Between the Medicaid program, subsidized insurance under the 2006 health care access reform law, and investments in state employee health insurance and public health programs, health care spending this fiscal year is on pace to rise to 43 percent of the overall state budget, according to an analysis of the spending bill being reviewed by Gov. Deval Patrick.

One in five Massachusetts residents will have their health care largely covered through the budget and taxpayer-supported health care costs next year will gobble up the majority of new discretionary state revenue, hitting $15.14 billion, up from $14.65 billion. But education accounts will also get a big boost, according to a Massachusetts Budget and Policy Center analysis of the budget lawmakers agreed to last week.

While lawmakers and the Patrick administration this year have described fiscal 2013 spending plans ranging from $32.4 billion to $32.5 billion, the centers analysis estimates total state appropriations and transfers at $35.229 billion. Center officials say the higher figure reflects revenues collected and spent on transportation, school construction, public employee pensions and health care based on directives that carve out such spending before deliberations on the rest of the state budget begin each year.

Patrick has until Sunday, July 8 to sign the budget and announce his vetoes and amendments to the bill.

The center provides independent research and analysis of state budget and tax policies. Northeastern University Law School professor Peter Enrich chairs its board, which also includes former Gov. Michael Dukakis, American Red Cross of Eastern Massachusetts CEO Jarrett Barrios, Community Catalyst Executive Director Robert Restuccia, and former Revenue Commissioner Navjeet Bal of Nixon Peabody.

Aside from a proposed $546 million increase in spending on Medicaid and health care reform, the fiscal 2013 budget, approved easily last week by the House and Senate after a deal was struck by a conference committee, proposes $6.95 billion in total education spending, an increase of $302 million.

The majority of the increased education spending, or $238 million is targeted for the K-12 education system, with higher education in line for an increase of $58 million to a total of $1.02 billion, and early education and care spending scheduled to fall to $500 million, from $507 million.

Taken together, proposed state spending on health care and education in fiscal 2013 will approach $22.1 billion, representing about 63 percent of all state spending. Health care spending, as a percentage of the budget, will rise to 43 percent from about 42.8 percent.

But even with the 5.3 percent increase in spending on Medicaid, budget managers will need to secure about $500 million in savings in the program to balance the budget next year. The savings, along with some spending cuts and $615 million in temporary revenues, are being relied upon to close an estimated $1.3 billion gap between available revenues and projected state spending based on fiscal 2012 levels. The centers analysis identifies $41 million in homeless shelter cuts and $8 million in child care subsidy cuts.

State spending on education and health care, by comparison, towers over investments in other key areas.

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Health care, education consume 63 percent of planned state budget

04-07-2012 19:15 Mitt Romney tried to clear up the confusion about where he stands on President Obama's health care reform. He shifts his campaign's position and falls in line with other Republicans on the president's health care reform. Jan Crawford reports.

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Romney sides with Supreme Court on health care law - Video

Written by Ken Borsuk, Editor Thursday, 05 July 2012 09:00

To the loud cheers of Democrats and lusty boos of Republicans, the partisan battle over health care reform came to a head last week when the United States Supreme Court upheld the key provisions of the Affordable Care Act (ACA).

The ruling on the ACA, more commonly known by the term Obamacare since this was a major priority of President Barack Obama, was one of the most closely watched Supreme Court verdicts in the last 10 years. And while the court upheld the constitutionality of key parts of the law, including the mandate that people buy health insurance, the battle over the law could now be headed right back to the political arena. Republican presidential candidate Mitt Romney has said he would repeal the law on day one and other Republicans are following suit with their own calls for repeal.

Health care could again become an issue in the upcoming fall Congressional elections, two of which involve town residents.

Mr. Himes famously dedicated his vote in favor of the ACA to the memory of former Greenwich Democratic Town Committee Chairman David Roberson, who was killed in a car accident in 2010 just weeks before the vote on the bill was cast. Mr. Roberson had been without health insurance at the time of his death and Mr. Himes said on the floor of the House of Representatives that a check up could have potentially addressed the heart ailment that caused him to lose control of his car.

In an interview with the Post this week, Mr. Himes acknowledged that this was an emotional vote for him and that he was happy to see it withstand the Supreme Court challenge. He added, though, that emotion was a double edged sword because emotion had also led to the overheated rhetoric around the ACA and the outright lies that it would establish the infamous death panels. He said that the decision by the court was a good one, not for him, but for the millions of Americans like Mr. Roberson who wouldnt have had health insurance but will have it under the ACA.

