SCOTUS - Obamacare - Sour Grapes

It seems some of the same folks who were co-conspirators in the scheme to shove Obamacare down the throats of the American public are now crying foul. The back room shady deals and political vote buying on a bill that was passed along strict party lines now has become, in the minds of some, a case of partisan judicial activism.

Have they no shame?

The Hill reports.

While several of the high court’s liberal justices seemed to cheerlead for its defense, Scalia appeared hostile to the law, an attitude that rubbed some Democrats the wrong way.

Scalia mocked the so-called “Cornhusker Kickback” without seeming to know that provision was stripped out of the law two years ago.

This argument is flaccid given that the Cornhusker Kickback was used to buy Sen. Nelson's vote.

Scalia also joked that the task of having to review the complex bill violated the Eighth Amendment’s ban on cruel and unusual punishment.

“You really want us to go through these 2,700 pages?” he quipped. “Is this not totally unrealistic, that we are going to go through this enormous bill item by item and decide each one?”

Name one member of Congress that read the 2,700 pages before (or after) voting on it.

Seems a bit disingenuous don't you think?

Obamacare - The Movie

Va bene signoras e signores

Why does health insurance cost so much?

Here's part of the reason:

How 'bout ANOTHER $17 Trillion ObamneyCareBux©?

Last time we looked, ObamneyCare© had racked up an additional $111 billion cost overrun, and we remarked at the time how ironic it was that that might have been a low-ball guesstimate.

Little did we suspect, though, a "massive $17 trillion funding gap."

Ooopsies.

"The $17 trillion in extra promises was revealed by an analysis of the law’s long-term requirements ... when combined with existing Medicare and Medicaid funding shortfalls, leaves taxpayers on the hook for an extra $82 trillion in health care obligations"

Which begs the continuing question: How many more of these little nuggets still lurk in the belly of the beast we had to pass in order to find out what's in it?

Wouldn't you like to be a pepper, too?

No, not that kind of Pepper, this kind:

"The food that inspires wariness is on course for inspiring even more wonder ... scientists reported this week ... that chili peppers are a heart-healthy food with potential to protect against the number one cause of death in the developed world."

The key ingredient, capsaicin, is why a lot of Asian restaurants include those little pepper symbols next to their spicy dishes. Many folks already use skin care and pain relief products containing the fiery capsaicinoids; this is apparently the first study to suggest that they help the heart in more ways than one:

"They lower cholesterol levels ... They also block action of a gene that makes arteries contract, restricting the flow of blood to the heart and other organs."

As with all things, moderation is the key; Dr Zhen-Yu Chen, Ph.D., who was involved in the study, warns that "we certainly do not recommend that people start consuming chilies to an excess."

Of course.

Now please pass that glass of cold milk.

[Hat Tip: FoIB Holly R]

SCOTUS vs Obamacare Summation

The folks at Unum were kind enough to provide a summary of the 3 days of March Madness, legal edition.

Most of their comments and observations where ho-hum, especially for those who have even a casual interest (you have got to be kidding!!) in this topic. But a few were of note and not overly legal-speak.

They made reference to the number of "amicus curiae" (friend of the court) briefs. According to Unum, the "typical" SCOTUS case might have 5 - 10 briefs.

Obamacare had 136.

Apparently there were a number of folks that are not too happy about Obamacrap and wanted to make sure their voices were heard.

Imagine that . . .

One observation concerning the mandate was this.

"PPACA prohibits medical underwriting - which means insurance companies will be required to cover individuals with pre-existing conditions. As a result, more unhealthy people will be covered . . ."

Well duh.

The comment continues.

"The individual mandate ensures healthy people will also have coverage, so the financial burden (of insuring those with health conditions) is spread more evenly."

This has attorney fingerprints all over it, which clearly indicates a lack of understanding of risk management.

Just because someone is required by law to purchase insurance doesn't mean it will happen. As long as the penalty (or tax) is minimal compared to the outlay for health insurance premiums, many healthy people (especially the young) will postpone the purchase, pay the penalty, and only buy when they need coverage.

All this does is make health insurance even more expensive than it already is.

Clearly there is a lot in balance here that effects almost everyone, regardless if you currently have health insurance or not.

