Healthcare

Republicans’ proposed repeal of health reform: Taking away from us what they keep for themselves

According to the Republican congressional leadership, one of the first actions in the 112th Congress will be House passage of a bill to repeal the Affordable Care Act. In so doing, they would take away key benefits and rights needed by America’s families, unravel a law that holds insurance companies much more accountable, and add a trillion dollars to the federal deficit over the next two decades. 

Incredibly, Republican leaders plan to take away from the American people the very health benefits and rights they intend to keep for themselves — courtesy of America’s taxpayers. 

This phenomenon was on clear display when new House members received their congressional orientation. Maryland Rep.-elect Andy Harris, who campaigned to repeal the Affordable Care Act, was furious when told that his federally subsidized healthcare coverage would not go into effect until February — some four weeks after his swearing in. Yet, he remains committed to taking away, immediately, comparable benefits and rights from his constituents and the American people.

The double standard, however, is by no means limited to Rep.-elect Harris. When it comes to healthcare, Republican congressional leaders are as intent on taking from us what they plan to keep for themselves.

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State Medicaid 'opt out' will undermine seniors’ care quality, threaten healthcare jobs

Governors have a unique perspective on how this historic recession has strained our budgets and challenged the ability of states to fund Medicaid -- the key safety net program for 60 million of our poorest Americans. Most states are required to balance their budgets, and with the recession drastically reducing state revenues, governors across America, myself included, have been forced to make difficult decisions. Since Medicaid is a substantial part of every state budget, the program is often a prime target for budget cuts.

Facing the worst economic downturn since the Great Depression, it is no surprise that some governors are now considering “opting out” of Medicaid completely and considering ways to provide essential services on their own. While I respect the challenging decisions faced by every governor, simply opting out of Medicaid is not the answer. In fact, it would open a Pandora’s Box of new problems.

Not only would a Medicaid opt out result in a state losing the considerable federal funding match, leaving it with far fewer resources to provide ongoing care, it would cause rampant healthcare job losses. This would be directly at odds with the top policy priority in Washington and every state capital -- creating jobs.

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No more waiting when it comes to primary care

In systems as big and complex as the U.S. healthcare system, movement does not come easy. Change is hard, and institutional inertia is the norm. The default is to wait and see. Right now, the vast majority of our healthcare system doing just that. It’s seven months into waiting and seeing what healthcare reform ultimately has in store. Before that, it waited to see what healthcare reform would look like. It’s waiting to see what the insurance companies will do, what hospitals will do, what accountable care organizations will do, and so forth.

But the question that healthcare practitioners and industry watchers are increasingly asking is, do we really have time to wait? According to the most recent U.S. Census projections, as the population approaches 341 million by 2020, the demographics of those seeking healthcare will shift to an older, more ethnically diverse, and more infirm mix of consumers. Healthcare providers will face far wider gaps in education and income. By that time, our nation faces a projected shortage of around 96,000 physicians. It’s estimated that 45 percent of that shortage will be primary care doctors, often patient’s first and most frequent point of contact with the medical system. Estimates show that the nation will be short 148,000 nurses by 2020, with that shortfall set to exceed 260,000 nurses by 2025, of which we estimate 85 percent will be in primary care.

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Making government and healthcare work

Even though we live in a country in which the populace is fiercely divided on so many important issues, it remains important in a vibrant democracy for citizens to have a healthy measure of confidence that their government will attempt to act in their best interests.  More specifically, that need for public confidence also extends to health reform.  If we want Americans to take part in the healthcare system, to make use of preventive care services and reduce incidences of chronic disease, then it’s necessary to establish faith that reform is indeed elevating health care quality and affordability.

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Health law individual mandate is unconstitutional (Sen. Mike Enzi)

During this holiday season, millions of Americans face growing concerns about their jobs, the economy and the overall direction of our country. These concerns are prompted, in large part, by the massive expansion of the federal government over the past two years, and its related intrusions into the everyday lives of all Americans.

These concerns were recently highlighted on a sign placed on the side of an industrial plant in Worland, Wyoming, that said, “As Regulations Grow, Freedoms Die.”

This message perfectly captures the great concerns that Americans feel towards many of the new laws being enacted in Washington, and especially the new healthcare law.  This new law is chock-full of mandates that will restrict American freedoms, and place regulatory and tax burdens on struggling businesses and families.

