Tag Archives: health care law

New Congress sees mandate to undo Obama’s agenda

Republicans’ grip on all levers of power stands as a mandate to the GOP-led Congress, which will move swiftly to try to undo eight years of outgoing President Barack Obama’s agenda.

With Republican President-elect Donald Trump weeks away from assuming office, GOP lawmakers plan to open the 115th Congress on Tuesday and immediately take steps to repeal Obama’s health care law. Beyond that, they’ll look at a tax overhaul, reversing Obama-era environmental regulations and other conservative priorities.

Republicans will face some obstacles. House Minority Leader Nancy Pelosi says Democrats “stand ready to fight vigorously” to protect health care and other priorities, and Republicans will have to compromise with Senate Democrats to move major legislation through that chamber.

A look at what the 115th Congress will be up to in 2017:

NEW MEMBERS

New members of the House and Senate will be sworn in on Tuesday, the first day of the new Congress.

In the Senate, five Democrats and two Republicans will be sworn in for the first time, joined by returning members who won re-election in 2016. After those members are sworn in, there will be 52 Republicans, 46 Democrats and two independents who caucus with the Democrats.

The House will have 52 new members — 27 Republicans and 25 Democrats. There will be 241 Republicans in the House and 194 Democrats.

CONFIRMING A NEW CABINET

Trump is sworn in on Jan. 20, and Republicans in the Senate will spend the first days and weeks of his presidency pushing to confirm his Cabinet picks. Democrats changed the rules and curbed the filibuster in 2013, making it easier for Republicans to move nominations. But even though they won’t be able to block Trump’s nominees, Democrats have pledged to fight many of them anyway, highlighting what they say is the hypocrisy of Trump’s populist message and his wealthy, corporate-favoring nominees for several posts.

REPEALING OBAMA’S HEALTH CARE LAW

The Senate plans to begin repealing Obama’s health care law on Tuesday, Congress’ very first day, with consideration of a procedural measure that will shield from Democratic filibusters legislation annulling much of that statute.

Lawmakers will then spend the next few months working on legislation canceling broad swaths of the law. Likely to go are its mandate that people buy health insurance or face IRS fines, and its expansion of Medicaid coverage to more lower-earning Americans. Some elements of the repeal likely wouldn’t go into effect for two to four years.

Republicans will then begin the more complicated task of building a new system. The GOP will have to craft new programs for the nation’s $3 trillion health care system and make sure insurance markets don’t collapse while the transition is under way.

TAX OVERHAUL

Senate Majority Leader Mitch McConnell, R-Ky., and Speaker Paul Ryan, R-Wis., want a massive overhaul of the tax system with the goal of simplifying a complicated tax code that rewards wealthy people with smart accountants as well as corporations that can easily shift profits and jobs overseas.

It would be the first major tax overhaul in 30 years. Trump has also advocated a tax overhaul, but with fewer details. He promises a tax cut for every income level, with more low-income families paying no income tax at all.

SUPREME COURT

Supreme Court Justice Antonin Scalia died 11 months ago, but the Senate still hasn’t considered a replacement. That’s because McConnell blocked consideration of Obama’s nominee, Judge Merrick Garland, saying the next president should make the pick. The strategy paid off, and the Republican Senate will consider whomever Trump nominates.

MEDICARE CHANGES

Ryan is the most powerful advocate in Washington for an overhaul of Medicare and a premium-support approach that would, over time, remake it into a voucher-like program that could force some seniors entering the program to buy health insurance on the open market instead of getting coverage through the traditional open-ended program.

But his ideas likely will run into a political reality. Trump said on the campaign trail that he wouldn’t cut the program, and Senate Republicans haven’t been as enthusiastic either.

Candidate Trump also initially promised not to cut Medicaid — the federal-state health insurance program for low-income and severely disabled people. During the campaign, Trump seemed to shift, backing “block grants” that limit federal funding.

SOCIAL SECURITY

Like Medicare, some House conservatives have said they want to overhaul Social Security and slow the program’s growth to curb spending. But Trump has said he doesn’t want to touch those programs, and Ryan told CBS’ “60 Minutes” in December that he has no plans to change Social Security.

REVERSING REGULATIONS

Republican leaders have complained throughout Obama’s presidency about burdensome regulations, a theme Trump used frequently during the campaign as well. GOP lawmakers now want to undo some of Obama’s regulations and executive orders using the Congressional Review Act, a rarely invoked procedure.

Many of the regulations they are targeting are environmental rules put in place by the Environmental Protection Agency, including the Clean Power Plan to cut carbon pollution from coal-fired power plants, a clean water rule that has drawn the ire of farmers and another rule imposed in December to protect nearby streams from coal-mining debris.

