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.

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.

North Korea is Firing Missiles Again

Yesterday, North Korea fired an intercontinental ballistic missile that could potentially reach the U.S. The U.S. then carried out a joint military exercise with South Korea to show off its power and send a warning message to North Korea. But the North just replied by saying that it would not stop developing its nuclear abilities as long as America’s “hostile policy” and “nuclear threat” persist. The missile traveled 578 miles, according to the South Korean military. It stayed in the air for about 37 minutes. That means that it could potentially reach Alaska.

The North’s plan is to mount a nuclear warhead on the missile. The timing of the launch was also significant. “The American bastards must be quite unhappy after closely watching our strategic decision,” a North Korean state media agency quoted its leader Kim Jong Un as saying. “I guess they are not too happy with the gift package we sent them for the occasion of their Independence Day. We should often send them gift packages so they won’t be too bored.”

North Korea’s state media claims the country now has the power to strike the United States with a nuclear warhead https://t.co/UQ9uGZ2Ebc pic.twitter.com/m9c4phzFm7

— CNN (@CNN) July 5, 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 5, 2017 appeared first on Law Street.

As Republican Senators prepared to release a version of their new health care legislation on Thursday, a group of protesters gathered outside Senate Majority Leader Mitch McConnell’s office. But many of them were eventually physically removed from the scene.

The rally was organized by ADAPT, a national disability rights organization, according to CNN. In their statement, the protesters said that they are “demanding [McConnell] bring an end to attacks on disabled people’s freedom which are expected in the bill.”

So, the majority of protesters were either advocates for those with disabilities or those directly impacted by a handicap, according to USA Today. Instead of calling their protest a “sit-in” they referred to it as a “die-in,” demonstrating their belief that the GOP health care bill would put many Americans in grave danger without dependable health care.

ADAPT’s statement also noted that the protest took place on the 18th anniversary of Olmstead v. L.C. – the Supreme Court decision that recognized disabled people’s right to live in communities rather than institutions.

After President Donald Trump took office and vowed to repeal the Affordable Healthcare Act, the Republicans have been trying to craft their own version of the bill. They faced harsh criticism from both sides of the aisle for their secrecy regarding the bill’s contents before unveiling it on Thursday.

Citizens nationwide were offended by both the process surrounding the creation of the bill and the contents of the bill itself. So, the protesters felt it was incumbent to voice their concerns to one of the most powerful Republicans in Congress.

While the protests remained mostly peaceful, Capitol Police were called in at some point and began to forcefully remove protesters despite their constitutional right to protest the government.

Capitol Police are physically removing protesters who are staging a “die-in” in front of McConnell’s office pic.twitter.com/8BU0dW63VI

— Andrew Desiderio (@desiderioDC) June 22, 2017

The police force ultimately arrested around 20 people, many of whom were either on respirators or confined to wheelchairs, according to the Huffington Post. Custodians also had to be sent to the hallway in order to clean up blood, according to Daily Beast reporter Andrew Desiderio.

The group took particular exception to the proposed cuts to Medicaid. At one point the crowd began chanting: “No cuts to Medicaid, save our liberty!”

“No cuts to Medicaid, save our liberty.” Group chants in front of @SenateMajLdr‘s office. pic.twitter.com/fVJpufMDgC

— Jessica Smith (@JessicaASmith8) June 22, 2017

The health care bill has to be voted on by the Senate and go back to the House, so it will likely be modified. But the violence that these protesters faced at the hands of Capitol Police is upsetting. Instead of having their voices heard, they had their free speech stymied and were physically injured.

Josh Schmidt

Josh Schmidt is an editorial intern and is a native of the Washington D.C Metropolitan area. He is working towards a degree in multi-platform journalism with a minor in history at nearby University of Maryland. Contact Josh at staff@LawStreetMedia.com.

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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.

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

The Role of Regulations

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

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

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

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

The Current Health Insurance Debate

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

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

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

Kevin Rizzo

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

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

Who is Affected

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

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

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

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

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

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

Ending the Medicaid Expansion

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

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

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

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

A New Funding Model

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

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

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

How it would Change Medicaid

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

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

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

Conclusion

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

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

Kevin Rizzo

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

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

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.

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.

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.

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

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

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

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

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

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

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

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

Alec Siegel

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

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

House Speaker Paul Ryan likely didn’t wake up this morning expecting to become a viral meme, but that’s exactly what happened.

During a press conference earlier today, Ryan delivered a presentation to explain the GOP’s proposed Obamacare replacement, the American Health Care Act. The house speaker used an old-school PowerPoint to explain key points with graphs and visual aides.

It didn’t take long before Twitter, trained to sniff out prime, meme-worthy blank canvases, offered up some alternative visual aides for Ryan’s presentation. Check out the top ten funniest Paul Ryan PowerPoint memes below!

10. Certified dab pro

Paul Ryan just gave a PowerPoint Presentation… pic.twitter.com/iOqvtglEhe

— President Goodtime (@SethGoodtime) March 9, 2017

Alexis Evans

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

The post Twitter Made Paul Ryan’s PowerPoint Presentation 100 Times Better appeared first on Law Street.

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

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

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

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

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

— Lauren Duca (@laurenduca) March 7, 2017

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

Obamacare vs Trumpcare pic.twitter.com/8VDZEAAtQx

— billy eichner (@billyeichner) March 7, 2017

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

— Dave Itzkoff (@ditzkoff) March 7, 2017

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

— Dave Itzkoff (@ditzkoff) March 7, 2017

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

— Fun_Beard (@Fun_Beard) March 7, 2017

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

— Andi Zeisler (@andizeisler) March 7, 2017

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

— Alia (@MizzzAlia) March 7, 2017

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

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

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

— Ashley Feinberg (@ashleyfeinberg) March 7, 2017

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

— shackas (@shackas) March 7, 2017

Obamacare vs GOP replacement pic.twitter.com/NdpwOqS75y

— Philip Lewis (@Phil_Lewis_) March 7, 2017

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

Victoria Sheridan

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

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

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.

The post What You Need to Know About the New GOP Health Care Plan 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:

Republicans Finally Introduce Their Obamacare Replacement

Yesterday, House Republicans presented their draft version of a replacement of the Affordable Care Act, which was one of President Donald Trump’s most ardent campaign promises. The new law would keep some of the ACA’s key components, such as prohibiting companies from denying coverage to people with pre-existing conditions and allowing people under 26 to stay on their parents’ health plan. However, it would reverse the expansion of Medicaid and drop the requirement that bigger companies must provide health insurance for full-time employees. It also does away with the provision that requires Americans to either have health insurance or pay a penalty fee. And it would get rid of federal subsidies for low-income individuals and, as many people have feared, defund Planned Parenthood for one year (more on that below).

According to Republicans, the ACA is “a sinking ship.” But Democrats are highly critical of this new 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,” said Minority Leader Nancy Pelosi. And some on social media were also critical of the language used to refer to the new plan, claiming it was out of touch and didn’t acknowledge the real costs of care in the U.S.

Yes, the reason poor have trouble affording health care is all the new iPhones they’re buying. https://t.co/EJsZaejOH1 pic.twitter.com/SWoUp2nvAe

— Jamelle Bouie (@jbouie) March 7, 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 7, 2017 appeared first on Law Street.

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

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

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

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

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

Alec Siegel

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

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

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

Samantha Bee Takes on Bo Bice’s Popeyes Drama

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

Emma Von Zeipel

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

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

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

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

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

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

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

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

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

Alec Siegel

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

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

Repeal

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

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

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

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

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

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

Replace

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

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

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

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

— Chuck Schumer (@SenSchumer) January 6, 2017

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

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

Alec Siegel

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

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

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

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

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

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

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

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

Alec Siegel

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

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Today President-elect Donald Trump met with President Obama in the Oval Office to discuss plans for the hand-off between presidencies and the peaceful transfer of power. While the meeting seems to have been cordial, it had to have been a little awkward given that Obama and Trump are bitter political rivals and Trump plans to “cancel every unconstitutional executive action, memorandum and order issued by President Obama” on his first day in office–that’s if Trump’s plan for his first 100 days in office is to be believed.

In October, Trump laid out a detailed list of his plans, and the first day alone looks daunting. Aside from beginning to lay the groundwork to appeal Obamacare, he also plans to put an immediate hiring freeze on all federal employees, begin renegotiating NAFTA, withdraw from the Trans-Pacific Partnership, move forward with the Keystone Pipeline, and suspend immigration from terror-prone regions where vetting can’t safely occur (aka begin banning Muslims)–and that’s not even half of his first day plans.

Trump also announced ten pieces of legislation he hopes to introduce to Congress that would: fund the construction of a wall along the Southern border (with the “understanding” that Mexico would reimburse the U.S.), promote school choice, and invest heavily in infrastructure.

As Vox notes, some of these actions, like the federal hiring freeze and immigration ban, he could easily do from the Oval Office, while other actions  would require cooperation from  relevant government agencies and Congress. But with a Republican controlled Congress on his side, he could easily tick off a few of these items on his list.

Below is a copy of Trump’s full 100 day plan titled “Donald Trump’s Contract With the American Voter” that was released in October.

What follows is my 100-day action plan to Make America Great Again. It is a contract between myself and the American voter — and begins with restoring honesty, accountability and change to Washington

Therefore, on the first day of my term of office, my administration will immediately pursue the following six measures to clean up the corruption and special interest collusion in Washington, DC:

* FIRST, propose a Constitutional Amendment to impose term limits on all members of Congress;

* SECOND, a hiring freeze on all federal employees to reduce federal workforce through attrition (exempting military, public safety, and public health);

* THIRD, a requirement that for every new federal regulation, two existing regulations must be eliminated;

* FOURTH, a 5 year-ban on White House and Congressional officials becoming lobbyists after they leave government service;

* SIXTH, a complete ban on foreign lobbyists raising money for American elections.

On the same day, I will begin taking the following 7 actions to protect American workers:

* FIRST, I will announce my intention to renegotiate NAFTA or withdraw from the deal under Article 2205

* SECOND, I will announce our withdrawal from the Trans-Pacific Partnership

* THIRD, I will direct my Secretary of the Treasury to label China a currency manipulator

* FOURTH, I will direct the Secretary of Commerce and U.S. Trade Representative to identify all foreign trading abuses that unfairly impact American workers and direct them to use every tool under American and international law to end those abuses immediately

* FIFTH, I will lift the restrictions on the production of $50 trillion dollars’ worth of job-producing American energy reserves, including shale, oil, natural gas and clean coal.

* SIXTH, lift the Obama-Clinton roadblocks and allow vital energy infrastructure projects, like the Keystone Pipeline, to move forward

* SEVENTH, cancel billions in payments to U.N. climate change programs and use the money to fix America’s water and environmental infrastructure

Additionally, on the first day, I will take the following five actions to restore security and the constitutional rule of law:

* FIRST, cancel every unconstitutional executive action, memorandum and order issued by President Obama

* SECOND, begin the process of selecting a replacement for Justice Scalia from one of the 20 judges on my list, who will uphold and defend the Constitution of the United States

* THIRD, cancel all federal funding to Sanctuary Cities

* FOURTH, begin removing the more than 2 million criminal illegal immigrants from the country and cancel visas to foreign countries that won’t take them back

* FIFTH, suspend immigration from terror-prone regions where vetting cannot safely occur. All vetting of people coming into our country will be considered extreme vetting.

