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We were told that once health care reform passed we would get to find out what's in it. From the AP:

President Barack Obama's health care overhaul law is getting a mixed verdict in the first comprehensive look by neutral experts: More Americans will be covered, but costs are also going up. Economic experts at the Health and Human Services Department concluded in a report issued Thursday that the health care remake will achieve Obama's aim of expanding health insurance — adding 34 million to the coverage rolls. But the analysis also found that the law falls short of the president's twin goal of controlling runaway costs, raising projected spending by about 1 percent over 10 years. That increase could get bigger, since Medicare cuts in the law may be unrealistic and unsustainable, the report warned.

In particular, concerns about Medicare could become a major political liability in the midterm elections. The report projected that Medicare cuts could drive about 15 percent of hospitals and other institutional providers into the red, "possibly jeopardizing access" to care for seniors.

…At the outset of the health care debate last year, Obama held out the hope that by bending the cost curve down, the U.S. could cover all its citizens for about what the nation would spend absent any changes. The report found that the president's law missed the mark, although not by much. The overhaul will increase national health care spending by $311 billion from 2010-2019, or nine-tenths of 1 percent. To put that in perspective, total health care spending during the decade is estimated to surpass $35 trillion. Administration officials argue the increase is a bargain price for guaranteeing coverage to 95 percent of Americans.

It should be remembered that the cost curve before health care reform was acknowledged by all to be unsustainable. No reduction and a slight increase, not much of a bargain. And then there is this:

In another flashing yellow light, the report warned that a new voluntary long-term care insurance program created under the law faces "a very serious risk" of insolvency.

Insolvent at the point of creation. We are indeed finding out what's in it.

Alaska is the latest state to sue the federal government over the constitutionality of health care reform, bringing the total number of challenges to 21 (20 have joined the Florida lawsuit, while Virginia has filed its own challenge). Alaska Governor Sean Parnell (R) — who is currently filling in for Sarah Palin but plans to run for a full term in this year — appeared on Fox News’ Greta Van Susteren last night and explained that he was joining the suit to prevent the federal government from ordering Alaskans to buy gym memberships and vehicles from General Motors:

PARNELL: The question really is, should we allow the federal government to require citizens to engage in commerce? You know, your previous people on the show were speaking to that because Congress could now conceivably require all Americans to buy federally approved gym memberships in order to lower obesity and blood pressure rate. Or the attorney general’s memorandum, you know, speculated, you know, they could now order us to buy GM cars under the threat of a tax surcharge so the federal government can better manage its stake in GM. It’s just…

Without mentioning that the Supreme Court has long held that the federal government has the right to regulate commerce or explaining how the lawsuit fits into the current state of law, Parnell argued that the effort is more about liberty, than health care. “I began to realize that we got to stop making this about the health care debate and start making it about our liberty. If those folks who have been on the front lines of — fighting for civil liberties, you know, people to the left of us for years and years, understood that this is about liberty, not about health care, it’s about being mandated to make a choice on a commodity — I think people would take a different view of things,” he told Van Susteren.

I suspect that many Alaskans will still think it’s “about health care.” Alaska is one of the states with the most expensive health insurance in the country, which is the main reason why 19.4% of the residents are without coverage. Chronic health issues such as obesity and prevalence of smokers are relatively high and health care costs have risen faster than the national average. Although Alaska has a fairly robust public health infrastructure — thanks to federal aid — the state does not impose rate restrictions or other regulations on the private health insurance market and a relatively small percentage of employers offer health coverage.

Sen. Mark Begich (D-AK) blasted the governor for ignoring Alaska’s health crisis and spending “countless hours and hundreds of thousands of dollars” on the frivolous lawsuit.” “That level of state dollars and resources could be better spent keeping our economy healthy, creating jobs for Alaskans and protecting public safety,” he said.

On a related note, Oklahoma may also soon join Alaska in challenging the health law. Leaders of the Oklahoma House and Senate said Tuesday “they plan to sue the U.S. Congress, president and U.S. Secretary of Health and Human Services to prevent provisions of the act President Obama signed into law last month from taking effect.” “A resolution authorizing the legislative leaders to file the lawsuit and allowing Oklahoma residents to opt out of mandated health insurance is heading toward final passage” and the state’s attorney general, who has initially refused to join the case, “said he would join the lawsuit if required by legislative action.”

