Obamacare

Top GOPer: Ban On Pre-Existing Conditions Discrimination 'A Terrible Idea'

Sahil Kapur | May 1, 2012, 1:42PM

Rep. Tom Price (R-GA), the No. 5 House Republican, says he opposes one of the Affordable Care Act's most popular provisions -- a ban on the insurance company practice of discriminating against people with pre-existing medical conditions.

"It's a terrible idea," he told Politico.

The remarks reflect a major conundrum for Republicans who, a year and a half after winning back the House, still have no idea how to replace "Obamacare" and are divided over how best to repeal it.

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Obamacare

How 'Obamacare' Is Saving Seniors Billions On Meds

Sahil Kapur | May 1, 2012, 6:16AM

In the first two years after "Obamacare" was signed, Medicare reforms in the law saved seniors a total of $3.4 billion in prescription drug costs by bridging a coverage gap, according to official figures.

Over 220,000 beneficiaries have saved an average of $837 in the first three months of 2012, the Medicare agency said Monday. That's on top of $3.2 billion in savings enjoyed by some 5.1 million seniors in 2010 and 2011 thanks to the Affordable Care Act, according to the advisory on the new figures.

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Obamacare

'Obamacare' To Yield $1.3 Billion In Rebates For Consumers

Sahil Kapur | April 26, 2012, 1:30PM

A lesser-known but important provision in "Obamacare" that regulates how health insurance companies spend their money is yielding benefits for consumers, a new study finds.

By this August, insurers are projected to send consumers a total of $1.3 billion in rebates, according to a Kaiser Family Foundation analysis released Thursday -- $541 million to large employers, $377 million to small businesses and $426 million to people with their own insurance plans.

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Barack Obama

Medicare, Social Security Reports Fuel Fight Over GOP Privatization Plan

Brian Beutler | April 23, 2012, 2:59PM

The Medicare and Social Security trustees presented mixed news for the country's two largest and most popular entitlement programs in annual reports released Monday. The analyses suggest that the 2008 economic crisis, and its lingering effects on the economy, have modestly weakened the programs' finances -- but that President Obama's health care law, if implemented as intended and matched with advancements in health care delivery, will extend the life of Medicare as expected.

The conclusions fuel an ongoing fight between the parties over the propriety of the programs, and the manner in which the federal government should act to provide sustainable retirement security for American workers. In particular, it puts the parties' vastly different views about Medicare back at the center of the 2012 election -- and will force Republicans to continue to defend their far-reaching plan to privatize that program.

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Barney Frank

Barney Frank: NRCC 'Twisting My Words' On Health Care

Sahil Kapur | April 17, 2012, 10:54AM

Rep. Barney Frank (D-MA)

Rep. Barney Frank told TPM Tuesday morning that the National Republican Congressional Committee is "twisting my words" by citing a recent interview to say Frank believes the Affordable Care Act is a "disaster."

"No, I have no issue with the subject matter or the bill itself," Frank said. "I was just commenting on the politics. And I was saying it was a mistake to have done it first." He was arguing that Democrats should have prioritized financial reform, Frank insisted -- which was more popular, and for which which Frank was the point person -- before moving on to health care.

In the interview with New York magazine, Frank said, "I think we paid a terrible price for health care. I would not have pushed it as hard. As a matter of fact, after Scott Brown won, I suggested going back. I would have started with financial reform but certainly not health care."

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HCR/SCOTUS

How John Roberts Could Uphold 'Obamacare'

Sahil Kapur | April 9, 2012, 6:05AM

In his written opinion on a recent case regarding the constitutionality of suspicionless, forced strip searches of inmates, U.S. Chief Justice John Roberts pointed at one way he could come down on the side of upholding President Obama's health care law and assuage libertarian fears of federal over-reach, some court-watchers speculate.

The constitutional questions in Florence v. Board of Chosen Freeholders of County of Burlington are different than those in the health care case. But experts see a potential connection in the broader philosophical point Roberts made in his concurring opinion.

Last week the Supreme Court held 5-4 that prisons may strip-search inmates, even those who are jailed for minor infractions, arguing that security concerns trump privacy in such an environment. Roberts wrote a short aside emphasizing that the court may later place limits to that power when necessary. The caveat suggests that Roberts is concerned about tarnishing his court's legacy by issuing opinions that reflect poorly on his tenure as chief justice in retrospect. And it highlights the fact that future courts can circumscribe federal powers -- including the one at stake in the fight over "Obamacare."