In the interim, it's back to the rack . . .

Cavalcade of Risk #154: Call for submissions

Ken Faulkenberry hosts next week's CavRisk. Entries are due by Monday (the 2nd).

To submit your risk-related post, just click here to email it.

You'll need to provide:

■ Your post's url and title
■ Your blog's url and name
■ Your name and email
■ A (brief) summary of the post ("Remarks")

PLEASE remember: ONLY posts that relate to risk (not personal finance tips and the like).

Thanks!

Disingenuous ObamneyCare© Proponents

Since the train-wreck itself is indefensible on any logical or legal grounds, it just make sense to hire union members to astro-turf ginned up protests. Here, a gaggle of SEIU-related "women" explicitly discuss how much they were paid for their participation:

[Courtesy of The Daily Caller]

SwedishCare: "Shut up or die"

Welcome to SvenCare©, where your nurses are hot (or not), you can literally be saved by the bell (or not), and you can call 911 but you better not say anything when you do:

"Swedish health authorities have come under criticism over the death of a woman whose repeated calls to emergency services were ignored because she was still able to talk."

But not, of course, for long. In Sweden, apparently, those cell phone minutes can kill you.

Literally:

"Jill Soderberg, 22, died in her home... shortly after she had placed her third and last call ... requesting an ambulance"

Hey, just because she was having major respiratory failure is no reason to be alarmed, right? After all, she could still talk, right?

Right?!

[Hat Tip: FoIB Jeff M]

Nate vs Chad: Entering the Ring

[Regular readers may recognize Nate Ogden as a frequent commenter and occasional guest-blogger here at InsureBlog. Well, it's our pleasure today to welcome Nate on board as a full-fledged Contributor. Nate's a Third Party Administrator in Northeast Ohio, and brings a very unique perspective to the whole insurance and risk-management business. In his debut post, Nate corrects the MSM on the subject of how self-funded plans are taxed. Welcome aboard, Nate! HGS]

Writing in the LA Times, Chad Terhune offers up his take on " a new type of self-insurance for small businesses with as few as 25 workers." While he does a better job than most media types (talk about a low bar), he still missed the mark. For one thing, this is not new at all. Some 15-20 years ago, there used to be a huge self-funded market for small groups. This is just a normal market cycle that repeats itself all the time. My family owns three TPAs(Third Party Administrators), we process the claims for self funded employers, and were based in Costa Mesa from 1980-2006. We had tons of 15 life, self-funded groups. There were carriers like Vasa Brougher that specialized in small group self funding.

For numerous reasons the market disappeared:

• Provider contracting favored the large carriers who did not rent their PPO networks. When you're self funded, you have to rent a PPO; generally, rental PPO's didn't have the deep discounts available to the "big boys." This was especially true in California until the Blues starting giving access to their PPOs 10 or so years ago.

• Poorly written COBRA laws made it extremely risky for small groups. Congress wrote the law, then left it up to the courts to interrupt the details. Large employers could afford a lawsuit while it put small employers out of business.

• The reinsurance market didn’t recognize the different needs of small employers compared to large ones, and thus the stop-loss policies didn’t provide all the protection small employers needed.

When we have these debates about health care reform and insurance it's important that the public be given accurate information. Small group self-funding is not some new concept just invented to circumvent State Regulation or PPACA reform. It has been around since the late 70's and early 80's. The failure of heavily regulated small group reform is just making it incredibly attractive right now. I would argue the reason you're seeing it more in California is that you have higher regulation there.

In most other States employers have been buying $5000+ deductible, fully insured plans, and then self-funding that deductible down. In California, most of the carriers worked hard to forbid this or to put enough restrictions on it to make it impossible.

Anyone arguing that self-funding only peels off the healthy risks has no idea what they are talking about. The vast majority of our business is groups that are moderately to very sick. Super healthy groups have premiums too low to make self-funding attractive. If everything works perfectly, they save a couple percent; if anything goes wrong, as it does on average once every five years, they pay considerably more. The groups flocking to self-funding are those that have been getting double digit rate increases year after year with no help from the carrier to fix the problem. Mr Terhune does mention getting claims data but doesn’t give it nearly as much discussion as it merits. Educating employees, often face to face, fighting with providers, finding waste and inefficiency is where the savings come from. Isn’t that what all groups should be looking to do?