Its a relief to me that health care reform will save hundreds of thousands of lives and improve services for millions of Americans, Mr. Himes told the Post. This isnt about whether Im relieved about my vote in favor of it but whether this is going to help Americans. [The Supreme Court decision] is a good thing for Americans with a pre-existing condition that will no longer be denied health coverage.

Despite the good news, Mr. Himes, who is facing a re-election campaign this November, said this is no time for complacency and urged people to be vigilant to fight against a potential repeal. Mr. Himes said based on his conversations with constituents health care is an issue, along with others like Iraq and European stability, that are far and away behind the American economy and jobs. He said he wasnt sure if Mr. Obsitnik would bring it up during the campaign.

Ive always been very level-headed about the health care reform, Mr. Himes said. It started us down a very long road toward creating a health care system that will provide affordable coverage to Americans. It is not a perfect bill and I have criticized it when necessary. If my opponent is like Mitt Romney will he say that we need to repeal and replace it without offering any kind of alternative? Mitt Romney has not offered any kind of new plan and I havent heard any other Republicans offering one up either. You dont get to criticize without being able to present an alternative.

Mr. Obsitniks campaign released a statement last Thursday urging the people to take action if they did want the law repealed.

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Health care ruling could impact fall races

STORY HIGHLIGHTS

Washington (CNN) -- As Massachusetts governor, Mitt Romney imposed a penalty on people who could afford health insurance but chose to go without it. As Republican presidential candidate, Romney opposes the federal health care law that does the same thing.

Last week, Romney's top campaign adviser said the federal penalty for refusing to get health coverage was exactly that -- a fine, not a tax. This week, Romney said it is a tax because the Supreme Court opinion he opposes declared it a tax.

Confused? So is the Romney campaign, apparently.

The back-and-forth shows the tightrope Romney must walk on the health care reform issue now that he is the certain Republican presidential nominee.

Rebounding from last week's Supreme Court decision that upheld the constitutionality of President Barack Obama's signature legislative achievement, Republicans seek to galvanize conservative contempt for the measure into a wave of electoral support in November.

They know that the only way to repeal the 2010 health care law is a GOP landslide that wins the White House and both chambers of Congress, so they want to make the act a major campaign issue.

Specifically, Republicans have seized on the high court's 5-4 ruling that the government has the power to enforce the health insurance mandate through its taxing authority. They contend the ruling shows Obama lied to the American public when he repeatedly denied in 2009 that the individual mandate amounted to a tax increase.

However, Romney's support for the same kind of individual mandate -- the requirement that eligible people have health insurance -- during his term as governor in Massachusetts leaves him vulnerable to questions about where he really stands.

Former GOP candidate Rick Santorum focused on that vulnerability during the Republican primary campaign, constantly pointing out that Romney lacked credibility in opposing the 2010 federal law known as Obamacare because of his support for similar reforms in Massachusetts.

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Romney walks health care high wire

A doctor and patient consult in Miami. GOP Gov. Rick Scott of Florida says he will delay implementing the health care law.

STORY HIGHLIGHTS

Washington (CNN) -- Repeal and replace -- or at least resist -- is the Republican mantra in the wake of last week's Supreme Court ruling upholding President Barack Obama's signature health care reform law.

Presumptive GOP presidential nominee Mitt Romney promises to get rid of Obamacare if elected, and at least four Republican governors say their states will hold off implementing main provisions of the 2010 law to see what happens in November.

However, analysts and industry experts contend the reality is that health care reform will happen out of necessity, whether through the Affordable Care Act or the momentum it already has created since being passed over two years ago.

According to a report by PricewaterhouseCoopers' Health Research Institute, 14 states and the District of Columbia have made "significant progress" toward implementing reforms, while another 19 states have made "moderate progress," leaving 17 states -- or about a third -- that have yet to change their laws or take other steps toward implementation.

The report, titled "Implications of the U.S. Supreme Court Ruling on Healthcare," says all players in the health care industry -- state governments, hospitals, insurance companies, employers and drug companies -- need to participate in the emerging reform process or risk getting left behind.

"Despite the political uncertainty, private-sector initiatives -- accentuated and accelerated by the law -- are moving forward," the report says. "The crucial question now is: Will health reform define your organization, or will your organization define the post-reform landscape?"

Republicans launch blitz against health care law

A repeated recommendation in the report advises industry leaders to "stop putting off key decisions," and it specifically calls on states to "stop taking a wait-and-see approach to health reform implementation."

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States face rising tide of health reform

With the Capitol in the background, Republican presidential candidate, former Massachusetts Gov. Mitt Romney speaks about the Supreme Court's health care ruling, Thursday, June 28, 2012, in Washington. (AP Photo/Charles Dharapak)

WOLFEBORO, N.H. -- Contradicting one of his senior advisers, Mitt Romney said Wednesday, July 4, that the individual mandate in President Barack Obama's health care plan is a tax, and stands as evidence that Obama has broken a promise not to raise taxes on the middle class.

