase" coverage under the individual mandate provision of the health overhaul law. ... In most cases the government would provide some help for those needing insurance (Reichard, 3/27).
Also, media outlets in California wonder about consequences of the court's decision -
KQED's State of Health blog: What Impact Will the Court's Decision Have on California?
California was the first state to pass legislation to set up a health insurance exchange. The state also set up a new high risk pool so people with pre-existing conditions can get health insurance. But what happens if the Supreme Court declares the individual mandate unconstitutional? Or overturns the entire law? What can still go forward in California? The answer depends in part upon whom you ask. But for the most part California — like all states — will find it tough to move forward without the backing of the federal law (Aliferis, 3/27).
California Watch: For California, Supreme Court Health Reform Decisions Put Billions On Line
California already has begun to overhaul its Medi-Cal program in anticipation of the influx of new patients. The state is relying more heavily on managed care plans to reduce costs and provide comprehensive care. And the program is making changes with an eye on continual improvement, said Marian Mulkey, director of the Health Reform and Public Programs Initiative of the California HealthCare Foundation (Jewett, 3/28).
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News outlets analyze the impact that key justices could have on the court's consideration of the health law.
Politico: John Roberts Court On Trial
If the wily chief justice felt squeamish about leading the Supreme Court into an election-year political maelstrom, that was nowhere on display Tuesday, when the Roberts-led conservative majority signaled its collective skepticism, even hostility, for President Barack Obama’s health care law (Thrush, 3/28).
The Wall Street Journal: Kennedy Leaves Both Sides Hopeful
The mystique that is Justice Kennedy—the almost-certain swing vote in any big Supreme Court case—was on full display during Tuesday's arguments over whether President Barack Obama's signature legislative achievement passes constitutional muster. After two intense hours of oral argument, both sides were investing their hopes in him. But neither could confidently predict how he will vote (Kendall, 3/27).
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On day 2 of the Supreme Court hearings, the crowds outside the court ballooned. Meanwhile, Wall Street and lawmakers seemed to take the proceedings in stride.
Kaiser Health News: Capsules: Pundits Parse Tough Questions By Conservative Justices
The second day of the momentous Supreme Court hearing on President Obama’s health law ended almost exactly at noon. By 12:03, many conservative lawmakers and television commentators who had been in the packed chambers stood on the marble steps outside, saying the health insurance mandate at the heart of the law appeared to be in deep trouble (Galewitz, 3/27).
The Washington Post: Court Watchers On Both Sides Speculate About Health-Care Mandate
Political Washington spent Tuesday engaged in an odd parlor game that combined the guesswork of charades with the messaging confusion of "telephone." Inside the Supreme Court, 500 people stared at nine justices, trying to divine the meaning behind questions, quips and even smiles. Outside, a peculiar subset of the capital's denizens were on their various electronic devices, eagerly trying to decode what those inside thought they saw (Fahrenthold and Aizenman, 3/27).
Bloomberg: Both Parties See Signs They'll Win In U.S. Health Ruling
Republicans and Democrats in Congress said they saw signs of eventual victory. ... Kentucky Republican Mitch McConnell, the Senate minority leader, said it was noteworthy that the four Republican- appointed justices who spoke peppered the Obama administration attorney defending the law with questions. ... [Senate Majority Leader Harry Reid] said he's confident the law, designed to expand health coverage to 32 million more Americans and control soaring costs, will remain intact (Litvan and Hunter, 3/28).
The Wall Street Journal: Health Executives Unfazed By Supreme Court Debate
Insurance companies and hospital chains brushed off concerns Tuesday the Supreme Court could strike down a requirement in the health-care law that would create millions of newly insured customers. ... Shares of major health insurers traded down as reports emerged that Justice Anthony Kennedy, a possible swing vote in the case, skeptically questioned the main attorney defending the provision. ... Insurers stocks' regained ground after the law's challengers took their turn responding to the justices' questions (Mathews and Radnofsky, 3/27).
Kaiser Health News: Slideshow: A Cold Morning But Hot Emotions Outside The Court
Americans gathered to express their support or opposition to the law -- or just to see history being made (Marcy, 3/27).
