Healthcare 4 All PA Response: Supreme Court Ruling on PPACA and Implications for the Single Payer Solution

This is the official Healthcare for All PA response from Executive Director Chuck Pennacchio to the Supreme Courts decision on Thursday.

 

Dear Friends of the Proven Single Payer Solution:

The Supreme Court of the United States ruled this morning, by a narrow 5-4 decision, that the Patient Protection and Affordable Care Act (PPACA) is largely constitutional.  Writing for the majority, Chief Justice John Roberts found the insurance purchase mandate permissible, but only if re-conceived of as a "tax" and, therefore, consistent with Congress' regulatory powers under the Commerce Clause.  The remainder of the national health insurance bill was also found to be constitutional, with the notable exception of the law's punishing effects of withholding funds from states that refuse to accept PPACA's new Medicaid eligibility standards.

Now that the Supreme Court is permitting the implementation of PPACA, what does the ruling mean for potential recipients, costs, access, quality, providers, jobs, economy, and sustainability?  And what will it mean for the proven Single Payer Solution that effectively addresses and resolves the aforementioned issues and steers clear of any current of future constitutional challenges?

Given the six-year implementation of the Massachusetts Model, the PPACA-related answers to the above questions are mixed - but, regrettably, mostly negative.  Yes, perhaps 2% percent of Americans - those aged 19 to 26 (2.6 M), those with pre-existing conditions (70 K), those who are indigent and uninsured (3 to 4 M) - will appreciate increased access to healthcare providers and services.  That is PPACA's best news - and one cannot understate or undervalue the importance of expanding healthcare to Americans previously shut out of the system altogether.  On the other hand, a significant chunk of the 2% targeted beneficiaries intended for inclusion in expanded healthcare will not get what they need because of the shrinking pool of primary care physicians, community hospital closures, unaffordable premiums/co-pays/deductibles, across-the-board cuts in healthcare spending, and systemic "gaming" and "cherry-picking" by a profit-centered health insurance industry.

Now for the predictable bad news - based on PPACA's legislative forerunner, the Massachusetts Model.  Initial Massachusetts successes in increasing those with health insurance paperwork and those with actual access to healthcare have given way, in the last four years, to alarming rises in the uninsured, the under-insured, taxes, premiums, co-pays, deductibles, hospital closures, physician flight, and overall healthcare outcomes  (http://tinyurl.com/723stts).  The Massachusetts legislature is now cutting, not increasing, services, as economic and budgetary restraints bring political calls for austerity.  Profit-first, health insurance-centered healthcare is proving to be unsustainable in a state that is disproportionately wealthier and more liberal than most.  If PPACA modeling can't work in Massachusetts, how can we expect it to work in the partisan puzzle palace known as Washington, D.C.?

Now for the good news: advancing the Proven Single Payer Solution. PPACA is simply unsustainable - financially, economically, morally, politically, and logically.  Simply put, PPACA over-promises and under-delivers.  It increases the power and profits of the profit-first, healthcare denying health insurance industry, while leaving patients, providers, taxpayers, municipal governments, businesses, labor unions, and more, at the mercy of the predatory medical-industrial-complex.  Politicians enable, corporate insurance profits, citizens suffer.

Only the Proven Single Payer Solution solves the system.  And, irony of ironies, PPACA provides state-based waivers and instruments to implement state-based single payer!  As healthcare-related costs continue to escalate out of control (to perhaps 25% of GDP in 2025), healthcare access diminishes, medical bankruptcies and preventable medical tragedies increase, and more, the system will collapse on itself.  Who knows where the tipping point is?  But we all know that the evidence and morality point to the American answer: Single Payer, aka, Expanded and Improved Medicare for All.  That is, publicly-funded, privately-delivered, guaranteed, quality, comprehensive, doc-and-nurse-retaining, cost-cutting, job-generating, healthcare for all.  Single Payer.  Centrist.  Sensible. Solution.

Today is a day to build on.  Our struggle continues.  We will win.  Healthcare for all!

