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:

Health Care Bill Fails in a Senate Vote Shocker

Late last night, the Senate failed to pass a “skinny repeal” of Obamacare. Three Republican senators defected. Two of the votes, Senator Susan Collins of Maine and Senator Lisa Murkowski of Alaska, were known “no’s” and had held strong through multiple repeal attempts. But the third, Senator John McCain, was a surprise. His vote was enough to kill the latest attempt in a seven-year crusade to repeal the Affordable Care Act. Scenes from the Senate floor last night were described as “tense,” as McCain indicated to his colleagues he was about to jump ship, and other members of Republican leadership tried to talk him out of it.

Late last night, the Senate failed to pass a “skinny repeal” of Obamacare. Three Republican senators defected. Two of the votes, Senator Susan Collins of Maine and Senator Lisa Murkowski of Alaska, were known “no’s” and had held strong through multiple repeal attempts. But the third, Senator John McCain, was a surprise. His vote was enough to kill the latest attempt in a seven-year crusade to repeal the Affordable Care Act. Scenes from the Senate floor last night were described as “tense,” as McCain indicated to his colleagues he was about to jump ship, and other members of Republican leadership tried to talk him out of it.

While McCain is getting much of the credit for being the third “no” vote, many are also calling for more recognition for Collins and Murkowski. After all, had McCain not come back to vote in favor of discussing the bill in the first place, he wouldn’t have needed to dramatically vote against it.

Tomorrow the headlines will focus on McCain, but let’s not forget it was Susan Collins and Senator Murkowski who held the line all the way. https://t.co/J2TWixYHC9

— Joy Reid (@JoyAnnReid) July 28, 2017

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 RantCrush Top 5: July 28, 2017 appeared first on Law Street.

And the beat goes on: Republicans on Tuesday voted–with a tiebreaking assist from Vice President Mike Pence–to move forward and debate health care legislation. Next up in the seven-year Republican crusade against Obamacare: hours of debate, possibly dozens of amendments, and, eventually, a floor vote. But the ultimate trophy of repealing and replacing the Affordable Care Act with a Republican-backed alternative remains elusive. Here is what comes next:

Debate then Vote-o-Rama

With the 51-50 vote Tuesday night on the motion to proceed, Senate Republicans are in for a long couple of days. First, they will debate for dozens of hours the various versions of the bill that have been proposed in the House and the Senate. Senators will also debate what will likely amount to dozens of amendments.

A so-called “vote-o-rama” will commence after the debate. Lawmakers from both parties will be permitted to introduce amendments to the health bill–Democratic aides have hinted the party will flood Republicans with amendments to trip up their efforts. Each amendment will be allotted one minute of debate before a vote, and the entire process can go on as long as is needed.

Option 1: Repeal and Replace

Senate Majority Leader Mitch McConnell (R-KY) has been leading the repeal-and-replace charge over the past seven years, and it falls to him to corral his fellow Republican senators to agree on a bill. McConnell’s ideal scenario would be to repeal Obamacare and replace it with a health law that suits Republican priorities.

But the majority leader has so far struggled to align moderate GOP lawmakers and the Senate’s most conservative members behind a single bill. Several Senators have stated their opposition to prior health care legislation either because of Medicaid cuts or its insufficient conservative bona fides. McConnell scored a small victory with Tuesday’s motion to proceed vote, but can he rally enough of his troops to agree on a common strategy?

The first attempt at passing comprehensive legislation failed on Tuesday evening, as nine Republicans broke ranks and opposed the Better Care Reconciliation Act (BCRA) by a 43-57 margin in a crucial procedural vote. That bill was Republicans’ primary choice to repeal and replace Obamacare and included two amendments to try to reconcile the party’s disparate corners.

The first, introduced by Sen. Rob Portman (R-OH), would add $100 billion to a stability fund to help offset slashed Medicaid funds. A second amendment, introduced by Sen. Ted Cruz (R-TX), would allow insurers to sell pared down plans as long as they concurrently sell more comprehensive plans that meet certain Obamacare requirements. Further votes on various versions of the BCRA or alternative bills could happen later this week.

Option 2: Repeal Only

A number of Republican Senators have already stated they will not support a repeal bill in the absence of replacement legislation. As early as Wednesday afternoon, a vote could be held on a repeal bill similar to one vetoed by President Barack Obama in 2016. According to the Congressional Budget Office, that bill would lead to 32 million more uninsured Americans within 10 years.

Another idea that has been floated is known as a “skinny repeal,” which would eliminate a few of Obamacare’s provisions while still leaving intact others. The narrow repeal would get rid of Obamacare’s individual and employer mandates, which required individuals to have health insurance coverage and employers to provide insurance or pay a penalty. It may also repeal Obamacare’s medical device tax. It’s possible that the “skinny repeal” bill could dramatically change when the House and Senate meet to reconcile each chamber’s respective bills.

The road ahead is still long and filled with potentially unbridgeable divides. Immediately following Tuesday’s vote, a number of Republicans suggested they would not support a bill that is not significantly different than what has already been presented.

Sen. Dean Heller (R-NV) said: “If the final product isn’t improved for the state of Nevada, then I will not vote for it; if it is improved, I will support it.” And Sen. John McCain (R-AZ), who returned from his week-long absence on Tuesday to cast a “yea” vote on the motion to proceed, said: “Asking us to swallow our doubts and force it past a unified opposition–I don’t think that’s going to work in the end, and probably shouldn’t.” McCain, who was recently diagnosed with brain cancer, said it “seems likely” the effort would fail.

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’s Next in the Republicans’ Effort to Repeal and Replace Obamacare? appeared first on Law Street.

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:

The Senate is Voting on…Something?

Today, the Senate will vote on something to do with health care, but it’s not clear exactly what. The Senate has been working to pass, or at least debate, some sort of bill to repeal and replace Obamacare for weeks, but the most recent efforts were derailed when senators couldn’t agree on the “replace” portion. After that, Senate Majority Leader Mitch McConnell started pushing for a “repeal now, replace later” approach.

One of the challenges for Senate Republican leadership is that no more than two Republican senators can defect. Senator Susan Collins of Maine has made it clear that she intends to vote “no.” While Senator John McCain, who was diagnosed with brain cancer last week, is reportedly returning to Capitol Hill to cast his vote, other defections could stop McConnell’s plan to move any sort of action forward. All eyes are now on two senators who seem likely to join Collins in dissension–Senator Shelley Moore Capito of West Virginia and Senator Lisa Murkowski of Alaska.

Regardless of what happens today, the secretive nature of the procedures have frustrated many:

Health care vote today.

– No final text
– No final Byrd guidance
– No final CBO score
– No public hearingshttps://t.co/SCxwL0g5Ev

— Dylan Scott (@dylanlscott) July 25, 2017

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 RantCrush Top 5: July 25, 2017 appeared first on Law Street.

In 2015, the United States spent a staggering $3.2 trillion on health care, or nearly $10,000 per capita–amounting to 17.8 percent of U.S. gross domestic product. Health care is one of the most expensive components of the federal budget, and health spending comes in a variety of different forms, including major public programs, direct subsidies, and a number of different provisions in the tax code.

While big insurance programs like Medicare and Medicaid tend to be the focus of most health care discussions, and account for most of the spending, the government provides and subsidizes health care in ways that many might not realize. Given the rising prominence of the health care industry in our budget and in our economy, it’s important to look at the current role played by the federal government. Read on to see how the government provides and incentivizes health insurance coverage and how much these efforts cost.

Government Health Care Programs

Two government programs account for a large portion of health care spending, and federal spending in general. Medicare and Medicaid are two entitlement programs that together account for roughly 25 percent of the federal budget. In 2016, the U.S. government spent a net total of $588 billion on Medicare, the health insurance program covering all Americans over the age of 65. Federal spending on Medicaid, which provides health insurance to people with disabilities, the elderly, children, and people with low incomes, totaled $368 billion last year. Because Medicaid is a federal-state partnership, states also account for a notable portion of health care spending. In 2016, federal funding covered about 63 percent of all Medicaid spending, excluding administrative costs. The remaining 37 percent, or about $204.5 billion, was held by the states.

It’s worth noting that along with Social Security, Medicare and Medicaid are the largest mandatory spending programs–spending that is built into existing laws and is not subject to annual appropriation bills. Forecasts predict that these programs will grow as a share of the federal budget in the coming years as the Baby Boomer generation retires. In its most recent forecast, the Congressional Budget Office (CBO) predicts, “outlays for mandatory programs increase as a share of GDP by 2.4 percentage points from 2017 to 2027–mainly because of the aging of the population and rising per capita health care costs. Social Security and Medicare account for nearly all of that increase.” Last year, Social Security amounted to 4.9 percent of U.S. GDP and spending on major health programs amounted to 5.4 percent of GDP.

In addition to Medicaid and Medicare, the government provides subsidies for people with incomes between 100 and 400 percent of the federal poverty level and who do not get health insurance through their employer. According to the CBO, the government spent $42 billion in 2016 on subsidies and other costs related to the individual insurance market.

The video below from the Brookings Institution gives an overview of health care spending trends over the past several decades:

The Tax Code

While the various provisions of the tax code that encourage individuals and companies to buy health insurance might not sound all that interesting, tax policy is a crucial part of the current health care system, and accounts for a significant amount of spending, or more precisely, foregone revenue.

Employer-provided Insurance

The government uses the tax code to encourage and discourage a wide range of behaviors. To encourage individuals and businesses to do certain things, the government uses tax expenditures, more commonly known as tax breaks. These provisions in the tax code forego tax revenue when people or businesses engage in certain activities. The largest of the existing tax expenditures deals with health care spending by employers. Specifically, the tax code excludes all spending toward employees’ health care premiums from taxation. This exclusion encourages employers to provide certain benefits to their employees because they can use pre-tax dollars to do so–if the same amount of money was given to employees in the form of traditional wages, it would be taxed. The exclusion is projected to cost about $260 billion in 2017, based on what the government would otherwise receive in payroll and income taxes. That annual cost makes the health care exclusion the third largest health care program, following Medicaid and Medicare.

The tax exclusion of employer provided health care dates back to World War II and emerged almost accidentally. In an effort to control inflation, the federal government froze wages, which prevented companies from paying their employees more. Instead, employers took advantage of an exception that applied to certain benefits–they started providing health insurance plans. Then in 1954, the IRS determined that payments toward employee health insurance are exempt from taxation. Over time, employer-subsidized health care became quite common, and today, most Americans get health care from their employer or a close family member’s employer.

While the tax exempt status of employer-provided health care has become particularly popular and politically durable–efforts to eliminate or even cap the tax benefits have not gotten very far–many economists believe that it has a distortionary effect on the health care system as a whole. The most frequent criticism of employer-subsidized health care is that it can spur growth in medical costs. Because premium payments are excluded from taxation, employers are incentivized to offer very generous health insurance plans instead of simply paying their employees higher wages. Economists argue that if more of the cost burden was placed on consumers when they use medical services, they would try to reduce those costs by searching for lower prices and avoiding unnecessary care. But when most of the cost of health care is masked by generous insurance plans, there is little incentive for individuals to cut costs.

Other criticisms of employer-subsidized health care focus on concerns about equity and progressivity. People with high incomes are more likely than those with lower incomes to benefit from health-related tax expenditures, of which employer-subsidized health care is by far the largest in value. Moreover, the nature of the tax exclusion makes it more valuable to people with high-incomes than those lower on the income scale. Because income tax is progressive–those with higher incomes pay higher tax rates–pre-tax money spent on health care is worth more to those with higher incomes because it would otherwise be taxed at a high rate. In 2015, about 45 percent of all benefits from health tax expenditures went to individuals with incomes in the top 20 percent, while just 0.5 percent of all benefits went to those in the bottom 20 percent.

Efforts to eliminate or curtail the tax preference for employer-sponsored health care date back to Reagan’s presidency, but few have made any notable progress. One notable exception is what’s known as the “Cadillac tax,” which was a part of the 2010 Affordable Care Act. The Cadillac tax, formally known as the high-cost plan tax, sought to rein in health care cost growth by discouraging employers from providing extremely generous health insurance plans. Health insurance premiums payments in excess of $10,200 for an individual or $27,500 for families will face a 40 percent excise tax. The tax was originally scheduled to take effect in  2018 but was pushed back to 2020 after widespread opposition in 2015. Both businesses and unions strongly protested the tax, which may be one issue that both Republicans and Democrats can agree on. While it is still scheduled to go into effect in a couple years, questions about its fate loom as recent health care legislation would push its implementation back even further.

Conclusion

Peter Fisher, a former under secretary at the Treasury Department, once famously advised, “Think of the federal government as a gigantic insurance company […] with a sideline business in national defense and homeland security.” When you look at the federal budget, you can see that Fisher’s comments are rooted in an important truth–health insurance is one of the most expensive aspects of the federal budget.

The government plays a large, if sometimes unnoticed, role in the American health care system. From major programs like Medicare and Medicaid, which together add up to roughly one-quarter of the entire budget, to tax provisions that encourage employers to provide insurance to their workers, the government has a hand in nearly everyone’s insurance. Rising health care costs have led to notable budgetary issues in the long term, particularly as the American population ages, which have led some to argue that entire programs need to be revamped to keep spending sustainable. While many agree that health care spending has gotten unusually high in recent years, actually controlling costs has proven challenging.

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 Much Does the Government Spend on Health Care? appeared first on Law Street.

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:

The Health Care Bill Goes from Dying to Dead

The outlook for the Senate Republican health care bill hasn’t been particularly rosy since its introduction. But things got even worse for Senate Majority Leader Mitch McConnell last night, when two more senators said they wouldn’t be voting for it. Senators Mike Lee of Utah and Jerry Moran of Kansas both said they oppose moving forward with the bill, joining Susan Collins of Maine and Rand Paul of Kentucky in their opposition.

After the news broke, McConnell said he would call for a vote to repeal Obamacare now, and come up with a replacement later. While that may appeal to far-right defectors like Paul, Lee, and Moran, it is sure to concern more moderate Republicans who want to ensure that things like Medicaid funding stay in place. For example, Senator Shelley Moore Capito of West Virginia–often cited as a potential to vote against the Senate health care bill in the first place–has already said she’s not in favor of that strategy. And President Donald Trump is blaming the Democrats for the bill’s failure…despite the fact that had all the Republicans in the Senate banded together, the bill could have passed.

We were let down by all of the Democrats and a few Republicans. Most Republicans were loyal, terrific & worked really hard. We will return!

— Donald J. Trump (@realDonaldTrump) July 18, 2017

With only a very small majority, the Republicans in the House & Senate need more victories next year since Dems totally obstruct, no votes!

— Donald J. Trump (@realDonaldTrump) July 18, 2017

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: July 18, 2017 appeared first on Law Street.

Last week, Judge Nicholas Francis of the Family Division in the U.K.’s High Court of Justice ruled that Charlie Gard’s parents had 48 hours to present evidence that experimental treatment will improve their son’s condition. At a subsequent hearing on Thursday, the judge decided that Gard should be evaluated by an American doctor who claims that an experimental treatment may improve his condition.

“I have to decide this case not on the basis of tweets, not on the basis of what might be said in the press, or to the press,” Judge Francis said last week as he gave his initial ruling, alluding to the global interest in the case.

But how has this case garnered so much attention from people in the U.K., people across the world, and even world leaders? Read on to learn more about the Charlie Gard case and the controversy surrounding it.

Who is Charlie Gard?

Charlie Gard, born August 4, 2016, suffers from a rare genetic condition known as mitochondrial DNA depletion syndrome (MDDS). It is caused by a mutation in which the cells’ mitochondria stop functioning. More specifically, Charlie has RRM2B encephalomyopathic MDDS, which progresses rapidly and can lead to death within a few months. There is currently no known cure.

Gard developed normally for the first two months of his life, but by mid-October, he was on life support at the Great Ormond Street Hospital (GOSH) in London. Today, at eleven months old, Charlie is unable to breathe without a ventilator, open his eyes, hear, eat unassisted, or move his limbs. His heart and kidneys are failing, and he suffers from persistent severe seizures.

What Can Be Done?

His parents, Chris Gard and Connie Yates, want him to undergo an experimental treatment called nucleoside therapy, which has shown some success in treating mitochondrial disease in laboratory mice.

