Senate Republicans unveiled a revised draft of their new health care bill Thursday, the chamber’s second crack at repealing and replacing the Affordable Care Act. The new draft, released at a closed-door, Republican-only meeting Thursday morning by Senate Majority Leader Mitch McConnell (R-KY), contains an amendment aimed at the Senate’s most conservative members. Only two Republicans can oppose the bill for it to still pass, though as of Thursday, a handful have expressed deep reservations about the proposal.

The revised legislation largely resembles the initial Senate plan which was released last month. Medicaid would still face steep cuts, a provision that has led many moderate Republicans from states that recently expanded Medicaid to oppose the bill.

Perhaps the most striking change to the bill is an amendment courtesy of Sen. Ted Cruz (R-TX), one of the Senate’s most conservative members. The so-called Cruz Amendment would permit insurance companies to offer plans that fail to meet certain Obamacare regulations, as long as they concurrently sell plans that do. Critics of the amendment, which was presented in the document in brackets–meaning it is liable to change–say it would hike care costs for sick people.

Under the revised plan, two taxes on the wealthy imposed by Obamacare would remain in place, as would a tax on health executives’ pay. The measure would also infuse a $112 billion “stability fund,” aimed at lowering premiums, with an additional $70 billion. Addressing lawmakers’ concerns about the ongoing opioid crisis, the bill earmarks $45 billion toward combating drug addiction.

Still, McConnell and Sen. John Cornyn (R-TX), the majority whip, must corral enough “yea” votes in a caucus with a cacophony of competing voices. There are moderates, like Sen. Susan Collins (R-ME), who have objected to the Republican bill at every turn. On Thursday afternoon, Collins tweeted, “Still deep cuts to Medicaid in Senate bill. Will vote no on MTP. Ready to work w/ GOP & Dem colleagues to fix flaws in ACA.”

And then there are heels-dug-in conservatives who viewed the initial bill as not being far enough to the right, like Sen. Rand Paul (R-KY) and Sen. Mike Lee (R-UT). Lee, who previously advocated for the Cruz Amendment, would like to see more details before signing off on the revised bill, according to a spokesman. The Congressional Budget Office, a non-partisan budget analysis agency, is reviewing two versions of the bill–one with the Cruz Amendment, one without.

Many senators have expressed reservations that the bill, which will likely be debated next week, will even be considered.

“I don’t even know that it’s going to get to a vote,” Sen. John McCain (R-AZ) told Politico. Appearing on Fox News on Thursday morning, Cornyn, the man responsible for ensuring the bill garners the requisite number of votes, said: “If you vote ‘no’ on this bill, it essentially is a vote for Obamacare because that’s what we’re going to be left with.”

Alec Siegel

Alec Siegel is a staff writer at Law Street Media. When he’s not working at Law Street he’s either cooking a mediocre tofu dish or enjoying a run in the woods. His passions include: gooey chocolate chips, black coffee, mountains, the Animal Kingdom in general, and John Lennon. Baklava is his achilles heel. Contact Alec at ASiegel@LawStreetMedia.com.

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As the national debate over health policy unfolds, it can be helpful to take a wider look at the health insurance landscape in the United States to understand how proposed changes would affect the system as a whole. A number of different ideas have been floated to restructure parts of the health care system, but looking at the system overall helps offer some important context to the current debate.  For example, when lawmakers propose reducing spending on Medicaid or changing the subsidies for the individual market, knowing how many people would see their finances change can put things in perspective. Read on to see where people get their health insurance and who remains uninsured.

Health Insurance Coverage in the United States

In the United States, people get insurance through a mix of government programs and private companies. Most Americans have private health insurance, the largest portion of which is provided through an individual’s employer, or their family member’s employer. Government programs provide insurance to about 35 percent of the population. Two government programs account for the vast majority of all people on public insurance, namely Medicare and Medicaid. Medicare is available to all adults over the age of 65 and is intended to provide insurance coverage for people as they age. Medicaid covers a more diverse group, including people with disabilities, the elderly, children, and the poor.

The chart below uses estimates from the Kaiser Family Foundation using 2015 data from the Census Bureau (note that the numbers are rounded and therefore add up to just over 100 percent).

As the chart shows, employer-provided insurance is the single largest source of insurance for most Americans, which is important to keep in mind when debating health policy changes. Private health insurance companies sell insurance to businesses in what’s known as the group market, while those who are not able to get insurance through their employer and do not qualify for public insurance can buy it on the individual market.

Much of the debate over health insurance regulation tends to deal with coverage sold through exchanges on the individual market, which actually apply to a relatively small portion of the entire population. About 7 percent, or 21.8 million people, buy individual health insurance for themselves and their family members–which includes people who buy insurance directly from insurance companies on and outside of public exchanges. Approximately 12.2 million people enrolled in a plan sold on one of the regulated exchanges at the beginning of 2017. Those insurance plans are the ones that are affected by the vast majority of the regulations that have become the focus of many policy debates. Notable examples of these regulations include rules that prevent insurers from denying coverage to people with preexisting conditions and ones that prevent or limit the the extent to which insurance companies can charge people more based on characteristics like health status or age.

One important exception is the Affordable Care Act’s ban on annual and lifetime limits, which prevent insurance companies from cutting off coverage after spending a certain amount. These limits apply to federally defined insurance benefits and affect almost all private health insurance plans including both employer-provided and individual coverage.

Who Are The Uninsured?

In 2015, approximately 9 percent of the population did not have health insurance, or about 29 million people in total. That number comes in the wake of the Affordable Care Act’s passage and enactment, which lead to a sharp decrease in the number of people without health insurance. The ACA increased coverage by expanding Medicaid eligibility and outreach while also creating subsidies to help individuals up to a certain income afford their health insurance premiums. The law also instituted a penalty, known as the individual mandate, for people who decide not to get insurance. So even after a massive effort to increase coverage, who remains uninsured and why?

According to survey data from the Kaiser Family Foundation, the most common explanation people give for not having health insurance is the cost of coverage–46 percent of respondents cited cost as the primary reason. However other reasons–like confusion about the requirement to obtain coverage, issues getting coverage, and preferring to pay the penalty rather than the cost of insurance–also explain why people do not have insurance.

Survey data indicates that the most of the people without health insurance are low-income. About 80 percent of the uninsured population have incomes below 400 percent of the federal poverty line–which is also the income threshold to qualify for subsidies under the Affordable Care Act, meaning that some federal funding is available to help them purchase insurance. There is evidence to suggest that a portion of the uninsured are not aware that they qualify for federal subsidies, and many who are aware may still forego insurance because even with financial assistance the cost remains too high.

While a plurality of the uninsured population is white, accounting for about 45 percent of the total, people of color are disproportionately more likely to not have insurance relative to their share of the total population. Approximately 15 percent of the uninsured population is black and just over 30 percent is Hispanic. Just over one-fifth of those without health insurance are not U.S. citizens, including both immigrants with and without legal status in the United States. Legal immigrants are eligible for subsidies when buying insurance on public exchanges, and after living in the country for more than five years, can be eligible for Medicaid.

Finally, legal challenges to the law resulted in the decision to expand Medicaid resting with the states, and several states–including ones with particularly large populations like Texas and Florida–chose not to accept funding from the federal government to help cover people with incomes up to 133 percent of the federal poverty line. Currently, 32 states including the District of Columbia opted to expand Medicaid, while 19 states have not. Because of this, there is a significant “coverage gap” in non-expansion states between the people who are eligible for Medicaid and those who are eligible for premium subsidies. The Kaiser Family Foundation estimates that more than 2.5 million people fall into this gap, as they would qualify for Medicaid if their state decided to expand coverage.

Conclusion

Health insurance coverage in the United States comes from a variety of different sources. Private health care continues to be the most prominent form of health insurance, with employer-provided coverage being the largest source. But the government also plays a particularly important role in the health insurance landscape. Medicare and Medicaid together provide coverage to nearly 35 percent of the U.S. population. Medicare provides health insurance to the elderly as they age, while Medicaid has grown to cover a diverse group of Americans who would likely have difficultly purchasing private insurance.

Recent efforts to increase insurance coverage, most notably the Affordable Care Act, led to a large reduction in the number of people without insurance, but despite those efforts, many remain uninsured. For a variety of reasons, roughly 9 percent of the population continues to go without health insurance, citing the cost of coverage as the primary reason. One way to reduce that number would be for all states to expand Medicaid, which would help resolve the coverage gap where many low-income Americans are stuck.

Recently, a lot of the discussion about health care has focused on regulations that affect individuals who do not get insurance through their employers. While people purchasing health care directly from insurers on exchanges account for a relatively small share of the overall population, their concerns have become particularly important to recent legislative debates. The cost of health insurance on the public exchanges have become unaffordable for many, and lack of competition in certain markets has left some areas with only one insurer to buy from. This problem many be getting worse, and next year, the number of insurers in some places may drop to zero. Given the pressing nature of these concerns, they tend to garner a lot of attention, and rightly so. But as we debate health policy, it’s important to keep in mind where the individual market fits into the overall landscape.

Kevin Rizzo

Kevin Rizzo is the Crime in America Editor at Law Street Media. An Ohio Native, the George Washington University graduate is a founding member of the company. Contact Kevin at krizzo@LawStreetMedia.com.

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Senate Republicans released their version of a bill to overhaul the health care system on Thursday. In general, the Senate version looks a lot like the version passed by the House in May with some important tweaks–notably, it includes steeper cuts to the Medicaid program in the long-term and changes the tax credit system to be a less generous version of the one currently in place. While it’s easy to get stuck in the details of these tweaks, arguably the best way to evaluate the bill is to look at its effects on taxing and spending. It may be most prudent to ask one question: should we offset tax cuts for the rich and businesses by cutting spending on the poor and working class?

The tax cuts in the American Health Care Act, or AHCA, amount to about $660 billion over 10 years and would be paid for, and then some, largely by slashing more than $800 billion in spending on Medicaid–the insurance program that provides health care to America’s most vulnerable, including children, the elderly, people with disabilities, pregnant women, and the poor. Although it would direct several billions of dollars to funds that help stabilize the individual insurance markets, that funding will end in 2026 while the changes the Medicaid will be permanent.

To understand current Republican proposals, it’s worth taking a minute to look at the law they seek to “repeal and replace.” The Affordable Care Act, or Obamacare, included a number of new taxes designed to help pay for new tax credits and a large expansion of the Medicaid program. The tax credits subsidized the cost of premiums for working class people who can’t get health insurance from their employer and the Medicaid expansion gave states funding to cover people living near the poverty line.

While the Affordable Care Act sought to raise taxes in order to increase insurance coverage, the American Health Care Act seeks to cut taxes, leading to a large reduction in the number of people with health insurance. According to the Congressional Budget Office, a non-partisan agency tasked with analyzing the effects of new legislation, the bill that passed the House would have increased the number of people without health insurance by 23 million by 2026. Although we will not have the updated projections for the Senate version until next week, that number is not expected to change very much.

The Senate version of the AHCA would undo the Medicaid expansion, phasing out the additional federal funding, and would reduce the value of the tax credits for most Americans who are currently eligible for them. In addition to ending the Medicaid expansion, the Republican bill would fundamentally restructure the Medicaid program by instituting a cap on the amount of funding per person enrolled. This new system would shift the burden of cost increases from the federal government–which currently covers a fixed percentage of all costs–to states and would amount to a significant reduction in the projected spending on the program in the long term. Medicaid is the country’s largest health insurance program, covering 20 percent of all Americans, including 30 percent of adults with disabilities, 60 percent of children with disabilities, 49 percent of births, 64 percent of all nursing home residents, and 76 percent of poor children.

For a more in-depth look at what the bill that passed the House would do to Medicaid, check out this article.

So who would benefit from the bill’s tax cuts? The AHCA would get rid of about 14 different taxes that target a broad range of groups, from high earners to indoor tanning companies. It would also slash some of the taxes put in place by the Affordable Care Act to target industries that stood to benefit from the coverage expansion, like medical device manufacturers and prescription drug makers. One of the most notable taxes was the one on investment income for individuals earning more than $200,000 per year and couples earning $250,000 and up per year. All of these taxes would be repealed, leading to a significant windfall for the wealthiest Americans. The Tax Policy Center estimated the net effects of the House bill and found that people with incomes greater than $200,000 would see their tax burden decrease by $5,640 on average, while the spending cuts would mean that the lowest income Americans would be hurt the most.

New TaxVox post explains how low income families would lose an average of $1,600 under proposed #AHCA https://t.co/F5IyOwub0e pic.twitter.com/Jn2KgfERT5

— Tax Policy Center (@TaxPolicyCenter) March 22, 2017

It’s also worth noting that the bill would repeal what’s known as the individual and employer mandates. The individual mandate requires people to maintain health insurance or pay a penalty at tax time. The employer mandate imposes a similar penalty on companies with a minimum number of full-time workers but do not offer health insurance to employees. Republicans have strongly criticized these penalties, which have been one of the driving forces behind the effort to scrap the Affordable Care Act.

There are a number of important differences between the House version and the Senate version of the Republican health care bill, which we will undoubtedly hear about during the coming debate. It also seems likely that changes will be made in the short period before Senate Majority Leader Mitch McConnell rushes the bill to the Senate floor for a vote. While it’s important to understand how these changes will affect people, taking a broader look at a very complicated bill might be the easiest way to make an assessment of it. If you think that taxes on businesses and the wealthy are too high and you don’t mind seeing an increase in the number of people without health insurance, then you’ll most likely support this bill. But if not, you may want to call your senator.

Kevin Rizzo

Kevin Rizzo is the Crime in America Editor at Law Street Media. An Ohio Native, the George Washington University graduate is a founding member of the company. Contact Kevin at krizzo@LawStreetMedia.com.

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Now that Republicans have made progress in their efforts to repeal and replace the Affordable Care Act, health insurance regulations are back in the forefront of public debate. A notable component of the Affordable Care Act (ACA) was the creation of essential health benefits, the law’s primary insurance regulation mandating what all policies must cover. This rule has been hotly debated and is something that the Republican replacement bill, the American Health Care Act, would allow states to seek waivers to define at the state level. While there are reasonable arguments on both sides of the debate when it comes to mandating high standards for health insurance plans, it may be helpful to look at how certain standards work in practice, and in certain cases, how their benefits can spill over into other public good.

The Role of Regulations

A new working paper by three economists, Ioana Popovici, Johanna Maclean, and Michael French, illustrate how state-level insurance regulations can have interesting spillover effects. They find that state laws that mandate insurance coverage for substance abuse treatment may have actually had a measurable effect on traffic deaths, decreasing fatalities by 4.1 to 5.4 percent. This is particularly important given that nearly 10,000 people die in alcohol-involved car accidents each year. While their research is designed to focus on the effects of state laws passed before the Affordable Care Act, their findings help show how improving access to services like substance abuse treatment can have larger societal benefits beyond those who are directly affected.

The researchers looked at what are known as state parity laws, which involve requiring insurance plans to cover substance abuse treatment like they cover medical and surgical services in terms of the costs to consumers. Between 1988 and 2010–before the ACA started mandating this parity for all insurance plans sold on exchanges–27 states passed their own parity laws requiring substance abuse treatment to be covered to some degree. The researchers look at states that passed these laws to see what their effects on traffic deaths might be. In the process, they identified and controlled for a range of variables that would otherwise affect traffic fatalities–from alcohol tax rates to population demographics–in order to find the direct consequences of parity laws.

While the study does have some limitations–data on the use of drugs that impair driving as well as data on accidents that didn’t result in death are unavailable–they build on a considerable body of research showing both that health parity laws increase use of substance abuse treatment and that such increase is associated with fewer traffic deaths. They also find that these laws correspond with a decrease in fatal weekend crashes–which is when alcohol-related accidents are particularly likely–and that the decrease was particularly large, 8.7 percent, in states that mandated full parity. They also find that parity laws are associated with a small decline in both heavy and binge drinking; however, that is based on self-reported survey responses, not clinical diagnoses of alcohol dependence.

This study isn’t necessarily groundbreaking–it does make sense to think that expanding access to substance abuse would lower substance-related traffic fatalities–but it provides an interesting look at the consequences of health insurance regulations in general. The study looks specifically at spillover effects, setting aside the direct and obvious benefits to individuals who gain access to addiction treatment, to show that high-quality insurance can have meaningful consequences beyond those who directly benefit. While it’s important not to overstate these findings, identifying additional benefits to regulations should be a part of the discussion as we evaluate new policies.

The Current Health Insurance Debate

The Affordable Care Act did a number of things to increase people’s access to health care–including expanding Medicaid to nearly 15 million people and providing subsidies to individuals below 400 percent of the federal poverty line–but it also included a number of regulations to make sure people’s insurance covered important services. These 10 essential benefits include things like prescription drugs, emergency care, maternity care, and, notably, substance abuse treatment. While it’s fair to say that requiring these services, and rules that prevent insurance companies from capping annual or lifetime spending on them, have increased the cost of health insurance for everyone, they are also the services that most people expect their health insurance to cover in the first place.

While the Republican bill largely focuses on health care access for low-income families and those who buy their insurance individually, allowing states to set their own essential health benefits could actually have ripple effects for the entire country, including the majority of Americans who get their health care from their employer. While employer plans are not required to cover the essential health benefits in the same way that individual plans sold on the federal and state exchanges are, they do apply to bans on annual and lifetime limits as well as yearly caps for out-of-pocket costs. And large employer plans are able to use any state’s definition of essential health benefits to determine those caps. If one state were to decide that substance abuse treatment is no longer an essential benefit, there could be an erosion in coverage for residents of that state and people across the country.

There are always trade-offs involved in setting health care regulations, but it’s important to understand the potential benefits involved as we debate major policy changes. Substance abuse treatment has proven to be an important and effective way to dramatically improve people’s lives, and based on recent research, mandating it can have additional societal benefits as well.

Kevin Rizzo

Kevin Rizzo is the Crime in America Editor at Law Street Media. An Ohio Native, the George Washington University graduate is a founding member of the company. Contact Kevin at krizzo@LawStreetMedia.com.

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As the American Health Care Act works its way through Congress, much of the debate has recently focused on issues like health insurance regulation. While that debate reflects important issues, like protections for people with pre-existing conditions, there is another part that would arguably have even larger consequences: the proposed cuts and changes to Medicaid. The AHCA would fundamentally change the funding structure for the safety net program and could have wide ranging effects on millions of Americans who rely on Medicaid for their health care. Read on for an overview of what’s in store for the program that provides insurance to nearly 20 percent of the country.

Who is Affected

Medicaid is the largest health insurance program in the country, which combined with the related Child Health Insurance Program (CHIP), covered nearly 75 million people as of February. Medicaid covers a diverse group of people including low-income individuals and families, people with disabilities, and the elderly.

The video below explores what the Medicaid program is and how it is paid for:

To understand the scope of the proposed changes to Medicaid in the American Health Care Act, it’s important to look at how the bill it’s intended to repeal and replace–the Affordable Care Act, or Obamacare–changed health insurance coverage in the first place. Generally speaking, the Affordable Care Act sought to increase insurance coverage by expanding the Medicaid program–through both increasing outreach and eligibility–while also creating regulated insurance marketplaces and providing subsidies to make health insurance more affordable.

The Medicaid expansion was directed at the lowest income Americans, specifically, people living below 138 percent of the federal poverty level, while insurance subsidies targeted those who were slightly better off but would still have difficulty paying for health insurance, namely those with incomes below 400 percent of the federal poverty level. Regulations also ensured that individuals could buy insurance on public exchanges and that prices couldn’t vary much according to an individual’s characteristics like age, sex, or health status, which was another way to expand coverage to those who were either priced out of the market or denied insurance outright.

While several components of the ACA sought to lower the rate of uninsured Americans, the Medicaid expansion played the largest role in achieving that goal. The AHCA includes important changes for insurance subsidies and regulation–the proposed cuts and changes to Medicaid are considerably larger. The Congressional Budget Office analyzed the effects of the AHCA in March after it was initially introduced and found that overall, the law would reduce the number of people with health insurance by 24 million within 10 years. The biggest chunk of that decrease, 14 million, would come from the proposed changes to Medicaid. While the law would not technically take people’s insurance away from them–states would have to make difficult decisions about enrollment and eligibility–it would amount to a large cut in federal spending on the program. In total, the CBO estimates that the bill would lead to an $839 billion decrease in federal Medicaid spending over the next 10 years.

The AHCA includes two primary changes to Medicaid that would lead to a significant reduction in people enrolled in the program. First, the bill would phase out the ACA’s Medicaid expansion, decreasing the number of people that states would get a high percentage of federal matching funds to cover. Second, it would change the program’s funding model from an open-ended commitment to an amount per enrollee that gradually increases over time.

Ending the Medicaid Expansion

The Affordable Care Act offered states matching funds to insure a large number of people newly eligible for Medicaid. A 2012 Supreme Court decision made the Medicaid expansion optional at the state level, and since then, 31 states and the District of Columbia have chosen to take the federal funds. At first, the government would pay the full cost of insuring these newly eligible enrollees, but over time the government’s share would drop, and by 2020, it would cover 90 percent of the cost of coverage. The matching rate for the enrollees who gained coverage from the expansion is actually higher than the traditional matching rate that states have historically received for those who were already eligible.

The American Health Care Act plans to unwind the Medicaid expansion starting in 2020. While the plan will end up with an estimated 14 million fewer people on Medicaid relative to current law, the AHCA’s passage will not technically take health insurance away from these individuals. Instead, it grandfathers in all newly eligible enrollees who are already in the program by December 31, 2019–allowing states to continue to receive the 90 percent fund matching for those individuals. However, for people who sign up after that point, the funding would drop to regular matching levels. This means that states will likely decide to restrict their program’s eligibility and return to standards that were in place before the Affordable Care Act.

