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obamacare
'Nothing Short of Catastrophic': Federal Judge Strikes Down ACA Preventative Care Provision
"Another reason why we need Medicare for All—the milquetoast ACA is being dismantled before our eyes," said one critic.
Mar 30, 2023
A ruling handed down by a U.S. district judge on Thursday will threaten a range of lifesaving preventative healthcare services for more than 150 million people, legal experts and advocates said, as the decision challenged the legality of a federal task force that enforces coverage for the services.
Judge Reed O'Connor, a Bush appointee who sits on the U.S. District Court for the Northern District of Texas, ruled that insurance companies do not have to comply with preventative care recommendations made by the U.S. Preventive Services Task Force (USPSTF), which was established by a key provision in the Affordable Care Act (ACA), also known as Obamacare.
O'Connor ruled that the appointments of members of the task force violate the Appointments Clause in the U.S. Constitution and said that violation "invalidates its power to enforce anything against anyone nationwide," according toSlate journalist Mark Joseph Stern.
The USPSTF has issued recommendations for a wide range of preventative care services, including screenings for breast cancer, colorectal cancer, cervical cancer, and diabetes; interventions and tests for pregnant patients; anxiety screenings for children and adolescents; and pediatric vision tests.
Under the ACA, insurance companies are required to cover those services, but following O'Connor's ruling coverage will no longer be mandated.
The decision is "nothing short of catastrophic to the U.S. healthcare system," said Stern.
\u201cI anticipated this decision in September when O'Connor first telegraphed it. It is nothing short of catastrophic to the U.S. health care system. Millions of Americans, including many pregnant women, will have to forgo basic care if it is upheld.\nhttps://t.co/eVpemaBN5c\u201d— Mark Joseph Stern (@Mark Joseph Stern) 1680184452
The ruling stemmed from a lawsuit filed in 2020 by Christian employers who objected to paying for services such as contraceptives and preexposure prophylaxis (PrEP), to prevent HIV transmission.
In September, O'Connor ruled that coverage for PrEP violated the companies' religious freedom in a decision that one doctor who specializes in HIV treatment condemned as "disgusting and inhumane" and likely "driven solely by homophobia and transphobia."
\u201cA Bush-appointed judge blocks the ACA's coverage of preventative care, including cancer screenings and the HIV-prevention drug PrEP, as the Stephen Miller-backed plaintiffs claim it "encourage[s] homosexual behavior, prostitution [and] sexual promiscuity."https://t.co/IVTbOmOzCg\u201d— Emma Vigeland (@Emma Vigeland) 1680191769
The companies are being represented by Texas attorney Jonathan Mitchell, who helped develop the state's abortion ban that allows private citizens to sue anyone who "aids or abets" a person who obtains abortion care.
More than 150 million Americans who have private health insurance have coverage for preventative care under the ACA, as well as approximately 20 million Medicaid and 61 million Medicare recipients.
Last July, as O'Connor was considering the case, titled Braidwood Management Inc., vs. Xavier Becerra, national health organizations including the American Medical Association, the American Academy of Pediatrics, and the American College of Obstetricians and Gynecologists warned that a ruling in the plaintiffs' favor would "reverse important progress and make it harder for physicians to diagnose and treat diseases and medical conditions that, if caught early, are significantly more manageable."
"With an adverse ruling, patients would lose access to vital preventive healthcare services, such as screening for breast cancer, colorectal cancer, cervical cancer, heart disease, diabetes, preeclampsia, and hearing, as well as access to immunizations critical to maintaining a healthy population," the organizations wrote. "Our patients cannot afford to lose this critical access to preventive healthcare services."
The Biden administration is expected to appeal O'Connor's ruling, and since insurance coverage contracts typically run through the end of the year, coverage will likely not change for many before 2024.
If upheld, the ruling will deal "a devastating blow to American public health," said University of California law professor Jennifer Oliva.
