Obama healthcare law issues before high court

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By James Vicini

Tue Oct 25, 2011 5:27pm EDT

n">(Reuters) - Six cases involving President Barack Obama's healthcare overhaul legislation are pending before the Supreme Court as part of the legal battle over the law's fate.

The following key issues have emerged in the legal briefs recently filed in the cases stemming from Obama's signature and most controversial domestic achievement that involved the biggest reform of the healthcare system in nearly 50 years:

INDIVIDUAL INSURANCE MANDATE

The most important issue involved whether the Congress exceeded its power by requiring that all Americans buy health insurance or pay a penalty. The law aims to provide more than 30 million uninsured Americans with coverage.

The Obama administration in its Supreme Court appeal argued that Congress could enact this provision, called the individual mandate, under its powers in the U.S. Constitution to regulate interstate commerce. The mandate is due to take effect in 2014.

Congress adopted the law to address a national crisis of health insurance costs rising beyond the reach of millions of Americans and coverage denied to millions more, Solicitor General Donald Verrilli, a former White House lawyer, said in a brief.

Opponents of the law, including 26 of the 50 states, argued that Congress exceeded its powers. They said the law dramatically expanded the federal government's power and argued that the provision should be struck down as unconstitutional.

Former Bush administration Solicitor General Paul Clement, who represents the states, called the law "an unprecedented legislative initiative" that seeks "to force individuals to engage in commerce so that the federal government may regulate them."

WHAT HAPPENS TO THE REST OF THE LAW?

In a broader issue, the states and the National Federation of Independent Business -- a lobbying group for small businesses -- said the entire healthcare law must fall if the mandate is declared unconstitutional.

The federation and states contend that the individual mandate is at the heart of the law, a carefully crafted compromise, and new insurance regulations and other provisions cannot survive on their own.

The administration disagreed. It said it would be wrong to strike down all other provisions of the law, especially those unrelated to the mandate, such as the requirement that insurers provide coverage for young adults.

The administration said a few key provisions, including one that will bar insurers from refusing to issue coverage to a person because of a pre-existing medical condition, could not be separated from the mandate.

EXPANSION OF MEDICAID ON THE STATES

The states also challenged the expansion of Medicaid, a federal-state partnership that provides health care to poor Americans. They argued that Congress unconstitutionally forced the expansion on the states by threatening to withhold billions of dollars in funds from states that refuse to cooperate.

The administration said the provision expanding Medicaid eligibility to cover individuals with income up to 133 percent of the federal poverty level was a valid exercise of Congress's power to set the terms in appropriating federal funds.

MUST THE PENALTY BE IMPOSED FIRST?

The Obama administration and some opponents of the law asked the court to address whether lawsuits challenging the mandate are barred because the penalty for not obtaining individual insurance has yet to be imposed.

At issue is a federal law aimed at preventing lawsuits from tying up tax collection and whether the challenges can only be decided after taxpayers actually begin paying the penalty for not purchasing insurance.

The administration said the law, the Anti-Injunction Act, did not require dismissal of the challenges to the mandate. But the administration said the Supreme Court should consider the issue and consider appointing a lawyer to make that argument.

ARGUMENTS LIKELY IN MARCH

The Supreme Court next month is expected to consider the various appeals, to officially agree to take up the law, and it could clarify the issues to be decided.

The next steps would be for legal briefs to be filed, the scheduling of oral arguments, most likely in late March, and a ruling expected by the end of June.

Legal experts said it was impossible to predict how the court might rule. A decision by the nine-member court, closely divided with five conservatives and four liberals, could come down to Chief Justice John Roberts and Justice Anthony Kennedy, who often casts the decisive vote, they said.

The Supreme Court cases are Thomas More Law Center v. Barack Obama, No. 11-117; National Federation of Independent Business v. Sebelius, No. 11-393; U.S. Department of Health and Human Services v. Florida, No. 11-398; Florida v. Department of Health and Human Services, No. 11-400; Virginia v. Sebelius, No. 11-420; and Liberty University v. Geithner, No. 11-438.

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Wells Fargo gives staff tough healthcare choices

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By Rick Rothacker

Wed Oct 12, 2011 8:27pm EDT

n">(Reuters) - Wells Fargo & Co, one of the largest U.S. employers, plans to cut costs by moving its workers into insurance plans that encourage them to spend less on healthcare.

The bank told Reuters that it is rolling out a new insurance approach next year that will give employees accounts to help cover medical expenses. They can either put their own pretax dollars in the accounts, or pay higher insurance premiums and have the company fund the account.