People on Medicaid tend to cycle in and out of the program relatively quickly, which means that even though the AHCA grandfathers in expansion enrollees, coverage numbers are expected to drop fairly quickly after 2020, when states get lower matching rates. The bill would also require people on Medicaid to re-enroll every six months, rather than every year under current law, to maintain their coverage. This requirement could make it easier for people to accidentally have a lapse in their coverage, which could make those who are grandfathered in unable to re-enter the program. Based on how quickly people have cycled out of the program in the past, the Congressional Budget Office estimates that two years after the expansion ends, fewer than a third of those who were grandfathered in will remain on Medicaid. By 2024, fewer than 5 percent will remain. While the federal government won’t technically take people’s insurance away from them, the drop in funding will likely force states to make the difficult decisions surrounding eligibility and enrollment.

It’s worth noting that politics are an important variable here, so estimating coverage changes can be more of an art than a science when the actions of state legislatures are involved. It’s likely that states will react to a decline in federal funding by reducing the number of people eligible for Medicaid benefits. They may even do so preemptively, as they know that their funding will soon be reduced. Generally, the law will sharply reduce federal funding for Medicaid, but changes will be determined at the state level as they start to shoulder more of the costs.

A New Funding Model

In addition to phasing out the Medicaid expansion, the AHCA intends to dramatically change the funding system for Medicaid. Currently, Medicaid operates as an entitlement program, meaning that the federal government has an open-ended commitment to pay for a large share of the program’s costs. This means that if more people enroll in the program, as is often the case during economic downturns, the federal government continues to bear much of the increase in costs. Similarly, if the cost of medical care increases significantly, as it has been for several decades, the federal commitment increases accordingly. The entitlement nature of Medicaid has been a target of Republicans for decades; however, this is the first attempt to restructure the program while Republicans maintain control of all three branches of government.

Under the AHCA’s per capita cap system, states will get a certain amount per person enrolled. Those amounts will vary based on the different groups eligible for Medicaid to avoid giving states an incentive to shift enrollment to lower costs. For example, the system is designed to prevent states from being pressured to drop enrollment for the elderly or disabled because they may cost more than children. Each year, the per capita cap will increase along with the changes in medical care services component of the Consumer Price Index, which tracks inflation. The medical services component is known as CPI-M. The per capita system will make funding responsive to enrollment changes, but if certain Medicaid costs outpace the overall cost growth for medical services, states will need to pay the additional amount. Generally speaking, shifting to a per person allotment will amount to a significant cut in overall Medicaid spending. The Congressional Budget Office anticipates that Medicaid costs will grow by 4.4 percent per year while CPI-M will grow at just 3.7 percent annually over the next 10 years.

Additionally, the amended AHCA allows states to opt for a block grant rather than a per person cap. This would give states a grant based on their Medicaid population and would give them a considerable amount of freedom in terms of how to use that funding. Proponents say that this would allow states to experiment with funds in order to find new ways to keep costs down and deploy spending more effectively. However, critics argue that a block grant could mean states could be forced to cover fewer people or services than under the per capita cap model, and considerably more so than the current law. This is because block grants would not respond to increases in eligibility, for example due to a recession, and like the per capita model, it would not respond to cost increases that result from new or more expensive types of care. States could charge enrollees more for their care and they could cap enrollment, which could mean even those who are eligible may not be able to join the program.

How it would Change Medicaid

To illustrate how different the system would be under a per capita cap, economists at the Kaiser Family Foundation ran the numbers for Medicaid outlays from 2001 to 2011 to see how tying funds to CPI-M would affect spending. The KFF finds that federal spending would have been $195 billion below actual spending during that period, which would amount to a drop of about 7 percent. Importantly, these changes have very different consequences for the costs involved in covering the different eligible groups in the Medicaid program. For example, spending tied to CPI-M would have been 6 percent lower than actual spending when it comes to the health care costs for the disabled, but it would have been 15 percent lower for children on the program. In both of these cases, states would have had to shoulder more of the costs, but the difference is considerably larger due to faster growth in child health care costs. There is also a lot of variation between states in terms of what they pay for the average Medicaid enrollee. In fact, spending varies so much per person, that 13 states would have actually seen an increase or no change in their overall funding if it was anchored to CPI-M. However, 37 states and the District of Columbia would have seen their funding drop. And for 26 of those states, the drop relative to existing law would have been larger than 10 percent.

Subsequent amendments to the AHCA–after the initial Congressional Budget Office analysis–increased the per capita spending for the blind, elderly, and disabled to CPI-M plus one percentage point. Those changes amount to an estimated $41 billion in additional spending over the next 10 years, according to revised CBO projections. While $41 billion is a significant increase it may not be in the scope of the overall cuts–instead of reducing Medicaid spending by $880 billion, the amended law is projected to drop spending by $839 billion. While the Kaiser Family Foundation estimates mentioned above are based on CPI-M, and AHCA increases that rate slightly for certain populations, its calculations remain instructive.

Critics of the plan argue that the proposed per capita spending caps would limit states’ ability to respond to changes and could leave them on the hook for a lot of spending if certain costs grow faster than overall medical inflation. And because these caps will effectively result in spending cuts relative to the current law, it will ultimately leave states with less funding while also reducing their responsiveness to cost changes. An example of where this could be a problem is in Medicaid’s role in addressing the opioid epidemic. Many people who joined the program after the Medicaid expansion were previously uninsured and did not have access to addiction treatment. Moreover, the entitlement nature of the program allowed the program to respond to costs related to the epidemic. This is important given the program’s role in treatment–in total, Medicaid and CHIP, the related health insurance program for children, cover thirty percent of the U.S. population dealing with opioid addiction.

Conclusion

The American Health Care Act includes a number of adjustments to the current health care system, but the most wide-ranging might be the proposed cuts and changes to the Medicaid program. President Obama’s health law led to a large increase in Medicaid enrollment and the AHCA would roll much of that back while going even further to change the funding structure of the entire program. Taken together these changes amount to an $839 billion spending cut over the next 10 years and 14 million fewer people with health insurance.

Advocates of the bill argue that it will rein in Medicaid spending levels to a more sustainable course while granting states the ability to experiment and cut costs. Critics argue that it will dramatically increase the number of people without insurance by reducing federal funding for Medicaid while not offering alternatives to those who can’t afford insurance. As Senate Republicans begin to work on their own version of the health care bill, these wide ranging changes to Medicaid will likely be an important part of the debate.

Kevin Rizzo

Kevin Rizzo is the Crime in America Editor at Law Street Media. An Ohio Native, the George Washington University graduate is a founding member of the company. Contact Kevin at krizzo@LawStreetMedia.com.

The post How the American Health Care Act Plans to Dramatically Change Medicaid appeared first on Law Street.

Federal workers can breathe a sigh of relief (at least for one week): the Senate and the House both passed a short-term spending bill on Friday to fund the government at its current levels until next Friday. This averted a government shutdown that would have occurred if a deal had not been reached by midnight.

Some of the most contentious issues preventing a longer-term spending bill from being passed were funding for the border wall and an Affordable Care Act subsidy for low-income individuals, among others.

Even the one-week funding bill had a bumpy road to its passage, as many Democrats threatened to oppose its approval as long as Republicans planned to vote on repealing and replacing the ACA this week (within the President’s first 100 days). In the end, the health care vote was not scheduled for Friday.

President Donald Trump did not seem too concerned with the possibility of a shutdown, telling Reuters on Thursday, “we’ll see what happens. If there’s a shutdown, there’s a shutdown.” He also harshly criticized the Democratic Party in a series of Tweets on Thursday, accusing them of putting roadblocks in place and being responsible for a potential shutdown.

The Democrats want to shut government if we don’t bail out Puerto Rico and give billions to their insurance companies for OCare failure. NO!

— Donald J. Trump (@realDonaldTrump) April 27, 2017

I promise to rebuild our military and secure our border. Democrats want to shut down the government. Politics!

— Donald J. Trump (@realDonaldTrump) April 27, 2017

As families prepare for summer vacations in our National Parks – Democrats threaten to close them and shut down the government. Terrible!

— Donald J. Trump (@realDonaldTrump) April 27, 2017

The one-week spending bill buys Congress more time to smooth out conflicts and draft up a longer-term spending bill for the rest of the year.

The environment for government workers has been tenser than usual, to say the least. In addition to the possibility of a shutdown, federal workers have recently had to endure the possibility of job cuts, as Trump’s budget proposals have called to reduce the federal workforce by as many as 200,000 jobs. Also on Friday, officials announced that Secretary of State Rex Tillerson proposed to cut 2,300 jobs in the State Department.

Meanwhile, a large number of federal appointments still have yet to be selected by Trump. Politico reported that 470 out of 556 positions requiring Senate confirmation do not have nominees yet. It remains to be seen if the remaining issues in the long-term spending bill will be ironed out before this temporary measure expires on May 5.

Mariam Jaffery

Mariam was an Executive Assistant at Law Street Media and a native of Northern Virginia. She has a B.A. in International Affairs with a minor in Business Administration from George Washington University. Contact Mariam at mjaffery@lawstreetmedia.com.

The post Crisis Averted: Congress Approves Funding to Avoid Government Shutdown appeared first on Law Street.

After Republicans’ first attempt to swiftly repeal and replace the Affordable Care Act failed, President Donald Trump finds himself in a difficult position: he has to administer a law that he has frequently called a “disaster.” The question now becomes: will President Trump and Tom Price, his Secretary of Health and Human Services, try as hard as possible to support the law that’s already on the books or will they take steps to undermine it?

As Republicans continue to try to broker a compromise between their more moderate and conservative wings–and there’s at least some evidence they are making progress–questions about the existing law may need to be answered before any new legislation makes its way to the president’s desk. While many of these pending decisions are somewhat small or would require a long time before taking effect, there’s one relatively arcane component of the Affordable Care Act–cost-sharing subsidy payments–that could swiftly pull the rug out from under the health insurance exchanges that about 12 million people rely on for health insurance. Read on for an overview of the Affordable Care Act exchanges and to see how a pending lawsuit gives President Trump unique control over the fate of a major part of his predecessor’s landmark accomplishment.

An Overview of the Health Insurance Exchanges

The Affordable Care Act, more commonly known as Obamacare, is an extraordinarily long piece of legislation that touched almost every part of the U.S. health care system–an industry that accounts for nearly one-fifth of the entire economy. One of the law’s primary goals was to lower the number of people without health insurance coverage. To do this, the law dramatically increased the number of people on Medicaid–the government-run health insurance program for low-income Americans–by expanding outreach and eligibility to a larger number of Americans. It also created federal and state-run health insurance exchanges on which people who do not get health insurance through their employer and also don’t qualify for Medicare or Medicaid can buy health insurance. While most of the coverage gains came from expanding Medicaid, creating regulated exchanges and offering subsidies made health insurance available to groups who previously did not have access to it on the individual market, notably those with preexisting conditions.

Individuals could buy health insurance before the Affordable Care Act’s passage, but insurers could charge people with chronic health conditions a lot more for insurance and could even deny coverage outright. The ACA introduced significant marketplace reforms to ensure that all insurance plans offered on the exchanges cover a minimum set of services, known as the 10 essential benefits, and prevented companies from denying anyone coverage because of a preexisting condition. The law also included provisions that prohibited charging people higher premiums based on certain characteristics like gender or health status. For other characteristics, the law set specific ranges at which companies can use to price premiums. For example, companies can charge no more than three times as much for their elderly customers as they can for their youngest customers.

The law had a number of provisions to try to make the marketplaces stable for insurers and consumers. One of the most discussed (and controversial) market stabilization components of the law is the individual mandate–the requirement that everyone get health insurance or pay a tax penalty. To help make insurance affordable for consumers, the ACA provided premium subsidies to people making less than 400 percent of the federal poverty line. The premium credits are tied to a benchmark plan to ensure that an individual or a family’s healthcare spending is capped at a certain percentage of their income. This means that if insurance premiums change dramatically from one year to the next then the subsidy will also adjust for those who are eligible. Finally, the law also had several stabilization programs that sought to reduce the risk that insurers would face when beginning to sell plans on the new exchanges.

Cost-Sharing Reductions

One of the many ways the law sought to make care affordable for low-income Americans is the cost-sharing reduction requirements. The cost-sharing reduction provision is relatively small in the overall scope of the law, but remains an important component because it addressed costs that people face when going to get care. In addition to premiums, health insurance plans typically include several forms of cost-sharing, which involve out-of-pocket costs when someone visits the doctor or fills a prescription. The Affordable Care Act sought to reduce these costs for people with incomes up to 250 percent of the federal poverty level. People who are eligible for cost-sharing reductions must enroll in silver insurance plans, the middle tier plans, on the insurance exchanges. Based on an eligible consumer’s income, insurers adjust the value of the plan to ensure that they cover a certain percentage of all costs. The government then provides a subsidy to insurers so they recoup those costs. A typical silver plan has an actuarial value of 70 percent, meaning that the insurance company will, on average, pay 70 percent of the cost for covered services–the other 30 percent typically comes through different cost-sharing. In plans eligible for cost-sharing reductions, the actuarial value of a silver plan increases based how close a person or family is to the federal poverty level. For the lowest income Americans who buy insurance on the exchanges, the actuarial value goes as high as 94 percent.

This year there are 7.1 million Americans who have plans with cost-sharing reductions, accounting for 58 percent of all plans on the exchanges. The total cost of the subsidies provided by the government is about $7 billion each year. This process–in which insurers are required to reduce cost-sharing for certain low-income customers and then the government subsidizes the insurers–is key to understanding the current challenge, which we’ll get to in the next section.

It’s worth noting that the law was not implemented exactly as it was designed, as legal and legislative obstacles played a significant role in the way the law took effect. Additionally, while the law has many provisions to reduce the burden on insurers and consumers, there are a number of local marketplaces that are particularly fragile at the moment. Several insurers have pulled out of the exchanges and there are several counties where people buying insurance on the health exchanges have only one insurance plan to pick from. At the same time, there are several places where the exchanges have been particularly successful–where strong competition between insurers has created a stable market for consumers. Debating the overall success of the Affordable Care Act and what should be done going forward is clearly important, but that is beyond the scope of this piece. What is clear is that the law led to a significant legal and political backlash, which brings us to the next part of the story.

The Lawsuit

The passage of the Affordable Care Act sparked a number of legal challenges, several of which have made their way to the Supreme Court. But the lawsuit that is the most important right now is the one challenging the cost-sharing subsidies. Interestingly, this lawsuit didn’t come from private citizens, small businesses, or religious institutions, but from another branch of the government.

In November 2014, Republicans in the House of Representatives filed a lawsuit against the executive branch to challenge two aspects of the ACA’s implementation. The lawsuit first argued that President Obama overstepped his constitutional authority by delaying the implementation of the employer mandate–a requirement that companies of a certain size must provide health insurance for their employees or pay a fine. Second, it claimed that the Obama Administration’s payments to insurers for the cost-sharing subsidies were illegal because the money had not been properly appropriated. A federal judge dismissed the first claim but allowed the second to proceed.

The Arguments

Both sides of the lawsuit agree that money cannot be spent unless it is properly appropriated, but the dispute focuses on the question of whether or not the current law amounts to an appropriation. House Republicans argue that although the ACA created the subsidy, the payments are not linked to a specific appropriation. Although the law calls for the payments to be paid, it doesn’t specify a source for the payments. This is not the case for the law’s premium subsidies, which are paid out in the form of refundable tax credits and are appropriated by the statute that allows the IRS to make refund payments. When the issue first emerged, President Obama asked Congress for a specific appropriation but Congress declined. After the lawsuit began, the Obama Administration argued that the same appropriation that is used for the premium subsidies can be used to make the subsidy payments to insurers.

Nicholas Bagly, a law professor and health care expert at the University of Michigan, has studied the implementation of the Affordable Care Act and argues that the Republicans’ lawsuit has a point. The justification used by the Obama Administration doesn’t quite make sense because tax credits are not the same thing as direct payments to insurance companies. As Bagley puts it, “It’s an enormous stretch to read an appropriation that governs refunds for individual taxpayers as also covering payments to insurers.” However, he also argues that the Republican lawsuit should have been thrown out by the courts in the first place. The White House and Congress are two coequal branches of government and they have the authority to resolve the dispute between themselves. If Congress has a problem with something the president is doing, it can pass a law that stops him from doing it. Congress could also pass a law appropriating the funding for the cost-sharing payments and the problem would be resolved. Allowing one branch to take an issue with another branch to the courts could set a problematic precedent as political disputes should ideally be resolved by elected officials.

What’s Next and Why It’s Important

After the district judge’s initial ruling–which allowed the cost-sharing subsidy claim to continue but dismissed the employer mandate claim–a separate ruling in 2016 ordered President Obama to stop making the payments. Obama immediately appealed the decision and the judge stayed her ruling so the White House could appeal. This means that right now, if President Trump decided to stop reimbursing insurers for cost-sharing reductions, he could drop the appeal and the judge’s injunction blocking the payments would stand. Doing so would have massive consequences for the fate of the health insurance exchanges. This is also something that the president has publicly considered, but the fate of these payments remains unclear.

On April 10, the Department of Health and Human Services told the New York Times that it planned to continue making the cost-sharing payments to insurers while the lawsuit was being litigated. But a few days later, in an interview with the Wall Street Journal, Trump said that he would consider withholding the payments as a way to force Democrats to negotiate on health care legislation. This was, in effect, a threat to undermine the insurance markets as a way to force a deal. Democrats have also reportedly considered demanding a specific appropriation for the payments for their support in a funding bill that will be needed before the end of April to avoid a government shutdown. While the politics of the issue remain unclear, the ultimate effects that ending the payments would have are fairly clear.

Consequences for Health Insurance Markets

Ending the cost-sharing subsidy payments would have dramatic consequences for the individual health insurance market. Ending the payments would not change the fact that insurers who sell plans on the exchanges would still need to provide cost-sharing reductions for customers who qualify–whether they get reimbursed by the government or not. The Kaiser Family Foundation, a non-partisan organization that analyzes health care policy, estimated that average premiums would need to increase by 19 percent to offset the lack of government funding. These estimates varied by location, ranging from a projected 9 percent increase in North Dakota to a 27 percent in Mississippi. Alternatively, insurers may simply leave the exchanges altogether.

After several insurance companies had difficulty turning a profit in the early years of the ACA’s implementation, several companies decided to stop selling plans in many markets. The current uncertainty surrounding the cost-sharing payments and health care policy more generally, could lead many companies to pull out from the exchanges. Trade groups have already started to warn lawmakers that blocking the payments may cause insurers to drop out of the markets. By June 21, all health insurers will need to decide whether or not they plan to sell insurance on the ACA exchanges next year. This year there are more than 960 counties in the country with just one insurer offering to sell plans on the exchanges, and if companies decide to pull out, several markets could collapse altogether.

Conclusion

As Republicans continue their efforts to repeal and replace the Affordable Care Act, President Trump may need to make decisions about the current law before he has an opportunity to sign a new law overhauling it. Arguably the most pressing of these challenges is what to do about the lawsuit challenging the cost-sharing subsidy payments. Trump could decide to stop the pending lawsuit and block the payments almost immediately, throwing exchanges that provide insurance to 12 million Americans into chaos. He could continue the current policy–allowing the appeal to move forward and payments to be made to insurers–or he could ask Congress to appropriate the required funding and resolve the issue once and for all.

In the meantime, the subsidy payments will continue to play an important role in legislative negotiations, particularly the funding bill needed to keep the government open past April 28. Meanwhile, insurers must deal with uncertainty as they decide if they want to continue to sell plans on the state and federal exchanges. While much remains in question, the end result will largely be the product of Congressional politics. Both parties seem to think they have the upper hand–assuming the other will be blamed if subsidy payments are blocked and insurers hike premium prices or leave the markets altogether.

Kevin Rizzo

Kevin Rizzo is the Crime in America Editor at Law Street Media. An Ohio Native, the George Washington University graduate is a founding member of the company. Contact Kevin at krizzo@LawStreetMedia.com.

The post Behind the Lawsuit that Could Upend the Affordable Care Act Exchanges appeared first on Law Street.

For most countries, health care is often a costly component of national budgets. That being said, the sheer volume of federal money spent on a nation’s health care system does not necessarily predict its efficacy. For example, the American health care system–with its rising premiums, drug costs, and glaring loopholes–could certainly be more efficient. The U.S. system has consistently ranked poorly among other industrialized nations, despite having the most expensive health care system in the world–17 percent of its GDP. As the White House grapples with how to handle health care under the new Trump Administration, American politicians may look to other countries for guidance.

One such country potentially worth emulating is the Netherlands. According to the global Prosperity Index, the Netherlands has one of the best health care systems in the world based on the country’s basic mental and physical health, health infrastructure, and availability of preventative care. Could this country’s critical health care reform and system structure be advantageous for the U.S.?

Netherlands Health Care Reform

In 1941, the Netherlands introduced a mandatory health insurance plan for low and middle income citizens. It provided most of the country’s population with basic health insurance, while wealthier citizens purchased private plans. But as the program grew, so did spending. In an effort to protect access to health care, the government passed the Health Care Prices Act in 1982 to control physician fees and revenues. Over the following decades, the Dutch started working toward creating a system that merged competition with universal access to health care.

Then, in 2006, the Netherlands passed the Health Insurance Act of 2006. This broad health reform law was intended to improve the health care system’s quality and efficiency by introducing uniform health insurance. Prior to the 2006 health insurance reform, the Netherlands health care system was comprised of four parts: long-term care insurance, supplementary private health insurance, social health insurance, and alternative private health insurance. After the reform, a new universal “private” social health insurance emerged, and long-term care and supplementary private insurance were maintained.

