Monday, July 16, 2012

Affordable Care Act Update

  1. A LONGER VIEW OF THE HEALTH CARE COURT OPINION
  2. HOUSE PASSES 'REPEAL OF OBAMACARE ACT'
  3. DASCHLE: DEFUNDING IS BIGGEST THREAT
  4. COST OF PRESIDENT'S HEALTH LAW RISES WITH EACH NEW ESTIMATE
  5. REACTION IN THE MEDICAL COMMUNITY
  6. CONSCIENCE RIGHTS (BACKGROUND)
  7. HHS MANDATE LAWSUITS
  8. RELIGIOUS FREEDOM TAX REPEAL ACT
  9. REACTION IN THE STATES
  10. EFFECTS ON PREVIOUS HEALTH CARE POLICIES
  11. SIDE EFFECTS OF THE HEALTH CARE LAW

1. A LONGER VIEW OF THE HEALTH CARE COURT OPINION

Rep. McClintock explained on the floor of the House, "There is a second even more chilling difference between a penalty and a tax. Under our Constitution, no penalty can be assessed without due process. You cannot be punished until you have had your day in court. But to challenge a tax, you must first pay that tax before you can seek redress through the court. You are punished first and then tried." (Congressional Record)

Finding silver linings in the ruling about the health care law is like finding silver linings in the health care law itself: it's fundamentally unhealthy for America in the long term.

Thomas Sowell asked, "How far do you bend over backwards to avoid the obvious, that ObamaCare was an unprecedented extension of federal power over the lives of 300 million Americans today and of generations yet unborn?" (Townhall.com)

That "generations yet unborn" part that is especially noteworthy here.

"This decision, if not reversed, will result in the greatest expansion of abortion since Roe, and a dark night of the soul from which our nation may never emerge." (FRC)

Father, we pray for our nation. We lift her up before you this day. We ask you to teach us what it means to humble ourselves. We pray for our churches. We ask for humility in our teachers and those taught. We ask for people to read your Word and understand how we should apply all of our lives to it, from the most private aspects to the most public aspects.

"David arose from the ground, washed and anointed himself, and changed his clothes; and he went into the house of the LORD and worshiped." (2 Samuel 12:20)


2. HOUSE PASSES 'REPEAL OF OBAMACARE ACT'

The House voted again Wednesday to repeal President Obama’s healthcare law, a largely symbolic gesture that gave Republicans some revenge against the Supreme Court ruling that declared the law constitutional.

Republicans also see it as a way to motivate their base this fall as they fight to keep control of the lower chamber, win the Senate and take the White House.

Members approved the repeal legislation on a 244-185 vote, after five hours of debate that stretched over two days. (Healthwatch)

Senate Minority Leader Mitch McConnell (R-Ky.) said Tuesday he wants the Senate to vote again "in the near future" on repealing President Obama's healthcare law.

McConnell had held off on forcing a repeal vote while he waited for the Supreme Court to rule on the healthcare law. Now that the court has upheld it, he said the Senate should follow the House's lead and hold another symbolic vote on repeal. (Healthwatch)

Legislation to repeal Obamacare under consideration in the House makes clear in two significant findings the massive health care law’s threat to religious liberty, conscience rights, and the protection of human life.

To protect religious liberty specifically and individual freedom generally, Obamacare must be repealed. Centralized health care policy that defines what individuals must buy, what employers must cover, and what insurers must offer puts the moral compass in the hands of bureaucrats and will continue to trample on conscience as implementation continues. (Heritage Foundation)

Father, we ask for truth in the headlines, the soundbytes and the tweets. May the full truth about this health care law be known. May no agenda contained in this law be hidden. May your people speak freely about what is happening in America.

"The Lord gave the word; Great was the company of those who proclaimed it." (Psalm 68:11)


3. DASCHLE: DEFUNDING IS BIGGEST THREAT

Even if Republicans can't repeal President Obama's healthcare law, they could do significant damage by cutting off its funding, former Senate Majority Leader Tom Daschle (D-S.D.) said Wednesday.

