in Houston, Texas
Price tag says $115 billion, study authors find Medicaid expansion in Texas ‘affordable’
Monday, Jan 28, 2013, 04:45PM CST
By Mark Lisheron
shot

With the unveiling today of a new report on the cost of expanding Medicaid under Obamacare, we are confident we have now heard the last three words on the subject: Smart, Affordable and Fair.

The Kaiser Commission on Medicaid and the Uninsured said pretty much the same thing in a lot more words with its study released back in November.

By affordable, the Kaiser Commission meant $1.03 trillion with the cooperation of all 50 states from this year through 2022.

The cost for Texas to be smart, affordable and fair is about $115 billion during the same decade, according to the new report by Billy Hamilton Consulting for Texas Impact, a grassroots religious non-profit based in Austin.

This figure is considerably less than the $150 billion the conservative Texas Public Policy Foundation estimated in its study, as much as $38 billion of it to comply with the Patient Protection and Affordable Care Act.

What this flurry of studies is selling, particularly in states like Texas with recalcitrant political leaders, is that all this expanding isn’t just affordable but practically free. And by free these analysts mean paid for by the magic money machine in that far off land where all dreams come true: Washington, D.C.

Of that trillion in the Kaiser study, why, only $76 billion would come from the states. And of the $115 billion only $15 billion would come from Texans, according to the Hamilton study.

What’s more, in the best tradition of John Maynard Keynes, all this free federal money will multiply itself in a direct and indirect boon to the Texas economy, $27.5 billion yielding $67.9 billion during the fiscal years 2014 through 2017, the study says.

Should you like to believe all that we’ve said here about the money being free and multiplying like fishes and loaves, feel free to ignore those marginalized cranks like this one suggesting all of Medicaid is paid for by taxpayers.

Next thing these folks will have you believing is that we are running national debt of $16 trillion.

***
Contact Mark Lisheron at 512-299-2318 or mark@texaswatchdog.org or on Twitter at @marktxwatchdog.

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Overweight? Smoke? Uncle Sam wants to help. Wellness programs started under 2009 federal stimulus persist, getting fatter with $1 billion in health care law
Monday, Sep 17, 2012, 10:29AM CST
By Mark Lisheron
scale

Months after the grant that brought it to life ran out, Live Tobacco-Free Austin lives on.

Like many of the wellness programs started with $372.8 million in stimulus funding, Live Tobacco-Free Austin secured a new federal grant before the old one had run out and retained most of the staff hired to run the program.

Contrary to the billing of the $862 billion American Recovery and Reinvestment Act as a one-time infusion, the smoking and obesity programs branded Communities Putting Prevention to Work were never meant to be orphaned.

While hundreds of new hires were spending hundreds of millions in advance of a March 2012 spending deadline, advocates were busy embedding promises for billions more in something called the Prevention and Public Health Fund created with the passage of the Patient Protection and Affordable Care Act, Obamacare.

The fund is expected to spread $1 billion around to wellness programs this year and increasing every year after to $2 billion by 2016.

To augment that, the Centers for Disease Control and Prevention began the Community Transformation Grant program, pouring $103 million into wellness programs, several, including $1 million for Austin’s smoking program, started through Communities Putting Prevention to Work.

The Texas Department of State Health Services received a $10 million Transformation Grant for its wellness programs.

Michael MarlowMichael Marlow

Michael Marlow, a California Polytechnic State University economics professor who has written critically on obesity and smoking crusades for the Cato Institute, says this sort of government paternalism is meant to be self-perpetuating.

“You have a one-size-fits-all approach to multi-faceted problems,” Marlow says. “There is no such thing as a temporary solution, just more money for more solutions.”

In the early part of 2010, about a year after the stimulus bill was passed, the Austin/Travis County Health and Human Services Department filed two of what would be 263 applications for Putting Prevention to Work through the Centers for Disease Control.

The CDC made 44 awards, including $7.5 million for a smoking program for Austin, rejecting its application for an equal amount for an obesity program. The San Antonio Metropolitan Health District was the only other Texas agency to get a grant, $15.6 million to combat obesity.

Los Angeles County got the largest grants, for smoking and obesity programs, $32.1 million; New York City got $31.1 million; Seattle/King County got $25.5 million; and Philadelphia, $25.4 million.

Cassandra Deleon had been working for the Texas Department of Health and Human Services when she applied for and was hired, along with eight others, to manage the Austin smoking program.

The grant was the largest of its kind secured by Austin/Travis County, and Deleon says staff saw in it a tremendous opportunity to change the social norms around smoking.

