Florida Judge Rules Health Care Law Unconstitutional
PENSACOLA, FL (January 31, 2011) — On Monday, U.S. District Judge, Roger Vinson, in Pensacola, Fla., ruled that the national health care law, was unconstitutional because it violates the Commerce Clause. The “individual mandate” that requires people to buy insurance was the foundation of his ruling and because of the unconstitutionality of it, the entire law must be declared void.
“I must reluctantly conclude that Congress exceeded the bounds of its authority in passing the act with the individual mandate. That is not to say, of course, that Congress is without power to address the problems and inequities in our health care system. The health care market is more than one-sixth of the national economy, and without doubt Congress has the power to reform and regulate this market. That has not been disputed in this case. The principal dispute has been about how Congress chose to exercise that power here,” Vinson wrote.
“While the individual mandate was clearly ‘necessary and essential’ to the act as drafted, it is not ‘necessary and essential’ to health care reform in general,” he wrote in his decision. “Because the individual mandate is unconstitutional and not severable, the entire act must be declared void.”
Department of Justice spokeswoman Tracy Schmaler said the department plans to appeal Vinson’s ruling to the 11th Circuit Court of Appeals.
“We strongly disagree with the court’s ruling today and continue to believe – as other federal courts have found – that the Affordable Care Act is constitutional,” she said. “There is clear and well-established legal precedent that Congress acted within its constitutional authority in passing this law and we are confident that we will ultimately prevail on appeal.
“We are analyzing this opinion to determine what steps, if any — including seeking a stay — are necessary while the appeal is pending to continue our progress toward ensuring that Americans do not lose out on the important protections this law provides, that the millions of children and adults who depend on Medicaid programs receive the care the law requires, and that the millions of seniors on Medicare receive the benefits they need,” she added.
In ruling against President Obama‘s health care law, Judge Vinson used Mr. Obama‘s position from the 2008 campaign against him, when the then-Illinois senator argued there were other ways to achieve reform short of requiring every American to purchase insurance.
“I note that in 2008, then-Senator Obama supported a health care reform proposal that did not include an individual mandate because he was at that time strongly opposed to the idea, stating that, ‘If a mandate was the solution, we can try that to solve homelessness by mandating everybody to buy a house,’” Judge Vinson wrote in a footnote toward the end of his 78-page ruling Monday.
In October, the judge dismissed four of the six counts in the suit led by then-Florida Attorney General Bill McCollum and joined by 25 other states. But he allowed two counts, including one challenging the law’s controversial requirement that Americans buy health insurance, to proceed. Arguments were heard in December. In his earlier ruling, Vinson said that a government report called the requirement to buy insurance legally unprecedented and worth examining in court.
“The individual mandate applies across the board. People have no choice and there is no way to avoid it. Those who fall under the individual mandate either comply with it, or they are penalized. It is not based on an activity that they make the choice to undertake. Rather, it is based solely on citizenship and on being alive,” he wrote.
Nearly two dozen suits have been filed in federal courts, but Monday’s ruling is the biggest judicial decision to come down the pike since Congress last March passed the bill aimed at covering 30 million uninsured Americans whether they want insurance or not.
In other cases, a federal district judge in Richmond, Va., ruled the individual mandate is unconstitutional but left standing other parts of the law. In Michigan, the argument concerning the “individual mandate” — the central tenet that requires Americans to start buying health insurance in 2014 or pay a penalty — was thrown out by another federal judge.
“That judge, under his mindset, said basically if someone thought that I were overweight, if they rule this way, the federal government would be able to mandate that I go down to the Gold’s Gym and fill out an application and contract with Gold’s Gym to lose weight and lower my cholesterol,” said South Carolina Attorney General Alan Wilson, whose state is among the parties filing the multi-state suit. “That is the kind of logic that we’re going to right now where you’re actually telling people that they have to engage in an activity and that is simply too broad a policy for the federal government.”
Defenders of the law say that Americans need to be protected from ruthless insurance companies that either refuse to insure children with illnesses and adults with pre-existing conditions or charge exorbitant amounts for individual coverage. The law aims to provide a federal umbrella under which Americans can purchase and keep insurance regardless of their health, career changes or ability to pay. With his ruling, Vinson said that is not the U.S. government’s job.
