Tag: Affordable Care Act

In 1960, the country was set to elect its first Catholic president, John F. Kennedy. Many conservative protestants in Southern states were wary of JFK’s faith and ties to the Vatican, questioning whether as president he would be able to make important national decisions independent of his faith and Vatican influence. In September of 1960, he gave an historic speech in Houston, Texas before a group of Protestant ministers, on the issue of his religion, declaring, “I am not the Catholic candidate for president. I am the Democratic Party candidate for president who also happens to be a Catholic. I do not speak for my Church on public matters – and the Church does not speak for me.”

Now, fifty-four years after that speech, there is a predominance of Catholics on the Supreme Court, mostly men and mostly very conservative. The five conservative male Catholics are voting in lock step to restrict the use of birth control, a necessary part of women’s health care, and income equality by siding with ant-union groups to limit union representation for some health care workers who are mostly low income women and minorities.

After Hobby Lobby

by Dahlia Lithwick, Slate

The Supreme Court term wrapped up nice and neat last week. Unless you are a woman.

For the first time in my memory as a reporter, there was a men’s term and a women’s term at the U.S. Supreme Court. The men’s term ended last Monday, with a pair of split decisions in Burwell v. Hobby Lobby and Harris v. Quinn, and a lot of mumbling on both sides of the political spectrum about the fact that-as Supreme Court terms go-this was a fairly uncontroversial one, marked by high degrees of agreement and consensus-seeking by the justices, and minimalist, incremental changes where there might have been tectonic shifts.

Not so, for women, who-almost a week later-are still reeling over the implications of the Hobby Lobby decision for contraceptive care in America; still parsing the emergency injunction granted in the Wheaton College case only three days after the Hobby Lobby ruling came down; still mulling whether the Hobby Lobby decision may prove a boon for women in the long run; and generally trying to understand how a term that was characterized as minimalist and undramatic by many male commenters, even liberal male commenters, represented a tectonic shift not just for America’s women, but for the three women who actually sit up there and do their jobs at the high court. [..]

It almost doesn’t warrant explaining yet again why the term was such a disaster for women’s rights and freedoms. One need look no further than the trifecta of the abortion buffer-zone case, McCullen v. Coakley; Burwell v. Hobby Lobby; and Harris v. Quinn, which determined that for purposes of the “agency fees” rule, home health care workers – 90 percent of whom are women v] and [minorities – are not really public employees, because the home is not really a workplace. And the fact that the female justices dissented from two of the above cases in the strongest terms is rather remarkable. But looking at the three cases together, it’s difficult not to notice something almost more remarkable: In the majority opinions in all three, there is scant attention paid to real women, their daily lives, or their interests, and great mountainous wads of attention paid elsewhere. It’s almost as if the court chose not to see women this term, or at least not real women, with real challenges, and opted instead to offer extra protections to the delicate women of their imaginary worlds. [..]

All this would be difficult enough, were it not for the fact that the five-justice majority at the court seems determined to offer all this help and chivalry in the face of the strenuous objections of their female colleagues who seem, at the close of this term, to have spent a good deal of energy howling into the wind that women need less delicate handling and more basic freedoms. The final irony is that the quality of “empathy”-the much maligned, squishy solicitude that is so often associated with female justices-is the quality that seemingly drove each of the decisions above. It wasn’t so much a clash of rigorous constitutional values that determined the outcomes in Harris, McCullen, and Hobby Lobby. It was simply a strong identification by the majority justices with the values that were arrayed in opposition to women’s freedoms and economic equality: the poor home-care worker, forced to support the speech of a union; the beleaguered sidewalk counselor denied the opportunity to counsel and persuade; the sympathetic religious employer, forced to pay for something his religion cannot tolerate. Nobody disputes that in each case those values are heartfelt and compelling. But the almost complete erasure of the values on the other side is a constitutional hat trick if ever there was one. It’s bad enough that the term ended so poorly for women. That it happened because of an abundance of empathy-the quality that allegedly makes us women bad judges and justices-is kind of the icing on the cake.

