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. Continue reading “The Health Information Exchange Deadline”
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. Continue reading “Health Care Access and Payment–November 2012”
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.
Continue reading “U.S. Healthcare Reform Has Just Begun”
The editors of this blog have asked a number of faculty members to write about those who have been influential in their understanding of the law. In this, the fifth post in the series, Professor Alison Barnes writes about her mentor and friend, Walter O. Weyrauch (1919-2008), who was Professor of Law at the University of Florida and Honorary Professor of Law at Johann Wolfgang Goethe University in Frankfurt am Main, Germany.
Walter Weyrauch remains a unique thinker in the law, known by many worldwide, and for more than two decades since I took his classes at University of Florida, my principal guide and inspiration in law and law teaching. Our dialogue, which included hundreds of snail mail letters on goofy art note cards, reflected Walter’s world view and legal philosophy, and confirmed and developed mine.
In demeanor, he had an impassive face and long pauses. What seems a dissonance in style became cause for student comment towards the very end of his teaching career. He said of his student evaluations: “They noticed I have a German accent” for the first time since he began to teach at University of Florida 50 years before. His chuckle over this was signature. Indeed, perception of him had evolved from the days when he was rumored to have been a lieutenant in the Luftwaffe. (Chuckle.) Well into his eighties, he negotiated his retirement three years away. He said, “I thought I would be ready; I am not ready.” In part, he feared he would have too much time to reflect on unresolved feelings about his own experience.
Walter provided to me two versions of his memoirs, one hard copy (typed on his manual typewriter) and a later electronic revision, scanned in by his assistant, for my editing. He had received annotations from several scholars, but these were the last so I have worked with them and hope they will be available for any who wish to read, search for their own names, comment. Continue reading “People Who Have Shaped the Teaching Careers of Our Faculty—Part 5: Walter Weyrauch, Mentor and Friend”
Monday/The Anti-Injunction Act – Pay taxes now, sue later, delays the decision. Decide about penalties now.
Tuesday/Individual Mandate for Minimum Coverage – The mandate is too much or too little for the Commerce Clause.
Wednesday – Severability and Medicaid Expansion – Strike down the ACA if the mandate is unconstitutional because it’s all part of one plan or save as much as possible. Strike down the Medicaid expansion because the states foresee it will cost and confuse them as have past expansions. Continue reading “Affordable Care Act Issues at the Supreme Court, in Tweet Style”
I was asked to talk about the law’s view of the case of Dan Crews, age 27, who wants to die as soon as possible. You may have read about him last fall in the Journal-Sentinel, and in spring in the Chicago Tribune as the story unfolded. You might hear about him on the WISN 10 o’clock news on Sunday, November 6.
Dan has had quadriplegia since a traffic accident when he was three years old, and uses a ventilator because his chest muscles don’t allow him to breathe on his own. He’s mentally sharp, and verbal since the ventilator is attached through a trachea tube. He has earned an AA degree.
He wants to switch off the respirator so he will stop breathing. Specifically, he wants help from Froedtert Hospital, where he has received his care over the years, to switch off the respirator.
My totally unscientific poll revealed that the well-settled law in this area is about as well-known as speed limits. Dan has a right to refuse medical treatment, and no one thinks the use of a respirator is anything other than medical treatment. Continue reading “A Non-terminal Man”
Please, don’t throw tomatoes yet! Everybody knows that prevention in the twentieth century, particularly due to use of infectious disease vaccines and more recently some innovative invasive procedures, has changed the demographic face of our population and the world’s.
Of course, while what “everybody” knows is never the whole of the matter, the inspiring story of diagnosis, followed by treatment, followed by survival is a wonderful sequence of events.
An upcoming symposium is about the flip-side of that coin (although it has been very hard to get people to talk about it). About eighteen months ago, we chose to bring together scholars who don’t necessarily presume that the mainstream health care perspective of diagnosis and follow-up treatment is more than a single widely endorsed perspective. The upcoming symposium, part of the annual series on health/disability/elder law held by Marquette’s Elder’s Advisor law review, proposes that prevention is often enough overrated that close examination is warranted. The symposium is titled “The Institutionalization of Prevention: We Win, We Lose.”
Cancer diagnosis and treatment is particularly, but hardly exclusively, illustrative. Continue reading “Is Prevention in Health Care Misguided?”
I write as briefly as possible about health care plans from the presidential candidates. I would not imagine telling you what to think about this, but I hope to present the differences in the proposals, both philosophically and practically. We are so busy reading our financial records with alarm! Please, add health care issues to your voting decision.
Note: The one-hour Turner Hall 4th St Forum on health care, taped last Thursday, is available as a podcast. The panel included Bill Jenkins, who has extensive experience as a leader with Aurora; George Lightbourn, public policy wonk and former Secretary of the Wisconsin Department of Administration; and David Newby, President of the Wisconsin AFL-CIO. And me, of course.
The differences between the McCain and Obama proposals are far greater than any past candidates. Obama presents a development or variation on the Clinton/Gore/Massachusetts plans that seek to spread risk and coverage. McCain takes health care coverage in a completely different direction. Below, I line up the elements, including major changes, sources and extent of coverage, cost containment, and extension of coverage to the uninsured. Continue reading “Priorities for the Next President: Health Care”