If employees opt to put their own money into the accounts, they are on the hook for more of their medical expenses if they get sick. If they stay healthy, they benefit from lower premiums.

These types of accounts are believed to be useful in encouraging consumers to think more about how they are spending healthcare dollars.

For most employers, these accounts are one option among many for health insurance, said Alexander Domaszewicz, a principal with human resources consulting firm Mercer.

Only a handful of other companies, including General Electric Co and JPMorgan Chase & Co, are going the same route as Wells Fargo and offering only account-based healthcare plans.

"It still isn't common for very large firms," Domaszewicz said in an interview this week.

But other companies may follow suit. Account-based health plans can cut employees' and companies' premium costs by 15 percent, according to Mercer.

Other employers often follow big companies like Wells Fargo when it comes to benefits, Domaszewicz said.

In materials sent to employees recently, Wells said it was making the change "because rising health care costs and the impact of federal health care reform require us to take a new approach to managing costs together."

Studies are mixed over whether the new U.S. healthcare law will drive up employers' healthcare costs, but overall U.S. health insurance premiums have surged over the last decade.

A study last month by the Kaiser Family Foundation found that the average annual premium for family coverage through an employer increased 9 percent to $15,073 in 2011 from the year before. Since 2000, premiums have risen 134 percent.

Employers pay nearly three-quarters of that premium, a rate that has held fairly steady for the last 10 years, according to the foundation's data.

"This is one of the fastest-growing expenses employers have," said Randall Abbott, a senior consultant at healthcare consulting firm Towers Watson.

Cost-cutting is particularly crucial in the financial sector, where the mortgage crisis, low long-term interest rates, and weak loan demand are depressing revenue. San Francisco-based Wells Fargo is looking to shave $1.5 billion from its quarterly operating expenses by the end of 2012 under a program known as "Project Compass."

Wells earned $7.3 billion for common stockholders in the first half of the year, up from $5.3 billion in the first half of last year.

A Mercer survey found that health benefits costs on average will rise 5.4 percent in 2012, the smallest increase since 1997, because employers have been so aggressive about cutting these expenses.

"We view this as effective use of healthcare services, not as cost-cutting measures," bank spokesman Ancel Martinez said on Wednesday.

LESS BARGAINING POWER

U.S. employers began widely offering healthcare coverage after World War Two to get around government salary controls.

With 275,000 full- and part-time employees, Wells Fargo is the 12th-largest employer among public companies, according to Fortune Magazine.

About one-third of the bank's employees already use some sort of account-based plan. Wells will still offer traditional plans in California and other states where switching would force too many employees to change their doctors.

Under the bank's program, employees can have a "health reimbursement account," which Wells funds, or a "health savings account," which workers fill with their own pretax dollars.

Both accounts will help cover out-of-pocket expenses until a deductible is met.

After that, Wells will cover between 80 and 90 percent of medical expenses, with the employee picking up the rest. After an employee reaches an out-of-pocket maximum, Wells covers 100 percent of additional expenses. An insurance company administers the claims.

Eligible preventive care, such as routine checkups, annual screenings and immunizations, is covered 100 percent. Employees can earn money to put into their accounts through participating in health and wellness programs.

A Wells employee in North Carolina covered on an individual basis would pay a premium of about $23 per two-week pay period for the health savings account option, compared with $48 for the health reimbursement account plan.

An employee in an individual plan can put up to $3,100 into a health savings account under IRS rules next year. The deductible in that plan is $3,000.

In the health reimbursement option, the company can put between $200 and $1,000 in an employee's account. The deductible is $2,000 for individual coverage. Employees must pay $25 for a primary office visit, which is less than the full cost. There are also co-pays for generic prescription drugs.

Employees who use health savings accounts can roll their money into the next year if they do not use it all and take it with them if they leave the company.

(Reporting by Rick Rothacker in Charlotte, North Carolina; and additional reporting by Bill Berkrot in New York; Editing by Dan Wilchins, Martin Howell, Lisa Von Ahn and Carol Bishopric)

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Obama's healthcare law appealed to Supreme Court

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Opponents of the proposed U.S. health care bill are pictured during a rally outside the U.S. Capitol Building in Washington, March 21, 2010.

Credit: Reuters/Jason Reed

By James Vicini

WASHINGTON | Wed Sep 28, 2011 6:43pm EDT

WASHINGTON (Reuters) - The Obama administration on Wednesday asked the U.S. Supreme Court to back the centerpiece of Barack Obama's sweeping healthcare overhaul -- the requirement that all Americans have health insurance.