There was one problem. For years tobacco was a potent political issue in Austin, but with the passage of what was, in 2005, one of the strongest local anti-smoking ordinances in the country a kind of exhaustion set in.

Austin spent about $1 million incorporating tobacco use data into the medical records of its hospital and clinic partners, Deleon says.The program set up the Live Tobacco-Free Austin website. The Ash Trailer - a vintage Airstream covered entirely with ash trays - was designed for public service appearances, she says.

Most of the funding, about $3 million, went into a radio, television and billboard campaign touting the benefits of living tobacco-free.

Deleon says she is pleased with how they deployed the grant money. The community transformation grant is testimony to the commitment to fight smoking, she says.

But this kind of program, she says, resists efforts to correlate spending with fewer people using tobacco. “We’re in the process of collecting data and, of course, were hoping for a reduction in tobacco use across the board,” Deleon says. “It’s more like that what we’ll be able to track is awareness of our live tobacco-free message.”

This is an example of the diminishing return on the money spent getting people to give up tobacco, Marlow says. After billions in federal, state and local subsidies, hundreds of thousands of tobacco-related deaths, punitive ordinances and prohibitive taxes on cigarettes, more than 45 million adults choose to continue to smoke, according to CDC figures.

“After all that’s been done, people who smoke know it’s unhealthy,” Marlow says. “Continuing to tell them that is not giving them any new information. But that isn’t going to stop the paternalists from spending money on what is no longer effective.”

There is evidence that smoking cessation programs will have to fight for funding with obesity, the new darling of federal wellness. The CDC made $230 million in obesity grants, compared to $142.8 million for smoking through the Communities Putting Prevention to Work program.

San Antonio, which has found itself on several of those much anticipated lists of the nation’s fattest cities, was an ideal candidate for its obesity grant, by far the largest single grant ever awarded to the Health Department, Christine Rutherford-Stuart, assistant director for the Community Health Division, says.

Unlike Austin, San Antonio’s bid for a Community Transformation grant was turned down. After an extension runs out and the $15.6 million is spent, the last of 13 people hired through the stimulus will be let go, Rutherford-Stuart says.

Assuming the one-time windfall wouldn’t come again, San Antonio spent nearly half of its money on bike and walking lanes and outdoor fitness equipment for parks and libraries, infrastructure that could be maintained in the future by other municipal departments, she says.

A full quarter of the funding went to physical activity programs. Among them is Siclovia, an annual bicycling event modeled after a popular rally in Bogotá, Columbia. More than 15,000 people participated in the first Siclovia, 40,000 last year and 60,000 people are expected on Oct. 7, Rutherford-Stuart says.

Another 20 percent of the grant went into nutrition and health plans, including the installation of salad bars in 108 public and charter schools in the city.

Rutherford-Stuart says the YMCA, its partner for Siclovia, has agreed to continue funding the event in coming years. The Health Department is relying on partnerships to continue exercise, fitness and nutrition programs in the absence of the stimulus money, she says,

Having put all of this in place, Rutherford-Stuart says her department will be hard pressed to find proof of actual improvement in public health. Through questionnaires the department hopes it might be able to track changes in behavior.

“We’re happy for the opportunity to use the grant money, but it will be a huge challenge going forward.,” she says. “It took decades to get where we are in San Antonio and in this country with obesity. It’s going to take decades to alleviate the problem.”

obesity by stateSource: CDC

Data from the CDC suggests what has been done at the federal level since the turn of this century has not worked. The current obesity rate of 35 percent - meaning nearly 110 million Americans are obese - is the nation’s highest ever.

In 2000, no state had an obesity rate greater than 25 percent. Today, two dozen have rates between 25 and 30 percent and a dozen top 30 percent, the CDC says. In 2000, 27 states could claim obesity rates of less than 20 percent. In 2010, none could make the claim.

The federal response to this failure is to redouble its efforts and its funding, making it clear to what were once pilot Communities Putting Prevention to Work programs that money will be made available to do further battle with fatty foods.

After exhausting its stimulus grant, Los Angeles County got another $9.8 million from the Community Transformation fund. San Diego County spent its $16.1million stimulus grant on obesity and got another $3 million in transformational funds. Philadelphia, too, got another $1.5 million after spending $15 million on obesity and $10.4 million on smoking.

Amanda Dudley, spokesman for the CDC’s National Center for Chronic Disease Prevention and Health Promotion, says the CDC has no intention of continuing the Communities Putting Prevention to Work as a national program.

The agency, however, refers to the grant money available through the Affordable Care Act as CPPW Phase Two funding.

