Tag Archives: mandate

Looking at the conservative ‘heritage’ of some core ACA features

Joanne Kenen

About Joanne Kenen

Joanne Kenen, (@JoanneKenen) the health editor at Politico, is AHCJ’s topic leader on health reform and curates related material at healthjournalism.org. She welcomes questions and suggestions on health reform resources and tip sheets at joanne@healthjournalism.org.

Photo: Fibonacci Blue via Flickr

The New York Times Magazine recently looked at the prolonged fight against the Affordable Care Act (ACA) waged by Heritage Action for America, the political arm of conservative think tank Heritage Foundation, which has helped populate the Trump administration both in and out of health care.

Vice President Mike Pence and Health and Human Services Secretary Tom Price are Heritage supporters and have brought in like-minded associates.

But, as we have seen, the task of repealing the ACA is hard, in part because the legislation has changed the health care landscape in so many ways. Continue reading

No shift to part-time work seen (yet) under ACA

Joanne Kenen

About Joanne Kenen

Joanne Kenen, (@JoanneKenen) the health editor at Politico, is AHCJ’s topic leader on health reform and curates related material at healthjournalism.org. She welcomes questions and suggestions on health reform resources and tip sheets at joanne@healthjournalism.org.

Photo by Marta P via Flickr

Photo by Marta P via Flickr

Remember all those stories about people being shifted into part-time work so their employers don’t have to provide health insurance?

According to a new Urban Institute report, funded by the Robert Wood Johnson Foundation, it hasn’t happened.

If, and when, the employer mandate fully kicks in (more on that below) things could change. But the anecdotes we’ve heard about employers cutting hours because of the Affordable Care Act are just that – scattered anecdotes. (And when it does occur, it might be a result of other business conditions, not the health law). Under the ACA the definition of “full-time” work is 30 hours; anyone working 30 hours a week or more would have to be covered. The fear was that employers would cut them to, say, 28 or 29 hours, to avoid that obligation. Continue reading

Covering state responses to Supreme Court decision on Affordable Care Act

Joanne Kenen

About Joanne Kenen

Joanne Kenen, (@JoanneKenen) the health editor at Politico, is AHCJ’s topic leader on health reform and curates related material at healthjournalism.org. She welcomes questions and suggestions on health reform resources and tip sheets at joanne@healthjournalism.org.

If the Supreme Court strikes key parts – but not all – of the 2010 health law, the best chances of fixing the gaps might come from the states.

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The conventional wisdom – and conventional wisdom based on justices’ comments during oral arguments is not worth its weight in gold – is that the Supreme Court in late June (maybe June 28) will issue the health care ruling and strike the individual mandate. The conventional wisdom, further, is that it will probably, but not necessarily, also strike two related insurance market rules – covering people with pre-existing conditions (AKA guaranteed issue) and limits on how much more older people can be charged for coverage than younger ones (AKA community rating.) But it could strike only the mandate, tossing the other insurance rules back to Congress to address.

The health reform law minus the individual mandate, community rating and guaranteed issue won’t work so well, either as a coverage tool or as a cost-container. (Although Medicaid expansion and subsidies for people buying plans in the exchange would proceed). And the health reform law without the individual mandate but with everything else intact will work even less well. Judging from the experiences of states that have tried such regulations without a mandate, insurance premiums are likely to soar.  In fact, it could be such a mess that it would actually increase pressure on legislators to address it.
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Get familiar with alternatives to ACA’s individual mandate

Joanne Kenen

About Joanne Kenen

Joanne Kenen, (@JoanneKenen) the health editor at Politico, is AHCJ’s topic leader on health reform and curates related material at healthjournalism.org. She welcomes questions and suggestions on health reform resources and tip sheets at joanne@healthjournalism.org.

The Supreme Court this month – probably June 28 but maybe a bit earlier – will rule on the Affordable Care Act.

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The central question is whether the individual mandate is constitutional. If the mandate is struck down, with or without some related insurance market rules, it pokes a huge hole in the 2010 health care law.

