Tag Archives: mandate

Covering state responses to Supreme Court decision on Affordable Care Act

About Joanne Kenen

Contributing editor to Politico Magazine and former health care editor-at-large, Politico, Commonwealth Fund journalist in residence and assistant lecturer at Johns Hopkins Bloomberg School of Public Health.

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

About Joanne Kenen

Contributing editor to Politico Magazine and former health care editor-at-large, Politico, Commonwealth Fund journalist in residence and assistant lecturer at Johns Hopkins Bloomberg School of Public Health.

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

About Joanne Kenen

Contributing editor to Politico Magazine and former health care editor-at-large, Politico, Commonwealth Fund journalist in residence and assistant lecturer at Johns Hopkins Bloomberg School of Public Health.

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.


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.

Health care bill moves forward

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 AHCJ's social media efforts and edits and manages production of association guides, programs and newsletters.

Following the Senate vote on the health care bill, reporters have rushed to cover the latest developments. Here is just a bit of the coverage:

Ricardo Alonso-Zaldivar and Erica Warner of The Associated Press have a point-by-point comparison of the Senate and House health care bills. Werner also has an interesting look at the winners and losers in the bill, including the residents of Libby, Mont., many of whom suffer from asbestos-related illnesses from a now-closed mineral mining operation.

On The Wall Street Journal‘s health blog, Jacob Goldstein reports on the Congressional Budget Office’s estimates on the Senate bill with the “public option lite” – with private plans overseen by a government agency.

Reuters’ Donna Smith offers an overview of the Senate health care bill in a Q&A format.

Scott Hensley of NPR’s Shots blog notes the weekend’s key development that led to the bill moving forward and he looks ahead to reconciliation.

In a piece that appears in USA Today, Phil Galewitz of Kaiser Health News points out that mandates, such as requiring all Americans to have health insurance, do not guarantee compliance. His article explains the mandate and the penalties for those who choose to go uninsured.

In the Los Angeles Times, Kim Geiger and James Oliphant also look at the mandate: why its in the bill, how it can cover people with expensive illnesses and “age rating.”

Plenty more coverage is emerging by the minute. Here is the bill.