Will the ACA Survive the Scales of Justice Yet Again?

In late December, the U.S. Court of Appeals for the 5th Circuit struck down the individual mandate of the Affordable Care Act but ducked the central question – is the rest of the ACA valid after Congress zeroed out the tax penalty for not having health insurance?

The case was sent back to the lower court to reconsider how much of it survives; the lower court judge previously ruled the entire law unconstitutional. This move reduces the likelihood of the Supreme Court considering the case before the 2020 election, but the Democratic-led states defending the law might appeal directly to SCOTUS.

The case was brought by 18 Republican-led states and the ACA has been defended mainly by a coalition of Democratic attorneys general, as the Administration refuses to defend the law.

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Sunshine, Ocean Views, & Not Enough Doctors

The Florida Keys usually conjures up images of sunshine, ocean breezes, and copious cocktails. But beyond the vacationers paradise, there is the reality of life in the Keys – and needing access to health care.

Across the 137 square mile archipelago, there are only 266 health care providers for 74,000 residents (and 2.25 million annual visitors). The Florida Keys has a serious shortage of health care providers and services.

There are two main types of shortage designations, as determined by the Health Resources & Services Administration (HRSA).

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More Than Medicare-for-All: Proposals to Achieve Universal Health Coverage

Since the passage of the ACA, more than 20 million Americans have gained health insurance. But the fight for affordable and accessible universal coverage continues.

Here are just some of the proposals that have been introduced in Congress:

  • The Medicare for All Act of 2019 (H.R. 1384/S.1129) would establish a national health insurance program administered by HHS.
  • The State Public Option Act (H.R. 1277/S.489) would allow states to offer residents of all incomes the option to buy into Medicaid. This option would compete with private plans on the ACA Marketplace.
  • The Medicare Buy-In & Health Care Stabilization Act of 2019 (H.R. 1346) would allow individuals aged 50 to 64 to buy into Medicare and provide some marketplace stabilization.
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Back to Basics: Congress

✌🏼out to my third semester of medical school & the 2019 Congressional session.

Not to worry, both will be back in full force in January!

Before I head for my vacation in the Conch Republic, I want to drop a basic civics lesson.

The basic of all basics – Congress refers to our bicameral (two chamber) legislature, made up of the House of Representatives and the Senate. It is one of three branches of government. It writes the laws and controls the money.

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All the Health Priorities in the $1.4 Trillion Spending Deal

The end of the year bipartisan spending deal will allocate $1.4 trillion in federal funding for the remainder of the fiscal year (through Sept. 30) and avoid a shutdown. The House has already passed the deal and the Senate is poised to do the same by tomorrow.

Samuel Corum for The New York Times (Source Linked)

So what health priorities made the cut for this deal?

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The Power of the Purse

Congress will send a $1.4 trillion spending deal to the President this week. It will fund the government and avert an end-of-the-year shutdown. The House has already passed the deal and the Senate will take it up by the end of the week. The government is currently operating under a continuing resolution that expires Dec. 20.

Read about the health-related specifics of what’s included in the deal here. But first let’s start with some key concepts related to Congress’ power of the purse.

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Back to Basics: Single Payer & Medicare-for-All

Estimates from the Urban Institute project that in 2020, the federal government will spend $732 billion on Medicare, $464 billion on Medicaid and CHIP, $60.4 billion on the health insurance marketplaces, and $27.5 billion to hospitals for uncompensated care. Households will spend $931 billion, employers will spend $955 billion, state governments will spend $285 billion on Medicaid and CHIP and $17.2 billion for uncompensated care, and providers will spend $24.1 billion.

We’re talking about an insane amount of money – honestly seems like Monopoly money to me.

Reigning in healthcare spending has to be a policy priority, it’s simply unsustainable. Medicare-for-All would shift most of the spending to the federal government, to the tune of $34 trillion over a decade.

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Congressional Committees with Health Care Jurisdiction

Health care is such a massive topic that it takes more than one Congressional committee to handle all the health-related legislation. It’s important to know which committee a bill will be referred to for any advocacy work! Speaking with committee members should be a priority.

Once a bill is introduced in the House or the Senate, it is referred to the committee with jurisdiction over the topic or program addressed in the bill. Committees then refer it to the appropriate subcommittee and conduct an evaluation of the proposed legislation. Let’s take a look at what is under the jurisdiction of the major health care committees on both sides of Capitol Hill.

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California Adopts Statewide Insurance Subsidies

Not only are the views of the California coast spectacular, but now they come with the bonus of a buffer to the rising cost of health insurance.

California will be the first state to offer state-funded tax credits for insurance purchased through Covered California, the state insurance Marketplace. The federal government offers credits as well, but many people fall into a coverage gap due to earning too much for Medicaid and the federal credit but too little to afford insurance on their own. The California credits will be paid for in part by a new tax penalty on Californians who do not have health insurance.

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Improving Quality of Care for End-Stage Renal Disease

I spent this rainy morning shadowing a pediatric nephrologist, the specialists for kidney function in kids. The number of conditions they see is vast, but each has a unique course and some can progress to renal failure, even with medical intervention.

Chronic renal failure is the result of slowly progressive kidney diseases (and it not often reversible). 1 in 3 American adults is at risk for kidney disease — the two main causes of CKD in the adult population are diabetes and high blood pressure. In kids, CKD is often associated with inherited disorders, malformations present at birth, and autoimmune diseases, to name just a few.

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