We’re going to post a longer, separate item on  what reporters need to understand about the next steps in policy – and how it might play out in the states. But first here are some quick resources on what the policy alternatives might be (short of repealing the law entirely, as many Republicans have proposed).
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Still plenty to watch, report on as Supreme Court considers health reform law

Joanne Kenen

About Joanne Kenen

Joanne Kenen, (@JoanneKenen) the health editor at Politico, is AHCJ’s topic leader on health reform and curates related material at healthjournalism.org. She welcomes questions and suggestions on health reform resources and tip sheets at joanne@healthjournalism.org.

I have a few quick thoughts on this week’s Supreme Court hearings and what it will mean for our coverage of health reform.

Most people in the courtroom (or people who, like me, listened to audio, read transcripts, wrote and edited a ton of copy and couldn’t avoid Jeff Toobin) ended up with the gut feeling that health reform is in deep trouble – that the court is likely to toss the individual mandate, some of the insurance provisions, and maybe a whole lot more. Maybe all of it.

Joanne KenenJoanne Kenen (@JoanneKenen) is AHCJ’s health reform topic leader. If you have questions or suggestions for future resources, please send them to joanne@healthjournalism.org.

But of course, we don’t really know what the court will do. Tough questions in public certainly let us know that all nine justices are not exactly the law’s biggest boosters. But what they will do, as they mull and debate behind closed doors, is not a sure thing. We can guess, but we don’t know. And we won’t know for about three months. (There’s a chance that it will be sooner – but traditionally big rulings come out at the end of the term. And this is a big, big ruling).

Remember the “Conventional Wisdom” was wrong before – wrong from the beginning. The CW didn’t think Obama was going to push for comprehensive health reform. The CW didn’t think he’d be able to enact health reform – particularly not after Scott Brown’s election. The conventional wisdom didn’t think there would be a fight about the mandate. Or that the mandate would end up in the Supreme Court. Or that it would be in deep, deep, deep trouble once it got there.

So what do we do for the next three months?

First of all, we are going to get spun – and the negativity about the oral arguments is going to help the anti-health law camp of spinners. (The “hey it’s hunky-dory, it’s all fine” advocacy world rings a little hollow at the moment – although they may turn out in June to be right.) Keep an eye out for that “the law is dead so let’s get real” drumbeat because if things are said often enough, in a media or political context, they can start becoming the new conventional wisdom and affecting how we report and write.

We might get pushed by editors to be more forceful about predicting the demise of the law (or the mandate) than we are comfortable with. Push back – you can certainly say there are real questions about the law’s survival. You can’t pick out hymns for its burial.
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Watch your state. Are officials slowing down implementation? Not submitting grant applications for exchange planning when they were before, or not putting out bids for exchange IT teams, etc.? Are the implementers slowing down – and are the non-implementers freezing? How much catching up will they have to do if the statute is upheld – and they have to meet some exchange certification deadlines by Jan. 1, 2013.

Is the court situation affecting state politics – local, congressional, presidential. How?

Is anyone talking about state initiatives to fill in if the parts of the federal plan are punctured? For instance, if the federal mandate fails, there’s nothing to stop a state from passing its own mandate; the federal constitutional questions don’t apply. I suspect few states will do this – but I can think of a handful that might. (If this does start to bubble up in your state, please email me your coverage.)

What are the hospitals’ and insurers’ and physician groups’ contingency plans? Are delivery system reforms and innovations on hold – or is the assumption that they can either proceed without the federal law, or that the relevant sections of the law will survive

And does the public know what it wished for? It wanted health reform when it didn’t have it. Then it decided it didn’t like health reform when it got it. Do Americans really want to go back to March 22, 2010 (the day before President Obama signed it)? And do they realize they can’t; that the health system has changed? Do they understand that people who are getting benefits under the first phases of the law’s implementation could lose them? And that costs will rise, the numbers of uninsured (now somewhere around 50 million) will rise, and Congress – so polarized that it has trouble doing much more than renaming post offices these days – is not going to come swooping in with a pain-free bipartisan fix-the-problems-with-no-cost-or-dislocation make-everyone-happy solution.

Related

Responses to the Supreme Court’s health reform decision

Webinar: Implementing health reform in the states

Affordable Care Act before the Supreme Court: What you need to know – A tip sheet by longtime legal journalist T.R. Goldman that addresses five key questions.