What will high court do on health law? 4 most possible scenarios

Last week, U.S. Supreme Court justices heard arguments about the constitutionality of the federal health-care reform law. At the center of the debate is whether the government can force people to buy health insurance, a provision often referred to as the individual mandate. There are four likely scenarios that will be the outcome of the justices' decisions, asserts Jennifer Haberkorn for Politico, all of which come with their own problems.

Scenario 1: The individual mandate is struck down, as well as insurance reforms: If these parts of the Affordable Care Act are scrapped, "Insurance companies will still be able to deny coverage based on customers' costly pre-existing conditions and charge more to older and sicker — or female patients," Haberkorn reports.

If that happens, the Obama administration and Democrats would likely blame Republicans for promoting a lawsuit that puts insurance companies in charge again. If reaction from the public is strong, Republicans may feel obligated to enact insurance reforms without an individual mandate. Ideas for doing this include "charging more if a person buys insurance at the last minute, tax incentives and a promise that if a person buys coverage, that person wouldn't lose it if he or she were to get sick and need it," Haberkorn reports.

Scenario 2: The mandate is struck down, but insurance reforms stay intact: Part of the reason why insurance companies agreed to stop denying coverage based on pre-existing conditions is they could offset the losses because the law would enlarge their insurance pool by 30 million people — the number of Americans who lack coverage.

If insurance companies are still required to stop denying coverage based on pre-existing conditions but the individual mandate is struck down "They could start a mini revolt over having to cover expensive patients without the mandate," Haberkorn reports.

Scenario 3: The entire law, or the majority of it, is axed: That would mean unpopular parts of the law would be trashed, but so would popular ones, including the pre-existing conditions piece as well as a provision that allows young adults to stay on their parents' health insurance until the age of 26.

In 2010, 26 provisions took effect and another 17 did last year. Nine new provisions are taking place this year. "Lawmakers designed the phase-in, in part, with the thought that the public would become more supportive of the law once certain provisions began to take hold," report Michael Doyle and David Lightman for McClatchy Newspapers.

Scrapping the law entirely could cause the most political fallout. "Republicans would try to move quickly to enact a small-scale health reform legislation aimed at restoring some of the popular pieces of the health law," Haberkorn reports. "But Democrats won't want to support something far less comprehensive than the Affordable Care Act, not with some 50 million Americans uninsured."

Scenario 4: The law stands: Though this is the hope of the Obama administration, "The mandate is considered relatively weak: The penalty for not obeying it starts at $95 in 2014 — that's nothing compared with the cost of insurance premiums," Haberkorn reports. The amount increases to $695 by 2016.

As for what the justices will do, "at least some of the court's conservatives seem prepared to kill the whole bill," report Doyle and Lightman. "My approach would be, if you take the heart out of the statue, the statute is gone," Justice Antonin Scalia said.

Justice Elena Kagan countered, "Half a loaf is better than no loaf," while Justice Ruth Bader Ginsburg suggested, "It's a question between a wrecking operation and a salvage job."

Some justices said the whole bill should be sacked, "on the theory that members of Congress would not have voted for it without the mandate," Adam Liptak reports for The New York Times. But Justice Sonia Sotomayor said killing the whole law "would be too broad an assertion of judicial power," Liptak notes. Justice Anthony Kennedy, the likely swing vote, said "We would be exercising the judicial power, if one provision was stricken and the others remained, to impose a risk on insurance companies that Congress had never intended."

The justices probably decided the future of the law Friday morning, reports Mark Sherman for The Associated Press. Typically, an initial vote is "followed soon after by the assignment of a single justice to write a majority opinion, or in a case this complex, perhaps two or more justices to tackle different issues. That's where the hard work begins, with the clock ticking toward the end of the court's work in early summer," Sherman writes.

In Kentucky, health advocates and officials are watching closely to see what happens. "I think the entire health-care sector and insurance sector are watching this closely because it has significant implications on both industries," said Stephen Williams, chief executive officer of Norton Healthcare. "This is very far-reaching."

In Kentucky, the law extends coverage for 35,000 young adults, reports Laura Ungar for The Courier-Journal. (Read more)

Sen. Rand Paul puts holds on federal synthetic drug bans

U.S. Sen. Rand Paul, left, has put a hold on several Senate bills aimed at banning chemicals used in synthetic drugs because he feels "enforcement of most drug laws can and should be local and state issues," said his spokeswoman Moira Bagley. The move has been criticized by other lawmakers, law enforcement and a woman from his home city whose daughter had a bad reaction to synthetic marijuana. (Photo by Matt Goins)

"When Ashley Stillwell, 19, bowed to peer pressure last August and smoked a substance called 7H, it quickly immobilized her," reports Bill Estep for the Lexington Herald-Leader. "Ashley's frightened friends poured water on her and shook her. When they couldn't rouse her, Ashley heard the others discuss dumping her body in the Barren River."

The teen recovered after she was taken to the hospital, but her mother Amy, of Bowling Green, is frustrated by Paul's move to block the legislation. Three Senate measures passed committee last summer, and the House voted 371-98 in December to approve a ban on synthetic drug chemicals. Senate rules allow one member to place a hold on a bill. "That doesn't mean it can't be voted on, but it slows the process and raises some hurdles," Estep reports.