The Washington Post: Health-Care Arguments Boil Over Outside Court
There was a kind of "Freaky Friday"-meets-the-county-fair vibe outside the high court as [Rep. Steve King, R-Iowa] and other tea-partying speakers not only appropriated the lingo of abortion rights but at one point chanted, “We! Are! The 99 percent!’’ (Henneberger, 3/27).
National Journal: Supreme Court Crowds Jostle, Shout On Second Day Of Health Care Case
Tea Party Patriots jostled with supporters of the Obama administration’s health care reforms in front of the Supreme Court on Tuesday, the crowds swelling until they spilled over onto the Capitol grounds on the second day of oral arguments about the law. (Khan and Friedman, 3/27).
Reuters/Chicago Tribune: Tea Party Activists Rally Against Health Care Law
"We don't see James Madison's constitution as an impediment. It was meant to be our bulwark against the socialists and what the socialists intended to do to cede our authority from us," keynote speaker Representative Michele Bachmann of Minnesota, who ran unsuccessfully for the Republican presidential nomination, said to roars of approval. ... Demonstrators were urged to take out cell phones and call their congressional representative or senator from the rally (Simpson, 3/27).
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Capitol Hill Watch
The group of House members has incorporated in a new budget proposal parts of the plan put forward by an Obama-backed deficit reduction commission. The effort is likely to be rejected by the House this week.
The Associated Press: Bipartisan Group Offers Alternative To GOP Budget
A bipartisan budget plan to cut the deficit by $4 trillion over 10 years with a mix of new tax revenues and spending cuts across the federal budget is headed for a House vote, but it is likely to be rejected by Republicans against higher hikes and Democrats opposed to curbs on Medicare and Social Security benefits. The proposal by Reps. Steve LaTourette, R-Ohio, and Jim Cooper, D-Tenn., is modeled after a much-praised plan by the co-chairmen of President Barack Obama's 2010 deficit-reduction commission (Taylor, 3/28).
The Wall Street Journal: Group Backs Simpson-Bowles Plan
A small bipartisan group of House lawmakers, bucking their Democratic and Republican leaders, is advancing a plan to reduce the federal budget deficit by more than $4 trillion over 10 years through a combination of spending cuts and tax increases. A vote on the measure could come as soon as Wednesday. It is widely expected to fail, but the degree of support for the plan could prove a bellwether of whether Congress decides to pursue a broad bipartisan budget deal this election year (Paletta, 3/27).
In the meantime, Democrats' own budget would cancel Medicare payment cuts, and a GOP plan championed by Rep. Paul Ryan could put Republicans in a bind.
Modern Healthcare: Dems' Budget Plan Backs Off Medicare Payment Cuts
The House Democrats' budget introduced this week would cancel the $1.2 trillion in deficit-reduction moves scheduled to begin in January, which include cuts of up to 2 percent in Medicare provider payments. The blueprint for future spending would replace those cuts with alternative "targeted spending cuts and revenue increases," according to a summary of the measure (Daly, 3/27).
Politico Pro: Ryan Plan Puts GOP In Long-Term Budget Bind
As House debate begins Wednesday, that's the bottom line of the new Republican budget blueprint, which breaks with the August debt accords and substitutes a vision of capping revenue at 19 percent of gross domestic product and scaling back government to fit into that suit. It’s a bold, even bellicose election-year challenge. But the strict revenue limits could postpone for a generation the conservative promise of a balanced budget. At the same time, deep cuts to health care and education most likely will make it harder for GOP front-runner Mitt Romney to appeal to independents and women voters in the presidential campaign (Rogers, 3/27).
And the Senate could vote this week on repealing the Independent Payment Advisory Board, a major part of the health law.
Modern Healthcare: IPAB, Med Mal Could See Senate Vote This Week
A combined measure to establish federal malpractice caps and repeal a controversial Medicare cost control board could come up for a Senate vote as early as this week. The measure, which passed the House of Representatives last week, was formally placed on the Senate's legislative calendar, although no specific date for a vote has been set (Daly, 3/27).
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In other campaign news, James Carville says a loss at the Supreme Court will help Democrats politically.