Yours in solidarity,

Chuck Pennacchio

Executive Director

Healthcare for All Pennsylvania 
cpennacchio@gmail.com

The Friday Morning Quarterback

So much is being written about yesterday's Supreme Court decision “upholding” the Affordable Care Act (ACA) that it's hard to gain a clear perspective on the consequences of the decision. One week for now, I may regret most of what I've written here.

Here's the Court's decision. For those interested in just the basics, check out The New York Times' annotated summary. However, I recommend that everyone read Justice Ruth Ginsberg's dissent (which starts after p. 59) in its entirety. It's a masterpiece of clarity and common sense.

In reacting to the decision, I think President Obama hit the right note by refusing to discuss its political implications and focusing on the millions of Americans who are or will become seriously ill who will benefit from the decision. Paul Krugman had a similar reaction.

Let's face it. Regardless of Chief Justice John Roberts' motives, we dodged a bullet here. Just look at the decisions—both good and bad—that were announced this week: the reaffirmation of Citizens' United by striking down Montana's campaign finance reform law, the rejection of mandatory life sentences for juveniles, the upholding of Arizona's right to stop and detain people merely because they appeared to be Hispanic. A conservative, activist Supreme Court has inserted itself into the history of the country with consequences that will be difficult or impossible to reverse. The most important issue in November's presidential election may be its implications for future Supreme Court appointments.

Roberts' denial that the ACA constituted the “regulation of interstate commerce,” when health care accounts for 18% of GDP, is not just absurd. The implications of ruling that people who refuse to buy health insurance are not engaged in interstate commerce because they haven't bought it yet are difficult to foresee. In the past, the commerce clause has been used to justify a variety of labor, public health and safety, and civil rights laws that protect people who are not directly engaged in interstate commerce, but who are indirectly affected by its consequences, i.e., people who live downwind from a source of industrial pollution. These reforms now appear endangered by this decision. Does this mean that corporations may refuse to hire or serve minority applicants because, after all, if they are excluded from participation, they are not engaged in interstate commerce? How will this decision impact Congress's ability to implement a national energy strategy by, for example, requiring people to purchase some of their energy from renewable rather than nonrenewable sources?

One important provision of the ACA that the Supremes failed to uphold was the expansion of Medicaid. Under the ACA, Medicaid was expanded to cover all folks under 65 whose incomes are 133% of the federal poverty level or less. This amounts to about half of the 30 million people who are not now insured, but would be under the ACA. Medicaid is administered by the states, but the federal government agreed to provide 100% of the money for the Medicaid expansion in 2014. This was to be gradually reduced to 90% in 2020. The incentive for states to comply was that, if they refused, the federal government would withhold all their Medicaid funds.

Chief Justice Roberts thought this was too coercive, a “gun to the head” of the states. This is the first time in our history that a state spending requirement has been rejected as too coercive. What other federal requirements will states object to? In 1987, the states were told that all federal highway funds would be withheld unless they agreed to raise the drinking age to 21. Presumably the Roberts court would consider this too coercive. Federal funds for public education are contingent on the states' meeting federal standards. Is that too coercive?

Will the states implement the Medicaid expansion even though there is no penalty for refusing to do so? The Democrats are optimistic. How can the states justify withholding benefits from poor people that are paid for entirely by the federal government? That's like turning down free money, right? However, just within the last three years, some states have turned down federal stimulus money and even unemployment benefits for their citizens. The Jackasses may have underestimated the extent of some Americans' hostility toward the poor, especially those Americans who mistakenly think that most Medicaid recipients are African-Americans.

If not all states implement the Medicaid expansion, the states in which this coverage is most likely to be denied are those whose citizens have the greatest need for it—states like Alabama, Mississippi, Louisiana and Texas. Although experts are still working out the detailed implications of yesterday's decision, it appears that, because the ACA assumes that the states will implement the Medicaid expansion, most of the people below 133% of the poverty level in any states that refuse to expand Medicaid will also be ineligible for low income subsidies to help them purchase health insurance. What a mess! Health care is far too important to be left to the states.