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Reaper
#11.
April 18th, 2010, at 9:38 AM.

Its is sleight of hand. The politicians took the approach that if you have to have health insurance like automotive and property insurance then the prices and amounts of bills and payouts will go down. Automotive went down cause it was like an equal share of the money Geico pays Safeway and etc etc. Where as in a hospital it is people with insurance verses the prices of the hospital. Medical / Health Care will always be a business. People saw the potential for the services and the constant need for the equipment as well as the services and the skills. It is simple supply verses demand. The company can charge $5 for a bandage wrap you can buy for $3 and the hospital charges you $12-$15 for teh same bandage to make up on costs of people not paying their own bills. Also the hospital has a mark up on services to cover the doctors salary who wants to pay off his school loans and live in a big house cause everyone associates doctors with money money money. Also people have gotten lazy and money thirsty so they go to hospitals and sue doctors every chance they get so now the hospitals have to cover the high insurance rates of mal practice. States that have put a high cap limit on law suits have seen drastic cut in cases of mal practice.

Congress may be fined tens of millions of dollars a year under its own health-care law, in part because the bill dumps members of Congress and their staffs from their current health-care plans.

But no one really knows for sure what the bill does, not even the experts. For instance, exactly who qualifies as an “employer” — and therefore is subject to fines up to $3,000 per employee — is undefined in the bill.

If Congress were subject to a $3,000 fine for each of its employees, it would need to shell out approximately $50 million each year to Uncle Sam. Congress’s research arm, the Congressional Research Service (CRS), informally confirmed the possibility to Republican aides.

Kathleen Sebelius, President Obama’s top health-care cabinet official, will be responsible for establishing most of the details of how the law is implemented. Many Republicans who have raised the issue of Congress’s fining itself believe Sebelius likely will exempt Congress with a regulation narrowly defining “employer,” for instance.

Still, the possibility of the fines, and the uncertainty surrounding them, are drawing heckles from the health-care law’s critics.

“That’s the irony — here we may be the first major employer in the country to be fined for not providing proper health insurance for our employees,” Rep. Dan Lungren, California Republican, told The Daily Caller while laughing. “Isn’t that contrary to the very premise of the bill?”

State and local governments may be on the hook for the fines, but unlike for members of Congress and their staffs, the health-care bill doesn’t specifically dump them from their health-care plans.

Before Congress incurs any fines, a complex series of events would be required to happen under the law. Generally speaking, an lower-tier aide — one not making a six-figure salary like some 2,000 House employees — would have to apply for government subsidies. The way the law works is that employers incur a $2,000 or $3,000 fine for each employee, depending on the circumstances, if only one of their employees obtains the subsidies.

So one lowly staff assistant could think he’s just getting some health-care help, while actually triggering a $50 million annual fine for Congress.

On the issue of the fines, CRS confirmed to Republican aides that the bill does not specify whether Congress would be considered an “employer” under the bill, thus triggering the coverage responsibilities and potential fines.

Previously, CRS explained why it’s “unclear” whether members of Congress and their staff will be able to keep their current health-care plans in an 8,100-word memo.

In that case, CRS argues that under standard lawyerly methods for reading laws, Congress should have been dumped from its current health-care coverage already. Nothing’s changed, though. The CRS memo notes that the law does not designate a government authority to resolve uncertainties, such as whether Congress is on the hook for $50 million a year.

The uncertainties surrounding the health-care law for just Congress’s health-care coverage are driving questions about how the rest of America will fare when its provisions kick into turbo in coming years.

“This is just terribly written legislation,” Lungren said, attributing many of the “drafting errors” and such to the unorthodox process by which the law was passed. “I doubt that when the senators voted on the bill they thought that was going to be the completed project. They needed to get their number of votes and they were going to do it whatever way they could and then anticipated a conference that somehow would have worked out the differences between the House and the Senate version. And because we had so few votes in both the House and the Senate, they did this other thing.”

That “other thing” was passing the Senate bill into law and a “fixes” bill hamstrung by the limitations of the budget reconciliation process which only requires a majority, not super-majority, vote in the Senate.

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Is Romney Preparing To Support Health Care Reform In The General Election?