Two more things: Mr Terhune is incorrect that self-funded groups don’t pay premium tax: they do, just on a smaller amount. This is one error the media always repeats and has for decades. Premium taxes apply to premiums (imagine that!), so the stop-loss premium is subject to them. For the most part, the claims paid by the employer are not subject to premium taxes (a handful of states have taxes based on claims).

Also, claiming that self-funded plans don’t contribute to the pools in PPACA is absolutely incorrect: self-funded plans have to pay the same per employee tax that fully insured plans do.

It sure would be nice to see the media care as much about accuracy as framing their message.

Unlucky 7

Lucky 7. 7 seas. 7 brides for 7 brothers. 7 hills of Rome. 7 hills of Constantinople. 7 Wonders of the World.

Throughout history 7 has been an almost magical number, even termed "lucky 7".

Maybe 7's luck just ran out.

Especially if your name is Barack Obama.

The folks at Heritage offer this recap and assessment of Obamacare.

In the 2 years since the passage of Obamacrap, there have been 7 failures directly tied to this law.

• The disappearance of child-only policies. Obamacare requires insurers who sell child-only plans to accept all applicants regardless of health condition. This allows parents to wait until their children are sick to enroll them in health plans. Two years later, one survey found that “17 states indicated that no insurers were selling child-only policies to new enrollees, and 39 states responded that at least one insurer exited the child-only market since the new law took effect.”
• “Free” preventive services cost Americans. Obamacare requires coverage of certain preventive services with no cost-sharing for the individual. Two years later, the list includes abortion-inducing drugs, sterilization, and other contraceptives as mandated coverage—even for many religious organizations. Heritage analysts report, “This created an outcry from members of many faiths who feel this decision is an attack on religious freedom and their ability to serve communities across the country.”

An addendum to the "no child health insurance left behind" comment, there are a few states (such as Georgia) where child only health insurance can be sold. The problem, the policies are not true major medical.

Parents can buy a child only health insurance plan in Georgia as long as they are willing to either buy a limited benefit basic health insurance plan, or a short term medical plan that is only good for 6 months.

Either of these options is fine as long as your child does not become seriously ill or has a major accident.

• A failing small business tax credit. Obamacare provides a temporary tax credit to small employers as an incentive for them to offer health insurance to their employees. Two years later, the IRS reports that only 7 percent of the originally estimated 4.4 million eligible small businesses have claimed the credit.
• A broke program for early retirees. Obamacare established a temporary reinsurance program from May 2010 to January 2014 to pay a portion of companies’ costs to insure early retirees between the ages of 55 and 65. Two years later, the program ran out of money almost three years early and is no longer accepting additional applications. As Heritage analysts explain, the program “clearly shifts the costs of paying for unsustainable promises made to public and private employees to federal taxpayers and further underscores how the true cost of implementing the health care law exceeds original estimates.”

These items get very little play in the media since they directly affect employers and only indirectly impact individuals and families. Still, this is just another example of what some may believe was good intentions gone awry.

Seems to me this is yet another case of government interference.

• Low enrollment in high-risk pools. Obamacare creates high-risk pools for individuals with pre-existing conditions who have been uninsured for at least six months to purchase insurance. Two years later, using the Administration’s own numbers, enrollment in the high-risk pools remains low: only 13 percent of initial estimates. Heritage analysts point out, “At the same time, medical-claims costs have been 2.5 times higher than initially projected, and the high-risk pools may still exhaust or exceed the available funding, even though they serve such a small portion of those they were intended to help.”
• A damaging medical loss ratio (MLR). Obamacare requires insurers to spend 80 percent (85 percent for large group plans) of premium revenue on medical claims or quality improvement. Two years later, Heritage analysts point out, “Seventeen states applied for the MLR waivers, arguing that the regulations would destabilize their markets.” The Administration has granted a full waiver to only one state; six received a partial waiver, and 10 requests were rejected. Some insurers have already left the market because of the requirement, and the strict medical loss ratio threatens the existence of health savings accounts, which are used by 11 million Americans.
• An unsustainable new entitlement. Obamacare created the CLASS Act, a government-run long-term care insurance program. Two years later, the Administration has declared the CLASS program unsustainable and halted its implementation. Heritage analysts report, “On February 1, 2012, the House of Representatives voted 267 (including 28 Democrats) to 159 to repeal the troubled CLASS program, and it now awaits consideration by the U.S. Senate.”