The Associated Press: Analysis: Health Ruling Looms Small In Obama Race
The Supreme Court's much-anticipated ruling on health care, expected in late June, may have one surprising outcome: a modest impact on President Barack Obama's re-election bid, even though he is intimately associated with the challenged law. That wouldn't be the case if anyone other than Mitt Romney was Obama's likeliest Republican challenger this fall. Romney, however, is singularly ill-positioned to capitalize on the issue because he championed a similar health care law as Massachusetts governor in 2006 (Babington, 3/28).
Politico: James Carville: Court Loss 'Best Thing' For Democrats
Overturning President Barack Obama's healthcare reform law would be a political boost for Democrats, veteran Democratic strategist James Carville said Tuesday. "I think that this will be the best thing that ever happen to the Democratic party because health care costs are gonna escalate unbelievably," Carville told CNN's Wolf Blitzer of a possible Supreme Court decision to strike down the law. "I honestly believe this, this is not spin" (Dixon, 3/28).
No matter what the court outcome, the president is changing the rhetoric.
The Associated Press: Spin Meter: President Embraces 'Obamacare'
Now that President Barack Obama's re-election campaign has lifted an unofficial ban on using the opposition's term for his health care law, Democratic activists have been chanting "We love Obamacare" in front of the Supreme Court. ... But no presidential campaign makes such a move lightly. Obama's campaign is trying to use the weight of his opponents' rhetoric against them. Like martial arts or wrestling, except with words (Alonso-Zaldivar, 3/28).
Meanwhile, Romney in California explains a bit about his plans for health care.
The Associated Press: Romney, On Leno, Cracks Wise -- Just A Little
Romney suggested he would keep popular provisions of the national health care law that protect children and would maintain some protections for people with pre-existing health conditions. "People with pre-existing conditions, as long as they've been insured before — they're going to be able to continue to have insurance," he said during a lengthy exchange on the subject (Hunt, 3/27).
In related news -
Boston Globe: President Obama Leads Mitt Romney In Latest Poll
Despite Republicans’ claim that their mission to repeal Obamacare is a reflection of the public will, only 34 percent of likely voters in (a new) Suffolk poll said they believe the (health) law should be wiped off the books. About a third did say the law should be modified (Borchers, 3/27).
The Associated Press: Dems, GOP Woo Unmarried Women Voters
The scramble for support from women generally and single women specifically accounts for the competing narratives spun by Republicans, who are focused on the economy, and Democrats targeting social issues, so far this year. Democrats have been trumpeting a "Republican war against women," a phrase coined because of GOP objections to birth control access. They have used the slogan against GOP front-runner Mitt Romney and it was the theme of a fund raising swing out West earlier this year for 11 female Democratic Senate candidates (Kellman, 3/27).
FactCheck.org/The Philadelphia Inquirer: Misleading On Health Insurance Premiums
Both the Republican National Committee and the Obama administration are making misleading claims about health insurance premium costs. An RNC ad falsely implies that the federal health care law is responsible for all of the $1,300 average increase in family coverage premiums last year. But at the same time, the Obama administration makes the misleading claim that families "could save up to $2,300" on health care costs per year in the future by buying insurance through exchanges called for by the law (Robertson, 3/27).
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Birth control and abortion legislation are making the rounds at state capitols. An abortion bill in Georgia was stopped Tuesday while Idaho backed away from its own pre-abortion ultrasound bill. Missouri advanced a bill to let some employers opt-out of providing coverage for contraception.
NPR: Texas, Feds Face Off Over Planned Parenthood
Texas and the federal government are going at each other again, this time over Planned Parenthood. The Texas Legislature cut off all Medicaid money to Planned Parenthood because of its involvement in abortions; in response, the federal government has suspended funding for the state's reproductive health program. Now, Texas is suing the Obama administration (Burnett, 3/28).
The Atlanta Journal-Constitution: Abortion Bill Skids to Stop
In a late-hour game of chicken, House Speaker David Ralston, R-Blue Ridge, on Tuesday rejected the Senate's weakening of House legislation that could set new limits on abortion, effectively stranding the bill. Ralston blamed the Senate for putting House Bill 954 in jeopardy, something Senate leadership rejected."I am not sure they have the resolve to tackle this issue," Ralston said. "The House passed a very strong bill and the Senate chose to amend it, and they apparently have not shown in their insisting on their position any willingness to go back and reconsider the House position" (Quinn and Torres, 3/27).
