Four health care stories to watch for in 2012
The following is a guest post from Darden Rice, Communications Director of Know Your Care.
What will the big stories be for the Affordable Care Act (ACA) in 2012? Access, affordability and quality win the day. The ACA year opens with a scintillating GOP primary and election year intrigue; and the Supreme Court hears arguments on the “individual responsibility” requirement and the constitutionality of the Act.
Through the year, sweeping Medicare quality and cost reduction projects roll out focused on financial rewards to health care providers for keeping patients healthier, reducing hospital reimbursement for avoidable readmissions, helping seniors receive care in their homes, cracking down further on waste, fraud and abuse, and continuing to close the donut hole gap in medication coverage.
Pharmaceutical companies start coughing up some money for branded products purchased outside of the country; and insurers start funding comparative effectiveness research aimed at answering questions about which treatments are most effective.
The states continue to ready themselves for the health exchanges due to go live in 2014. And a diversity database is established with the goal to reduce the gap in getting good health care for minority groups. All tolled, 2012 is focused on continuing to improve access, quality and affordability.
Here’s a look at the top stories.
1. The Supreme Court ruling – More than 100 law professors, 35 economists, and three Nobel Prize winners say there’s no doubt the new health law is constitutional. A majority of bipartisan circuit court judges have ruled in favor of the law’s “individual responsibility” requirement where everyone must have health insurance. This is an essential element of the Act, without which its goals to improve access, affordability and quality, could not endure.
2. The battle for the White House - The GOP candidates want to eviscerate the Act, but even if one of them were to prevail in the general election, it would take overwhelming agreement with a majority House Vote, White House support and 67 votes in the Senate, to abolish a law already on the books. Don’t expect the 2012 election to be an upset for the Affordable Care Act. The likely GOP nominee, Mitt Romney, also advocated for an individual responsibility requirement previously and passed similar health care legislation in Massachusetts. Reversing bans on lifetime limits, discrimination against those with preexisting conditions, reduced medication costs, free preventative care, and better quality, already in effect for millions of Americans will not be popular, or easy. Americans know that the quality of their lives depends on the quality of their health and they won’t be keen on losing it.
3. Oh, Florida! - Not much good news from the nation’s most unpopular governor, Rick Scott. Scott’s extreme response in Florida to block the reforms and the federal money provided for health care access are a big political risk. Florida isn’t accepting federal monies to ready itself for the exchanges, isn’t working on accountable care projects, isn’t working to expand benefits through Medicaid, and is spending its resources in delay and legal actions against the government in order to preserve industry profit at citizen expense. The consequence: Florida isn’t ready; its citizens aren’t covered; its healthcare future is in limbo. The federal government is poised to step in to set up the insurance exchange for its residents and has refused its request to allow Medicaid vendors to spend less money on health care. What other assaults will the governor cook up this year? Stay tuned.
4. Better Access, Affordability and Quality - Watch the numbers and follow the money! Hard trackers will report the numbers of private sector health care jobs created, people insured, protected and using preventive, acute and chronic services under the ACA. Goodbye lifetime limits and discrimination against those who with preexisting conditions! Expect more savings through quality and less tolerance for fraud, waste and abuse. Thirty-two health provider organizations will roll out innovative care delivery programs (accountable care organizations), for Medicare enrollees with payment based on quality of care outcomes. This year some seniors will get access to service in their home, and get rebates for medications when they fall in to the donut hole. And the pharma and insurance industries starts foot some of the bill for research to find treatments that work, while getting capped on profit at the expense of quality. Expect reports on the cost of premiums for states, employers, and individuals as the Health Care Exchanges rev up; what its like for people who need and use care, health care professionals who provide care, and hospitals and systems that support care; and payment based on effectiveness of care and patient oriented outcomes that matter, rather than on the volume of procedures and visits.
