Tag Archives: Supreme Court

Watch funding, implementation and court cases as health reform moves forward

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 election is over. Obamacare survived.

So what’s the story in your state or community?

Implementation. Or lack thereof.

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.

So here’s an overview of where things stand in D.C. – and what it means for the health beat.

(Soon we will post a short separate item on the new state insurance exchange deadlines. If your state wants to run its own exchange, the deadline is still Nov. 16. They have more time to fill in the details though.)

The Affordable Care Act will not be repealed. Maybe the House will still hold a few symbolic repeal votes, but it’s not going to be repealed. That does not mean that critics of the law won’t try to dismantle parts of it. Some likely targets include the Medicare Independent Payment Advisory Board and some of the industry taxes, particularly the medical device tax. Watch your own legislators to see where they go on this—if you are in a state or district with a medical device industry, watch the Democrats as well as the Republicans (and the medical device businesses themselves). Ask them how they want to offset the funding; if they eliminate one of the taxes that paid for the coverage expansion, where do they want to get that money instead? Adding to the deficit isn’t going to go over as a solution.

The law’s funding is vulnerable. How vulnerable and which parts? Hard to say yet. But for what it’s worth, #DEFUND is the new Twitter rallying cry for opponents of the law (some of whom do not seem to realize that the Republican House can’t act unilaterally … but I digress). There will be ample opportunities for Republicans to try to take a whack at this, not just through the annual budget and appropriations process but through the lame duck session of Congress getting under way this week that will try to find a way of averting, at least temporarily, the fiscal cliff. Continue reading

The Supreme Court has ruled. Now what?

Pia Christensen

About Pia Christensen

Pia Christensen (@AHCJ_Pia) is the managing editor/online services for AHCJ. She manages the content and development of healthjournalism.org, coordinates social media efforts of AHCJ and assists with the editing and production of association guides, programs and newsletters.

Now that the Supreme Court has issued a decision on health care reform, how do you localize and cover it for your readers, listeners and viewers?

To assist reporters across the country who will need to localize the decision and what it means for their states and local communities, AHCJ will host a one-hour online roundtable of experts to offer you suggestions on stories you can pursue right away and in the weeks ahead. We will help you identify stories that make sense for you as a local or regional reporter.

The U.S. Supreme Court

Photo by functoruser via Flickr

The event will take place at noon ET on June 29, the day after the court releases its ruling.

Participants include:

  • Alan Weil, executive director, National Academy for State Health Policy
  • Kevin Outterson, associate professor of law and associate professor of health law, bioethics and human rights, Boston University
  • Bruce Siegel, M.D., M.P.H., president and chief executive officer, National Association of Public Hospitals and Health Systems
  • Moderator: AHCJ President Charles Ornstein, a senior correspondent for ProPublica

To participate in the webcast, click on this link at the time of the webcast. You will need your AHCJ website username and password to log in. During the event, you will be able to send in questions through a chat function and listen to the answers via your computer’s speakers.

AHCJ is committed to helping you cover this milestone decision. And for many valuable tips and resources, visit our health reform topic pages, compiled by health reform topic leader Joanne Kenen.

Some related items you will find on the health reform topic pages:

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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Health Reform
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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.
Continue reading

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).
Continue reading

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.
Health Reform core topic

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.

Primer prepares reporters for Supreme Court review of health reform

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.

Back in 2009, when critics of what was then a health reform bill, not a health reform law, muttered about legal challenges to the constitutionality of the individual mandate, a lot of people in the health policy world didn’t take it all that seriously. Sure, they thought the law would be attacked in court, but there was skepticism that the legal scholars on the other side would be able to mount a legally powerful, consistent argument that would put the law, or at least key sections of the law, in jeopardy.
Health Reform core topic

They were wrong. The attorneys who oppose the law, including Randy Barnett and Paul Clement, made powerful arguments. The lower courts – and some intellectually influential appellate judges – have divided. Now it’s up to the Supreme Court.

To help you cover the extraordinary six hours of arguments over three days (without a television feed), we’ve done a tip sheet and resource guide. We asked legal writer T.R. Goldman to address five questions:

  1. Is the individual mandate’s “minimum coverage provision” that requires most people to obtain health insurance constitutional?
  2. If not – will the court strike the whole law down, or just certain sections (“severability”)?
  3. What role does Medicaid expansion play in the legal case?
  4. Can the court decide on the constitutionality of the mandate now, or under the Anti-injunction Act does it have to wait until mandate penalties are imposed in 2015?
  5. What are some tips for health reporters trying to cover this – particularly those covering from afar?

And on that last point – the bottom line is “Don’t assume anything.”

“The working assumption of many court watchers is that at least five Justices will vote to uphold the mandate’s constitutionality,” Goldman said. “There’s really no way to know, however, what the court will do.”

One last tidbit – not strictly health-relevant perhaps but interesting. In the 19th century, the oral arguments lasted for days – and attracted a crowd of spectators (before ESPN!)

Final thought – if you think the Supreme Court ruling is going to put an end to the controversy … You’re probably wrong.

Joanne 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.