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RICHMOND, Va.—A federal judge ruled Monday that a central plank of the health law violates the Constitution, dealing the biggest setback yet to the Obama administration's signature legislative accomplishment.

In a 42-page ruling, U.S. District Judge Henry E. Hudson said the law's requirement that most Americans carry insurance or pay a penalty "exceeds the constitutional boundaries of congressional power."

The lawsuit, brought by Virginia's attorney general, Republican Ken Cuccinelli, is the first court ruling against the law since President Barack Obama signed it in March. More than 20 federal lawsuits have been filed against the overhaul, and judges in two of those cases ruled in favor of the Obama administration.

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A Swedish man was forced to have his penis amputated after waiting more than a year to learn he had cancer.

The man, who is in his sixties, first visited a local clinic in Blekinge in southern Sweden in September 2009 for treatment of a urinary tract infection, the local Blekinge Läns Tidning (BLT) reported.

When he returned in March 2010 complaining of foreskin irritation, the doctor on duty at the time diagnosed the problem as a simple case of inflammation.

After three weeks passed without the prescribed treatment alleviating the man’s condition, he was instructed to seek further treatment at Blekinge Hospital.

But it took five months before he was able to schedule an appointment at the hospital.

When he finally met with doctors at the hospital, the man was informed he had cancer and his penis would have to be removed.

It remains unclear if the man would have been able to keep his penis had the cancer been detected sooner.

The matter has now been reported to the National Board of Health and Welfare (Socialstyrelsen) under Sweden’s Lex Maria laws, the informal name used to refer to regulations governing the reporting of injuries or incidents in the Swedish health care system.

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June 27, 2010 5:59 AM
Q&A with Stephen Berger
Former head of the Commission on Health Care Facilities in the 21st Century says NY's messy health system primarily needs primary care.
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Stephen Berger, currently chairman of private investment firm Odyssey Investment Partners, headed up the Commission on Health Care Facilities in the 21st Century.
Also See
Can hospitals thrive? NYU Langone offers an answer
Filed Under : 25th Anniversary Issue, George Pataki, Health Care, Hospitals
In his long career, Stephen Berger has held high positions in the financial industry, including posts at firms such as GE Capital, and in the public sector, including a five-year stint as head of the Port Authority of New York & New Jersey. In early 2005, he was drafted by Gov. George Pataki for one of his toughest jobs: heading the Commission on Health Care Facilities in the 21st Century.

In its final report, issued in November 2006, what became known as the Berger commission made a series of sweeping recommendations for “rightsizing” hospitals and nursing homes across the state. It mandated consolidations, closures, conversions and large-scale restructurings in an effort to create a more efficient health care system. In the end, nine institutions were closed and 48 were restructured—in many cases over the objections of health care executives, politicians and community residents.

Today, Mr. Berger says, New York still has too many inpatient beds, and he insists that much work is needed. Mr. Berger, now chairman of private investment firm Odyssey Investment Partners, was recently interviewed by Crain's health care reporter, Barbara Benson.

You have described the commission as only the first step. What's next?
When you look at the problems of health delivery networks in the state, there is a massive amount that can be done. But it has to be done over time, or else there is massive disruption. It will take a decade.

The goal of the commission was to take step one. To move to step two, you have to take on other parts of the system—like reimbursement, personal care and long term care—and begin to think how to fund alternative delivery mechanisms effectively and efficiently.

You have to move money from high-cost institutional providers to low-cost models, like clinics and primary care, so that every hospital isn't doing thoracic surgery to make money.

How does what you describe as a “totally dysfunctional” state government impact health care?
The commission was created because the system was failing, bankruptcies were taking place, and the market was not distinguishing between essential and nonessential institutions. The commission was a beginning, and was supposed to lay out a way to stay on top of problems.

But that hasn't happened. The politicians' notion was, “Look at all the hospitals [the commission] touched; look at all the things they still want us to do. This is all hot political stuff, and we're not touching it.”

