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The U.S. Supreme Court is set to hear opening arguments on a case challenging the constitutionality of the Affordable Care Act, or “Health Care Reform” law passed in 2010. The law is being challenged on a variety of grounds by 26 states.

The court’s decision, not expected until this summer, will have a major impact on the future of reform efforts. The court has a variety of options concerning this issue: 1) they can uphold the law in full; 2) rule that certain sections of the law are unconstitutional, while leaving some parts intact, 3) rule the entire law unconstitutional, effectively repealing it or 4) defer ruling based on an argument that a court can’t rule on a challenge to a tax that has not yet been assessed. Though a highly technical argument, which the court will hear first, it could punt this issue 3-4 years down the road.

The oral arguments will be as follows:

March 26 – 90 minutes on whether the Anti-Injunction Act (AIA) disallows the court from taking up the challenge against the individual mandate. The AIA prevents a court from striking down a tax before the tax is enacted. Even though the Affordable Care Act is current law, many of the provisions to not go into effect until 2014. Should the court rule in favor of the AIA, it would punt the court’s consideration of this issue into the future.

March 27 – 2 hours on the individual insurance mandate and whether the federal government has the constitutional authority to mandate a consumer’s purchase of health insurance.  The federal government will argue that the mandate is constitutional because it falls within the authority of Congress to regulate interstate commerce.  Meanwhile, the plaintiffs will argue that the law represents near limitless power of the federal government and that Congress cannot require an individual to enter into commerce under the interstate commerce clause of the Constitution.

March 28 – 1 hour on the constitutionality of the ACA’s Medicaid expansion. The plaintiff will argue that the federal government is overstepping its bounds by requiring states to expand their Medicaid programs.

Following the discussion the court will hear 90 minutes of argument concerning the ability for the individual mandate, should it be found to be unconstitutional, to be removed from the law, while leaving the rest of the law intact.

All of these possible rulings would set up a variety of challenges for hospitals, but perhaps most troubling is the scenario whereby the court strikes sections of the bill that would be beneficial to hospitals while leaving the existing Medicare cuts to hospitals also found in the bill. This “swiss-chesse” approach would punch holes in the law that could keep hospitals on the line for the $155 billion in Medicare cuts but hospitals would not benefit from the insurance mandate, should it be struck down, that would result in more insured patients.

Check the IHA Policy Blog for updates on this issue and for additional information and insight on the case.

Health Reform and Economic Impact, part 2 [VIDEO]

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On June 16-17, the Iowa Hospital Association hosted its summer leadership forum: Reform and the Road Ahead. Conference objectives were to discuss the current MedPAC recommendations regarding health care payment reform, how scale matters in health care and what the impact of the current U.S. economy will have on the entire health care industry.

The following video is the second in a two-part series of interviews conducted with a couple of the forum’s esteemed speakers. IHA had the chance to speak with David Swenson, Associate Scientist, Department of Economics at Iowa State University. Swenson provides his unique perspective on where the country is at in the current economic recession and how it may affect the economics of health care in the near future.

Part one of the series was posted last week and featured Herb Kuhn, President and CEO of the Missouri Hospital Association (Jefferson, MO), who discussed his thoughts on how health care reform will impact states like Iowa and Missouri.


YouTube link: http://www.youtube.com/watch?v=TyiolSNFgBg

Health Reform and Economic Impact, part 1 [VIDEO]

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On June 16-17, the Iowa Hospital Association hosted its summer leadership forum: Reform and the Road Ahead. Conference objectives were to discuss the current MedPAC recommendations regarding health care payment reform, how scale matters in health care and what the impact of the current U.S. economy will have on the entire health care industry.

The following video is the first in a two-part series of interviews conducted with a couple of the forum’s esteemed speakers. IHA had the chance to speak with Herb Kuhn, President and CEO of the Missouri Hospital Association (Jefferson, MO), on how health care reform will impact states like Iowa and Missouri.