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Supreme Court

DOJ: No, Obama Didn't Say Courts Can't Strike Down Laws

Brian Beutler and Sahil Kapur | April 5, 2012, 2:05PM

Attorney General Eric Holder

U.S. Attorney General Eric Holder responded Thursday to a federal appeals court's request for a letter explaining President Obama's assertion that the Affordable Care Act must be upheld, a move that even some conservatives considered a bridge too far.

Holder reminded the Fifth Circuit Court of Appeals that the president was making the point that the law jibes with longstanding precedent, but -- contrary to what the Republican-appointed judges suggested -- he wasn't challenging the judicial branch's authority to strike down laws that violate the Constitution.

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Paul Clement

How GOP's Lawyer Paul Clement Helped Defend 'Obamacare'

Sahil Kapur | April 5, 2012, 10:57AM

Paul Clement, the lawyer for the Republican-led states challenging "Obamacare," played a key role years ago, when representing the Bush White House, in expanding the same federal power that's now the constitutional basis for the health care reform law. Today his clients have different interests, and the 180-degree flip in his reasoning underscores an inconsistency in Republican views of the Constitution.

As the Bush administration's solicitor general in 2004, Clement argued before the Supreme Court in Gonzales v. Raich that Congress's power to regulate interstate commerce is broad enough to override state laws permitting medical marijuana patients to grow cannabis for personal consumption. Notably, two of the justices he won over in the the 6-3 decision were Anthony Kennedy and Antonin Scalia.

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John Roberts

John Roberts Faces A Legacy-Defining Predicament On 'Obamacare'

Sahil Kapur | April 4, 2012, 5:39AM

You're the chief justice of the United States, and you're presented with a choice: Either rebuke the political movement that gave you your dream job, or put your institution's reputation on the line by neutering a sitting president's signature legislation for the first time in 75 years.

This is the unenviable dilemma John Roberts faces as the Supreme Court prepares to rule on "Obamacare." Initial votes were cast by the justices last Friday, and a final decision on the law's constitutionality is expected by the end of June. And with four liberal justices considered a lock to uphold the law, Roberts is uniquely positioned to determine the law's fate, and faces considerable risks no matter what he chooses.

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Health Care

Why Overturning 'Obamacare' Could Lead To Single-Payer

Sahil Kapur | April 2, 2012, 6:06AM

If the Supreme Court strikes down "Obamacare," Republicans claim a huge short-term victory, but they may end up big losers in the long run. The future of the nation's health care system would be thrown into disarray, and conservatives may be forced to swallow a more bitter pill.

The prospect of moving toward a more liberal, government-controlled health care system is fraught with political peril, and therefore far from inevitable, but may wind up being the only way to prevent the demise of the unsustainable, existing system from leaving many more millions without access to health care. Without a mechanism like an individual mandate to cover the uninsured and tackle the free-rider problem, health care costs are set to rise at an unsustainable rate and compel potentially drastic action from Congress.

"Conservatives may find that they weren't careful about what they wished for in opposing 'Obamacare,'" Adam Winkler, a constitutional law professor at UCLA School of Law, told TPM. "The economic, social and political pressure for health care reform aren't going to just disappear. There's a reason every major industrialized country has national health care. If the Supreme Court invalidates the Affordable Care Act, we are likely to see a government takeover of health care in the next decade."

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HCR/SCOTUS

Schumer: Don't Be Fooled By Tough Questions From Justices On 'Obamacare'

Sahil Kapur | April 1, 2012, 12:08PM

The Democrats' top messaging guru on Sunday sought to calm progressive fears that the Supreme Court might strike down his party's crowning achievement -- and he starkly warned that overturning the health care reform law would make the justices look like activists.

"Anyone who judges how the court is going to rule based on the questions hasn't looked at the history of the questions before and then the results," said Sen. Chuck Schumer on NBC's Meet The Press. "I've been on the Judiciary Committee for 30 years in the House and the Senate, and one thing I've learned, you can't tell by the questioning as to how the court is going to rule."

The No. 3 Democrat cited the 2009 decision on the Voting Rights Act where he said the "questioning was really hostile" but the justices upheld the law 8-1. He added that, as TPM has reported, conservative judges in lower courts had peppered the administration's lawyer with tough questions and then voted to uphold the health care law.

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HCR/SCOTUS

Dems Warn Of 'Grave Damage' To SCOTUS If 'Obamacare' Is Struck Down

Sahil Kapur | March 28, 2012, 3:43PM

A handful of Senate Democrats sought to assure doubtful liberals that the Supreme Court justices aren't ready to strike down their crowning achievement, standing before cameras and mics Wednesday in front of the court. One warned that doing so would ruin the court's credibility.