The result is you've got St. Vincent's [the Greenwich Village facility that recently filed for bankruptcy and shut down], and you've got one institution after another in trouble.

It's not just the fault of the politicians. It's also the fault of the hospital associations. The hospitals should have recognized on their own that there would be continued problems, and they should have not played ostrich.

What should be on the state's agenda?
Continue to evaluate and shrink acute care. Really look at all the components of care as a single network, not as silos of care. What the state should be doing is going step by step to shift Medicaid reimbursement to create more primary care, and to take out additional hospital beds. I'm looking to reallocate those dollars to cover more people at far less cost.

We ought to have a long-term program that focuses on reducing costs and making access better. We have to begin to think of quality of care and delivering services to the customer instead of just taking care of all the providers: the hospitals, nursing homes, unions.

The hospital guys are in the hospital silo, and all the rest are in their own silos. [Yet] they look at [the whole pool of] Medicaid funding like this money is theirs. The political system responds to the provider pressure.

In addition, we have to educate people on what is good health care. A hospital on the corner is not necessarily health care. In a city like New York, there should be a balance of clinics, primary care and tertiary care. And we can take advantage of a wonderful invention called the ambulance to take you from place A to place B in six minutes.

What are the impediments to taking that next step?
Politics, unions, hospitals.

How can they be overcome?
This is going to sound terrible, but you need a situation of unavoidable crisis and financial disaster to force the political leadership and the players to do some very tough stuff. The way our government works is, you need chaos out of which you try to create some order. We are not there yet.

You keep talking about more primary care. How can we get it?
You change reimbursement to pay reasonably and pay for quality. You get an electronic medical record system. And then primary care gets hooked into the acute care system. You make that the primary goal of the state. It's a 10-year program, but you've got to do it.

We move toward effective primary care by funding it well and mandating electronic medical records. What [President Barack Obama] should have done in the stimulus package is to say, “Here's the rule: In five years, anyone who does not have an EMR system will no longer be eligible to be paid by Medicaid and Medicare.” They would all be on an EMR in five years.

What are some of the changes we'll see if we emphasize primary care services over hospitals?
In five years, emergency rooms will be less crowded, because people will be going to doctors' offices more. We will have people cared for at home, because frankly, we can monitor their blood pressure every day from a central station. You roll out these changes a piece each year, and 10 years later, you will have a very different health care system.

What reforms are necessary for Medicaid?
One: Restructure reimbursement. It does not make any sense to pay $43,000 for a hip replacement. Are there dollars there that should be flowing elsewhere, like primary care?

Two: Reduce the number of excessive procedures. My hunch says that for a variety of reasons, including people worried about medical malpractice, we have excessive procedures done.

Three: Reform the high cost of medical malpractice premiums, which will stop defensive, expensive medical procedures.

Four: Use EMR and other technology that monitors health data to improve home health care.

And lastly, we refuse to face the issues related to the last 180 days of life. Often the terminally ill are kept alive through major interventions, and the process of dying is prolonged unnecessarily. We are not dealing with the needs of the dying, but the assumptions and needs of the living. That is not fair. It is also wrong morally, and massively expensive.

Is it possible for us to not only slow the growth in health care spending, but reverse it—actually shrink it?
I had a session with hospital trustees in the first year of [Gov. Eliot] Spitzer's administration. They were arguing with Eliot about whether they could cut one-half a percent [from their hospitals' operating budgets].

He asked me, “What do you think?” I know them all; I work with them in business. I told them, “If we were in a recession and you had to cut 5% of your work force and your business to keep the company healthy, you guys would do the cuts in an afternoon and not even think about it.”

Medicaid is a $50 billion program in New York, and we're talking about taking out 2%. Hospitals are businesses, and they have to be willing to change how they run their operations.

Filed Under : 25th Anniversary Issue, George Pataki, Health Care, Hospitals

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House takes symbolic step to repeal health law

By RICARDO ALONSO-ZALDIVAR, The Associated Press
Updated 5:22 PM Friday, January 7, 2011
WASHINGTON — House Republicans cleared a hurdle Friday in their first attempt to scrap President Barack Obama's landmark health care overhaul, yet it was little more than a symbolic swipe at the law.