The therapy was used in Baltimore on Arturito Estopinan, a boy suffering from TK2-related mitochondrial depletion system. His father, Art Estopinan, met with Gard and Yates and discussed the treatment. According to him, while the treatment is by no means a cure, Arturito is “getting stronger every day.”

The video below goes into more detail about Estopinan’s treatment.

The treatment has never been used on mice or humans suffering from RRM2B MDDS and it is currently unavailable in the U.K.

According to the family’s GoFundMe page, a doctor in the U.S. accepted Charlie into the treatment program of their own hospital. So far, the family has received over 1.3 million euros in donations to get Charlie to the U.S. and pay for the treatment.

The Court Battle

The doctors at GOSH, however, are opposed to the idea. Although they applied for and received ethical permission to treat Charlie with nucleoside therapy, the baby’s condition had worsened so drastically by that time that they decided against moving forward with the treatment. The view is that his brain damage is too severe for treatment to be of any help, and that it would be kinder to let Charlie die with dignity. Against the parents’ wishes, they planned to take Charlie off life support, court documents show.

In the U.K., when parents and doctors disagree over the treatment of a sick child, the courts step in. Gard’s case went to the High Court, with Justice Francis presiding. On April 11, he ruled, “with the heaviest of hearts” that the hospital “may lawfully withdraw all treatment, save for palliative care,” and that it was in Charlie’s best interest not to undergo the experimental therapy. The Court of Appeals upheld the decision on May 25. The Supreme Court reviewed the case on June 8 but ultimately agreed with the lower court’s ruling. The family’s lawyers then petitioned the European Court of Human Rights, but on June 27, the court rejected the plea and ruled that Charlie’s life support would be turned off on June 30. GOSH later extended the deadline after Gard and Yates posted a video message blasting the hospital for not allowing them to take their son home to die.

The World Weighs In

Before the extension was announced, Pope Francis tweeted a message of support to the Gard family:

To defend human life, above all when it is wounded by illness, is a duty of love that God entrusts to all.

— Pope Francis (@Pontifex) June 30, 2017

There may not have been any names, but papal spokesperson Greg Burke clarified the pope’s meaning the next day by retweeting the message and adding #CharlieGard.

“The Holy Father follows with affection and commotion the situation of Charlie Gard, and expresses his own closeness to his parents,” Burke said in a statement. “He prays for them, wishing that their desire to accompany and care for their own child to the end will be respected.”

In addition, the Vatican-owned Bambino Gesu Hospital in Rome asked to have Charlie Gard transferred there, but representatives from GOSH refused due to legal reasons.

The pope’s tweet may have come as a response to the Pontifical Academy for Life, which put out its own statement three days prior. While supportive of Gard and Yates, the statement, signed by Archbishop Vincenzo Paglia, vacillates between middle-of-the-road and sympathetic to the decision of the European Court of Human Rights. “The proper question to be raised […] is this: what are the best interests of the patient? We must do what advances the health of the patient, but we must also…avoid aggressive medical procedures that are disproportionate to any expected results,” the statement reads. The Academy’s words raised eyebrows and ire across the board.

Whether rebuking his fellows or not, the pope is not alone in his support for the family’s efforts. Three days later, on July 3, President Donald Trump weighed in on the case:

If we can help little #CharlieGard, as per our friends in the U.K. and the Pope, we would be delighted to do so.

— Donald J. Trump (@realDonaldTrump) July 3, 2017

The tweet brought Gard’s case to America’s attention and raised support among the president’s fellow pro-life conservatives. An unnamed U.S. hospital offered Gard free treatment. Congressmen Brad Wenstrup (R-Ohio) and Trent Franks (R-Arizona) have promised to introduce a bill to give Charlie Gard lawful permanent resident status in the United States when Congress returns from recess. Rev. Patrick Mahoney–a pro-life evangelical preacher and president of the Christian Defense Coalition–flew to the U.K. last week as a self-appointed spokesperson for the Gard family. He claims to have met with a senior White House official beforehand and says he is currently keeping President Trump updated on the case.

Meanwhile, Prime Minister Theresa May voiced support for the hospital, saying, “I am confident that GOSH have and always will consider any offers of new information that has come forward for the well-being of a desperately ill child.” Foreign Secretary Boris Johnson agrees. In a conversation with his Italian counterpart, Johnson said it is “right that decisions continued to be led by expert medical opinion, supported by the courts.”

Vice President Mike Pence referred to Charlie’s case during an interview on Rush Limbaugh’s radio show on Monday, adding fuel to the fire in an entirely different way. “We hope and pray that little Charlie Gard gets every chance,” he said, “but the American people ought to reflect on the fact that for all the talk on the left about single-payer, that’s where it takes us.”

Back in Court

On July 7, GOSH applied to the High Court for a new hearing in light of other doctors’ claims that the treatment may help Gard. While not changing its views on the treatment or its effect on Charlie, the hospital acknowledged statements made by doctors in the United States and Vatican hospitals and is willing to explore the claims that the treatment would benefit Charlie.

The following Sunday, Gard and Yates presented a 350,000-signature petition urging the hospital to allow their son to travel to the U.S. for treatment.

The July 10 preliminary hearing, prior to Judge Francis’ above ruling, was fraught with emotion, including an outburst from Chris Gard. “When are you going to start telling the truth?” he screamed at the lawyer representing the hospital. At a different point, when his own lawyer reported that a U.S. doctor estimated a 10 percent chance of saving Charlie with the experimental treatment, Yates asked the judge, “You would if it was your son, wouldn’t you?” Judge Francis assured her that he would take that into account during Thursday’s hearing. “I don’t think there’s anyone involved who wouldn’t want to save Charlie,” he added.

Two hours into Thursday’s hearing, there was another altercation between the judge and the parents. When Judge Francis paraphrased the parents’ earlier comments about not wanting their son to live if there were no prospect of improvement, Yates shouted, “I never said that” and reiterated that she did not think Charlie was suffering. She and her husband then stormed out of the courtroom but returned an hour later.

On Friday, Judge Francis said that Dr. Michio Hirano, a specialist in neurology at the Columbia University Medical Center, will evaluate Gard before the court makes its decision. According to  The Mirror, a lawyer for GOSH stated the hospital invited Dr. Hirano to see Charlie back in January, but the visit never happened. In addition, Dr. Hirano reportedly never saw Charlie’s medical records or MRI scans, only summaries. He did, however, claim in his testimony (via video link) that Charlie has somewhere between an 11 and 56 percent chance of improving with the therapy. Judge Francis then determined that Dr. Hirano should travel to the U.K. and assess Charlie in person. He arrived early last week and met with several of Charlie’s GOSH caregivers and other specialists, including a doctor from the Vatican Children’s Hospital.

Judge Francis hopes to give his final verdict by July 25.

Conclusion

What started as one family’s tragedy has become a worldwide phenomenon. A combination of public appeals through social media and support from high-profile individuals has put Charlie and his family in the spotlight. It is difficult to say, though, whether or not this attention will help them in the end. Many cynical observers have wondered if politicians are taking advantage of the Gard family’s situation to push their own agendas. A variety of issues–from health care to government overreach to the right to life–will be shaken by the case’s final verdict. For now, though, Charlie remains on life support, and the world joins his parents in watching over him.

Delaney Cruickshank

Delaney Cruickshank is a Staff Writer at Law Street Media and a Maryland native. She has a Bachelor’s Degree in History with minors in Creative Writing and British Studies from the College of Charleston. Contact Delaney at DCruickshank@LawStreetMedia.com.

The post Breaking Down the Charlie Gard Treatment Controversy appeared first on Law Street.

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.

The post Senate Republicans Release Revised Health Care Plan appeared first on Law Street.

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.

The post By the Numbers: Health Insurance Coverage in the United States appeared first on Law Street.

Maryland is officially the first state with a law in place to protect funding for Planned Parenthood. The Maryland General Assembly passed a law in April ensuring the organization’s continuity; the law went into effect on July 1.

SB 1081 establishes the Family Planning Program in the Department of Health and Mental Hygiene and provides that Maryland will pay for Planned Parenthood’s health care services in the state if Congress cuts off funding for the organization. The bill, which was backed by a veto-proof majority in Maryland’s House of Delegates and Senate, became law without Maryland Governor Larry Hogan’s signature.

Karen J. Nelson, CEO of Planned Parenthood of Maryland, applauded the law’s passage in April but also highlighted the continuing fight for health care nationwide.

“As Marylanders, we must remember that a state solution does not change the fact that politicians in Congress are trying to prohibit millions of people from accessing care at Planned Parenthood,” Nelson said. “It’s incumbent on all of us to keep up the fight for women. No state should have to step in to fulfill the federal government’s responsibility to ensure everyone has access to care.”

In addition to defunding Planned Parenthood for one year, the U.S. House of Representatives and Senate health care bills include sweeping cuts to Medicaid spending. Supporters of Planned Parenthood joined other protesters on June 27 to specifically protest the Senate’s health care bill, including a group of activists dressed as women from “The Handmaid’s Tale.”

There are nine Planned Parenthood locations in Maryland, and their funding will be protected by the legislation. However, the future for Planned Parenthood is less promising in other states. Take Iowa for example–four of its Planned Parenthood clinics have recently closed. Iowa has approved a state budget that cut off the organization’s funding. Some Iowans fear that more closures could be on the horizon if the Senate’s health bill passes.

Planned Parenthood President Cecile Richards condemned Iowa’s defunding of Planned Parenthood on social media.

Today, a devastating “defunding” law in Iowa is forcing 1/3 of our health centers in the state to close.

— Cecile Richards (@CecileRichards) June 30, 2017

Here’s what that means: nearly 15,000 people will lose access to the doctors and nurses they trust. https://t.co/DMQ6NAUzwf pic.twitter.com/dwCDSuZ9Cd

— Cecile Richards (@CecileRichards) June 30, 2017

If other states follow in Iowa’s footsteps instead of Maryland’s, health care services could be in jeopardy for those states’ citizens who rely on Planned Parenthood.

Marcus Dieterle

Marcus is an editorial intern at Law Street. He is a rising senior at Towson University where he is double majoring in mass communication (with a concentration in journalism and new media) and political science. When he isn’t in the newsroom, you can probably find him reading on the train, practicing his Portuguese, or eating too much pasta. Contact Marcus at Staff@LawStreetMedia.com.

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The Senate Health Care Bill Debate Continues

Yesterday, the nonpartisan Congressional Budget Office released its analysis of the Senate health care bill, and said that 22 million people would lose health care coverage by 2026 if the new bill passes. In just one year, 15 million would be uninsured. Premiums and out-of-pocket expenses could increase dramatically for some low-income people and retirees. Also, the American Medical Association announced its opposition to the bill and said that it violates the long-standing medical principle of “first, do no harm.”

A few Republican senators have already said they will not vote for the bill–yesterday, Susan Collins and Rand Paul joined Dean Heller in standing against the bill. Others have expressed doubts. Majority Leader Mitch McConnell had aimed for a vote on the bill before the July 4 recess, but it doesn’t seem like that will happen. However, the bill would reduce the federal deficit by $321 billion over 10 years. The White House slammed the CBO, claiming the nonpartisan organization is “unreliable.”

The GOP cajoling to vote for the Senate health bill is:

“Vote for this bill or if we’re not careful, everyone will have health care.” pic.twitter.com/kCaENJLkd8

— Andy Slavitt (@ASlavitt) June 27, 2017

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: June 27, 2017 appeared first on Law Street.

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.

The post One Question That Will Help You Understand the Republican Health Care Bill appeared first on Law Street.

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:

It’s Health Care Bill Reveal Time!

This morning, Senate Republicans unveiled the draft of the new health care bill. They’ve been working on this bill behind closed doors for weeks now. House Republicans passed a first version of the bill last month, but President Trump urged the Senate to pass a “more generous” version. Under that House bill, 23 million people could lose their health care coverage. The Senate version is pretty similar to the House bill, except even less generous. Perhaps unsurprisingly, in the Senate version there are massive cuts to Medicaid, and it undoes important parts of Obamacare, like the individual mandate. It also eliminates Planned Parenthood funding.

BREAKING: Full text of the Senate’s closely-guarded health care bill has posted online. Read it: https://t.co/tWGoaC4whm pic.twitter.com/T18BUSFpTf

— CNN (@CNN) June 22, 2017

“Republicans are writing their health care bill under the cover of darkness because they are ashamed of it,” claimed Senate Minority Leader Chuck Schumer earlier this week.

via GIPHY

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: June 22, 2017 appeared first on Law Street.

Weeks after House Republicans passed a health care bill, GOP senators are drafting their own version of a law that would repeal and replace Obamacare. Among a variety of differences between the two Republican efforts, one is especially rankling to Democrats: the senators of the Budget Committee are cobbling together their bill in secret. According to a number of Senate aides, nobody outside that committee, including a number of Republican senators, has seen the bill’s precise language.

Influential Senate Democrats took to Twitter to pillory the secretive Republican process:

My advice today: focus 10% of your attention/outrage on Sessions testimony, 90% on the secret health care bill that is speeding to a vote.

— Chris Murphy (@ChrisMurphyCT) June 13, 2017

 Senate Majority Leader Chuck Schumer (D-NY) said Republicans “are trying to pass a health care bill in the dead of night.” He added:

If they were proud of this plan, they wouldn’t hide anything – they’d crow all about it! What exactly are they trying to cover up? 5/7

— Chuck Schumer (@SenSchumer) June 12, 2017

Republicans are hoping to vote on the bill by the July 4 recess, which gives them a window of a couple of weeks to finish drafting the bill, and send it to the Congressional Budget Office for a review. The CBO, a non-partisan analysis agency, released its evaluation of the House health care effort a few weeks after the bill was passed. It found that the bill could result in 23 million more uninsured Americans.

A CBO evaluation could take up to two weeks, so if Republicans hope to vote on the Senate bill by July 4, it would have to be completed in the coming days. But even as the bill nears completion, some high-ranking Republican senators are being kept in the dark as well.

“I want to know exactly what’s going to be in the Senate bill, I don’t know it yet,” Senator Ron Johnson (R-WI) recently told reporters. “It’s not a good process.” And Senator Lindsey Graham (R-SC) said “this is not the best way to do health care, but it’s the way we’re having to do it,” adding that the only thing about the bill he’s aware of is that “they’re writing it.”

While the particulars of the bill are largely unknown, there have been reports about some of its broad outlines. Overall, the bill is expected to be left of the legislation the House passed last month. Medicaid expansions would be phased-out over seven years instead of two, and tax credits would be offered to a broader range of low-income individuals.

Once the bill is out in the open, and hits the Senate floor for a vote, it faces a fractured chamber, not to mention a complete lack of Democratic support. To pass, the bill will need the support of a diverse contingent of Republican Senators–the more conservative members, like Senator Mike Lee (R-UT) and Senator Ted Cruz (R-TX), and more moderate ones, like Senator Susan Collins (R-ME) and Senator Lisa Murkowski (R-AK).

Meanwhile, Senator Bernie Sanders (I-VT), tweeted perhaps the most creative critique of the secretive Republican effort:

BREAKING: Senate Republicans just released the schedule of hearings, committee markups and public testimony for their health care bill. pic.twitter.com/iHtXyZqyMW

— Bernie Sanders (@SenSanders) June 12, 2017

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 Senate Republicans’ Health Care Effort is Cloaked in Secrecy appeared first on Law Street.

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:

Trump Allegedly Leaked Classified Information to the Russians

Last night, it was revealed that President Donald Trump disclosed highly classified information during his meeting with the Russian foreign minister and ambassador. This information involved an ISIS plot to use laptop computers on airplanes, and was so sensitive that details about it were withheld from other U.S. allies and even from some agencies within the U.S. government. According to the Washington Post, Trump allegedly also mentioned the specific city in which the threat had been discovered.