The appeal was largely expected as a high court ruling against the law could be a fatal blow to the president's signature domestic policy achievement and could have major implications for his re-election bid.

The same day the administration filed its appeal, 26 states and a major business group urged the justices to strike down the entire law, which would have a far-reaching impact on future healthcare coverage for Americans and company costs.

The case is likely to be heard and decided in the Supreme Court's upcoming term that begins next week and lasts through June 2012. A ruling is likely in the midst of the campaign for the November 2012 elections.

The administration and the opponents of the law called for a quick ruling by the high court to resolve uncertainty affecting the federal government, states and companies about the law's key provisions that are taking effect.

The 26 states and National Federation of Independent Business argued in their appeals the entire law should be invalidated because Congress exceeded its powers requiring that Americans buy health insurance or face a penalty.

The Obama administration filed its own appeal in which the Justice Department argued the so-called individual mandate, due to take effect in 2014, was constitutional and said the issue was appropriate for Supreme Court review.

"Throughout history, there have been similar challenges to other landmark legislation such as the Social Security Act, the Civil Rights Act and the Voting Rights Act, and all of those challenges failed," the Justice Department said.

"We believe the challenges to Affordable Care Act ... will also ultimately fail and that the Supreme Court will uphold the law," the department said in a statement.

White House adviser Stephanie Cutter said the administration asked the Supreme Court to hear the case "so that we can put these challenges to rest and continue moving forward implementing the law to lower the cost of health care and make it more secure for all Americans."

At issue was a ruling by a U.S. appeals court in Atlanta in August that declared unconstitutional the individual insurance requirement but refused to strike down the entire law.

That decision conflicted with rulings by other appeals courts that have upheld the law or have rejected legal challenges, including a lawsuit by the state of Virginia that was dismissed earlier this month on procedural grounds.

The law, passed by Congress and signed by Obama in 2010 after a bruising political battle, is expected to be a major issue in the 2012 elections as Obama seeks another four-year term. Republican presidential candidates oppose it and Republicans in Congress have pushed to repeal the law.

EXPANDING COVERAGE

Obama, a Democrat, has championed the law as a major accomplishment of his presidency and as a way to try to slow soaring healthcare costs while expanding health insurance coverage to the more than 30 million Americans without it.

The Supreme Court long has been expected to have the final word on the law's constitutionality. The dispute has important legal, political and financial implications for companies in the healthcare field.

Florida Attorney General Pam Bondi said the states sought Supreme Court review of their lawsuit.

"This healthcare law is an affront on Americans' individual liberty and we will not allow the federal government to violate our constitutional rights," she said.

Legal experts have said the nine-member Supreme Court, with a conservative majority and four liberals, most likely will be closely divided on whether the individual mandate requiring insurance purchases exceeded the power of Congress.

The Obama administration earlier this week said it decided against asking the full U.S. Appeals Court for the 11th Circuit to review the August ruling by a three-judge panel of the court that found the insurance requirement unconstitutional.

That decision cleared the way for the administration to go to the Supreme Court.

The states in their appeal also argued the law's expansion of Medicaid, a federal-state partnership that provides health care to low-income Americans, was unconstitutionally coercive, forced upon the states.

A senior Justice Department official told reporters that political considerations played no role in moving for Supreme Court review. The official said it was important to get a ruling soon so planning for the far-reaching law can proceed.

(Additional reporting by Jeremy Pelofsky and Karen Pierog in Chicago; Editing by Mary Milliken and Bill Trott)

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Obama healthcare law headed for Supreme Court

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President Barack Obama is pictured as he delivers remarks on the need to provide states with relief from key provisions of the No Child Left Behind education policy, at the White House in Washington September 23, 2011.

Credit: Reuters/Jason Reed

By James Vicini

WASHINGTON | Mon Sep 26, 2011 6:00pm EDT

WASHINGTON (Reuters) - The Obama administration on Monday cleared the way for the U.S. Supreme Court to decide in its 2011-12 term the president's signature healthcare law that requires Americans to buy insurance or face a penalty.

A Justice Department spokeswoman said it decided against asking the full U.S. Appeals Court for the 11th Circuit to review the August ruling by a three-judge panel of the court that found the requirement unconstitutional.

The decision not to seek review by the full appeals court will likely speed up consideration of the matter by the high court in its 2011-12 term that begins next week. A ruling could come by late June, in the middle of the presidential campaign.

The Supreme Court has long been expected to have the final word on the legality of the individual mandate, a cornerstone of President Barack Obama's healthcare law. A big uncertainty has been over when the court would decide the issue.