INFRASTRUCTURE

Trump made rebuilding the nation’s aging roads, bridges and airports a major part of his job-creation strategy in the presidential race. But those plans appear to have fizzled, somewhat, as GOP leaders have questioned the spending.

 

Opinion: Walker has rigged health insurance system to raise rates

A much larger number of Wisconsinites than previously believed are enrolled in substandard health plans that don’t meet the standards of the Affordable Care Act. In fact, almost as many people are enrolled in substandard “lemon” health plans in Wisconsin as in individual coverage through Healthcare.gov.

The state’s inadequate health insurance situation was revealed by J.P. Wieske, the deputy insurance commissioner for Gov. Scott Walker’s administration, in testimony before the Homeland Security Committee last week.

Wieske’s admission has major implications for the availability of affordable health care in Wisconsin. It provides evidence that the Walker administration is working to sabotage the health care law.

In the hearing Wieske testified (p. 6–7) that 203,000 Wisconsinites are covered by so-called “transitional plans,” the technical term for most plans not in compliance with the ACA. These are also often referred to as “grandmothered” plans. Currently 239,034 Wisconsin health consumers are enrolled in individual coverage on Healthcare.gov. The numbers show how much larger the ACA marketplaces in Wisconsin would be if transitional plans were prohibited.

Under the ACA, states were allowed to “grandmother” plans sold during the health care law’s implementation period, even when they did not meet the standards of the new law. The consumers in transitional plans tend to be healthier, because the insurance corporations were still permitted at the time to discriminate against people with health conditions. Wisconsin exercised the option to continue these plans, while Minnesota and many other states working to improve health insurance access banned them.

Transitional plans have two highly negative consequences for health consumers.

  • Substandard “lemon” plans increase prices in the ACA marketplace by skimming healthier people. These people were able to buy insurance before discrimination against people with health conditions was banned. This deprives healthier individuals from the ACA marketplace, leaving the remaining population sicker and costlier, and raising rates.
  • Substandard “lemon” plans might be cheaper, but they become dangerous for health consumers when they face a major injury or illness. The plans often have gaps in coverage or extremely high cost sharing.

There is strong evidence that allowing the health insurance industry to continue to sell transitional plans increases prices.

  • From the Rand Corporation: “Non-ACA-compliant plans … have a far more detrimental effect on the ACA-compliant market, raising premiums by as much as 10 percent and decreasing enrollment.”
  • From the American Academy of Actuaries: “In states with the transition policy, ACA-compliant plans exhibited less favorable experience, because lower-cost individuals were more likely to retain their prior policies.”
  • From Milliman Actuaries: “Integrating these underwritten members into the ACA pool is expected to improve the health status of the market as a whole, which could lower the relative cost of coverage on average.”

It is hard to escape the conclusion that the Walker Administration is deliberately trying to destabilize the Affordable Care Act by allowing insurance companies to skim healthier consumers. The impact of this policy is to rig the health care system against Wisconsin families who need access to quality affordable coverage.

The only party who benefits from the continuation of “lemon” health plans is the insurance industry, which is allowed to continue to profit by separating the healthy from people with health conditions.

— Robert Kraig and Kevin Kane, Citizen Action of Wisconisin

 

Supreme Court lineup fit for an election year

The Supreme Court’s lineup of new cases is fit for an election year.

Affirmative action, abortion and another look at the Obama health care law all are before the court, and they could well be joined by immigration, giving the justices a run of cases that reads like a campaign platform.

Also coming; disputes involving public-sector labor unions, the death penalty and the way electoral districts are drawn.

Decisions in these high-profile cases almost certainly will split the court along ideological lines, mirroring the country’s stark partisan split. What’s more, the most contentious issues won’t be resolved until late June, barely four months before the 2016 presidential election.

What started as a somewhat sleepy term – especially following major decisions last June on health care and same-sex marriage – has become much more interesting, says University of Pennsylvania law dean Theodore Ruger.

“This is a court that remains very assertive in its role in declaring what the law is,” Ruger said.

The accumulation of wrenching social issues and pointed policy disputes at the Supreme Court at this moment is mostly a matter of chance. A legal fight over the regulation of abortion clinics in Texas has been underway for two and a half years. President Barack Obama’s plan to shield from deportation millions of immigrants who are living in the country illegally was rolled out a year ago and almost immediately challenged in court. Faith-based groups that say they are forced to be complicit in providing objectionable birth control to women covered under their health plans have been challenging the Obama administration for more than three years.

It is still is possible the immigration dispute will not be heard until next fall, if at all.

Now that the cases are at the marble courthouse atop Capitol Hill, the justices’ decisions could feed campaign rhetoric that already has been heated on abortion and immigration, to name just two issues.