An official confirming Post story to us and says, ““it’s far worse than what has already been reported” https://t.co/xPggSHW9Bt

— Ben Smith (@BuzzFeedBen) May 15, 2017

The meeting in question took place the day after Trump fired former FBI Director James Comey, who was investigating the Trump/Russia ties. American journalists were blocked from attending the meeting, while a Russian photographer was allowed in. Now some U.S. officials have called the news shocking and reckless, and Democratic Congressman Al Green called for Trump’s impeachment, saying that he’s not above the law and that he must be charged. This morning, Trump seemed to admit that he did share the information, even after the White House completely denied the allegations last night. This is a mess that could have serious consequences.

it’s fun to recall that Trump’s campaigned for president on a platform of handling of classified intel securely and proper records retention

— Tim Murphy (@timothypmurphy) May 15, 2017

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: May 16, 2017 appeared first on Law Street.

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.

The post How Did Health Insurance Regulations Reduce Traffic Deaths? appeared first on Law Street.

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.

Following their failed effort to pass health care legislation in March, House Republicans are set to vote on a bill Thursday that would repeal and replace large chunks of the Affordable Care Act. According to House Majority Leader, Rep. Kevin McCarthy (R-CA), the bill has secured enough votes to pass. “We have enough votes,” he said on Wednesday night. “It’ll pass.”

The renewed push for a Republican health care overhaul began in mid-April when Rep. Tom MacArthur (R-NJ) introduced an amendment aimed at attracting the more conservative congressmen who balked at the initial bill. The so-called MacArthur amendment needed a boost, however, and Rep. Fred Upton, a Republican from Michigan, recently introduced another addition to the law: an $8 billion infusion for insurers to cover patients with pre-existing conditions.

“It’s our understanding that the $8 billion over the five years will more than cover those that might be impacted and, as a consequence, keeps our pledge for those that, in fact, would be otherwise denied [coverage] because of pre-existing illnesses,” Upton said at the White House on Wednesday.

Even if the bill passes the House, Republicans in the Senate could gum it up and give it a major facelift to attract Democratic support and make it more palatable to members of their own party. With a 52-48 majority in the Senate, Republicans have a much narrower margin of error. In order for the bill to pass the Senate, it would need 60 votes–eight Democrats would need to support it.

Republican Senators in states that expanded Medicaid under Obamacare–like Ohio and West Virginia–would likely take issue with the Republican bill’s squeeze on Medicaid payments. And hard-line conservatives like Mike Lee (UT) and Ted Cruz (TX), could nudge the bill more to the right. Senate Majority Leader Mitch McConnell (R-KY) told reporters passing the bill will “be a real big challenge on the Senate side as well.”

Meanwhile, the top ranking Democrats in the House and Senate, Nancy Pelosi (CA) and Chuck Schumer (NY) respectively, strongly rejected the new Republican bill. Schumer tweeted that Upton’s amendment is “like trying to cure stage 4 cancer with cough medicine.” Pelosi, in public remarks on Thursday morning from Capitol Hill, said “Republicans are in a lose-lose situation.” She added that for Republicans supporting the Obamacare replacement bill, “This is a scar that they will carry.”

A number of health industry organizations, including the American Heart Association, American Cancer Society, and AARP, have expressed their opposition to the bill. Andrew Gurman, president of the American Medical Association, said Upton’s amendment and other changes “tinker at the edges without remedying the fundamental failing of the bill–that millions of Americans will lose their health insurance as a direct result of this proposal.”

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 If the Health Care Bill Passes the House, Will it Pass the Senate? appeared first on Law Street.

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:

Will the New Health Care Bill Pass?

Republicans are set to vote on the revised version of their health care bill today, but it is still unclear if it will pass this time. The last version of the bill failed “bigly,” but this time House Majority Leader Kevin McCarthy says the GOP has enough “yes” votes to pass the bill. Recent changes to the bill would allow states to get waivers to redefine essential health benefits required in insurance plans, like mental health care or maternity care. Waivers would also allow insurance companies to charge more for people with pre-existing conditions, potentially pricing them out of the insurance market.

As late as Monday, some Republicans were still undecided, especially because of the pre-existing conditions part. But then yesterday, the GOP decided to add $8 billion to the bill to help cover people with pre-existing conditions, and some Republicans that had been undecided threw their support behind the bill. While $8 billion may be enough for the bill to pass in the House, it won’t be enough to cover Americans with pre-existing conditions.

The American people should understand that what Republicans are trying to do to health care today is a disgrace. https://t.co/rhAzY3udVL

— Bernie Sanders (@SenSanders) May 4, 2017

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: May 4, 2017 appeared first on Law Street.

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:

Trump is Getting Rid of Michelle Obama’s “Let Girls Learn”

Michelle Obama’s signature initiative for girls’ education, “Let Girls Learn,” will exist no longer. The program started in 2015 and focuses on education for girls in developing countries. White House officials have leaked that the program’s operations will end right away. Some aspects of the program will continue, but the name will no longer be used and it will cease to be a standalone program.

Tina Chen, Michelle Obama’s chief of staff, said that it was a disappointment considering the global recognition the initiative had. It also had bipartisan support and several years of funding already in place. Also yesterday, the new agriculture secretary, Sonny Perdue, announced changes to another one of Michelle’s initiatives–healthy school lunches. Perdue claimed that kids don’t like the healthier food with less sodium. “If kids aren’t eating the food, and it’s ending up in the trash, they aren’t getting any nutrition, thus undermining the intent of the program,” he said.

How is this moving the country forward and “Making America Great Again”? #trump100days https://t.co/0ijsKBj1LZ

— Delal Pektas (@delalpektas) May 1, 2017

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: May 2, 2017 appeared first on Law Street.

As Congress returns from a two-week recess–the Senate returns on Monday, the House Tuesday–its legislative to-do list is stuffed to the brim. President Donald Trump is expected to propose a tax plan on Wednesday. He has suggested a revamped version of the Republican health care plan, which failed to hit the House floor for a vote last month, could be introduced this week. But foremost on Congress’ agenda: passing a government spending bill and staving off a government shutdown, a prospect that would be deeply embarrassing for an administration that will see its 100th day in office on Saturday.

Funding for the government, absent a spending agreement, is set to run out on Friday. To avoid a shutdown–which last occurred in 2013 when congressional Republicans and former President Barack Obama were deeply divided–the White House will have to come to an agreement with Congress. Many Democrats and Republicans on Capitol Hill differ with the administration in their spending priorities, especially when it comes to Trump’s long-promised border wall between the United States and Mexico.

Many GOP lawmakers, and most, if not all, Democrats oppose paying for the wall with funds from the government’s coffers. Trump is adamant on following through on a promise that he sees as central to his election victory, however. On Sunday morning, the president reiterated his promise that Mexico will pay for the wall but asked for funding in the meantime:

Eventually, but at a later date so we can get started early, Mexico will be paying, in some form, for the badly needed border wall.

— Donald J. Trump (@realDonaldTrump) April 23, 2017

Attorney General Jeff Sessions, a security hawk who is generally seen as a hard-liner on immigration, recently said the wall will get funded “one way or another.” On NBC’s “Meet the Press,” Reince Priebus, Trump’s chief of staff, said: “We expect money for border security in this bill.” Priebus added: “And it ought to be. Because the president won overwhelmingly. And everyone understands the border wall was part of it.”

Mick Mulvaney, Trump’s budget director, also insists the administration will push hard for the border wall to be included in a final budget agreement. “We want our priorities funded and one of the biggest priorities during the campaign was border security, keeping Americans safe and part of that was a border wall,” he said on “Fox News Sunday.” Mulvaney did add, however, that Trump would sign a bill that did not include funding for the wall. “I don’t think anybody is trying to get to a shutdown. Shutdown is not a desired end. It’s not a tool. It’s not something that we want to have,” he said.

On Friday, the administration floated a proposal to bridge the divide with Democrats–whose support for a final budget deal is vital to keeping the government afloat–on the border wall issue. For each dollar spent on the wall, according to the administration’s offer, the government would spend a dollar on Obamacare subsidies. Through a spokesman, Sen. Chuck Schumer (D-NY), the minority leader, said the trade-off idea was a “complete non-starter.”

Trump, who is still hoping to secure a legislative achievement by his 100-day mark, sent a tweet on Sunday morning that encapsulated his lack of leverage heading into the budget battle with Democrats:

ObamaCare is in serious trouble. The Dems need big money to keep it going – otherwise it dies far sooner than anyone would have thought.

— Donald J. Trump (@realDonaldTrump) April 23, 2017

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’s Border Wall: the Issue That Could Shut Down the Government 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.

After bungling an attempt to overhaul Obamacare last month, it looks like Republicans will give health care reform another go. Tom MacArthur, a Republican congressman from New Jersey, recently proposed an amendment to the failed GOP effort, the American Health Care Act, eponymously titled the MacArthur Amendment. First reported by Politico on Thursday, the amendment is an attempt to placate moderate Republicans and far-right conservatives like the House Freedom Caucus, a bloc that helped sink the original bill.

President Donald Trump, whose 100th day in office–a standard marker of a president’s effectiveness–is on April 29, is seeking a legislative victory. But Congress will have its plate full next week, as it rushes to pass a government spending bill and, perhaps more important than passing a new health care bill, needs to come together to avoid a government shutdown. Trump, in a news conference on Thursday, sounded fairly confident that the new health care plan would rally House Republicans–something the first attempt utterly failed to do.

“We have a good chance of getting it soon,” Trump said. “I’d like to say next week, but it will be — I believe we will get it. And whether it’s next week or shortly thereafter.” The president, cognizant of the 100-day review tradition, added: “The plan gets better and better and better, and it’s gotten really, really good, and a lot of people are liking it a lot.”

MacArthur’s proposed changes to the AHCA, which did not make it to the House floor for a vote, revolve around giving states the option of opting out of requirements if they show growth. For instance, the amendment retains the requirements for insurers to offer guaranteed coverage for emergency services and maternity care, and pre-existing conditions must also be covered.

But if states prove that without those guaranteed coverages, premiums would dip, the number of insured would climb, or the “the public interest of the state” is advanced, then that state could seek a waiver for guaranteed coverage. States could circumvent the pre-existing coverage guarantee if they establish high-risk pools. These changes are designed to bring the party’s center and right flanks to agreement.

In a Facebook statement on Thursday, MacArthur, the architect of the amended bill, said: “This amendment will make coverage of pre-existing conditions sacrosanct for all Americans and ensures essential health benefits remains the federal standard.” Paul Ryan, the Speaker of the House from Wisconsin, hinted that the effort could be ready for a floor vote soon: “We’re in the midst of negotiating sort of finishing touches,” he said.

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 GOP’s Second Health Care Attempt appeared first on Law Street.

The Department of Veterans Affairs announced a new pilot program on Tuesday that would allow veterans in Phoenix to receive outside care at CVS MinuteClinics. The program is a new effort designed to alleviate the exorbitant wait times veterans face when seeking care at VA facilities. For now, the program is limited to the Phoenix area, where VA facilities treat about 120,000 veterans.

“Our number one priority is getting veterans’ access to care when and where they need it,” Baligh Yehia, the VA’s deputy undersecretary for health for community care, told the Associated Press. “The launch of this partnership will enable VA to provide more care for veterans in their neighborhoods.”

The current Veterans Choice Program (VCP) restricts veterans from seeking outside care unless they have to wait more than 30 days for an appointment. If the nearest VA clinic is over 40 miles away, then a veteran is allowed to seek outside care as well. The new Phoenix-area program allows VA staff to recommend a veteran to go to a MinuteClinic when “clinically appropriate.” VA Secretary David Shulkin has indicated he would like to scrap the current VCP restrictions.

Congress recently passed legislation that would funnel $10 billion into the VCP program. “Congress has once again demonstrated that the country stands firmly united when it comes to supporting our nation’s Veterans,” Shulkin said at the time. President Donald Trump, who promised throughout his campaign to reform the VA, is expected to sign the legislation on Wednesday.

In 2014, then-VA Secretary Eric Shinseki resigned after it was revealed that officials in Phoenix falsified reports about the wait times veterans faced at VA clinics. The fake reports covered up the fact that in some instances, veterans died while waiting for care. In a recent survey conducted by the VA, only 61 percent of veterans said they could get a medical appointment for primary care when they needed one.

Sen. John McCain (R-AZ) a veteran of the Vietnam War, where he was also a POW, supports the new program. “Veterans in need of routine health care services should not have to wait in line for weeks to get an appointment when they can visit community health centers like MinuteClinic to receive timely and convenient care,” he said.

And Tobias Barker, the chief medical officer of CVS MinuteClinic, told the AP he hopes the new program can be one of several solutions to providing medical care to America’s veterans. “We believe in the MinuteClinic model of care and are excited to offer our health care services as one potential solution for the Phoenix VA Health Care System and its patients,” he said.

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 VA Announces New Program Allowing Veterans to Get Treatment at CVS 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.

While on the campaign trail, President Donald Trump repeatedly vowed to “repeal and replace” the Affordable Care Act (commonly known as “Obamacare”). However, his first attempt at dismantling the federal statute crashed and burned before a single vote was even cast due to divisions among conservative and moderate Republicans on Capitol Hill. If passed, Trump’s health care bill would have slashed federal funding to Medicaid.

Now, in the wake of the embarrassing defeat, Trump’s fledgling administration is still looking to give the American people a better option for health care. Some experts believe this could still come in the form of reforms to Medicaid and Medicare, which have historically been mired in controversy.

So, lets take a look at how these health care programs, both enacted in 1965, have evolved over the years. How has the Affordable Care Act affected them? And what is the fate of these programs if a new health care bill is finally passed?

What is Medicaid?

Medicaid is a social health care program for certain individuals and families in the U.S. with limited income and resources. It was created through the Social Security Amendments of 1965–signed into law by President Lyndon B. Johnson–under Title XIX of the Social Security Act. It essentially acts as government insurance for those who are unable to pay for traditional health care costs.

The federal government matches state spending on Medicaid to enable states to provide medical assistance to residents who meet their individual eligibility requirements. While the program is jointly funded by state and federal governments, it is managed at the state level. Thus, every state has an immense amount of autonomy in determining who is eligible for the program. Since 1982, all 50 states have participated in the program–despite not being required to do so.

The Affordable Care Act (ACA) significantly expanded Medicaid eligibility, extending coverage to adults under 65 years of age who have incomes up to 133 percent of the poverty line, as well as making it available for low-income adults without dependent children. However, the Supreme Court’s ruling in National Federation of Independent Business v. Sebelius determined that states did not have to agree to the expansion. Thus, many states have continued to stay at pre-ACA funding and eligibility levels.

As a whole, Medicaid provides a variety of services for some of America’s most vulnerable populations. According to the National Council for Behavioral Health, Medicaid is the single largest payer of mental health services, paying for 25 percent of all mental health care and 20 percent of all addiction care. Four out of 10 children are treated under Medicaid, and a study published in Women’s Health Issues found that almost half of the 4 million births each year in the U.S. are covered by the program. Medicaid also often covers the costs of nursing homes and other long-term care options for elderly patients.

Medicaid Structure Explained

While poverty is a primary requirement for Medicaid eligibility, it alone does not qualify citizens for the program. Other categories, such as pregnancy, age, and disability, may also qualify a citizen for Medicaid eligibility. Interestingly, Medicaid also provided the largest portion of federal money for people with HIV/AIDS until Part D of Medicare was implemented (but more on that later). In most states, adults who receive Supplemental Security Income benefits (a federal income supplement program) are automatically enrolled in Medicaid. While state Medicaid programs are required by federal rules to cover comprehensive dental services for children, coverage for adult dental services is optional and oftentimes limited.

Some states choose to utilize the Health Insurance Premium Payment Program (HIPP). Under HIPP, a person under Medicaid is eligible to have private health insurance paid for by the Medicaid program. Essentially, the state pays the private insurance premiums for beneficiaries. States may also combine administration of Medicaid with other programs, such as the Children’s Health Insurance Programs (CHIP), for ease.

What is Medicare?

Medicare, in contrast, is a single-payer social health insurance program specifically for those aged 65 and older that has been administered by the federal government since 1966. With President Lyndon B. Johnson at the helm, Congress enacted Medicare in 1965 under Title XVIII of the Social Security Act. Medicare provides health insurance to some individuals under the age of 65 with disabilities as determined by the Social Security Administration. For example, any individuals with end stage renal disease or amyotrophic lateral sclerosis (ALS) are eligible for Medicare.

