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6 surprising health items that could disappear with ACA repeal

The Affordable Care Act of course affected premiums and insurance purchasing. It guaranteed people with pre-existing conditions could buy health coverage and allowed children to stay on parents’ plans until age 26. But the roughly 2,000-page bill also included a host of other provisions that affect the health-related choices of nearly every American.

Some of these measures are evident every day. Some enjoy broad support, even though people often don’t always realize they spring from the statute.

In other words, the outcome of the repeal-and-replace debate could affect more than you might think, depending on exactly how the GOP congressional majority pursues its goal to do away with Obamacare.

No one knows how far the effort will reach, but here’s a sampling of sleeper provisions that could land on the cutting-room floor:

CALORIE COUNTS AT RESTAURANTS AND FAST FOOD CHAINS

Feeling hungry? The law tries to give you more information about what that burger or muffin will cost you in terms of calories, part of an effort to combat the ongoing obesity epidemic. Under the ACA, most restaurants and fast food chains with at least 20 stores must post calorie counts of their menu items. Several states, including New York, already had similar rules before the law. Although there was some pushback, the rule had industry support, possibly because posting calories was seen as less onerous than such things as taxes on sugary foods or beverages. The final rule went into effect in December after a one-year delay. One thing that is still unclear: Does simply seeing that a particular muffin has more than 400 calories cause consumers to choose carrot sticks instead?  Results are mixed. One large meta-analysis done before the law went into effect didn’t show a significant reduction in calorie consumption, although the authors concluded that menu labeling is “a relatively low-cost education strategy that may lead consumers to purchase slightly fewer calories.”

PRIVACY PLEASE: WORKPLACE REQUIREMENTS FOR BREAST-FEEDING ROOMS

Breast feeding, but going back to work? The law requires employers to provide women break time to express milk for up to a year after giving birth and provide someplace — other than a bathroom — to do so in private. In addition, most health plans must offer breastfeeding support and equipment, such as pumps, without a patient co-payment.

LIMITS ON SURPRISE MEDICAL COSTS FROM HOSPITAL EMERGENCY ROOM VISITS

If you find yourself in an emergency room, short on cash, uninsured or not sure if your insurance covers costs at that hospital, the law provides some limited assistance. If you are in a hospital that is not part of your insurer’s network, the Affordable Care Act requires all health plans to charge consumers the same co-payments or co-insurance for out-of-network emergency care as they do for hospitals within their networks. Still, the hospital could “balance bill” you for its costs — including ER care — that exceed what your insurer reimburses it.

If it’s a non-profit hospital — and about 78 percent of all hospitals are — the law requires it to post online a written financial assistance policy, spelling out whether it offers free or discounted care and the eligibility requirements for such programs. While not prescribing any particular set of eligibility requirements, the law requires hospitals to charge lower rates to patients who are eligible for their financial assistance programs. That’s compared with their gross charges, also known as chargemaster rates.

NONPROFIT HOSPITALS’ COMMUNITY HEALTH ASSESSMENTS

The health law also requires non-profit hospitals to justify the billions of dollars in tax exemptions they receive by demonstrating how they go about trying to improve the health of the community around them.

Every three years, these hospitals have to perform a community needs assessment for the area the hospital serves. They also have to develop — and update annually — strategies to meet these needs. The hospitals then must provide documentation as part of their annual reporting to the Internal Revenue Service. Failure to comply could leave them liable for a $50,000 penalty.

A WOMAN’S RIGHT TO CHOOSE … HER OB/GYN

Most insurance plans must allow women to seek care from an obstetrician/gynecologist without having to get a referral from a primary care physician. While the majority of states already had such protections in place, those laws did not apply to self-insured plans, which are often offered by large employers. The health law extended the rules to all new plans. Proponents say direct access makes it easier for women to seek not only reproductive health care, but also related screenings for such things as high blood pressure or cholesterol.

AND WHAT ABOUT THOSE THERAPY COVERAGE ASSURANCES FOR FAMILIES WHO HAVE KIDS WITH AUTISM?

