n 2012, opponents of the Affordable Care Act (ACA) lost both at the Supreme Court and the ballot box. As a result, many opponents vowed to engage in scorched-earth tactics defunding the law or shutting down government. Last week, House Budget Committee Chairman Paul Ryan, R-Wis., announced where he stood with the release of a budget proposal he says would repeal ObamaCare.

The week before, however, the House of Representatives continued another approach, a back door that could slow or undermine the law's implementation with small cuts unlikely to spark a confrontation. The House passed a continuing resolution intended to keep the government running through September. Many conservatives balked because the measure's funding for health care reform looks like a win for President Obama. However that's not the whole story.

Small cuts

The House bill left out nearly a billion dollars in funding for insurance exchanges as well as funds for the IRS to prepare to enforce the law's tax rules. According to Rep. Nita Lowey, D-N.Y., this will delay "implementation of the Affordable Care Act. ... Without IT infrastructure to process enrollment and payments, verify eligibility and establish call centers, health insurance for millions of Americans would be delayed."

By JOHN BRESNAHAN and JAKE SHERMAN | 4/24/13 9:49 PM EDT

Congressional leaders in both parties are engaged in high-level, confidential talks about exempting lawmakers and Capitol Hill aides from the insurance exchanges they are mandated to join as part of President Barack Obama’s health care overhaul, sources in both parties said.

The talks — which involve Senate Majority Leader Harry Reid (D-Nev.), House Speaker John Boehner (R-Ohio), the Obama administration and other top lawmakers — are extraordinarily sensitive, with both sides acutely aware of the potential for political fallout from giving carve-outs from the hugely controversial law to 535 lawmakers and thousands of their aides. Discussions have stretched out for months, sources said.
Continue Reading

A source close to the talks says: “Everyone has to hold hands on this and jump, or nothing is going to get done.”

Yet if Capitol Hill leaders move forward with the plan, they risk being dubbed hypocrites by their political rivals and the American public. By removing themselves from a key Obamacare component, lawmakers and aides would be held to a different standard than the people who put them in office.

Here’s how it happened: Back during the Affordable Care Act negotiations, Sen. Chuck Grassley (R-Iowa) proposed an amendment forcing all members of Congress and all of their staffs to enter the exchanges. The purpose of the amendment was to embarrass the Democrats. But in a bit of jujitsu of which they were inordinately proud, Democrats instead embraced the amendment and added it to the law. Here’s the relevant text:



Let’s stop for a moment here and explain why this is unusual. Large employers — defined in the law as employers with more than 100 employees — aren’t allowed onto the insurance exchanges until 2017, and only then if a state makes an affirmative decision to let them in.

But the federal government is the largest employer in the country. So Grassley’s amendment means that the largest employer in the country is required to put some of its employees — the ones working for Congress — on the exchanges. But the exchanges don’t have any procedures for handling premium contributions for large employers.

That’s where the problem comes in. This was an offhand amendment that was supposed to be rejected. It’s not clear that the federal government has the authority to pay for congressional staffers on the exchanges, the way it pays for them now in the federal benefits program. That could lead to a lot of staffers quitting Congress because they can’t afford to shoulder 100 percent of their premiums. (There’s also a smaller issue related to how retiree benefits might be calculated. But I’m only willing to go so far into the weeds here.)

The U.S. Supreme Court’s ruling that penalties under the Affordable Care Act qualify as taxes has opened the door to another constitutional challenge, Dr. Steve Hotze, a Houston physician and prominent Republican donor, said at a Tuesday press conference announcing his lawsuit against the federal government.

“What we were promised was a new health care policy and change that could be good for all Americans,” Hotze said at the state Capitol, flanked by more than a dozen Republican legislators. “Really, all it’s turned out to offer us is higher premiums, higher taxes and a government that will allow its bureaucrats to interfere with the doctor-patient relationship.”

Hotze plans to file a lawsuit in Houston district court on Tuesday to prevent enforcement of the federal Affordable Care Act in Texas.

[...]

The lawsuit presents two constitutional challenges: First, it argues that the ACA violates the rule that requires revenue-raising bills to begin the U.S. House, because the original bill began as a tax credit bill for veterans — not a revenue-raising bill. Second, the lawsuit argues that the ACA violates the Fifth Amendment of the Constitution by essentially requiring citizens to pay money to other citizens by compelling employers to pay private insurance companies for health coverage.

The Court’s direct involvement in defining the meaning of the Origination Clause dates back at least to 1813 when Justice Joseph Story wrote that revenue laws are those

Later, in his Commentaries on the Constitution, Story reiterated this position when he wrote that the meaning of the Origination Clause was


³⁹ United States v. Mayo, 26 Fed. Cas. 1230, 1231 (C. C. Mass. 1813)(No. 15,755).
⁴⁰ Joseph Story, Commentaries on the Constitution (Boston: Hilliard, Gray & Co., 1833; reprint edition Littleton, CO:
Fred B. Rothman & Co., 1991) vol. 2, chap. XIII, sec. 877, p. 343.

One hospital charges $8,000 — another, $38,000

Posted by Sarah Kliff and Dan Keating on May 8, 2013 at 12:01 am

Consumers on Wednesday will finally get some answers about one of modern life’s most persistent mysteries: how much medical care actually costs.

For the first time, the federal government will release the prices that hospitals charge for the 100 most common inpatient procedures. Until now, these charges have been closely held by facilities that see a competitive advantage in shielding their fees from competitors. What the numbers reveal is a health-care system with tremendous, seemingly random variation in the costs of services.