Those who have worked and paid into the system through payroll tax are eligible once they reach age 65, regardless of income or medical history. Currently, there are a number of private insurance companies across the U.S. under contract for administration of Medicare. It is funded primarily through payroll taxes, general revenues, and premiums paid by Medicare beneficiaries.

In 1966, Medicare spurred racial integration, by making desegregation of waiting rooms and hospital floors a condition of receiving Medicare funds. According to David Barton Smith, a professor emeritus in health-care management at Temple University, nearly 2,000 hospitals had integrated by July 1966 in order to remain connected to federal money for the program. Although some hospitals resisted integration, and those who complied found ways to restrict multi-bed rooms, Medicare still played an important role in integrating the nation’s hospitals.

Medicare Structure Explained

Structurally, Medicare is complicated. There are four parts: Part A, hospital and hospice insurance; Part B, medical insurance; Part C, Medicare Advantage plans; and Part D, prescription drug plans. Hospital and hospice insurance covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care. Medical insurance under Part B is optional, and helps insured members pay for services and products that are not covered under Part A–usually outpatient care. Patients who miss their initial enrollment period for Part B incur a lifetime penalty of 10 percent per year on the premium.

Medicare Advantage plans under Part C are Medicare plans sold through private insurance companies. These plans are required to offer coverage that meets or even exceeds standards set by Original Medicare. However, they do not have to be identical in covering every benefit. These are considered “capitated” health insurance plans, which is a payment arrangement that pays a physician or group of physicians a set amount for each enrolled person assigned to them for a particular period of time, whether that person seeks care or not. The difference between Part C plans and Original Medicare is likened to the standard HMO versus non-HMO plan decisions other citizens make.

Finally, Part D covers prescription drug plans. It was created in 2003 under the Medicare Prescription Drug, Improvement, and Modernization Act and went into effect in 2006. Anyone with Part A or Part B is eligible for Part D, though the coverage is not standardized. Plans choose which drugs to cover, though they must cover at least two drugs in 148 categories and cover substantially all drugs in six protected classes (including antidepressants, antipsychotics, anti-convulsants, immuno-suppressants, as well as cancer, AIDS, and HIV drugs).

Medicaid and Medicare under the ACA

Medicaid was expanded extensively under the ACA. Currently, 73 million people are enrolled in Medicaid, and roughly 11 million are covered under the program because of the ACA expansion. States who chose to reject the Medicaid expansion are slowly facing the consequences of that decision. Reports issued by the Urban Institute, Lewin Group, and Rand Corp. have stated that these states are slated to lose billions of dollars–money that their own residents have paid in federal taxes.

The ACA expansion also made a number of changes to Medicare; many provisions were specifically designed to reduce the cost of Medicare. It was designed to help Medicare patients afford their prescription drugs by closing the Part D coverage gap, often referred to as the “donut hole,” by year 2020.

Furthermore, premiums under Part B and Part D were restructured; as a result, the wealthiest people with Medicare had their contributions increased. More oversight, stronger standards, and provider screenings were also enacted to prevent Medicare fraud and abuse.

What’s Next?

According to a recent Pew Research Center survey, 60 percent of Americans feel that the government should be responsible for ensuring everyone has health insurance. This number increased from 51 percent last year and has now reached its highest point in roughly a decade. Those on the other side of the argument–individuals who believe the government has no responsibility to provide health insurance for all–do, however, believe that the government should continue Medicaid and Medicare.

Following the death of Trump’s heath care bill that would have repealed and replaced the ACA, some states are looking to see if participating in the federally-funded Medicaid expansion is a lucrative path to take. As of last count, 19 states have opted out. Some contend that an expansion of Medicare may be a way to improve upon the ACA. Potentially lowering the age of eligibility of Medicare to 50 may also make private individual health more affordable. Moreover, offering Medicare as an option on health insurance exchanges could bring in younger people, reducing Medicare’s overall average costs by not just insuring those who cost the most to insure.

In contrast, there is also the option of implementing a full single-payer healthcare program, considered “Medicare for All”–a system that Senator Bernie Sanders has advocated for immensely. Under a single-payer system, any links between employment and health insurance would cease, as well as expanding the net for people over 65 to all Americans. Thus, the entire spectrum of care for every American citizen would be covered: primary, vision, oral, mental health, and more. Instead of paying a premium to for-profit insurance companies, Americans would merely pay a tax and employers would also pay taxes through payroll. Senator Sanders is poised to reintroduce the single-payer plan in the Senate, on the heels of the failed Republican ACA repeal attempt.

Conclusion

Despite the problems with the current health care system, such as rising premiums and fewer choices for citizens, Medicaid and Medicare have arguably been success stories in their more than 50-year history. Providing insurance and health care to the country’s most at-risk populations–the poor, the disabled, and elderly–is something to be lauded. What lies ahead for the programs, however, is up in the air until a new health care reform bill is passed.

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 The Evolution of Medicare and Medicaid in America appeared first on Law Street.

After seven years of stiff opposition to Obamacare, Republicans failed in their efforts to produce a successful health care replacement on Friday afternoon. After days of negotiating–both with the White House and with other House Republicans–House Speaker Paul Ryan decided to stall a vote on the bill, the American Health Care Act, after he told President Donald Trump the bill would not secure enough votes to pass.

Friday’s bizarre events were ripe material for Twitter’s finest to strut their stuff. Using #KillTheBill, people took to Twitter throughout the day to send shots at Ryan, Trump, and more. Some used photos and GIFs of a man who succeeded in passing a health care bill to convey their emotions:

Who’s tired of winning? Not me! #killthebill pic.twitter.com/Ylp0LpMAQu

— Peregrine (@Lies_Are_Chains) March 24, 2017

I guess Obama is just better at the art of the deal. #KillTheBill pic.twitter.com/ZnwiqJ9X5s

— Adriel L. Algiene (@AdrielLAlgiene) March 24, 2017

Others riffed on Republicans who do not support contraception to express their thoughts on the health care failure:

house republicans couldn’t agree on contraceptive coverage so they just pulled out instead. #killthebill pic.twitter.com/VWKOrXtCRv

— joe malunda™ (@maloonds) March 24, 2017

Lol when you pull out cause you don’t have a plan B pic.twitter.com/vMCSahyPtr

— Jessica Samakow (@jsam1126) March 24, 2017

Supporters of the House Freedom Caucus–a far-right group that strongly opposed the bill and is largely responsible for sinking it–also found joy in the health care debacle. These two blamed lawmakers they deem Republicans In Name Only (RINOs) for the failed effort:

Thank you, #FreedomCaucus! We’re showing the RINOs that we the people are a force to be reckoned with!#KillTheBill #Ryan

— Deplorable Zilla (@deplorablezilla) March 24, 2017

#KillTheBill
#RyanCare #ObamacareLite #FullRepeal
I Stand With The @freedomcaucus @POTUS @realDonaldTrump @SpeakerRyan @SenateGOP pic.twitter.com/dkJtjs4EiX

— #1775Lexington (@luckyone6565) March 24, 2017

Some people focused on Ryan, the leading force behind the Republican effort to repeal and replace Obamacare, and his perpetually mopey facial expression:

Time to repeal and replace Paul Ryan.#KillTheBill #FireRyan pic.twitter.com/e6G5lMRSMP

— P Martucci☆NYC4TRUMP (@martucci_peter) March 24, 2017

And, of course, people used Ryan’s first and only true love (hint: it’s not health care) to visualize how he was probably feeling deep in his heart on Friday afternoon:

pic.twitter.com/VS9daWXvzV

— Sean Dove (@_space_plans) March 24, 2017

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 #KillTheBill Is Now a Reality, Twitter Has Some Fun 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.

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:

Trump’s Ultimatum: Approve the New Health Bill or We’ll Stick with Obamacare

Donald Trump yesterday posed an ultimatum for House Republicans–approve the new healthcare bill, or he will leave Obamacare in place as it is. The vote on the new American Health Care Act was supposed to take place yesterday but was delayed, as too many Republicans had said they would vote against the bill. In a closed-door meeting last night, Trump said he wants the House to vote on the bill this afternoon whether it has enough votes to pass or not–he’s apparently tired of negotiating. If the bill doesn’t pass, Trump said he would move on to other issues, despite touting an Obamacare repeal as a priority throughout his campaign.

The president and VP Mike Pence held a meeting with the extremely conservative House Freedom Caucus yesterday afternoon to discuss the bill. A photo from the meeting circulated on social media and was heavily slammed. One of the main topics of conversation was whether to get rid of essential health benefits regulations, which require insurance plans to cover pregnancy and maternity services. But…notice anything missing from this photo?

Here’s the picture of the leaders negotiating away birth control, maternity care & abortion. Notice anything? #ProtectOurCare

(h/t @Emmya2) pic.twitter.com/X1dYUSa7nO

— Planned Parenthood (@PPact) March 23, 2017

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: March 24, 2017 appeared first on Law Street.

The morning after pill, also known as Plan B, is a backup contraceptive. It helps prevent pregnancy after a contraceptive failure or unprotected sex. That’s a good thing. But Plan B gets a bad rap; one of the most popular myths about it is that it “causes an abortion.” It doesn’t, but that doesn’t stop some pro-life organizations from purporting that misinformation, among other incorrect claims. Well, one reproductive rights advocacy organization, Lady Parts Justice League, has released a catchy little video dispelling those myths. And it’s sure to invoke nostalgia for any of us who watched Schoolhouse Rock as kids.

That’s right, she’s just a pill. The pill is voiced by Lea DeLaria, best known as “Big Boo” from “Orange is the New Black.” The video explains what the morning after pill actually does, and how it does not cause an abortion. The morning after pill doesn’t terminate a pregnancy, but instead keeps the pregnancy from occurring in the first place.

According to Lady Parts Justice, the organization chose to release the video specifically now, while Neil Gorsuch is going through confirmation hearings for the Supreme Court. Creator Lizz Winstead told the Huffington Post:

In his past rulings, [Gorsuch] has shown he lacks an understanding of basic science, for example, how pregnancy happens or birth control works. It is imperative that we don’t fill our Supreme Court with judges whose working knowledge of the reproductive system is akin to their working knowledge of pagers.

Given current debates over Trumpcare, a.k.a the American Health Care Act (AHCA) in Congress, access to emergency contraceptives may become more important than ever. Congressional Republicans continue to edit their draft, and are now reportedly ready to drop things like maternity care and preventative care like contraceptives from the plan in order to get it passed.

This is what GOP hardliners are saying insurers no longer have to cover. This may get the repeal passed. https://t.co/BOOAtHODQs pic.twitter.com/Y3uoh6jw1L

— Mark Harris (@MarkHarrisNYC) March 23, 2017

It’s important to all be on the same page about what emergency contraceptives do, and ensure that misinformation isn’t spread to the women who may need to rely on them in the post-Obamacare era. Lady Parts Justice figured out how to do that in an entertaining and relatable manner–so let’s keep the videos coming!

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 Catchy Schoolhouse Rock Parody Explains Plan B appeared first on Law Street.

GOP Health Plan Will Leave 14 Million Without Coverage in First Year

The Congressional Budget Office has released its analysis of the Republican healthcare plan, and the results don’t look very good. According to the CBO, 24 million people will be without coverage by 2026, and 14 million would lose their insurance in just the first year. While the plan would save about $337 billion in the coming decade, it would come largely at the expense of the poorest Americans–as the savings would mostly come from cutting Medicaid.

Democrats say that this should be enough to stop the bill. President Donald Trump, on the other hand, says that the media is trying to make Obamacare look great so that people will look back on it positively, but that “’17 will be the very worst year.” The Trump Administration has tried to downplay the importance of the CBO over the past few days and Health and Human Services Secretary Tom Price said, “We disagree strenuously with the report that was put out.”

CBO report on GOP health plan:
-24 MILLION fewer insured
-$880 billion cut from Medicaid
-Premiums 20% higher by 2018

Is this “winning?”

— Mark Takano (@RepMarkTakano) March 13, 2017

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: March 14, 2017 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.

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After seven years of nonstop handwringing, GOP lawmakers have finally made some progress in their promise to undo the Affordable Care Act. On Monday, House Republicans unveiled two draft laws that, taken together, provide a sketch for what the future of health care in America will look like. There is still a long way to go: hardline conservatives in the House have already admonished the new GOP health care plan for not changing enough; some GOP Senators have expressed reluctance to pull back Medicaid too much; and, of course, Democrats will be pushing back hard while the Republican-controlled Congress tries to push its new health care vision. Here is what you need to know.

What Won’t Change?

Though Obamacare has been the target of much Republican ire over the past seven years, some of the law’s most popular tenets would remain unchanged under the new law. For one, young adults can remain on their parents’ health plan until the age of 26, so many millennials can breathe a sigh of relief. In addition, in what was one of the ACA’s most lauded achievements, insurers will not be able to turn a customer with preexisting conditions away, or charge them more. Critics say that retaining these Obamacare staples while overhauling other elements is untenable. Remember, the GOP plan revealed on Monday is a rough draft, sure to go through many edits before any laws are actually changed.

What Will Change?

Mainly: tax credits. Income-based tax credits will still be part of the plan, but they will be phased out over time. Instead, tax credits will shift to an age-based model. Under 30? You’re eligible for $2,000 per year. Sixty or older? You could be eligible for as much as $4,000. Families would also receive more. Another change: in lieu of the mandate–Obamacare imposed a tax on the uninsured–insurers can levy a 30 percent increase on premiums if your insurance lapses.

Medicaid would be significantly altered under the Republican plan. Essentially, the federal government would pay a per-person cash allotment to individual states. The amount given would be determined by different categories of a state’s residents: children, elderly, people with disabilities. Mirroring the Republican ethos, the plan takes a bottom-up approach (states have more flexibility) rather than a top-down one (the federal government calls the shots). In addition, Planned Parenthood could stop receiving federal funding for one year.

The changes to Medicaid could be a step too far for some Republicans. In a letter to Senate Majority Leader Mitch McConnell (R-KY), four GOP Senators expressed their concerns. “We will not support a plan that does not include stability for Medicaid expansion populations or flexibility for states,” Senators Rob Portman (OH), Shelley Moore Capito (WV), Cory Gardner (CO), and Lisa Murkowski (AK) wrote.

What Happens Next?

More handwringing and, most likely, Republican infighting. In the coming days, two House committees, Ways and Means and Energy and Commerce, will review the plan. House Speaker Paul Ryan (R-WI) has said he hopes to get the full House to vote on the bill by the April 7 recess. The legislation faces a rocky road ahead. A number of House caucuses, including the Tea Party stalwart the Freedom Caucus, have branded the new health plan as “Obamacare Lite” and “Obamacare 2.0.” Whether hardline conservatives will squeeze more of their priorities into the final bill remains to be seen.

And of course, it is highly likely that no Democrats, in the House or the Senate, will support the plan. Rep. Nancy Pelosi, the Democratic leader in the House, had this to say about the newly revealed Republican plan: “Republicans will force tens of millions of families to pay more for worse coverage — and push millions of Americans off of health coverage entirely.”

But President Donald Trump, who promised to revamp Obamacare during his first days in office, is confident the plan will pass:

Our wonderful new Healthcare Bill is now out for review and negotiation. ObamaCare is a complete and total disaster – is imploding fast!

— Donald J. Trump (@realDonaldTrump) March 7, 2017

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 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.

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.

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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 Texas Health and Human Services Commission issued a final notice on Tuesday to Planned Parenthood that the health services provider will be barred from receiving Medicaid funds. Planned Parenthood said 11,000 women who seek treatment in 34 clinics across the state will be affected. The ruling is set to go into effect 30 days from when it was issued, unless a federal court denies the state’s move.

The group, which receives about $4 million each year in Medicaid funding, signaled that it will pursue an injunction in federal court. President of the Planned Parenthood Federation and Planned Parenthood Action Fund Cecile Richards, called the decision a “cautionary tale for the rest of the nation,” and warned that if similar moves are made in other parts of the country, “it will be nothing less than a national health care disaster.”

Federal courts have stepped in to dismiss similar state-level rulings over the past year. Judges stopped attempts to defund clinics in Mississippi, Arkansas, Louisiana, and Kansas. And earlier this year, the U.S. Supreme Court saved a number of abortion clinics in Texas from shutting down. But this has been a drawn-out battle between Texas and Planned Parenthood, and it’s unclear how courts will rule in this case.