Finally, let's remember that the ACA is no substitute for a single payer health care system. Even if it is completely implemented, it still leaves 27 million people living in this country uninsured. As presently written, it does little to control either the cost or the quality of our health care. Needless to say, there is still a lot more work to be done.

Please come to Philadelphia this Saturday for the 5th anniversary "Sicko" reunion. Meet Wendell Potter as well and learn about the very much alive and well single-payer healthcare movement.

Jerry Policoff at the state board of Healthcare for All PA has written an OP/Ed on the upcoming One Payer States conference in Philadelphia this weekend.

Subject: healthcare4allpa Please come to Philadelphia this Saturday for the 5th anniversary "Sicko" reunion.  Meet Wendell Potter as well and learn about the very much alive and well single-payer healthcare movement.

Below is my Op Ed News article that will probably be up and headlined by the time you receive this.  You won't want to miss these two exciting events.

Still "SiCKO After All These Years

Jerry Policoff/Op Ed News

Article Link: /articles/Still-SiCKO-After-All-Th-by-Jerry-Policoff-120628-166.html

If you care about affordable, accessible health care in the United States you'll want to be in Pennsylvania this weekend for two remarkable events that will re-unite Oscar-winning documentary film maker Michael Moore with the cast of his 2007 ground breaking film, "SiCKO," on the occasion of the fifth anniversary of the film's release.  Former Cigna executive turned whistleblower, Wendell Potter will be there as well in another reunion of sorts.  Moore and Potter have never shared a stage face-to-face before, but Wendell Potter's last official act before re3signing from Cigna was to attend the premiere of "SiCKO" to spy on Michael Moore and his film on behalf of the health insurance industry. 

The events:

Saturday, June 30, 2012 4-6 PM: An Intimate Reception with Michael Moore and Wendell Potter  

William Way Center Ballroom, 1315 Spruce Street, Philadelphia, Pa.  $100 minimum donation

Meet and chat with Michael Moore and Wendell Potter and hear the latest on the movement for universal healthcare in the U.S. from movement leaders from around the country.  Includes a light dinner.   Order reception tickets at http://tiny.cc/sickoreception

Saturday, June 30, 2012 7-9 PM:  "Still SiCKO After All These Years"

Plays and Players Theater, 1714 Delancy Street, Philadelphia, Pa. $40 Minimum Donation.

Join Wendell Potter as he reunites with the cast of "SiCKO" for a Q&A and discussion looking back at  how the film impacted their lives five years after its release.  Order tickets at: http://tiny.cc/sicko5

Proceeds to benefit Vermont Public Assets Institute (publicassets.org) and Healthcare-NOW! (healthcare-now.org).  Vermont Public Assets Institute is working to defend the newly passed Vermont single-payer healthcare law, already under assault from healthcare special interests.  Healthcare-NOW is a national single-payer advocacy group.

By Saturday the Supreme Court will have ruled on the whether all or part of President Obama's Affordable Act will remain the law of the land, but regardless of the Court's actions, and unbeknownst to much of the nation, the universal healthcare "single-payer" movement is very much alive, especially in the individual states where some 22 state-based single-payer movements are hard at work.   Advocates of state passage will be meeting in their annual "One Payer States" conference on Sunday, also in Philadelphia (not open to the general public, to compare notes, map out future strategy, and discuss the implications of the Court ruling.  Those items will certainly also be a major topic for discussion at Saturday's public events. 

Did you know that the Affordable Care Act contains state waiver provisions that would allow states  to experiment with alternative reforms  to the Exchanges, including single-payer  starting in 2017, or that President Obama has endorsed moving that waiver date up to 2014?  Were you aware that Vermont has already passed a single-payer bill and is currently studying how to implement it even as special interests mount a major pushback campaign against it?  Wendell Potter is a supporter of the Affordable Care Act as well as a single-payer advocate who is actively involved in assisting and defending the Vermont single-payer experiment.  You probably do not know that the Governor of Hawaii is a strong single-payer advocate who campaigned on establishing a single-payer system there, or that his Legislature as well as the Hawaii AMA are largely supportive.  A study group has already been formed in Hawaii in preparation for enacting single-payer legislation there.