The Associated Press/Kansas City Star: Birth Control Legislation Advances In Missouri
The Missouri Senate gave first-round approval Tuesday to a measure letting employers refuse to provide health insurance coverage for birth control in some instances. The legislation, endorsed in a voice vote, would let employers deny coverage unless an employee has a medical need for birth control. Democrats called the measure a "do-nothing" bill, noting that most of the bill’s provisions are already in state law and that Republicans had merely brought the bill up to appease religious voters (3/27).
The Associated Press: Idaho Won't Require Ultrasound Before Abortion
Idaho's Republican-controlled Legislature is backing away from a bill requiring that women seeking an abortion get an ultrasound before the procedure. The legislation has stalled in the state House after Rep. Tom Loertscher said Tuesday he wouldn't schedule a committee hearing, a move that ends the bill's chances this year (3/27).
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A selection of health policy stories from Texas, Missouri, Georgia, California and New York.
The Associated Press: Cuomo, Legislature Strike On-Time NY Budget Deal
The Senate's Republican majority refused to agree to create a "health exchange," or state-based health insurance market required under President Barack Obama's health care overhaul, for individuals and small businesses to insure more Americans. Since the Legislature didn't include a health exchange tailored to New York, Cuomo said he will establish one shortly by executive order (Gormley, 3/27).
Georgia Health News: Legislators Vote To Restore Child-Only Policies
These policies are usually bought by parents who have an employer policy that doesn't offer dependent coverage. ... When the Affordable Care Act required child-only insurance policies to accept kids with pre-existing health conditions, insurers in Georgia decided to stop offering new individual policies that cover children only. But late Monday night, the state Senate passed House Bill 1166 aims to restore these policies to the private insurance market (Miller, 3/27).
HealthyCal: Where Do They Go Now?
As a child, Lyudmia Shnaydman survived the horrors of World War II, though she lost her entire family. As an older adult she suffers from no fewer than four serious, chronic health problems. Now the state of California is giving her nightmares. ... Shnaydman is just one casualty of a budget rollercoaster that last year eliminated the entire Adult Day Health Care (ADHC) program of 35,000 clients, only to see it resurrected after a lawsuit as the new, smaller Community Based Adult Services (Perry, 3/27).
California Healthline: Assembly Bill Aims To Lift Caps on MRMIP
An Assembly committee gave initial approval to a bill that would make the Major Risk Medical Insurance Program more affordable for people with severe health issues. ... [Assembly member Bill] Monning's AB 1526 would eliminate the annual and lifetime limits on coverage in the Major Risk Medical Insurance Program, popularly known as MRMIP. ... "This is a program for people who are essentially uninsurable," Monning said (Gorn, 3/28).
The Texas Tribune: Interactive: Primary Care Workforce Shortages 2001-2011
A 2010 survey shows that fewer physicians are taking new Medicaid patients because of low reimbursement rates. At the same time, the state must face the prospect of adding millions more Texans to Medicaid by 2014, when the Affordable Care Act mandates that nearly all residents sign up for insurance. That means access to primary care will be critical (Murphy and Tan, 3/27).
The Texas Tribune: Interactive: Mapping Texas Medicaid Providers
Using the latest billing data available, this interactive map shows where some of the state's most active Medicaid providers are located in Texas — and how much they were reimbursed in fiscal year 2010. ... we narrowed the list below to account for those providers who many would consider to be the most actively engaged with Medicaid beneficiaries, from hospitals and physicians to advanced practice nurses (Aaronson and Tan, 3/27).
The Dallas Morning News: Texas Counties Lead Nation In Home Health-Care Use, Says Federal Report That Notes Fraud Concerns
The home health-care business is booming -- and that points to possible fraud, says a new federal report. "The new agencies appear to be concentrated in areas where fraud is a concern: California, Texas and Florida," the Medicare Payment Advisory Commission told Congress this month. "These states, like most, do not have state certificate-of-need laws for home health care, which can limit the entry of new providers." Texas particularly stands out on a list of counties with the highest rates of home health-care use (Egerton, 3/27).
The Texas Lawbook/The Dallas Morning News: U.S. Judge Upholds Texas Cap On Medical Malpractice Awards
A federal judge ruled Tuesday that a Texas law limiting noneconomic damages in medical malpractice cases to $250,000 is constitutional. The decision, applauded by tort reform advocates and denounced by trial lawyers and victims of medical malpractice, ends a four-year legal battle over whether the Medical Malpractice and Tort Reform Act of 2003 violated the U.S. Constitution (Curriden, 3/27).