In July 2015, an anti-abortion group released covertly filmed and heavily-edited videos that claimed to show Planned Parenthood officials agreeing to sell fetus parts for profit. The group has vehemently waved off the videos as heavily doctored and highly inaccurate. Tuesday’s notice cited the videos as “the basis for [Planned Parenthood’s] termination” from Medicaid. It also said the group fails to provide care “in a professionally competent, safe, legal and ethical manner.”

“Texans expect that when taxpayer dollars are granted to health care providers, it is only to those who demonstrate that the health and safety of their patients come before a profit motive that puts women at greater risk,” said a statement from the office of Texas Governor Greg Abbott, a Republican.

Planned Parenthood sued Texas in November 2015, when the state first signaled it would be cutting its access to federal money, a move that was also in response to the controversial videos released a few months prior. That case is still pending. A wider effort to defund Planned Parenthood could come early next year, when President-elect Donald Trump takes office. While he has expressed support for some of the services the group provides, Trump’s appointment for health secretary is Tom Price, a vocal opponent of Planned Parenthood.

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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Governor Gary Johnson is the nominee of the Libertarian Party, a party that places heavy emphasis on fiscal conservatism, limited government, and civil liberties. After studying political science at the University of New Mexico, Johnson founded Big J Enterprises. The construction contracting business became a lucrative success before he sold it in 1999. Johnson ran for Governor of New Mexico in 1994, won, and held that office from 1995-2003. During his tenure, Johnson drastically cut the size of the state government, lowered taxes, favored privatization of services like prisons and Medicaid, and was known for frequently exercising veto power. Johnson was also the Libertarian Party nominee in 2012.

Where does he stand on some of the prevalent issues of 2016?

Economy:

Many of Gary Johnson’s high-priority proposals have to do with Libertarian revisions to the economy. Johnson wants to end the corporate income tax to draw companies and jobs to the U.S., introduce a single consumption tax, and cut government spending by at least 20 percent.   

Immigration:

According to Johnson’s platform, he believes that making it easier for immigrants to legally obtain work visas and enter the U.S. will create a safer national environment. Johnson opposes an increase in border security and building a border wall.

Gun Rights and Control:

Johnson strongly defends gun ownership and wants to seek provisions to make it more difficult for individuals suspected of terrorism and mentally ill individuals to obtain guns.

Health Care:

Gary Johnson favors the repeal of the Affordable Care Act in exchange for privatized healthcare based on free market principles. Johnson has expressed intentions to cut funding to Medicare and Medicaid. He also supports the right for a woman to have an abortion.

Privacy and National Security:

In line with Libertarian Party ideology, Johnson is in fierce defense of personal privacy. He has expressed intention to dismantle the National Security Agency (NSA) if elected. In his book, “Seven Principles of Good Government,” Johnson also expressed that the Patriot Act should be repealed. His platform expresses fierce opposition to foreign military intervention.

What are Gary Johnson’s priorities?

Gary Johnson places strong emphasis on civil liberties, government downsizing, and the private, laissez-faire economic strategy. His platform consists of 13 points: wasteful spending, taxes, job creation, civil liberties, internet freedom, abortion, immigration, the war on drugs, criminal justice reform, education, foreign policy and national defense, creation of term limits and the environment.

Who is Gary Johnson’s vice president pick?

William “Bill” Weld, like Gary Johnson is a former Libertarian-Republican governor. Weld has served as the U.S. Attorney for the District of Massachusetts, the head of the Criminal Division of the Department of Justice, and as Governor of Massachusetts from (1991-1997). He was also nominated as Ambassador to Mexico, ran for U.S. Senate in Massachusetts in 1996, and was a candidate for Governor of New York in 2005. While Governor of Massachusetts, Weld had a similar track record to Johnson. He cut taxes, pursued the elimination of state employees and privatization of human services, and drastically reduced state spending.

How is Gary Johnson polling?

According to the last national poll conducted by Public Policy Polling on July 30, Gary Johnson is currently polling at 6 percent.

You can read here about the other third party candidate, Jill Stein of the Green Party.

Ashlee Smith

Ashlee Smith is a Law Street Intern from San Antonio, TX. She is a sophomore at American University, pursuing a Bachelor of Arts in Political Science and Journalism. Her passions include social policy, coffee, and watching West Wing. Contact Ashlee at ASmith@LawStreetMedia.com.

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The U.S. Department of Justice announced Wednesday it is charging hundreds of individuals across the country with committing health care fraud worth hundreds of millions of dollars, in what is being hailed the largest health care fraud bust in U.S. history. Here are the five fast facts you need to know.

1. 301 People Charged in Health Care Fraud Bust

The bust resulted in the takedown of 301 individuals, including 61 licensed medical professionals, 28 of whom were doctors. The charges include various health care fraud-related crimes, including conspiracy to commit health care fraud, violations of the anti-kickback statutes, money laundering, aggravated identity theft, and Medicare Part D pharmacy fraud.

Attorney General Lynch called out the alleged perpetrators in the release saying,

They target real people – many of them in need of significant medical care.  They promise effective cures and therapies, but they provide none.  Above all, they abuse basic bonds of trust – between doctor and patient; between pharmacist and doctor; between taxpayer and government – and pervert them to their own ends.

2. $900 Million in False Billings

The DOJ found the defendants to be responsible for a total of $900 million in false billings. The largest portion of fraudulent billings was traced to Florida, where a total of 100 defendants were charged for their involvement in approximately $220 million in false billings for home health care, mental health services and pharmacy fraud. According to the release,

In one case, nine defendants have been charged with operating six different Miami-area home health companies for the purpose of submitting false and fraudulent claims to Medicare, including for services that were not medically necessary and that were based on bribes and kickbacks.  In total, Medicare paid the six companies over $24 million as a result of the scheme.

Defendants in California, Texas, and Michigan are charged with committing more than $100 million worth of fraud in each state.

3. This Was a Joint Effort

Medicaid Fraud Control Units in 23 states and the Medicare Fraud Strike Force in 36 federal districts coordinated with the Justice Department and the Department of Health and Human Services in  the “unprecedented nationwide sweep.”

National Health Care Fraud Takedown Results https://t.co/LQk9OJpzKN pic.twitter.com/HMVFxvFrgd

— Justice Department (@TheJusticeDept) June 22, 2016

The Medicare Fraud Strike Force operations are part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint initiative announced in May 2009 between the DOJ and HHS to help prevent waste, fraud, and abuse in the Medicare and Medicaid programs.

4. New Study Identifies 27 Home Health Care Fraud “Hotspots”

The U.S. Health & Human Services Office of Inspector General released a new study in conjunction with the DOJ’s arrests citing 27 geographical “hotspots” in 12 states where health care fraud is committed most often.

Eye on Oversight: OIG identified 27 hotspots for probable home health fraud. Watch the VIDEO. https://t.co/1KPY9RQe6D

— OIG at HHS (@OIGatHHS) June 21, 2016

The states include Arizona, California, Florida, Illinois, Louisiana, Michigan, Nevada, New York, Oklahoma, Pennsylvania, Texas, and Utah.

5. This Recent Bust Helped Pad Federal Authorities’ Record

Since its launch in March 2007, the Medicare Fraud Strike Force has charged over 2,900 defendants who collectively have falsely billed the Medicare program for over $8.9 billion. Wednesday’s announcement marks the second time that districts outside of Strike Force locations participated in a national health care fraud bust, and they accounted for 82 defendants charged in this takedown.

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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Long-term healthcare institutions for the elderly are now more common than ever in America. There are thousands of nursing homes and residential-care facilities dispersed across the country. As a society, we rely on and trust these establishments to medically treat and handle with care our aging loved ones. Even though these places are instrumental to our healthcare system, nursing home regulations haven’t been widely updated in more than 30 years. That is until this month. The Obama Administration has set out to reform the rules required of nursing homes to qualify for Medicare and Medicaid. As they stand today, the rules aren’t up to speed with the innovative scientific advances and administration of health care. There are also alarming reports of abuse and neglect inside the system. But with promising new laws on the horizon, nursing home healthcare may be getting a makeover.

History of Nursing Homes in the United States

The normalization of nursing homes is a relatively recent development. Demographic and political shifts have created a standard use of these facilities. For many years, elderly citizens turned to almshouses, charitable housing for the sick, impoverished, inebriated, mentally ill, and homeless. The elderly lived in almshouses for a variety of reasons including poverty, disability, sickness, and/or separation from families. The Industrial Revolution started to bring more people into the cities and spread families apart. Many singles no longer had extended families to rely on for support.

At the turn of the nineteenth century, women’s and religious groups started to create specific housing for the elderly. Boston’s Home for Aged Women was created in 1850. Institutions like this generally required substantial entrance fees and certificates of good character. They were a marked upgrade and alternative to the almshouses. Many of these women were widowed or single, and had lived their lived as upstanding citizens. These requirements limited shelter to a small population; the impoverished still mostly resided in almshouses.

As time continued, almshouses started to exclusively aid the elderly. Younger people were removed and sent to specific-needs organizations like orphanages, hospitals, or insane asylums. In 1880, 33 percent of almshouse residents were elderly. By 1923, that number soared to 67 percent.

The almshouses were not places of luxury, but rather were found in extremely poor conditions. In 1992, Abraham Epstein, advocating for pensions, wrote that the almshouse “stands as a threatening symbol of the deepest humiliation and degradation before all wage-earners after the prime of life.” The enactment of the 1935 Social Security Act was in large a movement to remove almshouses altogether; however, elderly residents weren’t solely there due to poverty. Others required daily nursing and medical attention. The money received through pensions was often used to gain access to independent facilities that could provide medical care; however, conditions were not necessarily improved.

In 1955, the Medical Facilities Survey and Construction Act allowed federal support to those in public facilities. Both private and public nursing home residents received federal support. In 1965, Medicare and Medicaid was established, furthering the growth of nursing home facilities. Between 1960 and 1976, nursing homes grew by 140 percent, with 79 percent still private institutions. Through investigations conducted through the 1970s, it was concluded that the conditions were still subpar and not far enough removed from the stigma of historic almshouses.

The 1970s saw the first real regulations for nursing homes. The Office of Nursing Homes Affairs was established in 1971 and authorized to administer nursing home standards. Social Security reforms in 1972 “established a single set of requirements for facilities supported by Medicare and for skilled-nursing homes that received Medicaid.” A plethora of amendments to older acts were enacted as well.

By 2000, nursing home care became a $100 billion industry. Although the standard of care has dramatically increased since the days of the almshouse, it is time for a new round of regulations. The video below, created by the Common Wealth Fund, joins in the effort to improve nursing home quality care.

Nursing Home Care Today

Statistics

There are five, main long-term healthcare services: home health agencies, nursing homes, hospices, residential care communities, and adult day service centers. Approximately 8,357,100 people receive support from these services annually. Nursing homes alone account for 1,383, 700  people in the group, and 63 percent of those are age 65 and older. In 2000, 15 million people required long-term care. Due to Baby Boomers, that number is projected to rise to 27 million in 2050.

For those that reach the age of 65, 69 percent will acquire a disability before they die. And 35 percent will enter a nursing home at some point. One in every eight people over the age of 85 resides in an institution.

Financial Stats

A 2013 report estimates that between $210 and $306 billion is spent on long-term care per year. Most pay a majority out of pocket for assisted living, while Medicaid pays a majority for long-term nursing care and Medicaid pays for a majority of hospice care and short-term skilled nursing facilities. Almost one-fifth of the elderly community will pay more than $25,000 in out-of-pocket costs before they die. And in 2012, 14.8 percent of those over 65 were reported below the poverty line. This is even more significant as the private-pay prices for a private or semiprivate room in a nursing home grew by four percent in 2002. It grew another 4.5 percent in 2012. Lastly, Medicaid spent $83.8 billion on long-term care services in 2003, amounting to approximately one third of all Medicaid expenditures.

Proposed Regulation

There are a host of reasons why the Obama Administration has decided to tackle nursing home care regulations. First and foremost, current regulations don’t consider the advances in science and health care for the elderly. As previously stated, long-term care regulations haven’t been updated in nearly 30 years–consolidated Medicare and Medicaid requirements for long-term care facilities were set in 1989, and haven’t been updated since 1991. Science has seen invaluable progress since then. New proposals are also significant in light of reports over the last decade finding varying degrees of neglect and abuse among nursing care facilities. At the core of it all, current regulations aren’t up to par.

Highlights

The proposal bans facilities from hiring any personnel with a record of abuse and/or neglect, and develops policies that target abuse and/or neglect. Nurses would be trained in preventing elder abuse. Although there isn’t an assigned patient-to-nurse ratio, facilities will have to report staffing levels to Medicare officials for review. Low staffing is a common reason stated by those in the field why patients with dementia are given inappropriate and potentially dangerous antipsychotic drugs. The regulations would also limit the amount of antibiotic and antipsychotic drugs administered, toughen infection control, and reduce hospital readmissions.

It also suggests a baseline care program: a comprehensive plan for each resident created within 48 hours of a patient’s arrival. In addition, a nurse aide, a member of the food and nutrition services staff, and a social worker would be added to those involved in the development of the care plan. The proposal also covers “electronic health records and measures to better ensure that patients or their families are involved in care planning and in the discharge process.”

There are a number of revisions directed toward the personal happiness of the residents. The proposal includes open visitation (similar to hospital regulations) and the ability for residents to choose roommates as these facilities often double as homes. It also mandates the availability of “suitable and nourishing alternative meals and snacks” for residents who would like to eat outside the scheduled meal times. These types of policies create a more comfortable and home-like atmosphere.

A major concern in the long-term care community is enforcement. Toby Edelman, a senior policy attorney at the Center for Medicare Advocacy, states that “the biggest problem is that the rules we have now are not enforced. We have a very weak and timid enforcement system that does everything it can to cajole facilities into compliance instead of imposing penalties for noncompliance.” The proposed rules should allow violations to be more easily detected.

Conclusion

As the proposal states, “many of the revisions are aimed at aligning requirements with current clinical practice standards to improve resident safety along with the quality and effectiveness of care and services delivered to residents.” This is a way to ensure that every facility across the nation is legally required to provide equal quality of care to every patient. It is alarming that a comprehensive update to modernize the nursing home care system hasn’t been done in so many years. Residents want to feel safe and happy in their environment, and their families want to feel that their aging elders are healthy and receiving the best care possible.

Resources

Primary

Federal Register: Medicare and Medicaid Programs

Additional

CDC: Long-Term Care Services in the United States

Family Caregiver Alliance: Selected Long-Term Care Statistics

Kaiser Health News: New Regulations Would Require Modernizing Nursing Home Care

Net Industries: Nursing Homes

U.S. Legal: The History of Nursing Homes

White House: Administration Announces New Executive Actions to Improve Quality of Care for Medicare Beneficiaries

Jessica McLaughlin

Jessica McLaughlin is a graduate of the University of Maryland with a degree in English Literature and Spanish. She works in the publishing industry and recently moved back to the DC area after living in NYC. Contact Jessica at staff@LawStreetMedia.com.

The post Obama Proposes New Nursing Home Regulations 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.

ICYMI, check out the Best of the Week from Law Street, including banned beach drinking in Florida, vaginal probes at colleges, and a look at America’s public health spending.

#1 Beach Drinking Banned at This Popular Spring Break Destination

Spring break is a college rite of passage synonymous with beaches, bikini-clad babes, and binge drinking. However, it’s no secret that excessive alcohol consumption can lend itself to a dangerous environment for these vacationers, including reckless behavior, violence, and sexual assault. No one knows these kinds of dangers better than the residents of the spring break capital of the world, Panama City Beach, which is why their city council members have voted to make a change next year by banning beach drinking during spring break. Read full article here.

#2 Lawsuit Claims Valencia College Exams Included Vaginal Probes

Two female students from Valencia College studying medical diagnostics have recently filed a lawsuit claiming that their classwork at the school crossed a very serious line. The suit alleges that they were forced to endure invasive vaginal exams in front of all of their classmates. Read full article here.

#3 Are We Spending Enough on Public Health?

Treating people when they’re already sick is like beating back invaders who have already breached your defenses. In either scenario, prevention through good defense saves money, time, and lives. But when it comes to boosting our nation’s wellness defenses through public health spending, America falls short. Read full article here.