The law's fate before the nine-member court, closely divided with a conservative majority and four liberals, could come down to two Republican appointees, Chief Justice John Roberts and Justice Anthony Kennedy, legal experts have said.

The law, adopted by Congress in 2010 after a bruising battle, is expected to be a major political issue in the 2012 elections as Obama seeks another four-year term. All the major Republican presidential candidates oppose it.

Obama, a Democrat, has championed the individual mandate as a major accomplishment of his presidency and as a way to try to slow soaring healthcare costs while expanding coverage to the more than 30 million Americans without it.

The 11th Circuit appeals court, based in Atlanta, ruled by a 2-1 vote last month in favor of 26 states and others who challenged the mandate for exceeding the power of Congress.

The Obama administration could have asked the full U.S. 11th Circuit Court of Appeals to reconsider its decision. But that could have pushed back any Supreme Court ruling to its 2012-13 term.

The 2-1 ruling conflicted with other appeals courts that have upheld the law or have rejected legal challenges, including a lawsuit by the state of Virginia which was dismissed on procedural grounds.

A U.S. appeals court based in Cincinnati ruled Congress had the power to adopt the individual mandate, which takes effect in 2014. The losing side in that case, the Thomas More Law Center, already appealed to the Supreme Court in July.

The administration has steadfastly maintained its belief that the law will survive judicial scrutiny and be upheld by the Supreme Court. The states that have challenged the law have argued it went beyond Congress' authority to require coverage.

(Additional reporting by Jeremy Pelofsky; Editing by Doina Chiacu and Eric Walsh)

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Americans get too much healthcare, their docs say

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Devices used to take blood pressure, temperature, and examine eyes and ears rest on a wall inside of a doctor's office in New York March 22, 2010.

Credit: Reuters/Lucas Jackson

By Frederik Joelving

NEW YORK | Mon Sep 26, 2011 5:45pm EDT

NEW YORK (Reuters Health) - Here is a diagnosis of what's wrong with health care in America, straight from the horse's mouth: There's too much.

In a new poll of primary care physicians, nearly half of them said their patients received too much medical care and more than a quarter said they were practicing more aggressively than they'd like to.

That could mean ordering more tests, prescribing more drugs or diagnosing people with diseases, although they would never have experienced any symptoms.

On the other hand, just six percent of doctors believed their patients were getting too little care.

"Physicians at the frontline of medical care are telling us that their patients are getting too much care," said Dr. Brenda Sirovich of the VA Medical Center in White River Junction, Vermont, who worked on the survey. "And we don't think we are just talking about the 627 physicians that we surveyed."

The findings come at a time when the healthcare budget is already overstretched and many fear it is about to spiral out of control.

"We spend a lot on healthcare in this country, more than anywhere else," Sirovich, also at the Dartmouth Medical School, told Reuters Health. "We realize that this is unsustainable."

According to Organization for Economic Cooperation and Development (OECD), the U.S. spent $7,960 per capita on healthcare in 2009. That's $2,608 more than Norway, the runner-up, shelled out.

Dr. Lisa Schwartz and Dr. Steven Woloshin, who also worked on the new study, were two of the three authors of a book called "Overdiagnosed: Making People Sick in the Pursuit of Health."

THE TALE OF THE MORPHINE PUMP

And it's not only your wallet that could end up hurting from excessive testing, experts say. In a short article published along with the poll in the Archives of Internal Medicine, one doctor recounted the story of a man who developed intractable pain after falling on an icy driveway.

He had several tests at the hospital, but all of them came up empty, writes Dr. Philip Wickenden Bale of the T.J Sampson Hospital in Glasgow, Kentucky.

All along, the man's wife had been telling doctors that her husband had a morphine pump in his back to treat chronic pain and that he'd fallen onto the pump. But no one had listened.

"I was beating my head against a wall," she said, according to Bale.

His prescription? Just listen to your patient.

"Much science and technology, with associated expense, was used to eliminate conditions he didn't have, while the art of listening well might surely have led to a faster, cheaper remedy," Bale writes.

Excessive tests may also lead to diagnosing conditions that would never have caused any problem in the first place, such as a slowly developing prostate cancer or a slightly elevated blood pressure.

Yet after such a diagnosis, it's difficult for doctors not to proceed to treatment, which may cause side effects.

"When you do anything to somebody, whether it is an intervention or a test, you are putting them in to the healthcare system in a way that exposes them to risk," said Sirovich. "Unnecessary care is potentially harmful."

REIMBURSEMENT MODEL TO BLAME?

So why would doctors order tests that they themselves believe are excessive?