"This court would not only have to stretch, it would have to abandon and completely overrule a lot of modern precedent, which would do grave damage to this court, in its credibility and power," said Sen. Richard Blumenthal (D), a former attorney general of Connecticut. "The court commands no armies, it has no money; it depends for its power on its credibility. The only reason people obey it is because it has that credibility. And the court risks grave damage if it strikes down a statute of this magnitude and importance, and stretches so dramatically and drastically to do it."

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Stephen Breyer

How The Liberal-Leaning Justices Did A Better Job Defending 'Obamacare'

Sahil Kapur | March 27, 2012, 6:07PM

The Obama administration's top legal advocate was pilloried Tuesday for offering a less-than-eloquent constitutional defense of the health care reform law's individual mandate -- the provision at the heart of the challenge to "Obamacare." Thankfully for supporters of the law, some of the sharpest legal minds in the country unintentionally articulated his case better than he did -- the justices themselves. Liberal-leaning justices on the court each stepped in at various points to suggest arguments for the mandate's legitimacy.

Here are the four best arguments they made -- or at least hinted at -- that could sway their skeptical colleagues.

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Individual Mandate

Supreme Court Zeros In On Health Care Law's Centerpiece

Sahil Kapur | March 27, 2012, 5:47AM

The linchpin of President Obama's health care law will come into focus Tuesday as the Supreme Court hears two hours of oral arguments on whether Congress can require Americans to purchase insurance.

For supporters and foes of the law, and for court watchers who have been awaiting this case for over two years, Tuesday is the main event.

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Health Care

Alito, Breyer Call Out Obama Lawyer For Dubbing Mandate Both A 'Penalty' And 'Tax'

Sahil Kapur | March 26, 2012, 1:39PM

On the first day of health care reform arguments before the Supreme Court, two justices needled a top Obama lawyer for simultaneously calling the fine that will be paid under the law for not purchasing insurance a "penalty" and a "tax."

The confusion arises because of the administration's argument that the power to enforce the individual mandate is rooted in Congress' taxing power -- but that the mechanism itself is designed to be a penalty, not a revenue-generating policy.

The narrow but important distinction created a communication challenge for the lawyer representing the Obama administration.

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HCR/SCOTUS

Supreme Court Kicks Off Historic Case On Health Care Law

Sahil Kapur | March 26, 2012, 5:35AM

Supreme Court of the United States

The Supreme Court begins hearing arguments Monday morning on President Obama's health care reform law, a case with sweeping political and policy implications grand enough to make it one of the most important in years.

At stake: the future of this country's badly ailing health care system and perhaps even the legacy of its first black president. The political ramifications of the ruling will be enormous, with one of the two major political parties poised to see its vision for the future of government suffer a body blow.

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Affordable Care Act

The Most Radical Part Of The Health Care SCOTUS Challenge

Sahil Kapur | March 23, 2012, 5:37AM

The U.S. Supreme Court chamber (Associated Press)

It hasn't received nearly as much attention as the other main legal challenge to the health care law. But next Wednesday, the Supreme Court will hear arguments over whether the Affordable Care Act's expansion of the Medicaid program is too coercive to states, and thus violates the Constitution.

If upheld, the states' far-reaching argument could invalidate decades of government programs. The law requires states that accept federal matching funds for Medicaid to expand that program to cover everyone under 133 percent of the poverty line. That may sound like an onerous burden for state governments, many of which are already stretched extremely thin. But the federal government will be picking up most of the tab for the expansion. So the argument essentially boils down to this: The new Medicaid funds Congress is giving us to insure more of our residents is too good an offer to pass up, and should therefore be struck down.

"What they're basically saying is, you're making us a deal that we can't refuse because it's such a good deal. And therefore it's unconstitutional," Tim Jost, a law professor at Washington and Lee University, and supporter of the health care law, told TPM. "I mean just to state the argument shows how ridiculous it is."

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Affordable Care Act

Health Care Law Still A Liability For Vulnerable Dems

Sahil Kapur | March 22, 2012, 3:20PM

Democrats are reigniting their public relations efforts ahead of Friday's second anniversary of the health care reform law. But the nature of the messaging renaissance also exposes the political vulnerability for Democrats, who have been outmatched in the public opinion battle by the sheer ferocity of the unabated Republican assault on their landmark achievement.