The real action is in states, where Republicans are using federal courts and governors' offices to lead the assault against Obama's signature domestic achievement, a law aimed at covering nearly all Americans.

In a post-election bow to tea partiers by the new GOP House majority, Republican lawmakers are undertaking an effort to repeal the health care law in full knowledge that the Democratic Senate will stop them from doing so.

Republicans prevailed Friday in a 236-181 procedural vote, largely along party lines, that sets the stage for the House to vote next week on the repeal.

Shortly before the House vote, Republican governors representing 30 states opened up a new line of attack, potentially more successful.

In a letter to Obama and congressional leaders, the governors complained that provisions of the health care law are restricting their ability to control Medicaid spending, raising the threat of devastating cuts to other critical programs, from education to law enforcement in a weak economy. It's ammunition for critics trying to dismantle the overhaul piece by piece.

Moreover, a federal judge in Florida is expected to rule shortly in a lawsuit brought by 20 states that challenges the law's central requirement that most Americans carry health insurance. A judge in Virginia ruled it unconstitutional last month, while in courts in two other cases have upheld it. It's expected that the Supreme Court will ultimately have to resolve the issue.

Obama made history last year when Congress finally passed the law after months of contentious debate, closing in on a goal that Democrats had pursued for generations. Republicans say they changed history by taking back the House in the midterm elections, partly on the strength of their pledge to tea party supporters and other conservatives to undo the divisive law, whose final costs and consequences remain largely unknown.

Some Republicans hope to get enough momentum going to force Obama and the Democrats into an early capitulation. "If you have to do an amputation, get it over with," Rep. Steve King, R-Iowa, a repeal leader, said after the House vote. "We need to get this showdown over so we can go on to other issues."

But Senate Democrats say what King and other House Republicans think matters little, since they will block any repeal legislation on the other side of the Capitol.

During last year's election campaign, many Democrats sought cover when the health care law would come up. On the House floor, they unleashed a full-throated defense, accusing Republicans of trying to take away benefits that many people are already receiving, such as lower prescription costs for Medicare recipients, extended coverage for young adults on their parents' plan and newly available insurance for people with serious medical problems.

"Repeal this bill, and you're going to find more Americans dying," said Rep. John Garamendi, D-Calif. Obama's grassroots political operation, Organizing for America, sent out an e-mail requesting donations for a campaign against repeal.

The overhaul would provide coverage to more than 30 million now uninsured, expanding Medicaid to pick up more low-income Americans and offering tax credits to help the middle-class. Most Americans would be required to carry health insurance, either through an employer, a government program or by purchasing their own. The legal challenge to that mandate is coming mainly from Republican state attorneys general.

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What are the impediments to taking that next step?
Politics, unions, hospitals.

How can they be overcome?
This is going to sound terrible, but you need a situation of unavoidable crisis and financial disaster to force the political leadership and the players to do some very tough stuff. The way our government works is, you need chaos out of which you try to create some order. We are not there yet.

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Some new taxes coming with Obamacare.  
Flexible Spending Account Cap – aka“Special Needs Kids Tax”($13 bil/Jan 2013): Imposes cap of $2500 (Indexed to inflation after 2013) on FSAs (now unlimited). . There is one group of FSA owners for whom this new cap will be particularly cruel and onerous: parents of special needs children.  There are thousands of families with special needs children in the United States, and many of them use FSAs to pay for special needs education.  Tuition rates at one leading school that teaches special needs children in Washington, D.C. (National Child Research Center) can easily exceed $14,000 per year. Under tax rules, FSA dollars can be used to pay for this type of special needs education.