PCIP, the high risk pool substitute was actually a good idea. Had Obamacare created this plan and stopped there we would be much better off.

But Obama and company wanted something bigger. Something grand. Something regal.

The number 7 also has other associations.

The 7 dwarfs. 7 deadly sins.

Maybe Obamacare isn't such a BFD any more.

Perhaps 7 will now be known as an unlucky number.

At least if your name is Obama.

Health Wonk Review: SCOTUS in the news edition

FoIB David Williams hosts this week's round-up of wonky posts, focusing (unsurprisingly) on the health "care" reform case before the Supremes. If you've been following this (and who hasn't been?), here's your chance to see how folks on all sides see the case.

Wednesday ObamneyCare© Update

Even as the Supremes wrap up their little shindig, the train-wreck itself keeps on keepin' on:

"As the first quarter of 2012 comes to an end, more activities related to the Medical Loss Ratio (MLR) provision of [ObamneyCare©] will occur ... Foremost among these is the April 1 filing of a Supplemental Health Care Exhibit (SHCE) ... to assist state regulators in identifying and defining elements that make up MLR."

But that's just the beginning; there's more!

"In early April, [carriers] will mail letters concerning MLR to two groups of customers ... employers that are non-ERISA and non-government entities (such as churches and tribal groups) and may also be eligible for a rebate ... request that these employers provide written assurance that a certain portion of any potential MLR rebate paid to them will be used for the benefit of their subscribers."

Did you know about this requirement? Does your employer?

And there's this:

"[Carriers] will be legally required by [HHS Secretary Shecantbeserious] to pay the entire amount of any owed rebate directly to the subscribers of any terminated groups that cannot be located."

Of course! What could possibly go wrong with that?

FuneralCare©

Bob's been doing a yeoman's job of reporting on the SCOTUS ObamneyCare© trial, for which we're very grateful. Something came up yesterday, though, that I don't think got a lot of play in the MSM, and which seems to me to surpass even the "broccoli" argument. Justice Alito asked SG Verrilli:

"Do you think there is a, a market for burial services?"

The Solicitor General affirmed that he believed there was such a market, which allowed Justice Alito to ponder:

"[S]uppose that you and I walked around downtown Washington at lunch hour and we found a couple of healthy young people and we stopped them and we said, "You know what you're doing? You are financing your burial services right now because eventually you're going to die, and somebody is going to have to pay for it, and if you don't have burial insurance and you haven't saved money for it, you're going to shift the cost to somebody else."

At first blush, this would seem a stretch; after all, no one forces us to buy life insurance (which is what burial or mortgage insurance really is). But upon reflection, one is reminded that ObamneyCare© proponents repeatedly argue that we're all going to use the health care system at some point (a rather dubious assumption, to be sure), and that we must have insurance in place to (help) pay for that care.

Well, it may or may not come to pass that a given person will need health care, but there's no escaping the Man with the Scythe. That is, unlike illness, death is inevitable, so why aren't we required to purchase burial insurance, as well? It's the same premise, after all, with the added benefit of being true.

[Hat Tip: Co-blogger Kelley]

SCOTUS on Obamacare - Day 3

Don't count your chickens before they hatch but there seem to be several things in play here that don't look good for Obamacrap.

Once again the Los Angeles Times offers this early insight.

Picking up where they left off Tuesday, the conservatives said they thought a decision striking down the law's controversial individual mandate to purchase health insurance means the whole statute should fall with it.

The court’s conservatives sounded as though they had determined for themselves that the 2,700-page measure must be declared unconstitutional.

"One way or another, Congress will have to revisit it in toto," said Justice Antonin Scalia.

Agreeing, Justice Anthony Kennedy said it would be an "extreme proposition" to allow the various insurance regulations to stand after the mandate was struck down.

It should be noted that not all of the jousting came from the "conservative" jurists. So far Justices Kagan, Sotomayor, Breyer and Ginsburg have seemingly indicated disdain for at least some portions of the law. Most notably with regard to the individual mandate and the schizophrenic tax or penalty argument.

