Majority Opinion on “Obamacare” Doesn’t Lie in Either Extreme

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Category: Health Care, Marquette Law School, Public
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As is so often the case, the focus in news reporting on the fresh results of the Marquette Law School Poll, released on Wednesday, was on the race for governor, with Republican Gov. Scott Walker’s lead over Democratic challenger Mary Burke holding steady from the prior round of polling in January. (Walker led 48 percent to 41 percent this time, compared to 47 percent to 41 percent then.)

But there is a lot more in each round of polling, both results that shed richer light on voters’ views related to candidates and voters’ views on issues. Distinguished Fellow Mike Gousha looks at some of the former in his posting on this blog, which can be found by clicking here. Permit me to look at one aspect of the latter, the results related to the new federal health law, often called Obamacare — results which don’t get much time in the spotlight.

Professor Charles Franklin, director of the Marquette Law School Poll, pointed to one of the most interesting results related to health care in his discussion of the results with Gousha on Wednesday. Put simply: There isn’t much political mileage to be gained from being either strongly in favor or strongly opposed to the federal law. What the majority of those who were polled said they want is to keep the new law but improve it. Specifically, only 8 percent want to keep the law the way it is, only 18 percent want to see it repealed and not replaced. But 52 percent want it improved, while another 18 percent said they want it repealed but replaced with an alternative. That’s 70 percent who want a better plan than Obamacare, but still want a federal health care law (presumably in addition to or expanding on Medicare and Medicaid). Read more »

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Legislative Treatment of E-Cigarettes

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Category: Health Care, Public
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In recent months, efforts to subject e-cigarettes to the same laws as traditional cigarettes have swept the country.  The San Francisco Board of Supervisors has unanimously voted to subject the smokeless, tobacco-less cigarette to the same public bans as cigarettes.  Across the country in New Jersey, Governor Chris Christie recently unveiled a new budget plan that will subject e-cigarettes to the same excise tax rate as their tobacco-filled cousins.
So, should e-cigarettes and cigarettes be subject to the same laws?  Read more »
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Zelinsky: Use of HSAs and HRAs as Compromise to ACA Contraceptive Mandate Dispute

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Category: First Amendment, Health Care, Labor & Employment Law, Public, Religion & Law
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stethoscopeEd Zelinsky (Cardozo) has an interesting post on his OUP blog discussing a possible compromise in the on-going dispute between for-profit religious corporations, like Hobby Lobby, and the Obama administration’s Affordable Care Act’s (ACA’s) contraceptive coverage mandate.

Here’s a taste:

This entire controversy is unnecessary. The tax law contains devices for reconciling the religious concerns of employers like Hobby Lobby with the policy of expanding medical coverage: health savings accounts (HSAs) and health reimbursement arrangements (HRAs). The current regulatory exemption from the contraception mandate should be amended to include for-profit employers and to exempt from the federal contraception mandate employers (both non-profit and profit-making) who maintain HSAs or HRAs for their respective employees. Compromise along these lines would respect the genuinely-held views of religious minorities while implementing the federal policy of broadening access to health care.

An HSA/HRA compromise would eliminate the complicity of religious employers in the provision of contraception methods to which they object while enabling such employers’ employees to obtain on a pre-tax basis any medicines or devices such employees want, including contraception to which their employers object. Employers’ payments into their employees’ HSAs and HRAs would be the equivalent of the cash wages paid to such employees, wages which the employees are free to spend as they choose.

Personally, I do not see a RFRA or free exercise problem with ACA’s mandate because it is not a law that targets religion or otherwise substantially burdens religious rights of individuals. Read more »

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New “Marquette Lawyer” Magazine Offers Insights from Paul Clement

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Category: Education & Law, Federal Law & Legal System, Federalism, Health Care, Legal Practice, Marquette Law School, Public, Speakers at Marquette, U.S. Supreme Court
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Paul Clement has argued some 70 cases before the U.S. Supreme Court. He was solicitor general of the United States and now, in private practice, continues to present arguments in some of the most important cases of our time.

In the cover story in the new “Marquette Lawyer” magazine, Clement discusses some of the cases he’s been involved in, particularly the momentous Affordable Care Act decision of 2012 and several national security cases. He talks about what it is like to make an argument before the Court and especially what’s needed to prepare for an argument.

Clement’s thoughts were offered during his visit to Marquette Law School on March 4, 2013, when he delivered the annual E. Harold Hallows Lecture and held a special “On the Issues with Mike Gousha” event for law students. (Video of the lecture is available here and of the “On the Issues” here.)

Also in the new issue, an article describes the complex legacy of a class action lawsuit challenging how Milwaukee Public Schools deals with students with special education needs. Even as plaintiffs lost the case in court, they succeeded in influencing changes that they favored.