The Associated Press/Kansas City Star: Separate Rallies At Missouri Capitol Protest Federal Health Care Law, State Labor Legislation
The crowds for the duel gatherings were some of the largest in the past decade at the Missouri Capitol, which hosts gatherings for interest groups on a nearly daily basis during the legislative session (Lieb, Blank, and Duplanter, 3/28).
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Editorials and Opinions
The New York Times: The Supreme Court's Momentous Test
In ruling on the constitutionality of requiring most Americans to obtain health insurance, the Supreme Court faces a central test: whether it will recognize limits on its own authority to overturn well-founded acts of Congress (3/27).
The New York Times: Could Defeat In Court Help Obama Win?
If the Supreme Court decides to strike down the new health care law's individual mandate to purchase insurance, it will represent a remarkable election-year rebuke for President Obama – the rejection, by the nation's highest court, of a central provision of his main domestic policy accomplishment. It might also help him win re-election (Ross Douthat, 3/27).
The Washington Post: The Supreme Court Takes On Medicaid
On the third and last day of oral arguments on President Obama's landmark health-care law, the Supreme Court will grapple with a couple more issues, including whether the law's expansion of Medicaid unlawfully coerces states to participate (3/27).
The Washington Post: Obamacare Is Not A Civil Rights Issue
By now you've heard it plenty: The Affordable Care Act (ACA), a.k.a. "Obamacare," is like the Civil Rights Act of 1964. This creative bit of dot-connecting began with President Obama and has been perpetuated by countless talk-show hosts and their guests. ... This would be a dandy argument if the two issues were remotely related (Kathleen Parker, 3/27).
The Wall Street Journal: A Constitutional Awakening
Tuesday's two hours of Supreme Court oral arguments on ObamaCare's individual mandate were rough-going for the government and its assertions of unlimited federal power. Several Justices are clearly taking seriously the Constitution's structural checks and balances that are intended to protect individual liberty (3/27).
The Wall Street Journal: Insurers And The Supremes
Insurers were never the enemy of ObamaCare that it suited President Obama to pretend. That much is clear from their stance in this week's Supreme Court case. In a brief filed by America's Health Insurance Plans, the industry's main trade group, along with the Blue Cross Blue Shield Association, insurers conspicuously fail to take issue with the individual mandate or any feature of ObamaCare. Their sole concern is a question that will animate Wednesday morning's oral argument—"severability," or whether the individual mandate can be struck down without invalidating the rest of the law (Holman W. Jenkins Jr., 3/27).
USA Today: Editorial: Health Care, Yes. Broccoli, No.
Skeptics of the mandate suggested a range of possibilities. Cars? (Justice Antonin Scalia) Cellphones to dial 911? (Chief Justice John Roberts) Burial insurance? (Justice Samuel Alito) Broccoli? (Roberts and Scalia). Amid the metaphorical overload, it fell to Justice Ruth Bader Ginsburg to point out the rationale behind the individual mandate: "The people who don't participate in (the health insurance) market are making it much more expensive for the people who do," she observed about 20 minutes into the two-hour debate. Indeed. It's hard to make that case about consumers, and non-consumers, of any other product (3/28).
USA Today: Opposing View: Individual Mandate Masks An Ugly Deal
After all, a Congress that can force you to buy health insurance can also force you to buy solar panels, newspaper subscriptions and gym memberships. But let's be real. The reason the ACA forces every American to buy health insurance is that the law makes it a raw deal for people to buy it on their own. Of the 50 million people in America without health insurance, according to the U.S. Census, 55% — nearly 28 million — are under the age of 35. Thanks to decades of unwise government subsidies, regulations and mandates, these young Americans are forced to pay far more for health insurance than they consume in health care (Avik Roy, 3/28).
