MONDAY, June 18 (HealthDay News) -- The U.S. Supreme Court will soon decide the fate of the most consequential piece of health legislation since the enactment of Medicare and Medicaid nearly a half-century ago.

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America Awaits Supreme Court's Ruling on Health Care Reform

(AP) WASHINGTON - Is it too good to be true?

Health care spending has eased up recently, bringing a welcome respite for government and corporate budgets. But experts who track health care's economic indicators like the vital signs of a patient disagree on the diagnosis and what the future holds.

One explanation for the slowdown says it's a temporary consequence of the recession and an economy that can't seem to hit its stride. A more hopeful view says American medicine is moving from disjointed solo practice to teamwork models aimed at keeping patients healthier, and that's a permanent change.

It's not a stretch to say the future of U.S. health care depends on the answer. If the system can reform itself from within to reduce waste and deliver better results, it will help stave off sharp cuts to hospitals and doctors, as well as more cost shifts to their patients, working families with employer coverage and older people in Medicare.

Two doctors - one in Washington state, the other in Montana - come to different conclusions about what they're seeing.

Dr. Glen Stream of Spokane, Wash., says he sees the reason for the slowdown through patients in his examination room. A 55-year-old tech worker with diabetes, self-employed and uninsured after being laid off, is unable to afford brand-name medications. A 50-year-old woman at risk of liver cancer is refusing regular MRI scans for early detection. Although she has fairly good insurance, the copayments are too high.

"Far and away it is related to economic issues," Stream said. "I see people who have medical conditions who I should be seeing every three months. They tell me they can only afford to come in every six months or once a year."

Dr. Doug Carr of Billings, Mont., doesn't dispute the impact of the economy, but says long-lasting improvements are coming together beneath the surface and will emerge.

Carr is medical director for education at the Billings Clinic, in the forefront of developing something called a "patient-centered medical home." It's basically general-medicine doctors, physician assistants and nurses who closely follow patients with chronic illnesses to try to keep them from developing complications that require hospital treatment. More than 30 states are experimenting with the model, as are Medicare and major insurers and employers.

"We are seeing in early pilots up to a 10 percent reduction in premiums," said Carr. The savings stem mainly from fewer trips to the emergency room and less hospitalization, but also from better coordination that avoids duplicative and pricey imaging tests.

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U.S. health care spending eases up, for now