This week House Democrats held three events touting the law's benefits, specifically for women and young adults, and broadly for the public at large. But all of the members present at these events have either been party leaders who are well entrenched in their districts or Democrats who reside in safe districts and have little reason to worry.

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House Republicans

GOP's Gambit To Alienate Dems On Medicare Savings Board

Sahil Kapur | March 22, 2012, 5:22AM

Republicans have lost some, if not all, of the bipartisan cover they once had for their effort to repeal a key piece of President Obama's health care law. Could they have done so on purpose?

One health policy insider thinks that's possible -- and sees a political upside to putting all Democrats on the wrong side of powerful interest groups.

"It's an election year," the industry lobbyist and former GOP aide told TPM in an email. "One doesn't need legislative victories ... just tough votes for the other team!"

At issue is the House's Thursday vote to repeal a powerful Medicare cost-cutting panel created by the Affordable Care Act. Many Democrats also dislike the so-called Independent Payment Advisory Board (IPAB), and were set to join the GOP repeal effort. But that was before the GOP proposed paying for the cost of repealing it with a medical malpractice reform bill.

That will cost Republicans the support of dozens of Democrats who were otherwise on board to eliminate IPAB, House Minority Whip Steny Hoyer told reporters. Repeal is also nonstarter in the Senate and faces a veto threat from the White House.

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HCR/SCOTUS

Health Mandate Challengers Face Tough Slog Before The Supreme Court

Sahil Kapur | March 21, 2012, 5:45AM

When the Supreme Court hears arguments on the Affordable Care Act next week, the central question the justices will consider is whether the federal government has the authority to require Americans to buy health insurance.

The Obama administration will argue that it's an acceptable use of federal power to regulate interstate economic activities, backed by decades of judicial precedent. The 26 Republican-led states and other stakeholders challenging the law will decry it as an abuse of federal power that exceeds the limits of the Constitution's Commerce Clause.

Experts on both sides of the ideological divide say the ruling will come down to whether the justices rule with an eye toward precedent. If they do, they'll uphold the law. An ideology-driven move to strike down the mandate, a central component of the law, would mark a rare, swift departure from precedent.

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HCR/SCOTUS

Supreme Court Prepares To Determine Fate Of U.S. Health Care System

Sahil Kapur | March 19, 2012, 4:49AM

Shutterstock /stefanolunardi

In one week, the Supreme Court will hear arguments on a legacy-defining case for President Obama as it determines whether a crucial piece of his signature legislative achievement meets constitutional muster. The health care reform law's path to the high court has underscored a climate of supercharged partisan politics, and the highly anticipated decision expected this summer, in the dead heat of presidential election season, will help determine the trajectory of the nation's health care system.

The main question facing the justices is whether the law's requirement that Americans purchase insurance falls within the limits of federal power under the Constitution. They'll also hear arguments on whether, if the mandate is deemed unconstitutional, other aspects of the law such such coverage guarantee also need to be struck down. There's a chance that the court will punt the case to after 2014 under a law that says a tax may not be challenged in court until it is being collected.

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Affordable Care Act

An 'Obamacare' Cost Explosion? Hardly -- GOP Distorts CBO Report

Sahil Kapur | March 15, 2012, 2:09PM

House Speaker John Boehner (R-OH) and Houser Majority Leader Eric Cantor (R-VA)

Republicans and conservative media are cherry-picking a figure in a new Congressional Budget Office spending estimate (PDF) to assert that the cost of "Obamacare" has nearly doubled to $1.76 trillion. But the claim ignores the corresponding savings during the additional period of the spending projection, thus distorting the actual cost estimates of the law.

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Claire McCaskill

McCaskill: Obamacare Is Like Ryancare For Non-Seniors

Sahil Kapur | March 8, 2012, 6:02AM

United States Senator Claire McCaskill (Democrat of Missouri) holds a press conference in the U.S. Capitol

Grilled about her support for the Affordable Care Act, Sen. Claire McCaskill (D-MO) told a home state radio interviewer that the law's core structure is "exactly" like the House GOP Medicare privatization plan that conservatives support and liberals detest.

"The irony of this situation is that these are private insurance companies people will shop to buy their insurance. It's not the government," she told KMOX of St. Louis on Wednesday. "It's exactly what Paul Ryan wants to do for Medicare."

"It's subsidized by the government -- premium subsidies -- which is exactly, this is the irony," continued McCaskill, who faces a tough reelection battle this fall. "You think what Paul Ryan wants to do for seniors, you think it's terrific. But when we want to provide private health insurance for people who don't have insurance with subsidies from the government, you think it's terrible."

