Category Archives: insurers

ACA Declared Unconstitutional: Now What?


In another example of how cruel and inhumane the radical Conservative/Libertarian Republican Party has been regarding health care, a Federal judge in Texas late Friday, struck down the Affordable Care Act as unconstitutional.

The judge, Reed O’Connor, appointed by George W. Bush, struck down the law on the grounds that its mandates requiring people to buy health insurance is unconstitutional and the rest of the law cannot stand without it, as reported yesterday in the New York Times.

According to the Times article, the ruling was over a lawsuit filed earlier this year by a group of Republican governors and state attorneys general. States led by Democrats promised to appeal the decision, which will not have immediate effect.

However, the Times reports, it will make its way to the Supreme Court, where the survival of the law and the health of millions of Americans will be in doubt.
Judge O’Connor said, the Times quoted, that the individual mandate requiring people to have health insurance “can no longer be sustained as an exercise of Congress’s tax power.” In addition, the judge said, “the individual mandate is unconstitutional” and that the remaining provisions of the ACA are invalid.

The main issue, pointed out in the Times piece, was whether the law’s mandate still compelled people to buy coverage after Congress zeroed out the penalty as part of the tax overhaul this year.

20 states, led by Texas, argued that with the penalty zeroed out, the mandate had become unconstitutional, and that the rest of the law could not be severed from it, the Times wrote.

The Justice Department under former Attorney General Sessions, declined not to defend just the individual mandate, but the pre-existing conditions provision as well.

A spokesman for California attorney general Xavier Becerra said that California, and other defendant states, would challenge the ruling with an appeal in the US Court of Appeals for the Fifth Circuit in New Orleans.

Becerra’s statement, reported by the Times, said the following, “ Today’s ruling is an assault on 133 million Americans with pre-existing conditions, on the 20 million Americans who rely on the ACA’s consumer protections for health care, on America’s faithful progress towards affordable health care for all Americans…The ACA has already survived more than 70 unsuccessful repeal attempts and withstood scrutiny in the Supreme Court.”

The chief plaintiff in the case, Texas attorney general Ken Paxton, applauded the decision, and was quoted in the Times in a statement, “Today’s ruling enjoining Obamacare halts an unconstitutional exertion of federal power over the American health care system.”

Meaning that the American “health care system” can only be a private insurance-based system that allows companies to profit off some people’s health, or lack thereof. He is upholding the “right” of insurance companies, drug companies, medical device manufacturers, and others to profit at our expense and to play with the lives of millions of Americans who will lose what coverage the ACA gave them.

This also means, that any attempt to enact Medicare for All/single payer health care will result, at some future date, to a judge or court striking it down as unconstitutional.

Simply put, Conservative jurisprudence believes that the Constitution enshrines free-market health care.

The Times added that Paxton also said, “Our lawsuit seeks to effectively repeal Obamacare, which will give President Trump and Congress the opportunity to replace the ‘failed’ [quotes added] social experiment with a plan that ensures Texans and all Americans will again have greater choice (to be ripped off and overcharged) about what health coverage they need and who will be their doctor.”

In other words, Mr. Paxton wants the American health care system to stay where it is, so long as companies can make money from it.

Here are a few takeaways from the rest of the Times’ article:

• If the judge’s decision stands, about 17 million Americans will lose their health insurance, according to the Urban Institute. This includes millions who gained coverage through Medicaid expansion, and millions more who receive subsidized private insurance through the ACA marketplaces.
• Insurers will also no longer have to cover young adults up to age 26 under their parents’ plans
• Annual and lifetime limits on coverage will again be permitted
• And there will be no cap on out-of-pocket costs
• Also gone will be the law’s popular protections for people with pre-existing conditions

This last takeaway was front and center of the Democrats midterm campaigns, and while most Republicans insisted that they did not want to withdraw those protections, the article reported that most were silent after the ruling.

Without those protections, insurers could deny coverage to such people or charge them more; they could also return to charging them based on age, gender or profession, according to the Times.

The Kaiser Family Foundation, the Times noted, estimated that 53 million adults from 18 to 64 — 27 percent of that population would be rejected for coverage under practices in effect before the ACA.