Just two days earlier, campaign spokesman Eric Fehrnstrom said Romney agreed with Obama that the individual mandate was a penalty, not a tax -- despite the Supreme Court ruling that the law was constitutional precisely because it was a tax.

Fehrnstrom said Romney "agreed with the dissent, which was written by Justice (Antonin) Scalia, and the dissent clearly stated that the mandate was not a tax." The Scalia dissent said the health care plan was unconstitutional because it violated the Commerce Clause of the Constitution. The court's majority agreed that it violated that clause, but said it was legal because Congress had a separate power to impose taxes.

Fehrnstrom's comments caused consternation among many Republicans, who believed that the Supreme Court had handed Obama a gift when it used the tax argument to justify upholding the health care plan. In an interview with CBS News on Wednesday, Romney backed off from his adviser's remarks.

Asked about the Supreme Court ruling, Romney said that "while I agreed with the dissent, that's taken over by the fact that the majority of the court said it was a tax and therefore it is a tax. They have spoken."

He went on: "There's no way around that.

The remarks, coming during Romney's vacation at his New Hampshire vacation home, were the second time in recent months that the candidate has been forced to do damage control after controversial remarks by Fehrnstrom.

In March, as Romney closed in on the Republican nomination, Fehrnstrom suggested that the campaign would move more toward the political center in the general election. In words that brought undisguised glee to the Obama campaign, he said: "Well, I think you hit a reset button for the fall campaign. Everything changes. It's almost like an Etch A Sketch. You can kind of shake it up and restart all over again."

Romney was quick to assure conservatives that that wouldn't be the case.

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Health care mandate is a tax, Romney says

(CBS News) WOLFEBORO, N.H. - Mitt Romney tried to clear up the confusion about where he stands on President Obama's health care reform. Two days ago, his campaign spokesman said the requirement that every American buy health insurance is a penalty, not a tax. But on Wednesday, the candidate shifted his position.

Romney has come under fire since the Supreme Court's decision because his position on this tax issue has been at odds with every Republican, that of course they're saying that the health care law is a massive tax hike. But Wednesday, in his first interview since the Supreme Court decision, Romney tried to clear things up. CBS News correspondent Jan Crawford interviewed the GOP presidential hopeful at his vacation home. A transcript follows:

Romney: Well, the Supreme Court has the final word. And their final word is that Obamacare is a tax. So it's a tax. They decided it was constitutional. So it is a tax and it's constitutional. That's the final word. That's what it is.

Crawford: Have you changed your views on this? Do you now believe that it is a tax at the federal level, that the Supreme Court has said it's a tax? So it is a tax?

Romney: Well, I said that I agreed with the dissent, and the dissent made it very clear that they felt it was unconstitutional. But the dissent lost. It's in the minority. And so now the Supreme Court has spoken.

Romney: Individual mandate "is a tax"

There's now way around that. You can try and say you wished they would have decided in a different way, but they didn't. They concluded it was a tax. That's what it is. And the American people know that President Obama has broken the pledge he made. He said he wouldn't raise taxes on middle-income Americans. Not only did he raise the $500 billion that was already in the bill, it's now clear that his mandate, as described by the Supreme Court, is a tax.

Crawford: But does that mean the mandate in the state of Massachusetts under your health care law also is a tax, and that you raised taxes as governor?

Romney: Actually the chief justice, in his opinion, made it very clear that at the state level, states have the power to put in place mandates. They don't need to require them to be called taxes in order for them to be constitutional. And as a result, Massachusetts' mandate was a mandate, was a penalty, was described that way by the legislature and by me. And so it stays as it was.

Crawford: So at the state level, you're saying the Supreme Court says that's different? That the federal government--

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Romney: Health care mandate a "tax"

Monday July 2, 2012

BOSTON

Massachusetts is taking major strides forward in transforming health care for families and individuals in Berkshire County and across the commonwealth. By emphasizing integrated, whole-person care, the Patrick-Murray ad ministration is ensuring that we will again lead the nation in the next phase of health care reform.

Building on Governor Deval Patrick's health care cost containment efforts, one of our most innovative new initiatives focuses on a group of people who face particularly significant challenges. This group includes adults between 21 and 64 with physical, behavioral, or developmental disabilities. These individuals are sometimes referred to as "dual eligibles" be cause they are eligible for, and receive health care coverage from MassHealth -- the Massachusetts Medicaid program -- as well as Medicare.