Next, I will work with Congress to introduce the following broader legislative measures and fight for their passage within the first 100 days of my Administration:

1. Middle Class Tax Relief And Simplification Act. An economic plan designed to grow the economy 4% per year and create at least 25 million new jobs through massive tax reduction and simplification, in combination with trade reform, regulatory relief, and lifting the restrictions on American energy. The largest tax reductions are for the middle class. A middle-class family with 2 children will get a 35% tax cut. The current number of brackets will be reduced from 7 to 3, and tax forms will likewise be greatly simplified. The business rate will be lowered from 35 to 15 percent, and the trillions of dollars of American corporate money overseas can now be brought back at a 10 percent rate.
2. End The Offshoring Act. Establishes tariffs to discourage companies from laying off their workers in order to relocate in other countries and ship their products back to the U.S. tax-free.
3. American Energy & Infrastructure Act. Leverages public-private partnerships, and private investments through tax incentives, to spur $1 trillion in infrastructure investment over 10 years. It is revenue neutral.
4. School Choice And Education Opportunity Act. Redirects education dollars to give parents the right to send their kid to the public, private, charter, magnet, religious or home school of their choice. Ends common core, brings education supervision to local communities. It expands vocational and technical education, and make 2 and 4-year college more affordable.
5. Repeal and Replace Obamacare Act. Fully repeals Obamacare and replaces it with Health Savings Accounts, the ability to purchase health insurance across state lines, and lets states manage Medicaid funds. Reforms will also include cutting the red tape at the FDA: there are over 4,000 drugs awaiting approval, and we especially want to speed the approval of life-saving medications.
6. Affordable Childcare and Eldercare Act. Allows Americans to deduct childcare and elder care from their taxes, incentivizes employers to provide on-side childcare services, and creates tax-free Dependent Care Savings Accounts for both young and elderly dependents, with matching contributions for low-income families.
7. End Illegal Immigration Act Fully-funds the construction of a wall on our southern border with the full understanding that the country Mexico will be reimbursing the United States for the full cost of such wall; establishes a 2-year mandatory minimum federal prison sentence for illegally re-entering the U.S. after a previous deportation, and a 5-year mandatory minimum for illegally re-entering for those with felony convictions, multiple misdemeanor convictions or two or more prior deportations; also reforms visa rules to enhance penalties for overstaying and to ensure open jobs are offered to American workers first.
8. Restoring Community Safety Act. Reduces surging crime, drugs and violence by creating a Task Force On Violent Crime and increasing funding for programs that train and assist local police; increases resources for federal law enforcement agencies and federal prosecutors to dismantle criminal gangs and put violent offenders behind bars.
9. Restoring National Security Act. Rebuilds our military by eliminating the defense sequester and expanding military investment; provides Veterans with the ability to receive public VA treatment or attend the private doctor of their choice; protects our vital infrastructure from cyber-attack; establishes new screening procedures for immigration to ensure those who are admitted to our country support our people and our values
10. Clean up Corruption in Washington Act. Enacts new ethics reforms to Drain the Swamp and reduce the corrupting influence of special interests on our politics.

On November 8th, Americans will be voting for this 100-day plan to restore prosperity to our economy, security to our communities, and honesty to our government.

This is my pledge to you.

And if we follow these steps, we will once more have a government of, by and for the people.

Alexis Evans

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

The post Here is What Donald Trump Says He Plans to Do in His First 100 Days appeared first on Law Street.

The day after the election was rough to say the least. Not only had I overconfidently assumed that I’d be spending the day celebrating a woman finally breaking through the top political glass ceiling, but I hadn’t even allowed myself–up until that point–to imagine a reality where Donald Trump actually wins the 2016 presidential election.

Sleep deprived and legitimately scared for my life, I then began to mentally run through all the things that could now happen under a Trump presidency. For starters:

1. “The Great Wall of Mexico” could become a reality.
2. Marriage equality quite possibly could be overturned.
3. Abortion could become illegal.
4. Congress would likely work quickly to repeal Obamacare.

But wait, if Trump trashes the Affordable Care Act, that would mean no more free birth control!

I frantically began researching a form of contraception that would outlast a four-year Trump term and stumbled upon intrauterine devices. Commonly referred to as IUDs, these tiny T-shaped devices are inserted into a woman’s uterus as a long-acting reversible form of birth control.

Unlike the pill, versions such as Mirena can last up to five to seven years (which would be long enough to outlast Trump), and if you get one in the next 70 days, it’s probably free under Obamacare. According to Planned Parenthood, IUDs can cost as much as $1,000.

Apparently I wasn’t the only one ready to immediately schedule an appointment with my gynecologist. Women all across the country flocked to Twitter to urge women to get an affordable IUD while they still can.

Getting an IUD before January 1st that’s for damn sure

— Paige Daniel (@paigedaniel_) November 9, 2016

I have truly never been more shocked in my life. Hug your friends a little tighter, promise to protect each other, & everyone go get an IUD

— Rachel Varina (@rachelvarina) November 9, 2016

The only thing I was motivated to do today was set up an IUD consultation with my gyno.

— Cate Weinberg (@CateWeinberg) November 9, 2016

IF YOU CAN GET PREGNANT: TRY TO GET AN IUD IN THE NEXT 70 DAYS WHILE YOU ARE STILL COVERED.

— nurse lyons (@seelions) November 9, 2016

Get your IUD. If you have light periods, opt for a Paragard, which can last 10-12 years. Get your birth control that will outlast Trump.

— grimalkin (@grimalkinrn) November 9, 2016

IUDs aren’t for everyone, but this set-it-and-forget-it method can be 99.8 percent effective at preventing pregnancy. Anyone considering an IUD should definitely do thorough research and consult a medical professional before getting one. Here’s a comprehensive guide to five different kinds of IUDs to choose from.

Alexis Evans

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

The post Why I Frantically Started Researching IUDs the Day After the Election appeared first on Law Street.

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

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

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

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

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

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

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

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

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

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

Open enrollment for the 2017 exchange begins on November 1.

Alec Siegel

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

The post Average Premium Under Obamacare to Rise by 25 Percent Next Year appeared first on Law Street.

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

Brief History of Obamacare

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

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

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

Why Providers are Leaving

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

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

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

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

Implications

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

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

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

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

Conclusion

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

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

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

Resources

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

CNN Money: Choices Dwindling for Obamacare customers

MSNBC: On Groundhog Day, Republicans vote to repeal Obamacare

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

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

The Daily Caller: Another Huge Insurance Company Is Leaving Obamacare

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

Obamacare Facts: ObamaCare Enrollment Numbers

Michael Sliwinski

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

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

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

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

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

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

Alec Siegel

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

The post In 13 States And D.C., Affordable Care Act Premiums Will Rise 10 Percent In 2017 appeared first on Law Street.

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

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

— HuffPost Politics (@HuffPostPol) May 16, 2016

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

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

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

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

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

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

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

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

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

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

Alexis Evans

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

The post SCOTUS Asks For Compromise in Obamacare Contraception Mandate Case appeared first on Law Street.

If there’s one person who is sure to always hit us where it’s relevant, it’s Shonda Rhimes. On the mid-season finale of “Scandal” (spoilers ahead, for those who aren’t caught up), Mellie filibusters in front of the Senate for nearly a full day in order to ensure that Planned Parenthood’s funding isn’t considered discretionary, and Olivia aborts Fitz’s child. Even with the trigger warning at the beginning of the episode, viewers were surprised with where the plot took them.

All of this aired just eight days before a gunman attacked a Planned Parenthood in Colorado Springs, Colorado. It occurred in the midst of a lawsuit against the state of Texas for trying to remove Planned Parenthood from Medicaid funding. And it tackled a real-life issue that has been discussed with increasing fervor since the fall—defunding Planned Parenthood altogether. Planned Parenthood remains front-page news, which is rare for an organization that has been around for nearly one hundred years. Yet it stays relevant, and will continue to stay relevant in mainstream media as long as the country is polarized by the subject of abortion. So, here’s a breakdown of all the latest Planned Parenthood stories, and what they mean for the future of the organization and healthcare.

Is Planned Parenthood going to be defunded?

In short, as of right now, it’s hard to say whether Planned Parenthood will still be funded next year.

There are two ways that Republicans could go about trying to defund Planned Parenthood. There is a bill that just passed the Senate that would both remove federal funding from Planned Parenthood for one year and repeal part of the Affordable Care Act. This bill had already passed in the House of Representatives. However, given that it’s part of a bill to repeal Obamacare, President Obama is expected to veto it.

So, if that doesn’t work, it is possible that the defunding would be tacked onto the spending bill that has to pass by December 11 in order for the government to continue functioning.

Why defund Planned Parenthood?

The woman’s health organization has been under fire since several videos were released in July 2015 that imply that baby parts are sold by the organization. Since then, it has been proven that these videos were manipulated by an anti-abortion organization, but the damage had already been done. The president of Planned Parenthood has since had to testify before a congressional hearing, and the threat to defund the organization has become very real.

What would happen if Planned Parenthood is defunded?

If Planned Parenthood is defunded, the results could be disastrous. While it is anyone’s right to decide what side they fall on in the ongoing and ever-relevant debate about abortion, that is only a fraction of the work that Planned Parenthood clinics do across the country. According to its own statistics, 80 percent of its work is focused on preventing unintended pregnancies. Aside from that, it also provides 4.5 million STI tests and treatments each year, including nearly a quarter of a million HIV tests. When Planned Parenthood was defunded in rural Indiana, there was an explosion of HIV in the county. For many women, Planned Parenthood is the only source of STI testing, birth control, and other women’s health services available to them. Defunding Planned Parenthood would take those services away from the five million people who visit clinic locations each year.

Arguments for Defunding Planned Parenthood

On the flip side, the government funds that are funneled into Planned Parenthood each year have many other worthy recipients. Jeff Duncan, a Representative from South Carolina, said that the Boys and Girls Club, for example, only gets a fraction of the funds that Planned Parenthood gets each year. There is also the argument that there should be fewer government-sponsored programs all together, and Planned Parenthood is just another program that should be funded in another way.

However, no matter how it’s stated, it comes down to this—pro-lifers, and even some pro-choicers, don’t think that the government should fund any organization that has anything to do with abortions, even if it is illegal for federal funds to pay for abortions themselves. In this belief system, Planned Parenthood shouldn’t be a government-funded agency, and therefore defunding the organization would free up tax dollars for other uses.

What’s going on with Planned Parenthood in Texas?

Greg Abbott, the governor of Texas, announced in October that the state was going to remove Planned Parenthood from Medicaid funds. In return, Planned Parenthood and ten patients are suing the state of Texas in the hopes of stopping officials from cutting off the Medicaid funds that allowed the patients to be treated at Planned Parenthood locations. Texas is the fourth state, following Alabama, Arkansas, and Louisiana, to be involved in such a lawsuit this year.

Abbott made his announcement after the uproar that the July 2015 videos caused. The videos depicted supposed Planned Parenthood officials discussing selling aborted fetal parts for research, including staff members at Planned Parenthood Gulf Coast, which is located in Houston, Texas.

Does Planned Parenthood stand a chance of winning the lawsuit?

This lawsuit could go either way.

In Louisiana, Alabama, and Arkansas, the state had to stop proceedings to remove Planned Parenthood from Medicaid funds until officials looked into the matter more closely. This means that there is a chance that the removal is unconstitutional, or breaks some kind of law for restricting federal funds. Federal health officials did warn the Texas Health and Human Services Commission in October that removing Planned Parenthood from Medicaid funding could be a violation of United States law.

This is also not the first time that Planned Parenthood has sued the state of Texas. In 2012, Texas Republicans removed Planned Parenthood from the Texas Medicaid Women’s Health Program. The state of Texas argued that the federal government gave individual states the right to decide how to allocate federal Medicaid funds, and Planned Parenthood eventually lost the lawsuit.

As of November 23, 2015, the state of Texas had not yet received legal papers in the lawsuit. Once papers are received, the case will likely end up in front of a federal judge.

What about the shooting in Colorado Springs?