Rome wasn’t built in a day, and neither will be the ACA. This is a big law with a big agenda for a great nation. Already, it is improving access; improving quality through reduced waste fraud and abuse, paying for performance; better medical evidence and innovation; making health care overage and care more affordable; making big pharmacy and insurers pay their fair share; and driving the creation of health care sector jobs. These initiatives that will continue to return benefits for years to come. The individual responsibility requirement, up for a challenge in the Supreme Court this year, and health exchanges are critical to solving the affordability puzzle.
The ACA solves big problems with innovative and entrepreneurial solutions. There’s nothing more American than rolling up our sleeves and using our ingenuity to meet the important challenge of fixing our health care system.
The ends do not always justify the means and especially if they threaten to destabilize the greatest constitutional republic in world history. On Thursday, December 22, Ms. Darden Rice published a guest post titled, “Ten Reasons to Champion the Affordable Care Act.” At the time, I published a detailed reply and direct challenge to Ms. Rice asking her to answer three fundamental questions: 1) where is the enumerated power of Congress to mandate the People purchase a good or service; 2) what is the limiting principle to this assumed authority; and 3) why not a constitutional amendment? Ms. Rice did not reply.
Ms. Rice has now published a second guest post that continues to focus on the benefits but does not contemplate the broader legal and judicial implications of this Act.
You will see from my previous comments that I respect the great work Ms. Rice has performed in the local community but on this issue, Ms. Rice owes each of us the courtesy of an explanation supporting her position in the context of the three fundamental questions I have proposed and which are currently under review by the United States Supreme Court. Most importantly, Ms. Rice owes it to the preservation of our civil liberties to explain what the limiting principle of this Act is. If the Supreme Court rules in favor of the Act thereby establishing a new federal power to mandate the purchase of goods and services from private enterprise, the good intentions of this Act’s proponents will most surely be abused by future Congress’ that won’t always be friendly to one’s political membership and ideology. I recommend the question of limiting principle be the subject of Ms. Rice’s next contribution to this web blog.
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I encourage you to read Ms. Rice’s original guest post followed by my detailed reply expanding on this issues cited herein:
http://saintpetersblog.com/2011/12/ten-reasons-to-champion-the-affordable-care-act/
For a comprehensive list of news articles, opinions, editorials, research papers, print, audio and video comments from members of Congress and an inventory of legal filings on the subject:
http://www.healthcarereformconstitution.com
Very cogent and well-written articles, both of them. Let us all thank Ms Darden for her thoroughness and expression so needed by the public! It should be clear by now that the ACA will be a better system than most Americans have ever enjoyed! Who could be against the potentially increased GDP that can result from a healthier People?
To the reader above, may I suggest that IF there are questions of constitutionality, there have been a multiplicity of court challenges as mentioned in the article. They have not succeeded. And, we do have the past precedent of requiring auto insurance.
Will there be unforseen glitches? Maybe. Can we fix and rise above them in the march toward America’s renewed exceptionalism? Sure, haven’t we always?
What will, however, continue to stall that happy progress is the parrotting of “what ifs” that have issued during the last 3 years.
No bill or Act has been left unscarred, eroded and delayed by inaccurate and backward looking special interests. This, in a time of America’s heightened distress and at the expense of the hardworking taxpayer’s health and economic well-being.
(Just one example is the effect of this strategy upon the remarkable 7 bills across the nation to ratify/vote for the enduring Equal Rights Amendment that could free Americans from costly sex discrimination AND boost US GDP by up to 8 percentage points. NB. The reason Florida has yet to hold full ERA hearings? Florida’s Legislative Leaders, Speaker Cannon and Sen. President Haridopolos say that “ERA will ‘hurt’ business”. Again, special interests stall the promise of America.)
To Ms. Oestreich,
I appreciate your willingness to engage me on this subject. First, comparisons between a federal mandate for personal health insurance and the state auto insurance requirements are specious. I want to discredit any notion that a federal mandate for personal health insurance is the same as a state mandate for auto insurance. Second, I invite you to specifically consider the limiting principle of this Act and explain why you think any future Congress will not exploit this new precedent. Finally, why not a constitutional amendment?
