Health care decision hinges on crucial commerce clause

by Nina Totenberg, National Public Radio

June 11, 2012

All of Washington is breathlessly awaiting the Supreme Court's imminent decision on the Obama health care overhaul. Rumors circulate almost daily that the decision is ready for release. As usual, those rumors are perpetrated by people who know nothing, but the decision is expected by the end of this month.

The near hysteria is partially about politics: Congressional Republicans hate the bill, and some see President Obama's chance at a second term hinged to the fate of the law. But constitutional scholars know there is much more at stake here than an individual election. Just how much is illustrated by the legal history of the Commerce Clause of the Constitution.

It gives Congress the power to "regulate commerce ... among the several States," and it authorizes Congress to "make all laws which shall be necessary and proper" for achieving that goal. The Founding Fathers' purpose was to put an end to the interstate rivalries that balkanized the country after the American Revolution. But the words of the Commerce Clause are pretty general, and it is the Supreme Court that for more than 200 years has interpreted what they mean.

Early Decision: Broad Power

The court's first major Commerce Clause decision came in the 1824. The great Chief Justice John Marshall, who was himself one of the Founding Fathers, wrote in Gibbons v. Ogden that the Commerce Clause gives Congress broad power to regulate commerce and that this power is mainly limited by the power of the people to deny their representatives re-election if they don't like what Congress does.

The decision infuriated the likes of Thomas Jefferson, who viewed federal power as far more limited under the Constitution, but the ruling stood as the guiding light on commerce questions for about 70 years.

A Country Transformed

The next landmark case came in 1895, during the rise of great national corporations and concentrations of wealth. When the U.S. government, using the antitrust law, sought to block the leading sugar refining company from acquiring 98 percent control of the industry, the company fought back and won. In U.S. v. E.C. Knight Co., the Supreme Court ruled that since sugar refining took place before shipments of the product crossed state lines, Congress was powerless to regulate the industry.

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Health care decision hinges on crucial commerce clause

Health Care Costs Caused More Americans To Go Without Needed Care Last Year: Survey

Health care costs are weighing on Americans' minds -- and sapping their budgets, according to a new survey that shows that within the last year, more than half of people needing medical care didn't get it because of the expense.

Costs led 58 percent of people to put off or go without health care they needed in the previous 12 months, a increase from 50 percent last August, says a survey released Monday by the Henry J. Kaiser Family Foundation, a nonprofit research organization based in Menlo Park, Calif. Americans skipped doctor and dentist visits, didn't receive diagnostic tests, didn't take their medicines, cut pills in half or took other steps to save money that could make them less healthy, the survey found. Twenty-six percent of Americans reported they or a family member had difficulty paying medical bills, the same percentage as last August.

Even many who didn't experience difficulties with health care costs say they're concerned they might, the foundation reports: "While substantial shares of Americans report problems paying for care, even larger shares report they are worried about being able to afford health care and maintain insurance coverage." Sixty-four percent of those surveyed were concerned about their health care costs rising, according to the survey, which the foundation conducted last month. The survey's overall margin of error is plus or minus 3 percentage points.

Americans spent $2.6 trillion on health care in 2010, a tenfold increase since 1980, according to federal government figures. Higher prices for medical procedures, tests, drugs and other health care goods and services are increasingly burdensome on American households, contributing to higher health insurance premiums and fostering a population of uninsured people that's approaching 50 million. That money isn't buying Americans higher-quality care than is available in other rich countries, either.

An American family of four with job-based health insurance will spend more than $20,000 on premiums, deductibles, co-payments and other expenses this year, according to a recent analysis by Milliman, a firm that consults with companies about employee benefits.

Not surprisingly, the uninsured are worse off than those who have health insurance, the Kaiser Family Foundation survey shows. Almost half of the uninsured, 47 percent, reported difficulties covering their medical expenses and 81 percent of them said they'd put off health care they needed. But having health insurance doesn't guarantee access to affordable health care: 23 percent of people less than 65 years old who have health insurance said they faced trouble paying medical bills and 55 percent said they didn't get health care they needed because of cost.

A large share of those who need health care the most reported these difficulties. Forty-five percent of people who said they were in fair or poor health had problems with medical bills, compared to 29 percent of individuals in good health and 19 percent of those in excellent or very good health. Among the sickest people, 77 percent said they didn't receive necessary treatments.