On Friday November 27, 2015–Black Friday, the day after Thanksgiving best known for shopping deals—there was a fatal shooting at a Planned Parenthood clinic in Colorado Springs, Colorado. Three were left dead and nine injured in the shooting, and one of the deceased was a police officer. After a five-hour standoff with police, the shooter was taken into custody.

As of right now, the exact motive for the shooting is unknown. Robert L. Dear was arrested and appeared at a hearing on Monday November 30 wearing a security smocked designed to prevent suicides. Allegedly, when Dear was arrested, he uttered “no more baby parts,” but police have not been forthcoming with any other information.

How does this affect where Planned Parenthood stands?

The spotlight right now is on the potential Presidential candidates. None of the Republican candidates specifically addressed the attack until Saturday, a full day after the events took place, and then, it was on Twitter, and the statements were vague. Both Hillary Clinton and Bernie Sanders released supports of sympathy. President Obama, meanwhile, stated his continued frustration with gun violence in the U.S.

The Senate voted this week on the bill that will defund Planned Parenthood, and while it was successful, it goes before President Obama now. Additionally, Kevin McCarthy, the House majority leader, has stated that Republicans are no longer planning to force a government shutdown over the defunding of Planned Parenthood, something they had been threatening to do in early November. However, the status of Planned Parenthood’s funding remains to be seen.

How is all of this related to a prime-time television show?

Shonda Rhimes is not a woman who shies away from controversial issues, as the midseason finale of “Scandal” clearly showed us. It is Rhimes’ relevancy that strikes a nerve with viewers. She was able to show a scenario playing out in the Senate–which is exactly where the bill that may defund Planned Parenthood for a year sat at the time–when a Republican junior Senator from Virginia filibusters so that funding for Planned Parenthood is not downgraded to discretionary. Not only that, but we see Olivia Pope–a strong woman, a character with gumption–in the most vulnerable position a woman can find herself in: on a bed with her feet in stirrups and a doctor between her legs. Put the two women together in a single episode, and you leave your audience with a powerful image.

After the episode aired, Planned Parenthood released this statement:

Tonight, the millions of people who tune into Scandal every Thursday night learned that our rights to reproductive health care are under attack. Never one to shy away from critical issues, Shonda Rhimes used her platform to tell the world that if Planned Parenthood lost funding for contraception counseling, STI testing, cancer screenings, and safe, legal abortion—millions of people would suffer. And this episode wasn’t the first time one of Rhimes’ characters had an abortion, yet tonight we saw one of our favorite characters make the deeply personal decision that one in three women have made in their lifetime. We applaud Shonda Rhimes tonight—and every Thursday night—for proving that when women are telling our stories, the world will pause and watch. We just hope those in Congress—and throughout the nation—who are steadfast on rolling the clock back on reproductive health care access are taking note.

But, further proving the contentious nature of this issue, the conservative Media Research Counsel released their own statement the day after the episode aired:

Hollywood’s liberal values permeate movies and television. Last night’s episode of ABC’s Scandal was pretty much an hour-long advertisement for Planned Parenthood. In the most disturbing scene, the main character has an abortion to ‘Silent Night’ (a hymn celebrating the birth of Jesus) playing in the background. This is Hollywood’s moral depravity on full display.

This particular episode was an interesting juxtaposition when considered side-by-side with what is currently happening in Texas and Colorado Springs. Rhimes showed women making powerful statements about the importance and commonplaceness of women’s health organizations like Planned Parenthood. In the current contentious political climate, “Scandal’s” arc showed a fictional look at some very real issues.

Conclusion

Planned Parenthood will likely always be in the news; such is the case when something as polarizing as abortion is involved. Religious and moral beliefs will cause the country to be split in two on the issue, as has been the case since Planned Parenthood opened its doors one hundred years ago. As long as the issue is relevant, we will continue to see media portray the issue in different lights, both in fiction and in mainstream media. And it is likely that Planned Parenthood and the news surrounding it will stay relevant for a while.

Resources

Primary

Planned Parenthood: Planned Parenthood at a Glance

Additional

Texas Tribune: Planned Parenthood Sues Texas Over Medicaid Removal

Los Angeles Times: Planned Parenthood Sues Texas Over Medicaid Funding

The New York Times: What Defunding Planned Parenthood Would Really Mean

Denver Post: What We Know about the Planned Parenthood Shooting in Colorado Springs

Refinery 29: Scandal Season 5, Episode 9 Recap: The Women Take a Stand

Entertainment Weekly: Scandal Abortion Shock: ABC Hit Slams Planned Parenthood Defunding

NPR: After Planned Parenthood Shooting, Obama Again Calls for Action on Guns

The New Yorker: The Planned Parenthood Shooting and the Republican Candidates’ Responses

The New York Times: For Robert Dear, Religion and Rage Before Planned Parenthood Attack

The New York Times: No Shutdown Expected on Planned Parenthood

The New York Times: Planned Parenthood Sues Texas in Dispute of Funding for Clinics

Huffington Post: Indiana Shut Down Its Rural Planned Parenthood Clinics and Got an HIV Outbreak

Slate: The GOP Argument for Defunding Planned Parenthood is Incoherent

The Wall Street Journal: Republicans Look for Votes to Defund Planned Parenthood, Repeal Parts of Health Law

The Atlantic: ‘Scandal’ Gracefully Tackled Abortion in Its Midseason Finale

Refinery 29: Planned Parenthood “Applauds Shonda Rhimes” for Last Night’s Episode of Scandal

Daily Signal: Why Haven’t GOP-Led States Defunded Planned Parenthood?

Amanda Gernentz Hanson

Amanda Gernentz Hanson is a Minnesota native living in Austin, Texas. She holds a Bachelor’s degree in Chemistry from Hope College and a Master’s degree in Technical Communication from Minnesota State University, where her final project discussed intellectual property issues in freelancing and blogging. Amanda is an instructional designer full time, a freelance writer part time, and a nerd always. Contact Amanda at staff@LawStreetMedia.com.

The post Planned Parenthood’s Continued Relevancy appeared first on Law Street.

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

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

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

9. “Words no longer have meaning.”

Finally, we can all throw away our dictionaries.

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

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

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

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

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

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

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

Rhetorical mastery, thy name is Justice Scalia

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

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

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

image courtesy of Gage via Wikipedia

Image Cortesy of Carol Norquist via Flickr

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

2. “Pure Applesauce”

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

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

It’s jiggery-POkery, not jiggery-poKERY

Bonus Quote:

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

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

Maurin Mwombela

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

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

Update: 10:30am June 25, 2015

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

King v. Burwell: Battle Over ObamaCare

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

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

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

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

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

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

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

Obergefell v. Hodges: Marriage Equality’s Latest Frontier

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

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

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

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

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

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

Update: 10:30am June 25, 2015: 

Emily Dalgo

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

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

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

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

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

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

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

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

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

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

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

The Complications of Coverage

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

Can you get coverage if you become unexpectedly pregnant?

The short answer? Kind of.

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

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

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

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

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

Advocacy Groups

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

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

Insurance Companies

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

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

So, Plan Ahead…If You Can

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

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

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

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

Resources

Primary

CDC: Unintended Pregnancy Prevention

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

Healthcare.gov: Healthcare Insurance Marketplace

Healthy People 2020: Maternal, Infant, and Child Health

Additional

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

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

Young Invincibles: Without Maternity Coverage

Parents.com: Hospital Birth Costs

WebMD: What it Costs to Have a Baby

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

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

Ashley Bell

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

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Thousands of people try to make it big in the comedy world each year. Whether you are making YouTube and Vine videos or you are working the comedy club circuit, what rights do you really have to your own material? Successful comedy builds on the human experience, so many jokes seem to be about similar topics, but what are the chances that the wording two comedians use will be the same?

Accusations are thrown from one comedian to another over who really “created” a bit, causing problems for everyone from the late Robin Williams to Jimmy Fallon. It’s important to keep in mind that jokes are in essence little stories or songs–it takes time to perfect the verbiage, and then it takes even more time to perfect the delivery. These jokes, theoretically, are the creative property of the person who initially tells them, but it’s a little more complicated than that. Read on to learn about different rights and controversies in comedy plagiarism.

Protecting Comedy

Legally, it can be very difficult for comedians to protect their content–much harder than it would be for writers, singers, or even actors. Most comedians don’t record their shows, especially when they are just starting out in the business. They also may change up their routines each night depending on the way they read the crowd. They might tell the same joke, but use different words or a different delivery, which makes it hard to prove that it was “their” joke. Many comedians are now recording their sets (made easier with the proliferation of smartphones) as a way to publicize their acts, but also in anticipation that there will be some way to copyright what they do.

Copyright in the Internet Age

Comedians who post material on YouTube, Vine, or other social media sources face an even higher risk of being infringed upon because often the videos get buried in the plethora of material found online. In the video below, check out the reactions of YouTubers who watch Jimmy Fallon sketches that many claim have been stolen from famous YouTube comedians or video-bloggers. The comments come toward the end of the video.

The Independent recently published a piece highlighting the trouble with plagiarism within the comedic community. In an article titled “Plagiarism is No Laughing Matter for Comedians,” Gary Delaney, a British comic, spoke about his own interactions with the internet and his material:

It used to be the case that a comic’s set would last decades. But now I’ve got jokes I wrote in May, June, and July that aren’t working by October because they’ve been absolutely trashed around the Internet.

There are some products currently available to comedians, including a piece of software called iThenticate, which is often used by students to check papers for plagiarism; however, it could also be used to help comedians determine if their jokes have been duplicated online. The catch is that it can only find jokes that have been plagiarized in someone else’s writing, not in another format such as audio or video.

YouTube is able to find duplicate content through a system called ContentID; however, this system only works for videos that are similar–so it won’t do anyone any good if it is someone different telling the jokes or doing a funny scene. It just catches people who re-upload someone else’s videos.

YouTube itself has plagiarism rules, but they tend to focus more on the “big” companies or figures. For instance, reposted videos from Jimmy Kimmel’s “Celebrities Read Mean Tweets” series are more likely to be found and deleted than someone finding and re-posting a make-up tutorial from Gigi Gorgeous–even though she has well over a million followers. It all has to do with who brings in the most money, and that tends to be powerhouse comedians with television followings.

YouTubers, especially famous YouTubers like Jenna Marbles, Grace Helbig, Tyler Oakley, and Shane Dawson–have taken to doing “challenges” where they credit the original idea, but the question remains as to whether or not those will catch on.

So, can you steal comedy?

What exactly would the stealing of jokes entail? Since we are all living in the same world, it is important to note that the best jokes are often rooted in current events. This means that many jokes will have similar tones or topics, but the punchlines will be different. Take a look at this video of the late night hosts making similar jokes about ObamaCare.

Each one has a similar topic and each one has similar points–but they all tell the jokes a little bit differently with unique styles and takes on the topic.

Famous comedians, including Patton Oswalt, have admitted that sometimes jokes can be similar, even if someone has never heard the joke before. He also says that sometimes the joke slips out without thinking, saying: “Sometimes someone else’s joke sneaks into one’s brain without attribution, leading to an accidental instance of punch-line thievery. But the correct thing to do in that case is apologize and not do it again.” In fact, some of our most famous comedians have “stolen.” Milton Berle is a classic comedian, and even he has admitted to borrowing a joke or two.

But what is it that makes a joke original and someone’s property in the first place? That’s another problem that comedians have to identify and contend with. For example, “SNL” was recently accused of ripping off a “tiny hats” sketch. The two sketches in question here actually aren’t that similar, save for the fact that characters in them wear tiny hats as part of the punchline. Tim and Eric, the comedians doing the accusing, essentially claimed ownership over the comedic idea of tiny hats–but how could someone determine if that’s true? There’s no easy answer to these kind of controversies, or any real body of law to help comedians make these judgments.