Dashle — who was Obama’s first pick to lead the Health and Human Services Department and help shepherd healthcare reform through Congress — said the Supreme Court’s healthcare decision provided certainty to states and business interests, who can now move forward relatively sure that healthcare reform will remain the law of the land. (Healthwatch)

Conservatives in the House are pushing GOP leaders to continue the campaign against President Obama's healthcare law even after Wednesday's vote to repeal the law.

Defunding poses a serious challenge to the Affordable Care Act. Former Sen. Tom Daschle (D-S.D.) said Wednesday that it's one of the most potent weapons Republicans would have against the law if they win the White House or a majority in the Senate.

Republicans pledged to defund the health law after winning the House majority in 2010, but those efforts have produced only relatively minor cuts. (Healthwatch)

Previously reported in April:
The Obama administration is quietly diverting roughly $500 million to the IRS to help implement the president’s healthcare law.

The money is only part of the IRS’s total implementation spending, and it is being provided outside the normal appropriations process. The tax agency is responsible for several key provisions of the new law, including the unpopular individual mandate. (Healthwatch)

Father, we ask you to fully cut off all funding for the health care law. May there be no funds to implement this law. May the rule of law stand. May no funds from any source be used at any level of government to implement this health care law anywhere.

"And seeing a fig tree by the road, He came to it and found nothing on it but leaves, and said to it, 'Let no fruit grow on you ever again.' Immediately the fig tree withered away. And when the disciples saw it, they marveled, saying, 'How did the fig tree wither away so soon?' So Jesus answered and said to them, 'Assuredly, I say to you, if you have faith and do not doubt, you will not only do what was done to the fig tree, but also if you say to this mountain, "Be removed and be cast into the sea," it will be done. And whatever things you ask in prayer, believing, you will receive.'" (Matthew 21:18-22)


4. COST OF PRESIDENT'S HEALTH LAW RISES WITH EACH NEW ESTIMATE

The Republican side of the Senate Budget Committee released a chart showing how the cost of the Affordable Care Act is consistently rising.



This is a function of limits Congress has placed on how the Congressional Budget Office estimates the cost of pending legislation. By law, CBO must look at exactly the next 10 years of the law at the time it is doing the calculations, no matter when various provisions in the law are scheduled to go into effect.

Knowing how this process works, legislators and their staff front load the more revenue-positive provisions to take effect early in the first decade, and the less revenue-positive provisions to take effect later in the law.

That's exactly how the Affordable Care Act was written, and that is exactly why we've seen successive increases in the annual estimates from CBO of the cost of this law.

Incidentally, as Rep. Fleming, MD, noted on the House floor, at the time of enactment, CGO predicted Medicare to be "a program that would be maybe $3 billion annually would maybe top out at $12 billion. Of course we know now that it's in the hundreds of billions of dollars many times over what it was initially promised to be." Our challenge in 2012 is not new.

For the 2010 health care law, current linear extrapolations of the obviously upward trend (meaning add $0.3 trillion each year) put the 2012 estimate for FY2014-2023 to be $2.6 trillion, as the chart shows. 2014 is when many of the more significant components of the law go into effect. The law does not go fully into effect until near the end of its first decade.

All this is to say nothing yet of the market effect of the law on what is left of the health care marketplace which is already driving up costs. The astute reader will remember the promises and claims of the law to reduce costs.

Before the House voted on the repeal last week, it was noted the vote would be happening before the CBO could provide an official 10-year cost estimate of the repeal.

This estimate will be helpful for two reasons.

First, it will show a change from the previous estimate. Healthwatch said, "The delay could deny Democrats a useful talking point: When CBO scored House Republicans' first bill to repeal the Affordable Care Act, it estimated that repeal would probably increase the federal deficit by roughly $145 billion over 10 years." Or it could start showing, as it will in a year or two if not already, that it will stop the deficit-increasing effect of the health care law.

Second, an estimate of the repeal will be very straight-forward because the repeal is very straight-forward. That is, there are no stages over 10 years for the repeal to take effect. It simply wipes out the law all at once.

Healthwatch reported CBO expects a final score the week of July 23.

Father, we ask for clear voices to explain and for clear understanding among the nation at large of exactly how Washington has been working. We ask that both sides would take a step back, be honest with themselves and be honest with the American people about what exactly they are doing and where we are headed. We ask for a clear message this year and in the years to come of the effect repealing this law would have on our dire fiscal situation. We ask for your enduring mercy to turn us back from our wicked fiscal ways.

"Honest weights and scales are the LORD's; All the weights in the bag are His work." (Proverbs 16:11)


5. REACTION IN THE MEDICAL COMMUNITY

83 percent of American physicians have considered leaving their practices over President Barack Obama’s health care reform law, according to a survey released by the Doctor Patient Medical Association.

The DPMA, a non-partisan association of doctors and patients, surveyed a random selection of 699 doctors nationwide. The survey found that the majority have thought about bailing out of their careers over the legislation, which was upheld last month by the Supreme Court.

Even if doctors do not quit their jobs over the ruling, America will face a shortage of at least 90,000 doctors by 2020. The new health care law increases demand for physicians by expanding insurance coverage. This change will exacerbate the current shortage as more Americans live past 65. (Daily Caller)

On the House floor, Rep. Burgess cited reports that "only 31 percent of Texas doctors are accepting new patients who rely on Medicaid. In 2010, the last time the survey was taken, it was 42 percent. In the year 2000, it was 67 percent." (Congressional Record)

Also on the floor, Rep. Fleming, MD, gave a thorough discourse on the last 50 years of health care in America and why the approach to the 2010 health care is to "pull it out by its roots and start over again with step-by-step reform in health care with patient choices."

Father, we indeed ask that the 2010 health care law would be pulled out by its roots before it uproots health care in America. We ask for freedom and responsibility for all Americans in their health care.

"Every plant which My heavenly Father has not planted will be uprooted." (Matthew 15:13)


6. CONSCIENCE RIGHTS (BACKGROUND)

When the health care law was passed in 2010, nowhere in the bill was the mandate written that people had to pay for coverage of contraception, sterilization and abortion-inducing drugs—everything covered under the "full range of FDA-approved contraception." We had to pass the bill in order to see that was in it, too.

Now the bill is passed, signed into law, upheld by the Supreme Court, and the Department of Health and Human Services (HHS) is moving full speed ahead on implementation. With the full authority of the law behind them for providing "preventive" services, HHS has written regulations requiring nearly all employers to cover abortion-inducing drugs.

The law has teeth, too. For those employers exercising their conscience in not providing this coverage, they face fines of $100 per day per employee starting August 1, 2012.

To put that in perspective, the national average hourly wage is $16.57. Multiply that by eight hours in a day and you have a daily wage for the employee of $132.56, before taxes for the employee and after taxes for the employer. For any employer that exercises their conscience about paying for abortion this rule adds $100 per day to that total—per employee.

"That equals an astounding $36,500 per employee, per year. If a religiously affiliated grade school has 50 employees, they would be taxed $1,825,000 per year, every year, just for exercising their constitutionally protected rights. With taxes so severe and burdensome, it’s hard to imagine that any institution could keep its doors open," wrote Rep. Sensenbrenner.

And yes, this is in addition to the requirement for employers with 50 or more employees to buy health insurance for their employees. If employers exercising their conscience decide they cannot afford insurance and the $1.825 million fine, they can, as The New American reports, "pay an annual penalty of $2,000 per full-time employee if even one of their full-time employees receives a taxpayer subsidy for purchasing health insurance through a state exchange" or "an even steeper $3,000 per employee" for offering "unaffordable" coverage for those employees in the exchanges. And all the plans in the exchanges would offer the full range of FDA-approved contraception including abortion-inducing drugs.

Under these rules, there are no other options for employers offering health insurance. As HHS Secretary Kathleen Sebelius indicated at a House hearing, other than those grandfathered from before the law passed, no other health insurance plans will be authorized for the market.

In China, you are not required to comply with the one-child policy as long as you pay the $6,350 fine to have another child. It is only on not paying that fine that the forced abortion happens.

Pray for Secretary Sebelius and President Obama. This oppression is not necessary. This policy does not need to exist. It wasn't written anywhere in the law as passed. Pray for their hearts to turn away from these wicked ways.

"Immediately he preached the Christ in the synagogues, that He is the Son of God." (Acts 9:20)


Addressing the problems with the contraception/abortion mandate is happening on two fronts: judicial and legislative.

7. HHS MANDATE LAWSUITS

As National Review columns indicate, the HHS mandate violates the Religious Freedom Restoration Act (RFRA), and imposes a substantial burden on employers.

The Becket Fund for Religious Liberty announced that its lawsuits challenging the controversial HHS mandate will continue in light of the Supreme Court decision. In its opinion, the Supreme Court rejected claims challenging the individual mandate, leaving the Affordable Care Act intact and allowing religious-liberty lawsuits against the HHS Mandate to proceed.

“The court’s opinion today did not decide the issues in our cases,” said Hannah Smith, Senior Counsel at the Becket Fund for Religious Liberty. “We are challenging the Health and Human Services (HHS) mandate on religious liberty grounds which are not part of today’s decision. We will move forward seeking vindication of our client’s First Amendment rights.”

The Court’s decision leaves untouched the controversial HHS mandate, a regulation based on other provisions of the Affordable Care Act that the Court was not asked to review in this case. The mandate compels employers to provide drugs and services in their employee health care plans regardless of religious objections to those services. Employers who fail to comply face staggering financial penalties. (The Becket Fund)

With one recent addition, there are currently 24 lawsuits pending against the HHS mandate.

Pray for these lawsuits to expeditiously and effectively move forward. May the words of Justice Ginsburg take effect soon: "A mandate to purchase a particular product would be unconstitutional if, for example, the edict impermissibly abridged the freedom of speech, interfered with the free exercise of religion, or infringed on a liberty interest protected by the Due Process Clause."

"We ought to obey God rather than men." (Acts 5:29)


8. RELIGIOUS FREEDOM TAX REPEAL ACT

An attempt earlier this year to restore conscience rights to all Americans already failed in the Senate. (CHPP)

On July 10th, in the House of Representatives, Tennessee congresswoman Diane Black and Wisconsin congressman James Sensenbrenner, two Protestant lawmakers, introduced the Religious Freedom Tax Repeal Act (H.R. 6097), seeking to repeal the fine on faith the Obama administration’s abortion-inducing drug, contraception, and sterilization mandate imposes.

“The Religious Freedom Tax Repeal Act would stop the Obama administration from levying this huge tax on religious employers,” Representative Black said.

“With the HHS mandate, the administration has set up an impossible choice for many religious affiliated institutions: either violate the law and pay a tax, or violate your conscience,” Black says. “This means some of the most respected parochial schools, hospitals, soup kitchens, and universities across our country will have to choose between violating their faith to keep their doors open or paying a potentially devastating tax.” (Examiner)

A new Republican bill would remove the teeth from a contentious Obama administration health mandate by barring the federal government from penalizing employers that do not comply. (Healthwatch)

Pray that this bill gets a vote and that every American knows where their Representative stands on protecting religious liberty in America today.

"Let each be fully convinced in his own mind." (Romans 14:5)


9. REACTION IN THE STATES

Governor Perry wrote a letter to Kathleen Sebelius, Secretary for the U.S. Department of Health and Human Services with a message for the President. "I oppose both the expansion of Medicaid as provided in the Patient Protection and Affordable Care Act and the creation of a so-called 'state' insurance exchange, because both represent brazen intrusions into the sovereignty of our state.

"I stand proudly with the growing chorus of governors who reject the PPACA power grab. Thank God and our nation's founders that we have the right to do so." (Congressional Record)

The governor extended his remarks to the American people in an editorial published in USATODAY: "As a general rule, the more a salesman offers you to sign a long-term contract, the closer you should scrutinize the deal. That's the situation we're facing in Texas, as the Obama administration extends a handful of cash with one hand while keeping a sledgehammer behind its back."

Health and Human Services Secretary Kathleen Sebelius on Wednesday highlighted Democratic governors' commitment to implementing President Obama's healthcare reform law — a contrast to Republican governors who remain staunchly opposed to the law.