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IPAB

Liberals Push Back Against GOP's Latest Salvo In Battle Over Medicare

Sahil Kapur | March 6, 2012, 6:00AM

President Barack Obama speaks on the economy in Shaker Heights, OH on January 4, 2012.

House Republicans are set to advance legislation to repeal a key plank of President Obama's health care law -- the cost-cutting Independent Payment Advisory Board -- and have enlisted several Democrats for a cause that's central to the conservative goal of phasing out traditional Medicare.

On Tuesday, the powerful House Energy & Commerce Committee is set to pass repeal of IPAB. The Ways & Means health subcommittee will also hold a hearing on it, bringing the measure closer to a floor vote, and advancing an ongoing fight about whether the government or private insurers should parcel finite health care resources.

While progressive health care reformers have effectively attacked the GOP's vision of a subsidized private health insurance system for seniors, they've been slow to close ranks around the health care law's competing vision of a leaner, more efficient Medicare. But there are signs this is changing.

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Independent Payment Advisory Board

Why Republicans Are Fighting To Repeal Obama's Medicare Cost-Cutting Board

Sahil Kapur | February 28, 2012, 5:29AM

House Republicans are poised to advance legislation this week to repeal President Obama's Medicare cost-cutting board, a provision enacted in the health care reform law. The Energy & Commerce Committee is set to mark it up this Wednesday, and the repeal bill already has enough cosponsors to pass the House. It's not expected to survive the Senate or Obama's veto pen, but the debate over this provision cuts to the heart of the battle over how to save Medicare in the long run.

Some background: The Independent Payment Advisory Board (IPAB) is set to take effect in 2014, and would comprise 15 President-appointed and Senate-confirmed experts charged with holding down Medicare per-beneficiary spending by restricting reimbursements to providers. It is forbidden from cutting payments to beneficiaries. Congress can override the panel is by passing an alternate way to save the same amount of money, or with a three-fifths Senate majority. The health care industry has been outspoken in its hatred for IPAB. Republicans are united in their effort to kill it, and even some House Dems are on that page.

The question now is: Why is the party that's hell-bent on reining in Medicare pushing to repeal this powerful tool for doing just that? Part of it is to score political points by slicing off a key piece of the Affordable Care Act. But more importantly, Republicans don't want to keep Medicare in its current form. Many of them don't think that's feasible. They want to transition it to a privatized model a la the Paul Ryan plan, where seniors get a fixed subsidy -- or "premium support" -- to buy their own insurance on a private exchange.

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Affordable Care Act

GOP Governors Face Quandary In Key 'Obamacare' Battle

Sahil Kapur | February 23, 2012, 5:48AM

Republican governors are caught between a rock and a hard place as they grapple with how to handle the state-based insurance marketplaces required by the health care reform law. The Obama administration announced Wednesday that 10 states will be getting federal grants to lay the groundwork for these exchanges -- four of the states have Republican governors, who have apparently decided to bite the bullet and proceed with building them.

Here's the predicament: The Affordable Care Act gives states the option to set up their own exchange by 2014 -- essentially a regulated marketplace where consumers can pool together to buy insurance plans that must provide a package of essential benefits. If states don't set up an exchange, the federal government would be required to take over. From a policy standpoint it's a no-brainer: take the money and use the flexibility to your advantage. But that's politically tedious because as GOP governors or heavily Republican legislatures can't be seen as abetting the law that conservatives hate, even if the fallback option would be less desirable on a substantive level.

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Birth Control

Birth Control Lawsuits Have Shaky Legal Merit

Sahil Kapur | February 22, 2012, 6:17AM

President Obama's religious accommodation in his rule requiring insurance plans to cover birth control has failed to placate elements of the Catholic community, and, with strong GOP support, they remain determined to sue. But do the lawsuits, the latest of which was filed Tuesday, have much legal merit? Possibly, but if judicial precedent is any indication, probably not.

The tweaked regulation says religious non-profits like universities and hospitals do not need to pay for free birth control coverage in their employee health plans, and can pass the cost on to the insurance company. (Churches and houses of worship are entirely exempt.) But like other entities, Ave Maria University, a Catholic institution, argues in a new legal challenge that affiliating itself with any access to contraception would violate its religious beliefs.

But barring a departure from precedent, the lawsuits aren't set to go very far.