Chelsey D. Goff

Chelsey D. Goff was formerly Chief People Officer at Law Street. She is a Granite State Native who holds a Master of Public Policy in Urban Policy from the George Washington University. She’s passionate about social justice issues, politics — especially those in First in the Nation New Hampshire — and all things Bravo. Contact Chelsey at staff@LawStreetMedia.com.

The post ICYMI: Best of the Week appeared first on Law Street.

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According to UNICEF, 140 million children around the globe have lost one or both parents. These children are classified as “orphans.” While there are many reasons that children can become orphans, it is a global problem that affects a wide range of nations. Read on for a spotlight on some of the particular nations and regions that have the most orphans, and what is being done to help those children in need.

Sub-Saharan Africa

Sub-Saharan Africa is home to many orphans. Although sub-Saharan Africa is a large region, its nations share some of the same problems. The onset of the HIV/AIDS epidemic in sub-Saharan Africa began in the 1970s, and continued at high levels in the 1980s. In addition to HIV/AIDS, other diseases such as malaria and TB, and war and conflict in some states have left some 52 million of sub-Saharan Africa’s children without one or both parents.

In 2015 in sub-Saharan Africa, it was estimated by UNICEF that about 11 percent of children under 18 were orphans. Many of those children became orphans as a result of the HIV/AIDS crisis in the region. According to Nancy E. Lindborg, assistant administrator for Democracy, Conflict, and Humanitarian Assistance at USAID, 15 million children in sub-Saharan Africa have lost their parents specifically to the disease in 2014. However, as frequent as it is that children are orphaned because their parents die of HIV/AIDS, there are also other factors that leave them in non-parental care. For instance, high poverty rates can lead to the abandonment of children, particularly in rural areas or if the parents are migrant workers and unable to take their children to different locations with ease. Other diseases, such as malaria, can also play a role. While sub-Saharan Africa is a huge region and not all the issues faced by one country would be faced by another, these are common threads that many sub-Saharan nations experience.

Spotlight: Ethiopia 

Ethiopia, located in the horn of Africa, has a population of more than 90 million people. According to UNICEF, over four million of that population is made up of orphaned children. Just under one million are children who have been orphaned as a result of HIV/AIDS.

Addressing those health concerns is paramount to stopping the rising orphan levels in Ethiopia. Health care should be provided to ill parents to prevent mother to child transmission and to ensure that they can care for their children as long as possible. Children should benefit from access to quality health care, especially if they are HIV positive themselves.

A focus on community and capacity building ensures that healthcare facilities will be functioning institutions now and in the future. Healthcare professionals need to be trained within the country, and healthcare centers need to be available in villages and local communities. Recently, there has been a focus on a cycle of health care that can sustain itself. As Worldwide Orphans, the first group to bring HIV/AIDS drugs to orphans in Ethiopia, explained about its process:

Doctors, nurses and other healthcare professionals needed to be trained and mentored by experts in the treatment and ongoing care of children with HIV/AIDS. And so, WWO recruited an extraordinary team of pediatric AIDS specialists from Columbia University to work side by side with in-country professionals, examine and test each child, decide upon treatment, and consult on follow-up care. Seminars were held, with all materials translated into the country’s language. As a result, more than 400 healthcare professionals have been trained and taken their learning back to villages, towns, and cities across their countries.

This kind of community building can also be applied to education and development activities.

Eastern Europe

Eastern Europe’s experience at the end of the twentieth century was characterized by war, turmoil, and poverty. Even Eastern European nations that had rather advanced and progressive social services practices–such as the former Yugoslavia–were devastated by the infighting after the breakup of the Soviet Union and forced to revert back to a reliance on orphanages. As those institutions were often underfunded, overcrowded, and lacking appropriate resources, they didn’t help children to grow and thrive. While many Eastern European countries are moving toward shutting down these institutions, there is still much work to be done to ensure that children in these nations receive adequate support.

Spotlight: Bulgaria 

Bulgaria’s orphan population is high, at an estimated 94,000 in 2009. While the vast majority of these children are “social orphans,” meaning their parents are alive but unable to care for them or have abandoned them, they still require the same support and resources as children who have lost one or both parents.

For a long time, Bulgaria’s many orphans were kept in orphanages, which by their nature often are only able to provide a few staff members to care for large groups of children. For young children, this can be particularly damaging, as they don’t get the attention and nurture that they need. Studies show that for every three months in institutionalized care, infants and toddlers lose about one month of developmental growth. As a result of these concerns about orphanages, Bulgaria announced in 2010 that it would be moving toward de-institutionalization. The country hopes to close all orphanages by 2025. The Bulgarian government is looking to implement a model similar to what we see in the United States, where the focus is on placing children in foster families, kinship care, or small group homes. Dr. Jane Aronson, founder of Worldwide Orphans, described this process in 2011:

They have already done the first level of developmental screening of the most complex children and now they will go deeper into the psycho-social and family issues of these children. Their goals are reuniting the children with their families, closing large institutions, group home assignments and foster care.

This strategic plan will then be used for the orphanages for healthy children.

Many orphans in Bulgaria, and other parts of Eastern Europe, are Roma. Traditionally the Roma, or Romani people, have been oppressed and discriminated against throughout Europe. Due to that cycle, many Roma children become “social orphans” and are left in institutions. Recent estimates indicate that approximately 60-80 percent of children in orphanages are from the Roma minority who represent only four percent of the Bulgarian population. In addition, a 2011 study by the Helsinki Committee found that up to 50 percent of Bulgaria’s orphans are of Roma descent. Empowering this community and providing educational resources to these vulnerable children will help break the cycle of poverty and abandonment.

Latin America and the Caribbean

The country facing a large-scale orphan crisis in the Caribbean and Latin America is Haiti, particularly in light of the devastating earthquake that happened in January 2010. Nevertheless, there are a significant number of orphans in the region. While UNICEF reports 340,000 orphans in Haiti alone, there are many others in the region who have their own unique obstacles to overcome. UNICEF in 2013 put the number in the region at just over 8.4 million.

Spotlight: Haiti

Most estimates prior to the 2010 earthquake, including those from Worldwide Orphans, put the number of orphans in Haiti at over 400,000. While those numbers are now around 340,000, Haiti sees many of the issues similar to those in Ethiopia and Bulgaria, including intergenerational poverty and HIV/AIDS infection. UNICEF estimates the number of children orphaned in Haiti due specifically to HIV/AIDS at 100,000.

Due to the 2010 earthquake and the subsequent destruction of significant portions of the infrastructure, addressing the orphan issue effectively and efficiently in Haiti has been very challenging. Furthermore, even before the disaster, educational opportunities and jobs were hard to come by. Providing orphaned young people with skills and opportunity will help them to be resilient, by extension improve their communities, and hopefully break the intergenerational cycle of poverty. As Worldwide Orphans explains about its “Haitians Helping Haitians” program,

The youth training model has been replicated in a hospital in Port-au-Prince, where young adults are trained to work with babies and infants who have been abandoned at the hospital. This model provides them with much needed income, job skills and a chance to build self-esteem and positively contribute to their own community. Whether playing with infants and toddlers in the WWO Toy Library, or serving up arts and crafts, nature, performing arts, life skills, education, teambuilding activities at camp and in after-school programming, WWO’s youth corps of trainees are not only providing valuable enrichment to children suffering from chronic disease and the emotional scars of abandonment, they are building their own skills in child development which will serve them in future employment and in their own journeys into parenthood.

By providing children with resources to help themselves and their communities, Haiti will be better positioned to rebuild a nation that is still feeling the effects of such a devastating natural disaster.

Conclusion

Currently there are 140 million orphans worldwide. Most orphans are “social orphans” and likely have identifiable families–if there is the social infrastructure to find them. Unfortunately, in developing nations, there are so many orphans and very limited financial resources to reintegrate and reunite families.  Nations like Ethiopia, Bulgaria, and Haiti each demonstrate how issues of poverty, disease and conflict impact children in different cultures. However, it is important to remember that these problems are not necessarily unique. Virtually all across the world, children lose parents to disease (HIV, Malaria, etc) conflict and war, poverty, natural disasters and experience trauma that impacts their development. There’s no such thing as a one-size-fits-all approach to preventing orphaning. Instead, a combination of approaches, including early intervention, community capacity building, de-institutionalization, establishment of group homes and foster care, and other critical psychosocial support programming, like the work that Worldwide Orphans undertakes, needs to be implemented to ensure that every child grows up safe, independent, and healthy.

Resources

Primary

UNICEF: Ethiopia

UNICEF: Bulgaria

UNICEF: Haiti

UNICEF: State of the World’s Children 2015

Additional

Food, Nutrition and Agriculture: Orphans and the Impact of HIV/AIDS in Sub-Saharan Africa 

Borgen Magazine: House Subcommittee Discusses African Orphans

Worldwide Orphans: Ethiopia

Worldwide Orphans: Capacity/Community Building

Medwire: Bulgaria Special Report: Children Continue to be Neglected Due to ‘False Reforms’

NIH: Neurodevelopmental Effects of Early Deprivation in Post-Institutionalized Children

Worldwide Orphans: Bulgaria 

Huffington Post: Bulgaria: Changing Orphans’ Lives

EU Business: Abandoned Roma Children Fill Europe’s Orphanages

Children and Youth in History: UNICEF Data on Orphans by Region

Worldwide Orphans: Haiti

SOS Children’s Villages: Children’s Statistics

Worldwide Orphans

Worldwide Orphans is dedicated to transforming the lives of orphaned children to help them become healthy, independent, productive members of their communities and the world, by addressing their physical and mental health, education, and ability to achieve. WWO was founded in 1997 by Dr. Jane Aronson, who has dedicated her life to working with children. Worldwide Orphans is a partner of Law Street Creative. The opinions expressed in this author’s articles do not necessarily reflect the views of Law Street.

http://www.wwo.org

The post State of the World’s Orphans appeared first on Law Street.

The United States spends more money on health care than any other developed country. At the same time, studies find that patients in other countries enjoy better quality and more accessible health care than Americans. Why is American health care so expensive and what are the underlying issues that hold the United States back from necessary reforms? Read on to learn more about the U.S. healthcare system and how it stacks up internationally.

How does the U.S. healthcare system compare internationally?

According to the 2014 Commonwealth Fund analysis of the U.S. healthcare system in comparison to other industrialized countries, the United States ranks last among peer nations. This poor ranking is not a one-time thing, as almost all previous editions of the report from 2004-2010 also ranked the American healthcare system the lowest in terms of both cost and quality. The report compares the United States to some of the most developed and industrialized nations in the world, including Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United Kingdom. All of these countries spend much less on health care and have higher-quality services.

What are the problems with the American healthcare system?

The United States adheres to a Selective Health Coverage (SHC) system, also called a hybrid healthcare system. Roughly half of healthcare spending comes from private funds, while the government covers the other half through federal, state, and local funds. The majority of healthcare costs are covered through private insurance companies that sell health coverage to employers and private individuals at different rates. The government provides coverage through Medicaid for low-income households, and Medicare for retired Americans.

High Costs 

As the United States has no universal health coverage, people mainly receive health insurance from their employers, the government, or purchase it through exchanges. The Affordable Care Act, which entered into force in 2013, made it easier to gain coverage, but 10 percent of Americans still lack health insurance.

As each insurance plan includes deductibles, co-pays, and out-of-pocket costs, even with insurance, it could be quite expensive to seek medical services. In 2014, the average household spent $8,000 in medical costs, including monthly insurance payments, taxes, lost wages, out-of-pocket care, and other costs. These prohibitive costs mean that Americans may skip physician visits, treatments, tests, or follow-up care, even if recommended by their doctor.

The American healthcare system is one of the most expensive in the world. Around 18 percent of the country’s GDP goes toward healthcare costs. The Netherlands ranks next, but spends only 12 percent of its GDP on health care. The government spends by various estimates between $8,500 to $10,000 per capita annually, and still requires high out-of-pocket costs for its citizens. Other industrialized countries spend from $3,000 to $5,500 per capita and manage to cover more people and offer better services. Overall, the U.S. ranks last on the Commonwealth Fund’s rankings for national health expenditures. There are plenty of reasons for that, including but not limited to high costs associated with administrative hassles and duplicate testing. The United States is also the only developed country where medical costs contribute toward, and in some cases directly lead to, personal bankruptcy. Even such business giants as Starbucks and General Motors have acknowledged the disproportionately high costs of providing health care to their employees.

Low Quality 

The healthcare system in the United States isn’t very efficient. While most other countries have adopted some kind of unified system of communication with patients and other providers, the U.S. system’s administrative hassles were cited as a problem by the Commonwealth Fund. The overall health of the American population is worse than that of other industrialized countries. The U.S. ranks last on all three measures of healthy living, including mortality amenable to medical care, infant mortality, and healthy life expectancy at age 60.

What types of healthcare systems do other countries have?

National Services

The most popular type of healthcare system in the developed world is a national health services system. In this type of system, necessary medical care is fully paid for by the government. Hospitals and clinics are publicly operated, but private sector institutions also exist. Private medical clinics may have specific regulations they must follow, while the government pays them certain fees. Or, private medical clinics could operate solely like businesses and profit by providing superior, more personal or elective medical care. Many countries employ this mode;, including the United Kingdom, Spain, and New Zealand.

In the United Kingdom, health care is largely supported by tax contributions that are then used by the government to cover the vast majority of its population’s medical costs. Private coverage also exists, often through employers, but these premiums are affordable as to allow competition with public health care, which is free of charge. The U.K. healthcare system ranks first on the Commonwealth Fund’s list among other industrialized countries, particularly when it comes to efficiency and access.

National Health Insurance System

In a national health insurance system, also called a single-payer system, the government pays for all costs, but doesn’t operate healthcare services. Canada, Denmark, Taiwan, and Sweden are among those countries that operate a single-payer healthcare system.

Taiwan has one of the best healthcare systems in Asia. Health providers are employed by the public or private sector, but are paid standardized fees, which eliminates price competition and adds quality competition. In 2010, Taiwan spent three times less (6.5 percent) than the United States (16 percent) in its healthcare expenditures, covering 99 percent of its population. Administrative costs are also extremely low (1.5 percent) in comparison with the U.S., which spends 20-30 percent of overall healthcare funds on administrative costs.

Multi-Payer Health Insurance System

This system of health care is operated by Germany, Japan, and France. According to this model, all physicians are paid from a special fund, which is designated for healthcare services. The rates are the same for all physicians, cutting administrative costs for government, and creating quality competition.

Germany is a great example of a system that provides quality and cost-efficiency. Health services in Germany operate through an alliance of around 240 not-for-profit insurance providers that cover about 90 percent of the total population and are paid from a specifically designated “sickness fund.” The other 10 percent are generally high-income households that prefer private health insurance with superior services and quality. Amazingly, government expenditures for health care in Germany are half those of the United States, and the quality of health care is very high. Insurance companies and medical providers are closely regulated by the government, while employers and employees assume shared responsibility to pay taxes towards the “sickness fund.” Such a system helps to decrease the government’s costs and and provide more people with health coverage.

Watch the video below to learn more about Germany’s healthcare system.

Why is health care in the U.S. so expensive?

The complexity and for-profit nature of the American healthcare system is the primary reason for its high cost. As insurance companies are concerned with profit, they are always looking for ways to minimize their expenses and make money.

Expensive Mix of Services

The United States’ healthcare system provides a very expensive mix of services:

• The U.S. sees more specialist visits than in other countries, which are two-to-three times more expensive than general physician visits.
• Specialists often order more diagnostic tests and medical procedures that rack up the total costs. In comparison, other industrialized countries offer considerably fewer MRI scans, C-sections, and other procedures that could be avoided and are not always medically necessary.
• Duplicate testing is another issue that plagues American health care. As physicians and specialists make money from procedures, they often order duplicate testing. For example, dermatologists can order  biopsies from several affected skin areas, even if only one such procedure is required  for diagnosis.
• American hospitals also contribute toward the country’s expensive mix of services. They admit fewer people and, therefore, charge higher prices for hospitalization. They treat elderly people in the intensive care units (ICUs), while other countries subscribe to more specialized, palliative care, which is less costly.