“Regardless of how laudable its attempts may have been to accomplish these goals in passing the act, Congress must operate within the bounds established by the Constitution. Again, this case is not about whether the act is wise or unwise legislation. It is about the constitutional role of the federal government,” he wrote.
In his State of the Union address, President Obama said he was willing to open his mind to changes in the law if they made dollars and sense and didn’t prevent patients with pre-existing conditions or other barriers to insurance companies from gaining coverage. He pointed to the near-universally hated 1099 provision that orders businesses to report to the Internal Revenue Service all purchases exceeding $600 as the first provision to be scrapped.
Obama Chief of Staff Bill Daley repeated the president’s position on Sunday, adding that the law was intended to help employers as much as patients.
“The president has said he’s open to changes to this. He is not open to re-fighting the entire fight of health care,” Daley told CBS’ “Face the Nation.”
“I absolutely believe, having been in business and hearing from business people, the importance of a need for the reform of health care. It was the business community that was really saying to the politicians, this is costing us too much, it’s too much of a wet blanket on the economy,” he said.
HEALTH Act would help resolve medical liability crisis, protect access to care
CHICAGO, IL (January 26, 2011) — The AMA and 100 medical and physician organizations expressed their strong support for the Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2011 in a Jan. 25 letter. The HEALTH Act is bipartisan legislation that includes reforms intended to repair the nation’s broken medical liability system, reduce the growth of health care costs and preserve patients’ access to care.
The organizations sent the letter of support to the HEALTH Act’s sponsors—Reps. Phil Gingrey, MD, R-Ga.; David Scott, D-Ga.; and Lamar Smith, R-Texas, who introduced the bill Jan. 24.
“The proven reforms contained in the HEALTH Act would help reduce costs, while ensuring that patients who have been injured due to negligence receive just compensation,” the letter states. “This bill provides the right balance of reforms by promoting speedier resolutions to disputes, maintaining access to courts, maximizing patient recovery of damage awards with unlimited compensation for economic damages while limiting noneconomic damages to a quarter million dollars.”
Introduction of the HEALTH Act comes on the heels of Jan. 20 testimony by AMA Board of Trustees Chair Ardis Dee Hoven, MD, to the U.S. House of Representatives Judiciary Committee. During her comments, Dr. Hoven shared results from a recent AMA report that shows the nation’s medical liability system has become costly and unfair for patients and physicians, with an average of 95 medical liability claims filed for every 100 physicians. Watch video of Dr. Hoven’s testimony.
“The HEALTH Act would put in place proven reforms, similar to those already working in states like California and Texas,” Dr. Hoven said. “These reforms keep physicians’ liability premiums stable and ensure that patients—not lawyers—receive more of the awards.”
Source: AMA
Health Care and the State of the Union
WASHINGTON, DC (January 26, 2011) — In his State of the Union address, President Barack Obama addressed the contentious, continuing debate over the health care reform law with some “tongue in cheek” humor, “Now, I have heard rumors that a few of you still have concerns about our new health care law…” However, he was quick to establish that it is not a joking matter.
“What I’m not willing to do,” the President said,” is go back to the days when insurance companies could deny someone coverage because of a pre-existing condition.”
However, he acknowledged that there is room for improvement in the health insurance reform law, expressing an eagerness to work on any ideas brought forward to do that. He made it clear that he was not willing to scrap the law, “So I say to this chamber tonight, instead of re-fighting the battles of the last two years, let’s fix what needs fixing and let’s move forward.”
GOP Response: Repeal
House Budget Committee Chairman Paul Ryan (R-WI) provided the Republican reply to the State of the Union putting a different spin on what the President said, “The president mentioned the need for regulatory reform to ease the burden on American businesses. We agree — and we think his health care law would be a great place to start.”
“Health care spending is driving the explosive growth of our debt. And the president’s law is accelerating our country toward bankruptcy,” he said. “We will work to replace [the bill] with fiscally responsible, patient-centered reforms that actually reduce costs and expand coverage.”