WASHINGTON (CNN) -- Winners and losers are the natural consequence of the American legal system. In the Supreme Court, five majority votes among the nine members are enough to fundamentally change lives and legacies.The high court in coming days will issue rulings in perhaps its most important appeal in a dozen years: whether the sweeping health care law championed by President Barack Obama will be tossed out as an unconstitutional exercise of congressional authority.The stakes cannot be overstated -- what the justices decide on a quartet of separate questions will have immediate and long-term impact on every American, not only in the field of medicine but in vast, untold areas of "commerce." Health care expenditures alone currently make up 18 percent of the U.S. economy, and the new law promises to significantly expand that share. "I think the justices probably came into the argument with their minds made up. They had hundreds of briefs and months to study them," said Thomas Goldstein, publisher of SCOTUSblog.com and a prominent Washington attorney. "The oral arguments (in March) might have changed their minds around the margin. But we won't find out until the end of June."A century of federal efforts to offer universal health care culminated in the 2010 passage of the Patient Protection and Affordable Care Act. After months of bare-knuckled fights over politics and policy, the legislation signed by Obama reached 2,700 pages, nine major sections and 450-some provisions.At issue is the constitutionality of the "individual mandate" section -- requiring nearly all Americans to buy health insurance by 2014 or face financial penalties. Twenty-six states in opposition say if that linchpin provision is unconstitutional, the entire law must go. The partisan debate around such a sweeping piece of legislation has encompassed traditional hot-button topics: abortion and contraception funding, state and individual rights, federal deficits, end-of-life care, and the overall economy. The high court now has the final word.The court will not say precisely when the health care opinions will be released, but the last scheduled public session of the term is set for June 25. Depending on how long it takes the justices to finish up, that deadline could easily slip a few days.The justices have already secretly voted on the health care cases, as well as a dozen or so other separate appeals. They met privately as a group just days after the late March arguments, voting preliminarily. Individual justices were assigned to write the one or more opinions, as well as separate dissents. Only they and their law clerks know how this will end.And no one is talking -- that's an unbroken tradition of discretion rare in leak-loving Washington."At the Supreme Court, those who know, don't talk. And those who talk, don't know," Justice Ruth Bader Ginsburg said Friday in a speech at the American Constitution Society convention in Washington.The court holds fast to an unofficial but self-imposed deadline to have all draft opinions finished by June 1. They are circulated to colleagues, and subsequent dissents and concurrences must be submitted by June 15. Nothing is final until the decision is released to the public. Votes can and do change at the last minute.The last two weeks beginning Monday will be the busiest, most chaotic time. Justices and their law clerks are holed up in chambers, furiously working to frame and craft the final opinions, making sure every fact, every footnote, every legal theory is fully checked and articulated. The nine members know they are writing their legacies with this one issue. The outcome may be disputed, but the constitutional reasoning-- at least in their own minds-- must be sound."Getting themselves organized, identifying the different majorities, getting opinions written and circulated in dissents and concurrences will really test their capabilities in the final days," Goldstein said.The opinion-writing exercise is little-known, and the court likes it that way. Consistently predicting the outcome is a time-honored Washington parlor game, but rarely successful."Obviously everybody in a case of this magnitude is trying to read tea leaves. I think it's hard to read tea leaves," Paul Clement, lawyer for the 26 states opposing the law, told CNN Correspondent Kate Bolduan moments after the last of the cases were argued March 28. "I suppose if half the justices were snoozing through it, that would have been a bad sign for my side of the case. They obviously weren't snoozing through it."The first lawsuits challenging the health care overhaul began just hours after the president signed the legislation two years ago. After a series of reviews in various lower federal courts, the petitions arrived at the high court in November, when the justices decided to review them. Written briefs were filed, oral arguments held.The court is considering four key questions: Does the law overstep federal authority, particularly with the "individual mandate?" Must the entire Patient Protection and Affordable Care Act be scrapped if that key provision is unconstitutional? Are the lawsuits brought by the states and other petitioners barred under the Anti-Injunction Act, and must they wait until the entire law goes into effect in 2014? Are states being "coerced" by the federal government to expand their share of Medicaid costs and administration, with the risk of losing that funding if they refuse?Everything hinges on the mandate, also known as the "minimum coverage" or "must-buy" provision. It is the key funding mechanism -- the "affordable" aspect of the Patient Protection and Affordable Care Act -- that makes most of the other 450 or so provisions possible.It would require nearly all Americans to buy some form of health insurance beginning in 2014 or face financial penalties. May the federal government, under the Constitution's Commerce Clause, regulate economic "inactivity"?The coalition of 26 states led by Florida says individuals cannot be forced to buy insurance, a "product" they may neither want nor need. The Justice Department has countered that since every American will need medical care at some point in their lives, individuals do not "choose" to participate in the