President Barack Obama's health care reform law contains provisions designed to extend health coverage to more than 30 million people who have none today, including people who currently can't obtain health insurance because of pre-existing conditions. The Supreme Court is expected rule this month on whether the law is constitutional. Justices could leave the law in place, eliminate the individual mandate that most people must obtain health coverage and other provisions or invalidate the whole thing.

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Health Care Costs Caused More Americans To Go Without Needed Care Last Year: Survey

UnitedHealthcare to keep parts of health reforms

(CBS News) The Supreme Court this month could overturn all or parts of President Obama's landmark 2010 health care overhaul -- but even so, at least one major health insurer plans to voluntarily keep in place some of the reforms.

UnitedHealthcare on Monday announced that regardless of the court's decision, it will continue to offer some consumer protections and services that the law mandated: Allowing children up to the age of 26 to remain on their parents' health plan, coverage of preventive health services without co-pays, the elimination of lifetime dollar limits on policies, the elimination of rescissions (or retroactive termination of coverage), and the implementation of a clear appeals process.

The decision will ensure that a large swath of consumers will continue to benefit from some of the more popular elements of Mr. Obama's controversial law -- UnitedHealthcare serves more than 38 million people, making it one of the nation's largest insurers.

It could also alter the political fallout from the high court's decision. Should the Supreme Court reject Mr. Obama's law, the president could point to UnitedHealthcare's announcement to validate his policy agenda. However, should the court strike down the law, the practical impact could be less clear to voters, making the issue less of a galvanizing force for the left.

The Supreme Court heard arguments over the law's constitutionality in March, and the court is expected to hand down its decision between now and June 28.

Supreme Court to rule soon on health care, immigration; what happens next? Poll: Most want Supreme Court to overturn individual health care mandate Poll: Most think politics will influence Supreme Court health care decision

Stephen Hemsley, president and CEO of UnitedHealth Group, said in a statement his company is keeping the provisions in place because they "are compatible with our mission."

"The protections we are voluntarily extending are good for people's health, promote broader access to quality care and contribute to helping control rising health care costs," he said. "These provisions make sense for the people we serve, and it is important to ensure they know these provisions will continue."

The court's rulings and the consequences are hard to know at this point. The one certainty is that the court's consideration of the case is putting Mr. Obama's controversial health care law back in the spotlight squarely in the middle of the 2012 presidential race -- a move sure to rekindle the partisan passion that in part drove Democratic voters in 2008 and Republican voters in 2010.

A CBS News/New York Times poll released last week reveals that nearly seven in 10 Americans want the Supreme Court to overturn either all or President Obama's health care law or strike down just the individual mandate.

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UnitedHealthcare to keep parts of health reforms

Democrats Wary on Court Health Care Ruling

Chris Maddaloni/CQ Roll Call

For Congressional Democrats anticipating the Supreme Courts health care decision, the question is this: Why rush?

Republicans are quick to highlight their preparations for the courts decision. They have promised immediate action to repeal what is left of the law if its not completely struck down, and they have said they will hold individual votes on the laws more popular elements.

But in facing the public, many Democrats downplay the possibility that the court could strike down President Barack Obamas signature legislative achievement.

Were confident that the laws going to be upheld, said Rep. Debbie Wasserman Schultz (Fla.), chairwoman of the Democratic National Committee. It would be a dramatic narrowing of the jurisprudence of 70 years on the Supreme Court that gives Congress the ability to regulate commerce if the court strikes it down.

Behind the scenes, some Members and aides are broaching the possibility. Nevertheless, House and Senate Democrats are not expecting a flurry of legislative activity once the Supreme Court rules.

Instead, a Senate Democratic leadership aide said, they are taking their cues on how to respond from the White House.

Its unlikely that Congress would take up the health care bill again before the election, the aide said, adding that any efforts by Senate Democrats would not be embraced by the Republican-led House. To the extent that those discussions are taking place, they are being led by the White House.

Health and Human Services Secretary Kathleen Sebelius said last week at a White House forum on the law and womens health issues that the administration remains confident and optimistic the law will be upheld.

But if the ruling proves unfavorable, she added, Well be ready for court contingencies. However, she offered no details about how the administration would respond.

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Democrats Wary on Court Health Care Ruling

Undoing health law a mess?