Part two of the series will be posted next week and will feature David Swenson, Associate Scientist, Dept. of Economics at Iowa State University. (Update: click here for part 2)


YouTube link: http://www.youtube.com/watch?v=nWSOlXI7qiA

Obama Begins Town Hall Meetings on Health Care Reform

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President Obama will hold the first in a series of “tele-town hall” meetings today with seniors across the country.  The president, joined by Secretary of Health and Human Services Kathleen Sebelius, focus on the upcoming $250 rebates for seniors on Medicare who fall into the so-called prescription drug “donut hole.”

Due to a flawed formula, many who use the Medicare Part D prescription drug program do not receive the needed level of benefits leaving them on the hook for much of hte cost of prescription drugs.  The health care reform bill included rebates to beneficiaries affected by this and hopes to offset some of the cost.

The president will also take questions from seniors across the country as well as discuss efforts to combat senior scams and fraud in advance of the first mailing of the rebate checks.  An estimated four million seniors nationwide will receive rebate checks.

The event will be broadcast on C-SPAN and can be seen from the following locations in Iowa:

National Council on Aging
Iowa City Johnson County Senior Center
28 South Linn Street
Iowa City

Alliance for Retired Americans
Machinists Hall

2000 Walker
Des Moines

Alliance for Retired Americans
Black Hawk Labor Temple

1695 Burton Ave
Waterloo

Alliance for Retired Americans
IBEW 405

1211 Wiley Blvd. SW
Cedar Rapids

Cedar Falls Senior Center
528 Main Street
Cedar Falls

Buchanan County Senior Center
400-5th Avenue
Independence

Marshall County Senior Center
20 ½ E. State Street
Marshalltown

Kimball Ridge Senior Center
2101 Kimball Avenue
Waterloo

Dartmouth Hammers ‘Superficial’ New York Times Story

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Researchers at the Dartmouth Atlas of Health Care are reacting to a recent New York Times article with pointed criticism.  Principal scientists Elliott Fisher and Jonathan Skinner said they are “disappointed” in the article’s attack on the veracity of Dartmouth Atlas data, which has been widely cited and highly influential with regard to health care reform.  

The two scientists go on to point out several factual errors and misrepresentations in the article.  Among the errors: the Times claims Dartmouth data does take into account quality of care; Fisher and Skinner show that the atlas does indeed contain quality data.  The article also claims that “neither patients’ health nor differences in price are fully considered by the Dartmouth Atlas”; the scientists respond that risk adjustments are included in their studies.  As for price, they point out that because their investigations focus on actual measures of utilization, price adjustments are not necessary, though fully price-adjusted expenditure data is also available on the Dartmouth Atlas Web site, just the same. 

Rather than the Times article, which cites “critics” of Dartmouth’s work but fails to present any substantial criticism (or at least none that can hold up to scrutiny) and Skinner and Fisher describe as “superficial,” the researchers urge readers to take the time to read their initial but very thorough responses to the reporters’ questions, which the Times posted as a sidebar. 

In an article that ran in the Dartmouth campus newspaper, Fisher reiterated that the Dartmouth Atlas findings – essentially, hospitals that spend more on high-intensity health care “are less likely to deliver safe and effective care” – remain largely undisputed in the scientific community.  

“All of this research and all the findings they cite [in the Times’ article] are consistent with ours,” Fisher said. “The Times is not helping advance the public’s understanding of what’s going on.” 

Fisher went on to say that the potential remains to save “about 20 to 30 percent of health care spending” if more hospitals engage in “better performance measures, greater accountability and payment systems that reward improved performance.”

Like the scientists at the Dartmouth Atlas, IHA and Iowa’s hospitals are committed to understanding variations in health care delivery for the purpose of ensuring access to high-value health care.

 The New York Times, meanwhile, appears less interested in improving health care and more interested in creating controversy where there is none.