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IEDs, Alzheimer's, and national defense

Sandra Day O’Connor and Maria Shriver have called for a 10 year plan to defeat Alzheimer’s disease–“our generations defining challenge.”  Invoking the visionary leadership of both John F. Kennedy & Ronald Reagan, they spotlight the National Alzheimer’s Project Act as the greatest public and financial health issue of our time.  No doubt our country needs the push as millions of baby boomers age into their retirement years and Alzheimer’s “must be considered a full blown epidemic.” 

But, the country faces another epidemic, more immediate and a direct threat to national security, a disease of the brain like Alzheimer’s and a direct consequence of nearly 10 years of fighting in Southeast Asia – the disabling legacy of IED blasts and PTSD. The IED (improvised explosive device) has changed the wars in Iraq and Afghanistan and created harrowing suffering among hundreds of thousands of battlefield casualties. Over 2 million Americans have seen combat.  At least half of all killed in combat have fallen to IED attacks.  A quarter of the combatants – 500,000 men and women – have been victims of multiple blasts. All the surviving amputees from IEDs suffered “blows” to the head as well.  For every soldier killed or seriously wounded, ten more live with the long-term effects.  A common case - a senior NCO who had endured over 40 blasts, was working every day enthusiastically with all the commitment that can be imagined, despite having daily headaches, difficulty sleeping, and worrying that he couldn’t think as well as he did before.  No one has checked his performance.  He is a casualty, like thousands of other men and women who struggle each day to patch up their lives. 

Blast concussions from IEDs contribute to homelessness, suicide, unemployment, fractured families, and weaken the fighting force- the early signs of a growing and tragic epidemic.  The aftershock of hundreds of thousands of combat blasts ripples through the society with immediate and heavy impact.  Over a thousand veterans have committed suicide, one quarter the number that has been killed in combat.  The ratio of homeless veterans of these wars far exceeds those from Vietnam.

This epidemic will haunt our society, as has the medical fallout from previous wars.  Vietnam was followed by the stubborn “signature injuries” of PTSD and Agent Orange, and the Gulf War Syndrome still afflicts many veterans of Desert Shield/Storm.  Hundreds of thousands of men and women suffer the crippling aftershocks of their military service and continue to linger and impose billions in healthcare costs.  If this history is pertinent, then we are just seeing the bow wave of a great epidemic in brain disease in the injuries from IED blasts.

By invoking the legacies of JFK’s expedition to the moon and Ronald Reagan’s defeat of communism, the campaign plan for defeating brain disease assumes the look and feel of a military operation grafted on to a medical science endeavor.  In fact, defeating the devastating effects of IED blasts requires the strategic planning and organization of a Manhattan Project or moon shoot - projects that succeeded with strong leadership and action plans in pursuit of clear, tangible objectives. Such leadership is needed to treat mild traumatic brain injury, and guide the scientific enterprise, and balance the culture of medical science, anchored in academic institutions that are inherently open-ended and exploratory.  It is not likely that the problem of brain diseases – either IED induced or Alzheimer’s – can be solved with the discovery a vaccine (as developed for polio) or even multiple drugs (as for HIV) – diseases caused by identifiable infectious agents.  The brain disease of blast concussions is more complex, and links to many more biological, psychological, environmental, and social factors.  Any campaign to defeat or mitigate these illnesses extends beyond medical science and requires the planning and programming of a Manhattan Project.     

My experience over the past several years has shown that institutional processes and regulations have encumbered advances in brain science and developments of treatments. Despite nearly $2 billion that has been allocated to the problems of psychological health and blast concussion, few, if any, new treatments have been delivered to the troops and families. The current portfolio of research and development, which should be applauded, will take many years to show productive results. The Defense Centers of Excellence for Psychological Health/mTBI, established by the Congress, has not been able to achieve its intended goals and objectives. But, the demand for treatments is urgent, in the face of the probable continuing aggravation of symptoms and deterioration secondary to the blasts that affect the casualties. The planning and programming of a military campaign is vital.