The Affordable Care Act came under renewed legislative attack from Republicans almost as soon as the new Congress was seated, and the House of Representatives voted to repeal it – an effort most interpret as a symbolic gesture, because the repeal measure is unlikely to reach the floor of the Senate, and would never be signed by the President.
It is unclear how well either Democrats’ or Republicans’ plans for health care will be received by the public. According to a recent Kaiser/Harvard poll, roughly half of Americans now say they oppose the health care law. The poll showed that a majority of Americans disapprove of de-funding or otherwise slowing down implementation of parts of the bill.
Looking for Savings in Social Security, Medicare, Medicaid
While apparently lacking in specifics regarding the budget deficit and spending cuts, the President proposed a five-year freeze in annual domestic spending, outside of national security, Medicare, Medicaid and Social Security. Somewhat contradicting that commitment to freeze spending, he promised he would fund biomedical research, information technology and clean energy.
Further, the President said that freezing spending would not be enough, and suggested that defense and health care spending would also need to be cut, while reducing tax breaks and loopholes. “This means further reducing health care costs, including programs like Medicare and Medicaid, which are the single biggest contributor to our long-term deficit,” he said. He said he wants “a bipartisan solution to strengthen Social Security for future generations.”
The Republican response offered few details referring to the Republican Roadmap for America’s Future which calls for a large cut in Social Security, Medicare and Medicaid. This is in direct conflict with the Kaiser/Harvard poll which found the consensus of American public is opposed to large spending cuts for these three programs.
Mr. President: Don’t Forget The Link Between Medicare and Medicaid
In the face of a historic Medicaid funding crisis, Medicare funding stability crucial
WASHINGTON, DC (January 25, 2011) — Coinciding with President Obama’s State of the Union Address, two key health leaders reinforced the fact that adequate federal Medicare funding in the face of a historic and ongoing state Medicaid funding crisis is crucial for long term and post-acute care providers, the nation’s second largest health care employers.
“Stable, adequate Medicaid and Medicare funding are the twin pillars upon which quality seniors’ care and a strong U.S. jobs and economic base rest — and we are ready, willing and able to work with Congress and the President to do our part in helping revitalize America’s economy,” stated Governor Mark Parkinson, President and CEO of the American Health Care Association and National Center for Assisted Living (AHCA/NCAL), and Alan G. Rosenbloom, President of the Alliance for Quality Nursing Home Care.
The two leaders reiterated that the central objective of all long term and post-acute care facilities is to continue the positive trend of moving more residents and patients back to the community as quickly as possible. In addition, the AHCA/NCAL and Alliance leaders said, “Mr. President, we look forward to working with you and Congress to pass health policies that build upon existing efforts to maximize patient choice, enhance the cost-efficiency of care delivery, and improve patient care quality.”
Long term care providers were paid $7.17 per hour last year in Medicaid funding according to a new analysis – which is less than the current minimum wage of $7.25 per hour. Due to the fact that federal Medicare funding is essential to supplement unstable state Medicaid systems and inherent shortfalls, any potential cuts to Medicare in FY2012, they noted, would have significant, adverse implications on quality care for seniors, workers’ jobs, and national economic stability.
Americans Remain Divided Over Health Reform
WASHINGTON, DC (January 25, 2011) — Though the public remains divided on health reform overall, opposition to the new law ticked upward in January as Republicans ramped up efforts to repeal it, according to a new survey conducted by researchers from the Kaiser Family Foundation and the Harvard School of Public Health.
The survey also showed that there is no groundswell of public support for overturning the law, that many individual components of the legislation remain popular across the political spectrum and that a majority of Americans oppose the idea of lawmakers using the appropriations process to defund or slow down implementation of the law.
