Health reform poll: don't cut off funding

Conservatives sometimes argue that the best way to combat what they see as intrusive government regulation is to "starve the beast": use the Congressional power over spending to cut off funding for the government programs they find objectionable. Critics of health reform have advocated (loudly) for that strategy.

But what's America's reaction to that approach? "Not so fast," according to one poll. The majority of Americans (62%) oppose the idea of Congress using defunding efforts to slow down the implementation of the Patient Protection and Affordable Care Act (ACA), according to a new poll from the Kaiser Family Foundation and the Harvard School of Public Health.

The poll, The Public's Health Care Agenda for the 112th Congress, found that 57% of Republicans favor defunding health reform in the absence of repeal, but most independents are opposed (62%) along with the great majority of Democrats (84%). And, even among those who do not like the law and want to see it repealed, almost four in ten say they disapprove of cutting off funding.

Opinions remain divided. The poll reported that 50% of Americans hold an unfavorable opinion of the ACA, while 41% hold a favorable view. However, the public is divided on what should happen next.



Nearly as many people want to expand the law (28%) or keep it as it is (19%), as want to repeal and replace the law with a Republican-sponsored alternative (23%) or simply repeal it (20%). Kaiser noted that opinions about what should happen next remain highly partisan: 77% of Republicans back some form of repeal, while 51% of Democrats said they want the law expanded.

According to Kaiser, though the public is divided on what should happen next with the ACA, this does not mean that they want Congress to stop working on health care. When asked about the top two issues they would like addressed by the President and Congress in 2011, health care (46%) and the economy (40%) were the top two issues cited by survey respondents. The third most cited issue, the deficit, was cited by only 13% of respondents.

The survey was conducted January 4 through 14 and includes responses from 1,502 individuals ages 18 and older.

For a comprehensive analysis of the Patient Protection and Affordable Care Act, and additional information on health reform and other developments in employee benefits, just click here.

Arizona's Brewer has thrown down the gauntlet - will Sebelius pick it up?

There’s apparently at least one way to circumvent some provisions of the healthcare reform act while, at the same time, making the new law seem detrimental to those seeking Medicaid coverage and putting the current administration on the spot - simply ask the government’s permission to cut Medicaid spending in your state. Instructions for doing so are built right into the ACA. Arizona is now trying to do just that, and other states may follow.

To qualify for federal reimbursement for their Medicaid programs, state Medicaid plans may not have any eligibility standards or restrictive determinations of eligibility that were not in effect on the date of enactment of the ACA. There is an exception until January 1, 2014, however, for this “maintenance of effort” standard for states with budget deficits that certify to HHS that they have a deficit for the current fiscal year or are projected to have one for the following year. For those states, the maintenance of effort requirement will not apply to determinations of eligibility for non-pregnant and/or non-disabled adults with incomes above 133% of the federal poverty level.

Now, Arizona governor Jan Brewer wants to be the first to obtain the exception.

 On January 21, 2011, she signed state legislation authorizing her to make a two-year waiver request from the ACA’s maintenance of effort eligibility requirements. Subsequently, on January 25^th, she sent a letter to HHS Secretary Kathleen Sebelius requesting the waiver. It’s hard to believe that this doesn’t put Sebelius in a difficult position, since she will probably be criticized regardless of her decision. In her letter, Brewer painted a dire picture of her state’s finances, claiming that Arizona’s Medicaid program represents approximately 30% of the state’s General Fund spending. On the other hand, by granting the waiver, Sebelius will make it possible for Brewer to eliminate or drastically reduce coverage to approximately 280,000 people.

For a comprehensive analysis of the Patient Protection and Affordable Care Act, and additional information on health reform and other developments in employee benefits, just click here.

Health care reform is subject to never-ending Congressional games

The so-called repeal of the healthcare reform act is turning into a game of chess in Congress.

To begin with, Republicans may have an even tougher time repealing the ACA than they thought they would. Democrats have made clear that there will have to be a separate vote on individual portions of the healthcare reform law each time a bill to repeal it is introduced.

"If the Republicans offer an amendment on the floor, then we will require them to vote on the individual protections in the bill that are very popular and that even some of the new Republican House members have said they support," Senator Chuck Schumer (D-NY) said this week on CBS’ Face the Nation.

"Mitch McConnell has the right to offer an amendment," said Schumer, adding that, “If he does, if the Republicans offer an amendment on the floor, then we will require them to vote on the individual protections in the bill that are very popular, and that even some of the new Republican House Members have said they support.”

Some have accused Republicans of merely posing in their attempt to repeal the ACA, knowing that repeal will not really work, especially since President Obama has said that he would veto a repeal. Along those lines, Schumer told CBS that, "I think, at the end of the day, their effort to repeal is not going to work at all . . . . So we should work together to improve the bill, but this idea of repeal is not going to work."

Now, according to Greg Sargent of the Washington Post, Senate aides say Republicans may, in return, demand a vote by Democrats on certain portions of the PPACA that Republicans have termed "job killers," since Republicans have consistently sent the message that the PPACA is detrimental to the American job market. One such provision imposes an excise tax on medical device manufacturers, the cost of which the manufacturers warn could result in worker layoffs. A number of public comments on Sargent’s article complained that Congress was wasting time playing games, instead of spending time on other issues, such as the war in Afghanistan, global warming, the national deficit, and job creation.

For a comprehensive analysis of the Patient Protection and Affordable Care Act, and additional information on health reform and other developments in employee benefits, just click here.