health care market. Federal officials cite 2008 figures of $43 billion in uncompensated costs from the millions of uninsured people who receive health services, costs that are shifted to insurance companies and passed on to consumers. The law would expand insurance by at least 30 million people, according to government estimates.As with multiple questions, the justices have multiple options: allowing the mandate to stand or fall; if it falls, keeping all, parts, or none of the rest of the law; issuing a definitive statement on the centuries-long tension between federal and state power; treating health care as a unique aspect of "market" activity, allowing an exception upholding the law; and deciding who will craft the all-important opinions."Anyone who says the individual mandate isn't in any trouble is just deluding themselves," Goldstein said. "It's not clear that it will be struck down but you cannot say from those arguments, that it's anything other than a toss-up. The (Obama) administration had as hard a time from those justices as they could have expected, and they are desperately hoping that they can pull together a fifth vote in favor of the mandate."The justices never discuss internal strategy, and the full story of how health care was decided in the marble halls of the court may never be fully known.The current waiting game has prompted anxiety and a touch of political rancor outside the court.Legal sources say the White House has quietly set up an informal "war room" of sorts, ready to respond when the rulings are handed down.Low-key coordination is under way between the White House Counsel's office, Political Office, senior Oval Office and campaign staff, Capitol Hill Democrats, as well as select outside advisers and friendly advocacy groups.Republicans are quietly doing the same, with outreach to conservative activists and candidates. Managing the message will be all-important in a presidential election year.Publicly, Obama has said he was "confident that the Supreme Court will not take what would be an unprecedented, extraordinary step of overturning a law that was passed by a strong majority of a democratically elected Congress, and I just remind conservative commentators that for years, what we've heard is, the biggest problem on the bench was judicial activism or a lack of judicial restraint, that an unelected group of people would somehow overturn a duly constituted and passed law."Some conservative critics interpreted those remarks as a challenge to judicial authority, suggesting Obama was putting direct political pressure on the high court. Patrick Leahy, D-Vt., chairman of the Senate Judiciary Committee, urged the bench -- and Chief Justice John Roberts in particular -- to "do the right thing" and uphold the mandate.Presumptive Republican presidential candidate Mitt Romney used the same words when urging a different outcome."I hope they do the right thing and turn this thing down," Romney told donors last week in Atlanta. "And say it's unconstitutional, because it is."No one doubts the health care cases will have an immediate impact on Obama's re-election chances, as well as the long-term credibility of the federal courts, which are supposed to be beyond politics.Recent polling suggests a "legitimacy crisis" in the Third Branch. A New York Times/CBS poll this month shows only 44 percent of Americans approve of the Supreme Court's job performance -- a steady drop over recent years. Three-quarters of those polled now say the justices are sometimes influenced by their political views.A separate CNN/ORC International poll released June 8 found a majority -- 51 percent -- oppose the health care law in general, most because they think it is "too liberal," while 13 percent think it is "not liberal enough;" 43 percent of those surveyed favor the law.The key players could be two conservatives on the court: Roberts and Justice Anthony Kennedy, long labeled a "swing" vote."With the four more liberal justices almost certain to vote to uphold the individual mandate, the administration is really hoping for the votes of either the chief justice, who signaled that he had questions for both sides," said Goldstein, "or the traditional swing vote in the court, Anthony Kennedy, who really was tough on the government lawyer but toward the end suggested that maybe insurance was special enough that he could vote to uphold the mandate."Roberts has long talked about achieving consensus on divided issues, saying it brings long-term credibility and public confidence to the court's work. It has been mostly a pipe dream, as his nearly seven years of leadership has shown a continuing 5-4 conservative-liberal split on most hot-button issues."The court is bitterly divided over the individual mandate," Goldstein noted, "so if the administration is going to get his vote, it's either because he believes in a broad federal power or that he doesn't believe that the Supreme Court shouldn't overturn such an incredibly important economic statute."Health care will soon enter the history books, among the handful of the high court's greatest cases, the outcome no doubt monumental -- legally, politically, socially. An issue that affects every American will naturally attract that kind of attention.Picking winners and losers at this stage is a subjective, even partisan, exercise. The court itself will be both cheered and vilified however it rules. But as an institution, it has survived similar crises of confidence over its discretionary authority: slavery, racial integration, corporate power, abortion -- even Bush v. Gore.Rapid-fire reaction to health care will be swift and furious, from the campaign trail, professional punditry, and halls of government. Some individual Americans stand to gain from the decision, others could be hurt -- financially, emotionally, and physically.So why entrust all this in the hands of nine judges?The Supreme Court usually gets the last word in these matters, regardless of whether one agrees with their decisions -- even matters of life and death, which many argue are the stakes in this health care debate.Justice Robert Jackson may have put it best: "We are not final because we are infallible, but we are infallible only because we are final."