In June 2012, Chief Justice John Roberts provided the decisive vote that saved Obama’s health care overhaul in the midst of the president’s campaign for re-election.

A short time later, Republican candidate Mitt Romney proclaimed that as president he would do what the high court failed to do that June – get rid of the health care law. Obama won re-election, and the law survived.

Ruger said the chief justice wrote a nuanced opinion that appeared to show some sensitivity to the looming election.

“I think Roberts recognized this was going to be an issue in front of the voters,” Ruger said. The electorate ultimately would decide the health care law’s fate, he said.

Court decisions close to an election, especially when they produce big changes in the law, also can increase attention paid to those issues.

This is part of what Texas A&M University political scientist Joseph Ura called the court’s agenda-setting effect. Ura pointed to Brown v. Board of Education’s outlawing of racial segregation in public schools and Lawrence v. Texas’ ban on state anti-sodomy laws as examples of past decisions that altered “the existing arrangement of material or symbolic benefits in our political system.” Researchers found that those decisions “led to a large, sustained increase in the media’s attention” to those issues, Ura said.

Last term’s big rulings on health care and same-sex marriage already have prompted criticism of the court, and of Roberts and Justice Anthony Kennedy in particular, from several Republican presidential candidates. Sen. Ted Cruz of Texas, for example, has said that putting Roberts on the court was a mistake, even though Cruz endorsed his nomination in 2005.

The court’s 2010 decision in Citizens United that led to a flood of what critics call “dark money” in political campaigns remains controversial, and Democratic candidates have pledged to try to undo it.

The Roe v. Wade decision in 1973 that established a woman’s right to an abortion produced a backlash that eventually showed up in election returns, said Sara Benesh, a political scientist at the University of Wisconsin-Milwaukee. “A lot of scholars say (President Ronald) Reagan got elected because of Roe v. Wade. Pro-life forces really got him moving in his campaign,” Benesh said.

But there is little evidence that the court itself will become an issue in the campaign, except perhaps on the margins, she said.

The court and the justices are little known to the public. “It seems to me a long, drawn-out relationship between any decision the court might make and any decision an individual might make in the voting booth,” Benesh said.

Every four years, interest groups across the political spectrum try to make that connection for voters. Elections matter, they say, because the winner may get to choose justices who will serve for the next quarter century or longer.

Indeed, with four justices in their late 70s or early 80s, and the court so closely and fiercely divided, any appointment could dramatically change the court’s direction.

Back to U.S. Supreme Court: Justices ‘Obamacare’ subsidies

The Supreme Court has agreed to hear a new challenge to President Barack Obama’s health care law — a case that threatens subsidies that help millions of low- and middle-income people afford their health insurance premiums.

The justices said they will review a federal appeals court ruling that upheld IRS regulations that allow health-insurance tax credits under the Affordable Care Act for consumers in all 50 states. Opponents argue that most of the subsidies are illegal.

The long-running political and legal campaign to overturn or limit the 2010 health overhaul will be making its second appearance at the Supreme Court. The justices upheld the heart of the law in a 5-4 decision in 2012 in which Chief Justice John Roberts provided the decisive vote.

The case probably will be argued the first week in March, with a decision expected by late June.

White House press secretary Josh Earnest promised a vigorous defense before the high court.

“This lawsuit reflects just another partisan attempt to undermine the Affordable Care Act and to strip millions of American families of tax credits that Congress intended for them to have,” Earnest said.

In the appeal accepted late last week, opponents of the subsidies argue that the court should resolve the issue soon because it involves billions of dollars in public money.

“The need for a quick and final resolution of this question is undeniable. This ‘subsidies-for-everyone’ rule affects nearly every person across the country, health insurance policyholders, workers and employers, taxpayers, and state and local governments,” said Sam Kazman, general counsel of the Competitive Enterprise Institute, which is paying for the legal challenges to the health care law.

The health care law provides taxpayer-subsidized private health insurance for people who don’t have access to coverage on the job. More than 7 million people are currently enrolled and most are getting help, which is keyed to household income and the cost of a benchmark plan.

The issue at the Supreme Court is whether the wording of the law limits insurance tax credits only to consumers who live in states that have set up their own insurance markets, known as exchanges.

Only 16 states have set up their own exchanges, the Obama administration said in court papers.

In the other 34 states, including Wisconsin, more than 4.5 million people are receiving subsidies to pay their insurance premiums. And the aid is considerable, covering an average of 76 percent of the premiums.

Customers now pay an average of $82 on total monthly premiums averaging $346. The federal subsidy of $264 a month makes up the difference.

