We’re inching closer to the multi-day arguments set to happen before the SCOTUS regarding the constitutionality of the ACA, specifically, the individual mandate provision. A Kaiser Foundation tracking poll indicates that a third of all voters (respondents) think that the entire law will be revoked if the high court finds the plaintiffs’ assertions has cause. Perhaps what is more important is the fact that Americans remain divided over the issue of the existence of the law.

As the anniversary of the Affordable Care Act approaches on March 23, Americans remain as divided on the law as ever, with 37 percent in January saying they have a favorable view of it, and 44 percent having an unfavorable view. At the same time, the share of the public that favors expanding the law (31%) or keeping it in its current form (19%) remains larger than the share who would like to see the law repealed outright (22%) or repealed and replaced with a Republican-backed alternative (18%).

Mitt Romney, the probable GOP nominee for president, will have to exploit the differences between presiding over the initiation of the reform law’s progenitor in his home state of Mass. and Obama’s finished product — backed by the full faith and support of Big Insurance. | LINK to study PDF

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With the SCOTUS set to take up the ACA and its constitutionality this term, more fuel to the fire has just been added to an otherwise white hot election ’12.

Although recent polls seem to dignify the usually staid Newt Gingrich with the flavor-of-the-campaign tiara at the moment, the sure bet is on the “electable” former governor of Massachusetts and originator of all things Universal Healthcare, Mitt Romney. For President Obama, it presents an interesting “problem” which will require appropriate strategies for the White House in keeping the president on message, as they say, over the next twelve months.

No matter how the SCOTUS rules on the matter before it, Obama has got the winds of the ACA behind him. The wheels have been in motion for the past year-and-a-half to the get the first provisions of the reform law into place. Issues such as coverage extensions  for adult children of policy beneficiaries and increased employer-based protections for workers practically guarantees and confirms widening of likes versus dislikes ratio with respect to the law. All of this cannot be ignored by the court as it hears arguments early next year.

Conversely, Mitt Romney could benefit from a negative ruling by the court. After signing into law an individual mandate provision in Mass’s. law as governor, Romney initially praised the action, calling it the “ultimate conservative idea”. Known as much for his flip-flops on this issue (because he is running for president, after all) as he is for his corporatist, milquetoast demeanor — a negative decision of the courts would give him immediate justification for blasting it.

Perhaps that’s why he is mum on the issue now. Further, Romney can make the repeal of the law a central campaign mantra, if the SCOTUS upholds it — “realizing” that individual states can have mandates if they so desire, but not at the direct imposition of the feds.

Regardless, the rhetoric on the constitutionality of the ACA will ramp into high gear next summer; and the ride will be a tumultuous one for both candidates. | LINK

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A physician advocacy group has released a report detailing the costs to Massachusetts in the wake of its healthcare reform. The goal is to shed light on the potential costs to the country as a whole once reform begins in earnest. The single-payer advocacy group mainly cites that cost shifting of taxpayer subsidies to fund the private insurance marketplace is creating an access burden for the state’s impoverished and lower middle class by pricing them out.

Most of the gains in coverage have come from expansions in publicly subsidized insurance. This largely represented a shift of patients from the state’s former Free Care Pool, which compensated hospitals and community health centers directly for care of the uninsured, to private insurance plans, which is a more costly way to provide care.

Read the PDF of the entire report. The report appears to yearn for a less-than-market-based approach to solving this financial crisis as a way in which access to care can remain intact amid long-term reform sustainability. This report was released jointly among this group and via the state chapter of Physicians For a National Health Program.

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Now that the GOP field fighting for the ’12 nod has been essentially set, political pundits and junkies alike will now settle in for the real race and issues to emerge. In the case of the media-anointed frontrunner, former Mass. Gov. Mitt Romney, it is his tenure with what has become the nation’s incubator for universal care coverage on a global scale — colloquially known as Commonwealth Care — that will either haunt him … or define him in the all-important run up to January^[1].

Not only does Romney have to meet issues of his faith and politics (Mormonism) and social conservatism (regarded as a moderate, esp. by Tea Party activists) head on, he now has to prove that his stance on healthcare delivery is actually a conservative one — in spite of the fact that the law guaranteeing care to all of Massachusetts’ citizens was signed on his watch. The bar on how Romney will position himself just became a little more precarious, with news breaking that the WH’s blueprint for the reform law, pejoratively known as Obamacare, was based upon Romney’s Mass. law more closely as a model than was previously thought.