Case Study: Carlos Mencia

One of the most reviled comedians of the last few years is Carlos Mencia, who was confronted at one of his shows for stealing jokes. A video of the confrontation is found here. It contains graphic language, and most likely is not appropriate for work, but shows the argument between the comedian and his accuser.

Mencia has been accused of stealing jokes from George Lopez, Ari Shaffir, and Bobby Lee. One of his more famous accused thefts comes from Bill Cosby.

Though there was really nothing that any of the comedians could do about the theft, Mencia still felt the repercussions after the accusations. His fanbase shrank and a comedian who once had a bright career now struggles to pick up the pieces.

But Mencia is just one example of comedians who have been accused of stealing jokes. “South Park”  came under fire over an “Inception” joke that was already written for College Humor. Future “Daily Show” host Trevor Noah was accused of stealing jokes from Russell Peters. In another instance, Howie Mandel was accused of stealing a  joke from an “America’s Got Talent” hopeful.

Conclusion

So is there a reason to create laws around jokes and the rights of comedians? The United Kingdom already has some select laws, including one that says that any joke that is recorded is the sole property of that person. In an age where almost everything is recorded, we might be getting there worldwide. Until then, it is up to comedians to hold him or themselves accountable for the material they deliver–it ought to come straight from them and their own mind. While the laws may not quite be there yet, public reception is still something for comedians to worry about.

 Resources

Independent: Plagiarism is No Laughing Matter For Comedians

Time: Patton Oswalt on the Unsavory Business of Joke Theft

Center for Journalism Ethics: Comedian Daniel Tosh Calls Out ESPN For Plagiarism… With a Bit of His Own

Comedy Clinic: BUSTED! Comedian Caught Stealing Another Comic’s Material During ‘America’s Got Talent’ Taping?

Cracked: Six Ways to Not Suck at Stand-Up Comedy

Mediaite: Comedian Russell Peters Claims Trevor Noah Steals Jokes: ‘You Don’t Borrow in This Business’

Mental Floss: Stop Me if You’ve Heard This Before: A Look at Comedy Plagiarism

Plagiarism Today: YouTube’s Copyright Problem

Plagiarism Today: The Copyright Frustrations of a YouTuber

Slate: For Sale: Milton Berle’s Complete Joke Files

Split Sider: Is There Ever a Justification for Joke Stealing?

Noel Diem

Law Street contributor Noel Diem is an editor and aspiring author based in Reading, Pennsylvania. She is an alum of Albright College where she studied English and Secondary Education. In her spare time she enjoys traveling, theater, fashion, and literature. Contact Noel at staff@LawStreetMedia.com.

The post Already Heard That One? Problems in Comedy Plagiarism 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.

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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.

Check out the slideshow below for some of the best legal tweets of the week that you might have missed.

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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 The Best Legal Tweets of the Week appeared first on Law Street.

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

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

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

2. Marijuana Legalization: Let’s Be Blunt 

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

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

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

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

Image courtesy of [Annabelle Shemer via Flickr]

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

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

Image courtesy of [Daniel Borman via Flickr]

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

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

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

7. Debating Minimum Wage in America

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

8. “Gay Panic” Defense Outlawed in California

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

9. Campaign Finance: Free Speech or Unfair Influence?

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

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

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

Anneliese Mahoney

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

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

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

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

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

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

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

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

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

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

Anneliese Mahoney

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

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

I’m going to take a break from feminist issues today and discuss something that is, literally, life or death: America’s horrible healthcare costs.

Recently, just as I had my first run-in with military dress codes, I also got to experience a military doctor’s office. I went in for a physical exam, waited maybe ten minutes all around, and ended up leaving without having to pay a cent for the appointment or prescriptions. The only thought on my mind was: why can’t everyone’s health care be this great?

Outside of the United States, healthcare is that great in several countries. Just last summer while studying abroad in London, my friend rushed herself to the hospital thinking her appendix was bursting. Turned out to be just a pulled muscle, but an ER visit didn’t cost her a pence — and she wasn’t even a citizen!

So what’s wrong with American health care? For a country whose citizens claim it to be number one, we are way behind on things that really matter. According to the World Health Organization, America ranks thirty-fifth in life expectancy and thirty-seventh in healthcare systems.

Yikes.

Why are we so low in the rankings? The answer is not simple.

American healthcare costs are alarmingly higher than in other developed countries. An MRI in the U.S. averages $1,121, while in the Netherlands it’s only $319. Need an angiogram? That’ll be $914, but you could have gotten it for $35 in Canada! Are you on the drug Lipitor? Then you know it’s around $124 a month — it costs $6 a month in New Zealand. Some may argue that we are wealthier than these countries, so it makes sense that we would spend a bit more. Sure, but the amount the United States spends on health care is way above what it should be.

Then there is the argument that countries with free health care pay more in taxes. False. The average U.S. citizen pays more in taxes toward public health care than the United Kingdom, Canada, and a whole list of other countries with free health care.

Some blame insurance. American citizens not having health insurance was a factor in rising healthcare costs, yes. Those who didn’t have it still needed care, then went bankrupt from trying to pay for it, so our tax money ended up paying for it. The Affordable Care Act has alleviated some of the problem, but it is still being fought over in congress.

Still others point to over-utilization and malpractice spending, saying that Americans simply go to the doctor more and therefore spend more, but there is no data to support that either. Plus, who would want to go to the doctor more than they need to, especially when a doctor’s visit will soon cost more than a car?

None of these issues is the one thing that has skyrocketed our health care spending. In fact, all of them are to blame. Therefore, there will be no simple solution. Reaching a fix is made harder by the fact that the topic of health care is gridlocked in our government. Republicans block Democrats because they’re not Republican, and vice versa.

A lot of people like to gripe about Obamacare.

Half of Congress even decided to throw a hissy fit over not getting their way on the subject, and shut down the government. Sure, the Affordable Care Act might not be perfect, but at least it’s something. Those people most vehemently opposing it aren’t offering up any better solutions. Until both parties can get over their pride, sit down and say “what is going to be best, and cost less, for the American people?” healthcare costs will continue to be higher than they need to be.

My opinion? Healthcare should be free and easily accessible for everyone. Period.

Data and statistics for this post came from the WHO website and this article from The New York Times.

Morgan McMurray

Morgan McMurray is an editor and gender equality blogger based in Seattle, Washington. A 2013 graduate of Iowa State University, she has a Bachelor of Arts in English, Journalism, and International Studies. She spends her free time writing, reading, teaching dance classes, and binge-watching Netflix. Contact Morgan at staff@LawStreetMedia.com.

The post Debunking Common Myths About American Healthcare Costs appeared first on Law Street.

Hey y’all!

This is going to be a fun one!

Some of y’all know a while ago I was writing a personal blog, stumbled across Law Street, and was fired up by one of the contributors, Hannah Winsten. I wrote a rebuttal and the rest is history. I’ve been writing for Law Street for a few months now and have had the greatest pleasure in doing so, the team rocks! But in the back of my mind I always wondered when I would be able to have another encounter with Hannah. I like to think of her as the antithesis of me, she stands for everything that I don’t believe in, but in a good way!

The day has finally come. Ladies and gentlemen, Hannah is back and she has fired me up!

Hannah wrote a piece this week entitled, “LADIES: Vote Republican and You’ll Get the D” and I thought this will be a fun one. Boy was I right! I love how she starts right off with a sarcastic tone, throwing in those traditional pop culture references before pulling out the big words like ‘racist,’ ‘sexist,’ ‘homophobic’ and ‘Republican.’

First, she certainly did get it right that President Obama is getting close to being a lame duck, actually at this point he’s checked out and moved on to retirement on the golf course while still in the White House. Things haven’t gone the way he planned and homeboy has chunked deuce on the country, as pointed out by fellow Law Street writer Katherine Fabian here.

Who isn’t ready for the 2016 elections? I know I am!

Here we go again with Hannah only selecting bits and pieces of a report, only outlining what is beneficial and relevant to how she thinks and not the whole story. Yes, Politico reported a survey that states 49 percent of single women hold a negative view of the Republican Party, but it also says that 39 percent view Democrats unfavorably. If you go deeper into the article you also see that 48 percent of married women prefer a Republican to a Democrat. It isn’t a very positive article for Republicans but at least it is the truth and they are trying to do something about it.

Yes, the Republican Party has been perceived as the “good ole boys” party and women were neglected in some respects. But there are still plenty of Republican women in the country and I’m sorry but the idea that Republicans support rape and domestic violence is just vile. Does Hannah see all Republicans as toothless, alcoholic, wife-beating-if-they-step-out-of-the-kitchen inbreds? Referring to conservatives as ‘conserva-turds’ is almost as ridiculous as your girl, DNC Chairwoman Debbie Wasserman Schultz, making the comment that “What Republican tea party extremists like Scott Walker are doing is they are grabbing us by the hair and pulling us back.” Maybe you and Debbie get together in the last few days and brainstormed creative ways of calling the Republican Party abusive? Even people in the Democratic Party are distancing themselves from that foolish woman and her hideous remarks.

Nowhere in any Republican initiative or in that specific poll does it say that Republicans are planning to tell anyone that they are wrong. Nowhere. The report says that it is a “lack of understanding” between women and Republicans that “closes many minds to Republican policy solutions.” But let’s be honest, we don’t need a poll to tell us that there is a lack of understanding between the American people and politics. Not many in my generation or in younger generations take the time to understand politics, they just go with what they hear on television and we both know that is not an accurate depiction of politics at its core.

Hannah claims that Republicans will basically shake their fingers at all women, tell them they are wrong, and expect them to go out and vote for the GOP. What exactly are you reading that says any of that? Oh right, it is all based on opinion, not fact. Let’s go back to the Politico article where it states that the group that took the poll suggests “Republicans deal honestly with any disagreement on abortion, and then move to other issues.” Again, the report suggests this for Republicans. On the upside, there have been several Republicans who have come out in support of over-the-counter birth control, and many conservatives in general are Pro-Choice. Yes, Republicans should deal with the abortion topic with real facts, solutions, ideas, and then move on. Unlike Democrats who are still ignoring the facts of the IRS scandal, the Benghazi issue, ISIS, and most importantly Obamacare.

R.R. Reno made valid points in his opinion piece on the dilemma facing social conservatives, but my dear Hannah took what she wanted and neglected the rest. She assumes that this piece is to attack single women, assuming that they live with 12 cats and are terrified that they will end up alone so they recognize the strengths of getting a hand out when they are older and thus support the Democratic Party. What Reno was doing was quoting a statistic about marriage and vulnerability and then putting his two cents in on why McKinsey, a fictional character, may feel judged when someone “opposes gay marriage, because she intuitively senses that being pro-traditional marriage involves asserting male-female marriage as the norm — and therefore that her life isn’t on the right path.”

That is a valid argument and a valid way of thinking. I know that I was raised to believe that the order of life is to graduate high school, go to college, get a job, get married and have kids all under the age of 30. Guess what? I’m 29, I have two degrees (working on a third), and two jobs, but I am not married or have kids and it is a scary idea sometimes. Our parents’ traditional ways were engraved in our minds as young children, but the path our parents and older generations took is not what our generation wants to take. It will take time, but not everyone feels supported in their ventures because we aren’t doing what we were “supposed” to do. I’m glad I messed up and took a different path. I’m a better person for it. Reno was simply putting those ideals in a simple statement and showing that McKinsey chose to reject the norm so that she could feel accepted in her choices, and nothing is wrong with that.