\u201cA federal judge deals a devastating blow to American public health by enjoining the ACA preventative mandate nationally. Included among plaintiffs\u2019 claims was that it was against their religion for insurance plans to cover counseling for substance use disorder.\u201d— Jennifer Oliva (@Jennifer Oliva) 1680188419
Last year, a Morning Consult poll found that at least 2 in 5 Americans were not willing to pay out-of-pocket for preventative services currently covered by the ACA.
O'Connor previously ruled in 2018 that the ACA should be struck down in its entirety, but that ruling was overturned by the U.S. Supreme Court.
The judge's latest ruling offers "another reason why we need Medicare for All," said the Debt Collective. "The milquetoast ACA is being dismantled before our eyes. There is no reason not to fight for real solutions when the non-solutions stand no better chance."
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Does Mitch McConnell Really Give a Damn About the Supreme Court?
Ideology has never been as important to the Senate majority leader as power.
Feb 26, 2016
Many years ago, I worked on a documentary about the how and why of political TV ads. The primary focus was on two media consultants: the late Bob Squier, a Democrat, and Bob Goodman, a Republican.
One ad of which Goodman was incredibly proud was for a fellow in Kentucky running against Todd Hollenbach, Sr., the incumbent judge/executive of Jefferson County. Produced in 1977, the spot featured a farmer complaining about taxes that he claimed Judge Hollenbach had raised and then lied about.
As he mucked out a barn and his faithful horse whinnied, the farmer declared, "Maybe Hollenbach ought to have my job, because in my business, I deal with that kind of stuff every day."
Then he threw a shovel of manure right at the camera.
Hollenbach lost to the candidate who approved this message: Mitch McConnell.
McConnell has been shoveling it ever since, but perhaps never as stunningly as on Tuesday when he spoke from the floor of the US Senate. The now-majority leader of the so-called greatest deliberative body in the world blustered, as he has several times in the last couple of weeks, that Senate Republicans would never, ever consider an appointment by President Obama to replace the still-dead Supreme Court Justice Antonin Scalia.
The president, McConnell, said, "has every right to nominate someone, even if doing so will inevitably plunge our nation into another bitter and avoidable struggle."
Excuse me, Senator, the bitter and undeniably avoidable struggle was created by you on the Saturday that Scalia's corpse was found. The body was barely cold when you crassly announced that the duly elected President of the United States should not name the judge's successor but must leave it to the next president - more than 300 days from now.
McConnell continued, "Even if he never expects that nominee to be actually confirmed but rather to wield as an election cudgel, he certainly has the right to do that." Again, Senator, it's you who is wielding the blunt object.
And then the majority leader had the chutzpah, as they say down home in his Bluegrass State, to add that "Obama also "has the right to make a different choice. He can let the people decide and make this a legacy-building moment rather than just another campaign roadshow."
Oh, brother, look who's talking. Of all the pompous, insincere bloviation, ignoring courtesy, tradition - let alone the US Constitution - in the name of Senator McConnell's misbegotten ambitions.
Psychiatrists call this "projection," the defensive method by which people take their own negative beliefs or feelings and attribute them to someone else - otherwise known as shifting blame. In McConnell's case, add to it a megadose of the cynical manipulation and crass opportunism characteristic of most of his political career.
Not that it was always so. McConnell began his political life as a liberal Republican - remember them? -- interning for legendary Kentucky senator and statesman John Sherman Cooper. He supported the Equal Rights Amendment and collective bargaining. Friends say he was pro-Planned Parenthood, and he even wrote an op-ed piece in the Louisville Courier-Journal favoring campaign finance reform. Former McConnell press secretary Meme Sweets Runyon told Jason Cherkis and Zach Carter atThe Huffington Post, "He was kind of a good-government guy. He thought the government could do good and could be a solution."
But once Mitch McConnell got to Washington as an elected senator, the mood of the Republican Party shifted right, and so did he. Delay and obstruction became stepping stones. At the same time, the man who New York Times columnist Gail Collins famously described as having "the natural charisma of an oyster" developed a Jekyll-and-Hyde style of self-serving pragmatism - bashing government from Capitol Hill but using all of its perks to bolster support among his constituents.
