Newsletter Articles

MEDICAID EXPANSION IN ILLINOIS SHOULD BE PRAISED

March 4, 2015

By Julie Hamos

In 2013, the Illinois General Assembly and Gov. Pat Quinn wisely made a decision to expand Medicaid under the Affordable Care Act and thus help all low-income Illinoisans get and stay healthy. The Chicago Tribune’s February 2, 2015 editorial called Illinois’ Medicaid expansion law a “debacle” and a “failure.” In fact, the expansion is an enormously positive achievement.

It is true that the consultants hired by the state five years ago “guesstimated” that 342,000 adults would become eligible for the Medicaid expansion. That enrollment figure now stands at 541,000. The higher enrollment demonstrates how difficult it has been, historically, to count low-income adults, even though they were cared for at various times in emergency rooms, homeless shelters, mental health clinics, social service agencies, and jails.

The higher-than-expected enrollment demonstrates just how well the outreach efforts by state agencies—in collaboration with community organizations, health clinics, and hospitals—have worked. It also recognizes the important initiative by the Cook County Health & Hospitals System, which created a large health plan called CountyCare and enrolled 100,000 adults early under a special waiver—a number that was not anticipated in the original estimate.

Yes, this will cost the state somewhat more after 2017. But the federal government now is paying 100 percent of the Medicaid costs for these adults, and that will ratchet down to 90 percent by 2020 and stay at that level. We also included a safety valve in the Illinois expansion law: if the federal match falls below 90 percent, the Medicaid eligibility for these adults will end within three months. In that instance, the Governor and General Assembly will be able to reconsider their options.

This is the best deal ever offered by the federal government to Illinois and other states. For this reason, even the Republican states that have not expanded Medicaid are having second thoughts.

Already there are many wonderful stories of adults getting much-needed healthcare, sometimes for the first time in their lives. But this is not just altruism; healthier Illinois residents mean a healthier Illinois bottom line. The availability of high-quality healthcare under the Medicaid expansion means 541,000 more low-income residents will be able to get and stay healthier—and hopefully avoid admissions into costlier hospitals and nursing homes. This is straightforward math: not paying on the front end translates to paying more on the back end.

Instead of criticizing the expansion, we should be celebrating the huge influx of federal money that provides health coverage for the previously uninsured; reduced uncompensated care (that is otherwise passed on to paying patients and taxpayers); and the positive effects on both the health and economy of Illinois.

This is no failure. It is nothing less than long-term success.

Julie Hamos was the Director of the Illinois Department of Healthcare and Family Services from 2010 to early 2015. This article appeared as an op-ed in the February 5 edition of the Chicago Tribune.

King v. Burwell: The Latest Legal Assault on the Affordable Care Act

March 3, 2015

Featured, Newsletter Articles, Updates

By Mark Rosenberg, M.D.

Not content with serial votes to repeal the Affordable Care Act (ACA, aka Obamacare)—we count 67 votes to date—Republicans also have launched court cases intended to invalidate all or part of this landmark legislation. King v. Burwell, the latest of these legal assaults on Obamacare, is scheduled for oral argument in the U.S. Supreme Court on March 4.

One of the ACA’s primary tools for making healthcare affordable is to share the burden of premiums, and even deductibles and coinsurance, with income-qualified consumers. These advance premium tax credits are available to households earning up to four times the federally-defined poverty level, which comes to about $92,000 a year for a family of four.

The plaintiffs in King challenge the legality of the ACA’s premium tax credits and cost-sharing subsidies being made available to all income-qualified consumers who purchase health insurance through the Marketplace. They contend that the language in the statute makes these federal subsidies legally available only when a consumer literally purchases health insurance through a state-run exchange. They argue that, conversely, subsidies are unavailable to anyone living in a state that has opted to use the federal exchange rather than create its own.

According to rules of statutory interpretation, a law’s language should be read in the context of the legislation as a whole. The purpose of the ACA is to provide affordable health insurance to as many as possible, and the availability of subsidies furthers this goal. Reading the statute as extending subsidies to all income-qualified consumers, without regard to whether the exchange they go through happens to be operated by their state, is thus rational. Federal courts generally uphold the Executive Branch’s interpretation of a statute, as long as that reading is rational.