“Holland” Courtesy of Moyan Brenn : License (CC BY 2.0)

All people who legally live and work in the Netherlands are mandated to buy health insurance from a private insurance company. All insurers are required to accept each applicant, regardless of pre-existing conditions. Moreover, the plan is financed with individuals’ annual income-based contributions. Over half of all Dutch households also receive a subsidy from the government based on income. Since the system relies solely on a flat tax related to salary, the Dutch government does not have to shell out many resources to provide individuals with subsidies.

Today, the health insurance system appears to have more transparency than before. Consumers also have unrestricted choice between all insurance companies on the market. Interestingly, the Dutch approach is not a single-payer system. Instead, it combines mandatory universal health insurance with competition amongst private health insurers, creating more of a “risk equalization” system

Netherlands Health Care Structure

The Dutch do not aggressively regulate health care prices; instead, they’ve chosen to hone in on risk selection and primary care.  By tracking a myriad of factors such as: age, sex, pharmaceutical history, and hospital use, the government is able to determine which individuals are more risky to insure and how much it will potentially cost to cover them in the future. The government then pays more money to insurance companies taking on sicker patients. In an effort to offset these costs, each citizen is required to sign up for a general practitioner who acts as a “gatekeeper” to more expensive care and services. This allows the Dutch to cut back on unnecessary–and often costly–visits to specialized doctors. Individuals who are unhappy with their care have the option to change their insurance policy each year.

Insurers are also mandated to place all profits into a shared fund. That money is then distributed to other insurance companies whose patients are sicker than anticipated. Essentially, the Dutch have made insuring only the healthy a less viable and effective business strategy for insurance companies. The government has also set aside a health care budget, and still sets the price on most services. Since physicians are paid a lump sum each year–rather than fee-for-services–there is less incentive for them to overprescribe medications.

But no health care system is completely free from flaws. Cost-related access problems–not filling prescriptions, skipping recommended tests or treatments, or not visiting a doctor because of cost issues–still plague the Netherlands. However, timely access to health care, including elective or non-emergency surgeries, is much easier to receive in the Netherlands.

In many ways, the Dutch health care system is now an efficient “managed competition.” According to the United Nations’ 2017 World Happiness Report, the Netherlands ranked an impressive sixth out of more than 150 countries. While many factors were considered, health care coverage and life expectancy were integral in determining the overall happiness rankings.

What Can the U.S. Do?

In 2008, researchers noted that implementing a Dutch-like system in the U.S. could be attractive to many American citizens in an article entitled “Universal Mandatory Health Insurance In The Netherlands: A Model For The United States?” Consumer choice, in particular, is an aspect of the Netherlands’ health care overhaul that is incredibly desirable to Americans. The Affordable Care Act (ACA) may have been the U.S.’ first step toward implementing a health care system similar to the Dutch (insurance policy choices for consumers, attempts to insure more of the population, and coverage regardless of pre-existing conditions), but the system still has its glaring issues.

In 2014, the Commonwealth Fund produced a report that ranked the U.S. third out of 11 wealthy nations in timelines of care and effective care overall.  The Dutch, on the other hand, can provide universal coverage with very low out-of-pocket costs, while still maintaining speedy access to services. According to the study, the U.S. also ranked last on measures of equity; Americans with low incomes are far more likely than counterparts in other countries to not visit a physician when ill. Poor rankings in equity, efficiency, healthy lives, and cost-related access problems contributed to the U.S. ultimately ranking last overall in the study for the fifth time.

While the Dutch have managed to create an institutional framework to deliver universal access to health care along with market competition and consumer choice, the researchers found that the system still struggles to provide the most high-quality care. Meanwhile, the U.S. has integrated many high-caliber delivery systems, but fails to provide universal access to basic health insurance at an affordable rate. U.S. health care still remains the most expensive in the world, and yet it manages to underperform relative to other countries.

The U.S. and the Netherlands are perhaps most divided in the regulation of insurance companies. The ACA left a significant amount of diversity in the insurance marketplace, making it nearly impossible for the program to be fully transparent and simplified with the vast amount of choices. Obamacare offers four different varieties of insurance packages, while the Dutch program offers only one–which is probably most comparable to the Obamacare silver plans. Insurers in the U.S. are able to charge older customers up to three times as much as younger ones, adding even more complexity to the American system. Other researchers note that America’s “spend more, get less” model is tied to other issues–safe, affordable housing; employment prospects; reliable transportation; and consistent, well-balanced meals–that may be even more important to a population’s overall health than just specific medical care.

Conclusion

Building a perfect health care system is downright difficult, regardless of the country or government structure. However, the efficacy and success of the Netherlands’ universal system may be something the U.S. can learn from, and perhaps even integrate into its own system. While there is a lot of support for single-payer (“Medicare for all”), the Dutch system of health care isn’t too far removed from what President Barack Obama attempted to implement through the ACA. With more efficiency and management of the health insurance market, it’s possible the U.S. could save billions of dollars following a more Dutch-like system of health care.

Nicole Zub

Nicole is a third-year law student at the University of Kentucky College of Law. She graduated in 2011 from Northeastern University with Bachelor’s in Environmental Science. When she isn’t imbibing copious amounts of caffeine, you can find her with her nose in a book or experimenting in the kitchen. Contact Nicole at Staff@LawStreetMedia.com.

The post Could America Learn a Thing or Two From the Netherlands’ Health Care? appeared first on Law Street.

In a mad dash to secure support for the Republican health care bill, President Donald Trump issued an ultimatum to House Republicans late Thursday: pass the law, or keep the Affordable Care Act in place. Trump is dealing with a splintered House: the far-right flank, including the Freedom Caucus, thinks that the bill isn’t extreme enough. On the other hand, moderate Republicans want the bill to preserve some elements of Obamacare, like Medicaid spending. The House is expected to weigh in on the bill at 4:45 Friday afternoon–though the vote was originally expected for Thursday, so a further delay is not unthinkable.

“We have a great bill, and I think we have a good chance, but it’s only politics,” Trump said Thursday after a day of negotiations at the White House with members of the Freedom Caucus. It seems the ultraconservative group of House Republicans successfully wrangled Trump, who agreed to some of their requested changes to the bill: no guarantees for maternity care, emergency services, or mental health and wellness programs. Members of the Freedom Caucus, an increasingly powerful group, have threatened to oppose the bill unless it was amended in a more conservative fashion.

“We’re committed to stay here until we get it done,” Rep. Mark Meadows (R-NC), and the chairman of the Freedom Caucus, said on Thursday. “So whether the vote is tonight, tomorrow or five days from here, the president will get a victory.” But even after what seemed like a successful meeting, Trump is upping the pressure on the Freedom Caucus to support the bill. On Friday morning, Trump tweeted:

The irony is that the Freedom Caucus, which is very pro-life and against Planned Parenthood, allows P.P. to continue if they stop this plan!

— Donald J. Trump (@realDonaldTrump) March 24, 2017

The Freedom Caucus is not the only skeptical Republican faction that is demanding changes to the existing health bill, the American Health Care Act. Moderate Republicans–in the House and the Senate–would like to see changes made in the opposite direction; Medicaid spending, which covers many of their constituents, is a vital component of the bill for them. So the quagmire then, for Trump, and for House Speaker Paul Ryan (R-WI), the bill’s architect, is how to unite the competing Republican visions for the bill. No Democrats are expected to support the legislation, and only 22 Republicans can dissent for the bill to pass.

Even if Trump gets his way, and the bill passes the House on Friday, it will likely get a major facelift in the Senate before hitting his desk for a signature. On Thursday, President Barack Obama, whose health care bill has been mercilessly targeted by Republicans for seven years, sent a convivial message of hope to his followers on Thursday, the seventh anniversary of the signing of Obamacare.

“I’ve always said we should build on this law, just as Americans of both parties worked to improve Social Security, Medicare, and Medicaid over the years,” Obama wrote. “So if Republicans are serious about lowering costs while expanding coverage to those who need it, and if they’re prepared to work with Democrats and objective evaluators in finding solutions that accomplish those goals — that’s something we all should welcome.”

Alec Siegel

Alec Siegel is a staff writer at Law Street Media. When he’s not working at Law Street he’s either cooking a mediocre tofu dish or enjoying a run in the woods. His passions include: gooey chocolate chips, black coffee, mountains, the Animal Kingdom in general, and John Lennon. Baklava is his achilles heel. Contact Alec at ASiegel@LawStreetMedia.com.

The post Trump to House Republicans: Support Health Care Bill or Obamacare Stays appeared first on Law Street.

On Monday, the government’s official nonpartisan prognosticator, the Congressional Budget Office, weighed in on the newly-crafted House Republican health care bill. The projections, while not exact, paint a fairly stark picture: by 2026, the CBO report says, 52 million Americans would be uninsured, 24 million more than if Obamacare were to remain in place. The report does offer some teeth for more hardline conservatives who called the Republican plan “Obamacare Lite,” in that it would shave billions of dollars off the federal deficit.

The Trump Administration rejected the CBO report–and it sought to undermine it even before it was released–and Democrats highlighted its uninsured figures as proof that the GOP plan does nothing for ordinary Americans.

“We disagree strenuously with the report that was put out,” said Tom Price, the secretary of health and human services. Price added that the report does not account for regulatory steps he will take, or supplemental legislation Republicans will put forth in the coming weeks.

The report explains why the Republican plan, which, among other things, would scrap Obamacare’s mandate that Americans buy insurance or face a penalty, could cause the number of uninsured Americans to skyrocket. “Some of those people would choose not to have insurance because they chose to be covered by insurance under current law only to avoid paying the penalties,” the report said, “and some people would forgo insurance in response to higher premiums.”

Premiums under the Republican plan would start off higher than Obamacare–rising by 15 to 20 percent in 2018 and 2019–but would plummet by 2026, when premiums would be 10 percent lower than the current rate. And, despite concerns that the Republican plan would destabilize the insurance market, the CBO estimates that the plan would “lower average premiums enough to attract a sufficient number of relatively healthy people to stabilize the market.”

The immediate effects of the Republican plan could be devastating. Next year, the CBO estimates, the expected number of uninsured people could be 14 million more than under the current law. Medicaid, a target of the Republican plan, also called the American Health Care Act, would take a hit too. The number of Medicaid beneficiaries would drop by 17 percent by 2026, with 14 million less people covered by the program. In a boon to conservatives who lamented the AHCA as “Obamacare 2.0,” the CBO projects the plan would save $337 billion, largely as a result of less entitlement spending.

The CBO, a nonpartisan body whose current director was chosen by Republicans in 2015, is not considered a soothsayer; it is more of a meteorologist: largely accurate but never perfect. For instance, it initially projected Obamacare to insure 26 million Americans in 2017. Last year, the body revised that prediction to 15 million.

Two House committees passed the Republican health bill last week, and by the end of the month, the entire House is expected to vote. Some Republicans, like the members of the House Freedom Caucus, have called for a bill further to right. Others have expressed worry that its cuts to Medicaid are too deep. Some Republicans in the Senate have also hinted they might not support the bill. On Monday, after the report was released, Sen. Susan Collins (R-ME) said the report “should prompt the House to slow down and reconsider certain provisions of the bill.”

Alec Siegel

Alec Siegel is a staff writer at Law Street Media. When he’s not working at Law Street he’s either cooking a mediocre tofu dish or enjoying a run in the woods. His passions include: gooey chocolate chips, black coffee, mountains, the Animal Kingdom in general, and John Lennon. Baklava is his achilles heel. Contact Alec at ASiegel@LawStreetMedia.com.

The post What You Need to Know About the CBO Report on the GOP Health Care Bill appeared first on Law Street.

You may have noticed a lot of tweets pitting Obamacare against a new GOP bill recently. That’s because on Monday, Republican lawmakers introduced the American Health Care Act (AHCA), a measure meant to replace former President Barack Obama’s Affordable Care Act (ACA), also known as Obamacare, which helped provide about 20 million Americans with healthcare.

The proposal wouldn’t undo the ACA entirely: provisions allowing young adults to remain on their parents’ health insurance until age 26 and ensuring coverage for people with pre-existing conditions will remain intact. But the bill would eliminate Obamacare’s individual mandate that taxes people who don’t purchase healthcare and allow insurers to charge a 30 percent higher premium for those who let their coverage lapse for more than 63 days. It would also roll back the expansion of Medicaid (which is currently used by more than 70 million Americans) by 2019, restrict Medicaid funding to Planned Parenthood, and postpone the “Cadillac tax”–which fines employers for offering high-cost coverage to their workers–until 2025. Additionally, the measure could allow providers to charge older people five times more for insurance than younger people (under Obama the limit was three times more). For more information, read “What You Need to Know About the New GOP Health Care Plan.”

House Speaker Paul Ryan praised the bill, saying it would “drive down costs, encourage competition, and give every American access to quality, affordable health insurance,” and President Donald Trump has also tweeted out his support of the AHCA. But a handful of Republican senators and several Democrats, who have labeled the measure “Trumpcare,” see it as a downgrade that will increase healthcare costs.

Naturally, opposition toward the bill picked up on Twitter, where users began to draw comparisons between the ACA and the AHCA to famous movies, shows, or characters and their lower-quality knockoffs and sequels. Here are some of the most creative examples.

Obamacare v. GOP replacement pic.twitter.com/C1o8sIXB2I

— Lauren Duca (@laurenduca) March 7, 2017

https://twitter.com/morninggloria/status/838907799040114694

Obamacare vs Trumpcare pic.twitter.com/8VDZEAAtQx

— billy eichner (@billyeichner) March 7, 2017

Obamacare // the GOP replacement pic.twitter.com/sqTC8yUhAj

— Dave Itzkoff (@ditzkoff) March 7, 2017

Obamacare // the GOP replacement pic.twitter.com/MNbNfhC3sI

— Dave Itzkoff (@ditzkoff) March 7, 2017

Obamacare vs. the Obamacare replacement pic.twitter.com/vf6rQRou2l

— Fun_Beard (@Fun_Beard) March 7, 2017

Obamacare vs. Replacement Obamacare pic.twitter.com/hLyW5sX8HU

— Andi Zeisler (@andizeisler) March 7, 2017

Obamacare vs. GOP replacement pic.twitter.com/wQ9gi9hPsG

— Alia (@MizzzAlia) March 7, 2017

Obamacare vs. GOP Replacement pic.twitter.com/Ajs2fhzKnk

— Ira Madison III (@ira) March 7, 2017

obamacare vs gop replacement pic.twitter.com/74C01phBqh

— Ashley Feinberg (@ashleyfeinberg) March 7, 2017

Obamacare VS GOP replacement pic.twitter.com/3G20CtCckf

— shackas (@shackas) March 7, 2017

Obamacare vs GOP replacement pic.twitter.com/NdpwOqS75y

— Philip Lewis (@Phil_Lewis_) March 7, 2017

Reasons why people are against the bill differ, though. A handful of conservatives in Congress, like Sen. Rand Paul (R-Kentucky), want to overhaul Obamacare completely and have nicknamed the AHCA “Obamacare Lite” or “Obamacare 2.0.” All this criticism could mean that the bill won’t get the support it needs to pass.

Victoria Sheridan

Victoria is an editorial intern at Law Street. She is a senior journalism major and French minor at George Washington University. She’s also an editor at GW’s student newspaper, The Hatchet. In her free time, she is either traveling or planning her next trip abroad. Contact Victoria at VSheridan@LawStreetMedia.com.

The post Why is Everyone Tweeting About Obamacare vs. the GOP Replacement? appeared first on Law Street.

The Republican fantasy of a two-pronged “repeal and replace” strategy for Obamacare seems to be shifting to more of a fix-it approach. “Repair” is the latest buzzword that some Republican congressmen are attaching to their strategy for dealing with the Affordable Care Act. But insurers are confused. Consumers are worried. And President Donald Trump continues to signal his commitment to repealing the law, while Republicans have yet to coalesce around a comprehensive plan. Some have even backtracked on repealing it at all.

The retreat from “repeal and replace” began in earnest last week, during a Republican meet-up in Philadelphia. Lawmakers left the gathering with fractured ideas on how to continue with their years-long promise to dismantle President Barack Obama’s signature health care achievement. Some doubled down on a wholesale demolition, no matter the lack of a follow-up plan. Others embraced a piece-meal approach: repeal Obamacare, then patch it up bit-by-bit.

But still, others seem to be doubting the wisdom of a repeal in any form. Sen. Lamar Alexander (R-Tennessee), one of the leading Republican voices in the GOP’s health care effort, said this at a hearing on Wednesday:

I think of [Obamacare] as a collapsing bridge… You send in a rescue team and you go to work to repair it so that nobody else is hurt by it and you start to build a new bridge, and only when that new bridge is complete, people can drive safely across it, do you close the old bridge. When it’s complete, we can close the old bridge, but in the meantime, we repair it. No one is talking about repealing anything until there is a concrete practical alternative to offer Americans in its place.

All of this uncertainty has insurers worrying that 2018 will see premiums rise and the insurance market stumble. In interviews with executives from 13 insurance companies that provide insurance in 28 states, the Urban Institute found the uncertainty is “bad for their businesses and for the overall stability of the individual market, both inside and outside the marketplaces.” Insurers expressed particular concern that scrapping the ACA’s individual mandate–which levies a tax on anyone who decides to forgo insurance–could cause healthy individuals to leave the market, leading to higher premiums.

Alec Siegel

Alec Siegel is a staff writer at Law Street Media. When he’s not working at Law Street he’s either cooking a mediocre tofu dish or enjoying a run in the woods. His passions include: gooey chocolate chips, black coffee, mountains, the Animal Kingdom in general, and John Lennon. Baklava is his achilles heel. Contact Alec at ASiegel@LawStreetMedia.com.

The post Is the Republican Plan to “Repeal and Replace” Obamacare Over? appeared first on Law Street.

Uh oh, today is Friday the 13th. Enjoy the end of your week, but if you’re superstitious, be careful! Welcome to RantCrush Top 5, where we take you through today’s top five controversial stories in the world of law and policy. Who’s ranting and raving right now? Check it out below:

Samantha Bee Takes on Bo Bice’s Popeyes Drama

Samantha Bee introduced a new phenomenon to her viewers on Wednesday night: apparently a lot of white men in the U.S. are now experiencing “racism” and “harassment.” One example is former American Idol contestant Bo Bice, who was called a “racial slur” when he recently ordered some fried chicken at a Popeyes in an Atlanta airport. Bee hypothesized about what he could have been called, but it turns out he was just called “white boy” by one employee. Bice took this incident so personally that he broke down in tears during a Fox News segment. He also wrote an excessively long Facebook status in which he called the incident “racist behavior,” threatened legal action, tagged the local TV news station, and managed to get the young girl who worked at Popeye’s suspended from work. And in the interview with Fox News he said, “America, you should be ashamed!” Well Bo, here’s Bee’s full rant in response:

Emma Von Zeipel

Emma Von Zeipel is a staff writer at Law Street Media. She is originally from one of the islands of Stockholm, Sweden. After working for Democratic Voice of Burma in Thailand, she ended up in New York City. She has a BA in journalism from Stockholm University and is passionate about human rights, good books, horses, and European chocolate. Contact Emma at EVonZeipel@LawStreetMedia.com.

The post RantCrush Top 5: January 13, 2017 appeared first on Law Street.

Just after midnight, in the early hours of Thursday morning, Senate Republicans approved a budget blueprint measure that is the first step in the arduous journey toward repealing the Affordable Care Act. The measure is a largely procedural move that will pave the way for more formidable legislation to move through Congress later this month. Congress uses budget blueprints as a guiding device for future legislation; they do not require a president’s signature, and do not become law. A House vote on the budget blueprint could come as early as Friday.

While the Obamacare repeal effort is officially underway, Republicans are still split on how to replace the health care law. In a press conference on Wednesday, President-elect Donald Trump said repeal and replace would happen “essentially simultaneously.” 

In a statement, Senate Majority Leader Mitch McConnell called the vote “an important step toward repealing and replacing Obamacare,” adding that it will lead to “legislative tools necessary to actually repeal this failed law while we move ahead with smarter health care policies.” Senate Republicans unanimously voted for the measure, which passed by a vote of 51-48, while Democrats opposed it, deeming it the beginning of the end of health insurance for over 20 million people.

Senator Maria Cantwell (D-WA) said the GOP is “stealing health care from Americans.” Senator Ron Wyden (D-OR), said “health care should not just be for the healthy and wealthy.” And Senate Minority Leader Chuck Schumer of New York, who Trump recently called the “head clown” of the Democrats, said the vote was “irresponsible and rushed.”

For Republicans, the budget blueprint sets the stage to fulfill the party’s six-year effort to repeal President Barack Obama’s chief domestic policy achievement. The more substantial repeal legislation is expected to hit the Senate floor on January 27, though some Senate Republicans suggested that date is a placeholder, and a repeal bill could come at a later date.

The eventual repeal legislation–known as a reconciliation bill–will contain specific language that would repeal parts, if not all, of the ACA. Reconciliation bills are safeguarded from filibusters, and only require a majority vote to pass. Republicans control both chambers of Congress, so unless some Senate Republicans flip, that measure will almost surely pass. According to Trump, who held his first press conference in nearly six months on Wednesday in Manhattan, Republicans will have a replacement plan to offer sooner rather than later.

“It will be repeal and replace,” Trump said. “It will be essentially simultaneously. It will be various segments, you understand, but will most likely be on the same day or the same week, but probably the same day, could be the same hour.”

Alec Siegel

Alec Siegel is a staff writer at Law Street Media. When he’s not working at Law Street he’s either cooking a mediocre tofu dish or enjoying a run in the woods. His passions include: gooey chocolate chips, black coffee, mountains, the Animal Kingdom in general, and John Lennon. Baklava is his achilles heel. Contact Alec at ASiegel@LawStreetMedia.com.