The Supreme Court Has a Favorite Religion, and That’s a Big Problem

by Charles Pierce, Esquire’s Politics Blog

Jesus H. Christ on a three-month bender, if they’d just let Al Smith use his peyote the way he believed his supreme being meant it to be used, we all might have been spared this trainwreck.

Back in the early 1990’s, Smith and another man were denied unemployment benefits by the state of Oregon because they had tested positive for the active ingredient in peyote, which has been a sacrament in various Native American religions since before bread and wine became sacramental in Christianity. Smith pursued his case all the way up to the Nine Wise Souls then sitting on the Most High Bench, who ruled against him. Not yet short-timing his day job, Justice Antonin Scalia who, of a Sunday, takes bread and wine instead of peyote as part of his own religious rituals, wrote the majority opinion in the case, [..]

Almost everyone from the religious right to the ACLU popped their corks over this and, in purported response, the Congress passed the Religious Freedom Restoration Act in 1993. (And yes, you are still entitled to ask, “Restoration? Where’s it been?”) Bill Clinton, just beginning to triangulate himself toward re-election, signed the thing. Since then, a gradual slippage regarding that act has been quietly underway. The RFRA is no longer about peyote. It has become a Trojan Horse, sliding the country toward a de facto kind of established religion, which today’s ruling in Burwell v. Hobby Lobby makes eminently clear. Religious freedom exists in the realm of medicine only to those religions that the Court finds acceptable-and, I would argue, only to those religions to which the members of the Court belong.  Much will be written, and rightly so, about the boneheaded social subtext of the following nut paragraph in the 5-4 decision read today by Justice Samuel Alito. It is so obviously discriminatory toward ladies and their ladyparts that no explanation seems necessary.

Charlie up dated that article because of objection by some about his Papist take on Justice Alito’s majority opinion:

UPDATE — If you’re thinking that I’m hitting the whole Papist thing too hard, look at these two passages from different documents:

The belief… implicates a difficult and im-portant question of religion and moral philosophy, namely, the circumstances under which it is immoral for a person to perform an act that is innocent in itself but that has the effect of enabling or facili-tating the commission of an immoral act by another.

And…

Neither is it valid to argue, as a justification for sexual intercourse which is deliberately contraceptive, that a lesser evil is to be preferred to a greater one, or that such intercourse would merge with procreative acts of past and future to form a single entity, and so be qualified by exactly the same moral goodness as these. Though it is true that sometimes it is lawful to tolerate a lesser moral evil in order to avoid a greater evil or in order to promote a greater good,” it is never lawful, even for the gravest reasons, to do evil that good may come of it.

The first is from Alito’s opinion today.

The second is a section of Humanae Vitae, the 1968 encyclical from Pope Paul VI that restated the Church’s opposition to artificial birth control and pretty much blew up the Vatican’s teaching authority among a great percentage of the Catholic laity in the United States. I would guess that the percentage in question does not include Samuel Alito.

This begs to question: is this Supreme Court out of Control?

Supreme Court’s out-of-control spiral: Ideologues rewriting their own laws

by David Dayen, Salon

It may be incremental, but make no mistake: This court is using absurd eccentricities to legislate from the bench

John Boehner wants to sue the president for pursuing executive authority without congressional input? He may want to file a copycat suit against the Supreme Court, who have executed plenty of extra-legislative rule making of their own.

On Monday, the court established multiple new distinctions in the law, inventing them largely to satisfy ideological whims. If any branch of government is engaging in de facto legislating and overstepping the bounds of authority, it’s the Roberts court.

As you probably know, the court ruled in the Hobby Lobby case that closely held corporations, where the top five shareholders control more than 50 percent of the company, must be given an accommodation for providing birth control in their employer-based insurance coverage, if they say it violates their religious beliefs. The decision, written by Justice Samuel Alito, explicitly argues companies like Hobby Lobby could be granted the same accommodation as churches and religious nonprofits, where the government effectively provides direct access to contraception coverage. (I didn’t know the court’s majority exhibited such [strident support for single-payer v] healthcare!)