I hate to break it to you, Hannah, but if you think women are voting Democrat because they “want to have control over their own bodies, their own reproductive systems, and their own lives. They want to be able to support ourselves. They want to lead lives that aren’t wracked with violence,” then you should probably vote for the unrepresented party. Democrats are taking away more of your rights than Republicans. Remember that tiny thing called Obamacare? Yeah, do some research and you will find there are more restrictions than advantages. You want to live your own life without someone dictating what you can and can’t do? Should probably take another look at the Democratic Party and its belief in big government, controlling every aspect of our lives and making people believe that they are entitled to handouts instead of working hard for what they have in life. Democrats would rather rich people do the work and hand the benefits to the less fortunate and lazy. Democrats believe in helping everyone but also in accruing more debt — that doesn’t help the economy, it hurts it.

At least Republicans are trying to fix their issues, listen to the people, and change (slowly) with the times more so than Democrats. Not to mention they are taking responsibility for their errors.

If you think Hillary is going to be in the White House in 2016 you’ve got another thing coming. The same “what difference does it make?” Hillary who was so flustered and frustrated about being questioned on the topic of Benghazi that she lost her cool? The same Hillary Clinton who admitted to leaving the White House with her husband President Bill Clinton, personally $10 million in debt? I’m not sure that is someone I would want in the oval office. Let’s be truly honest. We all know that while President Clinton was busy getting blow jobs in the Oval Office Hillary was really running the country. So she’s been president, just behind the scenes, and we don’t need her again.

I’ve said this before, everyone is entitled to their own opinion but the moment that opinion turns into something disrespectful I have an issue with it. The holier than thou, self-righteous, talking down to anyone who doesn’t agree with you tone is not cool. I enjoy Hannah’s quick wit and sarcasm but sometimes she crosses the line. Republicans are people too and in most cases highly educated people who just don’t share your views. Ease up on the conservative detest because you are simply putting yourself in the category of abuse that you talk so much about hating.

—

Allison Dawson (@AllyD528) Born in Germany, raised in Mississippi and Texas. Graduate of Texas Tech University and Arizona State University. Currently dedicating her life to studying for the LSAT. Twitter junkie. Conservative.

Featured image courtesy of [Joe Wolf via Flickr]

Allison Dawson

Allison Dawson was born in Germany and raised in Mississippi and Texas. A graduate of Texas Tech University and Arizona State University, she’s currently dedicating her life to studying for the LSAT. Twitter junkie. Conservative. Get in touch with Allison at staff@LawStreetMedia.com.

The post Response: Let’s Stop with the Republican Bashing appeared first on Law Street.

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

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

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

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

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

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

—

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

Featured image courtesy of [Speaker John Boehner via Flickr]

Matt DeWilde

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

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

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

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

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

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

Depression

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

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

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

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

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

Policies

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

Substance Abuse and Mental Health Service Administration

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

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

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

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

Helping Families in Mental Health Crisis Act of 2013

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

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

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

Strengthening Mental Health in Our Communities Act of 2014

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

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

Affordable Care Act

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

Influence of Technology

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

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

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

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

Conclusion

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

Resources

Primary

Congress: H.R. 3717

Congress: Cosponsors: H.R.3717

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

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

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

Additional

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

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

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

NCTSN: National Child Traumatic Stress Network

SAMHSA: Who We Are

NAMI: Depression in Children and Teens

American Foundation for Suicide Prevention: Facts About Suicide and Depression

CBTReferee: Cognitive Behavioral Therapy

Alex Hill

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

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

The Affordable Care Act (ACA) never has a boring day in court, and today is no exception. Rulings were just made in two related ACA cases, and they couldn’t be more different. First, in a case called Halbig v. Burwell, the D.C. Circuit Court of Appeals ruled that people who get their insurance from the federal government exchange are not eligible for tax subsidies. More specifically, the 2-1 decision in Halbig says that subsidies are only permissible for those customers who enroll in health care exchanges run by individual states or the District of Columbia. Meanwhile, the Fourth Circuit Court of Appeals heard King v. Burwell on the same topic, this time ruling against the plaintiffs to hold the law as it stands. According to the Richmond, Virginia based Fourth Circuit Court, the federal government subsidies can stay. These rulings directly contradict each other, meaning that once again, the ACA’s status is uncertain.

As many states have opted to rely on the federal government’s exchange rather than establish their own programs, millions of Americans would lose tax credits for their health coverage if the D.C. Circuit Court’s decision stands. The ACA would lose much of its effectiveness in the 36 states that rely at least partially on the federal exchange. Before the Halbig decision was made, the Urban Institute reported that such a ruling, “would broadly undermine implementation of the ACA in [those] states, with substantial coverage and financial implications for their residents.” The report goes on to predict what monetary losses would be in 2016 for lower-income Americans who would have otherwise relied on those federal subsidies. Of the 11.8 million people projected to enroll in the federal government exchange, 7.3 million would likely receive tax subsidies. If the Halbig decision holds, those lower-income health care customers would lose $36.1 billion in 2016 alone, according to the Urban Institute report.

The Obama administration has now requested an en banc review of the case, in which all judges on the D.C. Circuit Court of Appeals would review the case. The fate of insurance subsidies in the states that rely on the federal exchange now rests in the hands of the 11 active judges on the D.C. Circuit Court.

In the Halbig case, the issue is the wording of the ACA. The law, as written, says that lower-income citizens are eligible for the subsidy if they receive insurance from “an Exchange established by the State under section 1311.” Because there is no mention of the federal government in the tax credit regulations, the D.C. Circuit Court’s interpretation limited subsidies to state exchange programs. Healthcare reporter Joe Carlson writes that such precise wording, “is widely seen as a drafting error.”

This discrepancy between the wording of the bill and the intention of the bill is what caused this debate. Jonathon Cohn of the The New Republic argues that at no point did lawmakers conceive that these tax credits should be limited to state exchanges. He wrote:

Not once in the 16 months I reported on the formal congressional debate did any of the law’s architects suggest they were thinking along these lines. It wouldn’t make sense in the context of the law, which depends upon those subsidies to accomplish its primary goal.

This was the same rationale behind the Fourth Circuit Court’s King decision. That ruling acknowledges the ACA’s linguistic ambiguity, and defers interpretation to the IRS, which did allow tax subsidies for people in the federal exchange. Further, the Fourth Circuit Court decision even included an analogy between Pizza Hut and Domino’s–comparing the similarities between the pizza chains to health coverage from a state and health care from the federal government. All argument aside, we all have to recognize that analogy is quite creative and apt–the two exchanges, like the pizza giants, are meant to provide the same service.

The conflicting arguments by the two appellate courts highlight the importance of the rift between semantics and intention. If the intention of a piece of legislation is so well understood that its literal wording is overlooked, are those who enforce that interpretation breaking the law? Or are they operating in accordance with the law? Furthermore, while the way that D.C. Circuit Court interpreted the law may seem overly strict, shouldn’t the legislature anticipate such questions and write laws exactly as they would like them to be enacted?

The cases are indicative of a philosophical disagreement between law as a means–the ACA was created to help insure those who can’t access health care–and the law as an end–the strict language of the ACA must be adhered to, regardless of why it was created. We aren’t just witnessing a dispute about tax credits; this may become a battle about the nature of law itself. The outcome has yet to be seen, but this proves that the battle over the ACA is far from over.

—

Jake Ephros (@JakeEphros)

Featured image courtesy of [Joe Mabel via WikiMedia Commons, Progress Ohio via Flickr, modified by Jake Ephros]

Jake Ephros

Jake Ephros is a native of Montclair, New Jersey where he volunteered for political campaigns from a young age. He studies Political Science, Economics, and Philosophy at American University and looks forward to a career built around political activism, through journalism, organizing, or the government. Contact Jake at staff@LawStreetMedia.com.

The post Conflicting Courts: Affordable Care Act Up in the Air Again appeared first on Law Street.

Birth control has been a source of political controversy since its first days on the market. In recent times, the debate over reproductive health care has traveled to the highest level of judiciary power in the country.

In the June 2014 Hobby Lobby ruling, the Supreme Court favored a corporation’s religious freedom over a woman’s right to affordable reproductive health coverage. Although the ruling did not completely strike down coverage set forth in the Affordable Care Act (ACA), it did set up the possibility for some employers to deny coverage. The IUD, or intrauterine device, is one of the contraceptive methods that no longer has guaranteed coverage. What are the policies surrounding birth control in America, and how truly effective is the IUD?

Pre-Hobby Lobby Policy

Passed in 2010, the Affordable Care Act (ACA) recognizes that contraception is a necessary preventive health service for women. The ACA requires coverage without cost-sharing for women for all FDA-approved contraceptives. This benefits all women who want to use an IUD because of the high upfront costs without insurance.  All FDA-approved birth control methods must be covered by the plans, which includes: IUDs, the pill, the patch, the ring, the shot, diaphragms, sterilization procedures, and cervical caps.

Hobby Lobby Ruling

On June 30, 2014 the Supreme Court ruled in Burwell v. Hobby Lobby that for-profit corporations are exempt from government regulations that would require them to cover certain contraceptives for their female employees. Hobby Lobby and Conestoga Wood Specialties consolidated their cases to challenge the contraceptive mandate in the Affordable Care Act. The ruling is limited to closely held corporations under the Religious Freedom Restoration Act (RFRA). While some supporters of the majority’s ruling claim the decision won’t affect many women, that is simply not true. More than 90 percent of all American businesses are made up my closely held firms, and they employ approximately 52 percent of the workforce.

The companies argued that just like places of worship and non-profit organizations with religious affiliations, their religious beliefs should exempt them from covering certain emergency contraceptives. This includes IUDs, Plan B, and Ella. Hobby Lobby objected to the morning-after pills and IUDs as they believed they cause abortions. The reasoning is that these forms of contraceptives prevent conception and fertilized egg implantation in the uterus, which to them is equivalent to aborting a life. Director of Contraceptive Development for the National Institute of Child Health and Human Development, Diana L. Blithe, has stated that there is no scientific evidence that these contraceptives work beyond fertilization. Birth control pills will continue to be covered, as they are not in opposition to the employer’s beliefs. The ACA originally allowed for non-profit religious organizations to opt out of providing coverage for contraceptives and have outside insurance companies cover the women, and Justice Alito suggested that for-profit corporations adopt this method as well.

While women were denied basic reproductive health care by this ruling, the male-dominated majority ruled that  would continue to be covered. This hypocrisy has been noted by the public and Justice Ruth Bader Gingsburg in her blistering dissent.

What is the IUD?

The IUD is a small, polyethylene “T-shaped” device that is inserted by a health care provider into a woman’s uterus to prevent pregnancy. In the United States there are two types of IUDs available: hormonal (Mirena and Skyla), which released progestin, and copper (ParaGard). Mirena is effective for five years and Skyla is effective for three years; both may give the woman lighter periods. ParaGard is effective for 12 years and does not alter periods. The main way both types of IUDs work is by manipulating the way sperm moves so they are unable to join with an egg.

What are the benefits of an IUD?

The IUD and the birth control implant are the most effective reversible contraceptive methods available. By not requiring user intervention, the risk of pregnancy is less than one percent. If inserted up to five days after unprotected intercourse, copper IUDs can also serve as emergency contraception.

Hormonal methods offer supplementary health benefits in addition to contraceptive use. Similar to a birth control pill, an IUD can treat menstrual pain, menstrual bleeding, and acne.

IUDs help women avoid pregnancy coercion — pressuring one into becoming pregnant — and pregnancy due to a sexual partner’s refusal to use contraception. The device is effective, long lasting, and it’s nearly impossible for a partner to detect one.

Many other forms of birth control are advertised for how effective they are in preventing pregnancy. This is true, if they are used properly. A good example for this is the male condom. It is a common belief that they are 98 percent effective in preventing pregnancy, however the Center for Disease Control (CDC) reports that 18 percent of women experience an unintended pregnancy while using this method. The discrepancy in information lies within the mighty if. IUDs are so efficient since they remove human error and are long-lasting. From the same CDC report, it was found that copper IUDs have a significantly lower 0.8 percentage.