Elimination of tax deduction for employer-provided retirement Rx drug coverage in coordination with Medicare Part D($4.5 bil/Jan 2013)

Tax on Health Insurers($60.1 bil/Jan 2014): Annual tax on the industry imposed relative to health insurance premiums collected that year. The stipulation phases in gradually until 2018, and is fully-imposed on firms with $50 million in profitsCodification of the “economic substance doctrine”(Tax hike of $4.5 billion).  This provision allows the IRS to disallow completely-legal tax deductions and other legal tax-minimizing plans just because the IRS deems that the action lacks “substance” and is merely intended to reduce taxes owed.
Read more: http://www.atr.org/comprehensive-list-tax-hikes-obamacare-a5758##ixzz1B2PW1WOG

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Comprehensive List of Tax Hikes in Obamacare
From Ryan Ellis on Friday, January 14, 2011 6:00 AM
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Next week, the U.S. House of Representatives will be voting on an historic repeal of the Obamacare law.  While there are many reasons to oppose this flawed government health insurance law, it is important to remember that Obamacare is also one of the largest tax increases in American history.  Below is a comprehensive list of the two dozen new or higher taxes that pay for Obamcare’s expansion of government spending and interference between doctors and patients.

Individual Mandate Excise Tax(Jan 2014): Starting in 2014, anyone not buying “qualifying” health insurance must pay an income surtax according to the higher of the following


     

1 Adult
     

2 Adults
     

3+ Adults

2014
     

1% AGI/$95
     

1% AGI/$190
     

1% AGI/$285

2015
     

2% AGI/$325
     

2% AGI/$650
     

2% AGI/$975

2016 +
     

2.5% AGI/$695
     

2.5% AGI/$1390
     

2.5% AGI/$2085

Exemptions for religious objectors, undocumented immigrants, prisoners, those earning less than the poverty line, members of Indian tribes, and hardship cases (determined by HHS)

Employer Mandate Tax(Jan 2014):  If an employer does not offer health coverage, and at least one employee qualifies for a health tax credit, the employer must pay an additional non-deductible tax of $2000 for all full-time employees.  This provision applies to all employers with 50 or more employees. If any employee actually receives coverage through the exchange, the penalty on the employer for that employee rises to $3000. If the employer requires a waiting period to enroll in coverage of 30-60 days, there is a $400 tax per employee ($600 if the period is 60 days or longer).

Combined score of individual and employer mandate tax penalty: $65 billion/10 years

Surtax on Investment Income ($123 billion/Jan. 2013):  This increase involves the creation of a new, 3.8 percent surtax on investment income earned in households making at least $250,000 ($200,000 single).  This would result in the following top tax rates on investment income


     

Capital Gains
     

Dividends
     

Other*

2010-2012
     

15%
     

15%
     

35%

2013+ (current law)
     

23.8%
     

43.4%
     

43.4%

2013+ (Obama budget)
     

23.8%
     

23.8%
     

43.4%

*Other unearned income includes (for surtax purposes) gross income from interest, annuities, royalties, net rents, and passive income in partnerships and Subchapter-S corporations.  It does not include municipal bond interest or life insurance proceeds, since those do not add to gross income.  It does not include active trade or business income, fair market value sales of ownership in pass-through entities, or distributions from retirement plans.  The 3.8% surtax does not apply to non-resident aliens.

Excise Tax on Comprehensive Health Insurance Plans($32 bil/Jan 201: Starting in 2018, new 40 percent excise tax on “Cadillac” health insurance plans ($10,200 single/$27,500 family). For early retirees and high-risk professions exists a higher threshold ($11,500 single/$29,450 family).  CPI +1 percentage point indexed.

Hike in Medicare Payroll Tax($86.8 bil/Jan 2013): Current law and changes:


     

First $200,000
($250,000 Married)
Employer/Employee
     

All Remaining Wages
Employer/Employee

Current Law
     

1.45%/1.45%
2.9% self-employed
     

1.45%/1.45%
2.9% self-employed

Obamacare Tax Hike
     

1.45%/1.45%
2.9% self-employed
     

1.45%/2.35%
3.8% self-employed

Medicine Cabinet Tax($5 bil/Jan 2011): Americans no longer able to use health savings account (HSA), flexible spending account (FSA), or health reimbursement (HRA) pre-tax dollars to purchase non-prescription, over-the-counter medicines (except insulin)

HSA Withdrawal Tax Hike($1.4 bil/Jan 2011): Increases additional tax on non-medical early withdrawals from an HSA from 10 to 20 percent, disadvantaging them relative to IRAs and other tax-advantaged accounts, which remain at 10 percent.