Their stories are unique, and their treatment plans they will receive under our innovative new "duals" initiative will also be unique. The duals demonstration is currently in a competitive procurement process to select health care organizations to provide integrated, coordinated care to 111,000 dual eligible individuals, while improving efficiency and controlling costs.

Among those individuals is Amy, a 50-year-old MassHealth and Medicare member who suffers from long-standing multiple sclerosis, with complete paralysis in both legs and partial paralysis in her arms. She has struggled over the years with

Amy sees a variety of different doctors on a regular basis. Her doctors do the best they can to help her, but lack an easy system to communicate with each other, resulting in missed opportunities to coordinate her care. Her medical providers aren't able to work closely with her personal care attendant, who helps Amy take care of basic daily functions like dressing and eating. She would like to join a peer-led depression support group, but she is not sure how to find one -- or whether there would be transportation available to help her get to meetings.

Amy's needs for health care are significant. But perhaps even greater is her need for a comprehensive, integrated health care plan that really addresses her unique circumstances, and a team of professionals well versed in caring for people with individuals working together for her.

The Patrick-Murray administration's new "duals" program will help Amy and the more than 111,000 other individuals in the commonwealth ages 21 to 64 who rely on both MassHealth and Medicare for their care. This population includes nearly 4,000 individuals living in Berkshire County. Under this initiative, these individuals will have a new option for accessing their health care benefits through Integrated Care Organizations (ICOs), which will be selected through a highly selective application process.

ICOs will provide medical and behavioral health care, as well as community support services, like peer support, non-medical transportation and home care services. Starting with the launch of the program in April 2013, each member will work with an interdisciplinary care team that includes a primary care doctor, specialists, a behavioral health clinician if needed, and care coordinators who can help them access both medical and community support services. Working together, the care team will develop a unique, individualized care plan for Amy and every member they serve.

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Better health care for most vulnerable

Washington — It looks like a tax, smells like a tax, and the Supreme Court says it must be a tax. But politicians in both parties are squirming over how to define the Thing in President Barack Obama's health care law that requires people to pay up if they don't get health insurance.

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Politics clouds definition of health measure

Conservatives fought Social Security, Medicare and the weekend when they were proposed. But once enacted, Republican and Democratic Presidents embraced all three as they became part of American life.

We can expect President Obama's court-tested health-care reforms which shift payment for uninsured people's health care from hospitals to taxpayers will also go on, even if Republican Mitt Romney is elected President.

Veteran Philadelphia investor James M. Meyer, of Tower Bridge Advisors, which manages $1 billion in other people's money, wrote a thoughtful account of the costs, purpose and likely durability of "Obamacare," in a note for clients of the West Conshohocken-based investment brokerage Boenning & Scattergood:

"Republicans want to repeal the law. Indeed, the House will vote on or about July 11 to try and do just that. Almost certainly a repeal bill will pass, but just as certain it will die a quick death in the Senate.

Mitt Romney has suggested that repeal of ObamaCare would be his first Presidential initiative if elected. But that is probably just rhetoric.

Outright repeal without a realistic alternative isn't going to sit well with the public. Few want to go back to a world where insurers can simply reject high-risk patients, where people can't [change] jobs for fear of losing coverage, or where children under 26 can no longer be covered on their parent's policies.

Instead, what are needed are mechanisms to make our health-care system more cost efficient. That requirement is going to be the same whether Obama or Romney is elected."

More insurance will bring more taxes a surcharge on investment income for higher-income Americans, and a tax on medical gadgets, though U.S. Rep. Jim Gerlach (R., Pa.), with device-makers in his district, wants that canceled.

It will cost many billions to extend Medicaid and subsidize insurance sold through state exchanges to the self-employed, workers at small firms, and others whose bosses don't insure.

The government has to attack rising costs, Meyer wrote. Suppliers need incentives to sell the "right" level of health care. Not just more health care. "The patient needs to have an economic stake in the decision to spend money on health care," he wrote. Maybe offer a menu of cost-benefit packages, like in Medicare Part D; incentives for health living; or vouchers.

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Philly Deals: With Romney or Obama as president, health-care reforms are here to stay

WASHINGTON In promoting the health care law, President Obama is repeating his persistent and unsubstantiated assurance that Americans who like their health insurance can simply keep it. Republican rival Mitt Romney says quite the opposite, but his doomsday scenario is a stretch.

After the Supreme Court upheld the law last week, Obama stepped forward to tell Americans what good will come from it. Romney was quick to lay out the harm. But some of the evidence they gave to the court of public opinion was suspect.