Three reasons stood out in the survey, which is based on a random sample of U.S. doctors: fear of malpractice lawsuits, performance measures and too little time to just listen to patients.

Four in 10 also believed that other primary care physicians would order fewer tests if those tests didn't provide extra income. (Of course, just three percent thought that financial considerations influenced their own practice style.)

"I'm not saying that physicians do tests in order to make money -- there is a potential to be a real cynic here -- but I think that the reimbursement model for most healthcare encourages utilization in a variety of ways," Sirovich said.

"It's a time for us to reflect about what incentives we have built into our healthcare system, and what directions they are taking us in."

SOURCE: bit.ly/7qXyI Archives of Internal Medicine, online September 26, 2011.

(This story changes paragraph two to say that more than a quarter of doctors said they were practicing more aggressively.)

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In Iowa, Perry rips Romney over healthcare plan

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Texas Governor Rick Perry speaks during the CNN/Tea Party Republican presidential candidates debate in Tampa, Florida September 12, 2011.

Credit: Reuters/Scott Audette

By Kay Henderson

DES MOINES, Iowa | Fri Sep 16, 2011 6:58pm EDT

DES MOINES, Iowa (Reuters) - Republican Rick Perry ramped up his criticism of presidential rival Mitt Romney on Friday, describing the health plan Romney backed in Massachusetts as socialized medicine and a miserable failure.

Perry, the Texas governor who leads opinion polls for the 2012 Republican race, attacked the healthcare law Romney signed as Massachusetts governor for forcing residents to get health insurance or pay a penalty.

"You know the model for socialized medicine has been tried before and it didn't work," Perry said during a speech at the Iowa Credit Union League's annual meeting. "It failed miserably whether it was in Western Europe or in Massachusetts."

Romney has been a target of frequent criticism for backing the Massachusetts plan, which conservatives see as a precursor to President Barack Obama's healthcare overhaul.

Romney has defended the Massachusetts law, while attacking Obama's federal version. He has said he wants to repeal the law Obama signed last year.

"We invite Governor Perry to come to Massachusetts so that he can see for himself that people buy private health insurance in a free market system. It is reckless and irresponsible to suggest otherwise," Romney campaign spokesman Ryan Williams said."

On the second day of a trip to Iowa, which holds the first nominating contest in the Republican race, Perry also ridiculed the jobs plan being pushed in Congress by Obama.

"We've tried for 2 1/2 years ... to stimulate the economy and you've got to ask yourself: 'How'd that work for us?'" Perry said. "Not very well."

Perry, a staunch social and religious conservative, has come under attack from his rivals for some of his policy stances in Texas and for his views on the Social Security government retirement program, which he has called a "Ponzi scheme" and a "monstrous lie."

Asked about the criticism, Perry said it was "political cowardice at its greatest."

In a Florida debate on Monday, Perry said he wanted to protect Social Security benefits for retirees and those nearing retirement, but would like to start an honest conversation about how to make the system financially sustainable.

(Writing by John Whitesides; Editing by Peter Cooney)

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HEALTH MANAGEMENT. China newborn baby deaths fall with improved healthcare

HONG KONG (Reuters) - Far fewer newborn babies in China are dying compared to 15 years ago, researchers reported on Friday, underscoring the success of a Chinese programme to encourage women to deliver in hospitals rather than at home.
Deaths among newborn babies fell 62 percent to 9.3 for every 1,000 live births in 2008, compared to 24.7 in 1996, they wrote in a paper published in The Lancet medical journal.
This improved figure puts China nearly on a par with Thailand at 8, Sri Lanka at 9 and Venezuela at 10. Advanced countries typically have much lower figures, such as 3 in Britain, 4 in the United States and 1 in Singapore, according to the United Nation's Children's Fund.
Led by Xing Linfeng and Yan Guo from Peking University in Beijing and Carine Ronsmans from the London School of Hygiene and Tropical Medicine in London, the researchers analysed data from 37 Chinese urban districts and 79 rural counties.
While less than half of all women in China gave birth in hospital in 1988, hospital births had become almost universal by 2008 with the exception of women in the least developed rural areas, they found.
However, some disparity still remained as babies born in hospitals in poorer rural areas were four times more likely to die than babies born in urban hospitals.
"Although most county-level or higher-level hospitals can deliver the elements of skilled birth attendance and emergency obstetric care that are essential to ensure neonatal survival ... many township hospitals do not fulfil these criteria," the researchers wrote.
An abstract of the paper can be found at: here(11)61096-9/abstract
(Reporting by Tan Ee Lyn)

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