So come one, come all to Philadelphia this Saturday for an entertaining and constructive learning experience.  You'll also be helping advance the U.S. move to truly comprehensive universal healthcare.  The U.S. is alone among the advanced industrialized countries on this planet to have so far failed to provide affordable, comprehensive health care to all of its citizens.

Jerry Policoff

1117 Wheatland Avenue/ H-4

Lancaster, Pa. 17603

Home phone:  717-295-0237

Cell: 717-682-4434

www.healthcare4ALLPA.org

Face Book Causes: HealthCare4ALLPA

Mission Accomplished

It's Wednesday. Here's something to think about while we're waiting for the nine Supreme beings to come down from the mountaintop tomorrow and hand us the tablet that will mean life or death for thousands of Americans.

By now, you probably know the recent history of health care reform. The individual mandate—the requirement that everyone purchase health insurance—originally proposed by the Heritage Foundation, a conservative think tank, was the cornerstone of Republican health care plans for two decades. They preferred it because it encouraged “individual responsibility.” President Obama opposed the individual mandate during the 2008 campaign, but he and the Jackasses eventually conceded in the hope of gaining conservative support. (Flip!) Then, in 2009, in an even more remarkable turnaround, the Elephants in Congress unanimously decided that the individual mandate was unconstitutional. (Flop!)

As Ezra Klein reports, in 2010, when 14 Republican state attorneys general filed their suit challenging the constitutionality of the Affordable Care Act (ACA), “it was hard to find a law professor in the country who took them seriously.” (Here's an analysis of why the ACA is constitutional.)

How did the corporate media report on the constitutionality of the law? First of all, here's what they were reporting on. There were nine court cases related to the constitutionality of the act. Four of these courts overturned the law and five upheld it. There were also several cases in which courts dismissed complaints without ruling on the constitutionality of the law.

Media Matters looked at all the reports devoted to these courts cases on the nightly newscasts of ABC, CBS, CNN, Fox and NBC—a total of 31 segments. Of these 31 segments, 26 (84%) reported decisions that the act was unconstitutional, 3 (10%) reported rulings that it was constitutional, and the remaining 2 (6%) dealt with dismissals. If instead of counting segments, you get out your stopwatch, you find that a remarkable 97% of air time was spent discussing cases that overturned the law.

Unfortunately, the researchers do not report the number of minutes these newscasts devoted to advertisements paid for by pharmaceutical companies, insurance companies and health care providers.

Newspapers were only marginally better. There were 59 articles about these court cases in the Los Angeles Times, New York Times, USA Today, Wall Street Journal and Washington Post. Thirty-five of them (59%) dealt with rulings that the ACA was unconstitutional, 17 (29%) dealt with decisions that it was constitutional, and 8 dealt with dismissals. Rulings of unconstitutionality were far more likely to make the front page.

It's possible that, initially, the greater attention given to rulings that the ACA was unconstitutional was due to the fact that journalists were surprised by these decisions, given the near-unanimity of their legal experts. However, that does not account for the consistency and longevity of these findings.

The bottom line is that this unbalanced coverage appears to have had its intended effect. A Gallup poll released earlier this month found that 72% of Americans think the ACA is unconstitutional. Several polls have found that the majority favor repeal of the law. For example, Rasmussen reported that, as of June 23-24, 54% of likely voters favor repeal and 39% oppose it. Although, as my colleague Paul Ricci reports, a majority of those folks favor starting work on a new health care reform bill, it's hard to imagine that any new health care legislation could get through Congress in the foreseeable future.

Healthcare Poll Insanity

Last Friday I did a post on the PUSH site showing how healthcare polling has remained consistent in the weeks leading up to the Supreme Court's Decision on the Affordable Care Act.  Last night I came across a tweet by Michele Bachmann stating:

MicheleBachmann ‏@MicheleBachmann 18 Jun 83% of surveyed doctors considering leaving medical industry if #Obamacare is fully implemented tiny.cc/lqt3fw #tcot

The tweet was retweeted by 130 of her 137,300 followers and favorited by 12.  These followers have hundreds to thousands who can pass this on to their followers.  This is what is meant by going viral.