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The 115th Congress has been sworn in, and President-elect Donald Trump will be moving into the White House in two weeks. The power shift in Washington, with a Republican majority in both chambers of Congress and a Republican president, is sure to result in a number of changes. Within the first few weeks and months of 2017, one of President Barack Obama’s crowning achievements, the Affordable Care Act, will take on a significantly different form. Read on to find out what Republicans plan on doing to Obamacare, and what their replacement might look like. 

Repeal

It is unclear exactly what the GOP-crafted health law will look like, but one thing is for sure: Republicans are dead-set on undoing at least some of the ACA’s major provisions. The number one target most GOP lawmakers agree on is the mandate that all Americans must have health care, or else face a fine. Leading Republican lawmakers acknowledge there must be some price to pay for healthy people choosing to go uninsured, but again, that penalty has not been fully articulated.

Republicans have been adamant about repealing two other aspects of Obama’s health care law. First, they will likely scale back federal funding for Medicaid, which was vastly expanded under the ACA. Nineteen states–all with Republican governors or legislatures–have rejected the expanded funding. Some Republican-led states have expanded their Medicaid programs however, which could make it a political risk for Congressional Republicans to cut federal funding entirely.

massive increases of ObamaCare will take place this year and Dems are to blame for the mess. It will fall of its own weight – be careful!

— Donald J. Trump (@realDonaldTrump) January 4, 2017

Earlier this week, Senate Republicans inched toward repealing the law, a process that could take at least a few months. They approved a budget blueprint, which will essentially pave a trail for further legislation to pass through, and will provide a shield against a Democratic filibuster. The Senate will likely vote on that measure next week and, if it passes with a majority vote, turn it over to the Republican-led House.

Republicans have promised that their repeal efforts would not take place immediately, so that those who are insured under the ACA would not be caught in a no-man’s land. Some experts say that delaying the effects of the repeal effort, especially with no clear replacement law at the ready, could lead to destabilized insurance markets. Paul Ryan (R-WI), speaker of the House and a vocal Obamacare critic, assured people who are worried they’ll lose coverage in the coming months that in 2017 “we don’t want people to be caught with nothing.”

Replace

“Trumpcare,” as President Barack Obama coined the Republican replacement to his health care law on Wednesday, is vague on its details. Congressional Republicans, and Trump, campaigned on a platform that vociferously opposed Obamacare, and voters who were angry at rising premium costs happily voted for an alternative. But what will that alternative look like? There are disparate visions among Republicans of what changes should or should not happen to Obamacare, and the final product is still being hammered out.

There are parts of Obamacare that could survive the GOP assault, including the option that people can remain on their parents’ insurance plan up until the age of 26. That is a highly popular element of the health care law that will likely remain in any future iteration.

Guaranteed coverage, one of Obamacare’s unprecedented (and most expensive) features, is also likely to remain in the Republicans’ replacement plan, at least in some form. Requiring insurers to offer coverage to customers with pre-existing conditions has led to increased premiums, and while Republicans have noted rising premiums as cause for a repeal, they have not said they will entirely scrap guaranteed coverage. Whatever directions the GOP decides to go in, expect the states to have more power and flexibility in designing their plans.

The ACA & Planned Parenthood bring critical health security to women across the US. To the GOP: Dont defund @PPFA Dont #MakeAmericaSickAgain pic.twitter.com/xip6WENNMm

— Chuck Schumer (@SenSchumer) January 6, 2017

In terms of the new pieces of the Obamacare replacement law, the details are hazy. GOP lawmakers will surely do something about the current marketplaces and government subsidies. Trump has mentioned opening up insurance marketplaces across state lines. Trump’s appointee for health secretary, Tom Price, has laid out a plan for tax credits in lieu of government subsidies, which could benefit middle-class Americans who earn too much to qualify for the subsidies under the current law. But like other parts of the law that will succeed Obamacare, details are scant.

The gears are already turning in the rush to repeal Obamacare, at least vast chunks of it. But Republicans are hardly in unison about what should follow. Many who have been insured under the law–including Trump supporters–have been uneasy with what might happen to them in the coming year. Republicans promise to delay the effective date of the incoming repeal, and Democrats promise to make repeal efforts as strenuous as possible for the GOP. The next few weeks and months will hopefully bring some clarity into the future of health care in America.

Alec Siegel

Alec Siegel is a staff writer at Law Street Media. When he’s not working at Law Street he’s either cooking a mediocre tofu dish or enjoying a run in the woods. His passions include: gooey chocolate chips, black coffee, mountains, the Animal Kingdom in general, and John Lennon. Baklava is his achilles heel. Contact Alec at ASiegel@LawStreetMedia.com.

The post What Will Health Care Look Like After Obamacare is Repealed? appeared first on Law Street.

In two vastly different meetings on Capitol Hill on Wednesday, Democrats and Republicans, led by President Barack Obama and Vice President-elect Mike Pence respectively, discussed the future of the Affordable Care Act. Pence and GOP lawmakers reaffirmed their commitment, and President-elect Donald Trump’s, to repeal and replace Obama’s top health care achievement. Obama and the Democrats doubled down on Obamacare’s bright spots, promising to not “rescue” Republicans by helping them to repeal the law. 

After the GOP meeting, which included Speaker Paul Ryan (R-WI), Pence told reporters that Americans “voted decisively for a better future for health care in this country,” and Republicans “are determined to give them that.” Pence said Trump, who promised to repeal and replace Obamacare during the campaign, will use his executive authority to reverse at least some of the law. Exactly what that replacement will look like is unclear.

What is crystal clear however, is the unified Republican resolve to gut Obamacare, a law that provides health coverage to about 20 million people. That process began on Wednesday, when the Senate voted 51-48 in support of a new budget blueprint that effectively clears the way for future legislation to repeal the law. Senate Republicans are expected to debate the budget proposal over the next few days. If the chamber officially accepts it, the House would then review the blueprint.

In a series of tweets on Thursday, Trump disparaged a potential Democratic ally with a nickname, criticized Obamacare, and called for a bi-partisan replacement plan. In one tweet, Trump called Senator Chuck Schumer (D-NY) the “head clown” of the Democrats’ opposition to a health care overhaul. In another tweet, Trump said Obamacare was a “lie from the beginning,” adding that both parties must “get together and come up with a healthcare plan that really works – much less expensive & FAR BETTER!”

As Republicans gathered to discuss repeal and replace, Democrats met with Obama for 90 minutes to prepare for the inevitable war on his signature achievement, and even hammered out marketing strategies for whatever future plan the Republicans propose. According to a White House aide present at the closed-door meeting, Obama suggested branding the Republican plan “Trumpcare.” After the meeting, Schumer, the Senate minority leader, said repealing the ACA would “make America sick again.”

He did not entirely shut down the possibility of working with the Republicans to craft a replacement. “If you are repealing, show us what you’ll replace it with first,” Schumer said. “Then we’ll look at what you have and see what we can do.” Ryan, a longtime critic of Obama’s health care law, assured those who are concerned they would lose coverage that there would be an “orderly transition.” He added: “the point is, in 2017, we don’t want people to be caught with nothing.”

Alec Siegel

Alec Siegel is a staff writer at Law Street Media. When he’s not working at Law Street he’s either cooking a mediocre tofu dish or enjoying a run in the woods. His passions include: gooey chocolate chips, black coffee, mountains, the Animal Kingdom in general, and John Lennon. Baklava is his achilles heel. Contact Alec at ASiegel@LawStreetMedia.com.

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The average premium cost for a midlevel plan on the federal health care exchange will rise by 25 percent in 2017, the Department of Health and Human Services (HHS) said on Monday. With two weeks to election day, it’s an issue that voters will be paying close attention to, and an issue Hillary Clinton and Donald Trump will likely address in the coming days.

In addition to premium hikes, customers in some states will have a much smaller pool of insurers to choose from, as a handful of major firms–United Health Group, Humana, Aetna–have pulled out or scaled back in a number of states. Customers in the 39 states that participate in the HealthCare.gov exchange can expect some relief in the form of income-based subsidies.

President Obama successfully passed the Affordable Care Act in 2010, and the federal marketplace launched in 2013, though not without some hiccups. Obama, who has acknowledged his fix for America’s health care–and perhaps one of his legacy-defining issues–is not a silver bullet, called the 2017 forecast “growing pains,” while pushing a government-sponsored “public option” to supplement the private plans. To quell customers’ concerns about rising out-of-pocket costs, the Obama administration pointed to increased subsidies that could help offset the costs in some cases, as well as the option of switching to a cheaper plan.

Donald Trump, as well as Republican lawmakers who have long doubted the ACA, pounced on the new HHS report. The first step to improving health care affordability is “to immediately deliver a full repeal of Obamacare,” according to his campaign website. Trump’s plan is largely based on the idea of opening up the insurance market across state lines, and removing the “barriers to entry into free markets.” Clinton’s stance on health care is to “defend and expand” the ACA while creating a “public option” and increasing subsidies.

Obamacare is a disaster – as I’ve been saying from the beginning. Time to repeal & replace! #ObamacareFail pic.twitter.com/5CvoMbVceT

— Donald J. Trump (@realDonaldTrump) October 25, 2016

Larry Levitt, senior vice president at the Kaiser Family Foundation, told USA Today that the premium increases are due to “insurers catching up to the fact that the number of sick people signing up for insurance is bigger than expected.” He added, “Whether this is a one-time market correction or a sign of more problems ahead will depend in large part on how consumers react to the changes.”

Despite the price jump, the percentage of Americans who are uninsured is at a historic low; only nine percent lack coverage. In a news release, HHS said that more than 70 percent of HealthCare.gov customers will be able to find plans costing less than $75 each month after tax credits are accounted for. And although one in five customers will have only one insurer to choose a plan from, the average consumer will have 30 plans to choose from.

While premiums are projected to increase significantly, most Americans who get health insurance on the exchanges qualify for federal subsidies, which are designed to go up with premiums to reduce the effect of rising costs on consumers. However, 5 to 7 million Americans either do not get individual insurance on the exchanges or do not qualify for federal subsidies, forcing them to bear the brunt of the cost increase or switch to a cheaper plan.

Overall, competition on the exchanges has dwindled. In 2016, there were 232 insurers in the 39 participating states (insurers are counted for each state they have plans in). In 2017, that number will shrink to 167.

Open enrollment for the 2017 exchange begins on November 1.

Alec Siegel

Alec Siegel is a staff writer at Law Street Media. When he’s not working at Law Street he’s either cooking a mediocre tofu dish or enjoying a run in the woods. His passions include: gooey chocolate chips, black coffee, mountains, the Animal Kingdom in general, and John Lennon. Baklava is his achilles heel. Contact Alec at ASiegel@LawStreetMedia.com.

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In August, Aetna announced that it was dropping its participation in many of the Affordable Care Act exchanges that it had previously used to provide insurance, citing significant losses as its reason. While this decision may have been made for other reasons, it will have major implications for the president’s landmark legislation commonly known as Obamacare. This problem goes beyond Aetna, which followed UnitedHealth’s decision to leave the exchanges in 2017–also pointing to significant losses as the motivation for its withdrawal. Read on to find out the full story behind the departures from the Affordable Care Act marketplaces, why companies are pulling out of it, and what implications this may have for the law going forward.

Brief History of Obamacare

Passing and then implementing the Affordable Care Act, or ACA, was no easy feat. A wide range of politicians, including the Clintons, have made efforts to reform American health care for years, but these attempts largely failed. However, that began to change in 2009 when support for an overhaul began to swell and Democrats held the presidency and both chambers of Congress. Following the untimely death of Senator Edward Kennedy and opposition from Republicans, a complex legislative process involving a filibuster, cloture, and budget reconciliation eventually led to the Affordable Care Act’s passage in March 2010.

The health care law included a number of protections for consumers, like eliminating insurance companies’ ability to deny someone coverage because of a pre-existing condition, eliminated lifetime and annual limits on coverage, and prevented rescission. It also created an appeals process so people could challenge insurance companies’ decisions and allowed children to stay on their parents’ health plan for longer. The law attempted to cater to businesses as well by providing them a time frame to offer coverage to employees and also provided a number of tax credits. It let certain people continue with their existing coverage if purchased before a certain date and encouraged new enrollees through a tax if they did not sign up. Importantly, the legislation also allowed states to expand Medicaid coverage, which contributed to a dramatic decrease in the number of people without health insurance.

The ACA was quickly challenged in the courts and after a long fight was largely upheld by a Supreme Court decision in 2012. While this was a major victory it was not the last issue to plague the Act. It has had to endure a number of problems from the online marketplace not working when it was initially launched to repeated, high-profile challenges in the House and Senate. As of February, approximately 12 to 20 million people had enrolled in health insurance either provided by the marketplace or through coverage expansion such as the one with Medicare.

Why Providers are Leaving

Aetna is likely leaving public exchanges for many reasons, but particularly it posted a $200 million loss in the second quarter of 2016 in its individual products. While it is not pulling out of all the states it was operating in, it is leaving 11 of the 15. Aetna’s decision actually leaves one county in Arizona without any coverage at all. Some evidence suggests that Aetna’s decision to leave the exchanges may have amounted to payback for the Justice Department’s efforts to block its merger with Humana. But Aetna argues that the decision was purely based on its recent losses on the exchanges.

The following video looks at Aetna’s pullback from the marketplace in terms of the company’s possible motives and the implications going forward:

The issue might be left at that, but Aetna is not the only company leaving the exchange. Along with Aetna, UnitedHealthcare and Humana–the company Aetna recently tried to merge with–are both leaving exchanges. On top of these departures are those of smaller providers, including several government-funded carriers. For many of these providers, the biggest problem is demographics. Namely, the people signing up for the program are older and sicker than expected. Some people may also be taking advantage of insurers by waiting until they are sick or need medical help to sign up. These people require higher costs, which are not being balanced out yet by new, healthier enrollees. Because of these unanticipated developments, insurers have had a hard time setting their prices and, as a result, they are losing money.

Adding insult to injury, the Affordable Care Act is dealing with more than just the loss of insurance providers. In a recent study done by the New York Federal Reserve, one out of every five businesses in that district has reported hiring fewer people because of the law. Additionally, there are now allegations that some healthcare providers are steering patients to Affordable Care Act policies instead of Medicare and Medicaid because they receive higher reimbursements. This would raise costs for insurers because sicker patients end up on the exchanges instead of government-run healthcare plans.

Implications

While it definitely sounds bad, what exactly does the departure of major providers from ACA exchanges mean for the law? For starters, it means there will be a lot less competition in many places. In fact, 36 percent of markets now will have only one provider, which is up from just 4 percent at the beginning of the year. In five states–Alabama, Alaska, Oklahoma, South Carolina, and Wyoming–there will be only the one provider. On top of this, 55 percent will have only two or fewer providers, which is also up from 33 percent at the beginning of this year.

The biggest issue here, aside from the fact that one county in Arizona may wind up with no coverage options at all, is that competition was supposed to be an important way to cut healthcare costs. Without a competitive market, insurance providers can offer lower quality service at higher prices because there is no alternative. The accompanying video looks at what the major insurance companies are doing:

The news is not all doom and gloom, however, as other carriers are expanding in certain areas including Cigna in Chicago and a startup call Bright Health in Colorado, which was actually founded by the leaders of United Healthcare. Additionally, not all insurers are losing money either in the Affordable Care Act exchanges. In fact, many smaller insurers, who have more experience in government healthcare markets like Medicare and Medicaid, are actually thriving. They are succeeding because the experience they have gleaned has helped them operate on more moderate government-style plans than the more expansive employer-sponsored plans that larger insurers like Aetna are most familiar with.

Even if these large insurers ultimately decide to pull out of the market now that does not prevent them from reentering in the future. In fact, the opposite is true, as along with its announcement that it was leaving the government exchange, Aetna also hinted at the possibility of a return when the market was more receptive to its practices.

Conclusion

Republicans have attempted to repeal all or parts of the Affordable Care Act as many as 60 times since it was passed without success. While politicians may have been unable to sweep away President Obama’s crowning achievement, the market may have succeeded. Losing yet another major healthcare provider, such as Aetna, deals a major blow to the Affordable Care Act as it decreases competition and brings into question the viability of the entire system.

At least that is how some perceive it. To others, it is simply the result of survival of the fittest, where the companies best equipped to do business in a government exchange are and are doing well. While insurance giants balk over reported losses, these companies may fill in the gaps and grow their own brands further. Many, including President Obama, believe that the recent difficulties in the exchanges should revive efforts for a public option akin to Medicare or Medicaid. But as competition decreases in many local markets, the system has many issues that need fixing.

The Affordable Care Act is unlikely to go away entirely. Even if insurers continue to leave Obamacare exchanges, the law will have allowed for a dramatic expansion in health care coverage. Instead of revolutionizing the way health insurance is provided to individuals, the Affordable Care Act may end up looking like a traditional entitlement program that made insurance available to more Americans. After all, only 11 million Americans get their insurance through exchanges, while around 150 million have employer-provided plans. But in order to ensure that the marketplaces are viable going forward, more people will need to enroll and insurance providers will need to return to provide coverage. And that is by no means a simple task.

Resources

The Atlantic: Why Is Aetna Leaving Most of Its Obamacare Exchanges?

CNN Money: Choices Dwindling for Obamacare customers

MSNBC: On Groundhog Day, Republicans vote to repeal Obamacare

Business Insider: Obamacare has Gone from the President’s Greatest Achievement to a ‘Slow-Motion Death Spiral’

CNBC: Health Providers May be Steering People to Obamacare to get Higher Reimbursement

The Daily Caller: Another Huge Insurance Company Is Leaving Obamacare

eHealth: History and Timeline of the Affordable Care Act (ACA)

Obamacare Facts: ObamaCare Enrollment Numbers

Michael Sliwinski

Michael Sliwinski (@MoneyMike4289) is a 2011 graduate of Ohio University in Athens with a Bachelor’s in History, as well as a 2014 graduate of the University of Georgia with a Master’s in International Policy. In his free time he enjoys writing, reading, and outdoor activites, particularly basketball. Contact Michael at staff@LawStreetMedia.com.

The post What a Major Insurance Provider Leaving the Obamacare Exchanges Means appeared first on Law Street.

Premiums for the lowest and second-lowest costing health care plans sold through the Affordable Care Act exchange will rise by a weighted average of ten percent across 13 states and the District of Columbia in 2017, a steeper increase than ever before, according to a study released Wednesday by the Kaiser Family Foundation, a non-partisan health policy organization.

The study considered preliminary data filed by insurers to state insurance departments in major population centers in each state that was studied–from Denver, Colorado and Portland, Oregon to Baltimore, Maryland and Richmond, Virginia–as well as D.C. As more states release their complete premium costs for 2017, more data will be added to the study, reflecting a more accurate picture of premium price hikes for next year nationwide. Figures released from insurers are still preliminary at this point, and are thus subject to change.

The lowest and second-lowest silver plans were used in the study because they are the most popular options under the ACA, making up 68 percent of the total market share. Second-lowest silver plans are also the benchmarks on which government subsidies are based. For both types of plans, premiums in Portland will see the highest increase in 2017, up 26 percent ($240 a month in 2016 to $302 in 2017) for the lowest cost plans, and 18 percent ($261 in 2016 to $308 in 2017) for the second-lowest cost plans. On the flip side of that, insurers in Providence, Rhode Island will be offering substantially lower premiums in 2017 for both plan types: A 14 percent decrease ($259 in 2016 to $224 in 2017) for the lowest cost plan, and a 13 percent decrease ($263 in 2016 and $229 in 2017).

From 2014–when the ACA exchange opened–to 2017, premium costs for both the lowest and second-lowest silver plans increased by a weighted average of five percent. And while these findings seem to support detractors of the ACA, also known as Obamacare, the authors of the study also found that eight in ten enrollees receive government subsidies for premium costs, and retain the freedom to switch to a lower cost plan. “Regardless of tax credit eligibility, most enrollees have multiple plans from which to choose and can often save money on their premium by switching to a lower-cost plan,” the authors wrote, citing evidence that shows most people are willing to shift to a lower cost plan when premiums rise, “even though this might mean changing insurers and potentially doctors as well.”

Alec Siegel

Alec Siegel is a staff writer at Law Street Media. When he’s not working at Law Street he’s either cooking a mediocre tofu dish or enjoying a run in the woods. His passions include: gooey chocolate chips, black coffee, mountains, the Animal Kingdom in general, and John Lennon. Baklava is his achilles heel. Contact Alec at ASiegel@LawStreetMedia.com.

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The Supreme Court of the United States announced Monday that it will not issue a landmark ruling in the Zubik v. Burwell case, instead it will send the contraception mandate case back to lower courts to explore if a compromise is possible.

Supreme Court punts in a major religious challenge to Obamacare’s contraception workaround https://t.co/3zxr7QMVPJ pic.twitter.com/DYgU67vJbS

— HuffPost Politics (@HuffPostPol) May 16, 2016

In the unanimous “per curium” opinion, SCOTUS determined that:

Given the gravity of the dispute and the substantial clarification and refinement in the positions of the parties, the parties on remand should be afforded an opportunity to arrive at an approach going forward that accommodates petitioners’ religious exercise while at the same time ensuring that women covered by petitioners’ health plans “receive full and equal health coverage, including contraceptive coverage.

The controversial case is part of an ongoing battle between the government and private employers over access to contraception, and whether or not employers can refuse to provide coverage.

As it stands, religious organizations like churches are exempt from the Affordable Care Act’s (ACA) mandate that contraception be covered under private health plans. However, non-profit organizations with religious affiliations, such as hospitals, charities, and universities, argued that they should be exempt as well.

The ACA has given private employers who have religious objections the option to file a Form 700 with their insurance companies notifying them of their objection, so the insurance company can then contact employees with contraception options, sans employer involvement.