Damn Obamacare is going to steal us away from the wonderful free market of the greatest healthcare system in the world...

http://www.washingtonpost.com/blogs/won ... her-38000/

House GOP To Hold Yet Another Obamacare Repeal Vote
........
And so House Republicans will vote on Thursday — yet again — to wipe out the Affordable Care Act. By their own count, it’ll mark the 37th time they’ve voted to fully repeal or partially dismantle the President’s signature achievement.
........
The nonpartisan Congressional Budget Office said Wednesday that it will not score the legislation due to time constraints. In a letter to Republicans, CBO’s director pointed to its most recent Obamacare repeal score, in July 2012, which said getting rid of the law would increase budget deficits by $109 billion over the next decade.
........
The repeal vote is expected to pass on a party-line vote. What happens next is less clear. It remains to be seen whether Republicans will be able to close that chapter after this and move on to more serious health care legislation, or whether they’ll remain trapped in a hopeless battle that they’ve lost in Congress, the Supreme Court and at the ballot box.

Federal judges peppered lawyers for the federal government and Hobby Lobby Stores Inc. with questions Thursday as the two squared off over the corporation's challenge to a part of the federal health-care law that requires it to offer employees health coverage that includes access to the morning-after pill.

"The Greens are a deeply religious family who have exercised their faith through their business for 40 years," Kyle Duncan, who argued the case before the 10th Circuit Court of Appeals, said of the family that owns Oklahoma-based Hobby Lobby.

[snip]

Lower courts have rejected Hobby Lobby's claim, saying that for-profit businesses aren't covered by an exemption added to the law for religious organizations. That exemption applies to churches but not to affiliated nonprofit corporations, such as hospitals, that do not rely primarily on members of the faith as employees.

The case was heard by eight 10th Circuit judges, not the typical three-judge panel, indicating its importance.

Obamacare Will Be A Debacle — For Republicans

The Affordable Care Act, aka Obamacare, is a policy Rube Goldberg device — instead of doing the simple, obvious thing, which would just be to insure everyone, it basically relies on a combination of regulations and subsidies to rope, coddle, and nudge us into a rough approximation of a single-payer system. There were reasons for this, of course, mainly political...Still, the question is whether this cobbled-together system will work, and there have been many conservatives rubbing their hands with glee over the prospect of failure.

Whoops.

We won’t really know how Obamacare works until it has been in operation for a while; but we do know that essentially the same system has been running in Massachusetts since 2006, and is doing pretty well. The question, then, is whether other states that don’t have MA’s initial advantages — especially an already low uninsurance rate and an already operating system of community rating — can make this thing work. The big fear has been of sharply rising premiums as insurers are required to cover people with preexisting conditions. And the biggest test case was always going to be California.

Well, the preliminary numbers for CA are in — and they’re looking very good, with costs coming in below expectations. At this point, it looks as if this thing is indeed going to work.

And think about the political dynamics. Because the Supreme Court decided to let states opt out of the Medicaid expansion, some states — notably Texas — will have a pretty dysfunctional version of Obamacare in 2014, although even those systems will provide significant benefits to many people. Still, the whole political calculus was supposed to be that Republicans in red states could point to the horrors of Obamacare and ride them to political victory. Instead, it looks as if we’re going to see blue-state residents reaping the benefits of a functional health care system, while red-state residents are denied many of those benefits, for what looks like no better reason than mean-spirited spite — because what’s going on is, indeed, mean-spirited spite.

I've seen what's coming and it's scary. It's a lethal dose of socialism being injected directly into the heart of the American health insurance market.

Heck, it's already wreaking havoc. By our estimates, Obamacare has already killed a million people by further straining an already weak healthcare system.

California's health exchange to serve as voter registration hub

Millions of Californians who contact the state's new health exchange to buy insurance will be given the opportunity to register to vote, too, a move that some Republicans fear could benefit Democrats.

Secretary of State Debra Bowen made California the first state to designate its health exchange as a voter registration agency Wednesday, but others are expected to follow suit, said Shannan Velayas, Bowen's spokeswoman.

"This is about making sure that all eligible Californians are offered the chance to register to vote," Velayas said Thursday.

A 1993 federal law requires states to designate their agencies and offices that provide public assistance or disability services as voter registration agencies, Velayas said.

The federal law commonly is known as "motor voter" because it ensured that applicants for drivers' licenses nationwide would be asked if they wanted to register to vote. <...snip...>

http://www.sacbee.com/2013/05/17/542741 ... ge-to.html

The message referred to Second Amendment rights and shooting someone, but did not include any direct threats. It was sent to House Speaker Andy Tobin, who opposes the Medicaid expansion, and eight other Republican House members.

"Please kill SB1492, the Medicaid Expansion Act," the email begins, before quoting the Second Amendment. It then reads, "If you are ever asked why you shot the person, the only answer from your lips should be, I felt my life, or/and my family's life was in immediate danger of death. So I did what I had to do in order to eliminate this threat. "

Currently, aides and lawmakers receive their health care under the generous Federal Employee Health Benefits Program. The government subsidizes upward of 75 percent of the premiums for the health insurance plans. In 2014, most Capitol Hill aides and lawmakers are expected to be put onto the exchanges, and there has been no guidance whether the government will subsidize those premiums. This is expected to cause a steep spike in health insurance costs.

More than a dozen senior aides interviewed by POLITICO about the issue declined to be named out of fear for future job prospects. The problem is most acutely felt at the staff level, where aides make between $35,000 and roughly $170,000 and budgetary problems have all but stopped pay increases and bonuses. Lawmakers have questioned leadership aides about the future of their health care.