Roll Call: Millennials – Much Is At Stake With Health Care
Let's assume the mandate is upheld. Young people will feel an immediate effect because they are the primary target of the law's linchpin mandate. According to the Census Bureau, young adults (ages 19 to 29) are more likely to be uninsured than other age groups and to report being in good health. Beginning in 2014, this group will be required to buy government-approved insurance. That means they’ll face a monthly bill for something they do not want, covering services they probably won’t use. The cost will be higher than it would be absent the law because the measure limits insurers’ ability to offer different prices based on factors such as health and age. Effectively, millennials will pay to support other, older people’s health care needs (Hadley Heath, 3/28).
The Baltimore Sun: Health Care Jujitsu
(T)he only way private insurers can afford to cover everyone with pre-existing health problems, as the new law requires, is to have every American buy health insurance -- including young and healthier people who are unlikely to rack up large health care costs. This dilemma is the product of political compromise. The administration couldn't get the votes for a single-payer system such as Medicare for all. Not a single Republican would even agree to a bill giving Americans the option of buying into it. But don't expect the Supreme Court to address this dilemma (Robert B. Reich, 3/28).
The Fiscal Times: How Obamacare Derailed The Economic Recovery
[M]any Americans think Obamacare failed to tackle many of the actual causes of excess healthcare spending – the lawsuits that mandate unnecessary procedures by vulnerable doctors (the CBO estimates capping malpractice awards would save taxpayers $54 billion over ten years), the fact that so many patients have "no skin in the game" and therefore undertake treatments oblivious to any reasonable cost/benefit analysis, and often wasteful reimbursement procedures (Liz Peek, 3/28).
Politico: Health Law A Leap Forward For Women's Health Care
Before health care reform, insurance companies could legally deny women coverage because they had been diagnosed with breast cancer. ... It isn't just breast cancer. In 2011, at least 19 million American women between the ages of 18 and 64 were uninsured and 129 million non-elderly Americans had some type of pre-existing condition. ... The new health care law guarantees coverage for every American — regardless of whether they have a pre-existing condition (Cate Edwards, 3/27).
Bloomberg: Broccoli-Bungling Defense Hurts Health Care
What, (Justice Anthony) Kennedy wanted to know, is the limiting principle on the government’s ability to regulate? ... The answer is that health care insurance is different because if the healthy people fail to get themselves coverage, it becomes extremely difficult -- under some conditions, impossible -- for the insurance market to operate…. If I choose not to buy broccoli, others can still buy it at a market price. If I choose not to buy health insurance, universal coverage becomes impossible (Noah Feldman, 3/27).
Houston Chronicle: Seniors Are Already Benefitting From The Affordable Care Act
As the law continues to be debated, we're likely to hear more of the same "government takeover" rhetoric. But ask a senior who's gotten a free checkup or a break on the cost of prescription drugs and you're likely to hear another story: about how the health reform law brings with it a sigh of relief (Betty Lee Streckfuss, 3/27).
The Seattle Times: Health-Care Freedom Can Be Costly
Then Paul Clement, the gifted lawyer for the states against Obamacare, made this suggestion: "The most straightforward one would be to figure out what amount of subsidy to the insurance industry is necessary. ... And once we calculate the amount of that subsidy, we could have a tax that's spread generally through everybody to raise the revenue to pay for that subsidy." Uh ... our unpaid hospital bills for one year, in this one state, now amount to two billion dollars! Instead of asking the free riders to pay, the constitutional solution apparently is to tax all of us into the poorhouse. The good news is we'll still be free. Broke but free (Danny Westneat, 3/27).
Politico: Obama's Disregard For The Constitution
By seeking to compel individuals to enter into specific commercial activity in the first place, the president and the Democratic Congress disregarded any semblance of congressional restraint. They recklessly exceeded federal constitutional authority and attempted to exercise a power the Constitution reserves to the states. As inconvenient as constitutional limits may seem, individual liberty requires that they be respected (Sen. Mike Lee, R-Utah, 3/27).
Arizona Republic: How 'Obamacare' Could Be Reformed
This week, the question is whether "Obamacare" is constitutional. That's a monumental legal issue. If Congress can require every person in the United States to purchase health insurance, there's nothing left of the Founders' concept of a federal government with enumerated, limited powers. Of course, there's not much left of that concept anyway. In some respects, this is a battle for the last bridge in a war that's already been lost (Robert Robb, 3/28).
