Health care reform: 5 ways to kill ‘Obamacare’ without repealing

Published in POLITICO

Even conservatives admit Mitt Romney’s promise to repeal President Barack Obama’s health care law with an executive order might not work — but that doesn’t mean he’s out of luck.

Romney could still begin to gut the law immediately by taking some more passive-aggressive steps — a jumbo-sized version of a strategy Obama has embraced on issues ranging from immigration to education.

Even if Romney can’t rely on a Republican-controlled Congress to pass a repeal bill, he could achieve a similar end, experts who have studied the law closely tell POLITICO. And although Romney’s health care advisers won’t say so on the record, they’re aware of the options and aren’t dismissing them.

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The Medicaid ruling’s ripple effect

Published in POLITICO

By J. LESTER FEDER and DARREN SAMUELSOHN

Think last Thursday’s Supreme Court ruling was just about health care? Think again.

Chief Justice John Roberts’s surprise opinion, which allows states to opt out of the law’s Medicaid expansion, could set up a series of legal showdowns between states and the federal government over the strings attached to billions of dollars in federal grants for everything from transportation to education and the environment.

It’ll take many years — and many lawsuits — before the full effects of Roberts’s health care ruling are sorted out. Still, legal experts on both the right and the left agree that the door is now open for states to challenge everything from the Clean Air Act to No Child Left Behind and anti-discrimination protections.

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Medicaid ruling could give red states more bargaining power

Published by POLITICO

By J. LESTER FEDER AND JASON MILLMAN

The Supreme Court ruling left the Democratic health care law intact — but it also left Republican in a stronger bargaining position when it comes to Medicaid.

The ruling gives them the right to opt out of the Medicaid expansion envisioned under the law. But they know one thing: President Barack Obama wants them to stay in, and so many might just go along and take the money — after they’ve squeezed out as many other concessions as they can get from the feds.

One of the most health care-savvy governors, Louisiana’s Bobby Jindal, is already wondering whether this creates a backdoor way to achieve the Holy Grail for Republican governors — turning his federal Medicaid dollars into a block grant.

“I believe [the feds] can go to the states and negotiate” to convert their Medicaid dollars into unrestricted lump payments “for states that want to do this,” Jindal said Friday in a call with reporters.

There’s a long road to get from Thursday’s ruling to serious negotiations, of course.

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Court allows Medicaid expansion

Published in POLITICO

The Supreme Court upheld the health reform law’s Medicaid expansion to 16 million new people in its ruling Thursday — but it also gave states greater freedom to opt out.

The health reform law took Medicaid, historically a health program primarily for poor children and the low-income disabled and opened it to anyone under 133 percent of poverty.

The court said Congress is free to broaden the program, which the federal government will largely pay for. But it also ruled that states can opt out — and the federal government cannot punish them by taking away Medicaid dollars they were promised by laws in place before the passage of the Affordable Care Act.

In other words, states can keep Medicaid basically as it is today — or it can go ahead with the broader version created by the health law. And it’s not immediately clear which path the more conservative states will follow.

The legal question facing the court was how far Congress can go in attaching conditions to federal funds.

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Advocates wait to see if work was worth it

Published in POLITICO

In less than 24 hours, the health care advocates whose lives have revolved around the health reform law will know whether the law has a future.

As they wait for word from the Supreme Court, they’re all finding different ways of saying the same thing: They’re a bundle of nerves.

Families USA’s Ron Pollack described himself as “nervous.” Former HHS exchange boss Joel Ario said he’s “on pins and needles.”

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How implementation could go ahead anyway

Published in POLITICO

If the Obama administration loses the health reform suit in the Supreme Court on Thursday, implementation might keep on chugging, even if the individual mandate is thrown out.

That’s because only the broadest options for striking down the law would actually upend the structures federal officials have been working to build, including setting up health insurance exchanges, adding millions of people to Medicaid and making major changes to Medicare.

So even if the hot-button mandate goes — and some of the key insurance rules the Obama administration says can’t be severed from it go with it — the court could say, “the [health reform law] is here to stay and we should move full steam ahead on implementation,” predicted Ethan Rome of Health Care for America Now.

Of course, the court could also cause what many experts call “chaos” by tossing out the whole Affordable Care Act. A slew of health insurance regulations could have to be rewritten, billions of dollars could be in limbo, and thousands of people in temporary health insurance programs could abruptly lose their coverage.

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HHS pushes out cash ahead of ruling

Published in POLITICO

By J. LESTER FEDER and KATHRYN SMITH and KYLE CHENEY

Conservatives wanted the White House to stop spending on the health care law until the Supreme Court rules on whether it’s constitutional.

But the administration has forged ahead, spending at least $2.7 billion since oral arguments in the case ended on March 28. That’s more than double the amount that was handed out in the three-month period leading up to the arguments, according to a POLITICO review of funding announcements from the Department of Health and Human Services.

While much — if not all — of this funding was in the pipeline well before March, the timeline for handing out specific funds is not set in stone, which gives the agency leeway over the kinds of dollars it has been handing out.

And the stakes have increased as the date of a Supreme Court ruling approaches, because money that is spent most likely won’t have to be repaid. But remaining funds will dry up if the court strikes down the law.

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