Advocates for children with autism and people with degenerative diseases argued that many insurance plans did not provide care their families needed. That’s because insurers would cover rehabilitation to help people regain functions they had lost, such as walking again after a stroke, but not care needed to either gain functions patients never had, such speech therapy for a child who never learned how to talk, or to maintain a patient’s current level of function. The law requires plans to offer coverage for such treatments, dubbed habilitative care, as part of the essential health benefits in plans sold to individuals and small groups.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation. This story from HKN is published under a Creative Commons license.

House Republicans change course on gutting ethics board

House Republicans, under pressure from President-elect Donald Trump, Democrats and good-government watchdogs, reversed course on a plan to gut an independent ethics board, according to a report from The AP.

The reversal came as representatives came together for the first day of the 115th Congress.

House Republicans had come under attack from Democrats, watchdog groups and also Trump over a secretive move to place the independent Office of Congressional Ethics under their control.

One vocal critic was U.S. Rep. Ron Kind, D-Wis., who said the “effort to take all investigative and oversight authority away from the independent Office of Congressional Ethics was a shameful first action for the new Congress.”

In an emergency meeting, faced with criticism, House Republicans voted to undo the change.

“With all that Congress has to work on, do they really have to make the weakening of the Independent Ethics Watchdog, as unfair as it may be, their number one act and priority,” was the statement on Trump’s Twitter account.

Congress should be focused on tax reform and health care, the statement said, and there was a reference to draining the swamp.

“We were elected on a promise to drain the swamp and starting the session by relaxing ethics rules is a very bad start,” GOP Rep. Tom McClintock of California said, according to the AP.

Republican  Rep. Tom Cole of Oklahoma: “People didn’t want this story on opening day.”

The ethics office was created in 2008 after several bribery and corruption cases in the House.

Regarding Republicans’ amendment dealing with the ethics office, House Speaker Paul Ryan, R-Wis., had issued this statement defending the move: “After eight years of operation, many members believe the Office of Congressional Ethics is in need of reform to protect due process and ensure it is operating according to its stated mission. I want to make clear that this House will hold its members to the highest ethical standards and the Office will continue to operate independently to provide public accountability to Congress. The Office will continue to be governed by a bipartisan independent outside board with ultimate decision-making authority. The Office is still expected to take in complaints of wrongdoing from the public. It will still investigate them thoroughly and independently. And the outside board will still decide whether or not evidence exists to warrant a full investigation by the House Ethics Committee. With the amendment adopted last night, the bipartisan, evenly-divided House Ethics Committee will now have oversight of the complaints office. But the Office is not controlled by the Committee, and I expect that oversight authority to be exercised solely to ensure the Office is properly following its rules and laws, just as any government entity should. I have made clear to the new Chair of the House Ethics Committee that it is not to interfere with the Office’s investigations or prevent it from doing its job. All members of Congress are required to earn the public’s trust every single day, and this House will hold members accountable to the people.”

Kind stated, “I am glad my colleagues realized this mistake and decided not to pursue the change. At a time when the people of Wisconsin have lost trust in Washington further weakening transparency and accountability for members of Congress is not the way to rebuild that trust. I will continue to stand up for Wisconsinites by fighting against any future attempts to limit the transparency and accountability of government.”

Danger list: A look at the Republican agenda for 2017

Republicans emerged from the November elections holding their greatest level of power in decades. Not only will Republicans control the White House and Congress, but the GOP also will hold 33 governors’ offices and have majorities in 33 state legislatures. A look at the GOP agenda for state legislative sessions.

ABORTION

• Ban most abortions after 20 weeks of pregnancy.

• Ban dilation and extraction abortions, a procedure more commonly used in the second trimester.

• Lengthen the time women must wait to have an abortion after receiving counseling about its effects.

• Block government funding from going to abortion providers such as Planned Parenthood.

BUSINESSES

• Reduce or eliminate corporate income taxes.