Des Moines Register: Whether Obamacare Wins Or Loses, Obama Triumphs
Small wonder President Obama chose not to delay the U.S. Supreme Court case on his health care reforms until after the election. His advisers are transforming the president’s signature legislation into a potent election issue — whether the justices leave it intact or rip it apart (Froma Harrop, 3/27).
Fox News: What Happens If "ObamaCare's" Individual Mandate Is Thrown Out?
Requiring health insurance companies to cover all comers without price discrimination would accelerate health insurance inflation and the exit of millions more Americans from the health insurance system—simply more small businesses and individuals would find coverage prohibitively expensive (Peter Morici, 3/27).
JAMA: Listening To History In The Making
Those who listen to the audio recordings of the Supreme Court debate taking place this week in Washington will not have the benefit of Howard Cosell’s blow-by-blow commentary to help them know who is winning, but they will be witness to a heavyweight debate that, like the Liston-Clay fight, has the potential to change the course of history (Andrew Bindman, 3/27).
JAMA: The Other Important Issue Before The Supreme Court—Medicaid Expansion
So much attention has been paid to the individual mandate that relatively few have bothered to focus on the other questions that will be debated tomorrow in front of the Supreme Court. One involves the expansion of Medicaid, and it is absolutely worth some time (Aaron E. Carroll, 3/27).
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The New York Times: Doctors Have Feelings, Too
Last month, an article in the journal Health Affairs made headlines in the news media — "Physicians Are Not Always Open or Honest with Patients." A vast majority of the nearly 2,000 doctors surveyed agreed that physicians should be fully open and honest in all their communications with patients. ... I suspect that the dishonesty that is being uncovered in a study such as this — and frankly, I was amazed that the number of less-than-truthful instances was so low — reveals more about the diagnosis of being human than anything else. ... I couldn't bring myself to tell this young mother that she was going to die" (Dr. Danielle Ofri, 3/27).
Chicago Tribune: How Can We Let Medical Research Funds Wither?
Not long ago, a friend of mine was describing his successful surgery to replace an abnormal heart valve. Never seriously hospitalized before, and grateful for a new lease on life, he marveled at modern surgical and medical care. How was all this possible, he asked. My answer was simple. It is the fruit of biomedical research (Eric G. Neilson, 3/28).
The Wall Street Journal: Desperately Seeking A Budget
The reality is that (Senator Majority Leader Harry) Reid has made a calculation that Democrats are better off with no budget at all. This allows them to attack (Rep. Paul) Ryan's cuts to programs like Medicare without Democrats having to show their own hand. It's reminiscent of what former Texas Congressman Dick Armey used to say: "Democrats live in mortal fear that voters are going to understand what they want to do once they get into office" (Stephen Moore, 3/27).
Des Moines Register: Health Care System Is Working For Cheney
Without his government-facilitated, taxpayer-subsidized health insurance, [Cheney] could have incurred huge medical bills. He'd be in the same boat as millions of other Americans. Those people find a way to pay the medical bills or they declare bankruptcy. So Dick Cheney is lucky in many ways. You can't help but wonder if he appreciates his health insurance. Perhaps he will become an advocate for the health reform law, which helps ensure everyone has coverage and prohibits insurers from discriminating against people with pre-existing health problems — such as Cheney's heart problems (3/27).
Boston Globe: Patients Deserve More Data On Physicians With Poor Records
Most people wouldn't buy a washing machine without doing significant research on the reliability of the product. Yet they are expected to choose a doctor without access to reliable data. In 1996, when the Massachusetts Board of Registration in Medicine launched its physician profiles, it promised a new era for the "informed patient." That turned out to be a false promise for the growing number of patients who face the task of choosing an unfamiliar doctor from health plan lists. If anything, other states have shot ahead of Massachusetts (3/28).
Journal of the American Medical Association: Toward Innovative Models Of Health Care And Financing
The US health care system is out of balance, favoring treatment of disease and disease complications over prevention and wellness. To establish a more sustainable balance, the Centers for Disease Control and Prevention and the Centers for Medicare & Medicaid Services are providing new funding for public health efforts and new opportunities for health delivery reforms. Individual states, which face the human and economic consequences of poor health outcomes, have a special incentive to facilitate this transition (Katharine R. Bazinsky, Dr. Laura Herrera and Dr. Joshua M. Sharfstein, 3/28).
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