Health Politics

The latest Health Wonk Review is up over at the InsureBlog, and features Henry Stern channeling Julie Andrews, pleased to find that even though the passage of the ACA led many wonks to move on to new issues, a few of his favorite... bloggers are still hard at work.

He's got... [cue the music]...

Econ from Shafrin and Mahar on Florida
"Smackdown" from Vineyard and ADA vs. OSHA
Elmore on privacy, tied up in HIT
These are a few of his favorite things.

California was quick out of the blocks and has gotten off to a very fast start in creating the state’s insurance exchange.  The legislation that establishes the California Health Benefit Exchange is actually two bills, a Senate bill that sets the government structure, and an Assembly bill that outlines the activities of the exchange and establishes the regulations that apply to plans offering products both inside and outside of the exchange.  The expectation is that these bills will be passed before the end of the legislative session which is to say by August 31^st. (We should be clear that this creates the basic structure for the exchange; it won't be fully up and running as a health insurance marketplace until 2014 when the federal health reform legislation goes into effect.)

Generally, the design of the exchange is informed both by California’s own experience with its small business insurance exchange, Pac Advantage, as well as by the experience of Massachusetts.  Jon Kingsdale, the former executive director of the Commonwealth Health Insurance Connector Authority in Massachusetts, was contracted to consult with the legislative staff and consultants who are crafting the bill.

Tony Cardona, a newly minted lawyer with an interest in health policy, is doing some work for us this summer. Here is the next in his series of posts about legal issues surrounding health reform.

One year ago, Julie Barnes, at the time the deputy director of the New America Health Policy Program, posted on this blog that according to a number of legal analysts, “if [the individual mandate] is drafted under the tax and spend powers, no problema.”

It wasn’t. The mandate was drafted under Congress’ power to “regulate activity that is commercial and economic in nature,” (ACA sec 1501(a)(1)) otherwise known as the commerce clause. Still, at the time the bill was signed into law, the government did not think there would be too much of a problema. (Legally, we mean. Obviously it’s been a political challenge all along).

I had an opinion piece in POLITICO looking at some of the conservative opposition to the individual mandate (an idea with Republican roots) in Missouri and beyond. And I note that for all the right wing rhetoric about the so-called "government takeover" of health care, the mandate is in fact the linchpin for preserving the private insurance market (albeit a market that will be regulated in new ways and forced to play by more consumer-friendly rules). If the fight reaches the Supreme Court:

It would be a bizarre outcome indeed if the justices ruled that the Constitution of a country founded on free-market principles did not allow a regulation necessary for the private market to function.

Tuesday, Missouri voters overwhelmingly passed a measure giving their state the power to ignore the federal law requiring people to have health coverage. These voters are clearly worried about government control of health care. But they’re playing a dangerous game that could spark a real government takeover.

The United States already has large, government-financed health care systems. Consider Medicare.

(This is another in a series of posts on legal aspects of health reform by Tony Cardona, a newly minted lawyer with an interest in health policy, is doing some work for us this summer.)

Law school books are filled with cases that you swear were completely contrived by a bored professor. The case of the kid who tried to redeem his Pepsi points for a fighter jet. The guy who rigged a shot-gun in his shack to shoot potential intruders. The infamous case of the man who receives hand surgery and ends up with a hairy hand.

Then there's the one about a farmer who was told he couldn't grow wheat for personal use because it impacted interstate commerce. (Just think about how that one would go over amid our current public debates about privacy and individual liberty.) The wheat case, Wickard v. Filburn, is a typical read for first year law students since it explores the constraints on Federal power to regulate private activities.

What does the federal court ruling by Judge Hudson allowing Virginia's challenge to health reform to go forward really indicate? New America Health Policy director Kavita Patel, MD, contributed to Politico’s Arena expert policy discussion yesterday. There are 21 state officials challenging health reform but the ruling by Virginia’s Federal District Court in the case brought by Virginia Attorney General Ken T. Cuccinelli is the first federal court decision regarding a state's standing to sue over the ACA. Her comments are below, and you can read more about the debate over the ruling's impact here:

The action in a federal court ruling yesterday by Judge Hudson certainly gives pause to anyone who dismissed the nationwide state and National Federation of Independent Business lawsuits as frivolous, but it certainly does not undermine the administration's significant health reform activities.

The National Association of Insurance Commissioners (NAIC) is working furiously to meet the self-imposed, end-of-summer (end of summer being rather loosely defined) deadline to release the medical-loss ratio definitions.  At “50 Ways to Implement Health Reform: State Challenges and Federal Assistance,” an event cosponsored by RWJF and the Alliance for Health Reform this week (summary here, webcast here), Brain Webb, manager of health policy and legislation for the NAIC, laid out the organization’s plans for establishing standard medical-loss ratios. The schedule allows data collection to begin by early 2011, facilitating a speedy and accurate dispersal of the first “rebate checks” to consumers in March 2012. Those rebates would be issued annually if insurers don't live within the MLR guidelines.

Connecticut could become the first state to offer its own public-plan option, even before most of national health reform unfolds.

The battle for the passage of health reform may have been won, but the battle over putting it into practice is just beginning. That conflict will unfold not only in Congress, on K Street, and in the courts but also in the states, which are charged with identifying and enrolling the millions of Americans without insurance coverage.