A look at some of their claims and how they compare with the facts:

OBAMA: "If youre one of the more than 250 million Americans who already have health insurance, you will keep your health insurance. This law will only make it more secure and more affordable."

ROMNEY: "Obamacare also means that for up to 20 million Americans, they will lose the insurance they currently have, the insurance that they like and they want to keep."

THE FACTS: Nothing in the law ensures that people happy with their policies now can keep them. Employers will continue to have the right to modify coverage or even drop it, and some are expected to do so as more insurance alternatives become available to the population under the law. Nor is there any guarantee that coverage will become cheaper, despite the subsidies that many people will get.

Americans may well end up feeling more secure about their ability to obtain and keep coverage once insurance companies can no longer deny, terminate or charge more for coverage for those in poor health. But particular health insurance plans will have no guarantee of ironclad security. Much can change, including the cost.

The non-partisan Congressional Budget Office has estimated that the number of workers getting employer-based coverage could drop by several million, as some workers choose new plans in the marketplace or as employers drop coverage altogether. Companies with more than 50 workers would have to pay a fine for terminating insurance, but in some cases that would be cost-effective for them.

Obamas soothing words for those who are content with their current coverage have been heard before, rendered with different degrees of accuracy. Hes said nothing in the law requires people to change their plans, true enough. But the law does not guarantee the status quo for anyone, either.

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Health care law: Is what Obama, Romney say true?

The Patient Protection and Affordable Care Act will hurt business owners, adds uncertainty to the health care market and will increase the cost of health care.

Those were the main points Rep. Rick Berg, R-N.D., made at a Tuesday press conference in Bismarck while calling for repealing the act. Last weeks highly anticipated ruling by the U.S. Supreme Court has led to Berg and other Republicans to call for the federal health care law to be struck down by Congress.

Citing the cost of the laws implementation over the next 10 years, Berg called it a $1.8 trillion takeover of our health care system. He said the laws provisions will make it difficult for small business owners who provide health care to their employees to continue to do so. Berg said there also is a negative financial impact on the public.

This is really a legacy of debt for our children and grandchildren, Berg said. It creates uncertainty throughout America. Its wrong for patients, its wrong for doctors, its wrong for seniors, its wrong for North Dakota, its wrong for America.

Dick Hedahl, owner of Hedahls Auto Plus in Bismarck, spoke about the potential impacts of the federal health care law on employee insurance.

Weve had health insurance for our employees for 55 years, Hedahl said.

Hedahl said the company has had its own health wellness program since 1992. This program, he said, has cut health care costs and promoted health among employees. Hedahl said provisions in the federal law could lead to cost increases in his companys insurance program.

It may cause us to drop our coverage, Hedahl said.

Jeff Neuberger, chief executive officer of Mid Dakota Clinic, said the law doesnt address the cost of health care. He said provisions such as the individual mandate make insurance more costlyfor the public.

It actually encourages people to consume more health care services, Neuberger said.

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Berg calls for health care law repeal

Local

Health care decision prompts responses

By JENNIFER DENEVAN, Needles Desert Star Monday, July 2, 2012 5:32 PM PDT

NEEDLES Last Thursdays ruling by the U.S. Supreme Court upholding the Patient Protection and Affordable Healthcare Act, often referred to as ObamaCare, has received varied responses.

Jeff Williams, board of hospital trustees president, said its a terrible thing for Needles to have been upheld. It will mean spending more money than will ever be made.

Its a lousy idea, he continued.

He said he thinks doctors will quit because the acts been upheld; and that doctors dont get paid enough as it is but theyll get paid even less under ObamaCare.

(Supreme Court Justice) John Roberts let us down by calling it a tax, Williams said. He got that wrong. Its a penalty.

Williams said he feels calling that portion of the act a tax is opening the door for the federal government to start taxing many items or services. What else can they penalize us for? he asked.

On paper Meaningful Use, the use of electronic paperwork and filing, sounds good, but in practice it really delays the process further, Williams said. For example, a prescription has to go through all the electronic processes before a patient can get the needed medicine, making it take two or three times as long as previously, he continued.

Originally posted here:

Health care decision prompts responses

By: Ryah Cooley The Affordable Care Act was ruled as constitutional. ...

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Health care law upheld to relief of CSULB students

The Supreme Court's validation of President Barack Obama's landmark health law sets off a scramble up and down California to find enough primary care doctors and other professionals to serve an estimated 3million newly insured patients by 2014.

California already rates below average in the number of doctors per capita.

But the state - rural and inland counties in particular - will face additional headwinds as health reform slashes the ranks of its 7 million uninsured.