Bagley said Paul is concerned about banning the substances before research can be done on them. Sen. Charles Grassley, an Iowan Republican who sponsored one of the bills, said reclassifying the chemicals as controlled substances would not prevent research from being conducted. "We cannot let the will of just one senator obstruct the will of many," Grassley said.

One in nine high-school seniors had used a substance known as K2 or Spice in the past year, the National Institute on Drug Abuse reported in December. That makes synthetic marijuana the second most-abused drug in that age group. Calls to poison-control centers about synthetic drugs have risen from 3,200 in 2010 to 13,000 last year, Estep reports.

White House drug chief Gil Kerlikowske said his office is "urging the Senate to pass that legislation." (Read more)

What would solve primary-care crisis, create jobs and help banks? Building community health centers, writer contends

The federal health-care reform law will mean a glut of new patients who will be newly insured and bog down the primary-care system. Thousands of construction workers are out of jobs as the economy remains stagnant. And the banking sector is still reluctant to lend. The answer to all three problems? Build more community health centers, writes Jeffrey Leonard in an opinion piece in The Washington Monthly. (Photo: Vista, Calif., Community Clinic)

"The way to meet the flood of new patients coming down the pike is to expand the nation's existing network of community health centers — nonprofit clinics that offer primary care to the medically under-served, often in rural areas or inner cities," writes Leonard, CEO of the Global Environment Fund and chairman of the magazine's board of directors. "But to get this done, there's no need to appropriate billions more in direct government spending. Rather, there is a way to lure skittish banks in lending private capital to finance a health-center construction boom in all 50 states, simply by tweaking the language of an existing federal lending program."

Though community health centers generally have difficulty raising their own funds to expand or build facilities, in part because they serve uninsured, low-income patients who can't donate to building projects, they are sound investments, Leonard contends, pointing out only "one or two" of the 1,200 community health centers in America today have ever defaulted on a loan.

Still, they have trouble getting loans from banks, even once they have been able to raise a chunk of funds, in large part because centers "in an economically distressed inner-city neighborhood serving a mixture of Medicaid patients and the uninsured, or one in a depressed heartland town where real estate prices are spiraling downward" are seen as a risk, Leonard explains.

Leonard suggests the centers be eligible for the Small Business Administration's 504 loan program, in which a small business asks a non-profit lender to issue "low-interest, fixed-rate, government-backed bonds to finance up to 40 percent of the project," Leonard writes. As of now, the loan program is only open to some for-profit businesses. But Congress could change that, thus opening up possibilities. Moreover, the loan program is "routine and efficient to process" and the "interest rates are among the lowest on the market," Leonard contends.

Another option would be for construction companies and real estate developers to put up the equity themselves, build the facilities and then rent them out to nonprofits "on a long-term lease or through various lease-to-own arrangements." "Indeed, hungry developers and construction firms would find any number of ways to get the hammers swinging," Leonard writes.

Overall, it's a win-win, Leonard argues."It's hard to imagine Congress appropriating any more direct spending to fuel the construction of health centers," he writes. "But there's no good reason why they shouldn't change a few words in a statute to achieve the same end. Not only would it quickly create much-needed jobs in the construction trades, it would also spark economic activity over the long run in some of the places in America that need it most." (Read more)

Caregivers of wounded soldiers find their lives are also changed; getting compensation

The wars in Iraq and Afghanistan disproportionately affect rural areas, which provide more than the average number of recruits. The soldiers who make it home alive come back changed, with traumatic brain damage, post-traumatic stress syndrome or other injuries that require full-time care. Mostly wives and older parents are left bearing the burden.

Catrin Einhorn of The New York Times reports that many caregivers have to quit their jobs and are forced to spend their savings and retirement funds to pay for treatment. A growing number of caregivers suffer from anxiety, depression and exhaustion as a result of their new routines. Rosie Babin, 51-year-old mother of a severely wounded 22-year-old son, was managing an accounting office before her son's injury. Though she's happy to have her son home alive, she now has to take blood-pressure medicine and sleeping pills. "I felt like I went from this high-energy, force-to-be-reckoned-with businesswoman to a casualty of war," Babin told Einhorn. "And I was working furiously at not feeling like a victim of war."

According to research by Joan Griffin, a research investigator with the Minneapolis Veterans Affairs Health Care System, most of the injured are in their 20s and 30s, making this the first time since Vietnam the V.A. has seen such an influx of youth, which extending the length of care to years and sometimes decades. On average, Griffin found that family members spend more than 40 hours a week providing care, making it nearly impossible for them to keep a job.

Organizations like the Wounded Warrior Project have tried to ease the financial burden on these families by lobbying Congress to provide direct compensation and other benefits to caregivers and their families. In 2010, the veteran's agency approved 1,222 applications and awarded monthly stipends of $1,600 to $1,800 to caregivers. Along with the money, they can receive health insurance and counseling, Einhorn reports. This law only applies to caregivers of service members injured after Sept. 11, 2001, and it's uncertain who will qualify and how compensation will be determined.
(Read more)