But the ruling also makes a number of novel assumptions. First of all, Alito found that, for the purposes of the Religious Freedom Restoration Act of 1993, corporations are not just people, but people with religious beliefs, granting them the right to free exercise of that religion, which the contraception mandate “substantially burdens.” But Alito clearly worried about a slippery slope, where suddenly religious corporations would ignore all sorts of laws by invoking their conscience. So he drew a completely arbitrary line. [..]

This has become a familiar pattern for the Roberts court, using an initial ruling to indicate eventual overturning of precedent, and then employing a subsequent case to finish the job. It perhaps makes the court look more moderate and judicious, treading ground carefully to reach their desired end state. But since there’s no real distinction under the law between the initial “signal flare” ruling and the second, deeper one, it amounts to making up the rules as it suits the conservative majority, either for public relations purposes or to better carry out their agenda.

And that’s the real point. The Roberts court has a history, as shown in these recent cases, of basically legislating from the bench, of making idiosyncratic, agenda-driven choices about which parts of laws to uphold and which to strike down.

Linda Greenhouse, a New York Times columnist and Dahlia Lithwick spoke with Bill Moyers about the latest decisions>

The latest session of the US Supreme Court was especially contentious, with important decisions on the separation of church and state, organized labor, campaign finance reform, birth control and women’s health, among others, splitting the court along its 5-4 conservative-liberal divide.

On the other hand, nearly two-thirds of the court’s decisions this term were unanimous – the first time that’s happened in more than 60 years. But there’s more to that seeming unanimity than meets the eye: in some instances, conservative justices went along but expressed their wish that the court had gone even further to the right, and many believe that some of the decisions might simply be a preliminary step toward a more significant breaking of legal precedent in years to come.

One more word on this court and future vacancies, there are those on the so-called left who will say we must vote for Democrats because of, omg, “It’s the Supreme Court.” Yet, Democrats failed to filibuster their nominations and, while only four Democrats voted for Alito, 22 voted for Roberts, Scalia was unanimous (98 – 0) (pdf), as was Kennedy (97 – 0) and 10 voted for Clarence Thomas. Even if the Democrats manage to hold onto their Senate majority, so far the Republicans have successfully used the filibuster to stop the body from dong its job. Unless, the Democrats are willing to ditch filibuster of SCOTUS nominees, I don’t see any Democratic president getting a nominee on the court that is as left as Ginsburg or Breyer

On Tuesday, the Congressional Budget Office released it’s latest report on the Affordable Care Act’s impact on the economy. In the report it estimated that the work force would be reduced by 2.3 million workers by 2021 (pdf). Needless to say, the right wing media and Republicans seized on this as proof positive that Obamacare was a “job killer.”

Well not so fast, this is what the report said:

CBO estimates that the ACA will reduce the total number of hours worked, on net, by about 1.5 percent to 2.0 percent during the period from 2017 to 2024, almost entirely because workers will choose to supply less labor-given the new taxes and other incentives they will face and the financial benefits some will receive. Because the largest declines in labor supply will probably occur among lower-wage workers, the reduction in aggregate compensation (wages, salaries, and fringe benefits) and the impact on the overall economy will be proportionally smaller than the reduction in hours worked. [..]

The estimated reduction stems almost entirely from a net decline in the amount of labor that workers choose to supply, rather than from a net drop in businesses’ demand for labor.

In other words, this isn’t about jobs, it’s about whether or not workers will choose to work less in order to hold on to their eligibility for subsidized health care or Medicaid.

The Washington Post‘s fact checker, Glenn Kessler clarified:

First, this is not about jobs offered by employers. It’s about workers – and the choices they make.