California has an unusually large number of doctors heading into retirement years. It expects a much higher-than-average rise in the health-intensive 65-and-older population. And it has one of the lowest reimbursement rates in the country for Medi-Cal, the state's primary program offering health coverage for the poor.

Especially for communities already struggling with doctor shortages, the court's somewhat unexpected endorsement of the Affordable Care Act suddenly presents a steep challenge.

"The Affordable Care Act will add hundreds of thousands of people to the rolls of the insured. That's good," said Dr. G. Richard Olds, founding dean of the UC Riverside School of Medicine. "But where are the primary care physicians going to come from to serve that population?"

According to a 2009 study by the California HealthCare Foundation, only 16 of 58 California counties had sufficient primary care doctors as measured against standards set by the American Medical

Many of California's most acute shortages are in the Inland Empire and the San Joaquin Valley, where communities struggle to attract and retain doctors. They also have some of California's highest uninsured rates - exceeding 30 percent of residents in some counties, according to a 2009 UCLA study.

That could mean the same counties already fighting doctor shortages could see big increases in the insured starting in 2014.

Asked if local providers in San Luis Obispo County were numerous enough to accommodate the new patients created by health reform, county health officer Dr. Penny Borenstein had a definitive answer: "No. Simply."

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Next health care headache: Shortage of doctors

The same week that President Obama’s health-care program squeaked through the U.S. Supreme Court, Canada marked the 50th anniversary of its own national health care. But it, too, needs to change, despite its huge popularity with most Canadians. Just not as drastically as the potholed U.S. system needs to change.

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Bill Mann's Canada: Canada’s single-payer health plan turns 50

Posted:Today Updated: 12:37 AM President Obama and Mitt Romney both make arguments -- likely to continue until November -- based on suspect data.

By CALVIN WOODWARD and RICARDO ALONSO-ZALDIVAR/The Associated Press

WASHINGTON President Obama promises nothing will change for people who like their health coverage, except it'll become more affordable, but the facts don't back him up. Mitt Romney groundlessly calls the health care law a slayer of jobs certain to deepen the national debt.

Welcome to the health care debate 2.0. As the claims fly, buyer beware.

After the Supreme Court upheld the law last week, Obama stepped forward to tell Americans what good will come from it. Romney was quick to lay out the harm. But some of the evidence they gave to the court of public opinion was suspect.

A look at their claims and how they compare with the facts:

OBAMA: "If you're one of the more than 250 million Americans who already have health insurance, you will keep your health insurance. This law will only make it more secure and more affordable."

ROMNEY: "Obamacare also means that for up to 20 million Americans, they will lose the insurance they currently have, the insurance that they like and they want to keep."

THE FACTS: Nothing in the law ensures that people happy with their policies now can keep them. Employers will continue to have the right to modify coverage or even drop it, and some are expected to do so as more insurance alternatives become available to the population under the law. Nor is there any guarantee that coverage will become cheaper, despite the subsidies many people will get.

Americans may well end up feeling more secure about their ability to obtain and keep coverage once insurance companies can no longer deny, terminate or charge more for coverage for those in poor health. But particular health insurance plans will have no guarantee of ironclad security. Much can change, including the cost.

Continued here:

Checking facts on opposing claims about health care law

In approving the constitutionality of the Affordable Care Act, Chief Justice John Roberts may have wanted to gently rebuke Congress for pushing the Commerce Clause too far, though he let it slide as a tax.

Even so, its important to place this ruling in context.

Today and into the foreseeable future, the political parties are far apart and not likely to compromise.

The same organizations that in 2009 contributed $1.2 billion to Congress in exchange for influence over the laws formulation remain engaged.

While the individual mandate will allow us to spread risk more broadly and make access more available, especially to lower income Americans, it isnt perfect.

The dire problems of extravagant health care use, unit pricing and cost remain largely untouched by the law in its current form.

High cost barely touched

Half or more of all U.S. health care spending provides no value by design, meaning that Americans pay double for health care compared to citizens in other developed nations, and our quality is spottier.

The requirement to keep up with this excess through the mandate will be onerous for many Americans.

As analyst Bob Laszewski points out, a household with a $60,000 annual income will need to find 9.5 percent, or $5,700, for the premium.

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Health care end game hasn't started

The U.S. Supreme Court today upheld President Barack Obama's Patient Protection and Affordable Care Act (PPACA), which is commonly referred to as Obamacare.

Politicians, policy advocates, attorneys and scholars are weighing in on the ruling today.