What made the court’s intervention surprising was the lack of disagreement among federal appeals courts that typically is a requirement for Supreme Court review. Justice Ruth Bader Ginsburg cited the absence of conflicting rulings when the justices rejected gay marriage appeals last month.

But at least four justices, needed to grant review, apparently agreed with the challengers that the issue is important enough to decide now.

Supporters of the health care law were flabbergasted and accused the court of veering into politics. The news came a week ahead of the second open enrollment season for subsidized private health insurance under the law.

“All of the general guidelines that the court traditionally uses in determining whether it should schedule an appeal are totally absent in this case,” said Ron Pollack, executive director of Families USA, an advocacy group that supported Obama’s health overhaul from its inception. Pollack called the court’s action “an unusual political act.”

The legal challenge to the subsidies is “the most serious existential threat” facing the Affordable Care Act, said Pollack.

When the court upheld the law in 2012, it still made a major change by ruling that the law’s Medicaid expansion for low-income people was optional for states. So far 27 states and the District of Columbia have accepted it. This week’s Republican election success makes it unlikely that the remaining 23 states will move any time soon.

The subsidies issue is being fought in several courts. In July, the Richmond, Virginia-based appeals court upheld Internal Revenue Service regulations that allow health-insurance tax credits under the law for consumers in all 50 states.

On that same July day, a panel of appellate judges in the District of Columbia, sided with the challengers in striking down the IRS regulations. The Washington court held that under the law, financial aid can be provided only in states that have set up their own exchanges.

In October, the entire Washington appeals court voted to rehear the case and threw out the panel’s ruling, eliminating the so-called circuit split. The appeals argument has been scheduled for Dec. 17, but that case now recedes in importance with the Supreme Court’s decision to step in.

The case is King v. Burwell, 14-114.

Hobby Lobby goes to court to challenge birth control mandate

In the most prominent challenge of its kind, Hobby Lobby Stores Inc. asked a federal appeals court on May 23 for an exemption from part of the federal health care law that requires it to offer employees health coverage that includes access to the morning-after pill.

The Oklahoma City-based arts-and-crafts chain argued that businesses – not just the currently exempted religious groups – should be allowed to seek exception from that section of the health law if it violates their religious beliefs.

The arguments centered on the Green family, founders of Hobby Lobby Stores Inc. and a sister company, Christian booksellers Mardel Inc. An eight-judge panel peppered both sides with questions about whether the contraceptives mandate is an undue burden on the Greens’ religious belief.

The Greens contend that emergency contraception is tantamount to abortion because it can prevent a fertilized egg from implanting in the womb. They also object to providing coverage for certain kinds of intrauterine devices.

Hobby Lobby’s lawyer argued that the Greens shouldn’t face fines for not complying with mandatory contraceptive coverage simply because their business makes a profit. The stores are a “profit-making company, yes, but also a ministry,” Kyle Duncan argued.

Duncan cited the Citizens United campaign-finance decision that said corporations have constitutional protections.

“We don’t say, well, a corporation can’t exercise a right because it’s in corporate form,” Duncan said.

“Is religion the kind of right can only be exercised by a natural person? Well, the question nearly answers itself. … It’s not a purely personal right.”

Hobby Lobby is one of more than 30 businesses in multiple states that are challenging the contraception mandate. Hobby Lobby is the most prominent company making the claim.

A lawyer for the U.S. Department of Justice argued that allowing for-profit corporations to exempt themselves from requirements that violate their religious beliefs would be in effect allowing the business to impose its religious beliefs on employees.

“If you make an exemption for the employer, it comes at the expense of the employee,” said Alisa Klein, who argued the government’s case in a similar contraceptives mandate appeal heard Wednesday in the 7th Circuit Court of Appeals in Chicago.

Klein talked about an imaginary Hobby Lobby employee who is told by her doctor she needs a type of intrauterine contraceptive that she is entitled to having covered under the new health care law. But because of her employers’ religion, “the next sentence would be, unfortunately you have to pay $500 to $900,” Klein argued.

She also compared the Hobby Lobby claim to arguments from pacifists that they shouldn’t owe taxes.

“This is much more like a taxpayer saying, `I don’t want to pay into the general treasury because I can identify a subset of government spending that violates my religious belief,'” Klein said.

The 10th Circuit in Denver opted to hear the case before eight active judges, not the typical three-judge panel, indicating the case’s importance.

Hobby Lobby calls itself a “biblically founded business” and is closed on Sundays. Founded in 1972, the company now operates more than 500 stores in 41 states and employs more than 13,000 full-time employees who are eligible for health insurance.

The 10th Circuit judges gave no indication when they’d make a decision in the Hobby Lobby case.