In 2013, Cherkis and Carter wrote:
Up until the tea party-led ban on earmarks a few years ago, McConnell played out this dichotomy across Kentucky. In Washington, he voted against a health care program for poor children. In Kentucky, he funneled money to provide innovative health services for pregnant women. In Washington, he railed against Obamacare. In Kentucky, he supported free health care and prevention programs paid for by the federal government without the hassle of a private-insurance middleman. This policy ping-pong may not suggest a coherent belief system, but it has led to loyalty among the GOP in Washington and something close to fealty in Kentucky. It has advanced McConnell's highest ideal: his own political survival.
"McConnell's hold on Kentucky is a grim reminder of the practice of power in America -- where political excellence can be wholly divorced from successful governance and even public admiration," the Huffington Post reporters continued. "The most dominant and influential Kentucky politician since his hero Henry Clay, McConnell has rarely used his indefatigable talents toward broad, substantive reforms. He may be ruling, but he's ruling over a commonwealth with the lowest median income in the country, where too many counties have infant mortality rates comparable to those of the Third World. His solutions have been piecemeal and temporary, more cynical than merciful."
And so it goes. "He privileges the scoreboard above all," The New Yorker's Evan Osnos wrote in 2014. "Asked about his ideological evolution, he explained simply, 'I wanted to win.'"
Tailoring his positions to adjust to the shifting seasons, what sets Mitch McConnell apart is that his motives aren't ideological but so baldly about holding onto personal power. His opposition to Obama's naming of a Scalia replacement puts the majority leader in solid with the far-right Republicans he purportedly so dislikes but who have threatened his job security over the last few years, both at home and in DC.
Moreover, McConnell is desperate to keep a conservative majority on the Court to preserve the unbridled flow of campaign cash that the Citizens United decision let loose and that he so successfully has tapped for himself and the GOP. Unlike the young man who penned that campaign finance reform op-ed back in Louisville, fundraising has become his favorite thing, and he's scary good at it. As his former Republican Senate colleague Alan Simpson said, "When he asked for money, his eyes would shine like diamonds. He obviously loved it."
And even if a Democrat holds onto the White House next year, chances are McConnell - the man who once said that the most important thing was to make Barack Obama a one-term president -- will still play a power broker role in determining which Supreme Court candidate will successively run the 60-vote supermajority gauntlet needed for Senate approval. It's good to be king.
But if he wants us all to wait for a Republican president to choose the next appointment to the Court, he might want to think twice. Donald Trump bows before no man - just ask him -- and he shovels muck even better than that farmer who helped Mitch McConnell win his first public office.
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Clinton's 'Public Option' is a Diversion: We Need Single Payer, Medicare for All
Feb 24, 2016
You remember the public option. During the drafting of the Affordable Care Act (ACA), efforts were made to include a public option - a government-run plan that would compete with private health plans in the insurance marketplace.
If the private plans proved that they could provide greater value, then they would prevail. If the government could do a better job, then the public option could expand by demand and eventually become the single payer for the nation, so supporters believed.
"Clinton is now showing us how the public option is a diversion from the reform we really need - single-payer."
The original concept for the public option was to allow individuals to buy into the Medicare program instead of purchasing private insurance. There were some obvious problems. Medicare lacked some important features required of private plans, such as catastrophic coverage, which establishes a maximum out-of-pocket responsibility for paying for health care. Also, the existing Medicare pool was composed of the elderly and those with long-term disabilities - expensive groups to insure. The exorbitant premium that would have to be charged could not be competitive with the private plans.
It was then decided to establish a new public insurance program that was designed like the private plans and that would have to follow the same rules. The insurance industry immediately opposed this since it would be "unfair" competition considering the government resources backing up the public plan, and the inherently higher administrative costs that the private insurers face, not to mention the need to profit from their operations - profit not being a feature of a publicly owned insurer. Several (anti-competitive) features were proposed for the public option which would give the private insurers a "fair" playing field.