WASHINGTON It sounds like a silver lining. Even if the Supreme Court overturns President Barack Obama's health care law, employers can keep offering popular coverage for the young adult children of their workers.

Don't miss these Health stories

A rising number of American men who underwent vasectomies a procedure once considered permanent are choosing microsurgeries to re-hook or reroute their reproductive tubes, according to two leading urologists.

But here's the catch: The parents' taxes would go up.

That's only one of the messy potential ripple effects when the Supreme Court delivers its verdict on the Affordable Care Act this month. The law affects most major components of the U.S. health care system in its effort to extend coverage to millions of uninsured people.

Because the legislation is so complicated, an orderly unwinding would prove difficult if it were overturned entirely or in part.

Better Medicare prescription benefits, currently saving hundreds of dollars for older people with high drug costs, would be suspended. Ditto for preventive care with no co-payments, now available to retirees and working families alike.

Partially overturning the law could leave hospitals, insurers and other service providers on the hook for tax increases and spending cuts without the law's promise of more paying customers to offset losses.

If the law is upheld, other kinds of complications could result.

The nation is so divided that states led by Republicans are largely unprepared to carry out critical requirements such as creating insurance markets. Things may not settle down.

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Undoing health law a mess?

Health-care prognosis: cloudy

By Jack Torry

The Columbus Dispatch Sunday June 10, 2012 10:56 AM

The U.S. Supreme Court is on the verge of ruling on the new health-care law, a decision that could throw health care into temporary chaos as providers and patients scramble to adjust to a wave of uncertainty in the system.

The justices, who might issue their decision as early as this week, could deliver a staggering political blow to President Barack Obama by striking down the 2010 law, the signature achievement of the presidents first term, designed to extend health care to millions of Americans without insurance.

The court also could stun conservative Republicans by giving their seal of approval to the law. Republicans in Congress joined by GOP state attorneys general objected that it unconstitutionally forced individuals to buy health insurance.

A growing number of analysts, however, suggest that five of the justices will cobble together a fractured series of opinions that could leave parts of the law intact while striking down other sections. Such a ruling could create confusion for hospitals, physicians and patients.

I think hospitals want clear direction either way, not just in the Supreme Court decision, but in all areas of public policy, said Jonathan Archey, a lobbyist for the Ohio Hospital Association. Whatever the Supreme Court does, were still going to have the issues that the (law) was designed to deal with.

The courts key votes belong to Justice Anthony Kennedy and, to a lesser extent, Chief Justice John Roberts. With the courts four liberal justices likely to uphold the law and conservative justices Antonin Scalia, Samuel Alito and Clarence Thomas seemingly hostile to it, Kennedy may emerge as he usually does the pivotal vote.

Hes always subject to the next mornings barometer readings, said Thomas Miller, a resident fellow and health analyst at the Washington-based American Enterprise Institute. But based on the way oral arguments unfolded, the best reading is that hes a vote against the individual mandate, but not a vote against striking down the entire structure.

Its hard it to get five votes to throw everything out the door because of (the courts) nervousness about being something that sweeping, Miller continued.

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Health-care prognosis: cloudy

Future Of Health Care Law Hangs In Balance

The Supreme Court may issue a ruling on the constitutionality of the Affordable Care Act as early as Monday. Guy Raz talks to NPR Health Policy Correspondent Julie Rovner about what will happen next if the court rules against the law. In Oregon, Rocky King, the state's health insurance exchange director, says the imminent decision keeps him up at night and historian Jeff Shesol explains why ...

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Future Of Health Care Law Hangs In Balance

Undoing health law could have messy ripple effects

By RICARDO ALONSO-ZALDIVAR Associated Press

WASHINGTON (AP) - It sounds like a silver lining. Even if the Supreme Court overturns President Barack Obama's health care law, employers can keep offering popular coverage for the young adult children of their workers.

But here's the catch: The parents' taxes would go up.

That's only one of the messy potential ripple effects when the Supreme Court delivers its verdict on the Affordable Care Act this month. The law affects most major components of the U.S. health care system in its effort to extend coverage to millions of uninsured people.

Because the legislation is so complicated, an orderly unwinding would prove difficult if it were overturned entirely or in part.

Better Medicare prescription benefits, currently saving hundreds of dollars for older people with high drug costs, would be suspended. Ditto for preventive care with no co-payments, now available to retirees and working families alike.