The CBO’s estimate is mostly the result of an analysis of the impact of the law on the supply of labor. That means how many people choose to participate in the work force. In other words, the nonpartisan agency is examining whether the law increases or decreases incentives for people to work. [..]

Some might believe that the overall impact of the health law on employment is bad because it would be encouraging people – some 2.3 million – not to work. Indeed, the decline in the workforce participation rate has been of concern to economists, as the baby boom generation leaves the work force, and the health care law appears to exacerbate that trend.

Moreover, the argument could go, this would hurt the nation’s budget because 2.3 million fewer people will pay taxes on their earnings. That’s certainly an intellectually solid argument – though others might counter that universal health care is worth a reduction in overall employment – but it’s not at all the same as saying these jobs would be lost.

On the brighter side, before a House hearing on Wednesday the Director of the CBO Doug Elmendorf made this argument:

“The reason we don’t use the term ‘lost jobs’ is there is a critical difference between people who like to work and can’t find a job – or have a job that’s lost for reasons beyond their control – and people who choose not to work,” he explained. “If someone comes up to you and says, ‘The boss says I’m being laid off because we don’t have enough business to pay,’ any other person feels bad about that and we sympathize for them having lost their job. If someone says, ‘I decided to retire or stay home and spend more time with my family and spend more time doing my hobby,’ they don’t feel bad about it – they feel good about it. And we don’t sympathize. We say congratulations.”

Matt Iglesias at Mother Jones makes a very salient point about the impact on the job force:

Obamacare will reduce employment primarily because it’s a means-tested welfare program, and means-tested programs always reduce employment among the poor.

If, for example, earning $100 in additional income means a $25 reduction in Obamacare subsidies, you’re only getting $75 for your extra work. At the margins, some people will decide that’s not worth it, so they’ll forego working extra hours. That’s the substitution effect. In addition, low-income workers covered by Obamacare will have lower medical bills. This makes them less desperate for additional money, and might also cause them to forego working extra hours. That’s the income effect.

This is not something specific to Obamacare. It’s a shortcoming in all means-tested welfare programs. It’s basically Welfare 101, and in over half a century, no one has really figured out how to get around it. It’s something you just have to accept if you support safety net programs for the poor.

It’s worth noting, however, that health care is an exception to this rule. It doesn’t have to be means tested. If we simply had a rational national health care system, available to everyone regardless of income, then none of this would be an issue. There might still be a small income effect, but it would probably be barely noticeable. Since everyone would be fully covered no matter what, there would no high effective marginal tax rate on the poor and no reason not to work more hours. Someday we’ll get there.

Optimistically, people leaving jobs or working less may be an opportunity for someone else to take their place. On the other side it could increase costs for employers who would then reduce the number of people they hire. This is an educated guessing game that we would not be engaged in if there were single payer or a public option that leveled the playing field.

Also in Economic Populist: Orwell’s Catastrophic Gradualism and 0.1% Apologetic

Private health insurance is an entirely unnecessary economic institution, whether a health care system is organized around public, co-operative, sole proprietary, private partnership, corporate not-for-profit or corporate for-profit provision of the health care services themselves. Therefore, the profits associated with private health insurance are a legacy rent extracted by private health insurers, protected by the backward-looking nature of our economic institutions, and the least justifiable of the institutional overheads that we pile on top of the necessary costs of providing health insurance.

The purpose of an economic subsystem is to provide material support to the social system that contains it. We are social animals sharing a common humanity, and making the quality of access to medical care for different members of our society depend upon the size of income flows and wealth balances they can tap into betrays a fundamentally perverse set of priorities. Before our society allocates resources to production of luxuries for a wealthy few, or even the production of luxuries for an adequately well-off many, it should allocate resources to meet the Basic Needs of all.

The Affordable Care Act (ACA) quite deliberately attempted to solve as few of the institutional problems as feasible among the many that we in the US face in ensuring access to, provision of, and quality of our basic need of medical care, while still hoping to possibly delay or stave off the collapse of our system for financing health care services that was already in progress by 2009.