Copyright CNN 2012

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Health Care Ruling To Be Among Court's Most Important

LEBANON, N.H. (AP) -- A leader of the effort to revamp Vermont's health care system said Monday the state will cope better than most if the U.S. Supreme Court guts President Barack Obama's health care law, but its reform efforts could be hurt by a loss of more than $200 million a year in federal subsidies.

Anya Rader Wallack, chair of the Green Mountain Care Board, made the comments during an appearance before about 40 physicians, administrators and staff at the Dartmouth-Hitchcock Medical Center. The "grand rounds" meetings are designed to keep health professionals up to date on trends in their field.

The effort by Gov. Peter Shumlin and the Legislature to push Vermont toward a publicly financed health system in which as many claims as possible are processed through a single payer could have a big impact at the Lebanon teaching hospital, which is just across the Connecticut River from Vermont and gets about 40 percent of its patients from that state.

And the federal law's fate likely will have a big impact on Vermont's envisioned Green Mountain Care plan.

The state passed a law last year designed to move Vermont toward but not all the way to a Canadian-style, single-payer health care system by 2017. Likely exceptions include federal employees living in the state and those working for "self-insured" employers

This year, lawmakers designed a health care "exchange," or marketplace, that will be the Web-based, one-stop shopping portal for consumers to compare plans and buy health insurance beginning in 2014.

But a linchpin of financial support both for the exchange and for the Green Mountain Care system planned for later are tax credits to be available under the federal law that have been counted on to help people buy health insurance in the exchange.

Wallack said one early estimate put the value of those tax credits at between $200 million to $300 million per year in Vermont. Other hoped-for federal funding for things like new computer systems to process patients' health records also could be in jeopardy, she said.

Much anticipation surrounded Monday's release of Supreme Court decisions because it was believed the federal health care law ruling might be among them. It wasn't, and the next time the court releases decisions is Thursday.

There's been speculation that the court could leave the multi-faceted law intact, strike down its most hotly debated provision a mandate for individuals to buy health insurance or overturn most or all of it.

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Vt. health official visits with NH doctors

by Bernice Yeung for California Watch

TUSCON, Ariz. -- Southern California's largest clinical laboratory and radiology company serving nursing homes faces fraud allegations, adding to thegrowing number of False Claims Act lawsuits filed against the health care industry nationwide.

According to court documents, Burbank-based Diagnostic Labs, which offers medical lab tests and radiology services, provideddeep discounts to skilled nursing facilities in exchange for business that can be charged to taxpayer-funded Medicare and Medi-Cal.

"This is an illegal kickback scheme, no more legal than if Diagnostic Labs, rather than providing below-cost discounts, had instead simply handed the SNFs (skilled nursing facilities) an envelope of cash," the lawsuit alleges.

The case against Diagnostic Labs was brought under the False Claims Act and a parallel state statute, both ofwhich makeit illegal to defraud the government. These laws are increasingly invoked in the health care arena, legal observers said.

"Since the start of the Obama administration, there has been a pretty pronounced and noticeable uptick in government investigations in which the False Claims Act is the spearhead of the investigation," said Zack Buck, a visiting assistant professor at Seton Hall Law School who teaches a class on health care fraud and abuse. "The government has put a lot of money into fraud investigations and prosecutions and as a result, the amount of settlements have grown and continues to increase."

According to a statement made recently by Stuart F. Delery, acting assistant attorney general of the civil division of the U.S. Department of Justice,morethan 630 whistleblowerlawsuitswere filed with the Department of Justice in 2011 more than any other year and an increase of nearly 50 percent since 2009. More than two-thirds of these cases are related toallegations offraud relatedto government health care programs.

These lawsuits have produced significantfinancial results for the federal government.

In 2011, the federal government collected $2.4 billion in settlements and judgments from health care cases more than fromany other industry, according to an analysis by law firm Gibson, Dunn & Crutcher. Over the past three years, the government has collected $6.6 billion in relation to health care fraud.

A majority of these funds are returned to the relevant federal or state-funded health programs.

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Radiology company accused of health care fraud