In short, an ideal veterans/military medical campaign starts with drafting multiple courses of action targeting the diverse dimensions of the brain disease, and top-flight coordination of efforts – early identification of injury, expedited trials of potential diagnostic tools and treatments, quick development of promising cures. It looks like a counterinsurgency plan, a “surge” of initiatives with the sophistication and imprimatur that succeeded in Iraq and is being carried out in Afghanistan (with all the complexity).  Rhetoric aside, customary medical science programs are driven by the scientific questions and individual interests of the respective researchers.  No matter how well intentioned, the fundamental focus on the target problem or patient often becomes obscured by the culture of the researchers. And, the convoluted politics of the regulatory agencies interfere.  In this way, potential and promising new treatments have been stymied and not pursued. Instead, really promising treatments – inexpensive and low risk - are being promoted independently and in “creative” fashion by their developers relying on good will and charitable donations if they can get them. This is good initiative, but inefficient and hurtful to the mission – ultimately helping the combat casualty.  If a fundamental element of an effective surge campaign (counterinsurgency) has been partnering with local and influential agencies, then formalized academic, private, and clinical partnerships are needed to attack this epidemic.
  
It may be time for the White House to engage in the Surge Against Brain Disease. Its leadership is needed to empower the National Alzheimer’s Project Act and broaden the appeal to unlock the mysteries of the brain. The veterans rely on a common sense approach to recovering their individual health and not just good science. The nation must act to reduce the epidemic burden on society of the medical consequences of this war, mitigate the projected cost, and minimize the lost years of potential productivity.

Stephen N. Xenakis is a child and adolescent psychiatrist and a retired Army brigadier general. He is in clinical practice and the founder of a nonprofit conducting research on brain-related diseases. He discusses this topic further on NPR's All Things Considered.

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The individual mandate is unconstitutional (Sen. Orrin Hatch)

Judge Henry Hudson’s ruling striking down Obamacare’s individual insurance mandate shows what a year and a few constitutional principles can accomplish. A year ago, liberal politicians and pundits scoffed at the mere suggestion that there was anything the federal government could not do. Today, Judge Hudson is only the first federal judge to say that, yes, the Constitution sets real limits on Congress.

Liberty requires limits on government, limits that government itself does not control. Congress’ authority to pass legislation, for example, must come from at least one of the powers listed in Article I of the Constitution. Those powers, however, do not mean whatever Congress wants them to mean. Our liberty requires that the Constitution control Congress, not the other way around.

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Our top priority will be full repeal (Rep. Fred Upton)

Today, a U.S. District Court ratified what many Americans have known for the past year: the health care law is not only bad policy, it is unconstitutional as well.  This decision strikes a blow for freedom and the enduring constitutional principles of our forefathers.

When the health care law was being debated, Energy and Commerce Republicans warned that Obamacare represented an unprecedented intrusion by government into the lives of American citizens.   At the time, we argued that the individual mandate violated Article I, Section 8 of the Constitution – the Commerce Clause – because it purported to regulate an individual’s ‘inactivity.’  If the government could compel individuals to engage in activities they wished to avoid – such as the purchase of health insurance – what restrictions could there possibly be on government’s power? 

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History and the facts are on our side

Today’s narrow ruling in Virginia on the constitutionality of a provision of the Affordable Care Act is just one of many recent rulings on similar cases that have come down in recent months.  Since the law passed, opponents of reform have filed more than 20 different legal challenges.   Judges have already granted the Administration’s motion to dismiss 12 of these cases.   And in two cases, federal judges looked at the merits of the opponents’ arguments, determined that the Affordable Care Act is constitutional and upheld the law.

We disagree with the ruling issued today in Virginia and the Department of Justice is considering its appeal options.

We are pleased that Judge Hudson agrees that implementation of the law will continue uninterrupted.   In the nine months since the health reform law was passed, we’ve made tremendous progress to strengthen our health care system, including lowering costs and implementing a new patient’s bill of rights to end some of the worst insurance company abuses. That work continues. And we’re confident that when it’s all said and done, the courts will find the Affordable Care Act constitutional. 

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Food safety bill important to our country's health and livelihood (Sen. Mike Johanns)

The livelihood of our country's agricultural producers depends upon consumer confidence in the entire food safety system. From production to the produce aisle, if this confidence is lost in any part of the system, agriculture – my state, Nebraska's, biggest industry – pays a heavy price. As Secretary of Agriculture, I witnessed firsthand how outbreaks and scares of food-borne illnesses devastated certain food industries and their producers. To help safeguard against future outbreaks and panics in our food system, I voted for the Senate food safety bill last week.

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