And although one of the primary goals of all stimulus programs was to create or retain jobs, Dudley was unable to say how many of those jobs CPPW created or retained or offer a generalized assessment of the impact the program had on government hiring.

Trying to count the jobs, she said, would be misleading because of the way Recovery.gov, the stimulus website tracking spending and job creation, collected the data.

Having also failed to negotiate Recovery.gov, Texas Watchdog contacted the recipients of the 10 largest CPPW smoking and obesity grants. Los Angeles County flatly declined to answer questions. Philadelphia officials said they were still analyzing what they had done with their grants. Four agencies did not respond to our inquiry.

What is clear from the four that responded - the Miami-Dade County Health Department, San Diego Health & Human Services Agency, the Seattle – King County Department of Public Health and the Southern Nevada Health District - was a commitment to continue on as long as the funding continued to come in.

Although almost all of its grant had been spent by July of this year, San Diego County hung onto all 13.7 full time equivalent positions, spokesman Michael Workman says.

A package of Community Transformation, Supplemental Nutrition Assistance Program Education and other grants and some county money has kept 6.7 jobs alive in a program that has been renamed Healthy Works.

“The program is considered a cornerstone of the County of San Diego’s Live Well, San Diego!, a 10-year initiative to improve the lives of San Diegans through healthy, safe, and thriving communities,” Workman says.

The other seven CPPW employees were re-assigned to other jobs on the county payroll, Workman says.

By Seattle-King County’s calculation, its grant paid the salaries for 134 jobs in the Public Health Department and with the community partners who participated in the obesity and smoking programs, spokeswoman Kathryn Ross says.

Roughly two-thirds of the Public Health employees brought on with CPPW money are staying, Ross says, through a combination of federal grants, some foundation funds and the reallocation of money in the department budget.

A good share of the work will involve developing a plan to make the one-time grant program sustainable, she says.

Of the 12 people hired by the Miami-Dade County Health Department funding had been found to hold onto more employees, although spokeswoman Rosa Oses-Prealoni says they are hoping to find more funding to keep several others.

The work will continue through other entities funded at least in part through federal, state and local taxes, Miami-Dade County, the Miami-Dade County School Board, the City of Miami, and the City of North Miami and the Consortium for a Healthier Miami-Dade.

Only in the Southern Nevada Health District, which kept its hiring to one person, was there an effort to make sure the CPPW money was spent on programs carried out largely by people already on staff, according to spokeswoman Jennifer Sizemore.

Regardless of the inability to account for or measure the effectiveness of these federal programs, which Marlow insists is dubious, the perception of crisis, in smoking and in obesity, creates an inertia difficult to halt.

“It’s a bottomless pit,” Marlow says, “and it will never stop.”

***
Contact Mark Lisheron at 512-299-2318 or mark@texaswatchdog.org or on Twitter at @marktxwatchdog.

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Gov. Rick Perry announces Texas will not expand Medicaid -- a program benefiting 1 in 6 Texans in 2009
Monday, Jul 09, 2012, 03:31PM CST
By Mike Cronin
surgery

Gov. Rick Perry sent a letter today to U.S. Health and Human Services Secretary Kathleen Sebelius announcing that Texas would defy two planks of President Obama’s health care law.

Though the U.S. Supreme Court declared the Affordable Care Act constitutional last month, Perry wrote Sebelius that Texas would not create the insurance exchanges “Obamacare” mandates. For states that choose not to set up exchanges --- one-stop sites for comparing health insurance options --- the federal government has indicated it will do so.

Texas also would not expand Medicaid, Perry wrote.

The Supreme Court’s June ruling also allowed states to legally decline to add to their Medicaid rolls.

That is a big deal, reports Elspeth Reeve today in The Atlantic Wire because:

Medicaid expansion was one of the primary mechanisms that Obamacare was going to be able to achieve its primary goal: increasing the number of people with health care coverage. And Texas, which is the second largest state by population, also has the highest rate of uninsured people in the country at 25 percent.

The governor used two primary arguments to explain his stance.

First, “both represent brazen intrusions into the sovereignty of our state,” Perry said in the letter. “In short, it essentially treats the states like subcontractors through which the federal government can control the insurance markets and pursue federal priorities rather than those of the individual states.”

And second, Perry described Medicaid as “a broken system that is already financially unsustainable.” One that “would threaten even Texas
with financial ruin,” Perry said.