GayCare©?

Actually, this is almost exactly what we've been preaching here at IB for over 7 years:

"[GOProud] argues that the problem with our tax code isn't just that it discriminates against gays. It's that it discriminates against every American who doesn't have his or her health insurance through an employer."

Hear, hear!

What the GOPRoud folks propose is something quite radical: equality. That is, a system where health insurance should not only not be tied to employment, but that everyone who buys a policy should get the same tax break as employers do now.

And they're also against "one-size-fits-all" insurance plans:

"We want a system where individuals and couples can make their own health-care decisions. Health-care needs are too important to be left to the discriminatory whims of a third party."

Now, they're also in favor of cross-state insurance sales, about which we're ambivalent: Bob, for example, has argued persuasively that opening up sales across state lines is no great shakes, while Mike favors lifting those restrictions.

YMMV.

Kudos to GOProud.

SCOTUS on Obamacare - Day 2

How the Court will rule on the mandate to purchase health insurance is anyone's guess at this time and it will most likely be June or July before their decision is rendered. But it seems some are attempting to call this game before the last strike.

This from the Los Angeles Times.

Even before the administration's top lawyer could get three minutes into his defense of the mandate, some justices accused the government of pushing for excessive authority to require Americans to buy anything.

"Are there any limits," asked Justice Anthony Kennedy, one of three conservative justices whose votes are seen as crucial to the fate of the unprecedented insurance mandate.

Excessive authority.

Indeed.

Perhaps sanity and reason will prevail after all.

Chief Justice John G. Roberts Jr. suggested that the government might require Americans to buy cellphones to be ready for emergencies. And Justice Antonin Scalia asked if the government might require Americans to buy broccoli or automobiles.

"If the government can do this, what else can it ... do?” Scalia asked.

Tough crowd.

Solicitor General Donald B. Verrilli Jr. tried to argue that the insurance mandate would not open the door to other requirements to buy products because healthcare is unique.

"Virtually everyone in society is in this market,” said Verrilli, who was prodded on by Justice Ruth Bader Ginsburg and other liberal justices. That means that if someone elects not to get health insurance but then gets sick, as everyone will, that person will pass along costs to everyone else, Verrilli explained.

True, and virtually everyone eats food. Some purchase it while others grow and slaughter their own. In doing so, they deprive grocers, wholesalers and others of their ability to earn a living.

Will the government decide to mandate that everyone purchase food through a food exchange and further restrict what they can and cannot buy? If they fail to buy the government mandated food items will they be penalized (or taxed)?

I find it humorous, in a morbid way of course, that the government is making their plea for "fairness" by stating those who do not purchase insurance cause health care cost shifting which results in higher premiums.

While this is true, the number of folks without insurance who fail to pay their bills is relatively small. Many states, including Georgia, allow someone to retroactively sign up for Medicaid AFTER THEY BECOME ILL OR INJURED, thus shifting their burden to the taxpayers.

With 46 million on Medicare and 58 million on Medicaid, roughly a third of the population is covered by a taxpayer funded plan with low reimbursements. The level of compensation by Medicare and Medicaid is, in many cases, below cost for most medical providers. The result is a cost shift to those with private insurance and/or the ability to pay out of pocket. That group pays a higher premium than would otherwise be required if not for the low reimbursement levels of those on government health insurance plans.

The government contributes more to high health insurance costs and premiums more than the deadbeats who are uninsured and do not pay their bills.

Bring out the torches and pitchforks.

ObamneyCare© and the MVNHS©: Twin sons...

Back in the late 70's, two really talented guys got together and created some timeless tunes. Their first collaboration was an incentive for a host of others who followed in their footsteps.

And so it is with the Much Vaunted National Health System© and ObamneyCare©. While the legal future of the latter is playing out as we speak, the former is well-established, and provides us a first-hand look at our own future under the bill we had to pass to learn what's in it:

"Thousands of elderly people are dying unnecessarily early because “despicable” age discrimination in the NHS is denying them treatment for cancer ... A lack of treatment or insufficient treatment is contributing to 14,000 deaths a year in people over the age of 75"

In England, they call that the NICE (National Institute for Health and Clinical Excellence). Here it's known as the IPAB (Independent Payment Advisory Board). They are, however, twin sons of different mothers.