The survey, fielded in the weeks prior to the House repeal vote, was conducted at a time of substantial change in the political landscape in Washington, as Republicans take control of the House and politicians of both major parties attempt to respond to public concerns over the rising federal budget deficit. While most Americans in the survey say they prefer spending cuts over new taxes as the main way to reduce the deficit, there is little public consensus about where to achieve meaningful savings and a majority opposes any spending reductions in two of the nation’s largest entitlement programs, Medicare and Social Security. Nearly half of Americans oppose any cuts in another major entitlement program, Medicaid. Large majorities oppose major reductions in all three programs.
“Budget experts say that the budget deficit cannot be tackled without taking on Social Security, Medicare and Medicaid spending, or by raising taxes,” said Kaiser President and CEO Drew Altman. “But the American people do not believe this at all. There is a huge gap in basic beliefs and understandings of the problem and what it takes to solve it.”
Mixed Views on Repeal, While a Majority Opposes Cutting off Funding
The share of Americans with unfavorable views of the health reform law rose to 50 percent this month, up from 41 percent in December, while the share holding favorable views remained largely unchanged at 41 percent. Increasing opposition among independents drove much of the change. Fifty-seven percent of independents had an unfavorable view of the law in January, up sharply from 41 percent in December, suggesting that GOP messages about the need to repeal the law resonated with independents during this time period.
The public also is divided on what should happen next. About as many people want to expand the law or keep it as it is (28% and 19%, respectively) as want to repeal and replace the law or simply just repeal it (23% and 20%). Now that the repeal vote in the House is over, Republicans are expected to turn to efforts to defund and slow down implementation of the law through the appropriations process and other means. Yet the survey finds that most Americans (62%) disapprove of such a strategy. Most Republicans (57%) favor defunding health reform in the absence of repeal, but most independents are opposed (62%) along with a large majority Democrats (84%). Even among those who don’t like the law and want to see it repealed, about four in ten say they disapprove of cutting off funding.
“The public is frustrated with politics as usual, and may be saying that defunding a law is not how government should work,” said Mollyann Brodie, senior vice president and director of the Foundation’s Public Opinion and Survey Research group.
The public’s concerns about the law are varied, and tend to vary by party affiliation. More than half of Americans, including 81 percent of Republicans and 57 percent of independents, believe it will entail too much government involvement in the health care system. Yet most Democrats, 58 percent, think it will lead to about the right amount of government involvement. Also, despite the Congressional Budget Office’s findings to the contrary, 60 percent of Americans think the law will boost the deficit over the next decade — a view common even among supporters of the law.
Component Parts of Health Reform Remain Popular
Despite such concerns, many of the law’s component parts remain popular. Substantial majorities of Americans say they favor many of its provisions such as gradually closing the coverage gap known as the Medicare doughnut hole (85%), providing subsidies for low- and moderate-income Americans to buy health insurance (79%), establishing a voluntary insurance program known as the CLASS Act to help pay for long-term care services (76%) and expanding the Medicaid program (67%).
Some provisions are less popular, including requirements that all but the smallest employers offer health insurance to their workers or pay a penalty (51% oppose this) and, most controversially, that nearly all Americans obtain health coverage or face a fine (76% oppose).
The survey shows, however, that public opinion about this last provision is somewhat malleable. Told that without the requirement, insurance companies would still be allowed to deny coverage to people who are sick, unfavorable views fall from 76 percent to 47 percent. On the other side, opposition rises to 85 percent when Americans are told that the requirement could mean that some people would have to buy health insurance they find too expensive or don’t want.
Most Want To Reduce the Deficit Without Big Cuts in Medicare, Social Security or Medicaid
About two in three Americans say they are “very concerned” about the federal budget deficit, including more than seven in ten Republicans and independents and fewer than half of Democrats. There is a similar partisan divide over when Congress should tackle the problem, with most independents (61%) and Republicans (70%) saying lawmakers should act quickly to reduce the deficit and most Democrats (61%) preferring to wait until the economy gets better.
Most Americans — including majorities of Republicans and independents (76% and 59%) and a plurality of Democrats (39%) — prefer spending cuts over tax increases as the main way to reduce the deficit. But finding spending cuts the public will accept will be difficult for lawmakers. Of the 12 areas of spending cited in the poll, the only one in which a majority of Americans say they are willing to support “major reductions” is the relatively small amount devoted to foreign aid. In addition, about four in ten would back major reductions in funding for the war in Afghanistan and in salaries and benefits for federal workers.