“The White House wanted to lean a lot on what we’d done in Massachusetts,” said Jon Gruber, an MIT economist who advised the Romney administration on health care and who attended five meetings at the Obama White House in 2009, including the meeting with the president. “They really wanted to know how we can take that same approach we used in Massachusetts and turn that into a national model.”

The president even presided over one of those meetings himself in mid-2009. In an effort to diffuse the impact of this revelation, aides to Romney suggest that Gruber’s role was not central to the ultimate tone of the reform law. Good luck with that strategy.

Gruber was personally recognized by Romney for his role when he signed the health-care bill into law and was later appointed by Romney as a board member to the Connector Authority. (He also was given a photograph of the signing ceremony personally signed by Romney that read: “Jonathan, with deep appreciation and congratulations. A Triumph! Mitt Romney.”)

It will be interesting (and fun) to see how Romney can continue to make distinctions between the ACA and his personal stamp on Massachusetts’ model of universal coverage. | LINK

1. IA caucuses and FL primary will occur on the 3rd and 31st, respectively

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It was only an election in an otherwise staid New York state US congressional district, but its tie to the entire debate on Medicare privatization has put this race and its winner — a Democrat — on the national stage. The Democrat challenger to the conservative incumbent was all but certain to wind up in the loser column, but running on an anti Paul Ryan message — she emerged victorious.

The results set off elation among Democrats and soul-searching among Republicans, who questioned whether the party should rethink its commitment to the Medicare plan, which appears to have become a liability as 2012 elections loom.

Quite an understatement. It was, perhaps, the most serious blow to the congressman’s push to overhaul Medicare by 2022. Over the last week, signals from other members in Ryan’s party have been building an abandonment scenario.

GOP presidential candidate New Gingrich blasted Ryan’s plan, calling it an experiment in “right wing social engineering”, only to retract from the intensity of those statements a short while later. Frosh Senator Scott Brown (R-MA) has also come out against Ryan’s proposals. Moderate GOPer Olympia Snow (R-ME) will now vote against it. Finally, an AP poll out earlier this week shows that most Americans apparently feel the same way that voters in NY-26 feel.

In the poll, 54 percent said it’s possible to balance the budget without cutting spending for Medicare, and 59 percent said the same about Social Security. Taking both programs together, 48 percent said the government could balance the budget without cutting either one. Democrats and political independents were far more likely than Republicans to say that neither program will have to be cut.

All of which, in advance of a Senate ‘no’ vote on the matter essentially assured, is causing the GOP more and more angst on this issue and how best to confront it in 2012. After backing this now unpopular Ryan plan, it’s time for the party to redouble its efforts on this, and other fiscal matters for election ’12. As the president’s war chest and approval ratings continue to increase in size and the GOP field for next year remains in floundering stage — it will be neat to watch, from a healthcare policy perspective, just what the GOP’s plans are now in the war on Medicare and health reform.

UPDATE: The Senate just rejected the Ryan measure along party lines. | LINK

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The predicted efflux of primary care physicians in Massachusetts, as a by-product of its universal coverage of healthcare, looks like it’s a reality. A new survey released by the state’s medical society shows that more than half of all primary care physicians in Massachusetts are no longer accepting new patients, and the average waiting time to see specialists is lengthening. A microcosm of the socialized structure of Canadian delivery? If these staff-to-patient ratios are any indication…well, you can be the judge:

Dr. Joseph Viadero, of Connecticut River Internists, said the four doctors and three nurse practitioners who staff the practice in Turner Falls, Mass., have about 12,000 patients spread between them and cannot take any new ones. “We’re overwhelmed and just have difficulty taking care of our own patients,” said Viadero, who has struggled to recruit any new primary care physicians to serve in the small western Massachusetts community.
[...]
Dr. Richard Dupee, a primary care physician in the Boston suburb of Wellesley, continues to accept new patients though he already has some 8,000 in his practice. He says he’s willing to put in the long hours necessary to keep up, but many younger doctors take a different approach. “They really look upon lifestyle more importantly than income,” said Dupee. “They want to quit at 5 o’clock is the bottom line.”