What are the disadvantages of an IUD?

IUDs, called the Dalkon Shield, debuted in the United States in the 1950s. However, they were later taken off the market because of complications found in early versions of the device. The previous design led to infections and unwanted pregnancies due to it’s complicated method of correct insertion. It was also not widely known by doctors that it had to be removed when a woman became pregnant in order to avoid infection. Pelvic inflammatory disease and infertility was linked to the Dalkon Shield.Alexandra Sifferlin of Time reported, “According to various reports, upwards of 15 women who became pregnant with a Dalkon IUD inside them died of infections after they miscarried.”

Some other disadvantages include:

• IUDs do not protect against sexually transmitted diseases (the male condom provides the best protection from most diseases).
• If a woman is uninsured, an IUD costs between $500 and $1500, including tests, exams, insertion, removal, and the IUD itself. The upfront costs may be a barrier for many women.

Are women using them now?

American women have the lowest rate of IUD se of any developed country and more than half have never heard of them. Laura MacIsaac, Director of Family Planning at Mount Sinai, stated, “IUD use in most of Western Europe, it’s about 20 percent, some countries 30 percent…in America, it’s about five percent.” While these numbers are low compared to other countries, since 2008 Planned Parenthood reports a 75 percent increase in IUD use among patients. In 2009, 8.5 percent of women using contraceptives relied on long-acting reversible contraception such as the IUD. This is a dramatic increase from 2.4 percent in 2002 and 5.5 percent in 2007.

Women between the ages of 25 and 29 who are married, women with no religious affiliation, and women covered by Medicaid use IUDs most frequently. Teenagers are less likely to use the IUD; only three percent of 3.2 million teenage women who use contraceptives chose this method.

Conclusion

IUDs have moved past their sullied past and become one of the most effective methods of birth control on the market. With their long-lasting effectiveness, lack of personal upkeep, and low pregnancy rate, IUDs are a favorable contraceptive option.

Resources

Primary

CDC: Current Contraceptive Use in the United States, 2006-2010, and Changes in Patterns of Use Since 1995

SCOTUS: Burwell v. Hobby Lobby

Additional

Planned Parenthood: IUD as a Form of Birth Control

Guttmacher: Changes in use of Long-Acting Contraceptive Methods in the U.S., 2007-2009

Guttmacher: IUD Fact Sheet

National Women’s Health Network: Not Your Mother’s IUD: Benefits and Risks of Modern IUDs

Time: Why is the Most Effective Form of Birth Control – the IUD – also the one no one is Using?

The New York Times: Religious Groups Equate Some Contraceptives With Abortion

Planned Parenthood: Birth Control Implant (Implanon and Nexplanon)

Washington Post: A LOT of People Could be Affected by the Supreme Court’s Birth

USA Today: Hobby Lobby Case: What Birth Control is Affected?

Huffington Post: Hobby Lobby Still Covers Vasectomies and Viagra

Alex Hill

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

The post The IUD: Beyond the Hobby Lobby Case appeared first on Law Street.

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

The Background

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

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

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

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

The Decision

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

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

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

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

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

The Impact 

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

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

—

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

Featured image courtesy of [Nate Grigg via Flickr]

Matt DeWilde

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

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

Happy April Fool’s Day, folks! Guess what happened last night while you were sleeping?

The Affordable Care Act’s first open enrollment period ended, and the government reached its goal metrics. Signups on Healthcare.gov and 14 state-based exchanges cleared the 7 million mark — the minimum enrollment goal — and will continue to grow over the next few weeks as last-minute signups clear the system.

This is pretty exciting. Why? Because Obamacare is officially too big to easily dismantle. The Republicans, with all their blathering on about bullshit death panels and anti-Americanism, have lost this fight. Healthcare reform is a thing that happened. And it’s not un-happening anytime soon.

And that’s a huge deal. Medical care is insanely expensive in the U.S., as is quality health insurance. Those high price tags have locked tons of low-income Americans out of quality healthcare, leaving them with lower standards of living and shorter life expectancies.

Basically, the high cost of healthcare has turned a basic human need into a luxury for the rich. It’s established that some lives (ahem, rich folks) are more important than others. And that’s super fucked up.

So thanks, Obamacare, for taking a first step toward fixing that problem.

But! Let’s not get too excited. Obamacare is still full of problems. The ACA is NOT universal healthcare — not by a long shot, and it shows. Let’s investigate, shall we?

Sarah, whose name has been changed to protect her privacy, is a recent beneficiary of the Affordable Care Act. She signed up for the Empire Catastrophic Guided Access Plan back in February. Under this plan, Sarah pays nearly $200.00 a month for the most basic of health insurance — her copays and deductible are high, making her policy little more than a guarantee that she won’t go completely bankrupt if she gets cancer tomorrow. (So we hope.)

Unsurprisingly, Sarah’s not super pumped about the state of her healthcare coverage. As a 20-something-year-old with mountains of student loan debt and a low-paying, entry-level job, she’s on a tight budget. And every month, $200 of that budget goes toward her health insurance — and that’s if she doesn’t actually try to use it.

So, why, if this plan was so lackluster, did Sarah choose it? Aside from the obvious factor of affordability (this plan is about as cheap as they come), Sarah wanted to make sure she could access birth control and STI screenings through her insurance.

“I signed up for this plan because, on the Planned Parenthood website, it listed Empire as an accepted insurer,” Sarah said. “But it turns out, for my plan, they are out of network, even though when I called they said I was covered.”

“Turns out STI screenings are not covered at all, so I have to not get tested ever, and I have to try to find a gynecologist who takes my insurance. I also no longer qualify for state assisted birth control at Planned Parenthood because I have health insurance that isn’t actually health insurance. I am literally worse off than when I was uninsured.”

So, thanks to Obamacare, Sarah is essentially paying more money for less access to the healthcare she needs. And that’s really not cool.

There have been a lot of GOP horror stories about the Affordable Care Act. This video is one of them.

Largely, these tales are vague, exaggerated, or entirely untrue. They’re pure propaganda for conservaturds who want to keep the healthcare industry as privatized and profitable as possible.

But then there are real people, like Sarah, who really aren’t making out too well under Obamacare. Stories like hers aren’t to denounce the ACA as a complete failure — even she conceded that the Affordable Care Act is a step in the right direction.

But Sarah is living proof that there are a lot more steps that need to be taken in that direction. Quality healthcare still isn’t truly accessible to countless American citizens. Obamacare is not universal healthcare. And that’s really what we need.

So, now that Obamacare has reached its enrollment goals, let’s keep pushing, shall we? Let’s make healthcare a thing that we can actually use.

—

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

Featured image courtesy of [Daniel Borman via Flickr]

Hannah R. Winsten

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

The post Obamacare Is Here to Stay! But It Still Kind of Sucks appeared first on Law Street.

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?

—

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.

Loves, how many of you watched the Oscars on Sunday night?

I did, after a fair amount of effort finagling a live-stream feed onto my TV. Thanks for the complication, Time Warner!

Anyway, if you stayed up to watch the end — or if you’ve been on the internet in the last 48 hours — you’ll know that Matthew McConaughey won Best Actor. Moment of silence for Leonardo DiCaprio, who’s having nightmares right now.

This what Leonardo DiCaprio’s nightmares look like #Oscars pic.twitter.com/yhkAkgDxSP

— Joel Pavelski (@joelcifer) March 3, 2014

Anyway, conservatives are freaking out about McConaughey’s Oscar acceptance speech. In it, the first thank you he threw out into the void was to God, making him one of only four actors to mention the Almighty in an Oscar acceptance speech over the last 12 years.

“First off,” said McConaughey, “I want to thank God, because that’s who I look up to. He has graced my life with opportunities that I know are not of my hand or of any other human hand. He has shown me that it’s a scientific fact that gratitude reciprocates … When you’ve got God, you’ve got a friend, and that friend is you.”

D’aw. Conservatives are drooling over this show of Christian religiosity. Please note, no one gave half a shit about the other three God-thankers in recent Oscar history — because none of them were white, Texas boys with a charming Southern drawl.

Anyway! Here’s what the conserva-turds have to say about Matthew’s Godly mention.

Rick Perry tweeted out Monday morning:

Texas boy counting his blessings. http://t.co/O6fbEN4QrF

— Rick Perry (@GovernorPerry) March 3, 2014

Tea Party darling Michelle Malkin proclaimed via Twitter:

Silence a Hollywood liberal: Give thanks to God. http://t.co/FYOMiCoQFg

— Michelle Malkin (@michellemalkin) March 3, 2014

And of course, not to be left out, Fox News chimed in with an unusually straight-news style headline: “Matthew McConaughey one of few to thank God in Oscar acceptance speech.”

Folks, the conservative Right’s excitement over McConaughey’s God speech is interesting for a few reasons.

First of all — holy racism, Batman. I mentioned that there were three other Oscar winners who thanked God in their acceptance speeches in recent years. Those actors are Denzel Washington, Jennifer Hudson, and Forrest Whitaker. They’re all Black. And no conservative pundits cared even a little, tiny bit, when they mentioned God on Oscar night.

Some would argue that’s because African-Americans are statistically more likely to be devout Christians. When stereotypes abound about church-going, Gospel-singing Black folk, who’s really surprised when Black actors start talking about God? Clearly, no one.

But I’d say that’s not the real reason conservatives are so much more excited about Matthew McConaughey’s Godliness than Jennifer Hudson’s. What’s actually going on here?

Conservatives see Matthew McConaughey as one of them. And they’re all kinds of pumped that someone on their team is a visible member of the Hollywood glitterati.

After all, McConaughey’s wearing the uniform. He’s white, straight, cis-gendered, and charmingly Southern. He’d fit right in if he headed back to the Bible Belt—he’s even related to a Confederate soldier. He’s a perfect poster boy.

But it goes deeper than that. The most important aspect of McConaughey’s conservative appeal is his narcissism.

After he finished thanking God, Matthew launched into a weird diatribe about how he’s his own hero. It was kind of bizarre, and if you try really hard, you can squeeze some inspirational juice out of it along the lines of, “You’re your own toughest competition, be the best you can be!”

Except you’d have to try really, really hard. The clearest takeaway here is that Matthew McConaughey is really obsessed with himself. And he kind of always has been. Remember when he got married, and all he could talk about was how lucky his wife was to have him as her Prince Charming? Barf.

Conservatives are notorious for their narcissism. That’s exactly the trait that allows them to vilify poor people, single mothers, women, and abortion providers. It’s how they came up with that term, “personal responsibility,” and used it to dismantle the social safety net. It’s the reasoning behind their destructive opposition to basic human needs, like universal healthcare, affordable housing, and nutritious food.

Conservatives are conservative because their politics lack empathy. They’re unable to put themselves into someone else’s shoes. It’s easy to fight for a ban on abortion when you’ve never been faced with an unwanted pregnancy. It’s even easier to claim that universal healthcare is communism when you’ve never been denied access to medical care because of your inability to cough up the cash.

It’s fairly common for conservatives to switch teams when they’re faced with shitty situations. Take this guy for example, who worked on the McCain-Palin ticket in 2008. He went from a Republican staffer to an Obamacare activist — after he was diagnosed with cancer and denied health insurance.

Republicans often can’t see the harm their policies cause until they’re in the middle of their own self-inflicted crosshairs. Even then, if they switch teams, it’s primarily for self-preservation. Right-wing politics is all about narcissistic self-interest. I do not like this, their policies scream like a toddler throwing a tantrum. And it’s imperative that I get what I want.

This pretty much sums up Right-wing politics.