Professor Phoebe Williams is featured in a profile story in the magazine, and the success of the Law School’s faculty blog is marked with a compilation of pieces written by Professor Daniel D. Blinka; Mike Gousha, distinguished fellow in law and public policy; and State Public Defender Kelli S. Thompson, L’96 . Read more »

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Two Americas

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Category: Congress & Congressional Power, Health Care, Public
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The federal government is now shutdown. What happens next is anyone’s guess, especially since we hit the debt ceiling in two weeks and still have to pass an actual budget to fund the government. To get out of the current stalemate, one compromise that has been floated is for Congress to pass a continuing resolution – funding the government until November – along with the “Vitter amendment.” The Vitter Amendment would prohibit Congress from exempting itself from Obamacare. So what is the controversy over Congress and its staffers having to purchase healthcare on the exchanges? What are the issues with Congress exempting itself from Obamacare? And what does it say about our legislature?

In 2009, during the peak of the legislative debate over healthcare reform, Senator Chuck Grassley (R) inserted an amendment in Obamacare that required all members of Congress and their staffers to purchase health insurance on the newly-created health insurance exchanges. Of course, members of Congress wouldn’t be alone in doing this. Starting today, millions of Americans are utilizing the exchanges. Read more »

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Health Commissioner: Milwaukee Must Deal with Race and Poverty Issues

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Category: Health Care, Milwaukee, Public, Speakers at Marquette
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If Milwaukee is to become a healthy city in both broad terms and in terms of specific issues, it must deal with issues in an honest, constructive way with poverty and race, City of Milwaukee Health Commission Bevan Baker said Thursday during an “On the Issues with Mike Gousha” session at Eckstein Hall.

“Milwaukee will not be the greatest, most relevant, healthiest city in America until we deal with our dirty linen,” Baker, health commissioner since 2004, told an audience of about 150.

“To do that,” he continued, “we have got to do what other cities have done, and that is to address race, to address poverty, to look at these issues, and say, it is tough, it is unimaginable, it makes me sick, it is ugly, but to be great we have got to do the unimaginable thing, and that is to once and for all say, and in true fashion, to take our spiritual and moral compass and say, Milwaukee will not be the healthiest, greatest, most relevant city in America until we deal with our dirty linen. That’s what New York has done and that is what Miami is trying to do and that’s what other cities in this nation I have lived in have done.” Read more »

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The Health Information Exchange Deadline

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Category: Congress & Congressional Power, Federal Law & Legal System, Federalism, Health Care, Public, Wisconsin Law & Legal System
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Friday’s deadline, November 16, calls for each state, including Wisconsin, to give the federal government a “blueprint” for a Health Information Exchange.  State exchanges compare the benefits and costs of insurance policies and post the results online so people and employers can choose which are the best values for them.  They will also make electronic patient records accessible for treatment and research for the public health.   As I noted in my election-eve blog post, exchanges (also called HIEs) are central to health care reform by making better consumer choices possible.

State blueprints would resolve such choices as whether the exchange will be a private non-profit company or a state agency, and what consent and protections are in place for patient privacy.  Overall, a state can choose whether its exchange will be run by the state, in a partnership with the federal government, or by the federal government.  If a state doesn’t provide a blueprint, its exchange will be formed and run according the rules and models in federal regulations that will be issued soon.  Read more »

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Health Care Access and Payment–November 2012

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A good question posed: What really happens to healthcare when the election dust settles? The continued implementation or the repeal of Obamacare, the Affordable Care Act, is proposed as a difference that turns on the tally of the votes for president for 2013 to 2017. I think the answer is yes, but for reasons not included in the rhetoric of party platforms.

The chances of outright repeal are slim to none, because the math doesn’t work. The votes for repeal have split along party lines. The House with its Republican majority has voted repeatedly for repeal but can’t effect it. The votes needed must be found in the Senate. A supermajority of 60 out of 100 senators is needed to repeal a law. There are 47 Republican senators, and 51 Democrats plus two independents with Democratic-leaning views. Thirty-three seats are at issue in the election and a Republican majority is possible, but a change of views by voters will not produce sixty Republican-leaning senators.

A procedural option theoretically can reduce the votes needed for repeal to 51, an ordinary majority.   Read more »

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U.S. Healthcare Reform Has Just Begun

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Category: Health Care, Public
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I wrote here last March 26 about the issues of the anticipated Supreme Court opinion on the Affordable Care Act (ACA). Around the time the decision was announced, it seemed redundant to comment when a barrage of words — first, predictive punditry, then, delight, outrage, and more punditry about the “real” future of U.S. Health care – poured from every news outlet and policy shop that exists to examine the health care industry and its regulation.

In August 2012, implementation is underway, complex and sometimes perplexing. And many problems are not addressed at all.

To recap: On June 28, 2012, the Supreme Court announced its rulings on the constitutionality of the ACA. Most provisions of the law, including the individual mandate, were upheld. One important provision, requiring states to adopt the Medicaid expansion, was struck down. States could refuse to expand their Medicaid benefits and still receive federal funds that` pay at least 50% of the cost of their existing health care program for the poor. Several states have refused the expansion, although the federal government provides 100% of costs until 2020. The objective justification is that such a federal “hook” is eventually reduced, other incremental expansion is likely to follow, and once states begin to accept the funds it is virtually impossible, politically and practically, to stop.