Partially overturning the law could leave hospitals, insurers and other service providers on the hook for tax increases and spending cuts without the law's promise of more paying customers to offset losses.

If the law is upheld, other kinds of complications could result.

The nation is so divided that states led by Republicans are largely unprepared to carry out critical requirements such as creating insurance markets. Things may not settle down.

"At the end of the day, I don't think any of the major players in the health insurance industry or the provider community really wants to see the whole thing overturned," said Christine Ferguson, a health policy expert who was commissioner of public health in Massachusetts when Mitt Romney was governor.

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Undoing health law could have messy ripple effects

Health Reform Weighed; Lawmakers Speak On Controversy

WHEELING - The strength and fitness of a new health care reform law in America is on the examining table this month as the U.S. Supreme Court reviews its overall constitutionality.

On March 23, 2010, President Barack Obama signed the Patient Protection and Affordable Care Act into law. The measure mandates comprehensive health insurance reforms that roll out through the end of 2014.

The high court is expected to rule on its constitutionality later this month. At issue is one provision of the new law requiring all Americans to obtain health insurance - or face a penalty. The provision goes into effect at the start of 2014.

The court's ruling should result in one of three scenarios, according to Jim Forbes, spokesman for Rep. David McKinley, R-W.Va.

First, the court could rule the entire bill unconstitutional. Second, the court could deem only the "insurance mandate" clause illegal, and keep the rest as it is. Lastly, justices could rule the entire measure is constitutional.

The law in its current form would decrease the federal deficit by $210 billion by 2021, according to figures compiled by the nonpartisan Congressional Budget Office. The new system is expected to cost $604 billion over the next decade, while also generating $813 billion in additional revenues attributed to new taxes and fees, according to the CBO.

And health care reform already is providing very real benefits to West Virginians, according to Sen. Jay Rockefeller, D-W.Va.

"In the last year alone, seniors have saved about $23 million on their prescription drug costs and 4,200 small businesses got a 75 percent discount on their premiums last December as a direct result of health reform," he said. "Consumers are better protected, seniors have more support and there are new tools to put the brakes on runaway health spending. Yes, controlling our spending is important, but we cannot shift that burden onto seniors and low-income West Virginians."

Sen. Rob Portman, R-Ohio, believes medical malpractice reform should be part of any health care system overhaul.

"Such common-sense reform would lessen the wasteful practice of defensive medicine, save the federal government billions of dollars and reduce health care costs passed on to employers," he noted.

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Health Reform Weighed; Lawmakers Speak On Controversy

Local health care plan awaits high court ruling

By MARYSHEDDEN | The Tampa Tribune

Published: June 10, 2012

TAMPA - Revamping of a Hillsborough County health plan for poor people remains in limbo as local leaders wait for a U.S. Supreme Court decision on national health care reform.

More than 13,000 Hillsborough residents participate in the 20-year-old health insurance of last resort. But those numbers likely will rise or fall once the high court decides whether President Barack Obama's Affordable Care Act is constitutional.

For months, the Hillsborough County Health Care Plan Advisory Board has hesitated in making changes to the local plan, with meetings focusing on a lot of "what ifs" about who qualifies for its primary care, specialists, out-patient treatment and prescription coverage.

Once the national debate about "Obamacare" is clarified, local leaders say, they will know how many people will need help from the local plan. To prepare, the advisory board already has identified which aspects of the plan it needs to evaluate for cost effectiveness and impact.

"We'll be ready for either pass or fail," said county Department of Family and Aging Services Director Gene Earley, who serves as the staff administrator for the advisory board.

The urgency to streamline and improve health services for residents was behind last week's request by Hillsborough County Commissioner Sandy Murman to re-evaluate the local plan. Murman said she didn't know the advisory board was making plans to do the same.

She pulled the request after speaking with Earley.

"This is the best time to be doing this and be ahead of the curve," Murman said.

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Local health care plan awaits high court ruling

Paulsboro resident leads health care mission to Haiti

On June 18, Paulsboro resident Sharon Byrne will embark on a health outreach mission to Haiti with her family nurse practitioner students from Drexel University.

Im the track director for the family nurse practitioner program at Drexel in addition to my clinical practice at Cooper University Hospital in Camden, said Byrne. Theres been a major push for our students to get involved in the community and do health outreach, and I was approached by someone in the Philadelphia-based organization Explorers Sans Frontieres. Basically, theyre a very reputable non-profit organization that has been doing outreach for a number of years in Haiti, Senegal and more. Theyve done 18 missions to Haiti thus far.

