Thursday, June 28, 2012

Affordable Care Act Constitutional!

Well, it's official.  The US Supreme Court has upheld the Affordable Care Act individual mandate under the Taxing Clause, rather than the Commerce Clause.  Analysis of the legislation and the decision will be everywhere for the foreseeable future - at least until after the Presidential election.

Of course, the haters who want to deny Obama his signature piece of legislation will argue that Obama has gone back on his promise not to tax all Americans.  And they will renew their - so far - ineffectual efforts to repeal the law.  The question is:  how viable is that dream?  Which is the bigger and more vocal group in this country - the people who will now be able to afford insurance coverage under the new rules and the exchanges, etc.?  Or the people who object to any new taxes, who want to repeal the law and end the gains made in the past two years?

Roberts' opinion practically invited the legislature to overturn the legislation by saying that the decision as to whether the Affordable Care Act is wise policy belongs to the country's elected leaders.  So how about that question my fellow Americans?  What are you going to tell your elected leaders about your take on this momentous decision?  How vocal are you going to be?  The decision you make today and the steps you take with your legislators may decide not only the fate of the Affordable Care Act - but the attitudes and changes that affect the future of Medicare and Social Security as well.   It's all of one piece to those who oppose social safety nets.

Think about that as you drink your morning coffee and read the pundits and the political posturing.  Obama may have won a battle but the war is just heating up folks.  The Koch Brothers and other conservative deep-pockets will not take this lying down.

Wednesday, June 27, 2012

Maybe Popeye was Right about Spinach!

I know this is the day before the Supreme Court is expected to hand down its decision on the Affordable Care Act and every journalist/political junkie is trying to guess the outcome.  I'm exercising self-restraint and will wait until the actual decision comes down to discuss that topic.

Instead I want to talk about Alzheimer's disease - or rather the avoidance of Alzheimer's disease.  My Mother was a fresh fruit and salad advocate for as long as I can remember.  We ate some meat (besides not being able to afford expensive cuts very often, Mother was more of a fish person).  Dad is a meat and potatoes kind of guy, but Mom made sure we always had salad at every meal and vegetables as a side dish.  We ate lots of fish (the kids, not Dad), including tuna, and rarely ate anything fried. Kale and spinach and broccoli and cabbage were all staples in our diet.  Of course, we were of part Irish descent, so potatoes graced our table on most nights.  I also can remember Mom cutting up fresh vegetables and putting them in ice water in the fridge for snacks along with whatever fresh fruit was in season.

Aside from the potatoes, this kind of diet is supposed to help protect one against Alzheimer's disease.  Yet Mom suffered from that debilitating illness for about 5 years before she died of a weakened heart.  I suppose the argument may be made that she would have succumbed to the dread disease at a younger age if she hadn't eaten such a healthy diet.  As it was, she wasn't definitively diagnosed until she was over 75.  Now that I'm in my sixties that doesn't seem so very far away.  Every time I forget where my keys are or where I parked in the mall parking lot, I feel the shadows getting closer and closer.

Anyway, why not try a healthy diet to avoid sickness?  If it works with other diseases, it seems to make sense that it would work for this disease too.  In that spirit, I share this link to the Alzheimer's Association webpage on a healthy brain diet.  Read it in good health.

Thursday, April 12, 2012

Accountable Care Organizations and Medicare

I remember going to an off-site lab for tests one day.  A male patient there, senior in years, was arguing with the clerk at the window.  It appeared that he had been to the lab weeks ago to have some blood work done as requested by his doctor.  The doctor had never received the results so the patient had come to the lab to obtain them.  The only problem was that the lab did not have the test results.  As a matter of fact, they didn't even have his lab tests.  They had been lost in some black hole  - most likely in the lab itself since they performed all test results right there.  The man was clearly frustrated.  His insurance had never been billed for the tests, either, so it was his word against the lab's that he had actually had the blood drawn.  No wonder his voice was rising a few notches.  Of course, being a senior citizen, I'm sure the young woman at the window put it all down to a "senior moment".

Well, scenes like that hopefully will happen fewer and fewer times starting - soon.  The Centers for Medicaid and Medicare Services (CMS) has announced that 27 Accountable Care Organizations have signed up to work with physicians and hospitals to help coordinate care for Medicare patients so that scenes like the one described above become the exception to the rule.

If we count the Pioneer Accountable Care Organizations and the physicians groups that CMS announced in 2011, the number of such organizations working toward better care coordination and shared savings for patients now numbers 65.  According to CMS, they are reviewing almost 3 times that number of additional applications for entry into the program in July 2012.

Read more about the status of Accountable Care Organizations in Mary Mosquera's April 10, 2012 article entitled "CMS unveils "27 Medicare shared savings ACO's" on  These organizations come courtesy of the Affordable Care Act "Shared Savings Programs" which is expected to lower costs by improving health care.

Wednesday, April 4, 2012

Maryland Moves Forward With State-Run Health Exchanges

Marylanders take note!  The U.S. Supreme Court may not decide until June what it's going to do with President Obama's signature Affordable Care Act, but our Governor Martin O'Malley is committed to the Act's overall concept.  Maryland legislators and the Governor have decided to move ahead with plans to initiate the Maryland Health Insurance Exchange even if the Supreme Court overturns the entire act!  How's that for dedication to a principle?

O'Malley plans to have his administration ready to initiate coverage under the Maryland Health Insurance Exchange sometime in late 2013.  O'Malley is dedicated to the change envisioned by The Affordable Care Act because they mean changes for the better in health care coverage and in the competitive ability of employers.  O'Malley believes that Maryland is recognized as a leader in the health reform movement as a result of the state's efforts to build the Maryland Health Insurance Exchange. He would like to see Maryland's state-run program as a model for other states.