In contrast, a majority of Americans said they would support no spending reductions in Social Security (64%) and Medicare (56%), two entitlement programs that together account for about a third of all federal spending. Nor do they want to see any reduction in spending for public education (63%). Nearly half say the same thing about Medicaid (47%). Very small percentages of Americans support the “major reductions” that some believe are necessary in programs such as Social Security (8%), Medicare (8%) and Medicaid (13%), the survey found. This is true even among Republicans, just 18 percent of whom support major reductions to Medicaid and 10 percent of whom support major reductions to Medicare and Social Security.
“The upcoming battle lines are clear,” said Robert Blendon, professor of health policy and political analysis at the Harvard School of Public Health. “One side will argue we need across the board cuts in domestic spending to quickly reduce the deficit, the other that popular health care programs should not be cut even if the deficit is not reduced. Which side will win is not clear.”
Even among Republicans, who are more likely than Democrats and independents to back spending cuts, majorities say they would not support any reductions in Social Security (59%) and public education (53%). Moreover, 52 percent of Republicans want no reductions in funding for national defense, another major area of federal spending and one in which independents and Democrats would support some cuts. When it comes to funding for expanding insurance coverage under the health reform law, 44 percent of Republicans say they would support major reductions while almost as many Democrats (38%) want to see no reductions.
The public’s reluctance to touch Medicare, Social Security and, when it comes to big cuts, also Medicaid may stem from the benefits, direct and otherwise, that people believe they confer on their families. More than three-quarters of Americans rated Medicare as either “very important” (55%) or “somewhat important” (22%) to their families, while nearly six in ten said the same thing about Medicaid (39% “very important,” 20% “somewhat important”). Sixty-eight percent of Americans say the country’s budgetary problems can be addressed without trimming Medicare spending at all.
Methodology
This Kaiser Family Foundation/Harvard School of Public Health survey, The Public’s Health Care Agenda for the 112th Congress, was designed and analyzed by public opinion researchers at the Kaiser Family Foundation led by Mollyann Brodie, Ph.D., including Claudia Deane, Liz Hamel, Sarah Cho, Bianca DiJulio, and Theresa Boston and by Professor Robert Blendon, Sc.D. and John Benson at the Harvard School of Public Health. The survey was conducted January 4 through January 14, 2011, among a nationally representative random sample of 1,502 adults ages 18 and older. Telephone interviews conducted by landline (1,000) and cell phone (502, including 203 who had no landline telephone) were carried out in English and Spanish by Social Science Research Solutions. The margin of sampling error is plus or minus 3 percentage points. For results based on other subgroups, the margin of sampling error may be higher.
House votes to repeal Obama’s health care law
WASHINGTON, DC (January 18, 2011) – Swiftly honoring a campaign pledge, newly empowered Republicans pushed legislation to repeal the nation’s year-old health care overhaul through the House Wednesday night, brushing aside implacable opposition in the Senate and a veto threat from President Barack Obama.
The 245-189 vote was largely along party lines, and cleared the way for the second phase of the “repeal and replace” promise that victorious Republicans made to the voters last fall. GOP officials said that in the coming months, congressional committees will propose changes to the existing legislation, calling for elimination of a requirement for individuals to purchase coverage, for example, and recommending curbs on medical malpractice lawsuits.
Last March, the House voted to pass ObamaCare by a tally of 219 to 212 — a margin of 7 votes; today it voted to repeal ObamaCare by a tally of 245 to 189 — a margin of 56 votes. Ten months ago, the vote was 51 percent to 49 percent — a margin of 2 percentage points; today it was 56 percent to 44 percent — a margin of 12 percentage points. So the margin for repeal was 49 votes and 10 percentage points bigger than the margin for passage.
Even though Democrats are certain to block the bill in the Senate, Republicans are determined to chisel away at the law through attempts to deny funding for parts of the legislation as they go into effect in the coming years.