I did follow the tiny.cc link above to the report and found that it came from the Doctor Patient Medical Association which faxed or mailed 16,227 forms to doctors nationwide and 4.3% were returned or a total of 699.  I have worked on mail surveys of physicians and getting a large response rate can be a problem unlike phone surveys.  Mail in surveys are cheaper than phone but incentives are often needed to increase response rates.  Even with a small incentive a response rate of 25% is typical.  Small response rates may not be a problem if those who respond are representative of those who did not.  For this poll, with a response rate that low it may be hard to justify that it is representative.  They do provide demographics but do not compare it to national physician demographics. 

It's so tempting to jump to conclusions on research findings when it's supports what one already believes.  It's tempting to rip on congresswoman Bachmann because of her past statements, as Jon Stewart does below.  I'll stick to this statement and her comment above.  Others who haven't made as many outrageous statements can just as easily make the same mistake without reading the results more carefully.  This is also meant to show the power and peril of social media like Facebook and Twitter. . Remember the hysteria caused by Sarah Palin's death panels post on Facebook? How many people still believe her?

The Daily Show with Jon Stewart
Get More: Daily Show Full Episodes,Political Humor & Satire Blog,The Daily Show on Facebook

**Update**


Sarah Palin has resurrected her 'death panels' claim on her Facebook page to her 3.4 million followers.  It has been shared by 369 and "liked" by 1,479 since being posted on Monday.  The LA Times debunks it here.



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Healthcare Polls in Anticipation of SCOTUS Decision

With the political class anxiously awaiting the Supreme Court's (SCOTUS for short) decision on the Affordable Care Act (ACA) as if it were an endless Christmas night (Healthcare 4 All PA has prepared official responses for the possible ways in which it may rule).  There has been a flurry of new polls on the act summarized below from the website Real Clear Politics:

Polling Data

Poll	Date	Sample	For/Favor	Against/Oppose	Spread
RCP Average	4/5 - 6/18	--	38.6	49.4	Against/Oppose +10.8
Associated Press/GfK	6/14 - 6/18	1007 A	33	47	Against/Oppose +14
Rasmussen Reports	6/9 - 6/10	1000 LV	39	53	Against/Oppose +14
Reuters/Ipsos	6/7 - 6/11	1099 A	45	44	For/Favor +1
CBS News/NY Times	5/31 - 6/3	976 A	34	48	Against/Oppose +14
CNN/Opinion Research	5/29 - 5/31	1009 A	43	51	Against/Oppose +8
NBC News/Wall St. Jrnl	4/13 - 4/17	1000 A	36	45	Against/Oppose +9
Quinnipiac	4/11 - 4/17	2577 RV	38	51	Against/Oppose +13
FOX News	4/9 - 4/11	910 RV	40	53	Against/Oppose +13
ABC News/Wash Post	4/5 - 4/8	1003 A	39	53	Against/Oppose +14

The polls generally state public opposition when they are averaged together in the top row of the table above.  Obviously these polls cover a long time frame from April to June, the period of the court's deliberation.  The sample sizes are given in the next column with the letters stating from which population it was taken.  A means general American public, RV means registered voters, and LV (in the Rasmussen poll) means likely voters in the next election, the most biased of the three sample types above.  Among other factors, the way in which the sample of a poll or survey is selected can bias it's results.

With the exception of the Reuters/Ipsos poll, all of the ones above show at least an 8 point spread against the ACA which would be outside the margin of error so we can be confident that that is the way that the US population feels about the law.  Clicking on the link above for each of the polls will take you to the summary report for the poll.  For the Reuters poll there is a 45-44 split which is within the margin of error (+/- 3%).  The poll does ask a further question of those who oppose the law if it goes too far or does not go far enough.  Of those who are asked this question, there is a 22-68% split for those who say it does not go far enough relative to those who say it does.  When that 22% is added to the 45% who support the bill there is a 54-44% split in favor of universal healthcare like the ACA or stronger.  The CNN poll has found a consistent pattern for the last two years.  When combining those who oppose the ACA because it is not liberal enough with those who support it they find a 56-34% split in favor relative to those who oppose it because it is too liberal. Neither poll probes what 'not liberal enough' or 'not far enough' means.