Byrne said she was approved by Drexels international studies office for the experience for her students in their final semester.

This is our first outreach program for the masters nursing department, she said. We will be there for five days running a one-day well child clinic at a school near Port-au-Prince, coordinating a full-day womens health clinic and spending three days in Port-au-Prince addressing chronic and acute health care needs of anyone from infant to older adult.

Five nurse practitioner students will accompany Byrne, as well as Drexels director of international studies, a representative from ESF and several other medical professionals and volunteers. The group has received donations from pharmacies and medical supply companies for the mission.

Basically, Haiti is still very lacking in routine health care, and thats one of the major things we want to address, she said. Many of their health needs revolve around issues that we also face here like diabetes, hypertension and high cholesterol. A lot of what well be doing is addressing those needs and doing preventative health education with patients and some of the providers there.

Byrne said she and her students are looking forward to the trip because they feel there are still a lot of under-served people in Haiti who have health needs that have not been recognized since the earthquake.

The students are not only getting some clinical practice, but theyre getting the chance to go on a humanitarian type of mission, said Byrne. Just to work with people from other cultures and learn sensitivity is a great opportunity. They can become liaisons for health care and the United States. We hope to let people in Haiti know that we are still genuinely interested in their health and well-being.

Contact reporter Jessica Driscoll at jdriscoll@southjerseymedia.com.

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Paulsboro resident leads health care mission to Haiti

Health care divides U.S. House candidates Gill, Davis

Both candidates for the U.S. House in the 13th Congressional District have faced the fear associated with having a spouse with cancer. But they still have radically different views on how the nation should mold healthcare policy.

David Gill, an emergency room physician from Bloomington, the Democratic candidate, lost his first wife of nearly 20 years Polly -- to cancer in 2007.

Rodney Davis of Taylorville, the Republican candidate, is thankful that surgery following discovery of colon cancer in his wife, Shannon, in 1999, has left her cancer-free.

The new 13th includes part of Springfield. Davis was recently appointed to replace U.S. Rep. Tim Johnson, R-Urbana, who won the primary, but dropped out of the Nov. 6 election.

Davis and Gill both have mentioned their families when discussing health care during the campaign.

With the extensive bureaucracy of Obamacare, Im not too sure wed have that same result today, Davis told Sangamon County Republicans when he appeared before committeemen last month.

He thinks the health care plan signed into law by President Barack Obama, officially the Patient Protection and Affordable Care Act, should be replaced with what Davis calls a market-based healthcare safety net. Included would be greater use of government-backed clinics to avoid the high cost of emergency rooms for minor ailments.

Gill advocates a national healthcare system he calls improved Medicare for all, which would cut insurance companies out of the health-care process. Gill has been a member of Physicians for National Health Care since long before Polly became ill.

Her illness didnt impact where Im at on the issue, Gill said in an interview. That said, she was another example of the types of difficulties that Americans face because of the way we finance our health care here.

Gill and his daughter Tally, 19, who just finished her freshman year at the University of Illinois, appeared in a campaign video about Polly and her illness.

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Health care divides U.S. House candidates Gill, Davis

‘Labours of love’ for health care groups

The Donors: Lorne Swartz and friends

The Gift: $5-million and climbing

The Cause: Various health care groups

A few years ago, Lorne Swartz and some friends started talking about philanthropy and how to teach their young children the importance of giving.

We wanted to show them that the easiest thing in life is to write a cheque, the hardest thing is to actually donate your time and do something for somebody, said Mr. Swartz, president of Scout Logistics Corp., a Toronto-based transportation company.

The group organized a giant charity ball-hockey tournament and other sporting events. They raised about $1-million and donated the proceeds to the Canadian Cancer Society. They eventually created a charitable foundation to formalize the effort and launch an even more ambitious fundraiser a massive party at Mr. Swartzs home in Torontos exclusive Bridle Path neighbourhood.

Dubbed the Bridle Bash, the party attracts more than 1,000 guests and has featured performers such as Burton Cummings. Everything is donated and all the money raised, as much as $600,000 per event, goes toward various health care projects. The party is held every two years (there have been four so far) and Mr. Swartz and the foundation, called the Bridle Bash Foundation, are in the process of organizing the next one.