“The Congress can do better in terms of replacing Obamacare with common-sense reforms that will bring down the cost of health insurance and expand access for more Americans,” House Speaker John Boehner said Wednesday.
Republicans also intend to try to reverse many of the changes Democrats made to Medicare Advantage, the private alternative to the traditional government-run health care program for seniors.
Like the repeal bill itself, these other measures will require Senate approval and a presidential signature to take effect, and the prospect is for months of maneuvering on the issue.
Debate across two days leading to the vote was markedly restrained, as lawmakers in both political parties observed self-imposed vows of civility in the wake of the shooting rampage in Arizona that left six dead and Rep. Gabrielle Giffords wounded.
But there was no mistaking the significance many first-term Republican lawmakers attached to a day they had long waited for, finally getting a chance to speak and then vote on the House floor against a law they had campaigned for months to repeal.
Three Democrats voted with Republicans on the repeal measure, Dan Boren of Oklahoma, Mike McIntyre of North Carolina and Mike Ross of Arkansas.
Senate Majority Leader Harry Reid has said the legislation will not see the light of day there, but the GOP Leader, Sen. Mitch McConnell of Kentucky, said bluntly, “I assure you we will” have a vote on it.
The law faces another challenge, well beyond the reach of Obama’s veto pen. More than half the states have filed suits against it, and while some judges have upheld the legislation, one recently ruled it was unconstitutional to require individuals to purchase insurance. The Supreme Court is widely expected to have the final word.
The Obama administration has made a major effort in recent days to emphasize parts of the bill that have met with public approval, including one that permits children to age 26 to remain on their parents’ policies if they do not have on-the-job coverage of their own. Democrats also argue that repeal would short-circuit other changes yet to take effect, including a ban on the insurance industry’s practice of denying coverage or charging sharply higher premiums on the basis of a pre-existing medical condition.
Republicans intend to address the same issues with legislation they say they will bring to the House floor in the coming months, according to officials who have been involved in discussions on the issue, but no details were immediately available.
Last year, for example, the Republicans proposed a 10-year, $25 billion program to help states fund programs in which high-risk individuals could receive affordable coverage.
GOP leaders are working on the assumption that the repeal legislation will not become law, and they intend to draft future bills as changes to the structure that Obama and Democrats put into place.
On one point, they conceded no change was warranted. Majority Leader Eric Cantor, R-Va., told reporters on Tuesday seniors would be permitted to keep the $250 they have been promised to help defray the cost of drugs under the Medicare prescription benefit.
The legislation Obama signed last year was sweeping in its scope.
The Congressional Budget Office said at the time that when fully enacted, it would spread coverage to tens of millions who now lack it and — in a forecast rejected by Republicans — reduce federal deficits over the next decade.
Beginning in 2014, millions of Americans would be required to carry health insurance, whether through an employer, a government program, or their own purchase. New insurance marketplaces called exchanges would open in each state, enabling individuals and small businesses to pick from menus of private plans that met government standards. Federal subsidies would help defray the costs.
The American Center for Law and Justice (ACLJ), which is challenging ObamaCare in the courts, said today’s vote by the U.S. House of Representatives to repeal the troubling health care law is “historic and reaches far beyond symbolism by reflecting the will of the American people.”
The ACLJ has heard from more than 70,000 Americans who have signed on to a petition urging Congress to repeal ObamaCare.
“This vote is historic and reaches far beyond symbolism by reflecting the will of the American people,” said Jay Sekulow, Chief Counsel of the ACLJ. ”A clear majority of members in the House – as well as most Americans – understand that health care reform must happen, but the pro-abortion, government-run ObamaCare falls short in so many areas. This repeal vote emphasizes a legislative commitment to derail ObamaCare – whether it’s through the repeal process or, as some are advocating, by defunding the law. The legislative action coupled with the significant legal hurdles can only result in one outcome: an end to ObamaCare, a fresh start for health care reform.”
The ACLJ is aggressively challenging ObamaCare in court. It has filed its own federal lawsuit in Washington challenging the constitutionality of the law. And, it represents members of Congress in filing amicus briefs supporting legal challenges by Virginia and Florida.