Larry Levitt, senior vice president of the Kaiser Family Foundation wrote on Twitter, “If this Texas decision on the ACA is upheld, it would throw the individual insurance market and the whole health care system into complete chaos…But the case still has a long legal road to travel before that’s an immediate threat,” the Times quoted.

Democrats attacked the decision as absurd. Incoming House Speaker Nancy Pelosi said that when the party took control of the House next month, it would “move swiftly to formally intervene in the appeals process to uphold the lifesaving protections for people with pre-existing conditions and reject Republicans’ effort to destroy the Affordable Care Act.”

Healthcare Dive.com, in reporting Friday about the decision, wrote that a decision had been waiting in the wings since September, when the Justice Department asked Judge O’Connor to wait until the individual market’s open enrollment period ended, which was also a convenient time for Republicans running in the midterms.

Healthcare Dive.com also stated that the decision would be appealed to the conservative Fifth Circuit, and possibly to the Supreme Court, where advocates worry that it will be struck down.
Providers such as the American Hospital Association (AHA) and American Medical Association (AMA) urged a stay until a higher court could take it up.

One state not a part of the defendants was Maryland, according to Healthcare Dive.com. Maryland’s Democratic Attorney General, Brian Frosh, brought its own case seeking a reaffirmation of the ACA’s constitutionality.

Attorney General Frosh argued that Maryland residents who became insured under the ACA would be harmed if the law was unconstitutional or eliminated. About 150,000 people in Maryland gained insurance through the ACA marketplace in 2018, and more than 300,000 are insured through the state’s expanded Medicaid program.

The Maryland case is still ongoing.

So now what?

In the short-term, nothing will change, as mentioned in the two articles above. However, in the long-term, there will be serious consequences, just as Larry Levitt said on Twitter Friday.

But more importantly than chaos in the insurance market and health care system, millions of Americans will once again be at the mercy of insurance companies, be denied coverage for pre-existing conditions, including pregnancy, cancer, and a whole host of illnesses, be denied life-saving drugs, or rejected for surgeries, etc.

And among those millions, many will die needlessly because of the greed of the insurance companies and the actions of a Cowboy judge.

What does this mean?

Allow me to put on a different hat here and offer an opinion as to what may transpire in the future, since none of us are clairvoyant. As someone who studied both American history and American government and politics, in my opinion, we will not see universal health care in this country unless and until, to use a medical metaphor, this Conservative/Economic Libertarian virus is eradicated from the American political system, or at least is brought under control.

I do not say this lightly, nor am I being flippant here. Let’s face facts. The Republican Party stands in the way of the adoption of rational, universal health care for all Americans because they are the defenders of a rapacious, greedy Capitalist health care system that demands that investors, shareholders, insurers, manufacturers, and service providers and consultants, be allowed to profit by the health and welfare of the American people.

However, as also reported in the New York Times on Sunday, the ACA could be hard to knock down, despite the judge’s ruling, according to legal scholars quoted in the article.

Yet as Ezra Klein writes in Vox.com, Republicans have refocused Democrats on building what they failed to build in 2010: a universal health care system simple enough and popular enough that it is safe from constant political and legal assault. And that means some version of Medicare-for-all. Democrats are promising swift action once they take over the House in a few weeks, so we wait and see how that will turn out.

But on the other hand, as I have pointed out in previous posts, both those penned by myself, and those that I reposted from other sources, the medical-industrial complex is pushing back hard against any move to alter this broken system.

Two recent posts, Healthcare Lobbying Group Double-Crossing Democratic Voters and Establishment looks to crush liberals on Medicare for All – POLITICO highlights the attempt by the health care industry to keep the status quo, or at least to convince Democratic politicians who might be opposed to full single payer health care, to offer alternatives that will allow the insurance companies to profit from providing coverage to only those who are not sick, which is called adverse selection.

There are some people in this country who argue that what we need is not less competition in health care, but more. However, this misses the point. Whether or not there is more or less competition is not the reason why our health care system is broken. The reason why it is broken is because there is competition in the first place. No other Western country has this problem, and they all have some form of universal, single payer health care.

So, the prognosis for the future of universal health care is cloudy, if not downright gloomy. Advocates for single payer, improved Medicare for All must take a sober hard look at reality and formulate a strategy to meet this new and regrettable challenge. And they must do so with a clear eye and mind on the realities of the political landscape, and not be lulled into thinking that just because polls indicate approval by voters, that enacting Medicare for All will be easy or accomplished quickly. We have enemies, and one of them is Reed O’Connor.