The group still holds a softball tournament and is developing a cook book with proceeds from sales going to the Make-A-Wish Foundation. So far the Bridle Bash charity has raised about $5-million in total and has supported projects at more than 20 not-for-profit organizations. We look for charities that need the money and are going to use the money right away, Mr. Swartz said.

The entire effort is driven by close friends who have stayed together for years, he note. Were a group of friends, about 40 of us, who grew up together and are actually still friends, he said with a laugh. The foundation, is one of those labours of love.

pwaldie@globeandmail.com

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‘Labours of love’ for health care groups

Canada's Quebec sues tobacco giants for $60bn

The Canadian province of Quebec has announced that it is suing tobacco giants for more than $60 billionin a bid to recover health care costs associated with smoking-related illnesses.

The lawsuit targets the Canadian tobacco companies and their parent companies abroad and seeks damages related to the cost of treating patients from the 1970s until 2030, Quebec Justice Minister Jean-Marc Fourner said.

"These manufacturers neglected to warn consumers, including children and teenagers, about the harmful aspects of their products," Fournier said on Friday, blasting the tobacco industry for targeting young people in advertisement campaigns.

Big Tobacco had anticipated the filing, with Donald McCarty, Imperial Tobacco Canada's vice president of law, immediately condemning the move as a "cash grab" by the provincial government.

McCarty said the Quebec administration was "looking to score political points while conveniently forgetting that it has been a senior partner in the tobacco industry for decades.

"Governments have licensed us, have taxed us and our consumers, and have regulated us, all in full knowledge of the risks associated with tobacco use," he said.

Ontario, British Columbia, New Brunswick and Newfoundland have already launched similar lawsuits but Quebec's, for more than 60bn Canadian dollars ($58bn), is by far the biggest so far.

Nova Scotia, Prince Edward Island, Saskatchewan and Manitoba are to file suits shortly, and Alberta has indicated it will also seek damages.

'Burden on health system'

The Canadian Cancer Society said hefty settlements granted to state governments that have sued tobacco giants in the US convinced Canadian provinces to go after the industry.

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Canada's Quebec sues tobacco giants for $60bn

Obama Aides Helped Plan Ads to Back Health Bill, GOP Says

By Drew Armstrong - 2012-06-09T04:00:00Z

House Republicans say a drugmaker- funded advertising campaign run by supposedly independent groups was part of an agreement with the Obama administration to help pass the U.S. health-care law in 2010.

Republicans are using e-mails and memos to agitate against the overhaul ahead of a U.S. Supreme Court decision on the laws constitutionality, due later this month. The correspondence involved White House aides, drugmaker lobbyists and Democratic strategists as they built support for the law.

The documents, released on May 31 and yesterday, suggest presidential aides helped plan a $150 million advertising campaign paid for by the drug industry. The advertisers were seemingly independent groups created by the lobbyists in consultation with strategists linked to the administration, the memos suggest. The organizations were called Healthy Economy Now and Americans for Stable Quality Care.

The memos show that the White House traded billions of dollars in policy concessions to PhRMA for millions of dollars worth of advertising, said House Speaker John Boehner, a Republican from Ohio. PhRMA is the Pharmaceutical Research and Manufacturers of America, the industrys Washington lobby group.

The accusations are baseless and politically driven, wrote Eric Schultz, a White House spokesman, in an e- mail. Republicans, who previously admitted this is not serious and merely a partisan effort to distract the Presidents re- election campaign, are now attempting to recycle an old story that was well covered during the original debate.

The drug industry agreed to $80 billion to $125 billion in taxes, discounts and other concessions to help fund the health laws programs during the run-up to approval in March 2010. They avoided potentially harmful policies, including one that would have allowed importation of cheaper brand-name drugs, an issue PhRMA lobbyists discussed at length with the Administration, according to the memos released last month.

At a news conference yesterday in Washington, Boehner called the groups created by the lobbyists to run the ad campaign a Super PAC paid for by PhRMA, and run by Jim Messina out of the West Wing of the White House.

This is wrong and the administration must be held accountable for their actions, Boehner said.

At the time of the e-mails, Messina was an aide to then- White House Chief of Staff Rahm Emanuel. He now manages Obamas re-election campaign. The health-care law was passed without a single Republican vote.

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Obama Aides Helped Plan Ads to Back Health Bill, GOP Says