Wisconsin Gov. Scott Walker said, "I continue to oppose ObamaCare. One of my first acts as Governor was to authorize Attorney General J.B. Van Hollen to add Wisconsin to the federal lawsuit opposing ObamaCare. Wisconsin will not take any action to implement ObamaCare. I am hopeful that political changes in Washington, D.C. later this year ultimately end the implementation of this law at the federal level. If there is no political remedy from Washington and the law moves forward, it would require the majority of people in Wisconsin to pay more money for less health care. Additionally, it would increase the size and cost of government, decrease the quality of healthcare and, in our state, reduce access for those truly in need of assistance. The federal government should not tell individuals and families what to do with healthcare. The alternative is more transparency and a more active role by consumers, so we can truly control costs."

Robert Kraig, executive director of Citizen Action of Wisconsin, said, "This historic ruling is a major step towards establishing the freedom of every American to make their own health care decisions. We are one step closer to every American having the peace of mind of knowing that health care will be there when they need it. The court's decision is a particular relief to nearly one million Wisconsinites who have preexisting conditions who will face outrageous discrimination if they ever have to buy insurance on their own. Now that a conservative Supreme Court has affirmed the constitutionality of the health care law, we believe that Governor Walker has a moral obligation to restart the implementation process here in Wisconsin. We call on Walker to stop playing politics with people's lives."

Rick Esenberg, president of Wisconsin Institute for Law and Liberty and adjunct professor of law at Marquette University Law School, said the reasoning for the Supreme Court's decision was surprising because most observers expected the decision would be made based on Congress' ability to regulate interstate commerce rather than as a function of Congress' taxing power. "I believe that our Constitutional scheme has given only limited powers to Congress and that if Congress can impose a penalty on you, if Congress can attempt to mandate that you do something then it's hard to see what limitations on the authority exist other than those we might find in the Bill of Rights," Esenberg said.

Ed Fallone, associate professor of law at Marquette University Law School, said, "I am very gratified that the court upheld the law. I think the arguments in favor of its Constitution were overwhelming. I'm only disappointed that it was upheld on the taxing power theory as opposed to the commerce clause theory."

Wisconsin Manufacturers & Commerce president and CEO Kurt Bauer said, "The fact that a divided court upheld the constitutionality of the health care law does not make it good public policy. As Chief Justice Roberts noted in his decision, Congress, not the Supreme Court, made the policy choices under the Constitution and hopefully lawmakers will have the good sense to repeal this misguided law. The so-called Affordable Health Care Act will actually drive up the cost of health care, and in the absence of massive tax increases is likely to bankrupt the federal government. The uncertainty that businesses of all sizes feel continues with today's decision and will be a drag on economic growth." U.S. Sen. Ron Johnson (R-Wis.) said, "Today's Obamacare decision establishes that there is no area of Americans' private lives that is off limits to federal intrusion and control. Freedom took a real body blow. It is now up to Congress and hopefully a new President to repeal this unpopular monstrosity and replace it with free market reforms that will actually improve the quality and restrain the cost of health care in America."

Moveon.org political action executive director Justin Ruben said, "Today, the Supreme Court ruled in favor of the health of this nation. MoveOn members fought hard for the Affordable Care Act, and today's decision means millions of Americans including many MoveOn members will be able to access affordable, quality health care. Today, justice was upheld. But the fact that the Affordable Care Act was ever in jeopardy shows how politicized this court has become. All too often, this 1 percent court has legislated from the bench on behalf of corporations and the wealthy instead of acting as fair arbiters of the law. The next president will nominate as many as three new justices, setting the court's direction for a generation. There's every reason to believe Mitt Romney would try to put more 1 percent justices on the court. MoveOn will dedicate our energy and resources to reelecting President Obama to ensure more fair-minded justices are seated on the court."

Judd Legum, editor in chief for Think Progress and vice president for communications for the Center for American Progress Action Fund, said, "This is a victory for millions of Americans who are already benefiting from the health reform law and the tens of millions who will benefit in the future but the fight is not yet over. Now that health care reform has been declared undeniably constitutional, its enemies will attack it in every other way they can. If they succeed more people will get sick, will die, and will go bankrupt because of a broken health care system. Health care is a basic human right. The Supreme Court knows this and saw the challenge to Obamacare for what it was an extreme, partisan attack on the health and well-being of American families. We cannot go back to the days where families lose their homes or go bankrupt trying to save their loved one's lives, where cancer patients scramble to cover out-of-pocket costs to continue treatment, and when being a woman is considered a pre-exisiting condition."