Administrative Costs

There are thousands of health insurance plans available in the market, leading to variations in coverage, deductibles, co-pays, premiums, and other features. Not only is this system confusing, but such a system increases administrative costs as all doctor’s offices, laboratories, and hospitals have to bill insurance companies and patients for each rendered procedure and each doctor’s visit. As insurance plans vary greatly, medical facilities and patients have to constantly phone insurance companies to clarify details of premiums to find out what procedures are covered by the insurance company. Such a system creates unnecessary administrative hassles and drives up overall costs. It’s estimated that the United States “wastes” half of the $361 billion spent on administrative costs by spending it on expenses that could be avoided and are not necessary.

Pharmaceutical Spending 

Medical facilities and insurance companies are not the only players in the healthcare market. Drug manufacturing companies charge higher prices in the U.S. than in other industrialized countries. For example, branded prescription drugs are twice as expensive in the U.S. than in the rest of the developed world. In 2011, the United States paid $985 per capita for prescription drugs and other medications. That’s almost double what most other high-income countries spent on pharmaceuticals. This difference is due to the fact that other industrialized countries are often able to negotiate lower prices as they purchase pharmaceuticals in large quantities to provide medications for the whole population.

Interestingly, innovations and new medical technologies also drive up the cost of health care. The United States has more high-tech medical equipment than other industrialized countries. On top of it, it also has more stand-by equipment than other countries. The need to pay for the maintenance of these state-of-the-art technologies results in higher prices for tests, scans, and analysis for patients.

More Chronic Diseases 

People in the United States are less healthy than in the majority of developed countries. Obesity and other chronic diseases are more common in the U.S. than in its peer countries. That means that insurance companies and the government will spend a lot of money on managing chronic conditions that often require constant treatment, high-tech tests, and frequent hospitalizations.

Will the American healthcare system change?

If the United States ranks so poorly in health care, why doesn’t it do something to fix the problems? The answer to that question lies in the intersection between money and politics.

Interest-Group Lobbying

Many profit from the current healthcare system, including drug manufacturers, medical equipment providers, specialist physicians, insurance companies, and others who have considerable influence on public policy. The interests of those who make a profit from the current healthcare system are well represented through lobbying. In 2009, around 4,525 healthcare lobbyists were hired by more than 1,750 companies, including 207 hospitals, 105 insurance companies, and 85 manufacturing companies. For example, Big Pharma spent $22 million on healthcare lobbying in 2011; Blue Cross Blue Shield and biotech companyAmgen spent $21 million each on healthcare lobbyingthat year. None of the players involved in the healthcare business wants to lose profits, so lobbyists are trying to block any efforts that can damage their clients, even if those efforts could bring better health care to millions of Americans.

What are the possible solutions?

Even after the implementation of the Patient Protection and Affordable Care Act in January 2013, roughly 10 percent of Americans are still uninsured. In order to fix that problem, the United States could work toward implementing another system of health care, but that’s unlikely to gain much ground.

There have also been alternative solutions offered, such as the so-called “managed competition” model proposed by Stanford University Business School professor Alain Enthoven more than two decades ago. According to this model, insurance companies, physicians, hospitals, drug manufacturers, and other actors in the healthcare industry could come together to form an entity that has the responsibility to provide care for specific municipalities based on an annual allowance. This strategy could produce higher quality and lower costs simultaneously.

Another proposed solution is based on the implementation of a universal tax credit, similar to the child tax credit, that provides a $1,000 reduction in income tax to families that have a child. Money for this tax credit could be obtained from existing health insurance subsidies, like Medicaid and Medicare.

Conclusion

The United States’ healthcare system has not served its people well, especially when looked at in comparison to its peer nations. There are many faults to the current system, including high costs, inefficient practices, and an unwillingness by many to change. In order to effectively provide health care to as many people as possible, more changes need to be made. While the Affordable Care Act was a step in the right direction, the United States is still at the bottom of the list when it comes to effective health care.

 Resources

Commonwealth Fund: How the U.S. Healthcare System Compares Internationally

CNN Money: Healthcare Lobbying Boom Continues

Department for Professional Employees, AFL-CIO: The U.S. Healthcare System: An International Perspective

Forbes: U.S. Health Care Ranked Dead Last Compared to 10 Other Countries

Forbes: Universal Coverage is Not “Single Payer” Healthcare

Forbes: Why We Should Replace Obamacare With a Universal Health Tax Credit

HealthPAC: How Other Countries Do it

Global Post: Eight Places That Do Health Care Better Than the US

Global Post: Special Report: Health Care in Taiwan

Atlantic: Why Do Other Rich Nations Spend So Much Less on Health Care?

Center for Public Integrity: Lobbyists Swarm Capitol to Influence Health Reform

Law Dictionary: How Many Americans Really Do Not Have Health Insurance?

U.S. News & World Report: Obamacare Enrollees, by the Numbers

Valeriya Metla

Valeriya Metla is a young professional, passionate about international relations, immigration issues, and social and criminal justice. She holds two Bachelor Degrees in regional studies and international criminal justice. Contact Valeriya at staff@LawStreetMedia.com.

The post American Health Care: Last Place Among Peer Nations in Latest Study 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.

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Once again, the fate of the Affordable Care Act–Obamacare–rests in the hands of the nine justices of the Supreme Court. This time, the case is called King v. Burwell, and today, on this rainy Wednesday, oral arguments began. The case itself serves as an argument for proofreading and very deliberate writing, given that most of the accomplishments made by the implementation of Obamacare pretty much hang on one word written into the law: “state.”

Here’s a quick summary: Obamacare requires everyone to have insurance, and for those who buy insurance from the Exchanges implemented by the law, subsidies are supposed to be provided. Now, some states didn’t set up their own exchanges but instead relied on the federal exchange. Which should be fine, except there’s this one little part of the law that says:

The premium assistance amount determined under this subsection with respect to any coverage month is the amount equal to the lesser of—

(A) the monthly premiums for such month for 1 or more qualified health plans offered in the individual market within a State which cover the taxpayer, the taxpayer’s spouse, or any dependent (as defined in section 152) of the taxpayer and which were enrolled in through an Exchange established by the State under 1311 of the Patient Protection and Affordable Care Actor

A very literal interpretation of this clause would make it seem like those subsidies only apply to those who get their insurance on the state exchanges. But the IRS went ahead and gave subsidies to those on the federal exchange anyway, mostly because the government is arguing that the law was intended to be chopped up like that.

To put it simply: we’re watching a Supreme Court case over the use of the word “state” when it maybe should have said “government” or another less descriptive word.

Anyway, it’s not that this is a traditional legal issue. It’s a political play masked as a lawsuit–Republicans don’t want Obamacare to survive, and this is yet another attempt to get the law rendered significantly less effective than it is now.

No one knows exactly what’s going to happen–while the argument itself seems relatively specious, justices’ political beliefs could play a part. Justice Anthony Kennedy, the perennial swing vote, and Chief Justice John G. Roberts, who wrote the decision in the last big Obamacare case, are both being viewed as potential defectors from the conservative side of the bench.

Protesters from both sides have shown up at the Supreme Court, despite a rainy morning. In fact, I saw people camped out there as early as midnight last night–awaiting the chance to make their opinions about America’s healthcare future known.

TOP’s Claudette w/daughters demanding #SCOTUS keep health care for 9.6 mill. Americans #KingvBurwell #DontTakeMyCare pic.twitter.com/Z6XZDiJ1WO

— TXOrganizingProject (@TXOrgProject) March 4, 2015

Good size turnout of happy patriots defending the Constitution. “KEEP THE IRS OUT OF MY HEALTH CARE!” #KingvBurwellpic.twitter.com/BlWccHjGvL

— Tea Party Patriots (@TPPatriots) March 4, 2015

In some ways the biggest question isn’t what the court will do–after all that’s out of everyone’s hands with the exception of the nine justices–but what will happen after King v. Burwell is decided. If it’s decided that people can’t, in fact, get subsidies from the IRS if they’re on the federal exchange, the federal government can’t really do anything.

So that leaves two possible groups who can act–the United States Congress, and the states that relied on the federal exchanges. Unfortunately, it’s relatively unlikely that either will act. The states that chose not to set up the exchanges in the first place often did so because they did not agree with Obamacare. Congress…well a Republican-controlled Congress, will certainly not amend the law to fix it.

The most recently floated possibility came in the form of an op-ed from Representatives John Kline (R-MN), Paul Ryan (R-WI), and Fred Upton (R-MI). Entitled “An Off-Ramp From Obamacare,” and published in the Wall Street Journal, Kline, Ryan, and Upton used heavy-handed car-wreck metaphors to describe an alternative to the subsidies should King v. Burwell find that the federal subsidies are not allowed. This new plan would allow states to opt-out of Obamacare’s mandates, both for the individuals and employers, and would give people tax breaks rather than subsidies to buy insurance.

That doesn’t seem that different, but there is a worrisome element to the plan put forth by Kline, Ryan, and Upton. And that is the idea that people can afford to purchase the insurance and then wait until tax time to recoup that money. For the millions of Americans who live paycheck to paycheck, that isn’t necessarily a possibility.

Let’s be honest here, this entire thing is a mess. The Supreme Court could go either way, and if it chooses to declare the subsidies null and void, there will be a lot of people struggling to figure out what that means for their health care. If that’s the case, there’s no guarantee that House Republicans will actually get their crap together to make this “off-ramp” a reality, and even if they do, there will still be a lot of problems. The future of Obamacare looks just as messy as its past.

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 King v. Burwell: Win or Lose, the Newest ObamaCare Case is a Mess appeared first on Law Street.

Law Street’s top three stories of the week ranged from the truly outrageous, to the infuriating, to the utterly baffling. Anneliese Mahoney  brought us the number one most read article of the week about a Canadian couple who dotted all their insurance i’s and crossed all their doctor’s permission t’s and still were hit with a million-dollar hospital bill when they unexpectedly had their baby while on vacation in the U.S.; Mahoney also wrote about the startling  sexual assault allegations surrounding Bill Cosby and the rape culture in which we’re immersed; and writer Ashley Shaw told the tale of the very worst neighbor you can imagine–one whose dogs dogs killed the neighbor’s beagle so she decided to sue them. I told you it was utterly baffling. ICYMI, here is the best of the week from Law Street.

#1 Meet the World’s Most Expensive Baby

A Canadian couple decided to go on a nice, warm visit to Hawaii. Jennifer Huculak and her husband Darren Kimmel were three months away from the birth of their daughter when they came to the U.S. on vacation. Unfortunately, a few days after their arrival, Huculak went into labor and gave birth to a baby girl. Because their daughter was born premature, they racked up some expensive hospital bills. Well, actually, expensive is kind of an understatement. To be more precise, they are being charged $950,000 for the medical care they received. Read full article here.

#2 Bill Cosby Allegations: A Striking Example of Rape Culture

Bill Cosby has, to many, gained the sort of “elder statesman” distinction in the acting world. For all intents and purposes, things were going well for him this year. He signed up to do a new show on NBC and announced a Netflix standup special. Then a comedian named Hannibal Buress did a bit in which he accused Cosby of being a rapist. Read full article here.

#3 Woman Sues Neighbors After Her Own Pit Bulls Kill Their Beagle

I have a quiz for you (don’t worry, it’s only one question, it isn’t math, and it’s multiple choice): If your four pit bulls break through a fence and enter the neighbor’s yard, then kill Bailey the ten-year-old beagle that resides there, what do you do? a. Apologize. b. Offer to buy the neighbors a new dog. c. Both a and b. d. Sue the neighbors for $1 million. Read full article here.

Chelsey D. Goff

Chelsey D. Goff was formerly Chief People Officer at Law Street. She is a Granite State Native who holds a Master of Public Policy in Urban Policy from the George Washington University. She’s passionate about social justice issues, politics — especially those in First in the Nation New Hampshire — and all things Bravo. Contact Chelsey at staff@LawStreetMedia.com.

The post ICYMI: Best of the Week appeared first on Law Street.

A Canadian couple decided to go on a nice, warm visit to Hawaii. Jennifer Huculak and her husband Darren Kimmel were three months away from the birth of their daughter when they came to the U.S. on vacation. Unfortunately, a few days after their arrival, Huculak went into labor and gave birth to a baby girl. Because their daughter was born premature, they racked up some expensive hospital bills. Well, actually, expensive is kind of an understatement. To be more precise, they are being charged $950,000 for the medical care they received.

Now, despite being our friendly neighbors to the North, there are many differences between the U.S. and Canada. They have poutine, their milk sometimes comes in bags, and they have free health insurance. As a result of the extreme differences in healthcare provisions, Canadian tourists are required to buy health insurance for their travels here.

That’s exactly what Huculak and Kimmel did. Before going on the trip they not only got permission from her doctor to travel, but also purchased insurance through Blue Cross.

Unfortunately, just a few days into the trip her labor was induced by a bladder infection, which was not only unforeseeable, but even her doctor in Hawaii explained that this kind of thing “just happens.” Huculak’s daughter, Reece, is now healthy, but had a lot of complications due to her premature birth. She spent two months in an intensive care unit, and Huculak spent time in the hospital as well.

Blue Cross is flat out refusing to pay the $950,000 bill, arguing that Huculak had a “pre-existing condition,” which their policy does not cover. She did not have a pre-existing condition or a high-risk pregnancy, both of which her doctor has confirmed and tried to convey to Blue Cross. Kimmel and Huculak even claim that they specifically talked to a Blue Cross Representative who told them that they were covered. Of course, Blue Cross’ response to the media has been pretty unhelpful; a representative said in response to CTV News:

We review each claim carefully and are confident that our decision to decline this claim was done in a considered manner based on the contract terms, the situation which resulted in this emergency medical claim, and a review of recent medical history.

It seems like Kimmel and Huculak are now seriously considering bankruptcy, because they really have no other choice. They simply can’t pay the $950,000 medical bill. Their other option is to continue fighting Blue Cross, but that also is tough given that they’ve been on that path for what would seem to be about a year now and clearly not much progress has been made.

A case like this comes down to the fact that insurance is a fundamentally difficult process to negotiate, particularly health insurance. Even when you think you take all the necessary steps–purchase what you’re supposed to, speak to a representative, and travel after getting advice from a doctor–it’s still possible to basically get screwed by the insurance company. Kimmel and Huculak learned that lesson a very, very hard way.

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 Meet the World’s Most Expensive Baby appeared first on Law Street.

Ever wonder how your city compares to the rest of the world? Well lucky for you there’s a scientific system that will show how your city measures across the globe. The most up-to-date system of international quota and best way to compare cities is the ISO 37120, which works to measure the quality of food, environment, health care, business, government standards, and overall quality of life through a measurement of carefully calculated standards. Here is everything you need to know about ISO 37120, the world’s largest developer of voluntary international standards.

What is ISO?

History of ISO

In 1946, 25 countries came together to devise a tool that could track, benchmark, and improve city services and living conditions. Their goal was to improve the quality of cities by “[creating] strategic tools that reduce costs by minimizing waste and errors, and increasing productivity…help companies to access new markets, level the playing field for developing countries and facilitate free and fair global trade.” After a year of collaboration, the International Organization for Standardization (ISO) officially emerged and began recruiting more countries to participate in its global effort.

Click here to read the ISO’s full story.

How does ISO work?

The ISO is a non-governmental organization that is financed through the sale of electronic standards to members. It works to create a system of measurements geared toward a city’s performance in different areas of operation and production. ISO conducts an analysis of economics, business, and other fundamental principles of a functional municipality, then creates “requirements, specifications, guidelines, or characteristics, that can be used consistently to ensure that materials, products, processes, and services are fit for their purpose.” ISO then devises several implementation methods for almost guaranteed success and prosperity in a  city’s various industries, such as business, government, food, environment, and energy.

The ISO system is uniform and consistent in its measurements in order to conduct a fair analysis of each city’s quality, and can accurately enact or recommend a specific policy for areas in which certain cities may lack. The system adheres to a specific assessment to assure that the test remains completely objective and results in an accurate measurement. There are six statutes that the ISO agrees to maintain at an international level: transparency; openness; impartiality and consensus; relevance and effectiveness; coherence; and country interests. This allows for a scientific and fair system of evaluation.

Click here to read the ISO in Brief.