Therefore, even if the ACA succeeds in staving off that collapse, we are left with a health care system that needs further reform. And if the ACA merely succeeds in delaying that collapse, then that simply increases the urgency and necessity of solving additional institutional problems.

Thus the fundamental issue that the ACA faces. The fundamental issue is not the functioning of the web site for signing up for coverage. It is not the deliberate monkey-wrenching of our already thoroughly corrupted political system as a side-show to try to game the new system for maximum short-term profits (even at the risk of returning system of finance of health to its path of ongoing collapse). It is that even if the ACA “succeeds”, it succeeds in such in a reform with such limited ambitions that it inevitably requires much more to be done.

In a NYT‘s op-ed in New Year’s Day, Michael Moore called the ACA awful

I believe Obamacare’s rocky start – clueless planning, a lousy website, insurance companies raising rates, and the president’s telling people they could keep their coverage when, in fact, not all could – is a result of one fatal flaw: The Affordable Care Act is a pro-insurance-industry plan implemented by a president who knew in his heart that a single-payer, Medicare-for-all model was the true way to go. When right-wing critics “expose” the fact that President Obama endorsed a single-payer system before 2004, they’re actually telling the truth.

What we now call Obamacare was conceived at the Heritage Foundation, a conservative think tank, and birthed in Massachusetts by Mitt Romney, then the governor. The president took Romneycare, a program designed to keep the private insurance industry intact, and just improved some of its provisions. In effect, the president was simply trying to put lipstick on the dog in the carrier on top of Mitt Romney’s car. And we knew it.

Emergency Room visits have increased for those with insurance rather than decrease. This is probably due to the problem of finding a physician who will accept the patient’s insurance plan. What was needed was a mandate that physicians and hospitals accept all insurance plans.

Access to Health Care May Increase ER Visits, Study Suggests

   Supporters of President Obama’s health care law had predicted that expanding insurance coverage for the poor would reduce costly emergency room visits as people sought care from primary care doctors. But a rigorous new study conducted in Oregon has flipped that assumption on its head, finding that the newly insured actually went to the emergency room more often.

   The study, published in the journal Science, compared thousands of low-income people in the Portland area who were randomly selected in a 2008 lottery to get Medicaid coverage with people who entered the lottery but remained uninsured. Those who gained coverage made 40 percent more visits to the emergency room than their uninsured counterparts. The pattern was so strong that it held true across most demographic groups, times of day, and types of visits, including for conditions that were treatable in primary care settings.

   The finding casts doubt on the hope that expanded insurance coverage will help rein in rising emergency room costs just as more than two million people are gaining coverage under the Affordable Care Act.

   Instead, the study suggests that the surge in the numbers of insured people may put even greater pressure on emergency rooms and increase costs. Nearly 30 million uninsured Americans could gain coverage under the law, about half of them through Medicaid. The first policies took effect on Wednesday.

This will only push up the costs of health care and increase the costs for consumers and tax payers.

This video explains in less than 8 minutes why healthcare in this country is so expensive and still sucks.

Published on Aug 20, 2013

In which John discusses the complicated reasons why the United States spends so much more on health care than any other country in the world, and along the way reveals some surprising information, including that Americans spend more of their tax dollars on public health care than people in Canada, the UK, or Australia. Who’s at fault? Insurance companies? Drug companies? Malpractice lawyers? Hospitals? Or is it more complicated than a simple blame game? (Hint: It’s that one.)

For a much more thorough examination of health care expenses in America, I recommend this series at The Incidental Economist: http://theincidentaleconomist….

The Commonwealth Fund’s Study of Health Care Prices in the US: http://www.commonwealthfund.or…

Some of the stats in this video also come from this New York Times story: http://www.nytimes.com/2013/06…

This is the first part in what will be a periodic series on health care costs and reforms leading up to the introduction of the Affordable Care Act, aka Obamacare, in 2014.