Universal coverage does not equal universal access. Not much more than half of Massachusetts’ internists and family docs accept an adequate number of Medicaid and subsidized care patients (via Commonwealth Care). | LINK

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As the one year anniversary of the PPACA nears, the mother of President Obama’s top domestic achievement — Massachusetts’ guaranteed universal healthcare delivery — will get some ink this week. Because that legislation’s staunchest advocate, once a chief executive himself — former Gov. Mitt Romney, will have to learn how to integrate his support for such a system of healthcare delivery into his platform if he is to embark on a run for the White House in 2012. He may have to consult damage control specialists to defend his Mass. health legislative record.

Sen. Jim DeMint (R-S.C.) “would never consider” endorsing former Massachusetts Gov. Mitt Romney for president again in 2012 unless Romney repudiates the health reforms he sought as governor, a source close to DeMint said Thursday [3/17/11].

Is this much ado about nothing? Or is there political scrambling afoot? As other GOPers wishing to position themselves as bonafide competitors in next year’s primary season know all to well, it is only the fool who does not work to manufacture similarities between Massachusetts RomneyCare to the nation’s ObamaCare. DeMint, who endorsed Romney’s healthcare vision orginally, offers a glimpse into the strategies that potential GOP foes will take should the perceived frontrunner Romney throw his hat into the proverbial election ’12 ring: brand Romney’s hand in healthcare reform as tantamount to a government takeover by attacking the law’s mandate provisions. | LINK

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Believe it or not, the very first indication of polling the citizens of Massachusetts on issues of satisfaction of that state’s universal healthcare delivery has just occurred. The results show that consumers of healthcare in Massachusetts are pleased with it. A clear majority of patients (well over 80 percent) have had at least one visit with a physicians under the state’s publicly subsidized program since its inception five years ago.

Juxtapose this with the ongoing Obama mandate for universal access to care under the ACA, and you’ve got a recipe for continued controversy as long as the GOP-dominated House makes the case for piecemeal repeal of the legislation in its entirety. Here in Minnesota, a bill will probably pass the legislature (only to be vetoed ultimately by the state’s Dem governor) that would put a hold on any state funding for universal access under reform if certain elements of the law are judged unconstitutional — a decision likely to be made by SCOTUS. | LINK

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One of the fundamentals of healthcare reform is applying the cost of receiving care to the true quality of actual care that is received, creating a perception of quality in the process. Oftentimes, this is where the myriad criticisms and critiques of the reform model begin to diverge. One key quality aspect of reform is the promise of care delivered in a cost-effective manner — something Insurance obviously has a stake in, but healthcare consumers as well. Is the axiomatic “you get what you pay for” applicable to reform? With respect to the number of personal bankruptcies due to medical costs for consumers in the nation’s bellwether of reform — Massachusetts — one study fails to show a benefit to consumers’ wallets.

Researchers took a random sample of Massachusetts’ bankruptcy filers in July 2009 and sent surveys to 500 households. The Massachusetts healthcare reform was implemented in 2008 — they compared their data to 2007 information. Medical bills were still 52.9 percent of all bankruptcies in the state. One of the study’s authors cited the still too prohibitive cost of insurance for some of the insured, creating offsets that still levied higher expenses for the delivery of care to the uninsured in the state. | LINK

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Due to the recent attempt on the life of a sitting congresswoman, all legislative activities this week will be suspended. This includes the possible vote on the repeal of the ACA led by the House GOP majority — an action that is widely seen to fail in the Senate. HHS Secretary Sebelius, perhaps in a moment of Freudian musing, acknowledged this somewhat in a visit to Massachusetts, irking Tea Party and GOP hardliners by saying

The vote in the House, I think people understand, is sort of symbolic so there isn’t a (protest) march being planned. That’s sort of a waste of time and energy.

Them’s fightin’ words. It didn’t take representatives of those factions long to respond.

The secretary and her boss are trying to act as if November 2010 never happened,” said Jameson Cunningham, spokesman for the Tea Party Patriots. “The election last November was nothing if it wasn’t a referendum on Obamacare.

While Sebelius’s words are essentially correct — House action would somehow have to sail through the Senate and bypass the long arm of President Obama’s veto pen — they are just the latest kindling in the effort by the reform law’s opponents to keep this issue on boilerplate status. The administration remains confident, however, that even the most contentious provisions of the law (i.e., the individual mandate) will successfully fend off constitutional challenges. | LINK

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