On Sunday, the New York Times’ Kevin Sack reported on the difficulty Mitt Romney faces in convincing conservative voters that the new health care reform law is substantially different from the reform he signed in Massachusetts. “As he promotes himself as a problem-solving pragmatist, Mr. Romney can justifiably point to the landmark universal coverage law in Massachusetts that he, as governor, proposed in 2006,” Sack writes. “But as he appeals to conservative activists and Republican primary voters, he is trying to draw nuanced distinctions between his Massachusetts law and the federal legislation that shares many of its fundamental elements, including a requirement that people have insurance.”

Currently, Romney is denying that Massachusetts served as a template for national health reform reform, but Sack’s article suggests that the former Governor may be prepared to change his position if he wins the Republican Presidential nomination in 2012:

“I keep on scratching my head,” Mr. Obama said at a fund-raising reception in Boston. “I say, ‘Boy, this Massachusetts thing, who designed that?’ ”

In response, Mr. Romney is reminding audiences that Mr. Obama has cast the Republicans as the “party of no,” devoid of ideas. “And yet,” Mr. Romney said in Bedford, “he’s saying that I was the guy that came up with the idea for what he did. He can’t have it both ways.”

He added, “If ever again somewhere down the road I would be debating him, I would be happy to take credit for his accomplishment.”

Taking credit for ObamaCare shouldn’t be too difficult. Romney is already coming around to supporting key portions of the new health care law. On Monday, Romney appeared on Fox News Business and made the case for the individual mandate and subsidizing insurance to individuals who can’t afford to buy their own coverage. “Everybody in America today has health care. If they get sick, even without insurance, they get free care, paid for by government. We said no more of that. No more free riders. We want people taking personal responsibility for getting health insurance if they can afford it,” he said.

“We said, no, no. If you can afford it you have to buy insurance on your own. Half the people can afford it, bought insurance on their own. No more government subsidy for them. Others we had sliding scale based on income.” Watch it:

Last week, Romney added even more nuance to his position, telling the New Hampshire Union Leader that it was unconstitutional for the federal government to require everyone to purchase insurance coverage. “I think it’s unconstitutional on the 10th Amendment front,” he said.

The Maternal Health Task Force is looking to those working in maternal health for their comments on the recent findings published in the Lancet that suggest a dramatic reduction in global maternal mortality.

Lisa Russell is a  Film maker and a member of the Maternal Health Task Force Editorial Committee.

Lisa shares her thoughts on the new paper published in the Lancet–or as she calls it, the maternal health “shake up”:

I think what is most interesting in light of the recent findings on new maternal mortality estimates, is the impact this will have on maternal health advocacy messaging.

For so long, we’ve embraced statistics that illustrate the severity of maternal mortality. We all know the staples: “every minute a woman dies of complications due to pregnancy and childbirth” or “every year 500,000 women die in childbirth.” We see films and stories of women in our advocacy materials who are victimized and we learn very little about their lives outside their loss and/or injury.

I am a film maker and when I film in Africa, I am often asked, “Why is it when filmmakers come to Africa, they always want to film the bad parts of Africa?” And my friends in New York ask why I always choose to make “sad face” documentaries. Often, these are the types of projects that organizations working to improve global health are looking and asking for—and with my background in public health, they are also the sort of film I am qualified to make.

We have become complacent with our messaging because our statistics and stories are powerful and effective (at least we think they are)—and they pull at heart strings. However, I think with the recent findings and subsequent change in projections, that we as a community will be forced to reframe our issue and hence our messaging and I think that may ultimately benefit, not only the maternal health community, but the global health world in general. I have believed for some time that global health advocacy is in need of revision or evolution – if anything, to not burn out audiences who are bombarded by stories of poverty and ill-health. Messaging, fundraising and awareness building can still be effective when we show progress, not just problems; when we give attention and a spotlight to individuals or organizations ( both local and global) who are doing it right—and making significant improvements in the health of communities.

I would love to get the call to produce a film about how a certain healthcare worker, with improved medical training, helped save the lives of XY women in her village. I would start my film with the number of women’s lives saved, not lost. I would flip the power dynamic; I would not portray communities as powerless—instead I would ask questions about how the West and world leaders might better support those unsung heroes who are working—and succeeding—at saving lives.

I think this maternal health “shake up” is an opportunity to tell new stories – success stories – of what is working.  Stories that the world–and my African and New York critics–will welcome!

For more from Lisa, take a look at her latest post on the MHTF Blog, A Look Behind the Scenes of Lisa Russell’s Film on Obstetric Fistula.

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