The Little Sisters of the Poor, a network of nursing homes operated by Catholic nuns, protested filing Form 700, along with several other non-profit organizations, because it believed that doing so would make it complicit in providing contraception, which is recognized as a sin under Roman Catholic doctrine.

In the concurring opinion written by Justice Sonia Sotomayor, and joined by Justice Ruth Bader Ginsburg, both justices underscored the court’s caution to lower courts not to read too much into the ruling. Sotomayor writes,

Today’s opinion does only what it says it does: ‘affords an opportunity’ for the parties and courts of appeals to reconsider the parties’ arguments in light of petitioners’ new articulation of their religious objection and the government’s clarification about what the existing regulations accomplish, how they might be amended and what such an amendment would sacrifice. As enlightened by the parties’ new submissions, the courts of appeals remain free to reach the same conclusion or a different one on each of the questions presented by these cases.

This case has been considered the sequel to SCOTUS’s Burwell v. Hobby Lobby case, which determined for-profit organizations can be exempt from “a law its owners religiously object to if there is a less restrictive means of furthering the law’s interest.” Under the Hobby Lobby ruling, organizations were given the same option of having insurers contact employers directly in the company objected.

Now, the lower courts will have to decide again if that same alternative puts too much of a burden on religious institutions. If so, these non-profits may gain a special exemption.

Alexis Evans

Alexis Evans is an Assistant Editor at Law Street and a Buckeye State native. She has a Bachelor’s Degree in Journalism and a minor in Business from Ohio University. Contact Alexis at aevans@LawStreetMedia.com.

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Today the Supreme Court ruled 6-3 to uphold important provisions of the Affordable Care Act. But in his strongly worded dissent, Justice Antonin Scalia used some of the most creative and entertaining language in Supreme Court history. Here are the top 10 funniest quotes from the dissent:

10. “The Court’s insistence on making a choice that should be made by Congress both aggrandizes judicial power and encourages congressional lassitude.”

I absolutely agree. Not to mention the vociferous remonstrance the Court will face after their incongruous conjecture.

9. “Words no longer have meaning.”

Finally, we can all throw away our dictionaries.

8. “Could anyone maintain with a straight face that §36B is unclear?”

Sorry, I tried my best, but I couldn’t

7. “What are the odds, do you think, that the same slip of the pen occurred in seven separate places?”

Well if we take the number of words written in the bill at 381, 517 and multiply that by the chances of a writing error at 1 in 1000 words, but account for the flux of the earth’s gravitational field using Gauss’s theorem as it pertains to the Capitol Building, then the chances are 1 in 999, BUT multiplying by the chance of it occurring in the exact places where the issue is mentioned using a factorial… it’s not very likely.

6.”We should start calling this law SCOTUScare.”

It does have a nice ring to it, but I don’t know how Obama would feel about that.

5 “Understatement, thy name is an opinion on the Affordable Care Act!” Later, “Impossible possibility, thy name is an opinion on the Affordable Care Act!” (tie)

Rhetorical mastery, thy name is Justice Scalia

4. “A sense of belt-and-suspenders caution.”

I hope the Court isn’t ruling on any fashion issues anytime soon.

3. “The Secretary of Health and Human Services is not a State.” Later, “Because the Secretary is neither one of the 50 States nor the District of Columbia.” (tie)

image courtesy of Gage via Wikipedia

Image Cortesy of Carol Norquist via Flickr

I don’t know. I’m definitely seeing some resemblance here.

2. “Pure Applesauce”

Really, just for me!? No additives or anything!?

1. “The Court’s next bit of interpretive jiggery-pokery…”

It’s jiggery-POkery, not jiggery-poKERY

Bonus Quote:

“Imagine that a university sends around a bulletin reminding every professor to take the ‘interests of graduate students’ into account when setting office hours, but that some professors teach only undergraduates. Would anybody reason that the bulletin implicitly presupposes that every professor has ‘graduate students,’ so that ‘graduate students’ must really mean ‘graduate or undergraduate students’? Surely not.”

Besides how random this reference is, of course not. Professors don’t care about undergraduates.

Maurin Mwombela

Maurin Mwombela is a member of the University of Pennsylvania class of 2017 and was a Law Street Media Fellow for the Summer 2015. He now blogs for Law Street, focusing on politics. Contact Maurin at staff@LawStreetMedia.com.

The post The Top 10 Most Creative Quotes from Antonin Scalia’s Obamacare Dissent appeared first on Law Street.

Update: 10:30am June 25, 2015

Two high-profile decisions will impact millions of lives this month, including millions of millennials, as the U.S. Supreme Court issues its opinions on ObamaCare and same-sex marriage. These cases face what many regard as the most conservative court in decades, but center on two of the most prominent and progressive social justice movements in decades. At a recent Center for American Progress (CAP) event focused on the important cases of this term, I was able to hear the implications of these cases, and they’re definitely worth our attention. In the justices’ hands rests the future and stability of the American health care system and legality of marriage equality for all. The stakes couldn’t be higher this month, and that’s exactly why you should be informed of what’s going on. Here’s a breakdown—in plain English—of what you need to know:

King v. Burwell: Battle Over ObamaCare

Just because you’re young and healthy doesn’t mean you don’t need health insurance, and this particular court case will definitely impact young people. A little background is important to grasp how, though. The Affordable Care Act (ACA) was signed into law in March 2010. It established health insurance exchanges–marketplaces that facilitate the purchase of health insurance in each state. Exchanges provide a set of government-regulated, standardized health care plans from which individuals may purchase health insurance policies. If the individual has a limited income, the exchange allows that person to obtain premium assistance (AKA: premium subsidies) to lower the monthly cost of the health care plan, making the plan affordable.

The ACA provides states three options for the establishment of exchanges: state run exchanges, a partnership with the federal government, or complete federal control of the exchange within the state. In 2014, appellants in Virginia, D.C., Oklahoma, and Indiana argued that premium subsidies are only available under a state-run exchange, citing one clause that says that premium subsidies are available “through an Exchange established by the state.” Using this phrase, litigants argue that the ACA provides premium assistance exclusively to individuals purchasing health care on state-run exchanges.

The Fourth Circuit Court of Appeals rejected that argument, saying that the context of the phrase reveals that Congress obviously intended for the subsidies to apply in all exchanges. But in July 2014 David King, a Virginia resident, and his co-plaintiffs  petitioned the Supreme Court and in November, the court agreed to accept the case. Oral arguments were in March 2015 and in June the outcome will be released, which has the potential to strike a detrimental blow to the Affordable Care Act. Since the ACA was signed into law, thirty-four states chose not to set up their own exchange marketplace and instead allow the federal government to operate the exchange, accounting for 75 percent of the people nationwide who qualify for premium subsidies. If the Supreme Court reverses the previous decisions and rules that only state-run exchanges qualify for premium assistance, that 75 percent will no longer be considered eligible for assistance. If the Court rules against the Obama Administration this month, about 6.4 million Americans could lose their health care premiums.

"Nearly 1 in 3 uninsured Americans have already been covered—more than 16 million people" —@POTUS #ACAWorks pic.twitter.com/rXVNHrkiW1

— The White House (@WhiteHouse) June 9, 2015

But there’s no certainty which way this will go. At the panel discussion on Monday at CAP, Elizabeth G. Taylor, Executive Director at the National Health Law Program expressed her skepticism of the Supreme Court’s decision to hear this case. “What I fear is that not only do we not have an activist court, but that it is standing in the way of efforts by publicly-elected officials to name and address social problems.” Ian Millhiser, Senior Fellow at CAP, argued that the King v. Burwell case is the “weakest argument that I have ever heard reach the Supreme Court.”

It’s especially important to keep in mind that young people will be disproportionately impacted by a SCOTUS ruling against Obamacare; over 2.2 million enrollees are between the ages of 18-34, making millennials the largest group insured under the ACA. For example, a decision against the ACA could cause young people under the age of 26 (who are automatically covered under their parents’ plans, thanks to ObamaCare) to lose their health care plans if their parents can no longer afford health insurance without federal subsidies. Whether or not SCOTUS protects those Americans remains to be seen.

Obergefell v. Hodges: Marriage Equality’s Latest Frontier

Obergefell v. Hodges will decide whether or not states are required to license a marriage between same-sex couples, as well as if states are required to recognize a lawfully licensed, out-of-state marriage between two people of the same sex.

Obergefell v. Hodges – the case #SCOTUS is considering, whether #LGBT couples have a constitutional right to marry http://t.co/FCJ6yo0ZGD

— V R Gaitonde (@weareji) June 9, 2015

Again, this decision will be important for young people, particularly because of the part we’ve played in the debate. Of Americans under age 50, 73 percent believe in marriage equality. Roberta A. Kaplan, Partner at Paul, Weiss, Rifkind, Wharton & Garrison LLP, stated at the CAP event Monday that the arguments in favor of marriage equality have remained the same over the years, but what has changed is the ability of judges to hear those arguments. “There’s no doubt that what made this change is the American public,” she said. While the Supreme Court does not exist to respond to the public, it certainly appears to be aware of the momentum behind the marriage equality movement. Just weeks after Ireland became the first country to legalize same-sex marriage on a national level by popular vote, SCOTUS will issue an opinion that could put the U.S. in the same progressive bracket as 18 other countries, allowing same-sex couples to marry nationwide.

Regardless of the decision though, the fight for equality won’t be over. Let’s say the Supreme Court rules in favor of marriage equality both ways. States will be required to marry same-sex couples and recognize marriages performed out of state. But the next concern for these couples is the potential for more subtle discrimination. “Same sex couples will be allowed to marry but states will be able to discriminate in other ways,” warned Millhiser. Losing jobs, healthcare, or being denied housing and loans without explicitly stated homophobic motivations are classic examples of discrimination that could very well be implemented on the state level by authorities who are adamantly against same-sex marriage. If the ruling does come out in favor of gay couples, increasing skepticism is a must to keep unlawful, prejudiced actions in check.

Both of these cases have a lot on the line, although obviously for very different reasons. Michele L. Jawando, Vice President of Legal Progress at CAP said, “I would like to believe that the court is paying attention, and I do believe that the American people have a role to play when it comes to these decisions.” This is where you come in. Speaking loudly and acting louder can truly change the course of history. Lobbying Congress, rallying for your cause, educating yourself and speaking out to educate the public on the importance of these issues are crucial methods of putting public and political pressure on the justices. I’d like to believe that the American Constitution is a living and breathing document that transforms throughout history, expanding to encompass progressive views and constantly redefining what it means to be an American; let’s hope I feel the same way at the end of June.

Update: 10:30am June 25, 2015: 

Emily Dalgo

Emily Dalgo is a member of the American University Class of 2017 and a Law Street Media Fellow during the Summer of 2015. Contact Emily at staff@LawStreetMedia.com.

The post The Two Supreme Court Cases We Should All Be Watching appeared first on Law Street.

The miracle of childbirth morphs into a financial nightmare for mothers without insurance or without maternity coverage in their insurance. While we all know having a baby involves much more than a visit from the stork, you might be shocked by the convoluted web of hidden costs and insurance infrastructure behind pregnancy and early motherhood in the United States. The system favors planned pregnancy and hits unintended mothers hard with unexpected costs and complications.

A woman planning for pregnancy will surely have done her insurance research, selecting a plan to cover the services she wants for pregnancy, delivery, and the baby’s first months. Her monthly insurance premiums will probably run a few hundred more dollars per month, but she’ll be pretty well taken care of. But what happens to those who find themselves pregnant without insurance or locked into plans without maternity coverage? Let’s find out. (Hint: it’s expensive.) And since the CDC estimates about half of all pregnancies in the United States occur unplanned, many women could be burdened with heavy financial woes.

Babies: You Pay for Way More Than Onesies, Diapers, and Toys

How much does having a baby cost? WebMD gives an estimate of up to $15,000 for hospital costs alone. A report from Young Invincibles provides the whopping range of $10,000-$20,000 for delivery, not counting potentially expensive complications during pregnancy and childbirth. Finally, a Truven Health Analytics study put the bill for uninsured vaginal births at a crippling $30,000, and uninsured c-section births broke the bank at $50,000 and up. Estimates fluctuate so much because every little service involved in an American pregnancy gets nailed with a different price hinging on a number of factors. This means that every woman can wind up with a different bill depending on the care she needs, the care her baby needs, her insurance or lack thereof, the hospital she chooses, and even where she lives. This makes planning ahead challenging for both insured and uninsured women.

Even talking directly to service providers might not help matters much. In a New York Times article, Elisabeth Rosenthal recounts the struggle of one uninsured expectant mother trying to get answers:

When she became pregnant, Ms. Martin called her local hospital inquiring about the price of maternity care; the finance office at first said it did not know, and then gave her a range of $4,000 to $45,000. ‘It was unreal,’ Ms. Martin said. ‘I was like, How could you not know this? You’re a hospital.’

Pregnant women might not be able to get exact numbers, but they can expect their baby bills to be pricey.

To put it all into perspective, when Kate Middleton gave birth to Prince George, the bill was only $15,000 and Kate enjoyed a private suite, chefs, and other amenities uncommon in American maternity wards. Where Americans itemize every cost, other countries put a lump-sum premium on births.

Additionally, mothers face many other costs to “having a baby” other than just giving birth. There’s a whole slew of services involved in prenatal care like ultrasounds and other diagnostics tests moms and babies need to stay healthy. If you have maternity coverage through your insurance, many or all of these services will probably be covered. But if you’re uncovered, you could spend up to $2,000 on prenatal care alone. And the payments don’t stop after you’ve given birth. Both new baby and mom could require specialized postnatal care. If you need that, you might have to bump your tab up by a couple grand more.

The Complications of Coverage

Most individual health plans (outside of employer-sponsored healthcare) don’t include maternity coverage. Many women could easily have insurance that lacks maternity care without realizing it. They could also have maternity coverage they haven’t studied closely in the absence of baby plans, leading to many unexpected costs. Investigating maternity insurance is a formidable task, as you have to look at every detail on what the coverage will pay for before, during, and after the actual birth. Even if you do serious calculations for what percentage of the different services will be covered, you could still be surprised by the final bill as costs of medical care can change with the market.

Can you get coverage if you become unexpectedly pregnant?

The short answer? Kind of.

The Affordable Care Act (ACA) made it possible for women to sign up for pregnancy coverage in special enrollment periods. While that’s wonderful,  the coverage doesn’t go into effect until the day the baby is born which doesn’t help the mother at all for care she needs during pregnancy. I did an experiment through Healthcare.gov to see if I qualified for special enrollment under the Affordable Care Act. Sure enough, the questionnaire language read as “had a baby” and not “got pregnant.” At the end of the process, the vague answer I got from the marketplace was hardly what I would want if I were actually a pregnant woman hoping to get coverage:

It looks like you may qualify for a Special Enrollment Period. This means that you can probably enroll in a 2015 health plan through the Marketplace even though the annual Open Enrollment period is over.

The ACA helps when the baby arrives, but not so much with expensive prenatal care and the cost of actually having the baby. Women able to get coverage through special enrollment could still rack up a lot of debt if you don’t have thousands of dollars waiting comfortably in an emergency fund. On the up side, the baby will be covered when it’s born. The ACA does offer an enormous help to women with incomes below a certain amount. Women who qualify can apply to receive coverage through Medicaid and the Children’s Health Insurance Program (CHIP) at any time during their pregnancy. The women who suffer the most in our system are those who make enough on paper, but lack insurance prior to getting pregnant.

Should you be able to get coverage if you become unexpectedly pregnant?

Different stakeholders’ answers to this question shed some light on why the decision involves too many factors to merit a “yes” or “no” answer. To make the discussion simple, let’s see what two major sides of the argument say.

Advocacy Groups

Advocacy groups including Young Invincibles, Planned Parenthood, and March of Dimes believe women should be able to get coverage for being pregnant (not just having a baby) whenever they want. They affirm since nearly half of all pregnancies are unplanned, we need more flexibility in maternity coverage to keep women and newborns in the United States healthy. In addition to the potential for complications in the delivery room, access to prenatal care could help women with heart conditions, diabetes, or who are at risk of preeclampsia (dangerous high blood pressure during pregnancy) get the preventive care they need to stay healthy and also deliver healthy babies.

If a woman doesn’t have coverage, she might forgo the key preventive, yet expensive, medical services she needs to stay healthy. Advocacy groups find the situation unacceptable and look toward the government for change.

Insurance Companies

Insurance companies say if women can get maternity coverage at any time, more people will wait to get coverage. Insurance company costs would spike and eventually trickle down for others enrolled in their plans to absorb. They also argue more flexible maternity coverage would make predicting costs more difficult as the system could become even less predictable.

To this concern, the nonprofit Young Invincibles released a report saying since the Affordable Care Act’s enactment, more women get insurance and fewer leave out maternity coverage, mitigating these risks for insurance companies in offering more open forms of pregnancy coverage.

So, Plan Ahead…If You Can

According to Healthy People 2020 data, about 30 percent of pregnant women do not receive early or adequate prenatal care. While many factors could claim responsibility for this statistic, surely a lack of insurance or lack of ability to get insurance plays a part. Skipping out on prenatal care puts the mother at risk, triples her risk of having an underweight baby, and increases the baby’s risk of death.

So to summarize…what happens if you’re pregnant without insurance?

• You will probably pay a lot of money to have your baby;
• The ACA will help you change coverage once your baby is born; and,
• Calculating your spending will be a headache.

Our system favors planned pregnancy. If you’re a woman of childbearing age, you can start saving for a rainy (or pregnant) day, pay a few hundred dollars more a month for just-in-case coverage, or join the voices of advocates hoping to achieve more flexibility for one of life’s most beautiful accidents.

Resources

Primary

CDC: Unintended Pregnancy Prevention

Healthcare.gov: Health Coverage if You’re Pregnant or Plan to Get Pregnant

Healthcare.gov: Healthcare Insurance Marketplace

Healthy People 2020: Maternal, Infant, and Child Health

Additional

Kaiser Health News: Pregnant and Uninsured? Don’t Count on Obamacare

Childbirth Connection: Better Maternity Care Could Save $5 Billion Annually

Young Invincibles: Without Maternity Coverage

Parents.com: Hospital Birth Costs

WebMD: What it Costs to Have a Baby

U.S. News & World Report: Health Insurance Premiums to Fluctuate Under Obamacare

Childbirth Connection: The Cost of Having a Baby in the United States

Ashley Bell

Ashley Bell communicates about health and wellness every day as a non-profit Program Manager. She has a Bachelor’s degree in Business and Economics from the College of William and Mary, and loves to investigate what changes in healthy policy and research might mean for the future. Contact Ashley at staff@LawStreetMedia.com.

The post Pregnant Without Insurance? Prepare for a Big Bill appeared first on Law Street.

The University of Notre Dame, a Roman Catholic institution, may now resume its battle against birth control after the Supreme Court revived its religious objections to the government contraceptive coverage requirements. The whole debate boils down to an Obamacare provision that has religious opponents in this case advocating for some separation between church and state.

The 2010 Affordable Care Act, otherwise known as Obamacare, has been a topic of contention for some religious organizations unwilling to adhere to its contraception provision. The act mandates employers supply health insurance policies to their female employees that cover contraception and sterilization, but detractors say that violates their religious beliefs.

Christian business Hobby Lobby battled boycotts while defending their moral opposition to the act last summer in the Supreme Court and won. Burwell v. Hobby Lobby Stores, Inc.‘s landmark decision in favor of Hobby Lobby set a precedent for other religious organizations to seek exemptions from the law due to their religious preferences, based on the Religious Freedom Restoration Act. The justices asked the 7th U.S. Circuit Court of Appeals to reconsider its decision for the Catholic university in light of that ruling.

According to Reuters, the lower court threw out a February 2014 appeals court ruling denying Notre Dame an injunction against the requirement. The appeals court ruling pre-dated the Supreme Court’s June 2014 Hobby Lobby exemption decision. Despite the landmark decision, courts have continued to hear cases on the issue, but have all decided in favor of the government, finding “the compromise does not impose a substantial burden on the plaintiffs’ religious beliefs.”

Louise Melling, deputy legal director for the American Civil Liberties Union, discussed Notre Dame’s objections with the Wall Street Journal. She advocated for women’s rights, saying:

It’s absurd to assert that simply filling out a form stating an objection violates religious freedom. What Notre Dame and others really object to is women getting the contraceptive coverage they need. That’s discrimination, plain and simple.

The Catholic church and some Christian opponents don’t see the issue as discrimination, but rather a violation of their rights to represent their beliefs while operating private businesses. Catholicism has historically been opposed to all forms of birth control except abstinence and natural family planning. So, insurance plans that cover birth control, especially in the form of emergency contraception like the Plan B pill and intrauterine devices, stand contradictory to their beliefs.

However, the church may be loosening its stance some when it comes to sex. Pope Francis, who has been recently hailed as a revolutionary force in the Catholic Church, was just quoted saying “Catholics needn’t feel compelled to breed like rabbits.” Even so, following the church’s voice on sexual matters has become less and less important for modern Catholics.  The New York Times broke down Gallup’s “Values and Beliefs” survey from last May finding:

Catholics were only slightly less open to birth control, with 86 percent of them saying that it was “morally acceptable” in comparison with 90 percent of all respondents. But Catholics were more permissive than all respondents when it came to sex outside marriage (acceptable to 72 percent of Catholics versus 66 percent of Americans overall) and gay and lesbian relationships (70 percent versus 58).

Regardless of the feelings of average Americans, however, Notre Dame has stuck to the lawsuit.

Overall this battle between church and state is a fight over health vs. morals. Providing adequate health care coverage for employees is an employer’s responsibility, and maintaining sexual and reproductive health is essential to all women’s wellbeing. The Supreme Court’s decision and reexamination of Notre Dame’s objections may mean some women will have to decide whether or not they’re willing to forfeit that right to adhere with company culture when choosing to work for a religious organization.