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Affordable Care Act

Supreme Court Considers Delaying Health Care Ruling To 2014

Sahil Kapur | February 21, 2012, 11:45AM

The Supreme Court is poised to rule this summer on the constitutionality of the health care reform law's requirement that Americans buy insurance or pay a tax penalty. But it has the legal option to delay a decision until at least 2014, and although the possibility has received little attention, new evidence suggests that justices are considering it more strongly.

The temporary escape hatch involves the Anti-Injunction Act, an age-old law that says courts may not halt a tax that isn't yet being collected. (Under the Affordable Care Act, it won't be collected until 2014.) Although the Fourth Circuit Court of Appeals last fall tossed out a lawsuit against the mandate on this basis, most courts have decreed that the statute doesn't apply here.

But further evidence that justices may disagree came Tuesday, when the Supreme Court increased the time for next month's oral arguments from 5.5 hours to 6 hours, allotting an extra half hour to discuss the application of the Anti-Injunction Act. That means there will be a full hour and a half to discuss whether the court has the authority to rule on the health law this year.

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Affordable Care Act

GOP Snatches 'Obamacare' Cuts As Payroll Fight Wraps Up

Sahil Kapur | February 15, 2012, 6:25PM

While Democrats will claim victory in the impending deal to extend the payroll tax cut through 2012, Republicans have also won some fodder for their base on a key issue: They've managed to slice off a piece of the health care reform law -- albeit a fairly small piece.

A summary of the deal circulated to allies and insiders by House GOP leadership boasts that they've extracted concessions worth $11.6 billion from the Affordable Care Act in negotiations with Democrats. The cuts hit the prevention fund and provider reimbursements -- it's not a big chunk of the nearly $1 trillion law, but it's a salient political win for Republicans after Democrats repeatedly resisted efforts to cut the ACA in the Super Committee and December deal.

The Republicans may also have won on what could become an important matter of principle: whether savings from the projected wind-down of war spending could count as offsets. Democrats had wanted the cutbacks from the "Overseas Contingency Operation" (basically, the wars in Iraq and Afghanistan) to be able to be used as offsets for the so-called "doc fix." Republicans had been under immense pressure to cave on that as well. However, many argued that since these operations had been scheduled to wind down anyway, then they did not count as real savings. Furthermore, some feared that if they allowed this maneuver for the "doc fix" then Dems would try to use it to bankroll their pet infrastructure projects.

Here's the relevant except from the GOP-written Wednesday document, obtained by TPM and the numbers confirmed by Democratic and Republican leadership aides:

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Birth Control

Putting The Growing Birth Control Firestorm In Perspective

Sahil Kapur | February 6, 2012, 4:05PM

The Obama administration's requirement that health insurance plans cover birth control has provoked a full-blown Republican firestorm over religious liberty. But the policy itself carves out an exemption for churches and doesn't require any individual or employer to violate a religious belief -- it simply ensures that their employees with different beliefs have the same access to birth control as all other women.

The background: The Affordable Care Act provides that insurance companies cover certain preventive health services without copays. Last August, the Department of Health and Human Services drew upon recommendations from the Institute of Medicine and decided that birth control be part of that package. It said employer-based health care plans must cover contraceptive services without copays. The move received limited attention at the time.

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Birth Control

Boehner: Birth Control Mandate Is Unconstitutional

Sahil Kapur | February 2, 2012, 2:55PM

U.S. Speaker of the House John Boehner (R-Ohio) speaks to the press during his weekly press conference on Capitol Hill in Washington, D.C. on December 1, 2011.

As religious groups freak out over the Obama administration's contraception mandate, House Speaker John Boehner (R-OH) piled on by claiming that the policy is unconstitutional.

The mandate, authorized under the Affordable Care Act, holds that employer-provided health insurance plans must provide birth control to women without co-pays. Houses of worship are exempt, and religious nonprofits are allowed an additional year before they begin complying. But conservative religious organizations and their allies on Capitol Hill say that's not enough.

"I think this mandate violates our constitution," Boehner told reporters on Thursday. "I think it violates the right of these religious organizations. And I would hope that the administration would back up and take another look."

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CLASS Act

Long-Term Care On Life Support As House GOP Passes Repeal Of CLASS Act

Sahil Kapur | February 1, 2012, 7:06PM

Shutterstock /stefanolunardi

"Where is your heart?" cried Rep. Bill Pascrell (D-NJ). "Have you no heart?"

Despite the congressman's plaintive objections during Wednesday's House debate, his Republican colleagues passed a bill 267-159 to repeal the ill-fated CLASS Act. The Community Living Assistance Services and Supports program, championed by the late Ted Kennedy, aimed to provide a long-term care insurance program. Wednesday's party-line vote deepens a partisan stalemate over how to fill that major hole in the U.S. health care system, as the legislation now goes to the Senate where it's expected to perish.