Turns out this is not mere hyperbole to many Texas health-care experts, Medicaid advocates and doctors, as Texas Watchdog’s Mark Lisheron reported last year.By 2009, the Medicaid hunger in Texas had grown by nearly four times to $24.6 billion, gobbling up a little more than one in every four dollars in the state budget,” Lisheron reported. The story showed that one in six Texans receive Medicaid, the costs of which in Texas are projected to grow $3 billion every year.

Those developments occurred due to Congress passing many laws during the 1980s that expanded Medicaid coverage beyond its original scope, the story showed:

  • In 1984, Medicaid would now cover children whose low-income families did not receive direct federal cash assistance. Pregnant women and their infants would get covered.
  • In 1986, undocumented immigrants and the homeless would get emergency care through Medicaid.
  • In 1987, the federal government mandated sweeping nursing home reform.
  • In 1988, Congress passed the Medicare Catastrophic Coverage Act, an expansion of Medicaid to cover long-term care for the elderly and disabled not already covered by Medicare

The health care law raised the income requirement for Medicaid to 133 percent of poverty level -- or $30,657 for a family of four.

***
Contact Mike Cronin at mike@texaswatchdog.org or 713-228-2850. Follow him on Twitter at@michaelccronin or @texaswatchdog.

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Photo of surgery via the US Department of Defense.

Supreme Court upholds health care law, and, according to Texas Gov. Rick Perry, 'has abandoned us'
Thursday, Jun 28, 2012, 01:20PM CST
By Mark Lisheron
Supreme Court

Stunning partisans on the left and the right, the Supreme Court this morning upheld the Patient Protection and Affordable Care Act by a vote of 5 to 4.

Chief Justice John Roberts wrote the decision for the majority comprised of Stephen Breyer, Ruth Bader Ginsburg, Elena Kagan and Sonia Sotomayor. Justices Samuel Alito, Anthony Kennedy, Antonin Scalia and Clarence Thomas were in the minority.

The Supreme Court majority came to its conclusion by deciding that the individual mandate in the 2,000-page Affordable Care Act, requiring citizens who chose not to buy health insurance to pay a penalty was, instead, a tax.

The court also ruled unconstitutional the authority of the federal government in the so-called ObamaCare bill to withhold federal funds from states refusing to cooperate in the expansion of the Medicaid program.

Gov. Rick Perry today said the “Court utterly failed in its duty to uphold the Constitutional limits placed on Washington,” in a statement issued to the press. “Now that the Supreme Court has abandoned us, we citizens must take action at every level of government and demand real reform, done with respect for our Constitution and our liberty.

“Freedom was frontally attacked by passage of this monstrosity. Obamacare is bad for the economy, bad for health care, bad for freedom. Americans have made clear their overwhelming opposition to its convoluted, burdensome and overreaching mandates.”

The reasoning for upholding the Affordable Care Act as a tax rather than a mandate is certain to be the subject of furious legal argument.

The court’s decision refers to the mandate as a “shared responsibility payment” to the federal government. Failure to make such a payment results in a penalty collected by the Internal Revenue Service in the same way as a tax, the ruling says.

The majority made clear that an individual mandate as outlined in the Affordable Care Act would illegitimately force individuals to engage in commerce by buying health insurance.

John RobertsJohn Roberts

“Construing the Commerce Clause to permit Congress to regulate individuals precisely because they are doing nothing would open a new and potentially vast domain to congressional authority,” the Roberts decision says. “Congress already possesses expansive power to regulate what people do. Upholding the Affordable Care Act under the Commerce Clause would give Congress the same license to regulate what people do not do. The Framers knew the difference between doing something and doing nothing. They gave Congress the power to regulate commerce, not to compel it. Ignoring that distinction would undermine the principle.”

Instead, the decision does what Congress failed to do in drafting the bill: find the reasoning for its health insurance requirement on the grounds that Congress possesses the power to “lay and collect taxes.”

Texas’ Greg Abbott, one of the 12 original attorneys general to sign on to the ObamaCare lawsuit, took note of what he called “a novel application of the facts” in a statement he issued today from Washington, D.C.

“The Court did what Congress was afraid to do--called ObamaCare a tax on all Americans,” Abbott wrote. “This is particularly ironic since President Obama, himself, insisted this was not a tax.”

In addition to its clearest delineation of the Commerce Clause in more than 15 years, the Court said the federal government would be in violation of the Constitution if it cut off funding to states that refused to expand Medicaid in the ways outlined in the Affordable Care Act.

Justices Breyer and Kagan joined Roberts in the opinion that Congress has no constitutional power to withhold existing federal grants as a way of compelling participation in expanding a program.