U.S. Rep. Paul Ryan (R-Wis.) said, "The federal government is tasked with protecting our cherished liberties not infringing upon them with mandates and intrusions into our lives. Today's ruling affirms another broken promise by President Obama, who misled the American people in selling the law by insisting that the federal mandate was not a tax. Despite today's disappointing decision on the law's constitutionality, there is no question that the law remains terrible policy. It is bad news for individuals, whose personal health care decisions are threatened by greater government control. It is bad news for workers, whose paychecks and jobs are threatened by the hundreds of billions of dollars of new tax hikes and crippling uncertainty from the massive law. It is bad news for seniors, whose health security is threatened by the bureaucratic restrictions to access from the law's changes to Medicare. It is bad news for future generations, whose prospects for greater opportunity are stifled by the trillions of dollars of new debt that will result from this law. It is incumbent upon citizens and their elected leaders to clear this partisan roadblock with full repeal, and advance common-sense, patient-centered solutions. We can still ensure universal access to quality, affordable health coverage without a budget-busting federal government power grab. I remain committed to advancing reforms that realign incentives so that individuals and their doctors not government bureaucrats or insurance company bureaucrats are the nucleus of our health care system. This requires reforms to equalize the tax treatment of health insurance, invite true choice and competition, and ensure critical programs like Medicare and Medicaid can deliver on their promise in the 21st century. "Today's decision strengthens the case for repeal and replace. With the right leadership in place, I am confident we can advance real health care solutions for the American people. It is now in the hands of the American people to determine whether this disastrous law will stand."

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Reaction pours in over historic court ruling on health care

Republican governors like Rick Scott of Florida who say they will defy President Barack Obama and opt out of a planned expansion of Medicaid health coverage for the poor are setting up a fight with the health care providers in their own backyards.

When the Supreme Court upheld Obama's health care reform law last Thursday, it surprised practically everyone by ruling that states may decline to extend Medicaid coverage to 17 million people with incomes below 133 percent of the federal poverty level, which is $14,856 for an individual this year.

A growing number of Republican governors, including Scott, Terry Branstad of Iowa, Bobby Jindal of Louisiana, and Scott Walker of Wisconsin say they won't carry out any parts of the law, which threatens to deny millions of poor people access to the Medicaid coverage it provides.

But Obama and those uninsured people aren't the only ones who stand to lose. Hospitals that currently treat the poor for free in emergency rooms were counting on a broad expansion of health insurance coverage to cut down on the number of unpaid bills on their books. The American Hospital Association and other national industry groups endorsed the health care reform law, calculating that more insured people would make up for $155 billion in lower Medicare payments over a decade.

A smaller Medicaid expansion would be bad news for hospitals, especially in states like Florida and Texas with large numbers of uninsured people, according to Sheryl Skolnick, a health care equities analyst at CRT Capital Group in Stamford, Conn. "That risk is real and meaningful: the hospitals may end up paying for the poorest and sickest of today's uninsured anyway AND see cuts in Medicare and Medicaid on top of that," she wrote in a note to clients Friday.

Pressure from the influential hospital industry could soften resistance in the states to adding more people to the Medicaid rolls, especially since the federal government will pay 100 percent of the costs of these new beneficiaries from 2014 to 2016 and then phase down its share of the expenses over three years, reaching 90 percent starting in 2020. Hospitals, which are required by federal law to treat anyone with a medical emergency regardless of their ability to pay, were left with $39.3 billion in unpaid bills in 2010, according to the American Hospital Association.

Florida won't take part in the Medicaid expansion, Scott said in a statement Sunday, despite the fact that 25 percent of the state's residents younger than 65 are uninsured, the second-highest rate in the U.S. That was 3.9 million people in 2010, based on data compiled by the Henry J. Kaiser Family Foundation. According to the Urban Institute, 1.8 million Floridians would would qualify for Medicaid benefits under health care reform starting in 2014.

"You're going to have a lot of cuts with no corresponding increase in the number of people that hospitals see that have any sort of coverage," said Bruce Rueben, the president of the Florida Hospital Association. Florida's hospitals ate $2.55 billion in unpaid bills left by uninsured people in 2010, according to the association, which supported the health care reform law.

Even though Medicaid pays just 45 percent to 75 percent of the treatment costs incurred by hospitals in Florida, it's better for them than not getting paid at all. In addition, people with any kind of health care coverage are more likely to visit a regular doctor than to seek treatment at emergency rooms, Rueben said, which should keep those patients out of hospitals.

Getting the Medicaid expansion in place has already become the "number one priority" for the Texas Hospital Association, said John Hawkins, the senior vice president for advocacy and public policy at the organization. "It's the kind of thing that hits our members right on the margin when they're trying to digest other payment cuts," he said.

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Health Care Reform Defiance By Republican Governors Worries Hospital Industry