The impasse in a nutshell: The Obama administration conceded last October that it saw no viable path to implement CLASS within its statute, citing financial solvency problems. But the President and his Democratic allies oppose repealing the program and would rather repair it. Republicans, who decry CLASS as costly, unworkable and predicated on a budget gimmick, have no intention of letting that happen. They're insisting on outright repeal and say Congress must start from scratch on the long-term care problem -- although they haven't yet offered an alternative.

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Affordable Care Act

Did Health Care Reform Hurt The Private Insurance Part Of Medicare? Apparently Not

Sahil Kapur | February 1, 2012, 1:15PM

President Barack Obama

The Obama administration announced Wednesday that the Medicare Advantage program, which allows seniors to receive health coverage through a private insurer, is enjoying lower costs and more customers as a result of the health care reform law.

Medicare Advantage enrollment has risen 10 percent over the last year while average premiums have fallen by 7 percent, said Health and Human Services Secretary Kathleen Sebelius. She also pointed out that similar improvements were seen the previous year.

The figures bolster President Obama's defense of his signature achievement, and for Democrats it has the added bonus of refuting earlier Republican warnings that "Obamacare" would gravely undermine the choice provisions in Medicare.

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Affordable Care Act

Dems Pin Fate Of Health Care Law On 2012 Election

Sahil Kapur | January 19, 2012, 1:47PM

Kathleen Sebelius, Secretary of the Department of Health and Human Services

President Obama's health secretary Kathleen Sebelius made a spirited defense of the health care reform law Thursday -- one of several signs that Democrats are stepping up their defense of the law ahead of a 2012 election cycle in which Republicans plan to use it as a political pinata.

"We need to understand exactly what's at stake when people talk about repealing the health care law. And make no mistake: those attacks are going to keep coming," Sebelius said in a speech organized by Families USA.

"I believe that over the next few months, we'll see the biggest barrage of attacks and misinformation about the law that we've seen yet," Sebelius continued. "The law's opponents are going to take their best shot. And the reason why is that they know that the facts are not on their side."

So far, the law has insured 2.5 million young adults, saved seniors over $1 billion on prescription drugs and encouraged preventive care visits. But the bulk of the benefits begin in 2014, including some 30 million newly insured Americans and guaranteed coverage regardless of preexisting conditions.

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Affordable Care Act

Hospitals Step Up War On GOP's Cuts For Payroll Tax Package

Sahil Kapur | January 19, 2012, 5:38AM

Hospitals are reigniting a battle with House Republicans that grew bitter last month after the GOP pushed to offset its payroll tax cut package with deep cuts to hospital payments under Medicare. The undercurrents of this fight are deepening fissures between hospitals and Republicans over the passage and future of the Affordable Care Act.

The American Hospital Association, the industry's top lobbying group, on Friday issued an action alert -- provided to TPM by a source -- to its roughly 40,000 members, mobilizing them against some $14 billion in cuts pushed by the House GOP to hospital bad debt payments and outpatient services to help fund a longer payroll tax cut, unemployment insurance and a two-year Medicare doc fix. A hospital source told TPM the cuts are very much in play.

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Affordable Care Act

How To Easily End The 'Doc Fix' Problem -- And Why House GOP Is Opposed

Sahil Kapur | January 16, 2012, 5:32AM

Rep. Phil Gingrey (R-GA) And House GOP Doctors Caucus

One of the items Congress extended for two months in the December payroll tax package is current Medicare payment rates to physicians, averting a steep 27.4 percent cut. Although a yearlong "doc fix" is seen as likeliest when lawmakers return to town this week and begin negotiating pay-fors, even that would merely be punting an issue in need of a permanent fix.

Over the last few months there's been serious talk in Congress of buying out the "doc fix" issue once and for all with war savings from troop withdrawals in Iraq and Afghanistan, estimated at over half a trillion dollars.

The idea has been championed by Senate Majority Leader Harry Reid (D-NV), House Minority Leader Nancy Pelosi (D-CA), Senate Minority Whip Jon Kyl (R-AZ) and multiple other key senators including John Kerry (D-MA), Debbie Stabenow (D-MI) and Tom Harkin (D-IA).

But even though this plan could remove for free the $300-billion-and-growing albatross from the nation's neck, it faces fierce resistance from House Republicans. In fact, some of the vocal opponents are doctors in the caucus, whom Leadership tends to give the first bite at the apple on health issues.