The insurers were still concerned that they could not compete against even a restricted government plan, and thus they continued to oppose it. There is a basis for that concern since the private Medicare Advantage plans are able to "compete" with the traditional Medicare program only because of the overpayments that are being made to the private plans. If they were in the same playing field, the private plans would perish.
Nevertheless, the issue of the public option became moot when Sen. Joseph Lieberman, with no votes to spare, threatened to kill the entire Affordable Care Act if the public option were included.
We were left with the co-ops as a substitute for the public option. The co-ops are nonprofit organizations in which the insured members are the owners. Congress, under the Republicans, has refused to provide promised funds, and half of them have collapsed. They are now being used by opponents of single-payer to "prove" that the government would be incapable of running a single-payer system - an obvious non sequitur.
Since the enactment of ACA there have been endless calls to add a public option. Single-payer failed to gain traction because of the pervasive meme that single-payer was not politically feasible. But if we could just get a public option, that would automatically evolve into a single-payer system, they said.
Then along came Bernie Sanders. He carried the message that not only was single payer politically feasible, it was a moral imperative to achieve health care justice for all.
To the surprise of Hillary Clinton and her campaign staff, Bernie Sanders came out of nowhere and gained traction carrying the single-payer banner, and, as a result, has become a genuine challenge to her candidacy.
Hillary Clinton has always been an opponent of single-payer and instead has supported the private insurance industry. Some misinterpreted a statement of hers from many years ago as supporting the fact that we would have a single-payer in the United States. But that statement was not in support of single-payer but rather was her threat to us that if we did not accept her managed-competition model of reform, we would have single-payer.
So what was her campaign to do? They decided to bring back the concept of a public option to appease those who were turning to Sanders because of his advocacy of single-payer. They are relying on the meme that the public option is our door to single-payer (even though it is not true). But what is her version of the public option?
She says we should build on ACA. She has proposed no new federal public option legislation but she is merely suggesting that the states look at Section 1332 of ACA which authorizes waivers for limited innovations on a state level.
Imagine the difficulties that states would have, within the confines of Section 1332, in building their own intra-state public plan. Unless they used private insurance innovations such as high deductibles, narrow provider networks, and tiered services, the premiums would be unaffordable to most. A single-payer system would be funded equitably through progressive taxes, but you could not do that with a public option since that is only one plan in a multi-payer system.
In 2009, David Himmelstein and Steffie Woolhandler explained in very brief terms why the public option is a flawed concept:
The "public plan option" won't work to fix the health care system for two reasons.
1. It forgoes at least 84 percent of the administrative savings available through single-payer. The public plan option would do nothing to streamline the administrative tasks (and costs) of hospitals, physicians' offices, and nursing homes, which would still contend with multiple payers and hence still need the complex cost-tracking and billing apparatus that drives administrative costs. These unnecessary provider administrative costs account for the vast majority of bureaucratic waste. Hence, even if 95 percent of Americans who are currently privately insured were to join the public plan (and it had overhead costs at current Medicare levels), the savings on insurance overhead would amount to only 16 percent of the roughly $400 billion annually achievable through single payer - not enough to make reform affordable.
2. A quarter century of experience with public/private competition in the Medicare program demonstrates that the private plans will not allow a level playing field. Despite strict regulation, private insurers have successfully cherry-picked healthier seniors and have exploited regional health spending differences to their advantage. They have progressively undermined the public plan - which started as the single-payer for seniors and has now become a funding mechanism for HMOs - and a place to dump the unprofitably ill. A public plan option does not lead toward single-payer but toward the segregation of patients, with profitable ones in private plans and unprofitable ones in the public plan.
Hillary Clinton is now showing us how the public option is a diversion from the reform we really need - single-payer. It is up to us, the people, to convince our politicians that single-payer is what we want. It will not happen without us.
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