For this reason, every one of the United States Circuit Courts of Appeals that has considered lawsuits challenging the availability of federal subsidies for insurance purchased on exchanges not established by a state has ruled against the plaintiffs. Yet the Supreme Court has agreed to hear King v. Burwell. Based on voting in previous cases heard by the Supreme Court, including the 2012 decision upholding the constitutionality of the ACA, many assume that four justices will agree with the plaintiffs in King, leaving the decision primarily in the hands of Chief Justice Roberts. The question then becomes whether Roberts would concur in a legal analysis, rejected nearly unanimously by the lower federal courts, that deprives millions of people of affordable healthcare.

A Supreme Court decision invalidating federal subsidies for health insurance purchased on federally-run exchanges would deprive more than eight million people in some 34 states of the financial help they need in order to afford health insurance, unless their states create their own insurance exchanges. Ironically, some 80 percent of those eight million individuals who stand to lose health insurance are white working poor who live in the South, a region that votes reliably Republican in most elections. The ruling would not affect those earning less than 138 percent of the federally-defined poverty level as these people qualify for Medicaid, as long as they live in one of the 28 states or the District of Columbia that have accepted the federally-funded Medicaid expansion available under the ACA. (The Supreme Court’s 2012 decision held that the federal government could not mandate states’ participation in expanded Medicaid). A decision for the King v. Burwell plaintiffs also would have the consequence of increasing premiums for health insurance since the pool of insured individuals would be vastly decreased, thus increasing insurers’ risk per insured.

There is no question that a Supreme Court decision that would seriously undermine Obamacare and deprive millions of health insurance would be viewed widely as a partisan political act and not a legal pronouncement based on the merits of the case. But the Court may have an “out.” Recent reporting in The Wall Street Journal has questioned whether the King plaintiffs have the legal standing required to pursue the case. According to the Journal, it is possible that none of the named plaintiffs is subject to the ACA’s individual mandate that requires individuals to purchase health insurance. Two of the plaintiffs may be entitled to veterans’ healthcare; one, who may be homeless, may earn so little as to be exempt; and the fourth will become eligible for Medicare in June. This could give the Supreme Court a procedural basis for rejecting the lawsuit.

THE AFFORDABLE CARE ACT Five Years After Enactment

Newsletter Articles, Updates

By Mark Rosenberg, M.D.

Five years after the passage of the Affordable Care Act, despite the many assaults against the law known as Obamacare, there is much to celebrate. Currently, approximately 12 million Americans have health insurance as a result of the availability of federal subsidies for insurance purchased on the state and federal exchanges, the federally-funded expansion of Medicaid by more than half of the states, and the provision that allows children to remain on their parents’ health insurance until their 26^th birthdays.

Despite all this, many Americans hold an unfavorable view of Obamacare. Polls generally break down along party lines, with favorable views by Democrats and mostly unfavorable views by Republicans and many Independents. Yet when each provision of Obamacare is presented by pollsters without connecting them to the legislation, people’s views are overwhelmingly favorable. For example, few would do away with the new provisions for expanded health benefits like cost-free cancer screening or the legislation’s prohibition against such prior insurance practices as refusing to cover preexisting conditions and limiting the amount of benefits available under a plan annually and for the insured’s lifetime. In other words, when people know what Obamacare is all about, they overwhelmingly approve of the Affordable Care Act.

Here’s some of what we know so far about how the Affordable Care Act has worked.

Fewer Uninsured

From a high of over 16 percent during the recession, the rate of uninsured Americans fell below 13 percent by the fourth quarter of 2014. Of the newly insured under the Affordable Care Act, over 70 percent had no prior insurance. More than eight million Americans have received tax subsidies through the federal and state insurance exchanges. Another 9.7 million people in 27 states receive Medicaid, with all costs paid by the federal government.

In Illinois, projections were that about 200,000 would enroll in Medicaid, but that number has grown to over 500,000. While some criticize the state for taking on so many Medicaid recipients, the fact is that having those individuals receive health insurance is a good thing, reducing the burden on hospitals, especially Cook County, which has balanced its budget. See “Medicaid Expansion in Illinois Should Be Praised,” on page 5 of the March edition of Tenth News for more about the benefits of the Medicaid expansion in Illinois.

Better Health

While it is too early to predict improvements based on the provisions of Obamacare that require insurers to cover screening and preventive health care at no cost to the consumer, in Massachusetts, whose decade-old “Romneycare” was a model for Obamacare, there has been a modest decrease in mortality rates.