• Relax business regulations and professional licensing requirements.

EDUCATION

• Expand the availability of vouchers, scholarships or tax credits that allow taxpayer money to cover K-12 tuition costs at private schools.

• Expand opportunities for charter schools.

GUNS

• Allow people with concealed gun permits to carry weapons on college campuses.

• Reduce the costs for concealed gun permits and ensure that permits from one state are recognized elsewhere.

•  Allow people to carry concealed guns without needing permits or going through training.

LAWSUITS

• Limit how much money plaintiffs can win in medical malpractice and personal injury cases.

• Restrict where lawsuits can be filed in an attempt to prevent plaintiffs from bringing suit in jurisdictions perceived to be favorable.=

• Restrict who can qualify to provide expert witness testimony.

• Reduce the rates used to calculate interest on monetary judgments.

UNIONS

• Enact right-to-work laws, which prohibit workplace contracts that have mandatory union fees.

• Restrict the collective bargaining powers of public employee unions.

• Require members of public employee unions to annually affirm their desire for dues to be deducted from paychecks.

• Curtail or repeal prevailing wage laws, which set minimum pay scales on public construction projects.

On the Web

Pew’s Stateline reports.

 

 

Republican wins could lead to amending U.S. Constitution

The November election put Republicans in full control of a record number of state legislatures around the country, a level of power that gives the party an unprecedented opportunity: change the U.S. Constitution.

Republicans already control Congress, the White House and more governors’ offices than they have in nearly a century. But it’s the state legislatures that could produce lasting change.

The GOP now holds numerical majorities in 33 legislatures, one shy of the two-thirds required to initiate a convention on constitutional amendments. There is no credible talk of using that power for amendments on hot-button social issues, such as banning abortion or gay marriage. But conservatives have a list of bread-and-butter governing issues they would like to see enshrined in the Constitution.

One, to require a balanced federal budget, is already approaching the level of support that would trigger a convention. Beyond that, a major state-level push is planned during 2017 for a constitutional convention that could also consider amendments to impose term limits on members of Congress and rein in various federal powers.

President-elect Donald Trump has pledged support for an amendment on congressional term limits.

“The possibility of constitutional change is in the air,” said law professor Jeffrey Rosen, president and CEO of the National Constitution Center in Philadelphia, a nonprofit museum that is hosting academic debates and symposiums about the efforts to amend the Constitution.

The U.S. Constitution has been amended 27 times since it was ratified in 1788, and its Article V spells out two ways to propose amendments. By a two-thirds vote of each chamber, the U.S. House and Senate can refer an amendment to the states. Or two-thirds of the state legislatures can request that Congress call a convention of the states.

Both scenarios require three-fourths of the states — or 38 — to ratify an amendment before it takes effect.

If the supporters of a balanced budget amendment succeed, it would be the first time in the nation’s history that states initiated the process. That scenario has become more likely as a result of the November election.

It takes 34 states to trigger a convention for constitutional amendments, meaning a unified Republican push would need the help of only a few Democrats in a single state to reach the mark.

“The overwhelming success of one political party at the state level is something of real constitutional significance,” said Akhil Reed Amar, a constitutional law professor at Yale University.

Every state except Vermont has some sort of balanced budget requirement, according to the National Conference of State Legislatures. The U.S. government does not, but not everyone agrees that’s a problem. During recessions, for example, federal government spending can help drive the economy even if it means spending at a deficit.

Twenty-eight state legislatures already have approved measures calling for a convention to propose a federal balanced budget requirement, although they use a variety of terms that could raise legal questions about whether they all count toward the threshold.

Organizers at the nonprofit Balanced Budget Amendment Task Force have lined up sponsors in nine additional Republican-led legislatures — Arizona, Idaho, Kentucky, Minnesota, Montana, South Carolina, Virginia, Wisconsin and Wyoming — with the goal of reaching the two-thirds threshold in 2017.

But Republican control is no guarantee of success.