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John Roberts, the New John Marshall?

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Category: Constitutional Law, Health Care, Legal History, Public, U.S. Supreme Court
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Immediately after learning that Chief Justice John Roberts had cast the deciding vote to uphold the Affordable Care Act’s individual mandate, I emailed my colleague Scott Idleman and suggested that Roberts was trying to be the new Charles Evans Hughes.

The reference, of course, was to Chief Justice Hughes who presided over the United States Supreme Court from 1930 to 1941. During the critical years of the early and mid-1930’s Hughes and his moderate Republican colleague Owen Roberts frequently sided with the Court’s three-man liberal bloc to uphold the constitutionality of a variety of relief statutes enacted to mitigate the harsh effects of the Great Depression. In doing so, Hughes frequently engaged in imaginative readings of supposedly settled parts of the Constitution, like the Obligations of Contracts Clause, the Due Process Clause of the Fourteenth Amendment, and the Commerce Clause.

I was not the only one to make the Hughes connection. The next day, my friend Dan Ernst of Georgetown University made a similar observation on the Legal History Blog.

However, I have come to believe that the better comparison for Chief Justice Roberts ’ Obamacare decision are the opinions of his legendary predecessor, Chief Justice John Marshall.

Read more »

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Best of the Blogs: Aftermath of the Supreme Court’s Ruling on the Affordable Care Act

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Category: Constitutional Interpretation, Constitutional Law, Health Care, Judges & Judicial Process, Political Processes & Rhetoric, Public, U.S. Supreme Court
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The Supreme Court’s decision upholding the constitutionality of the Affordable Care Act has generated a great deal of “instant analysis” on the web.  This post will survey some of the noteworthy commentary.

I have not read anything that has caused me to re-evaluate my initial reaction to the decision.  I thought that neither Justice Robert’s Commerce Clause analysis nor his Taxing Power analysis was particularly compelling, yet I was struck by the manner in which the Chief Justice managed to construct a 5-4 majority that paralleled Marbury v. Madison insofar as the ruling chastized a sitting President with its rhetoric while simultaneously handing the President a major policy victory.  Upon further reflection, I still believe that future Supreme Court justices will find it quite easy to evade the boundaries that the language of the NFIB v. Sebelius decision purports to place on federal government power.  All it will take is a change in one vote for a future Court to designate the opinion’s Commerce Clause analysis as “dicta,” or else to find the requisite level of coercion lacking the next time that Congress’ deploys its Spending Power in a similar fashion.  While the rhetoric of the opinion promises doctrinal limits on federal power, the actual holdings of the decision fail to deliver on that promise.

John Yoo has come to the same conclusion.  In an op ed piece in the Wall Street Journal he considers the spin that some political conservatives have placed on the Court’s ruling — that it was a victory for the advocates of limited governent — and finds these assertions to be no more than a “hollow hope.”  He rejects the comparison to Marbury v. Madison, and instead compares the opinion of Justice Roberts to the “switch in time” that led the Supreme Court to uphold New Deal Era legislation during the Franklin Roosevelt Administration.  By frustrating the Supreme Court’s best chance since the 1930s to reverse what Yoo views as an anti-originalist acceptance of broad legislative power, Justice Roberts has let Professor Yoo down. Read more »

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Victory For ObamaCare!

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Category: Business Regulation, Constitutional Interpretation, Constitutional Law, Health Care, Judges & Judicial Process, Public, U.S. Supreme Court
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The decision in National Federation of Independent Business v. Sebelius is a victory for the supporters of the Affordable Care Act, and a fairly broad vindication for the constitutionality of the law.  Here are my initial thoughts:

This is a big win for the Obama Administration.  The only portion of the law struck down is the Medicaid expansion provision, on the grounds that Congress cannot threaten to take away funds previously granted to the States if the States fail to accept new conditions.  This strikes me as a fairly reasonable gloss on the case of South Dakota v. Dole and, at the same time, a constitutional interpretation that still allows Congress a fair amount of flexibility to attach conditions to the receipt of new federal dollars.

I am not persuaded by Justice Robert’s argument rejecting Congress’ power under the Commerce Clause.  It strikes me as primarily conclusory rather than analytical, and my initial reaction is that it should be considered dicta since Justice Roberts upholds the ACA on other grounds.  Of course, I have already made clear that I am inclined to agree with Justice Ginsburg that the Court’s precedent under the Commerce Clause provides ample support for the ACA’s constitutionality, as I argued in previous posts here and here.

Nor am I convinced by Robert’s tax argument.  He labors a great deal to make the case that the ACA does not impose a “tax” for purposes of the statutory Ant-Injunction Act but nonetheless imposes a “tax” under Congress’ constitutional taxing authority.

It appears to me that Roberts tried to split the baby in a statesman-like way, by giving victory to Obama but by using reasoning and language designed to placate President Obama’s critics.  Am I the only person who read Justice Robert’s opinion and thought of Marbury v. Madison?

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