Along with the individual mandate, the forced expansion of Medicaid was the impetus for the lawsuit filed March 23, 2010, by the state of Florida against the U.S. Department of Health and Human Services.

Eventually, 26 states would sign onto the suit decided by the court today.

The 11th Circuit Court of Appeals had ruled with the states and against the individual mandate and against the state and Congress’ right to force the states to expand Medicaid.

“The threatened loss of over 10 percent of a State’s overall budget is economic dragooning that leaves the States with no real option but to acquiesce in the Medicaid expansion,” today’s ruling says.

The ruling goes on to repudiate the government’s claim “that the expansion is properly viewed as only a modification of the existing program, and that this modification is permissible because Congress reserved the ‘right to alter, amend, or repeal any provision’ of Medicaid.”

Greg AbbottGreg Abbott

"This is an historic victory for individual liberty, states’ rights, and limited government,” Abbott said. “Today the Supreme Court made crystal clear that the federal government is more restrained than yesterday. The Court also agreed that States are individual sovereigns that cannot be commandeered by the federal government. In this instance, by forcing States to expand Medicaid, the federal government tried to hold States hostage.”

Brooke Rollins, president of the Texas Public Policy Foundation called the Medicaid portion of the ruling a silver lining. “This,” she said in a statement, “at least protects, to some extent, the prerogatives of the states under the Tenth Amendment.”

To say that those following ObamaCare to the nation’s highest court were surprised by the decision would be a Grand Canyon-sized understatement.

Liberal legal experts and pundits were all but throwing themselves off of metaphorical bridges on Wednesday. Politico’s Roger Simon concluded before today’s decision that the High Court has lost its honor, that it was accountable to no one in America.

Conservative groups like the Heritage Foundation had already laid the groundwork for market based reforms, assuming the court would invalidate at least the individual mandate.

After the ruling, roles were reversed. Peter Suderman, senior editor for the libertarian Reason magazine and website, noted how different the outcome was in comparison to expectations.

“Although the overall ruling is a victory for supporters of ObamaCare, the particulars of the Supreme Court’s decision today are almost exactly the opposite of what most observers expected. It’s like a ruling from Bizarro World.”

Patrick Gaspard, executive director of the Democratic National Committee was more succinct when he tweeted, “it’s constitutional. Bitches.”

A short time later he followed with, “I let my scotus (Supreme Court of the United States) excitement get the better of me. In all seriousness this is an important moment in improving the lives of all Americans.”

However surprised, the ruling today changed few minds. President Obama praised the court and reiterated the justness of the Affordable Care Act in spite of it political divisiveness.

Republican presidential candidate Mitt Romney, who hoped for a repeal by the court, said the responsibility for the repeal falls now to the people.

“As you might imagine I disagree with the Supreme Court decision, and I agree with the dissent,” Politico reports Mitt Romney saying just after the ruling. "Obamacare was bad policy yesterday, it's bad policy today. If we want to replace Obamacare, we have to replace Obama.”

Arlene WohlgemuthArlene Wohlgemuth

Arlene Wohlgemuth, health care specialist for the Public Policy Foundation, said today renaming the health care mandate a tax does not legitimize it.

“Congress now needs to act quickly to repeal this law and take a new approach to health care reform,” Wohlgemuth said.  “But this time, we need to fix health care the right way – with patient-centered reforms that emphasize the patient-doctor relationship and allow them to make more effective and economical health care choices with less interference from insurance companies or government.”

Trevor Burrus, co-author of important amicus briefs filed in the case for the Cato Institute’s Center for Constitutional Studies, warned of irrational exuberance on the day before the ruling.

Burrus, who wrote passionately for the repeal of ObamaCare, cautioned that the Supreme Court was deciding on a single case, neither rolling back nor pushing forward the role of the federal government in the lives of individuals.

Either decision, he said, would continue to be fought in the court of public opinion.

“It’s a big decision, we all know that,” Burrus said. “But contrary to what some have said or written, there is no sky is falling here. What we’ve seen is the expansion of constitutional interpretation to the point that it now matters so much to people who is going to control their health care choices and the choices of their kids.

“That’s the importance of this case.”

Editor's Note: This story was updated at 1:40 p.m. with comments from Gov. Rick Perry, Attorney General Greg Abbott, and Arlene Wohlgemuth, a health care specialist for the Texas Public Policy Foundation. 