So, it makes sense for people like Michelle Malkin and Rick Perry to be excited about Matthew McConaughey’s Oscar speech. God talk aside, it was about as narcissistic as you can get. And that resonates with conservatives.

So, while your Internet is blowing up about the Godliness of McConaughey, please remember that his speech wasn’t reflective of Christian values like peace and charity. It’s no coincidence that conservatives are excited about it.

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

Featured image courtesy of [Denise Cross Photography via Flickr]

Hannah R. Winsten

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

The post Matthew McConaughey Is Narcissistic at the Oscars, Becomes Conservative Hero appeared first on Law Street.

This year promises to be an interesting one in law. Here are some of the most interesting cases, trials, and legal topics y’all might want to keep your eyes on in 2014.

(Note: I have tried not to include Supreme Court cases that were heard in 2013 but will be ruled upon in 2014, as most of those have already been heavily covered by the media during oral arguments.)

8. Lavabit and Ladar Levison 

The case: After Edward Snowden’s revelations about NSA spying, it was discovered that he was using an encrypted email service called Lavabit. The owner, Ladar Levison, was court-ordered to hand over access to the entire site to the government, because Lavabit’s programming made it impossible to hand over access to just Snowden’s account. In protest, Levison shut down the site, defied a gag order, and has now filed an appeal.

Why it matters: This year, mainly from the NSA spying scandal, we learned about the technological abilities our government uses to monitor US citizens. This court ruling will either stifle or extend those abilities. For those who oppose the government having access to personal information, this Lavabit case may set important precedent — and it really will be a case to watch.

7. Jodi Arias Sentencing

The case: In 2013, we saw the extremely weird case involving Jodi Arias in Arizona. She was eventually convicted of murdering her boyfriend, Travis Alexander. It was a gruesome and disturbing case in which the jury found her guilty; however, they could not agree on whether to sentence her to life in prison, or death. A mistrial was declared on the sentencing portion of her trial and the new sentencing trial will also have new jurors.

Why it matters: The Defense has gone so far as to request a change of venue for the resentencing portion. They have argued that the huge media attention directed at the case has the potential for bias. That may be true, and it certainly wasn’t the first case with a big media blitz –Casey Anthony ring a bell? But if that’s actually the case, a change in venue won’t help — this case was huge all over the country. I’m reminded of an SNL skit from a few years ago about choosing jurors for OJ Simpson’s 2007 robbery and assault case. Watch it here, it’s really funny. But all joking aside, it’s the truth. It will be incredibly hard to find jurors who haven’t heard of Jodi Arias. Is it possible that our obsession with watching justice unfold is getting in the way of justice itself? Maybe we’ll get some answers with this retrial. 

6. McCullen v. Coakley 

The case: Oral arguments for McCullen v. Coakley are scheduled before the Supreme Court later this month. This case has been waiting for its day in court since 2001; there was appeal after appeal before the Justices agreed to hear it. It involves a law that Massachusetts instituted to create a 35-foot buffer zone around reproductive health facilities.

Why it matters: First of all, as I mentioned, this case has been going on for a very long time. The Supreme Court’s decision will add some sort of finality to it, no matter what the decision may end up being. Second, it could reverse a much-relied upon precedent, Hill v. Colorado, which allowed an eight-foot buffer zone. Finally, it raises an important constitutional issue about which right is more important: the right to free speech, assembly, and protest, or the right to seek an abortion without harassment?

Hopeful finality for this case.

5. Silkroad Case

The case: The infamous illegal-good site Silk Road was removed from the web this Fall, and its alleged creator, Ross Ulbricht, was arrested. The site sold drugs and fraudulent IDs, among other things. In addition to being indicted for his work on the site, he has now been accused of hiring assassins. The $80 million he allegedly made through the site is now in government custody. In 2014, he’ll either work out some sort of deal with the government, or face trial.

Why it matters: Silkroad had a huge market. It was relied upon by many people to get illegal goods relatively safely. Most of the Bitcoins (an electronic currency) in existence went through this site. And it was really only a matter of time until it shut down.

But, and this point is becoming a common trend on my list, it’s also another mark of how the government’s ability to use technology for prosecutorial purposes is evolving. I can assure you that this will have ramifications in the future, because people aren’t going to stop buying illegal stuff over the Internet. They’ll just get better at it.

4. Marriage Rights

The case(s): The Supreme Court already put a stop to Utah’s same-sex marriage licenses in 2014. The case will now go to the nearest appeals court. This is just one example; there are other cases regarding the rights of homosexuals to marry all over the United States.

A spontaneous reaction after the DOMA ruling last year.

Why it matters: 2013 was a banner year for gay rights in a lot of ways, but it’s important to note that the court cases will probably continue for years to come. There’s a lot of work to be done, and it doesn’t seem like the Supreme Court would unilaterally rule to legalize gay marriage. In 2014 we will continue to see more cases, trials, and hopefully, victories.

3. Voting Rights Cases

The case(s): There have been a lot of efforts at the state level to change voting rights laws, and the DOJ and various special interest groups have stood up to these changes when needed. But in 2013, part of the Voting Rights Act was struck down by the Supreme Court. So, each challenge to voting rights has to be filed against separately. As a result, many suits will be heard in 2014 to states’ attempted voting rights changes.

Why it matters: The change to the Voting Rights Act makes it more difficult for suits to be filed against voting rules, but special interest groups will also be under pressure to make changes before the 2014 midterms and 2016 national elections.

2. Contraception

The case(s): There were contraception cases regarding coverage through the Affordable Care Act that made it to the court in 2013, but many more will be on deck in 2014. One involves a nonprofit called Little Sisters of the Poor, and others involve for-profit companies like Hobby Lobby.

Why it matters: Not only is contraception a hot political issue, these cases involve parts of the Affordable Care Act. Parts of the ACA have already made it to the Supreme Court, but this will be a new decision will have ramifications as to whether or not companies are required to cover contraception for their employees, regardless of religious beliefs.

1. NSA Cases

The case(s): A lot of cases have been filed regarding the NSA’s monitoring of US citizens. A few may make it to the high court. US District Court Judge Richard Leon in Washington recently ruled that the NSA monitoring was unconstitutional. Meanwhile, District Court Judge William Pauley in New York dismissed a similar case. That kind of contradiction could lead to a big legal showdown in 2014.

Why it matters: The NSA surveillance debate was one of the biggest controversies of the year, and raised many legal questions about the ability of the government to monitor its people. What happens in these cases could set a serious precedent.

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

Featured image courtesy of [Dan Moyle via Flickr]

Anneliese Mahoney

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

The post Cases to Watch in 2014 appeared first on Law Street.

Happy New Year, folks! Welcome to 2014.

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

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

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

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

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

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

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

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

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

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

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

It’s a lose-lose situation.

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

Yay solutions!

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

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

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

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

We’re looking at you, Ruth Bader Ginsburg.

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

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

Featured image courtesy of [Parenting Patch via Wikipedia]

Hannah R. Winsten

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

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

Happy New Year’s Eve, lovelies!

Folks, I can’t wrap my head around this 2014 business. I literally feel like 2013 didn’t happen. A year has never passed so quickly in my entire life. (Don’t I say that every year? Whatever.) Anyway! In honor of this super awesome day — a day that marks fresh starts, new beginnings, and exciting adventures — I thought we should talk about resolutions.

That’s right. New Year’s Resolutions. And not those bullshit ones about losing weight and juicing half your food and spending more time on Skype with your long distance friends. No one ever sticks to those. I’m talking about some resolutions we can really believe in, à la Miranda Hobbes.

Buzzfeed did a fabulous post last week about how the red-headed attorney  was the most empowering of the four Sex and the City characters, and I’d have to agree. If she was a real person, I’m pretty sure she’d be a fan of The F Word, am I right?

So! Without further ado, let’s be more like Miranda this year, mmkay?

Resolution #1: Don’t be afraid to tell someone to fuck off. Ever. Embrace that power gladly.

HBO / Via loveforlabels.eu

Miranda may have been the queen of no-fuss breakups, but this resolution doesn’t just apply to romantic relationships. Republican douchebags preventing you from accessing a safe abortion? Tell ’em to go fuck themselves. Obamacare failing to provide you with real health insurance? Tell ’em to fuck that. Say it loud and say it proud, folks. Because that’s the only way we’re going to make anything better.

Resolution #2: Fuck up the patriarchy and its traditional gender roles.

Thanks HBO!

Loves, Miranda may have been a totally femme straight lady, but she rocked a suit and tie like nobody’s business. She also earned more money than any of her boyfriends, failed to romanticize marriage and motherhood, and even embraced a lesbian identity (albeit, a fake one) in order to make partner at her law firm.

Remember when Miranda bought that ginormous apartment all by herself? Or when she told all of her friends to STFU about their man problems and focus the conversation on something more substantive?

Miranda subverted all the patriarchal expectations surrounding gender — namely, that women should be quiet, submissive, and dependent on a man. And you know what? She was fucking awesome at it.

Let’s resolve to be equally awesome at toppling the patriarchy.

Resolution #3: Don’t apologize for your sexuality.

HBO / Via tumblr.com

Anybody remember the scene we’re referencing here? It’s epic.

Miranda’s been going through a dry spell, and one day, as she’s walking down the street, a group of rowdy construction workers starts catcalling her. Like any good feminist, Miranda got pissed about the street harassment that follows women fucking everywhere. But, she took a unique and super badass approach to handling it. She walked right up to her catcallers and asked them if they were actually interested in fucking her. Because she was horny, and had no time for silly games. Be prepared to make good on your offer — or STFU.

Not surprisingly, her harassers were totally intimidated and basically tried to curl up into little balls and disappear right there in the middle of the street. What can we learn from Miranda here? Don’t be ashamed of your sexuality. Know your needs and seek to have them met, unapologetically. Get it, grrrl.

Resolution #4: Don’t second guess yourself. Call bullshit when you see it — and stand up for yourself.

HBO / Via tumblr.com

While the three other ladies of SATC bitched about how to keep a man, Miranda told them how it is, plain and simple. As a feminine presenting person, you’re often expected to metaphorically — and sometimes, literally — bow down to your partner if you want your relationship to stay intact.

Well, loves, Miranda says fuck that. And I do too.

Let’s all resolve to stay empowered as individuals this year. Let’s be the best people we can be, independently. And if somebody doesn’t like that — whether it’s your partner, your boss, your professor, or the entire Republican party — fuck ’em. Life’s too short.

See folks? Isn’t Miranda awesome? I told you.

Are you with me on these resolutions for 2014? What would you add to the list? Blow it up in the comments!

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

Featured image courtesy of [John Gilbert Leavitt via Flickr]

Hannah R. Winsten

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

The post New Year’s Resolution: Fuck Shit Up with Miranda Hobbes appeared first on Law Street.

How was your weekend, loves? Mine was fabulous!

But Obamacare’s weekend was kind of rough.

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

That’s right. You heard me correctly.

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

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

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

Probably a lot.

These cons are SERIOUSLY getting on my nerves.

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

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

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

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

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

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

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

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

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

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

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

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

This is a bullshit choice.

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

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

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

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

I really wish I was, Chelsea.

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

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

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

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

This is stupid, am I right?

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

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Featured image courtesy of [LaDawna Howard via Flickr]

[Featured image courtesy of the LA Times]

Hannah R. Winsten

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

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

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

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

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

That was sarcasm, friends.

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

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

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

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

“Well, what’s really going on?”

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

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

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

[New York Times]

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Featured image courtesy of [Daniel Borman via Flickr]

Peter Davidson II

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

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

On September 30, I logged into Facebook and saw the most peculiar post.  A friend of mine works for the federal government, and his status read: “I really hope I can go to work tomorrow.”