A Wyoming measure calling for a convention on a balanced budget amendment was shelved in 2015 after the state Senate altered it to make it contingent on assurances that Wyoming would not see a reduction in federal revenue.

Montana’s Republican-led House overwhelmingly defeated a resolution calling for a convention on a balanced budget amendment when it last met in 2015. Opponents expressed fears of a “runaway convention” during which delegates might propose all types of possible amendments.

Similar fears have thwarted past attempts at passing a balanced budget amendment. The movement peaked at 32 states when Missouri passed a resolution calling for a convention in 1983, then dipped to about half that as numerous states rescinded their resolutions. The tally began growing again after Republicans swept into control of many capitols in 2010.

The possibility of a convention dominated by delegates from a single party is “alarming,” said Carolyn Fiddler, a spokeswoman for the national Democratic Legislative Campaign Committee.

“There are no rules. They can just throw out the whole Constitution if they want to,” Fiddler said. “It’s the wildest of Wild West situations.”

Supporters of a balanced budget amendment hope to allay such fears by convening this coming summer in Nashville, Tennessee, to propose rules and procedures for a future convention on constitutional amendments. They contend a convention is unlikely to veer off into contentious issues such as abortion and gun rights because amendments ultimately will need bipartisan appeal to win ratification from 38 states.

The mere possibility of a state-initiated convention has been enough to prompt Congress to action in the past. With states just shy of the two-thirds mark in 1912, Congress instead wrote its own amendment requiring senators to be elected by a vote of the people rather than through state legislatures. The states then ratified the amendment.

But Congress has repeatedly fallen short of the two-thirds vote needed to refer a balanced budget amendment to the states. The last time both chambers tried was in 2011.

During the past three years, eight states have passed resolutions calling for a convention that would go beyond a balanced budget amendment to include other fiscal restraints, term limits for Congress and federal officials, and unspecified restrictions on federal power. Though still far from the two-thirds threshold, supporters of those causes believe the Republican rise to power could help their movement grow rapidly.

“With the election and things that have happened, it provides really a once-in-a-lifetime opportunity to restore critical structural checks in our constitutional system,” said Utah state Rep. Ken Ivory, a Republican attorney.

Ivory was elected in September as the presiding officer of a simulated convention of the states designed to demonstrate that the method of proposing constitutional amendments actually can work. Among those present at the event was law professor Randy Barnett, director of the Center for the Constitution at Georgetown University.

“Amending the Constitution is always a longshot, no matter how you go about it,” Barnett said. But if 34 states — including 33 Republican ones — call for such a convention, “it would be very difficult for the Congress to stop that.”

After four years, Wisconsin GOP forced to adopt air pollution standards

After four years of Republican defiance and a lawsuit, the state Department of Natural Resources is finally ready to adopt federal air pollution standards.

The U.S. Environmental Protection Agency published new limits on fine particulate matter in January 2013. Wisconsin law requires the DNR to adopt rules matching EPA standards to ensure state permits meet federal requirements but the Republican-controlled agency didn’t do it.

Environmental groups Clean Wisconsin and the Midwest Environmental Defense Center sued in 2014 to force the agency to comply.

The groups and the DNR quietly settled the lawsuit last year with an agreement calling for the DNR to get rules reflecting the federal standards into state code by March 31, 2017. Agency officials have now drafted the regulations and the DNR board is expected to adopt them at a Dec. 14 meeting and forward them to Gov. Scott Walker. If he signs off and no lawmakers object, the rules would likely go into effect in late March.

“We’re glad to see DNR finally adding these health-based air quality protections to help address the many respiratory illnesses like asthma, bronchitis and emphysema that many Wisconsin residents face,” said Amber Meyer-Smith, Clean Wisconsin’s government relations director. “It’s unfortunate that the DNR needs to be compelled to add these protections, but we’re glad they’re complying with the settlement timelines.”

