WASHINGTON REPORT for The Physicians Foundation

The Physicians Foundation seeks to advance the work of practicing physicians and to improve the quality of healthcare for all Americans.

Mission statement, the Physicians Foundation

January 28, 2012 - The ensuing report, compiled and written by Lee Stillwell, an Inside-the-Beltway consultant for the Physician Foundation, a non-profit organization representing over 500,000 physicians in state medical societies, tells physicians what to expect in 2012 – from now until the Supreme Court decision in June and November 6 election. Stillwell predicts political sniping, gridlock,and an agreement to disagree.

“It may have been a short and subtle message, but President Obama made it perfectly clear in his Tuesday State of the Union speech to Congress that he intends to protect his 2010 health care law now under attack in the courts and before Congress.

Obama limited direct mention of his historic legislation to a few sentences:

-- “I will not go back to the days when health insurance companies had unchecked power to cancel your policy, deny your coverage, or charge women differently than men…”

--“I’m a Democrat. But I believe what Republican Abraham Lincoln believed: That government should do for people only what they cannot do better by themselves, and no more. That’s why our health care law relies on a reformed private market, not government program.”

The message-- that the President had drawn a line in the sand about repeal of Obamacare-- was clear, but it already has been dismissed by the Republican Congress and the representatives of a host of states that are challenging the health care law right now before the U.S. Supreme Court.

And, all eyes now are looking forward to March when the court will hear oral arguments; and then to June, when a landmark ruling is expected before summer adjournment.

Surprisingly, the justices agreed to hear five-an-a-half hours of arguments from lawyers—the court normally limits time to no more than three hours.

The central provision to be considered is an individual mandate requiring Americans to buy health insurance by 2014, or pay a penalty. In addition to deciding if the mandate is Constitutional, the court also will consider if the rest of the law can take effect without that provision.

Expansion of the joint federal-state Medicaid program will be reviewed by the court with the states claiming the new law goes too far in forcing them into participation with a threat of a cutoff of federal dollars.

Lastly, the justices will decide whether a decision is premature because a federal law generally prohibits challenges to taxes until taxes are paid.

Earlier this month the Obama Administration submitted its first brief on the merits of the individual mandate, arguing it is an acceptable use of Congress’s taxing power and defends the policy under the Constitution’s Commerce Clause. Although the same tax argument presented by the Administration has failed in the lower courts, Justice Department officials say they still believe in it.

Meanwhile, GOP legislators already are moving to replace the law in June, according to Rep. Joe Pitts(R-Pa.), chairman of the House Energy and Commerce health subcommittee.

'We’ll have a window of opportunity to—with everyone looking—to explain that the Affordable Care Act is not fully implemented yet,' Pits said. 'A lot of people think it is. So we’ll use that opportunity in that window to discuss the full ramifications of the Affordable Care Act and what we’ll replace it with.'

Speculation about what will be included in such a package are malpractice reform, a tax break on health insurance to the employee instead of employer, creating high-risk insurance pools for people with pre-existing conditions, and allowing insurers to sell their products across state lines.

Pitts said the 'timing' for such a package is 'above his pay grade,' meaning leadership will make the call.

Speaking of leadership, Speaker of the House Rep. John Boehner(R-Ohio) told his GOP legislators in a close-door retreat in Baltimore last weekend that this year should be a referendum on the president’s policies, according to sources. The strategy for the House Republicans in the 2012 election year appears to be a minimalist agenda that is designed to be a referendum on Obama.

Consequently, it is no political surprise that Boehner said Sunday that the GOP may withhold support for the payroll tax legislation to force President Obama to approve the Keystone pipeline project just rejected by the Administration.

The GOP’s intention to be tough in negotiations with the payroll tax bill was obvious Tuesday at the first meeting of a bipartisan House-Senate Conference Committee tasked with finding $160 billion in revenue to pay for the one-year extension of the payroll tax, unemployment benefits and a provision that would prevent a 27.4 percent pay cut in Medicare fees for physicians.

Negotiators are far apart and many are skeptical that a deal can be reached before the end of February when the current two-month extension expires.

Now, the GOP-controlled House Rules Committee is moving much faster to cripple a provision in the health care law—repeal of the CLASS Act, a program designed in the law to handle long-term care. Administration officials put the program on hold because staff has not found a way to make it solvent. The committee voted to send legislation to officially repeal the CLASS Act to the floor for a vote next week. The bill is expected to pass the House but fall short in the Democratic-controlled Senate.

Four powerful Republican members of the House Ways and Means Committee also publicly poked the White House with a letter demanding hundreds of pages of memos, including those involving the White House Office of Health Reform and how it made decisions on health care legislation. The four Congressman included Fred Upton (Mich.), chairman; Cliff Stearns(Fla.), chairman, subcommittee on oversight and investigations; and health subcommittee chairman Pitts along with his vice chair, Michael Burgess(Tex.). The legislators seem serious about getting all of these documents, which were given to a reporter for a magazine article, and you can expect the political rhetoric to heat up.

Even the Administration’s decision to release the 2013 budget a week late-Feb. 13 instead of Feb. 6—is drawing incoming political flak from the GOP, who are loudly pointing out to media that President Obama’s budget has been late three of four years.

Expect little legislative or regulatory success this year and a great deal of heated political rhetoric tied to that Nov. 6 Presidential and Congressional election.”

Tweet: In State of Union. President Obama said there was no retreat on health law, and that it relied on private reform not government takeover.