Click here to see a visual representation of ISO.

Members of ISO

ISO is funded through the sale of subscriptions to members worldwide. There are 163 member countries, each with one representative who attends conferences and meetings to discuss standards and strategies for implementation. Member countries are separate from their measured cites in that a member country does not designate each city to participate. Cities make the decision to participate independently of their federal governments, and often include the feedback of businesses and local governments, and they are assessed individually, separate from their countries. The role of the country members is to decipher the needs of their cities and create policy to improve overall quality of life.

Benefits of the ISO System 

Cities that participate in ISO 37120 will benefit in the following ways:

• More effective governance and delivery of services
• International benchmarks and targets
• Local benchmarking and planning
• Informed decision making for policy makers and city managers
• Learning across cities
• Leverage for funding and recognition in international entities
• Leverage for funding by cities with senior levels of government
• Framework for sustainability planning
• Transparency and open data for investment attractiveness
• Comparable data for city decision making, insight and global benchmarking

The benefits of being a part of the ISO standard are clear in that cities receive expert advice, regulations, and guidelines; productivity will inevitably increase, and the overall quality of life improves for the city’s residents. Business, government, and society can all prosper when put up against international standards and given a sense of stability and regularity.

Is this system a requirement for cities?

Cities are not legally required to register for ISO 37120, yet they may receive pressure from several different sources to do so. According to former World Bank official Dan Hoornweg, “It’s a potential game changer for world cities and everyone who works for cities, for journalists evaluating city performance, for the World Bank in determining grants and more.” With cities openly sharing information on services, this will create more competition and encourage cities to raise the bar on the services that they provide. Cities want to keep up with this international rat race.

 ISO Technology and Graphic Standards

One way that ISO profits and upholds its mission is by selling its electronically documented standards to cities. A catalog of 19,500 international standards are available for purchase on the ISO website.

ISO is largely based in an online platform. This allows countries to collaborate internationally and to ease technical communications. This focus on technological development also made ISO services more readily available to the less developed countries. In 2013, El Salvador, Uganda, and Rwanda all became members of the ISO online community.  Also in 2013, ISO created online stores; now 19 countries can sell ISO products (graphic decals, standards, and country codes).

Cities that participate in the ISO system have the option to buy graphic decals in virtual or physical form to illustrate how to operate a product or signify its validity based on the ISO system’s standard and seal of approval.

How does ISO 37120 benefit developing countries?

Using the ISO 37120 can have a positive impact on developing nations. This standard gives those countries a model of what standards to strive for. According to ISO: Action Plan for Developing Countries, there are several areas that the ISO would like to work on, including: agriculture, construction, mechanical engineering, manufacturing, distribution, transport, medical devices, information and communication technologies, the environment, energy, quality management, conformity assessment, and services. Working on  issues in developing nations creates a global community in which they receive collaborative support to create a more prosperous and functional community.

One way that ISO works to  encourage development in third world countries is to hold a contest every two years. The German Institute for Standardization, a member of ISO, is  hosting the contest this year for young professionals in developing countries. This year the theme is: ‘Sustainable energy future: How can standards help meet the challenge?’ The winner will receive a trip with paid expenses to the German Institute for Standardization, where they will receive professional training on business and management. Efforts such as this target the youth in less-developed nations, and stimulate thoughts and instills drive in the future of these nations.

Click here to read the ISO Action Plan for Developing Countries

Standards of Evaluation

Click here to see a full list of ISO 37120 indicators.

Health

A city’s overall quality of health is generally measured by the following indicators: A citizen’s average life expectancy; the mortality rate of children who are under the age of five years old; the number of doctors and hospital beds per 100,000 population; the number of people who live in poor conditions or slums (this is also a measure for economic standing ); and the amount of solid waste, both produced and recycled.

• Emergency services and fatalities: How a city responds to emergencies also factors into a city’s quality. The number of firefighters, fire-related deaths, and deaths from natural disasters per every 100,000 population measures the quality of emergency response systems and effectiveness for unpredictable  occurrences. The ISO also measures the number of police per 100,000 people, as well as the number of homicides.
• Issues at the forefront in Health: ISO has made some helpful advancements in health within the past year. In cancer research, an advancement in digital technology was made to help in identifying breast cancer. A mammogram is an x-ray of the breasts that detects abnormal or cancerous cells. The ISO system has successfully made it possible for digital images to be transmitted clearly from facility to facility. Kevin O’Donnell, a technological expert at ISO, said: “Thanks to the standard, images can be read on any equipment. The DICOM format allows these images to be uploaded and reviewed wherever they are taken.  Being able to compare current images to prior images to get a sense of changes and progression, or lack thereof, is vital for radiologists and oncologists.”

Click here to view more ISO issues ISO.

Improving Standards

To improve health standards ISO mainly focuses on upgrading the level of care by implementing new technologies and developing a more efficient and effective system in handling general health and medical crises.

Food Standards

The ISO food standards are constantly being improved. Food regulations include transportation, storage, and production. Academic, research, government, and food industry organizations all participate in this quest to meet and keep health requirements up-to-date.

There are specific sets of standards that apply to organizations, caterers, farmers, and manufacturers. ISO would like to certify as many food institutions as possible in order to eliminate health hazards in the food industry, such as salmonella and listeria.

ISO in the Alcohol Industry

An example of the food trade regulating itself would be the alcohol industry. A large beer company, headquartered in St. Petersburg, Russia uses ISO to improve its business and increase revenue. By adhering to strict principles and standards of making the alcohol, companies can become more productive and prosperous in their sales and relationships with consumers. ISO standards including “procurement, production, distribution, and after sales service” contributed to the rebirth of this once failing company.

To view how this beer company saved itself from bankruptcy view the video below.

Environment

The benefits of having the environment monitored and regulated include a reduction in the cost of waste management services and products, lower distribution prices, and the improvement of a city’s image.
The general quality of  the environment is measured by two basic standards:

1. Fine particulate and particulate matter concentration and the amount of green house emissions. The amount of open green area is also a feature of measurement in the ISO 37120 system.
2. By monitoring these environmental factors, ISO and cities can work to cut down on air pollution and environmental damage through the increase in energy efficiency and the promotion and development of renewable energy technologies.

Energy

One goal of ISO 37120 is to better conserve energy. This requires a city to first measure and become aware of  its expenditure and the source. Then a feature of ISO, ISO 50001, works to create an energy management system to more efficiently use energy.

To judge the standard of energy in each city ISO uses a few mandatory standards:

• The amount of residential electrical usage
• The percentage of the population that uses an electrical service
• The amount of energy that public venues consume per year
• The amount of energy that is derived from alternative or renewable resources

Transportation

ISO 37120 measures both public and private transportation, as well as the passengers of personal automobiles per the standard 100,000 measurement. These statistics assist ISO in measuring environmental factors in which transportation contributes to the output of environmentally detrimental fumes.

ISO also adheres to a system in which it measures the safety, test methods, engineering, and performance in vehicles.

Water (Sanitation and Waste)

ISO 37120 measures the amount and level of treatment that the city’s water will go through before consumption. It also measures the improvement of sanitary services, the amount of people with potable water service, and the amount of water that is consumed.

One way that ISO is working to make water management efficient is by assessing the “water footprint,” and the cycles and impacts of water usage in cities. This initiative examines a specific environmental factor that works to maximize the usage of a city’s resources and minimize its negative effects on the environment.

ISO is constantly working on ways to improve environmental protection plans, especially with the growing fear of global warming. Right now, ISO is working to “go green,” by trying to cut down on pollution and carbon emissions produced by cities.

Business and Government

Economy

A standard of evaluation for cities participating in the ISO will be judged based on three standards of monetary importance: The city’s unemployment rate, the number of people living in poverty, and the value of the properties. Also, the financial worth of the city is measured by the percentage of debt to the overall revenue.

Government

Two main factors are used to measure the quality of a municipality’s government: The number of eligible voters in the last election, and the number of women who are elected at the city level.

These variables work to measure the level of participation of the city in local legislation. This is especially important to developing countries where governmental participation in vital to the expansion and evolution of an under-developed country.

Education

Education standards are judged by the following criteria: “Primary education student/teacher ratio, percentage of female school-aged population enrolled in school, percentage of students completing primary education, [and] percentage of students completing secondary education.” Once again this statistic is particularly relevant in developing countries, in that education is a primary tool which advances a community intellectually and economically.

Technology

ISO 37120 also measures the number of internet and cell phone connections per the standard 100,000 persons. This measures how technologically advanced a city is, and the level of industrialization they have reached in comparison to the rest of the world.

Issues at the Forefront in Business

An issue that has infected not only consumers but also governments and businesses is the issue of counterfeit drugs and products in circulation. According to the ISO, “Counterfeit products exist in virtually every area – food, drinks, clothes, shoes, pharmaceuticals, electronics, auto parts, toys, currency, tickets for transport systems and concerts, alcohol, cigarettes, toiletries, building materials and much, much more.” When consumers buy counterfeit products they are keeping money from the government and increasing taxes for taxpayers. Also, “financial turmoil for businesses such as low turnover, stolen know-how, lost jobs, wrongful lawsuits caused by counterfeited products and price hikes.”

Ultimately this underground market is devastating the economy. How will ISO combat this detrimental circulation of illegal goods? First off, the organization plans to enact legislation that would enforce regulations across industries to eliminate the illegitimate vendors that are illegally benefiting from a market which that have no rights to. Also, pre-market and market surveillance can help to identify illegal goods before or after they are available to the public; then further action to remove the product and possible legal action would be taken to discourage future frauds. Taking action on an international level is also part of the ISO plan.

City Growth and ISO

A megacity is defined as a growing city with a population of 10 million or more people. Check out this global breakdown of the world’s megacities.

Conclusion

As cities consistently grow throughout the world, they also run into more issues with the massive influx of people. Although the economy can reap benefits, pollution, politics, and  environment become targets of mankind, and the overall quality of life begins to suffer. With the future of developing cities at stake, the ISO can step in to benchmark and ultimately regulate the standards of living on an international scale. The ISO works to oversee and create a plan to manage cities that experience development at a quick and potentially unmanageable rate.

 Resources

Primary

ISO: About

ISO: 10 Good Things for SMEs

ISO: ISO Standards in Action

ISO: We are ISO. 

Additional

Citiscope: Here are the 46 performance measures the world’s cities will be judged by 

GovTech: Finally, Clear Performance Data for Comparing the World’s Cities

University of Toronto: Global Cities Gather in Toronto for Summit and to Launch the World Council on City Data 

Smart Cities: Stakeholder Platform 

CNBC: Megacities’ Explosive Growth Poses Epic Challenges

Global City Indicators Facility: Pilot Cities

Madeleine Stern

Madeleine Stern attended George Mason University majoring in Journalism and minoring in Theater. Her writing on solitary confinement inspired her to pursue a graduate degree in clinical counseling after graduation. Madeleine is an avid runner, dedicated animal lover, and a children’s ballet instructor. Contact Madeleine at staff@LawStreetMedia.com.

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The Obama Administration once again announced an extension of an Affordable Care Act deadline this week. For anyone who’s counting, we’re up to at least 11. This time it’s late signups for people who have technical problems that prohibit them from signing up by the March 31 deadline. If that’s you, you can now apply for an extension to mid-April by checking a box on the application. The Administration is trusting that you’ll abide by the honor system and will really only ask for an extension if you need it.

The President has issued many delays since the healthcare law was implemented. Here’s a brief recap:

• Starting in November 2012, the Department of Health and Human Services delayed for a month the decision to set up a federal exchange.
• In July 2013, the employer mandate was delayed. The statute originally imposed fines on businesses with more than 50 employees that do not offer health insurance. Now, no fines will be enforced in 2014.
• November 2013 saw two different delays — one for open individual enrollment in 2015, and the other being open enrollment for small businesses. A month later, the deadline to apply on the individual exchange was delayed twice in a row — first on November 12, and then November 24.
• High-risk pools (groups of people with pre-existing conditions who were uninsured) were slated to end January 1, 2014, but they were extended to March. As soon as we reached that deadline, it was extended yet again.
• The deadline for employers with 50 to 100 employees to offer healthcare was again delayed in February 2014 — they are now allowed to wait until 2016 to offer health insurance.

There is predictably criticism from Republicans ranging from the need to fix key parts of the law to repealing it outright. One suggestion is to repeal the tax on medical devices, a main revenue source for the Affordable Care Act, while others have called for an investigation looking into the constitutionality of the delays. Michael McConnell, quoted in the Washington Post, has said that the continuing deadline delays are blatantly illegal. “Statute does provide broad discretion, but unless there’s some explicit statutory authorization they don’t have the right not to do it … That’s the difference. Suspending and dispensing with statutes are equally impermissible.”

When it comes to allowing the executive branch to implement delays in the law, the main concern is over Congress’ role. Congress, the main federal legislative body, is supposed to take up these delays. By allowing the President to give out executive orders delaying legal statues, legislative jurisdiction becomes confused. Who, in fact, has the right to make these delays?

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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 [Wikimedia]

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 Is it Legal for the President, and not Congress, to Implement ACA Delays? appeared first on Law Street.

“Ho Ho! Hey Hey! Birth control is here to stay!” Or is it?

Just when we think that the debate about contraception coverage has been laid to rest, another group of angry women are chanting outside of the supreme court and fighting for their right to be insured for their contraceptives. Although this time is a little different. This fight against contraception coverage was not brought about by a religiously affiliated group or a non profit religious organization, but by two corporations whose owners have certain religious beliefs. Thus, the debate regarding contraception coverage under the affordable care act continues, leading to the convening of the United States Supreme Court on Tuesday March 25, 2014.

What is the background regarding this debate?

A provision of the affordable health care act requires many employers to provide a variety of birth control methods to female employees who have comprehensive insurance coverage. This law does not apply to all employers due to the 1993 Religious Freedom Restoration Act, which prevents law from substantially burdening an individual’s free exercise of religion. With this act, it was decided that the responsibility to provide birth control to employees was not extended to religious employers such as churches and religiously affiliated groups.

Who are the challengers?

This case has been brought to the supreme court by two for-profit corporations who argued that their businesses are run under religious principles. This includes the Hobby Lobby, arts and crafts chain that is run by a Christian family and Conestoga Wood Supplies, a cabinet making company owned by a Mennonite family.

The argument of the government:

The requirement of corporations to pay for contraceptives for female employees is an insurance that that all women will have equal opportunity and access to services regarding their health care. It is not the right of the employers to decide which form of contraception is best for their female employees, because that is the job of their doctor. It is believed that the corporations providing of birth control will lead to less abortions overall.

The argument of the two corporations:

They are not rejecting all forms of birth control, but instead feel that covering the costs of certain methods such as condoms, birth control pills and diaphragms would be within the boundaries of their religion. Now, there are various methods of birth control, but the main ones that are in contention include emergency contraceptives such as the morning after pill because the corporations feel if they comply, they are condoning abortion.

What will the outcome be?

We will have to wait and see. A ruling from the Supreme Court is expected in June. It is for the court to decide whether the challengers have the right to object to this birth control coverage of specific types of contraception under the 1993 Religious Restoration Act mentioned above. This would mean that the religious beliefs of the corporations were, “substantially burdened”, which is of course up for the Supreme Court to decide.

Where I stand:

There is a large difference between a for-profit company and a non-profit, religiously affiliated organization. In my opinion, there is difference between who should cover birth control and who has the right to opt out. Corporations are now trying to play the religion card, which is a very slippery slope. Let’s think about this. There are many for-profit businesses out there with owners who most likely have some religious affiliation or another. Simply because a business owner closes their doors on Sunday or considers themselves a Christian should not give them the easy way out for covering the birth control of employees, as is the law under the affordable care act. Once some corporations are granted their “religious liberties”, who is to say that not all corporations with a religiously practicing owner can opt out of paying for birth control. These companies are not religiously affiliated, they are not non-profit and they need to pay to cover their employee’s birth control.

For more information, to see the protesters and to decide for yourself:

[Reuters] [The New York Times]

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Taylor Garre (@TaylorLynn013)

Taylor Garre

Taylor Garre is a student at Fordham University and formerly an intern at Law Street Media. Contact Taylor at staff@LawStreetMedia.com.

The post Not Another Contraception Debate 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.

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.