Health vs. Auto Insurance Mandate
First, state governments mandate auto insurance and not the federal government as you have suggested. There is a fundamental difference between the inherent police powers of the States and the enumerated powers of the federal government. Whereas the States enjoy plenary police powers, the national government is limited to the enumerated powers granted to it by the U.S. Constitution. I have previously explained why I think this mandate is not an enumerated power and currently maintain a website explaining the same (http://www.healthcarereformconstitution.com).
Second, automobile insurance requirements impose a condition on the voluntary activity of driving; a health insurance mandate imposes a condition on life itself.
Third, automobile insurance requirements are limited to those who drive on public roads. Automobile insurance requirements typically do not apply to the operation of a motor vehicle on private roads and property. What a state may require of someone using its public rights-of-way is wholly different from what it may do to control a person’s private behavior.
Finally, states require drivers to maintain auto insurance only to cover injuries to others. The automobile insurance requirement does not require drivers to insure themselves or their property against injury or damage. Similarly, the automobile insurance requirement does not require passengers to have liability coverage even though they mutually benefit from travelling over the public rights-of-way. Thus, the auto insurance requirement only seeks to ensure that drivers can pay damages for their wrongful conduct to others on state roads; they do not tell drivers how to take care of themselves.
Limiting Principle
Since passage of the Act, I have debated a number of people on the Act’s constitutionality. Most debates end when I get to the question of limiting principle. For lack of an answer, it is usually at this point when the debate breaks down and I am rudely insulted or falsely charged as lacking compassion. What is the limiting principle? If the Supreme Court rules in favor of the individual mandate, thereby empowering the federal government to require the purchase of a private product, not because of a voluntary act but simply because of life itself, could the federal government:
A) Require all citizens to own their place of residence or in the alternative, mandate payment of an annual home ownership penalty or tax? Homelessness is a matter of critical national concern that already depends on significant federal spending to support social services, subsidize housing construction and rent.
B) Require every person to own a firearm or in the alternative, mandate payment of an annual public safety penalty or tax? Crime is a matter of critical national concern. If every person owns a firearm for personal defense, this could drive down the high cost of public safety.
C) Require everyone to purchase a vehicle manufactured by an American car company or in the alternative, mandate payment of an annual foreign car penalty or tax? We are all aware of the unprecedented move by the federal government to take temporary ownership of Chrysler and General Motors during the recent recession. The federal government argued that the U.S. economy was so dependent upon the success of these two American-owned companies that any type of bankruptcy proceeding would threaten to destabilize and destroy the U.S. economy.
Sure these hypothetical scenarios seem preposterous today but if the Supreme Court rules in favor of the individual mandate, then the legal and judicial precedent for these types of decisions becomes a very real threat to our civil liberties.
Constitutional Amendment
Why not a constitutional amendment? Ms. Oestreich, you are the founder and president of Equal Rights Alliance, Inc. an organization whose very existence is to advocate for passage of a constitutional amendment under the procedures required by Article V of the U.S. Constitution. If the public support for a federal government-run or government-managed health care or insurance program is as strong as you insist, then the Congress should begin proceedings under Article V to formally amend the U.S. Constitution thereby granting itself legal authority. Such an action would avoid the type of abuse we are now witnessing of the Commerce Clause, give clear authority to the Congress to enact a government-run or government-managed health care or insurance program, give clear authority to the Congress to mandate that individuals purchase health insurance, and require popular support by three-fourths of the sovereign States as opposed to 279 legislators plus one executive located in the isolation of Washington D.C.
In conclusion, everyone needs to understand why this is a violation of Congress’ enumerated powers in Article I, Section 8, and how this subversion of the amendment process in Article V threatens the civil liberties of all men and women equally. If you value your liberty, the integrity of the rule of law, the supremacy of the U.S. Constitution, and the federal order of our Republic, then you should be opposed to the individual mandate and the process by which is was approved.
(Auto insurance comments provided with assistance from Randy Barnett, Nathaniel Stewart and Todd Gaziano, “Why the Personal Mandate to Purchase Health Insurance is Unprecedented and Unconstitutional.” 09 December 2009.)