***
Contact Mark Lisheron at 512-299-2318 or mark@texaswatchdog.org or on Twitter at @marktxwatchdog.

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Texas AG Greg Abbott and his Republican counterparts amass power, challenge federal authority
Tuesday, Apr 24, 2012, 10:53AM CST
By Mark Lisheron
Greg AbbottGreg Abbott

Texan Greg Abbott is one of the commanders of a new legion of Republican attorneys general in defiance across a broad front of federal legal authority.

Doubling their number to 24 since 2000, these tightly knit Republican AGs have over the past two years coordinated challenges to ObamaCare, its contraception mandate and the Environmental Protection Agency, according to a penetrating analysis today by Reuters.

"There seems to be, in addition to the size, an intensified cohesion and collegiality among the (Republican) AGs," Abbott told Reuters. "Part of it is based on personality. Part of it is based on sense of purpose."

On March 26 Abbott won an appeal of the EPA’s rejection of the state’s permitting process for some power plants. The Fifth U.S. Circuit Court of Appeals ruled the EPA had exceeded its authority in making its ruling.

The state’s top attorneys have pushed back against federal challenges to voter identification laws and redistricting maps passed by their legislatures.

The Reuters story singles out Abbott for his role in questioning the validity today of a section of the 1965 Voting Rights Act that forces Texas and other southern states to have all changes to their voting district maps approved by the federal government.

While the Supreme Court did not directly address the issue, the court voted unanimously that the lower federal courts had overreached in redrawing district maps passed by the Texas Legislature.

***
Contact Mark Lisheron at 512-299-2318 or mark@texaswatchdog.org or on Twitter at @marktxwatchdog.

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Two years later, ‘weak claims’ of states challenging health care act taken quite seriously by Supreme Court
Thursday, Mar 29, 2012, 11:41AM CST
By Mark Lisheron
syringe

On March 23, 2010, the day President Obama signed the Patient Protection and Affordable Care Act into law, the New York Times took careful note of the occasion, its pomp and celebration.

Near the top of the account was a description of the president’s curlicue signature; the 22 souvenir signing pens; the blue bracelet with the word, Tedstrong, for the late Sen. Ted Kennedy, an inspiration for the reform care bill, on the president’s wrist.

Nine paragraphs down, the story mentions in a single sentence a lawsuit brought by the attorneys general in a dozen states contending the bill that would become known as Obamacare was unconstitutional.

When the lawsuit wasn’t being ignored it was being dismissed by the “experts.” Doug Kendall, founder of the Constitutional Accountability Center, a liberal legal think tank in Washington, D.C., embodied what passed for analysis at the time.

“Their embarrassingly weak claims are political theater, not genuine constitutional arguments, and a waste of both taxpayer money and judicial resources,” Kendall wrote in an op-ed piece for the Detroit Free Press.

“At the center of the Florida suit is the claim that the Patient Protection and Affordable Care Act is ‘an unprecedented encroachment on the sovereignty of the states,’ and thus a violation of the Constitution's 10th Amendment. This argument should produce laughter from the bench for the simple reason that states are entirely free to rid themselves of any burdens imposed by the act by withdrawing from the federal Medicaid program.

“The act reflects the genius of our federalist system, which makes the AGs' grandstanding in this lawsuit all the more unfortunate.”

Three full days of grandstanding over a laughable bit of political theater came to a close Wednesday with the press gripping the corners of the pall in preparation for the burial of Obamacare.

Supporters of the law must now think the unthinkable, as the Washington Post said this morning. What was once thought embarrassingly weak threatens to undo what the Post calls “the most far-reaching accomplishment of the Obama presidency” and redefine the power of the federal government.

As the redoubtable Fred Willard once said, “Wha’ happened?”

The law’s foundation, the requirement forcing every eligible American to buy insurance, happened. After a second day of brutal grilling, the conservative members of the court weighed scrapping the entire Affordable Care Act if the majority invalidates the insurance mandate, the Wall Street Journal reported today.

Justice Ruth Bader Ginsburg on Wednesday said the court had a practical decision to make, that between “a wrecking operation” and “a salvage job,” according to the New York Times today.

To salvage the law, Justice Antonin Scalia said, would require something far more practical, heroic, frightening, something almost no member of Congress had done before casting a vote for the Affordable Care Act.

“You really want us to go through these 2,700 pages?” the Times said Scalia asked a government lawyer. “Is this not totally unrealistic? That we’re going to go through this enormous bill item by item and decide each one?”

***
Contact Mark Lisheron at 512-299-2318 or mark@texaswatchdog.org or on Twitter at @marktxwatchdog.

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Supreme Court hears arguments today on health care requirement that all individuals buy health insurance; Texas AG: Law has ‘gripped the entire nation’
Tuesday, Mar 27, 2012, 09:49AM CST
By Mark Lisheron
gavel

The Supreme Court has set aside two hours today to hear why requiring Americans to buy health insurance has or does not have legal grounding in the Constitution.