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Affordable Care Act

Is The Obama Admin Trying To Box In Scalia On The Health Care Mandate?

Sahil Kapur | January 11, 2012, 5:22AM

Justice Antonin Scalia

On first blush, it seems like a no-brainer that Antonin Scalia will vote to overturn the health care reform law's requirement that Americans buy insurance: the Reagan-appointed justice is a staunch conservative who's beloved by Republicans; for what possible reason could he deliver such a devastating blow to his own side and boost President Obama?

The answer: judicial precedent. His own. And the Obama administration has noticed.

In its brief filed with the Supreme Court Friday, the Justice Department cited no fewer than 10 times the 2005 Gonzalez v. Raich case, in which Scalia (and Justice Anthony Kennedy) broke with the court's conservative wing to hand down what scholars viewed as one of the broadest declarations of federal power under the Commerce Clause: a 6-3 ruling decreeing that Congress may ban a medical-marijuana patient from growing cannabis for personal use in California where it's legal.

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Affordable Care Act

Kaiser: Health Care Reform Favorability At New Low

Kyle Leighton | October 28, 2011, 9:03AM

A new survey from the Kaiser Family Foundation shows the Affordable Care Act (ACA) with its lowest ever level of support in their polling, a huge shift from September, when Americans' view of the new health care reform law ran nearly even at 41 percent favorable versus 43 unfavorable. The October poll showed that 51 percent of Americans have an unfavorable view, against 34 percent who see it positively.

Kaiser has tracked the popularity of the new law since it was passed, and it's been fairly popular some past surveys: in June of 2010, 50 percent of Americans liked what they saw with only 35 percent disliking it. But for the most part, the ACA favorability numbers have remained in the 40 percent range on either side.

Of course, many of the provisions actually in the health care law haven't been implemented yet. Kaiser has a very handy breakout of what's currently in effect by the law's timeline and the areas of policy that each provision effects here. For instance, a majority of the insurance provisions have not yet gone into effect, including major (and some might say the MOST important) reforms like guaranteed availability of insurance and essential health benefits, neither of which will happen until 2014.

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Mitt Romney

Mitt Romney's Epic Health Care Journey: How He Flip-Flopped On Mandates

Benjy Sarlin | May 12, 2011, 7:21AM

Former Gov. Mitt Romney (R-MA)

Seeking to defuse his biggest vulnerability in the GOP primaries, Mitt Romney is set to deliver a speech outlining his position on health care on Thursday. The issue has been his glass jaw ever since 2009, when Democrats launched a successful push to pass health care reform modeled on a Massachusetts law widely considered Romney's signature achievement as governor.

The element of both laws that is most despised by those on the right is a requirement that people purchase insurance, leaving Romney in the awkward position of fiercely defending his own law's use of a mandate while labeling it an unconstitutional government takeover on a national level.

"Governor Romney has made it very clear over the last many years, including during the 2008 presidential cycle, that he opposes a federally imposed individual mandate," a Romney spox told NRO this week.

While it's true that Romney did not call for a federal mandate in the 2008 election, he has in fact supported two sweeping health care proposals in Congress that included an individual mandate, the most recent in 2009. In addition, he's repeatedly boasted that Massachusetts mandate would -- and should -- eventually be adopted on a widespread scale.

TPM SLIDESHOW: Meet The 2012 GOPers: Ex Gov. Mitt Romney (R-MA)

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Mitt Romney

Nikki Haley, Former Romney Supporter, Says He Needs To Clarify Position On Health Care

Benjy Sarlin | May 10, 2011, 12:43PM

South Carolina Gov. Nikki Haley (R)

South Carolina Gov. Nikki Haley (R), a co-chair of Mitt Romney's presidential campaign in her state in 2008, told TPM on Tuesday that Romney needs to firmly address Republican fears that he'll use his health care law from Massachusetts as a national model.

Her comments come ahead of a speech from Romney this week on health care, which is widely considered his biggest vulnerability with Republican voters. President Obama has repeatedly credited Romney's health care law as governor of Massachusetts, which included an individual mandate now despised by conservatives, as a model for his own Affordable Care Act.

"I think what we don't want is for states to have mandates on them like what President Obama's done," Haley told TPM when asked about the governor's speech. "Massachusetts made a decision within their state and they decided that was right for them. It certainly is not right for South Carolina, it's not something I want to see, so what we want to hear from him is that this isn't something he's going to impose as President across all states in the country."

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