O'Malley also promised that if the Supreme Court's action means that the change in health coverage will be on a state-by-state basis going forward, then Marylanders can expect to see the state in the forefront of those entering into partnership agreements with the federal government.  His first choice is for the entire country to tackle reform but he is prepared to lead Maryland into the future even if the Supreme Court strikes the entire act down.  A man of principle indeed!

Wednesday, March 28, 2012

Affordable Care Act - Oral Arguments Day #2

Well, folks, Tuesday's oral arguments certainly did not disappoint.  I have to admit that my biggest take-away from the arguments has been an absolute deep respect for Justice Sotomayor.  What an admirable addition to the SCOTUS bench!  Her questions are erudite.  She goes straight to the heart of the issue.  She's polite, respectful of other people, their ideas and opinions, yet definite in her own opinions and ideas.  She seems the most prepared of any of the Justices and I believe she has asked the most questions although Justice Kennedy was very engaged.

Did we gather any inklings from Tuesday's arguments and questions to guess what the ruling will be?  I don't think so.  For my money, the Justices asked tough questions of both sides of the issue.  And I'm not sure that the kind of questions asked translate in any way to what the final decision will be.  I'm a complete outsider on these proceedings but I can't help but feel that the real decision-making process is going to take place between the Justices as they try to sway each other toward adopting a majority opinion.  Maybe something one side or the other said may bolster a Justice's opinion but there were no surprises from counsel on either side.  (Although I have to agree with other commentators that the Administration's advocate could have been more...more...I don't know...maybe a greater stage presence would have helped?) Anyway, I don't think that matters to the Justices.  We're really only talking about two Justices that are possibly in the swing seat.  Roberts and Kennedy.  Do not believe that yesterday's arguments swayed anyone into a totally new position. 

Today, C-SPAN starts playing the oral arguments at 12:30PM.  Today the discussion centers around what happens to the rest of the law if the mandate is overturned.  Can the mandate or the mandate/penalty be severed from the rest of the law so that the remainder of the Act stays in place?  The other big question presented today centers around the expansion of Medicaid.  Federalism may hang in the balance.  Stay tuned for the fireworks.

Tuesday, March 27, 2012

Oral Arguments Day #1 - Affordable Care Act

Well, did you watch the first set of Supreme Court oral arguments on the Affordable Care Act?  The case that is bringing the arguments forward is Florida v. Department of Health & Human Services.  If you were on the moon yesterday and missed the national news coverage of this exceptional court proceeding, you can catch the audio coverage on C-SPAN which has set up an oral arguments page on its website.

I found them pretty informative and definitely worth watching.  The Justices were undoubtedly engaged in this debate.  They interrupted Counsels (all of them at one point or another) to ask pointed questions and not waste time on lawyer meandering.  All of them seemed to be coming down on the side of not punting this discussion another two years.

The topic for this set of questions was very arcane.  To oversimplify the question, is the penalty imposed by the Affordable Care Act actually a tax which in turn means that the Anti-Injunction Act prohibits the Court from taking jurisdiction and addressing the constitutional issue until the tax actually goes into effect?  The Justices are expected to answer that question before the end of the 2012 term in June.

In the meantime, let me just say that I was very impressed with Justice Sotomayor's questions and her manner.  She was definitely on top of the issue and the cases and traded case names with counsel in a kind of verbal short-hand that peppered the discussion and led counsel in some instances in directions they may not necessarily have wanted to tread.  In many ways, it was a history lesson on the hows and whys the act came into being.

One of the more interesting facets of this particular issue is that the Court appointed a counsel to argue that the Anti-Injunction Act applies in this instance.  The Justices took that step because the two opposing sides on the case agree (for different reasons) that the Anti-Injunction Act does not apply and the Justices wanted the opposite arguments brief and argued.

Stay tuned for take #2 today when the Court visits the issue as to whether the individual mandate is constitutionally permitted.  You can catch the audio coverage in its entirety on C-Span at 1PM and at other times throughout the day.

Monday, March 19, 2012

Health Care Reform - Next Stop Supreme Court

Butter your popcorn, folks, and save your seats for the U. S. Supreme Court case of the year.  Next week, March 26, 2012, has been set for oral arguments in the national debate on the Affordable Care Act.  The main topic is, of course, the health insurance mandate provision for which several hours of debate have been secured.

Of course, nothing is as simple as it seems.  The Court may choose to decide the case (which would be sometime in the summer, expectations currently being July) or it may choose to punt the decision until after 2014 when the mandated coverage provision takes effect. 

This is a case that should interest each one of us because the answer will personally affect all of us.  If the Court decides the mandate is constitutional, then the remaining provisions of the Affordable Care Act will continue apace.  The mandate provisions and the affordable insurance exchanges will go into effect in 2014.

If the Court decides the mandate is not constitutional, it then has to decide whether the entire Affordable Care Act falls or if only the mandate falls.  This is huge.  Some of the Act's provisions are already in effect and if the Court decides the Act itself falls, we would flip back to pre-Affordable Care Act times.  No coverage under Mom/Dad's policy until age 26 for dependents; a return to pre-existing conditions exclusions for children, just to name a few.  If only the mandate falls, then costs become a huge issue for which there are currently no alternatives - except maybe Ryan's plan.

So, buckle up.  It's going to be a bumpy ride.  If you want to familiarize yourself with the issues at stake next week, Kapur's article is a good read: