Playing Doctor with Americans’ Lives

3Doctors400Republicans, in both the House and the Senate, are currently colluding to gut Healthcare Reform and deny actual healthcare to millions of women across our nation using a process called Reconciliation.  Reconciliation is an expedited budgetary process that offers some procedural advantages: it needs only the support of a simple majority in the Senate, and cannot be filibustered. The bill they intend pass via reconciliation is HR3762, inappropriately named, “Restoring Americans’ Healthcare Freedom Reconciliation Act” … it should be named “Butchering All Hope of Being Able to Afford Effective Healthcare Act.”

This reconciliation bill includes language to repeal key parts of Obamacare: the individual mandate, the employer mandate, the medical device tax and the ‘Cadillac tax.’ There are press posts saying that it will also end the Independent Payment Advisory Board (IPAB), but I can’t find such a provision in the bill.In addition, it would defund Planned Parenthood for one year

Defunding Planned Parenthood for a Year—

Here’s the section which specifically codifies the vilification of Planned Parenthood as a “Prohibited Entity” that just happens to provide “essential” healthcare for millions of women across our nation:

SEC. 202. FEDERAL PAYMENT TO STATES.
(a) In General.—Notwithstanding section 504(a), 1902(a)(23), 2002, 2005(a)(4), 2102(a)(7), or 2105(a)(1) of the Social Security Act (42 U.S.C. 704(a), 1396b(a)(23), 1397a, 1397d(a)(4), 1397bb(a)(2), 1397ee(a)(1)), or the terms of any Medicaid waiver in effect on the date of enactment of this Act that is approved under section 1115 or 1915 of the Social Security Act (42 U.S.C. 1315, 1396n), for the 1-year period beginning on the date of the enactment of this Act no Federal funds may be made available to a State for payments to a prohibited entity, whether made directly to the prohibited entity or through a managed care organization under contract with the State.

(b) Definition Of Prohibited Entity.—In this section, the term “prohibited entity” means an entity, including its affiliates, subsidiaries, successors, and clinics—

(1) that, as of the date of enactment of this Act—

(A) is an organization described in section 501(c)(3) of the Internal Revenue Code of 1986 and exempt from tax under section 501(a) of such Code;

(B) is an essential community provider described in section 156.235 of title 45, Code of Federal Regulations, that is primarily engaged in family planning services, reproductive health, and related medical care; and

(C) provides for abortions, other than an abortion—

(i) if the pregnancy is the result of an act of rape or incest; or

(ii) in the case where a woman suffers from a physical disorder, physical injury, or physical illness that would, as certified by a physician, place the woman in danger of death unless an abortion is performed, including a life-endangering physical condition caused by or arising from the pregnancy itself; and

(2) for which the total amount of Federal and State expenditures under the Medicaid program under title XIX of the Social Security Act in fiscal year 2014 made directly to the entity and to any affiliates, subsidiaries, successors, or clinics of the entity, or made to the entity and to any affiliates, subsidiaries, successors, or clinics of the entity as part of a nationwide health care provider network, exceeded $350,000,000.

[Emphasis mine]

Please note that the provisions to completely eliminate any funds for Planned Parenthood were proposed and recommended by the Ways and Means Committee currently led by Rep. Paul Ryan, that same Paul Ryan who will is expected to be elected as Speaker of the House next Wednesday — that is, unless the right wing extremists of the Republican Freedom Caucus renege and cast their votes for their beloved Rep. Daniel Webster instead.

Repealing the Individual and Employer Mandates —

Repealing individual mandate provisions are likely to increase, rather than decrease, the number of U.S. residents without health coverage, thus eliminating the progress that has been made in holding people responsible for their healthcare.  If the CBO forecasts are correct, the H.R. 3762 mandate repeal provisions could increase the number of uninsured U.S. residents by 55 percent to 65 percent. But, that’s okay with Republicans because for each person who doesn’t buy health insurance, the government doesn’t have to shell out $760-$815.  But they took it one step further.  To help their corporate benefactors, they also plan on repealing the mandates on employers to provide medical coverage.  Thus, ordinary Americans seeking to access affordable healthcare coverage for themselves and their families are going to rapidly find themselves up the proverbial creak, with no paddle, a leaky boat and no pail with which to bail out their boat.

The house voted on passage of HR3762 on Friday.  The vote was 240-189 with 5 Democrats not voting.  One Democrat (Peterson) voted for passage and ALL THREE of Nevada’s Congressional Republicans voted ‘AYE’ for passage! The bill is now off to the Senate, where it can be considered without a 60-vote cloture requirement (assuming the package passes muster with the Senate “Byrd Rule.”).

The Byrd Rule is a Senate rule that amends the Congressional Budget Act of 1974 to allow Senators, during the Reconciliation Process, to block a piece of legislation if it purports significantly to increase the federal deficit beyond a ten-year term or is otherwise an “extraneous matter” as set forth in the Budget Act.  It is named after West Virginia Senator Robert Byrd.

The Congressional Budget Office (CBO) assessed the effects of HR3762 on long-term deficits and direct spending as follows:

  • Including macroeconomic feedback, CBO and JCT estimate that enacting the legislation would increase net direct spending as well as on-budget deficits by more than $5 billion in one or more of the four consecutive 10-year periods beginning in 2026.
  • Excluding macroeconomic feedback, CBO and JCT estimate that enacting the legislation would not increase net direct spending by more than $5 billion in either of the first two consecutive 10-year periods beginning in 2026; however, the agencies are not able to determine whether enacting the legislation would increase net direct spending by more than $5 billion in the third or fourth 10-year period.
  • Excluding macroeconomic feedback, CBO and JCT estimate that enacting the legislation would increase on-budget deficits by more than $5 billion in one or more of the four consecutive 10-year periods beginning in 2026.

And because enacting the legislation would affect direct spending and revenues, ‘pay-as-you-go procedures‘ apply.

The President is then expected to veto, setting up the need for a veto-override vote in Congress.  In a statement promising Obama’s veto, the White House said the GOP measure “would take away critical benefits and health care coverage from hard-working middle-class families.”

However, a conservative revolt could derail the bill’s progress, as some conservative groups are opposing because the bill leaves some parts of ObamaCare intact


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US Court of Appeals Upholds Health Care Reform Law

“Despite questions raised as to our subject matter jurisdiction, we conclude we have jurisdiction, and we affirm the district court’s conclusion that the Act is constitutional,” Senior Circuit Judge Laurence Hirsch Silberman wrote for the majority (PDF).

For those who don’t want to read through the whole opinion, here’s the salient portion related to the opinion:

“The Government counters that the individual mandate is well within the bounds of congressional power. Congress can regulate even purely local, intrastate economic behavior so long as, in the aggregate, it substantially affects interstate commerce. The manner in which consumers pay for services in the interstate health care market is such an example. Because virtually everyone will, at some point, need health services, no one is truly inactive, and the health services market is inextricably intertwined with health insurance. Congress found that those who do not purchase health insurance, and instead self-insure, almost inevitably take health care services they cannot afford. Hospitals, by virtue of federal law and professional obligation, provide these services, and as a result, $43 billion in annual costs are shifted to the insured, through higher premiums. That, in turn, makes health insurance less affordable and increases the total number of uninsured. Therefore, it is argued that Congress rationally concluded that decisions about how to pay for health care, in the aggregate, substantially affect interstate commerce. The Government contends, moreover, that the individual mandate can be upheld as an essential element of the Affordable Care Act’s broader reforms, like the guaranteed issue and community rating requirements, which all agree are within Congress’s power. That is because Congress found that absent the mandate, the guaranteed issue and community rating requirements would lead individuals to wait to buy insurance until they needed care, causing higher premiums, again reducing the number of insured, and destroying the efficacy of Congress’s regulatory scheme.”

“The Government concedes the novelty of the mandate and the lack of any doctrinal limiting principles; indeed, at oral argument, the Government could not identify any mandate to purchase a product or service in interstate commerce that would be unconstitutional, at least under the Commerce Clause. But the Government does stress that the health care market is factually unique; there are few other markets, it says, where participation is a virtual certainty, or where declining to buy a product disproportionately causes a national economic problem.”

“That a direct requirement for most Americans to purchase any product or service seems an intrusive exercise of legislative power surely explains why Congress has not used this authority before–but that seems to us a political judgment rather than a recognition of constitutional limitations. It certainly is an encroachment on individual liberty, but it is no more so than a command that restaurants or hotels are obliged to serve all customers regardless of race, that gravely ill individuals cannot use a substance their doctors described as the only effective palliative for excruciating pain, or that a farmer cannot grow enough wheat to support his own family. The right to be free from federal regulation is not absolute, and yields to the imperative that Congress be free to forge national solutions to national problems, no matter how local–or seemingly passive–their individual origin.”

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