This is the second of three days of testimony in a lawsuit to invalidate the Patient Protection and Affordable Care Act, brought by Texas, 25 other states, the National Federation of Independent Business and two individual plaintiffs.

The court is expected to rule on the suit sometime in June.

As articulated by Attorney General Greg Abbott of Texas, the lawsuit contends the Affordable Care Act, or Obamacare, violates the Constitution by forcing Americans to engage in commerce without their consent under threat of penalty.

The legal defense for the health care law is expected to argue that the universal need for health care creates an environment in which everyone is engaged in its commerce, whether through health insurance, their own savings or at the expense of the government and the American health care system, according to a story today by the Washington Post.

Justices on Monday showed little inclination toward an argument that they withhold judgment on Obamacare until after 2014 when the insurance mandate takes effect and only after lawsuits are brought challenging the mandate and the penalties, the Wall Street Journal is reporting.

Court-appointed attorney Robert Long invoked the Anti-Injunction Act, put in place by the federal government in the 1800s to keep tax revenue flowing by giving itself the power to delay lawsuits over tax assessments.

The argument has neither the support of the authors of the health care act nor its opponents.

Following Monday’s arguments, Abbott, Gov. Rick Perry and Comptroller Susan Combs reiterated their calls for the repeal of Obamacare, the Dallas Morning News says.

"I have been here to the U.S. Supreme Court multiple times, and I've never seen crowds like this,” Abbott said in a press release issued Monday. “The entire plaza around the Supreme Court is completely crowded with protesters against Obamacare and with supporters of Obamacare. This shows that this law is something that has gripped the entire nation.”

***
Contact Mark Lisheron at 512-299-2318 or mark@texaswatchdog.org or on Twitter at @marktxwatchdog.

Keep up with all the latest news from Texas Watchdog. Fan our page on Facebook, follow us on Twitter and Scribd, and fan us on YouTube. Join our network on de.licio.us, and put our RSS feeds in your newsreader. We're also on MySpace, Digg, FriendFeed, and tumblr.

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Photo of gavel by flickr user walknboston, used via a Creative Commons license.

State health chief says $15 billion+ needed to offset Medicaid growth in Texas
Wednesday, Feb 01, 2012, 05:58PM CST
By Mark Lisheron
pills

A year ago the Texas Public Policy Foundation commissioned a report that predicted Medicaid without dramatic reform would bankrupt Texas and every other state.

Tom Suehs told Texas Hospital Association administrators today the day of reckoning might be coming a lot sooner than the study, Final Notice: Medicaid Crisis predicted, Quorum Report posted this afternoon.

The Legislature in its next session will need to add $15 billion to $17 billion in general revenue to offset the wild growth of Medicaid in the state, Suehs, the executive commissioner of the state Department of Health and Human Services, says.

(Please note: The entire story is available only to Quorum Report subscribers.)

Legislators made a decision in the last session not to fully fund Medicaid in an effort to pass a legally required balanced budget, Suehs told hospital administrators.The bill, he says, is coming due.

Suehs told the Hospital Association conference he has played Medicaid doomsayer with the Legislature before.

“I basically said something to the effect, ‘I don’t see how the Legislature’s gonna get out of this session without some form of revenue.’ I got in trouble for that,” Suehs said. “And I’m going to say the same thing today. I think I have a little bit more data with me today.”

In its own doomsday prediction, the Public Policy Foundation said program growth alone would eventually outstrip the state’s ability to pay for it. The expansion of public health care through the Patient Protection and Affordable Care Act would add an estimated $31.2 billion to $38.6 billion to the overall growth in Medicaid of $112 billion between 2014 and 2023.

Make that overall growth of $127 billion to $129 billion in Medicaid with the Suehs adjustment.
 
***
Contact Mark Lisheron at 512-299-2318 or mark@texaswatchdog.org or on Twitter at @marktxwatchdog.

Keep up with all the latest news from Texas Watchdog. Fan our page on Facebook, follow us on Twitter and Scribd, and fan us on YouTube. Join our network on de.licio.us, and put our RSS feeds in your newsreader. We're also on MySpace, Digg, FriendFeed, and tumblr.

Follow Texas Health Care Report on Twitter, and fan us on Facebook. Texas Health Care Report is a project of Texas Watchdog.