Additional Reading:

Judge Rules Obamacare unconstitutional, endangering coverage for 20 million
Obamacare ruling delivers new shock to health system

 

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Establishment looks to crush liberals on Medicare for All – POLITICO

FYI to all Progressives and Medicare for All supporters:

The coalition that fought Obamacare repeal has fragmented as the party tries to follow through on campaign promises.

Source: Establishment looks to crush liberals on Medicare for All – POLITICO

Injured Worker Arrested When Employer Could Not Cut WC Benefits

The Charlotte Observer today reported on the case of an injured worker who suffered a brain injury after a fall in 2003 at his employer’s workplace. And because they could not cut off his benefits, they had him arrested.

In case you find this incredible, here is the link to the article:

https://www.charlotteobserver.com/news/local/article217808590.html

Is this what it has come to today in Workers’ Comp? That insurance companies refuse to continue lifelong payments to injured workers because they believe he is faking his injuries, so they and his employer have him arrested?

This is more than harsh; this is despicable.

 

This election is about your pre-existing medical condition – Managed Care Matters

Fellow blogger, Joe Paduda, summed up what is at stake for millions of Americans, your humble blogger included, if the GOP holds onto the House and Senate after the Midterm election thirteen days from today.

At the bottom of Joe’s post is a link to a Blue Cross/Blue Shield website. Scroll down to the part labeled “Medical Condition Rejection List.” It covers every conceivable illness and condition that human beings may suffer from, and included on that list is peritoneal dialysis, which I am undergoing, and hemodialysis also.

If the Republicans get their way, the only people who will have health insurance are perfect specimens, and we all know that there is no such thing as a perfectly healthy human being. We are all born with, or have the potential to get, some form of illness or disease at some time in our lives. It’s in our genes.

Unless of course, you are Superman/Superwoman.

Here is Joe’s post:

Will you be able to afford health insurance, and will that insurance cover your pre-existing medical conditions? For most, that’s the biggest issue in the upcoming election. Congressional Republicans are planning to pass legislation that allows insurers to: a) stop … Continue reading This election is about your pre-existing medical condition

Source: This election is about your pre-existing medical condition – Managed Care Matters

GSK is paying docs again — and patients are the worse off

A shout out to Maria Todd for bringing this to my attention.

This would not be happening if we did what every other Western nation does, and give our citizens universal health care that does not line the pockets of multinational corporations, drug companies, medical device manufacturers, and Wall Street investors.

Health care should not be subject to the pursuit of profit.

One of the world’s largest drug makers, GSK promised it would no longer pay doctors to promote its medicines. Now it says doing so put it at a disadvantage.

Source: GSK is paying docs again — and patients are the worse off

Healthcare Lobbying Group Double-Crossing Democratic Voters

For nearly a year now, I have been advocating single payer health care ever since I was diagnosed with end-stage renal disease. BTW, I am doing fine, even if I have been rejected twice for access to transplant centers due to personal reasons I won’t go into here.

Today, I found an article on The Intercept.com that reported that several candidates for Congress and other offices in Hawaii and other states have secretly secured opposition to “Medicare for All” single payer healthcare, even though they have told their voters that they support it.

According to the article, the candidates in Hawaii’s 1st Congressional District, former state Sen. Donna Mercado Kim, Hawaii Lt. Gov. Doug Chin, and Honolulu City Council Member Ernest Martin are taking heat from opponents for talking to an industry-friendly group, the Healthcare Leadership Council (HLC).

The Healthcare Leadership Council seeks to advance the goals of the largest players in the private health care industry. These candidates are talking to the HLC even as public opinion is moving towards positions opposed by giant health care companies.

Kaniela Ing, a state lawmaker running for the seat on a democratic socialist platform stated that, “Democrats running in a primary election will say they support ‘Medicare for All,” but what do they say to lobbyists behind the scenes?”

In fact, the article reports, one leading candidate has campaigned on a pledge to crack down on over-priced pharmaceuticals and promote single payer, but told the consultant sent from the HLC that he would maintain drug industry friendly pricing policies and views Medicare for All with skepticism.