The other polls do not ask similar questions.   The AP poll does ask if SCOTUS overturns the ACA what Congress should do and found that 77% want them to work on a new law.  Of course single payer was not mentioned in any of these polls or surveys but there does seem to be a receptiveness in the public to stronger reforms of the health care system.  The challenge now will be to get the message out.

**Update**

The Nation magazine has produced a graphic which illustrates part of what I wrote above.

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Pearl Korn: With the Affordable Care Act Hanging by a Thread, It's Time for Single-Payer

Healthy Artists Video on Bicyclists Injury

Any day now the Supreme Court of the United States or SCOTUS will announce it's ruling on the Affordable Care Act (ACA) or Obamacare.  Julie Sokolow at Healthy Artists has produced another video clip profiling an artist, Daniel Menges who experienced an injury while riding his bicycle and was aided by the Affordable Care Act.  While we agree that some are helped by the Act who weren't before (because this person could be kept on his mother's insurance until he's 26)   Many cyclists are uninsured making them vulnerable to injury by cars and bad roads and trails.  Cycling has many health and environmental benefits and should be encouraged.  Bike Pittsburgh advocates for safer riding conditions for cyclists.  You can read about their efforts on their blog.

There still are many improvements that need to be made to the ACA as are spelled out in this website.in posts below and in the tabs above.

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STOP Obamacare in Pennsylvania and the Uninsured

 

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Santorum: No One Has Ever Died Because They Didn’t Have Health Care | The New Civil Rights Movement

Bob Mason's Letter to the Pittsburgh Post-Gazette

Healthcare for All Pa vice President Bob Mason had a Letter to the editor posted in the Pittsburgh Post-Gazette on Friday, June 15 in response to an article linked to in the repost below. 

As you advocated in the editorial "Dropping the Baby:  DPW is Wrong to Cut Newborns' Hospital Care"  (June 8), valuing life should include adequate funding for newborns' hospital
care under Medicaid, which pays for almost half of all births in
Pennsylvania.  Even at a time of austerity, some sacrifices are just
too great.

Absent financial support for obstetrical services, hard pressed rural
hospitals might be forced to eliminate them, further decreasing the
availability of medical care for pregnant women in many counties
in the Commonwealth. This gap should also be viewed in the context of
the United States' ranking 31st in infant mortality.

Fortunately, there is a humane and affordable solution.  Pennsylvania
has a single payer plan, the Family and Business Health Security Act (SB 400/HB 1660),
which builds on the advances of the federal Affordable Care Act and
would fund comprehensive health care for all Pennsylvanians through
publicly financed, privately delivered services.  It would save
billions of dollars for taxpayers, businesses, and government through
a significant reduction in the overhead of the current health
insurance industry ( as much as 30%).  The plan also
includes mechanisms to address the gap in health care in
Pennsylvania's rural areas.

Let's welcome the newest Pennsylvanians with the care all human beings
should receive.  (More information is available at
www.healthcare4allpa.org.)

--
Bob Mason
Vice President
Health Care 4 All PA

**Related Post**

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Since August, 88,000 Pennsylvania children have lost Medicaid benefits - Philly.com

 

The Pennsylvania Medicaid Budgetary Squeeze

Ed Grystar on the Other Possibilities Network

Watch live streaming video from otherpossibilities at livestream.com

Ed Grystar of the Western PA Coalition for Single Payer Healthcare gave an online interview with The Other Possibilities Network to talk about Single Payer Healthcare. He wrote an Op Ed in the Pittsburgh Post Gazette with Health Care for all PA director Chuck Pennacchio and Tony Buba. It can be seen above.