Not exactly music to these ears.

[Hat Tip: PowerLine]

SCOTUS Secrets

Did you know SCOTUS has a blog? Neither did I.

If you have an interest in whazzup in the high court, here you go.

Obama vs. Obama

SCOTUS on Obamacare - Day 1

Over the next few days SCOTUS will hear arguments for and against Obamacare. One issue that is being debated today is one that could stop this case dead in its' tracks for at least 3 years.

(Scroll down for updates)

As reported by Cox Washington Reporter Jamie Dupree, this is a concern that has had almost no play in the press.

At issue is a law from 1867 known as the Anti-Injunction Act. The basic thrust of that law is it prohibits lawsuits against a tax until that tax has been levied and collected.

Fast forward to 2012, and the tax penalty linked to the invidiual mandate has not been applied as yet - so the legal theory is very clear - no one has standing at this point to challenge the individual mandate penalty in court.

"That succeeded in one lower court," said legal scholar Thomas Miller of the American Enterprise Institute, but like many other legal experts, Miller does not see this derailing the Obama health law challenges.

"I think the Court will finally decide they can go forward; this is a big case," Miller said.

In many forums on the legal challenge to the Obama health law, this question presented on the first day of arguments is almost always glossed over - I watched hours of different legal preview events in recent weeks and there was bare mention of it as a real possibility.

But it is important to note that sometimes, the Justices will look to find a way to side step a major issue, and wait for it to return at a later date.

"It is an obscure provision in the IRS code," acknowledged Kent Streseman of the Chicago-Kent College of Law.

"The bottom line is it could stop the Affordable Care Act litigation in its tracks," said Streseman, "and prevent courts from hearing these suits until basically April of 2015."

What's really interesting about this first day is that no one brought this issue before the Court on appeal - instead, the Justices decided that they wanted to hear arguments on this matter.

So, while I'm not even close to being a legal expert, that tells me there was some support among the Justices for seriously looking at this option.

Because there was no "plaintiff" so to speak, on this matter, the Court actually appointed a lawyer to make the case, as attorney Robert A. Long, Jr., gets the honors on Monday.

UPDATE.

Is it a tax or not?

The Washington Examiner weighs in.

The Obama administration has to thread a difficult needle. U.S. Solicitor General Donald Verrilli argued today that the penalty for non-compliance with the mandate did not function as a tax for the purposes of the Anti-Injunction Act. Tomorrow, he'll have to argue that it does operate as a tax, and thus is a constitutional exercise of the congressional power to levy taxes.

Justice Samuel Alito asked Verrilli whether he could point to another case in which courts identified something as not a tax for the purposes of the Anti-Injunction Act while still ruling it was a constitutional exercise of taxing power. Verrilli could not name any. But he went on to explain that the government had identified a number of penalties that would fall into the same category, including three that concern alcohol and tobacco.

Transcript of day 1 on ACA SCOTUS hearing.

Verilli's "uh-oh" moment . . .

“General Verrilli, today you are arguing that the penalty is not a tax. Tomorrow you are going to be back and you will be arguing that the penalty is a tax,” said Justice Samuel Alito, in one of the few laugh lines throughout the 90 minutes of argument Monday.

Shecantbeserious over-reaching - Again

Once again, Madame Secretary has weighed in on health insurers' legitimate rate-increase requests. This is clearly an over-step: nothing in ObamneyCare© grants her this power (and, in fact, it is solely the states' right to make these determinations):

"The U.S. Department of Health and Human Services (HHS) and state insurance regulators started the rate review program to implement a section of [ObamneyCare©]"

And, once again, here's the uproar from the States.

Organ Transplants and Death Panels

[Welcome USA Today readers!]

Did taxpayers (through Medicare) pay for Dick Cheney's heart transplant? How much does a heart transplant cost? Should anyone, other than the patient and doctor, decide who is entitled to an organ transplant?

Heart transplants cost anywhere from $600,000 to $1,000,000. Most heart transplant patients are between the ages of 50 and 64 and the average wait time is 9 months.