Alexis Evans

Alexis Evans is an Assistant Editor at Law Street and a Buckeye State native. She has a Bachelor’s Degree in Journalism and a minor in Business from Ohio University. Contact Alexis at aevans@LawStreetMedia.com.

The post SCOTUS Revives Notre Dame’s Contraception Mandate Objections appeared first on Law Street.

It’s a new year, and I for one am excited to see what it will bring. No matter what, there will definitely be a lot of legal issues to discuss, debate, and bring changes to all of our lives. The five cases below are the top five to watch in 2015; some have already appeared before SCOTUS and await decisions in 2015, while others will be heard throughout the year. Here are five fascinating Supreme Court cases to watch in 2015.

Anthony Elonis v. United States

Law Street has actually been covering this interesting case for a while–check out our coverage of the case, the University of Virginia law clinic that’s gotten involved, and the all the legalese behind it. The reason we’ve followed it so closely is because it really is fascinating. Anthony Elonis was convicted of threatening multiple people, including his wife, an FBI agent, the police, and a kindergarten class. But these weren’t threats in the classical sense. They were written on his Facebook page in the form of rap lyrics. He claims the posts are art, protected under the First Amendment, and that he never intended to hurt anyone. It will be up to the Supreme Court to decide if such intent needs to be shown when convicting someone of making threats. The case was heard on December 1, 2014, but the court has yet to rule.

King v. Burwell

In King v. Burwell, SCOTUS will yet again be asked to weigh the Affordable Care Act. This time, it’s all about the tax subsidies, and weirdly, the central question in really depends on one word: “state.” The way that the ACA reads, in order for an individual to qualify for a tax subsidy, he needs to be receiving healthcare “through an exchange established by the state.” So, can people residing in states that haven’t set up their own exchanges, but instead rely on the federal program, get those tax subsidies? The IRS certainly thinks so and has been granting the subsidies. It’s an argument based pretty much on semantics, but it could have a huge effect on the ACA itself. This case will be heard in March.

Peggy Young v. United Parcel Service 

This case will ask the Supreme Court to weigh in on how pregnant employees are treated. Peggy Young, formerly a delivery driver for UPS, is arguing that the company violated the Pregnancy Discrimination Act (PDA). The PDA says that pregnant workers should be treated the same as any other worker who is “similar in their ability or inability to work.” Young and her lawyers argue that other employees who sustain temporary injuries or something of the like are moved to other positions, while she was forced to take unpaid leave. UPS claims that those other workers are given different jobs based on policies that don’t apply to Young, and she was treated the same as she would have been had she sustained an injury out of work. It will be up to the Supreme Court to decide who’s in the right here. The case was just heard in December 2014; an opinion is forthcoming.

Holt v. Hobbs

Holt v. Hobbs will require the justices to look into prison procedures that prevent inmates from growing a beard in Arkansas. The plaintiff, Gregory Holt, wants to be able to grow a half-inch beard in accordance with his Muslim faith. The state is arguing that it could be used to smuggle drugs or other contraband. SCOTUS will have to rule on whether or not those prison procedures violate the Religious Land Use and Institutionalized Persons Act (RLUIPA). The question that the justices will consider is whether or not there’s a compelling enough government interest to prevent Holt from expressing his religion. The case was heard in October 2014; the opinion will be issued this year.

Alabama Legislative Black Caucus v. Alabama

This case centers on the practice of gerrymandering. The justices will have to decide whether or not it was illegal for Alabama to redraw the districts in 2012 after the Census in a way that packed black voters into particular districts. The Alabama Black Caucus says that it relied too much on race when drawing those districts. While partisan gerrymandering is usually legal, racial gerrymandering is not–so the justices will have to decide which actually happened here. This case was heard in November 2014; the opinion is expected in the coming months.

Anneliese Mahoney

Anneliese Mahoney is Managing Editor at Law Street and a Connecticut transplant to Washington D.C. She has a Bachelor’s degree in International Affairs from the George Washington University, and a passion for law, politics, and social issues. Contact Anneliese at amahoney@LawStreetMedia.com.

The post SCOTUS Cases to Watch in 2015 appeared first on Law Street.

The 2014 midterm elections weren’t the only reason to pay attention to political news this year. Keep scrolling to check Law Street’s top 10 political stories of 2014.

1. BridgeGate: 7 Reasons to Watch the Chris Christie Scandal

This winter, revelations about Governor Chris Christie’s involvement in the shutting down of the George Washington Bridge came to light. The whole scandal raised a lot of questions about Christie’s ability to be a contender on the national stage, quite possibly as the 2016 Republican Presidential nominee. Whether or not Christie chooses to run, there will be a lot of eyes on his handling of “Bridgegate.”

2. Marijuana Legalization: Let’s Be Blunt 

The states of Colorado and Washington voted to legalize recreational marijuana in 2012, and the sale and use started moving into the public sphere earlier this year. However, given that Colorado and Washington were the first two states to do so, many were left with questions about how exactly the legalization worked, what affects it could have on society, and how the Washington and Colorado laws would interact with federal law.

3. Drone Rules: Are They Enough to Protect Civilians?

Drones have evolved from being a futuristic fantasy to real part of American military strategy. However, like any new innovation, the legality is developed after the technology itself. In early 2014, the Obama Administration’s drone strike policies were a hot topic of conversation, especially after the disclosures regarding a December 2013 strike in Yemen.

4. Hobby Lobby: They Want to Remove the Corporate Veil — and Your Birth Control Coverage

Image courtesy of [Annabelle Shemer via Flickr]

Another hot political topic in 2014 was the Supreme Court case that’s widely become known as Hobby Lobby. It questioned whether or not the Affordable Care Act (ObamaCare) required employers to provide contraception for their employees, regardless of the company’s religious beliefs. Concerns about the case extended far beyond whether or not those particular employees would get contraceptive coverage, as it could have set a dangerous precedent for all sorts of discriminatory policies.

5. Obamacare Is Here to Stay! But It Still Kind of Sucks

Image courtesy of [Daniel Borman via Flickr]

The much maligned Affordable Care Act (Obamacare) finally went into effect this year, with the first open enrollment period. The act provided healthcare for many who previously didn’t have it, but that doesn’t mean that it was anywhere close to perfect. Partisan bickering over the law remained steady, but the Affordable Care Act can certainly be considered a step in the right direction.

6. Stuck in McAllen: Jose Vargas and the Texas Immigration Crisis

This summer, the arrival of undocumented youth at the Texas border sparked political debates, some outrage, and acts of compassion. One of the biggest advocates for these young people was a man named Jose Vargas, a prominent undocumented immigrant who works as a journalist and advocate. When Vargas traveled to McAllen, Texas, one of the towns most heavily affected by the arrival of the children, he was briefly detained and then released–cementing his status as one of the lucky few.

7. Debating Minimum Wage in America

As the cost of living in the United States continues to creep upward, and the American economy rebounds from one of the worst economic crises in recent history, many people still struggle to meet ends meet. Minimum wage jobs are an important sector of our economy–but what exactly do we mean when we say minimum wage? It’s an important political question that has yet to find an exact answer.

8. “Gay Panic” Defense Outlawed in California

For some time, the “gay panic” defense served as a way to claim a sort of self-defense in regards to hate crimes. While it doesn’t have a strong track record of actually succeeding, there were no laws specifically forbidding it. This fall, California became the first state to actually ban the “gay panic” defense, an important step in the fight against homophobia.

9. Campaign Finance: Free Speech or Unfair Influence?

In the wake of Citizens United and other landmark court decisions, our rules about campaign finance have seen some extreme changes in the last few years. These changes will have a huge impact on the 2016 Presidential elections, and pretty much every election moving forward, unless more changes happen. Given the topsy-turvy world that is the debate over campaign finance, anything is possible.

10. Just Get Ready For It: Another Clinton in the White House

We’ve all barely recovered from 2012, not to mention this year’s midterms, but speculation about 2016 has, predictably, already begun. Probably the Democratic front-runner at this point, Hillary Clinton has a lot of support. There are many reasons to get on the Hills bandwagon–including feminism, foreign policy, and her awesome facial expressions.

Anneliese Mahoney

Anneliese Mahoney is Managing Editor at Law Street and a Connecticut transplant to Washington D.C. She has a Bachelor’s degree in International Affairs from the George Washington University, and a passion for law, politics, and social issues. Contact Anneliese at amahoney@LawStreetMedia.com.

The post ICYMI: Top 10 Political Stories of 2014 appeared first on Law Street.

Health care costs have long been a hot topic of conversation in American culture. We’ve had problems with our health care system because the costs are high, of course, but also because sometimes they’re simply unknown. Often people who go in for a procedure, even with insurance, have no idea how much they’re going to owe until they receive a bill in the mail. One state has finally decided that that’s a bad way of doing things–starting this month, the state of Massachusetts is providing “price tags” for healthcare.

As of last week, if you are insured through a private company, you can go on that company’s website, type in what medical procedure you’re looking to get, and it will tell you how much it costs. This is part of an act that Massachusetts passed in 2012 that aimed to create greater transparency in healthcare costs, and make the system more efficient.

Now this system isn’t perfect, nor is it centralized. Not every single cost associated with a particular medical procedure will be listed–for example some places won’t list the cost of reading a scan or processing a test or an accompanying hospital stay.

The WBUR reporter who checked out the system, Martha Bebinger, also noticed some other interesting components. Health care costs vary by hospital or doctor, as well as by insurance provider. In some cases the difference was negligible, but in others, it was striking. For example, the cost of an Upper Back MRI ranges from around $600 to $1800, depending on where you go. Bebinger also noticed that the costs can change from day to day.

This is a valuable tool, because in addition to allowing patients to figure out where would be the best place to get a particular procedure, it also allows them to plan ahead. Some of the sites also create calculations of co-pays and the like, making the sites even more budget-planner friendly. Some of the sites allow the ability to leave patient reviews, so people can get some idea of the quality of the healthcare they will get before they actually commit. And while the system is by no means centralized, all of the big insurance providers in Massachusetts seem to have created some sort of online site with the ability to price-check.

The new requirements have also been applauded because of the hope that they may drive healthcare prices down. If people are able to readily access prices, they will shop around, and private doctors may offer slightly lower prices to incentivize customers.

The only possible concern I see is that people may be discouraged from going to the doctor’s office if they know in advance how much it will cost. However, I would imagine that those cases would be few and far between, and that overall, more transparency will benefit people who are on a budget.

Massachusetts has, in the past, introduced innovations in its health care system that ended up becoming national trends–the Affordable Care Act was loosely based on Massachusetts’s system of healthcare. Massachusetts may once again be in the position of testing an idea that could eventually end up a national norm.

Anneliese Mahoney

Anneliese Mahoney is Managing Editor at Law Street and a Connecticut transplant to Washington D.C. She has a Bachelor’s degree in International Affairs from the George Washington University, and a passion for law, politics, and social issues. Contact Anneliese at amahoney@LawStreetMedia.com.

The post Healthcare Procedures in Massachusetts Now Have Price Stickers appeared first on Law Street.

In June, Seattle made the news when the city announced that it would be upping its minimum wage to $15 per hour. In a time when arguments over the minimum wage has led to various strikes, discussions, and political debates, the Seattle move was unprecedented. It was pretty smooth too–the Seattle mayor was able to negotiate between a lot of different parties in order to create such a high minimum wage without much resistance. But now the change has finally hit a road bump–attorney Paul Clement is suing the city of Seattle for the minimum wage hike.

The lawsuit, filed by Clement, is on behalf of an organization called the International Franchise Organization. This move has received support from several major organizations, including the United States Chamber of Commerce and National Restaurant Organization, both of which recently joined the lawsuit.

The problem that these groups have with the new minimum wage law stems from the way in which it distinguishes between national chains, franchises, and small businesses. The current text of the law will require large corporations with chains in Seattle to adopt the $15 minimum wage within the next three years. Small businesses have up to seven years to implement it. Franchisees–small businesses that are affiliated with but not operated by larger chains, must implement it within three years. Examples of franchises include Pizza Hut, Dunkin Donuts, and Subway.

The Mayor of Seattle, Ed Murray claims that franchises have support that small mom-and-pop businesses don’t–namely in the form of advertisements, supplies, and menu creation.

The lawyer filing the suit on behalf of the franchisees, Paul Clement,  has had a lot of success with arguing cases in front of the Supreme Court. He has argued 74 cases in front of the highest court in the land, including two of the most talked-about cases of this year–Clement was involved in both the Hobby Lobby and Aereo cases. Clement was also involved in cases related to the Affordable Care Act, and argued on behalf of the Defense of Marriage Act.

He explained why he felt so strongly about the rights of franchisees to receive more time to implement the minimum wage:

I think that that points to the issue that’s at the heart of this case: corporate separateness. When you walk into a McDonald’s or Days Inn or coffee shop that has a dozen outlets, you’re not walking into corporate headquarters. These franchised companies are organized differently from a company that’s one monolithic company with one set of management and one set of employees.

Clement also claims that this is a direct attack on the franchise model of business–mostly coordinated by unions.

This suit marks an interesting turn in a large nation-wide debate about minimum wages. The argument isn’t being made that the wage hike shouldn’t happen, but rather that it’s being pushed on too quick of a time-table. That’s a good sign for minimum wage increases, and indicates that the organizations currently challenging the law realize that. Although $15 is a lot more than what most places are proposing, the idea of a minimum wage hike in general appears to be widely supported. As of a poll about 10 months ago, roughly 75 percent of American support raising the federal minimum wage to $9 per hour. Whichever way the Seattle fight goes, hopefully the minimum wage will soon take a big jump.

Anneliese Mahoney

Anneliese Mahoney is Managing Editor at Law Street and a Connecticut transplant to Washington D.C. She has a Bachelor’s degree in International Affairs from the George Washington University, and a passion for law, politics, and social issues. Contact Anneliese at amahoney@LawStreetMedia.com.

The post Seattle Minimum Wage Battle Heading to Court appeared first on Law Street.

John Boehner says the House of Representatives is suing President Obama for not faithfully executing the laws he has sworn to uphold. The suit claims that when Obama delayed the employer mandate for ObamaCare, he changed the law, something which can only be done by Congress. But this might not be Boehner’s only motive to sue. It sounds a bit implausible, considering Boehner has no love for the President, but he may be suing Obama to avoid impeaching him. And if that’s the case, it’s a downright genius move.

Boehner himself has said impeachment is not being considered, but he needs to silence the calls from other Congressman and noisy pundits in his party. Impeachment is a bad option for the Republicans for a few reasons. One is that Boehner knows that even if the House did impeach Obama, the Senate would never go along with it. Also, as unpopular as Obama is, he’s still more popular than the House of Representatives. The same thing happened the last time Republicans impeached a president–President Bill Clinton. The whole ordeal led to the Speaker of the House having to resign and Republicans losing the midterm elections. Boehner seems to know that it is a terrible political move to impeach the president.

But perhaps the biggest reason Boehner wants to silence the calls for impeachment is that the Democrats are using impeachment speculation to fuel their fundraising efforts. It’s an election year where the left’s base did not have much to be excited about, but the impeachment talks have riled them up. For example, you’d think that FOX news would be very excited about Obama impeachment rumors, and would be covering the issue far more than any other news organization. In fact, they have mentioned impeachment a respectable 95 times so far this month. But MSNBC, the liberal bastion, has mentioned impeachment a whopping 448 times. Both organizations claim to deliver unbiased news, but I think we all know that FOX and MSNBC are on opposite ends of the political spectrum, and the fact that the liberal news station mentions impeachment so much more shows how they want to get their base riled up. Boehner knows every time a Republican calls for impeachment on TV, it becomes a sound bite at the next Democratic Party fundraiser.

The lawsuit is also largely symbolic. It is doubtful that a court will say the House has standing to sue, and even if the House somehow wins the suit, the result would just be that Obama would immediately have to enforce the employer mandate. But odds are the case wouldn’t be decided until after the mandate begins enforcement in 2015 anyways.

There’s nothing for Boehner to gain legally, but there’s a lot to gain politically. This allows him to show he is doing something for those calling for impeachment. It allows conservative representatives to go back to their districts and tell their constituents that they have taken action against Obama. It is a symbolic gesture against Obama that will come to nothing in the long run–exactly what Boehner needs right now. This move also buys Boehner precious time. He can argue that impeachment would be pointless before the court makes it ruling. He’d be able to stretch out that excuse until the 2016 elections, at which point the whole impeachment argument would become null and void anyways.

Boehner has let the conservative end of his party control him before. For example, he could not get them in line nine moths ago, leading to a government shutdown. This lawsuit is his way of asserting control as the Speaker of the House. While the Democrats will still be able to fundraise by slamming the lawsuit, it gives substance to Boehner’s claim that impeachment is not being considered. The media will also focus on the lawsuit instead of impeachment rumors. This lawsuit has allowed Boehner to appease his conservative base, while limiting Democratic fundraising talking points. He found the narrowest of lines and is balancing on it beautifully. It will only take a slight breeze from his right to knock him off, but until that happens, this is an excellent move on Boehner’s part.

—

Matt DeWilde (@matt_dewilde25) is a member of the American University class of 2016 majoring in politics and considering going to law school. He loves writing about politics, reading, watching Netflix, and long walks on the beach. Contact Matt at staff@LawStreetMedia.com.

Featured image courtesy of [Speaker John Boehner via Flickr]

Matt DeWilde

Matt DeWilde is a member of the American University class of 2016 majoring in politics and considering going to law school. He loves writing about politics, reading, watching Netflix, and long walks on the beach. Contact Matt at staff@LawStreetMedia.com.

The post Politically Genius: Boehner’s Suit Against Obama appeared first on Law Street.

The transition from teenage years to adulthood can be a stressful shift for many people. Making decisions that shape their future and becoming more self-sufficient can be made even more challenging with mental illness. Young adults between 18 and 25 have higher rates of mental illness and substance use disorder than adults 26 years of age and older. Some argue that rates of mental illness in contemporary young adults can be attributed in part to advancements in technology. By actively participating in social media, many of today’s youth compare themselves to their perceptions of their peers as modeled online. According to Larkin Callaghan of the 2×2 Project, a public health science site, teenagers especially “now rely so much on external and immediate gratification, social status and image, and the superficial gain they get from social media that they are forgoing values that contribute to a sound internal life.”

Existing data on mental illnesses in young Americans exposes the unfortunate reality that a significant portion face significant challenges.

• Nearly 6.4 million people aged 18 to 25 had mental illness, representing almost one in five young adults in America.
• 10.6 million people in 2012 reported an unmet need for mental health care.

Even though adolescents and young adults are extremely vulnerable to mental health problems, many go without proper treatment services. These clinical interventions are imperative in supporting the transition to a healthy adulthood while minimizing damage to the individual. During this formative period it is important to reduce the negative consequences and promote positive mental health awareness. Read on to understand what is being done about mental illness in young Americans.

Depression

There are a vast amount of mental illnesses that people may suffer from, and often an individual may have more than one at a time. Everyone is not affected the same way by the same disease, and there is not a one-size-fits-all cure. The following is only a glimpse into depression, one of the more common illnesses affecting young adults.

It was once believed that children could not suffer from depression. If a teen were to show symptoms, they were written off as being moody and that it was a normal part of the growing-up experience, but we now know that that is certainly not the case. Although the signs of depression may differ from those of depressed adults, young adults are susceptible to this illness as well.

According to the National Alliance on Mental Health, approximately 11 percent of adolescents have a depressive disorder by age 18. For both girls and boys aged 10 to 19 years, depression is the predominant cause of illness. It is more common for girls to have depression as compared to boys; twice as many girls as boys are diagnosed.

One of the most tragic results of depression is suicide. Behind traffic accidents and deaths from HIV/AIDS, suicide is the third most common cause of death for people aged 15-24. Depression is not the sole cause of suicide, which is the result of many complex factors. Ninety percent of those who commit suicide are diagnosed with a psychiatric disorder. While more females than males are diagnosed with depression, there are four male suicides for every female suicide.

• It is estimated that there are eight to 25 attempted suicides for every death.
• One out of 10 adolescents aged 16 to 17 had major depressive episodes in the past year, and three quarters of these adolescents were female.
• 67 percent of young adults with mental illness do not receive treatment.

Policies

In an attempt to help those suffering with mental illnesses the government has sponsored various agencies and policies to focus on mental health reform.

Substance Abuse and Mental Health Service Administration

In 1992 the Substance Abuse and Mental Health Service Administration (SAMHSA) was created within the U.S. Department of Health and Human Services. The mission of the agency is to lessen the impact of mental illness and substance abuse on the American people. SAMHSA makes services, information, and research more accessible.

SAMHSA has an annual budget of $3 billion, with one third devoted to mental health and the remaining two thirds for substance abuse prevention and treatment programs. The grants distributed to states by this agency serve as the main source of funding for public substance abuse and mental health treatment, usually through community mental health centers.

One of the ways SAMHSA has helped those with mental illnesses is by funding the National Child Traumatic Stress Network (NCTSN). The mission of NCTSN is to provide access to treatment and care to children who have been exposed to traumatic events.

The reason SAMHSA provides so many resources is that the agency acts on the assumption that prevention works, treatment is effective, and that people can recover from substance use and mental disorders

Helping Families in Mental Health Crisis Act of 2013

Introduced in the House of Representatives in December 2013 by Representative Tim Murphy, the Helping Families in Mental Health Crisis Act “fixes the nation’s broken mental health system by focusing programs and resources on psychiatric care for patients & families most in need of services.” As of July 2014 the bill has 94 co-sponsors; 59 Republicans and 35 Democrats, but has yet to be signed into law.