DNR officials said at the time the lawsuit was filed that they were working on drafting the rules but it was slow-going because the rule-making process requires the DNR to analyze the standards’ economic impact. Agency spokesman Andrew Savagian said this week that Walker authorized the DNR to begin work on the rule in June 2015. He had no immediate comment on why work didn’t start until the settlement was reached.

Fine particulate matter is a mix of small particles and liquid droplets made up of acids, organic chemicals, metals, soil or dust particles often found near roads, dusty industries or in smoke from forest fires or power plants. The particles can pass through the throat and nose and enter the lungs, causing health problems, according to the EPA. The federal rules revised the annual standard for the amount of particulate matter allowable in the air from 15 micrograms per cubic meter to 12 micrograms per cubic meter.

DNR officials wrote in a Nov. 7 memo to Secretary Cathy Stepp that all areas of the state are currently within the new standards. They solicited information about what effect adopting the federal standards would have on businesses and particulate matter sources from more than 1,600 stationary sources in Wisconsin and a half-dozen business associations, including Wisconsin Manufacturers and Commerce, the state’s largest business group and a staunch Republican ally, and concluded the regulations would have little to no impact.

The 2015 settlement also required the DNR to adopt tighter restrictions the EPA set in 2010 for sulfur dioxide and nitrogen oxide. The DNR sent those rules to the Legislature in April 2015, shortly before the settlement was approved. They went into effect this August.

Savagian said that rule took so long because it was the first one the DNR’s air program implemented under the economic impact requirement.

Sulfur dioxide is a gas produced from fossil fuel combustion at power plants and other industrial facilities. The gas has been linked to a number of respiratory ailments, according to the EPA. Nitrogen oxide results from vehicle emissions and contributes to smog. It can cause airway inflammation and exacerbate problems for asthma suffers, the EPA has said.

It’s unclear how Donald Trump’s presidency and solid Republican control of Congress will affect the future of environmental regulations. Trump has vowed to get rid of all federal regulations, and the GOP already has shown a willingness to do the same.

 

Tough turf lessons: Assessing the GOP, Democratic ground games in Wisconsin

Seven months ago, as Wisconsin Republicans looked ahead to the upcoming presidential election, they focused on the state’s nonpartisan race for the state Supreme Court as a test run of sorts.

They figured out the most effective way to identify and register Republicans with a low likelihood of voting and persuade independents to get to the polls. They analyzed where and when to put resources into the field. They looked at how best to spend on mailings and phone calls.

“When we looked at the Supreme Court race, it was an opportunity for us to fine-tune our operation,” said Mark Morgan, state director for the Republican National Committee.

Conservative Justice Rebecca Bradley won by more than 95,000 votes in April.

In November, Republican Donald Trump eked out a much tighter victory — just over 27,000 votes — against Hillary Clinton.

Republicans, both nationally and in Wisconsin, say the difference-maker for Trump was the ground game, which they built for more than a decade, first with a series of recall elections in 2011 and 2012 and honed with the Supreme Court race.

The Wisconsin GOP has a reputation as one of the best state party operations because of it, said Luke Martz, a Republican consultant who worked in eight states.

“They run a very tight ship,” said Martz, who was Bradley’s campaign manager and noted that though that race benefited from the party’s work, there was no coordination. “They know what they’re doing. They know how to win races.”

While Republicans revel in victory, Democrats are trying to chart a path forward as they look ahead to 2018, when they’ll have to defend U.S. Sen. Tammy Baldwin’s seat and attempt to win back the governor’s office.

The state spokeswoman from Clinton talked up Democrats’ efforts despite November’s outcome.

“Democrats up and down the ticket were supported by a robust organizing operation and an incredible volunteer network across Wisconsin,” said Gillian Drummond, who also is a longtime Wisconsin Democratic operative. “From phone banks in small towns to knocking doors in cities and organizing events everywhere in between, the Democratic operation was second to none.”

The Republican ground game can’t be credited for all of their success.

Clinton underperformed President Barack Obama’s 2012 totals in Democratic counties. Key voters — young people, women, African-Americans and Hispanics — did not turn out in the numbers she needed to win.