HLC spends over $5 million a year on industry advocacy and brings together chief executives of major health corporations, and represents an array of health industries — from insurers, hospitals, drugmakers, medical device manufacturers, pharmacies, health product distributers, and information technology companies.

HLC’s outreach in Hawaii began in January. The group told candidates, in an email obtained by The Intercept, that it was in the process of forming a coalition to “jointly develop policies, plans, and programs to achieve their vision of a 21st century system that makes affordable, high-quality care accessible to all Americans.”

This language obscures their national campaign to monitor and blunt the energy behind progressive policy reform. In an email to The Intercept, Michael Freeman, executive vice president of HLC said that they survey “congressional candidates every election cycle regarding their views on a wide range of healthcare issues.”

Former state Sen. Kim’s dossier profile said she is very pro-market, opposes any attempt at single payer, does not support price controls on pharmaceuticals and agrees that Medicare and Medicaid need to be managed by the private market.

It would seem that besides the opposition from the insurance companies and the pharmaceutical industry, single payer, Medicare for All, is under assault below the radar of most voters, if not most Democratic voters during the primaries.

Despite alleged strong support for bills such as the one Bernie Sanders introduced, lobbyists for the medical-industrial complex are fighting hard to defeat health care reform for all Americans, and no matter what the public attitude is, they will prevent at all costs, the transition to single payer.

HLC also keeps tabs on candidates who could be a threat to their agenda, such as Ing, stating that she vocally supports a single payer, public health care system.

Lobbyists have told executives in the health care industry to be vigilant about the threat of single payer.

“It would be a mistake for us to overlook the growing number of lawmakers who are supportive of measures to expand significantly government’s role in healthcare,” according to a report HLC published at the end of last year. The report went on to say that while these ideas do not have the political support to pass at the moment, the “momentum on the Democratic side of the aisle is undeniable,” They have dispatched teams of lobbyists to keep tabs on rising candidates.

So, even if you vote for a Democrat in November, chances are, that they will double-cross you when it comes to supporting Medicare for All. Which is wrong-headed on their part, especially the hospitals and pharmaceutical companies.

If more people are covered, and the government pays for their health care, hospitals will get more patients covered under the plan and thus more revenue, even if they charge lower prices than for private insurance, and drug companies will sell more drugs to these patients, even if the prices are brought under control.

What difference does it make if a patient gets their health are from a government plan like Medicare or Medicaid, as many already do, or if they get it through private insurance? The hospitals and drug companies still make money, just a smaller amount. The number of newly insured will offset any assumed loss of profit, thereby increasing profit, and just not from a select group of people who can afford health care on their own.

Advocates for single payer need to be vigilant also. Don’t buy a pig in a poke. Confront these and other candidates for office to see if they really believe in single payer, or are pigs with lipstick.

 

 

 

Update to Cayman Islands Hospital Delivers Lower Cost Care

Last week, The Economist published a short article on how the medical travel industry  thrives.

I had intended to write about the article, but there was not much there to go on, except for the part that mentioned Health City Cayman Islands. (See post, Cayman Islands Hospital Delivers Lower Cost Care).

As reported in The Economist, when the work first began on the 2,000-bed hospital, the $2 billion project was expected to attract more than 17,000 foreign patients annually, mostly from the US.

However, when the first wing opened in 2014, fewer than 1,000 overseas patients arrived in its first year, according to the International Medical Travel Journal.

One reason give for this was that the backers of the project based their projections of customer numbers on a flawed study, according to an investigation by a government public-accounts committee.

Fewer Americans came, the article said, partly because health care insurance companies were not interested in sending people overseas.

This is not unexpected, even if the backers themselves expected more patients to come from the US. American exceptionalism and the belief that the American health care system is the best in the world, is one reason for the reluctance of US insurers to send patients out of the country.

The other reason is that doing so would not bring in more profit from the ever-growing health care systems that hospitals are building as they purchase more and more practices, and add on more services like insurance that used to be separate from the provider community.

Until health care providers travel overseas to treat patients, as The Economist reports, the lack of patients at Health City Cayman Islands and elsewhere will continue. During the Olympics a few years ago, Dubai Health City advertised regularly during commercial breaks, Perhaps that is what Health City Cayman Islands should do.