The Subcommittee on Health investigated the federal mental-health systems and worked with advocacy groups, professionals, and families. The bill has numerous proposals, such as:

• Creating an Assistant Secretary for Mental Health and Substance Use Disorders within the HHS. The Assistant Secretary will direct and supervise the Administrator of SAMHSA.
• The Assistant Secretary will also establish a National Mental Heath Policy Laboratory to: 1) collect information from grantees; 2) evaluate and distribute to grantees the best practices and services delivery models.
• Direct the Assistant Secretary and the HHS Secretary to, “award planning grants to enable up to 10 states to carry out 5-year demonstration programs to improve the provision of behavioral health services by federally qualified community behavioral.”
• Medicaid would be amended to forbid a state medical assistance plan from barring payment for same-day primary care service or mental health service to an individual at a federally qualified health center or community behavioral health center.
• Prescription drugs used to treat mental health disorders would be covered by Medicare.

Strengthening Mental Health in Our Communities Act of 2014

Sponsored by Congressman Rob Barber, the Strengthening Mental Health in Our Communities Act of 2014 would create a White House office on Mental Health Policy in the Executive Office. As of July 2014, the bill has been referred to the Subcommittee on Crime, Terrorism, Homeland Security, and Investigations. The President would appoint a Director who would be charged with many duties including:

• Monitoring Federal activities with regard to mental health, serious mental illness, and serious emotional disturbances.
• Making recommendations to the HHS Secretary.
• Reviewing the Federal budgets on mental health services.
• Work with NGEs, state and local government to improve community-based mental health services.
• Annually updating and developing a summary of advancements in serious emotional disturbances and mental illnesses research.

Affordable Care Act

The Affordable Care Act (ACA) has made it somewhat less challenging for young people to receive mental health care. Federal health law now requires insurance companies to extend the same amount of coverage for mental health as a surgical or medical treatment would receive. Also, young people can remain on their parents’ insurance until they are 26 years old. If they do not stay on their parents’ insurance they are able to receive low-cost coverage through federal or state exchanges.

Influence of Technology

Technology is both a blessing and a curse to those with mental illness. By continuously being surrounded by technology, the brain is less able to unwind and de-stress. Excessive use of technology can lead to a feeling of isolation, and over-use of social media sites such as Facebook can promote narcissism. Users depend on others ‘sharing’ and ‘liking’ their posts to receive superficial gratification. Displaying individual success has taken priority over working with others to better the community.

However, advancements in technology are a practical way to provide people living with mental illness with helpful resources. It is now easier for individuals to quickly reach healthcare providers and find supportive online communities. By having care readily available, a greater portion of the population is able to receive treatment and support.

Apps, such as CBTReferee, are an example of this pioneering technology. CBTReferee allows users to catalog their thoughts as they occur, making them able to monitor flawed thinking. It is then easier for the person to evaluate and assess if their thoughts are unrealistic, unfair, or untrue.

BellyBio Interactive Breathing is a smartphone application aimed at helping those with anxiety and stress. The app generates soothing music and monitors breathing patterns while guiding the user through deep breathing exercises.

Conclusion

Mental illnesses disproportionately affects young Americans. By finding proper treatment. either through government programs or private care facilities, individuals with mental illnesses can be supported and managed in a healthy way.

Resources

Primary

Congress: H.R. 3717

Congress: Cosponsors: H.R.3717

HHS: Administration Issues Final Mental Health and Substance use Order Disorder Parity Rules

Congress: H.R.4574 – Strengthening Mental Health in Our Communities Act of 2014

World Health Organization: WHO Calls for Stronger Focus on Adolescent Health

Additional

SAMHSA: Serious Mental Health Challenges among Older Adolescents and Young Adults

2×2 Project: The Declining Mental Health of Millennials: Is Depression the New Normal?

Psych Central: The Many Problems with the Helping Families in Mental Health Crisis Act

NCTSN: National Child Traumatic Stress Network

SAMHSA: Who We Are

NAMI: Depression in Children and Teens

American Foundation for Suicide Prevention: Facts About Suicide and Depression

CBTReferee: Cognitive Behavioral Therapy

Alex Hill

Alex Hill studied at Virginia Tech majoring in English and Political Science. A native of the Washington, D.C. area, she blames her incessant need to debate and write about politics on her proximity to the nation’s capital.

The post Mental Illness in Young Americans appeared first on Law Street.

RANT WARNING: Be advised, this post may cause bouts of annoyance, defeatism, and pessimism.

Courtesy of Wifflegif

Initially, I planned to write an upbeat post about the recent celebrations of pride happening across the country: the Puerto Rican Day Parade, LGBT Pride, America’s success in the World Cup, and the Fourth of July, to name a few. I thought it would be interesting to extrapolate from these events a larger analysis of celebrating (or not) one’s identity. And then damn Hobby Lobby happened. Womp womp.

Last week, the Supreme Court held in two cases collectively referred to as Hobby Lobby that for-profit corporations are exempt from complying with the Affordable Care Act’s contraception mandate on the basis of religious beliefs. Specifically, the Court found that the ACA’s contraception mandate was not the “least restrictive” way for the government to implement this law and thus it created too substantial a burden on the religious freedoms of the companies at issue. In reaching this conclusion, the Court pointed to a less restrictive workaround in the ACA for nonprofits: If there are religious objections to a medical treatment, third parties will provide coverage to the employees.

More broadly, as Justice Ruth Bader Ginsberg argued in her 35-page, no-I’m-not-retiring-yet-assholes, dissenting opinion, Hobby Lobby stands for the principle “that commercial enterprises, including corporations, along with partnerships and sole proprietorships, can opt out of any law (saving only tax laws) they judge incompatible with their sincerely held religious beliefs.”

That’s right: corporations are indeed people. Those legal entities (which, by the way, are created for the purpose of separating the individuals involved from the corporate entity so that those individuals may be shielded from legal liability) apparently eat, sleep, breath, love, and pray? They sound more human than Darth Vader Cheney.

And as persons, corporations can also speak freely (i.e., wholly bankroll political campaigns) and freely exercise their religion (i.e., infringe on a woman’s reproductive rights).

Hell, with the direction in which this Court is taking corporate personhood, businesses — like any actual individual person in this country — may be able to discriminate on a wider scale. What happens when a business owner’s religious beliefs clash with, say, Title VII’s ban on discrimination in employment? What happens when a business owner acts on his belief that being gay is a sin? In answering these questions, I keep seeing the Jim Crow days when business owners were free to discriminate on the basis of race; I keep seeing the 1980s when they were openly homophobic and sexist. That idea is indeed what makes this “a decision of startling breadth,” as Justice Ginsberg put it.

Sure, I understand that slippery-slope, parade-of-horribles arguments are necessarily illogical. But tell that to African Americans who lived through the aftermath of Plessy v. Ferguson’s separate-but-equal holding. Yes, Justice Samuel Alito, writing for the majority in Hobby Lobby, did promise that the ruling would not open the door to discrimination (exemptions to our anti-discrimination laws). Call me cynical, call me a blasphemer, but frankly I don’t have a whole lot of faith in this Court’s word — this Court that has been so adept at totally flouting precedent and stare decisis when it suits its political ends. Remember Citizens United? Bush v. Gore anyone?

Courtesy of DPMS via Flickr

In fact, we need look no further than last Thursday. Just days after the Court issued its Hobby Lobby ruling, it granted an unsigned emergency order in a new case involving Wheaton College, finding that the very workaround it had hailed as a less restrictive means by which the government could implement the ACA was also unconstitutional — that it substantially burdened the religious freedom of religious employers. What on Earth?! In the span of less than a week Hobby Lobby has already gone further than Hobby Lobby!

So now I sit here wondering what’s next. I wonder how far down this road the Supreme Court will take us. Debbie Downer over here, I know. But this is seriously like the worst season finale ever.

—

Chris Copeland (@ChrisRCopeland) is a staff attorney at a non-profit organization in the Bronx, a blogger, and a California ex-pat living in Brooklyn. When he’s not reading, writing, or watching horror, he explores the intersection of race and LGBT issues with Law Street.

Featured image courtesy of [American Life League via Flickr]

Chris Copeland

Chris Copeland is a staff attorney at a non-profit organization in the Bronx, a blogger, and a California ex-pat living in Brooklyn. When he’s not reading, writing, or watching horror, he explores the intersection of race and LGBT issues with Law Street. Contact Chris at staff@LawStreetMedia.com.

The post Down the Hobby Lobby Rabbit Hole: Are Federal Anti-Discrimination Laws Next? appeared first on Law Street.

In a 5-4 decision, the Supreme Court ruled that the contraceptive mandate in the Affordable Care Act, when applied to closely held corporations such as Hobby Lobby, violates the Religious Freedom Restoration Act (RFRA). Justice Samuel Alito wrote the opinion for the majority, which also included Chief Justice John Roberts, Justice Antonin Scalia, Justice Clarence Thomas, and Justice Anthony Kennedy. The opinion was a narrow one–Justice Alito made it clear that they were ruling on the specifics of this case–not opening the floodgates for other religious challenges. His opinion also stressed that this ruling only applies to closely held corporations with fewer than five majority owners. But despite the narrow ruling, this is a clear victory for Hobby Lobby.

The Background

In order to understand how the court arrived at this opinion, we must first understand RFRA, the law under which the contraceptive mandate was challenged. That law states that, “government shall not substantially burden a person’s exercise of religion even if the burden results from a rule of general applicability.” An exception to this law can only be provided if it shows a compelling governmental interest and that governmental interest is achieved using the least restrictive means possible. This means the interest must be achieved in a way that least violates our First Amendment right to religious freedom. Therefore, in order for Hobby Lobby to win this case they had to:

1)   Show that a corporation could practice religion and be considered a “person” under this law;

2)   Show that Hobby Lobby’s ability to exercise religion had been substantially burdened by the contraceptive mandate;

3)   Either show that the contraceptive mandate was not a compelling governmental interest or prove that it was not achieved in the least restrictive means possible.

The Decision

The majority opinion held that a corporation could practice religion because its administration could make business decisions based off of religious beliefs. The majority also claimed that because companies do donate to charities, they are capable of caring about values that transcend profits–such as religion. Finally, they pointed out that in certain cases, Congress has specifically added clauses into laws specifying that corporations would not qualify, and would have done exactly that if they did not intend for corporations to be covered by RFRA.

On the other hand, the dissent, written by Justice Ruth Bader Ginsburg, argued that a corporation cannot exercise religion because there is no clear way to decide who determines its religion. Would it be 51 percent of the shareholders? Or the majority shareholder? The CEO? This objection is why the majority applied this ruling only to closely held corporations with five or fewer owners, such as Hobby Lobby. These are often family-owned and can feasibly run their company based off of religious issues.

The owners of Hobby Lobby, the Green family, believe the contraceptive drugs they were required to include in their employees’ health coverage are similar to abortions. Their religious beliefs state that life starts at conception. Therefore, their ability to exercise their religion is substantially burdened by the contraceptive mandate.

Once the majority established that Hobby Lobby could be considered a person under RFRA and that it faced a substantial religious burden, they had to determine if the contraceptive mandate could be considered a legal exception. The majority conceded that providing contraceptive coverage was a compelling government interest, but also said that it was not done in the least restrictive way. They assert that because there is a penalty for not providing the contraceptives, the Greens were forced to either act against their religion or pay a significant fine. The majority opinion says that this is not the least restrictive way to provide contraception coverage, as the government could just provide the contraceptives itself and allow the Greens to respect their beliefs.

Another argument brought up in the dissent is that this ruling could lead to religious exemptions for other issues, such as coverage for immunizations and blood transfusions. However, the majority held that they were only ruling on the contraception mandate, stating that this ruling does not mean they would rule the same way for any other health care challenge under RFRA. The opinion specifically cites immunizations as an example of governmental interest that is compelling and is reached by the least restrictive means possible.

The Impact 

Now that we understand the ruling, let’s examine its impact, particularly on the Affordable Care Act. If we look at the ACA’s overall ability to provide healthcare, the impact is minimal. The ruling only strikes down one mandate, and says the government can still provide contraceptives itself. So in a way, it could expand governmental coverage of healthcare. Where this hurts the ACA is in the political battlefield, where the fact this was a very narrow ruling means almost nothing. All that matters is that the Democrat’s health care law overreached. This issue could very well serve as a rallying point for conservatives in the 2014 mid-term elections.

Already there are headlines popping up that make it seem like the Supreme Court ruled against the ACA. But at the end of the day, all the Supreme Court did was curb a small portion of the contraception mandate. They didn’t rule any mandate unconstitutional. They just provided a religious exception, while still leaving routes open for women to get the coverage the ACA promises.

—

Matt DeWilde (@matt_dewilde25) is a member of the American University class of 2016 majoring in politics and considering going to law school. He loves writing about politics, reading, watching Netflix, and long walks on the beach. Contact Matt at staff@LawStreetMedia.com.

Featured image courtesy of [Nate Grigg via Flickr]

Matt DeWilde

Matt DeWilde is a member of the American University class of 2016 majoring in politics and considering going to law school. He loves writing about politics, reading, watching Netflix, and long walks on the beach. Contact Matt at staff@LawStreetMedia.com.

The post Hobby Lobby Wins Big, but Obamacare Doesn’t Really Lose appeared first on Law Street.

By most accounts, the rollout of the Affordable Care Act (ACA) has been incredibly rocky. Even as problems with Healthcare.gov have stabilized and enrollment numbers have increased across the nation, the law, alternatively called ‘Obamacare,’ is being hit with numerous lawsuits challenging its various provisions. One such notable lawsuit is Sebelius v. Hobby Lobby Stores, Inc., and it has arrived at the Supreme Court.

The case pits Health and Human Services Secretary Kathleen Sebelius against arts and crafts giant Hobby Lobby, and it underscores the fierce resistance by some companies to the 2010 law. The heart of the case lies in the issue of whether or not the ACA’s provision forcing employers to cover contraception as a part of employee-based health care is an attack on religious freedom. Hobby Lobby Stores filed a suit against the United States in September 2012 citing the Free Exercise Clause of the First Amendment, as well as the Religious Freedom Restoration Act, signed by President Clinton in 1993.

The Free Exercise Clause, if anyone needs reminding, states, “Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof…” As for the Religious Freedom Restoration Act, the gist of the bill is that it prevents the government from passing legislation that would make it extremely hard for someone to exercise their religion. In this case, Hobby Lobby claims that the ACA  makes it too difficult for the family of ownership (the Greens) to exercise their religion due to the provision of contraceptive medication in employee’s healthcare premiums. It is important to note here that there is no explicit mention of contraception coverage in the wording of the healthcare bill.

The arts and crafts chain store only took their case to the next level after the Supreme Court refused to grant an injunction excusing Hobby Lobby from providing contraception coverage, saying simply, “Applicants do not satisfy the demanding standard for the extraordinary relief they seek.” Then, in July 2013, U.S. District Judge Joe Heaton provided the Green family an exemption from the “contraceptive mandate.” In his ruling, Judge Heaton said:

Given the importance of the interests at stake in this case, the fact that the ACA’s requirements raise new and substantial questions of law and public policy, and that substantial litigation as to the mandate at issue here is ongoing around the country, the court concludes there is an overriding public interest in the resolution of the legal issues raised by the mandate before Hobby Lobby and Mardel are exposed to the substantial penalties that are potentially applicable. The public interest therefore lies in preserving the status quo until the issues raised by plaintiffs’ claims are resolved.

The tables were turned on Hobby Lobby when the Center for Inquiry filed its own amicus curiae brief with the Supreme Court in January 2014. In the brief, the Center cited the Establishment Clause of the First Amendment, the same basis of argument used by Hobby Lobby, stating that the government cannot make an exception on religious grounds for one company. With the Supreme Court granting certiorari since November 2013, many are eager to see the result of this massively influential case, and the next arguments are scheduled for March 25.

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Dennis Futoryan (@dfutoryan) is an undergrad with an eye on a bright future in the federal government. Living in New York, he seeks to understand how to solve the problematic issues plaguing Gothamites, as well as educating the youngest generations on the most important issues of the day.

Featured image courtesy of [DangApricot via Wikipedia]

Dennis Futoryan

Dennis Futoryan is a 23-year old New York Law School student who has his sights set on constitutional and public interest law. Whenever he gets a chance to breathe from his law school work, Dennis can be found scouring social media and examining current events to educate others about what’s going on in our world. Contact Dennis at staff@LawStreetMedia.com.

The post The Craft of Contraception Rights: SCOTUS to Hear Sebelius vs. Hobby Lobby appeared first on Law Street.

Happy New Year, folks! Welcome to 2014.

This is going to be one hell of a year — and it’s already kicked off with a bang. Not a fun, happy, feminist bang, but a bang nonetheless.

During her final moments of 2013, Supreme Court Justice Sonia Sotomayor signed a temporary stay on the enforcement of the contraceptive coverage requirements in the Affordable Care Act. What does that mean? Basically, she just made it that much harder for women across the country to access birth control.

Not your finest moment, Justice Sotomayor. Courtesy of the Collection of the Supreme Court of the United States, Steve Petteway source via Wikipedia.

Here’s how it went down. As of December 30, 2013, the Affordable Care Act requires employer-sponsored health insurance to cover birth control. So, basically, if you get health insurance on your day job’s dime, you legally cannot be prevented from using it to snag some birth control pills. Awesome.

But! As always, some folks were pretty pissed off about this. Namely, Christian folks. A whole slew of Christian-values nonprofits and businesses objected to this piece of the ACA, claiming it infringed on their religious freedom. The logic here, is that if Christian values include not supporting contraception or abortion, a Christian employer shouldn’t have to subsidize those services for its employees.

Fair enough, churchgoers. The government can’t force you to support — financially or otherwise — actions that are forbidden by your religion. That’s what religious freedom is all about, right? Getting to practice your faith freely, without anyone telling you it’s not allowed?

Yes! Absolutely. But, there’s another side to the freedom of religion coin. While the government can’t prevent anyone from freely practicing their faith, it also can’t push any particular faith on its citizens. So, while the government can’t stop Catholics from attending church on Sundays, it also can’t force Jews to celebrate Christmas. The street runs both ways.

And this is where things get tricky. While Christian organizations have a fair point — being legally forced to subsidize contraception if they’re religiously opposed to it is majorly problematic — they’re also forgetting the other side of the coin. They’re right in asserting that they can’t be forced to do anything that interferes with their religious beliefs, but they can’t, in turn, force their religious beliefs on anyone else.

And that’s the tragic flaw in their anti-Obamacare logic. If Christian businesses were given their way — and allowed to forego contraceptive coverage for their employees — they would be forcing workers to live by a set of Christian standards, unless they paid a steep price tag. What happens when the employees of a Christian company aren’t Christian themselves? What happens when they’re Jewish, Buddhist, Muslim, Hindu, or Atheist? Can those employees be forced to live by Christian values?

Absolutely not. Now you’re infringing on their religious freedom.

And here lies the central problem. Forcing Christian businesses to pay for contraceptive coverage might be infringing on their religious freedom — but allowing them to not pay for it might infringe on workers’ religious freedom.

It’s a lose-lose situation.

But! As per a compromise cooked up by the Department of Health and Human Services, there seemed to be a solution. Under this plan, Christian companies and nonprofits had to sign a form stating their religious affiliation, and instead of paying for contraceptive coverage themselves, the insurers paid for it, and were reimbursed.

Yay solutions!

Awesome! Way to use your problem solving skills, people. This way, religiously opposed employers don’t have to pay for contraception, but employees can still access those services if they choose.

But, this wasn’t good enough for many a Christian employer. Signing a form was, apparently, too much to ask. So lawsuits poured in. And Justice Sotomayor was sympathetic.

So, with the hourglass running down on 2013, she signed a mandate preventing this piece of the law being enforced. What does that mean? Religious employers can deny workers contraceptive coverage. For folks working at Christian institutions, birth control will only be an option if they can afford to pay a whole ton of money out of pocket. Which really means, birth control won’t be an option at all.

The Obama administration has until tomorrow to respond. From there, we’ll all just have to wait around for the Supreme Court to make a final decision sometime this summer, after it’s had a chance to sift through all of the case filings. And, mind you, things aren’t looking too good on that front, considering this problem was brought about by one of the most feministy of Justices. If Sotomayor is making it hard for women to access birth control, who the fuck is going to make it any easier?

We’re looking at you, Ruth Bader Ginsburg.

The tricky business of religious freedom has been a constant roadblock for women and feminism. What do you think about this latest Obamacare battle?

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Hannah R. Winsten (@HannahRWinsten) is a freelance copywriter, marketing consultant, and blogger living in New York’s sixth borough. She hates tweeting but does it anyway. She aspires to be the next Rachel Maddow.

Featured image courtesy of [Parenting Patch via Wikipedia]

Hannah R. Winsten

Hannah R. Winsten is a freelance copywriter, marketing consultant, and blogger living in New York’s sixth borough. She hates tweeting but does it anyway. She aspires to be the next Rachel Maddow. Contact Hannah at staff@LawStreetMedia.com.

The post Happy New Year! Your Birth Control’s No Longer Covered appeared first on Law Street.

Here at Law Street, we are very interested in the changing world of law. So as the wild ride that was 2013 comes to an end, I thought it would be fun to count down the biggest changes, innovations, and crazy moments in the world of law and politics this year.

8. George Zimmerman Trial 

What happened: On July 14, 2013, George Zimmerman was found not guilty of the murder of Trayvon Martin. This verdict was understandably met with widespread shock. Some people were angry, some were vindicated, but everyone had an opinion.

Protests like this happened all over the country. Courtesy of Werth Media via Flickr.

Why it matters: Anyone who regularly reads my pieces knows that I’m a big fan of talking. I think, maybe misguidedly, that open dialogue is a great thing and solves 80 percent of problems. And if you’re looking for strong dialogue in 2013, look no further than the debate that occurred immediately after the Zimmerman acquittal. We saw conversations about the implications of stand your ground laws, gun control, and institutionalized racism. Now my hopeless naiveté won’t go so far as to say that these conversations were productive. But they happened, they’ve been introduced, and my dearest hope is that next year I’ll be able to say that we’ve made progress out of the tragedy that was Trayvon Martin’s death.