Plus, Democrats had to raise money without any visits from Clinton or the Obamas — the first presidential election since 1972 when one of the major party candidates skipped the state.

Still, the Republican track record in Wisconsin since 2010 shows:

  • Scott Walker winning three elections, including a recall.
  • Johnson twice, the second in a presidential year.
  • Republicans flipping control of the Legislature.

They now have their largest Senate majority since 1971 and their biggest in the Assembly since 1957.

Republicans shifted their strategy in 2004 after party leaders realized they couldn’t win elections just through television advertising alone, GOP operative Mark Graul said. Republicans have invested in sophisticated data analytics to target the right voters at their homes, contacts that are more effective than phone calls, Graul said.

Republicans also instituted a “turf model” or “neighborhood team” approach that divided the state into 99 different regions.

“We didn’t leave any stone unturned,” said Juston Johnson, the national party’s regional political director for Wisconsin. “We went into communities that we haven’t necessarily been in before.”

The GOP state operation wasn’t daunted like others after the 2012 presidential election, when Obama carried Wisconsin by 7 points. It kept the infrastructure for the 2014 midterm races and increased permanent staffing and number of offices in 2015.

Ultimately, the program went from four offices and eight staffers to 40 offices with 162 paid staff and trained organizers, Morgan said.

Republicans made 4.7 million voter contacts this election cycle, including knocking on 1 million doors in the final five weeks of the race, Morgan said. In 2012, less than half that many doors were knocked on in the final five weeks.

House Speaker Paul Ryan, of Janesville, provided a critical boost by funneling $1 million from his re-election fund to the state party.

Conventional wisdom among political operatives is that a solid ground game will, at best, yield up to 3 points in an election.

Trump won Wisconsin by less than a point and Republican Sen. Ron Johnson won by 3.4 points.

“The early investments paid off,” Morgan said. “The infrastructure is second to none.”

Wisconsin faces nearly $700 million budget hole

Gov. Scott Walker says the state is on track to face a nearly $700 million budget shortfall by mid-2019.

The estimate from the state Department of Administration is the first to take into account spending requests made by state agencies for the next two years.

The $693 million gap is about 2 percent of what state agencies requested in funding and is far from the $2.2 billion gap that existed at this same point two years ago.

State law requires a balanced budget.

What comes next is the every-two-year push and pull between what state agencies say they need, what the governor proposed they get and what the Legislature ultimately passes.

The drama plays out in stages.

Walker will likely submit his budget, with scaled back funding from what agencies asked for, in February.

The Legislature, where the Republicans will have their largest majorities in decades, will then spend months rewriting the spending plan before passing it likely in June.

Walker can then move things back closer to what he wanted through his powerful veto authority.

Republican Senate Majority Leader Scott Fitzgerald declined to weigh in on the report’s findings. His spokeswoman, Myranda Tanck, said Fitzgerald would withhold comment until after he could review Walker’s budget proposal in a couple months.

Other legislative leaders did not immediately respond to a request for comment.

The state budget affects nearly every person’s life in the state, including how much gas costs, when hunting season begins and ends, eligibility for state-funded health insurance through Medicaid, and how much income, sales and property should be taxed.

Writing the budget could also be affected by changes coming out of Washington, with Republicans in full control of Congress working with Donald Trump as president.

Their promises to either repeal or replace large portions of the federal health care law and move toward different ways of sending money to the states for such things as Medicaid and highways could alter Wisconsin’s budget picture.

Walker and Republicans both in the state and nationally, have talked about moving toward block grant funding for the states that would give policy makers more flexibility but that Democrats and opponents fear could lead to less money going toward programs like Medicaid that help the poor and disadvantaged.

The state budget estimate for the next two years will be further refined in January when the nonpartisan Legislative Fiscal Bureau releases likely figures for state tax revenue in the next two years.

The next state budget will run from July 1 through June 30, 2019.

Wis. GOP builds biggest majorities in decades

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