HHS released letters from 12 governors reiterating their plans to move forward with state-based insurance exchanges. The letters are essentially a round-up of every Democratic governor whose state has already established an exchange. (Healthwatch)

Texas Gov. Rick Perry declared Monday his state would not participate in the health law’s Medicaid expansion, becoming the sixth Republican governor to make such a promise. Taken together, those governors opting-out would single-handedly shrink the Medicaid expansion by nearly 4 million people.

While the stakes are high for the White House, the territory is by no means uncharted. Washington has twice faced off with states over federal health care expansions, when Medicaid initially launched in 1965 and with the Children’s Health Insurance Program in 1997. In both cases, all 50 states ultimately signed up – but not without some wrangling. (Washington Post)

A House Democrat warned Virginia Gov. Bob McDonnell (R) that refusing the healthcare reform law's Medicaid expansion will be a "costly and historic mistake."

The Supreme Court's decision to uphold the law has touched off a fiercely partisan debate over whether to expand Medicaid. Many GOP governors have said they will refuse federal funds to expand the program because they worry that financial obligations to future beneficiaries will be too great. (Healthwatch)

Maine Gov. Paul LePage (R) on Thursday waded back into the controversy over his remarks comparing implementation of the administration’s healthcare law to Nazi Germany.

He said the government will end up rationing healthcare under the Affordable Care Act, a charge that congressional Republicans have made before (without Nazi comparisons).

Pressed further by the Seven Days reporter, LePage said “the Holocaust is probably a bad example,” but that “they’re going to be rationing health care, as they do in Canada.” (Healthwatch)

The now-optional Medicaid expansion puts many governors in a tricky spot. Supporters say state leaders would be foolish to turn down enormous federal grants to expand their Medicaid rolls. Opponents say state leaders would be foolish to grow the program, putting themselves on the hook for future costs amid a wave of budget crises. (Healthwatch)

Pray for wisdom for each state governor. The United States fiscal situation today is much different than it was in 1965, and these policies stand to make them much worse.

"Owe no one anything except to love one another." (Romans 13:8)


10. EFFECTS ON PREVIOUS HEALTH CARE POLICIES

What are the implications of the recent Supreme Court decision for Health Savings Accounts? Not good, if the Obama Administration continues its undeclared war on HSAs.

The American Bankers Association noted in their HSA update last week that "While the political impact of the Supreme Court decision will be debated, the real-world effect on Health Savings Accounts is certain. Individuals and small businesses will discover that obtaining HSA-qualified health plans - the one thing you must have to open a health savings account - will become increasingly more difficult, a negative result for these consumers.

"Individuals and small businesses have more difficulty finding affordable coverage than any other market segment. The Affordable Care Act's many regulations make obtaining coverage harder for these consumers, not easier."

Regulations are slowly strangling HSAs. Under Obamacare, "fully insured" policies must spend at least 80 percent (small group and individual market) or 85 percent (large group market) of every premium dollar on health care related expenses (called the medical loss ratio or MLR). The remainder can be spent on administrative costs (improving health care delivery or combating fraud) and profits.

The problem is that HSAs have an MLR that is significantly lower (around 60-70 percent) by design because policyholders are paying out-of-pocket for claims before the deductible is met. (Manhattan Institute)

Father, from the prescription drug program to health savings accounts, this law is eviscerating everything we've had in place to encourage citizens and patients to keep their own health care costs lower.

"The LORD is in His holy temple, The LORD's throne is in heaven; His eyes behold, His eyelids test the sons of men." (Psalm 11:4)


11. SIDE EFFECTS OF THE HEALTH CARE LAW

Federal trade regulators warned Friday that scam artists are using the healthcare law to ask for consumers' personal information over the phone.

The Federal Trade Commission (FTC) said that the illegal activity began after the Supreme Court ruled on June 28 to uphold the vast majority of the law.

Scam artists "say they're from the government" and use the Affordable Care Act as a hook to verify information, according to an FTC alert. (Healthwatch)

Father, as if the law as written and implemented did not provide enough trouble and confusion as it is, we still seek the rule of law in America and ask that you silence those who would add to and multiply the confusion from this law. Keep us from being distracted from seeking you. We love You.

"He that will love life, and see good days, let him refrain his tongue from evil, and his lips that they speak no guile." (1 Peter 3:10)

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