Lower Costs

There is evidence that since the ACA took effect, there has been a sustained slowdown in healthcare cost inflation, from about a seven percent annual increase to an annual increase of just under four percent.

With plans paying 100 percent of the cost of preventive care and screening, Americans no longer have to choose between a mammogram and the week’s groceries. And a catastrophic diagnosis or accident no longer is a prelude to bankruptcy.

The other big winners are hospitals, which no longer have to write off tens of thousands of dollars billed to patients with no insurance and no means to pay for expensive medical procedures.

And even though health insurers no longer can deny benefits for care related to preexisting conditions or raise insurance premiums when people get sick or impose limits on what they will pay (to the contrary, Obamacare limits the annual out-of-pocket costs of consumers, requiring health plans to pay 100 percent when those limits are met), health insurance companies are among the biggest beneficiaries of the Affordable Care Act. Health insurance companies’ markets have expanded, and they are selling their plans to millions of Americans who were previously uninsured and unable to afford to pay premiums.

Tenth Dems Enjoys Political Satire by the Capitol Steps

March 2, 2015

Newsletter Articles, Updates

By Mark Levy

Some fifty to seventy Tenth Dems joined a sell-out crowd to enjoy a Sunday afternoon presentation by The Capitol Steps at the North Shore Center for the Performing Arts on January 25.

The Capitol Steps, well known for more than 30 years for delivering performances of incisive political satire, search out all corners of the national political spectrum and leave no point of view unscathed. This latest presentation did not disappoint.

The many short clips that made up this performance demonstrated that each viewpoint provides several examples worthy of satire.

One of my favorite sketches was excerpted from the famous Simon and Garfunkel song “The Boxer.” It portrays Dick Cheney preparing to testify before a congressional committee to explain why the Bush administration believed Iraq was harboring weapons of mass destruction. So sang Simon and Garfunkel: “Lie lie lie, lie lie lie, lie lie lie lie lie lie lie lie lie lie lie lie.”

Another clip portrayed President Obama meeting Russian President Vladimir Putin, as Obama took out his pocket phone to snap a “selfie” of the two world leaders together.

On national security topics, The Steps suggested the federal government should no longer need NSA for listening surveillance when it could simply scan with President Obama’s oversized ears.

The program materials note that the show constantly changes based on the scandal of the day. For those of us who engage in political activities with serious intent, it’s good to pause and poke a little fun at ourselves once in a while.

“WE DON’T WANT NOBODY THAT NOBODY SENT”

February 10, 2015

Newsletter Articles

By Mark Rosenberg

In 1948, a University of Chicago law student named Abner J. Mikva stopped at a Democratic committeeman’s office to volunteer to work for Adlai Stevenson and Paul Douglas. The response to his request to volunteer was, essentially, “We don’t want nobody that nobody sent.” Ab Mikva was not daunted, and that encounter was the beginning of a stellar political career.

After serving in the Illinois House of Representatives for 10 years, Ab Mikva served as U.S. Congressman in Hyde Park and then in our own Illinois 10th Congressional District. His career path changed when he was appointed to the D.C. Circuit Court of Appeals in 1979. He left the bench in 1994 to become White House Counsel to President Bill Clinton.

In 1997, along with his wife, Zoe, Judge Mikva started a civic engagement program for Chicago youth called the Mikva Challenge (See www.mikvachallenge.org). This organization works with 5,000 young people each year to involve them in the democratic process. These youngsters work as election judges, and they volunteer with campaigns and with local grassroots organizations that work to improve schools and communities. “Of all the accomplishments in my professional life, what I am most proud of is helping found the Mikva Challenge,” Mikva has said.

Among those mentored by Ab Mikva over the years was a young lawyer named Barack Obama.

In December 2014, President Barack Obama awarded Judge Mikva the Presidential Medal of Freedom.

To honor Judge Mikva’s example, Tenth Dems presents an annual award in his name. Past recipients of the Ab Mikva Leadership Award include such luminaries as Loretta Durbin, former State Senator Susan Garrett, State Senator Melinda Bush, State Senator Daniel Biss, and former 10th District Congressman Brad Schneider.

MEDICAID EXPANSION IN ILLINOIS SHOULD BE PRAISED

King v. Burwell: The Latest Legal Assault on the Affordable Care Act

THE AFFORDABLE CARE ACT Five Years After Enactment

Tenth Dems Enjoys Political Satire by the Capitol Steps

“WE DON’T WANT NOBODY THAT NOBODY SENT”

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