On a normal Monday, that would be the weirdest sentiment.  I’m used to seeing complaints about how the week is off to a slow start, or how the weekend is too long. Those statements are expected (and usually true).  This post, though, was different.

While there was an air of lightheartedness in the post, there also was a sense of concern about the uncertain future.

As I type this, the U.S. government is in the midst of a shutdown.  Approximately 800,000 people find themselves out of work due to a government-mandated furlough (leave without pay).

Here’s a quick and dirty recap of the past week: the marketplace for providers to offer their services to the hundreds of thousands of people now eligible for healthcare under the Affordable Care Act (Obamacare) opened on October 1, 2013.  The Democrat-controlled Senate approved a version of the appropriations bill that would fund the government.  On Friday, September 27, the Republican-led House responded with their own version of the bill, which also funded the government if key provisions of the Affordable Care Act were cut.  In a move to signal that he is playing hardball, Senate Majority Leader Harry Reid sent the Senate home for the weekend, meaning the House’s version wouldn’t even be considered until Monday.  Monday was the last available day for compromise to be reached without a government shutdown.  This meant that the House would not receive the Senate’s revisions until later on Monday, and would have little time to vote before the shutdown took effect at 11:59 p.m.

Speaker of the House John Boehner accused the Senate and the Obama Administration of putting partisan politics before the needs of the public.  The Democrats responded with the exact same accusation.  A stalemate occurred, and that is where we presently find ourselves.

Instead of attempting to compromise, various members of both parties are speaking to the press to posture themselves in a favorable light to their constituents.  These members of Congress are failing to realize that while they offer sound bites to various media outlets, their positive spin will never outweigh forcing almost one million Americans out of work.

It’s going to be hard to be reelected when sentiments like this one from the Washington Post: “We’re very hardworking people- we do a lot for people across the country.  And I feel that we’re obviously being used as a political pawn, but we’re also not being valued for what we do.”

It sucks when Congress can’t get their stuff together for the hardworking people they’re supposed to serve.

What does the shutting down of the government entail?  It’s essentially commandeering the Titanic, post-iceberg.  You’re in control of a sinking ship, but you’re coasting along until it sinks.  To slow down the sinking process, various items are being thrown overboard.  How does the government cruise?  By cutting the hours, and thus the payment, of your friends, neighbors, parents, siblings, and possibly you.

“Isn’t a shutdown the equivalent of a snow day?”

Yes it is- at least for the first few days (I know much about unemployment, and the first two or three days are actually kind of sweet: catching up on TV, sleeping in, and going to the gym in the middle of the day are great).  As time wears on, reality rears its ugly head via the accumulation of bills.

In fact, this shutdown really puts things in perspective.  For the past few months, I’ve been complaining about being an unemployed JD.  My complaints have been numerous, considering I really have nothing to worry about: I have no bills, a free roof over my head (thanks mom and dad!), and the luxury of looking for work full-time.

Furloughed government employees are adults with families, tuition, mortgages, car payments, and future plans, all of which are funded by their salaries.  Salaries that, for now, they no longer receive. Most importantly, they want to work!

So, let’s just hope that Speaker Boehner and Majority Leader Reid stop this stick-measuring test and make the best decision for the 800,000 people without income right now.

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Featured image courtesy of [NoHoDamon 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 When the Government Won’t Let Its Employees Work appeared first on Law Street.

The government has been shuttered for three days now, and things are already starting to look bleak.

I’ve written about how the GOP’s obsession with defunding Obamacare is really about a racist, sexist, elitist desire to keep privilege (and life’s basic necessities) concentrated among rich, white, straight men. And that’s what’ll happen if the Affordable Care Act gets defunded.

But even though Obamacare hasn’t been axed, those of us who are outside of privilege are already starting to feel the heat. While Congress engages in the world’s most irritating staring contest, government programs that disproportionately serve women and people of color are already starting to run dry.

Thanks, Hyperbole and a Half!

One of the first things to circle the drain are WIC payments. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) has been deemed a non-essential government service. That means, while the government is shut down, WIC’s doors will be closed. More than half of the country’s babies rely on WIC to receive proper nutrition, and their mothers are the ones who will be left with crying, hungry, and sick children.

I’m sorry, but how can feeding babies possibly be considered non-essential? That’s really just awful. Especially considering that Republicans added a “conscience clause” to their ridiculous, let’s-shut-down-the-government ransom bill that would cut women off from accessing contraceptive and other preventive health services.

So basically, the GOP is pushing legislation that would simultaneously result in more babies, while denying food to those who already exist. And who has to figure out how to survive in all this mess? Women. More specifically, poor women of color. I’m sure they really appreciate that, Ted Cruz.

 And it doesn’t stop there. Head Start programs, which provide early education to low-income children, might have to stop serving their students, depending on how long this government shutdown lasts. A handful of Head Start programs will get hit immediately, with the rest following suit as this game of Congressional chicken drags on. Again, we’re seeing the GOP push legislation that creates more kids, while denying education to the ones who are already here. And who has to pay the price? All the mothers who will skip work, and potentially miss out on wages, to care for their children who have been turned away from shuttered Head Starts.

And those wages are really important, especially if this shutdown lasts any substantial amount of time. As temperatures drop, heating bills will rise, and the Low Income Home Energy program — which disproportionately serves women — won’t be able to provide assistance. Neither will the Temporary Assistance to Needy Families program, which is, once again, overwhelmingly used by women. Single mothers will have to decide between paying rent, feeding their children, or heating their homes. How can we allow that to happen?

All of this is happening because our elected Congress-people can’t — or won’t — do their jobs. This is professional incompetency at its finest, and it’s entirely unacceptable. But it also reveals a lot about our national state of affairs.

While the GOP may have started this ridiculousness with the goal of blocking legislation that would benefit underprivileged people, it’s clear that systematic inequality is already in place. Anyone who argues that racism and sexism are things of the past only needs to look at what’s happening right now to see that they’re wrong.

If racism and sexism were over, women and people of color wouldn’t be hit the hardest when our lawmakers fail to do their jobs. They wouldn’t be the ones who have to choose between feeding their children and heating their homes. And most importantly, those struggles would be making top headlines in news outlets across the country.

But that’s not the case. Women and people of color are getting the short end of the stick when it comes to this government shutdown, and they’re barely making any headlines about it. It’s no coincidence that veterans — who are mostly white and male — failing to receive government benefits has caused national outrage, while the single mothers who depend on WIC remain largely in the shadows.

As Republicans fight tooth and nail to keep women, people of color, queer people, and the poor disenfranchised, they wind up highlighting all of the ways that these communities are oppressed in the first place.

So thanks, guys. You’re making my job a little bit easier.

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

Featured image courtesy of [cool revolution via Flickr]

Hannah R. Winsten

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

The post SHOCKING: Women Are Disproportionately Shut Out by the Shutdown appeared first on Law Street.

Well folks, it happened. After a collective freak out from the media – and a collective yawn from the general public – the government shut down today. Not surprising.

If you’ve been keeping up with this latest political soap opera, you’ll know that House Republicans planned this ridiculousness months ago, when they refused to meet with House Democrats and Hash out their budgetary differences ahead of time.

You’ll also know that this government shutdown isn’t the end of the world. A ton of federal employees will be furloughed, possibly without pay, military troops will stop receiving paychecks, national parks will close, passport applications won’t get processed, and Social Security checks will probably be a bit delayed. Obamacare will still become law. And Ted Cruz will forever be known as the latest King of Crazytown. (I told you all that someone would replace Michele Bachmann!)

To the average American, some of these facts will be irritating, inconvenient, or downright awful. (Are you the poor soul who planned a Washington, D.C. vacation for this upcoming week? No panda for you!) And the economy will definitely take a dip. But overall, nothing too horrific.

But! Let’s not get too comfy in our government-shutdown-who-cares apathy. Even though this doesn’t mean our entire democracy will come crashing down around our shoulders, it does bring up some very interesting questions about who matters in our government.

Let’s start with Obamacare, shall we?

A few days ago, Ted Cruz filibustered Congress for 21 hours, talking about why Obamacare is an awful, terrible idea.

First of all Ted, trying to dismantle healthcare reform while engaging in a very medically irresponsible activity probably isn’t your smartest idea. Just something to think about.

Forrest knows what’s up.

Second of all, what is so awful about Obamacare? Why is Teddy over here torturing himself, and creating quite the media circus, over defunding it?

Here’s what’s so awful about it – Obamacare benefits mostly everyone, but mostly poor people and women. Who are, incidentally, often the same thing. Also people of color and queer folks. Again, many times the same thing. Who does it benefit the least? Rich people! White people! Men! Again – many times, one in the same.

Ted Cruz’s obsession with defunding Obamacare is reflective of a larger idea that’s present across both parties, but which has come to a particularly alarming head within the GOP. Poor people, women, people of color, and queer people don’t matter. They are not worth out tax dollars or our reform efforts, and bills – like Obamacare – that would benefit them are offensive. That’s a really classy concept, isn’t it?

Seriously. It’s pretty gross that House Republicans would rather the government shut down than to extend basic healthcare to folks who don’t have access to racial, gendered, or economic privilege.

Now, obviously, that’s pretty shitty. But since the whole government shutdown thing isn’t overly dire, it’s not really a big deal, right? Jerks will be jerks, can’t we call just roll our eyes and move on?

Not really. Very soon, this government shutdown won’t be our only problem. In just 17 days, Congress will have to vote to lift the United States’ debt ceiling. While this sounds like voting to allow the government to spend more and rack up more debt, that’s not at all what it means – instead, lifting the debt ceiling simply means voting to keep the American economy running.

Without lifting the debt ceiling, the U.S. won’t be able to pay any of its bills. That means indefinitely delayed Social Security checks, no more benefits for veterans, and no more paychecks for soldiers. Also, hundreds of thousands of companies that do business with the U.S. government won’t get paid, the cost of borrowing money will skyrocket, and the U.S. won’t be seen as a safe place for business or investment.

Basically the U.S.’ economy, and the global economy, would go kaput. You think 2008 was bad? Failing to lift the debt ceiling would be much, much worse. And guess what! The GOP doesn’t want to do it.

Unless of course, a whole bunch of entirely unreasonable demands are met. Halting healthcare reform, building an oil pipeline, and nixing the regulation of greenhouse gases all make the list. It reads, essentially, like Mitt Romney’s campaign platform.

But, you see, Mittens lost the 2012 election for a reason.

He wasn’t shy about his disdain for the less fortunate, for those of us who are outside of privilege. We all remember his comment about the 47 percent. And last November, we all collectively decided that his wasn’t the kind of attitude we wanted in the White House. The American people have spoken! This case should be closed.

Mitt.

But the GOP isn’t willing to let it go. Some of their other demands over the past few years have included eliminating funding for Planned Parenthood – which would leave thousands of women, mostly poor and of color, without access to necessary healthcare – slashing food stamp funding – a program that is already insufficient for making sure the poor don’t starve to death – and preserving or implementing a bunch of tax reforms that benefit the rich and screw the rest of us.

The pattern is very clear. To the GOP, political negotiation means demanding people who are outside of privilege be made as vulnerable as possible. It means crusading against women, poor folks, people of color, and the queer community. It means threatening political and economic ruin for the entire country if our lives and livelihoods aren’t seriously threatened.

So, even though this latest government shutdown isn’t the end of the world, it’s only one episode in an ongoing political drama. And in 17 days, things could get much, much worse.

Because today, the Republican Party has shown that it would rather shut down the government than support a whole bunch of disenfranchised citizens gaining access to healthcare.

What will they do on October 17th?

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

Featured image courtesy of [Mount Rainier National Park via Flickr]

Hannah R. Winsten

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

The post Here’s Why Republicans Shut Down the Government appeared first on Law Street.