Photo of pills by flickr user EssjayNZ, used via a Creative Commons license.
Supreme Court to hear challenge to health care act brought by Texas, 25 other states; AG Greg Abbott says federal government has exceeded authority
Monday, Nov 14, 2011, 11:12AM CST
By Mark Lisheron
Lady Justice

The Supreme Court announced this morning that it will consider a challenge by Texas and 25 other states to the constitutionality of the Patient Protection and Affordable Care Act.

The court said it will rule whether the controversial health care overhaul violated the Constitution by forcing Americans to carry health insurance and whether the bill is illegal without the requirement, according to the Washington Post.

The Post says the court will also decide whether or not the penalty for refusing to purchase health insurance included in the health care bill constitutes a tax, a point the bill’s supporters have from the start denied.

Should the penalty be ruled a tax, the court would withhold judgment on the entire bill until penalties are levied, the story says.

Texas Attorney General Greg Abbott, at the forefront of the legal challenge to Obamacare, issued a statement moments after the Supreme Court made its announcement.

"With the Supreme Court's decision to hear our challenge to ObamaCare, the federal health care law is closer to an end,” the statement said. “Given the substantial implementation costs associated with this 2,700-page law -- and the unconstitutional mandate that it will impose on all Americans -- we are pleased that the Supreme Court has moved quickly and agreed to hear this very important case.

“As the federal district court and the 11th Circuit Court of Appeals ruled in this very case, the federal government exceeded the constitutional limits of its authority by requiring all Americans to buy government-approved health insurance."

The court made its decision to hear the case in a private scheduling conference this past Thursday, as a public split on the health care law kept tally of lower court decisions.

Uncertainty and partisanship over such a sweeping change in how health care is delivered and paid for played a major role in how lawmakers in Texas and elsewhere approached their own reforms.

An effort to establish a health care insurance exchange, one of the many new requirements of the health law, was crushed in the past session of the Texas Legislature by Obamacare opponents waiting on the Supreme Court.

Opponents filed more than 25 lawsuits. The Supreme Court accepted the case brought by Florida that includes Texas, two dozen other states and the National Federal of Independent Business.
 
***
Contact Mark Lisheron at 512-299-2318 or mark@texaswatchdog.org or on Twitter at @marktxwatchdog.

Keep up with all the latest news from Texas Watchdog. Fan our page on Facebook, follow us on Twitter and Scribd, and fan us on YouTube. Join our network on de.licio.us, and put our RSS feeds in your newsreader. We're also on MySpace, Digg, FriendFeed, and tumblr.

Follow Texas Health Care Report on Twitter, and fan us on Facebook. Texas Health Care Report is a project of Texas Watchdog.

Photo of statue of Lady Justice by flickr user Scott*, used via a Creative Commons license.
Appeals court sides with Texas, 25 other states, says mandatory insurance requirement in Obamacare is unconstitutional
Friday, Aug 12, 2011, 01:23PM CST
By Mark Lisheron
gavel

A federal appeals court in Atlanta a little while ago upheld the contention of Texas and 25 other states that the mandatory insurance requirement in the Patient Protection and Affordable Care Act is unconstitutional.

The three judges of the 11th Circuit Court of Appeals split on the decision, which is expected to be argued before the Supreme Court, according to a story just filed by Associated Press.

Texas Attorney General Greg Abbott, who has been outspoken in his opposition to the insurance requirement, reiterated in a statement today that Congress overstepped its Constitutional authority in passing the health care law.

“Obamacare is closer to an end,” Abbott said. “This is an important ruling for freedom and limited government. No public policy goal, no matter how important or well-intentioned, can be allowed to trample the protections and rights guaranteed by our Constitution.”

The AP story says the appeals court’s decision on the insurance mandate was not as sweeping as lower court decisions that deemed much of key tenets of the Affordable Care Act unconstitutional.

Several challenges to the health law’s constitutionality are making their way through the courts. An appeals court and three federal judges have so far upheld the law, and two have invalidated it.
 
***
Contact Mark Lisheron at 512-299-2318 or mark@texaswatchdog.org or on Twitter at @marktxwatchdog.

Keep up with all the latest news from Texas Watchdog. Fan our page on Facebook, follow us on Twitter and Scribd, and fan us on YouTube. Join our network on de.licio.us, and put our RSS feeds in your newsreader. We're also on MySpaceDiggFriendFeed, and tumblr.

Follow Texas Health Care Report on Twitter, and fan us on Facebook. Texas Health Care Report is a project of Texas Watchdog.

Photo of gavel by flickr user s_falkow, used via a Creative Commons license.
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