7. Jeff Bezos Buys the Washington Post 

What happened: Jeff Bezos, the founder of Amazon, bought The Washington Post this summer in a $250 million deal. Now this might seem a little off topic — what does the purchase of a newspaper have to do with law and politics?

Why it matters: The world is changing. Media is changing, and we know this because a multi-billionaire who made his fortune from an internet sales company just bought one of the most influential papers in the country. That’s big because it means our media is getting smarter, it’s gaining control, and the internet is increasingly becoming a one-stop-shop for all we need. Plus, if Amazon follows through on its promises, we might get our newspaper delivered by drones, which would be pretty cool.

I’m mostly really excited about this drone delivery idea, guys.

6. Pope Francis Begins His Papacy

What happened: On March 13, 2013, Pope Francis became the head of the Catholic Church.

Why it matters: He immediately enacted some pretty serious changes. He downgraded the extravagant Vatican facilities. He has been advocating for more inclusive Church policies. He stated, “If a person is gay and seeks God and has good will, who am I to judge them?” He has said that the the Catholic Church needs to stop being so obsessed with social issues. The Pope changing his views on this could push some big changes for American politics. Don’t get me wrong, he is still a Catholic Pope and he is still a conservative man. But he works with the poor and he seems to be a man of the 21st century, and I have to give him props for that.

High Five, Pope Francis.

5. The Manti Te’o Girlfriend Hoax

What happened: This is probably an odd one to put so high on my list, but it was a very, very weird story. A Notre Dame linebacker, who now plays for the San Diego Chargers, told a story about his girlfriend, a Stanford University student named Lennay Kekua who had died of Leukemia. In January 2013, it was discovered that Lennay Kekua never existed. Her relationship with Te’o was purely online. The culprit behind the hoax turned out to be a man named Ronaiah Tuiasosopo, who may have fallen in love with Te’o while pretending to be his fictional girlfriend.

This refers to the online part, not the falling in love part. That part’s slightly less weird.

Why it matters: We’re at the point where a convincing and moving relationship can be forged 100 percent online. I know I’m a millennial who does everything online, but maybe I’m a bad one, because I simply can’t fathom that. I think this marks a big change in our world. Five years ago, if a professional athlete revealed that he had an online relationship with a woman he had never met, it would be completely ridiculous. Now, it was ridiculed, and commentators were surprised, but people understood how it could happen. Online presences can supersede our real lives now, and that’s scary.

4. Dems Detonate “Nuclear Option”

What happened: After a series of failed judicial nominees, Senate Democrats took drastic action. They changed the rules so that federal judicial nominees can move to the confirmation process with a simple majority of Senators, rather than a super majority of 60.

Why it matters: This will fundamentally change the way in which federal judicial nominees are confirmed. It may also permanently change the courts. If Presidents no longer need to pick moderates who can garner a 60-vote confirmation, the courts will get more liberal during a Democratic presidency, or more conservative during a Republican presidency.

3. NSA Spying Scandal

What happened: Although this event started in 2012, it got really big in 2013. Edward Snowden’s release of the extent of NSA monitoring shocked the American public. Snowden has since fled the United States.

The American reaction.

Why it matters: The intersection of politics, law, and technology continues to weave a tangled web, and the NSA scandal was the greatest proof of that phenomenon. We are being watched, and there’s nothing that we can do about it. Comparisons to Big Brother and 1984 were made, but that’s the truth, and people realized that this year. There’s a different level of trust in the government now.

2. The Affordable Care Act Mess

What happened: The rollout of the Affordable Care Act was the biggest mess I’ve seen in a long time. From the government shutdown that preceded it, to the internet issues, to the logistical problems, it was kind of a hot mess.

See another hot mess for context.

Why it matters: The ACA is still in place. It’s not perfect. It has problems. But it’s still a law and despite the Republicans’ best efforts, it will continue. That was an important lesson for everyone to learn this year. We will have hot mess laws and these laws will create problems;  however, they will remain the law. We can fix or repeal them, but we can’t pretend they don’t exist, and we can’t pretend that we can will them away.

1. Gay Rights

What happened: 2013 was a huge year for gay rights. In June, the Supreme Court handed down big successes for federal and state gay marriage rights. Gay marriage became legal in Maryland, Delaware, Rhode Island, Minnesota, New Jersey, New Mexico, Utah, Hawaii and Illinois.

Why it matters: Obviously there’s still a long way to go, but any slow, small steps down the right path are good. Notably conservative states — Utah and New Mexico — even got in on the action, albeit through court-mandated measures.

So here’s to 2013. It was wild, it was weird, and it was revolutionary. I don’t know about you all, but I’m excited to see what 2014 brings.

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Anneliese Mahoney (@AMahoney8672) is Lead Editor at Law Street and a Connecticut transplant to Washington D.C. She has a Bachelor’s degree in International Affairs from the George Washington University, and a passion for law, politics, and social issues. Contact Anneliese at amahoney@LawStreetMedia.com.

Featured image courtesy of [Sally Mahoney via Flickr]

Anneliese Mahoney

Anneliese Mahoney is Managing Editor at Law Street and a Connecticut transplant to Washington D.C. She has a Bachelor’s degree in International Affairs from the George Washington University, and a passion for law, politics, and social issues. Contact Anneliese at amahoney@LawStreetMedia.com.

The post The Most Influential News Events of 2013 appeared first on Law Street.

Ask anyone what the biggest political controversy is of President Obama’s presidency: you’ll hear a few people talk about Benghazi and the NSA will inevitably come up. But it’s pretty safe to say that the majority of respondents will reference the Affordable Care Act. Otherwise known as ObamaCare, the ACA has been a huge talking point for partisan politics. And like with any hugely-partisan issue, lies abound. Here are the top 10 lies being told about the ACA:

10. 8.2 million Americans can’t find full-time work because of ObamaCare
Who Told it: The RNC and multiple Republican politicians, including John Boehner and Eric Cantor.

Courtesy of Talk Radio News Service via Flickr.

Why it’s a lie: The RNC looked at the Bureau of Labor Statistic’s figures this summer. They report the amount of people who are working a part-time job and would like to be working full time. What they do not report is why these workers are working a part time job….in fact there’s literally nothing about the Affordable Care Act in these statistics. Awesome unfair extrapolation RNC, you go.

9. “Obamacare contains an ‘abortion surcharge and a secrecy clause’ that forces ‘pro-life Americans…to pay for other people’s abortions.” 
Who told it: Rep Chris Smith (R-NJ)

Why it’s a lie: If you don’t want abortion coverage, you don’t choose one of the plans that includes abortion coverage. States are required to offer plans with and without the provision. If a woman chooses to have abortion coverage, she pays a separate fee into a separate account so that no federal dollars support abortion services. Every American has the option to choose a plan that does not give to abortion coverage.

8. Obamacare will add $6 trillion to the deficit.
Who told it: Rep George Holding (R-NC)

This was the time the same Rep fell asleep in Congress.

Why it’s a lie: Because the Affordable Care Act won’t raise the deficit at all, as projected by the CBO. In fact, it will reduce the deficit. Go back to sleep, Rep Holding.

These next couple examples will come from a category I like to call “things that happened on Fox News that aren’t true.”

7. A woman named Allison Denijs went on the Sean Hannity show and claimed that Obamacare would cost her more, and wouldn’t contain insurance for her daughter with a preexisting condition. 

Who said it: It was part of a segment on Sean Hannity’s show meant to show that “Average Americans are feeling the pain of Obamacare and the healthcare overhaul train wreck.”

Why it’s a lie: Stories like this are popping up on conservative outlets all across the country. But the case is that these stories aren’t actually true. Let’s look specifically at Ms. Denijs’s story. Her family currently pays $13,000 to purchase their own insurance, and then another $600 a month to cover their daughter with a preexisting condition. But under Obamacare, preexisting conditions are no longer an issue. A reporter who interviewed her found that she had never even looked at the exchange, and that she could find almost the exact same plan for just $7600 a year through the exchange.

6. On the same program, a man named Paul Cox claimed that he had to cut back on employee’s hours at his small construction business. 
Who said it: It was part of a segment on Sean Hannity’s show meant to show that “Average Americans are feeling the pain of Obamacare and the healthcare overhaul train wreck.”

 Why it’s a lie: The same Slate journalist who followed up on the Denijs’ story found that Mr. Cox only has 4 employees. Remember, Obamacare only applies to small businesses with 49 employees or more. This was the result of Slate’s interview with Cox: ” Paul revealed that he has only four employees. Why the cutback on his workforce? “Well,” he said, “I haven’t been forced to do so, it’s just that I’ve chosen to do so. I have to deal with increased costs.” What costs? And how, I asked him, is any of it due to Obamacare? There was a long pause, after which he said he’d call me back. He never did.”

5. Congress and the President are exempt from Obamacare. 
Who told it: Lots and lots of people. I’ll choose to harp on Rep Steve Scalise (R-LA) though.

Why it’s a lie: The ACA provides insurance for people who don’t already have it through employers. Congress provides insurance to its staffers and members. So in a sense, they are exempt, it’s just the same way that most Americans are. They do not need to use the exchanges to find insurance because they already have it.

On the note of people being exempt….

4. Muslims, Amish, and some other religious groups are exempt from the law. 

Who said it: A few different sources, but it mainly came from a chain email/Facebook/meme that claims that the word “Dhimmitude” is contained in the ACA text. It claims that Dhimmitude is the “Muslim system of controlling non-Muslin populations conquered through jihad (Holy War). Specifically, it is the TAXING of non-Muslims in exchange for tolerating their presenceAND as a coercive means of converting conquered remnants to Islam!”. It also claims that “Muslims are specifically exempted from the government mandate to purchase insurance and also from the penalty tax for being uninsured! Islam considers insurance to be “gambling,” “risk-taking,” and “usury” and is thus banned. Muslims are specifically granted exemption based on this.”

Why it’s a lie: There is a “religious conscience” exemption in the ACA. But it’s not based on a religion as a whole, rather a specific sect. For example, Amish might be exempt because they have established a history of making their own provisions. Self-employed Amish, don’t, in fact, pay Social Security taxes because they don’t collect Social Security benefits. They are self-sufficient. Muslims in the US are required to have the insurances as everyone else, for example, car insurance. They do not have the same kind of history as Amish groups, so they most likely wouldn’t meet this exemption.

3. It’s possible to go to jail if you don’t pay for insurance under Obamacare. 
Who said it: On Fox and Friends on October 28th, Brian Kilmeade stated that young people will either get insurance or pay the penalty “in order to avoid prison time or whatever ramifications.”

Liar, Liar, Pants on Fire

Why it’s a lie: There is a penalty in place if you don’t have insurance through an employer and don’t get it through the exchanges or some other means–$90 or 1% of income. However, there is specifically no criminal penalty–meaning it’s impossible to go to prison. (Unless of course, you don’t pay any of your taxes, but that’s a whole different story.) Here’s what the ACA says:

In the case of any failure by a taxpayer to timely pay any penalty imposed by this section, such taxpayer shall not be subject to any criminal prosecution or penalty with respect to such failure.

2. President Obama lied when he said “If you like your coverage you can keep it.”
Who said it: Everyone. I’m not kidding. Everyone.

Why it’s a lie: So this one is tricky. Obama did, multiple times, say if you like your coverage, you can keep it. Multiple times. And the thing is, that’s not completely true. If you like your coverage, but your coverage covers absolutely nothing, then you cannot keep it. The purpose of the ACA is to make sure that every single person in the United States has affordable, adequate healthcare that won’t lead to bankruptcy if a medical emergency occurs. If you’re a healthy youngish adult, it’s completely possible to get an insurance plan that stays great if you’re healthy, but bankrupts you if something happens. So, some people won’t be able to keep their plans, because their plans are bare-bones pieces of crap from the insurance companies that barely cover a paper cut. Was it correct of Obama to say that everyone can keep their plans? No. And he deserves all the political backlash he’s receiving for that. But, does forcing people to get adequate coverage hurt anyone? Absolutely, not. It’s good for those people, it’s good for the economy, and chances are it might even be cheaper. Remember to look for the silver lining, people.

1. Obamacare is the worst thing to happen to the US since slavery.
Who said it: Dr. Ben Carson during the Value Voters Summit.

Why it’s a lie: To channel the always amazing Amy Poehler: REALLY? Really, Dr. Ben Carson, since slavery? To begin, how could you ever consider comparing a bill intended to provide healthcare to everyone to enslaving other humans. That’s not apples vs. oranges, that’s kittens vs. demons. Also, I know that a lot of us slept through US History, but this country has done a lot of horrible, horrible things since slavery. We’ve had half a dozen wars, Japanese-American internment, dropping nuclear bombs on other nations, and now I’m too angry to think of any more. But seriously, Dr. Ben Carson, how did that ever seem like a good comparison?

And I know I’m supposed to be done now, but for anyone else who wants to get really angry today, let’s remember that a very large percentage of Americans don’t even know what the ACA is. Need I remind you of this Jimmy Kimmel video?

That’s it, I’m done.

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Anneliese Mahoney (@AMahoney8672) is Lead Editor at Law Street and a Connecticut transplant to Washington D.C. She has a Bachelor’s degree in International Affairs from the George Washington University, and a passion for law, politics, and social issues. Contact Anneliese at amahoney@LawStreetMedia.com.

Featured image courtesy of [LaDawna Howard via Flickr]

Anneliese Mahoney

Anneliese Mahoney is Managing Editor at Law Street and a Connecticut transplant to Washington D.C. She has a Bachelor’s degree in International Affairs from the George Washington University, and a passion for law, politics, and social issues. Contact Anneliese at amahoney@LawStreetMedia.com.

The post ObamaStillCares: Top Ten Lies About the Affordable Care Act appeared first on Law Street.

How was your weekend, loves? Mine was fabulous!

But Obamacare’s weekend was kind of rough.

On Sunday, The Daily Kos reported that the frustrating, glitchy, failure-face of a website that is Healthcare.gov is such a mess, in part, because of coordinated conservative hackattacks.

That’s right. You heard me correctly.

Conservatives are hacking into Healthcare.gov to prevent it from working correctly.

Specifically, hackers have been launching DDoS attacks—an acronym that stands for Distributed Denial of Service—against the site, which function to make a network unavailable to users.

Sound familiar? I think so! How many gazillions of stories have you heard about uninsured, Obamacare-enthused folks getting kicked off the site, denied access to sign up for their government-sponsored health benefits?

Probably a lot.

These cons are SERIOUSLY getting on my nerves.

And that’s not all. In addition to these hackattacks—which are being launched with a tool called “Destroy Obama Care,” no joke—conservative lawmakers are encouraging insurance companies to fraudulently screw over their customers, and blame Obamacare for the ridiculousness.

For example, in Florida, douchebag extraordinaire Governor Rick Scott required insurance companies to blame Obamacare for any canceled plans, even if their reasons for canceling those plans had NOTHING AT ALL to do with Obamacare.

Lie, he said. It will be profitable, he said.

But actually. Because let’s be real here. Insurance companies make a lot of money for doing very, very little. They make healthcare prohibitively expensive. They’ve made medicine less about saving lives, and more about making money.

I mean really. The U.S. is the only country in the world where Breaking Bad makes any goddamn sense.

So when conservative lawmakers freak out about how horrible Obamacare will be, they’re really just lamenting the oncoming fall of big business. Of insane wealth disparities. Of that line in the sand that separates the haves from the have-nots.

Because what LOGICAL reason exists to vehemently defend the existence of companies that make healthcare INACCESSIBLE to the vast majority of Americans?

Seriously. Let’s look at a hypothetical example, shall we?

Mom gets breast cancer. It’s fairly advanced, but not untreatable.

She doesn’t have health insurance, because it’s way too expensive. She made a choice between paying for her monthly groceries, and electricity, and heat, and part of her mortgage payment—OR paying for health insurance. Years ago, she chose the former.

So now, here we are. Breast cancer. It wasn’t caught earlier because Mom lives in a state where women’s health funding has been slashed. Her local women’s clinic closed down. (Thanks Republicans.) She hasn’t had a mammogram in years. Preventive care wasn’t readily available to her.

Now that she has her diagnosis, Mom faces a choice. She can get treatment for her breast cancer, but she’ll go bankrupt paying for it. Or, she can forgo treatment, continue scraping by for now, and wait for the inevitable.

This is a bullshit choice.

The reality for Americans without insurance is completely absurd. They live in a wealthy, developed nation, where there are clean hospitals, abundant medicine, and well-equipped doctors. Quality medical treatment is right here. It’s there for the taking.

But it’ll cost you your house. And your groceries. And the clothes on your back. Actually, if you take advantage of all those lifesaving facilities, you’ll likely wind up bankrupt and homeless.

So really, for these Americans—for this fictional, hypothetical working mom with breast cancer—what’s the point of being American? What’s the point of living in the United States? She might as well live in a struggling, rural nation that has very few hospitals, and very little medicine. Her access to those facilities would be roughly the same.

And that’s completely insane. It makes no sense that uninsured people in the United States must choose between two life-destroying options: forgo treatment and wait for death, or go into total financial ruin.

I really wish I was, Chelsea.

The only reason anyone should forgo medical treatment is if treatment does not exist. You can’t go to the hospital for chemotherapy if there is no hospital, if there is no chemo.

But we do have hospitals. We do have chemo. And so, people should be able to use them. While also keeping a roof over their heads and food in their mouths.

This is not a difficult argument to make. This is just common sense.

But conservatives are abandoning that logic. They’ve made it their mission to defend a system that clearly isn’t working. They’re defending a healthcare system that bankrupts people. They’re defending insurance companies that lie and swindle their customers. They’re encouraging those insurance companies to act fraudulently.

This is stupid, am I right?

So lovelies, let’s try and put an end to this madness, mmkay? Obamacare is not ideal, but it’s a step in the right direction. It’s a step toward affordable and accessible healthcare for all. So let’s get behind it.

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Featured image courtesy of [LaDawna Howard via Flickr]

[Featured image courtesy of the LA Times]

Hannah R. Winsten

Hannah R. Winsten is a freelance copywriter, marketing consultant, and blogger living in New York’s sixth borough. She hates tweeting but does it anyway. She aspires to be the next Rachel Maddow. Contact Hannah at staff@LawStreetMedia.com.

The post Conservatives Are Deliberately Hacking Healthcare.Gov appeared first on Law Street.

On October 22, 2013, the New York Times ran an article describing the various problems that have accompanied the roll out of a central tenet of the Affordable Care Act (Obamacare), www.HealthCare.gov.   The gist of the article focuses on the technical issues that the public has encountered when trying to shop the online marketplace for health insurance.  Essentially, the volume of interested potential buyers has diminished the ease with which the site was to be navigated.

Because of the apparently gargantuan inconvenience of a website loading slowly, there is a large demand for apologies from all levels of the government, starting with President Obama and trickling down to Department of Health and Human Services Secretary Kathleen Sebelius.

Indeed, after our government’s united front in reopening the government (after a shutdown that was their fault) and subsequent dangerous proximity to reaching the debt ceiling, it was shocking that Speaker of the House John Boehner called for the Obama Administration to answer questions related to the flaws in the website’s launch.

That was sarcasm, friends.

Because a glitch in a website visited by thousands of people a day is totally a reason to delay or repeal the availability of health insurance.  That’s also sarcasm.

These problems are called growing pains! Are they annoying? Absolutely.  But they happen- there is no need to make a mountain out of a molehill.  Especially when you consider what Americans stand to gain from the Affordable Care Act.  With health insurance, more people can visit their primary care physicians for routine physicals and for small aches and pains.  It’s often small aches that turn into large medical problems.  Large medical problems lead to large medical bills.  Similarly, there are catastrophic events.  Nobody plans to get hit by a bus on their way to work.  Nobody plans to be in a car accident.  These catastrophes happen, and health insurance provides a buffer of security the necessity of which is not always readily apparent.  When you’re in the thick of medical debt, though, you wind up kicking yourself for not taking advantage of small monthly insurance payments.  The utility of medical insurance, and the costs of that insurance, can be exponentially less than the cost of catastrophic care.  Emergency room visits by the uninsured, for example, have frequently been cited as one of the primary reasons for high costs of healthcare.

This all seems unnecessary considering the fact that we’re in the world’s super power, and that there are concrete examples of how a government-mandated expansion of healthcare can thrive (take France or Sweden, for example).

Do you guys know what this is called?  It’s called a stall tactic.  It’s also called a diversion.  This “controversial” roll out of the website is meant to distract you from what’s really going on.

“Well, what’s really going on?”

Oh nothing, just thousands of people being presented with an opportunity to have a primary care physician for the first time.

Just decisions about your health being ripped from the sole decision of a private insurance company that is more concerned with their bottom line than a rash on your arm.

At the end of the day, the website problems are frustrating, but they are not insurmountable.  The failure of a website to run as efficiently as we would prefer is certainly not a reason to engage in protracted political debates, especially after being so closely linked to a sixteen day protracted political debate that left hundreds of thousands of people out of work.  Health care, for now is debatable (it shouldn’t be, but it is).  Two things that are not debatable are the necessity for protections against the unpredictable occurrences in life and the inconvenience of a website that will eventually help thousands of people.

[New York Times]

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Featured image courtesy of [Daniel Borman via Flickr]

Peter Davidson II

Peter Davidson is a recent law school graduate who rants about news & politics and raves over the ups & downs of FUNemployment in the current legal economy. Contact Peter at staff@LawStreetMedia.com.

The post Everyone, Let’s Lay Off the Obamacare Online Marketplace? appeared first on Law Street.