Dick Cheney was 71 and was on the transplant list for 20 months.

Did Medicare pay for Cheney's transplant?

We have no idea. Using the Medicare organ transplant criteria it is unlikely, but not impossible, that Mr. Cheney paid out of pocket for some, if not all, of the cost of his surgery.

Obamacrap requires the establishment of an Independent Payment Advisory Board (IPAB), termed "death panels" by those who oppose too much government intrusion in our lives. Once established, this 15 member panel of individuals appointed by the President and then subject to Senate confirmation.

This raises a question. Should 15 individuals, appointed by political process, have this much authority over the level of treatment that is covered by Medicare? The panel (as currently conceived) will make general recommendations, not preside over individual cases and determine who lives and who dies.

As one Bioethicist has noted, "The timing of Cheney’s transplant is ethically ironic given that the battle over extending health insurance to all Americans reaches the Supreme Court this week.

If the President’s health reform bill is deemed unconstitutional, those who are wealthy or who can easily raise money will continue to have greater access to heart, liver and other forms of transplantation than the uninsured and underinsured."

If/when the IPAB becomes reality does anything really change with regard to access to expensive medical care?

We don't know for sure, but the role of the IPAB is to limit coverage and payment for expensive medical treatment. Chances are good that when it comes to medical care, the gap between rich and poor will widen even further.

Even in countries where the government controls payment for medical care the standard of care for the wealthy is not limited by government rules. This begs the question, will Obamacare level the playing field with regard to medical care or create an even bigger chasm between rich and poor?

Essential Health Benefits and the Coverage of Contraceptives

A full and formal definition of essential health benefits (EHBs) is not yet available from HHS. Meanwhile, churches and church-affiliated benefit sponsors have strongly objected to the Administration's attempt to force them to cover contraceptives and "morning after" pills.

The Administration is now seeking comments by June 19 on how to address the objections - - while still ensuring that plan participants get contraceptive coverage. In other words, this Administration still wants to eat its cake and have it, too.

The Administration also recently released a set of “Frequently Asked Questions” that suggests employers determine EHBs using one of the HHS-designated benchmark plans. These FAQ's are found here (.pdf download).

Question/Response #10 is revealing:

First part of Q10. How would the intended EHB policy affect self-insured group health plans, grandfathered group health plans, and the large group market health plans?

A: Under the Affordable Care Act, self-insured group health plans, large group market health plans, and grandfathered health plans are not required to offer EHB.

The plain meaning of this sentence seems to be that these types of plans are NOT required to cover contraceptive services because they are not subject to federally-required EHBs in the first place.

Or so I thought.

Well not so fast, Sherlock.

Second part of Q10. How would employers sponsoring such plans determine which benefits are EHB when they offer coverage to employees residing in more than one State?

A - To determine which benefits are EHB for purposes of complying with PHS Act section 2711, the Departments of Labor, Treasury, and HHS will consider a self-insured group health plan, a large group market health plan, or a grandfathered group health plan to have used a permissible definition of EHB under section 1302(b) of the Affordable Care Act if the definition is one that is authorized by the Secretary of HHS (including any available benchmark option, supplemented as needed to ensure coverage of all ten statutory categories).

So the real test is: “if the definition is one that is authorized by the Secretary of HHS.“ Thus does Kathleen Sebelius keep her ultimate and final authority to personally approve or deny EHBs for any benefit plan- - even for those types of plans which the statute itself exempts. The government gave and the government has taken away; blessed be the name of the government.

This is further evidence that the Administration has no intention whatsoever to “compromise” with the sponsors of church and church-affiliated benefit plans. Expect no compromise even for church-affiliated plans that are self-insured, or in the large group market, or are grandfathered. Rather the Administration fully intends to force all plans to offer contraceptive coverage including those of church-affiliated sponsors who object on religious grounds, in apparent violation their First Amendment protections. Because Kathleen Sebelius says so – not because the statute says so.

My opinion: this issue is clearly about government overreach, not whether the particular social goal may be worthwhile. As citizens we should expect that our own government will always pursue its goals using legal and Constitutional means - rather than by double-dealing with us and by ignoring limitations placed on its powers in the Constitution and Bill of Rights. Maybe that's just me.