Flexible Spending Account Cap – aka“Special Needs Kids Tax”($13 bil/Jan 2013): Imposes cap of $2500 (Indexed to inflation after 2013) on FSAs (now unlimited). . There is one group of FSA owners for whom this new cap will be particularly cruel and onerous: parents of special needs children.  There are thousands of families with special needs children in the United States, and many of them use FSAs to pay for special needs education.  Tuition rates at one leading school that teaches special needs children in Washington, D.C. (National Child Research Center) can easily exceed $14,000 per year. Under tax rules, FSA dollars can be used to pay for this type of special needs education.

Tax on Medical Device Manufacturers($20 bil/Jan 2013): Medical device manufacturers employ 360,000 people in 6000 plants across the country. This law imposes a new 2.3% excise tax.  Exemptions include items retailing for less than $100.

Raise "Haircut" for Medical Itemized Deduction from 7.5% to 10% of AGI($15.2 bil/Jan 2013): Currently, those facing high medical expenses are allowed a deduction for medical expenses to the extent that those expenses exceed 7.5 percent of adjusted gross income (AGI).  The new provision imposes a threshold of 10 percent of AGI; it is waived for 65+ taxpayers in 2013-2016 only.

Tax on Indoor Tanning Services($2.7 billion/July 1, 2010): New 10 percent excise tax on Americans using indoor tanning salons

Elimination of tax deduction for employer-provided retirement Rx drug coverage in coordination with Medicare Part D($4.5 bil/Jan 2013)

Blue Cross/Blue Shield Tax Hike($0.4 bil/Jan 2010): The special tax deduction in current law for Blue Cross/Blue Shield companies would only be allowed if 85 percent or more of premium revenues are spent on clinical services

Excise Tax on Charitable Hospitals(Min$/immediate): $50,000 per hospital if they fail to meet new "community health assessment needs," "financial assistance," and "billing and collection" rules set by HHS

Tax on Innovator Drug Companies($22.2 bil/Jan 2010): $2.3 billion annual tax on the industry imposed relative to share of sales made that year.

Tax on Health Insurers($60.1 bil/Jan 2014): Annual tax on the industry imposed relative to health insurance premiums collected that year. The stipulation phases in gradually until 2018, and is fully-imposed on firms with $50 million in profits.

$500,000 Annual Executive Compensation Limit for Health Insurance Executives($0.6 bil/Jan 2013)

Employer Reporting of Insurance on W-2(Min$/Jan 2011): Preamble to taxing health benefits on individual tax returns.

Corporate 1099-MISC Information Reporting($17.1 bil/Jan 2012): Requires businesses to send 1099-MISC information tax forms to corporations (currently limited to individuals), a huge compliance burden for small employers

“Black liquor” tax hike(Tax hike of $23.6 billion).  This is a tax increase on a type of bio-fuel.

Codification of the “economic substance doctrine”(Tax hike of $4.5 billion).  This provision allows the IRS to disallow completely-legal tax deductions and other legal tax-minimizing plans just because the IRS deems that the action lacks “substance” and is merely intended to reduce taxes owed.

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Mon Aug 3, 2009 3:36pm EDT

WASHINGTON (Reuters) - U.S. President Barack Obama will keep his promise not to raise taxes on people making less than $250,000 a year, the White House said Monday, rebutting comments by administration officials that indicated otherwise.

"The president has made a very clear commitment to not raise taxes on middle-class families," White House spokesman Robert Gibbs told a regular briefing.

"Let me be precise. The president's clear commitment is not to raise taxes on those making less than $250,000 a year," he said.

Quoted from senders

that is why Santabarbara pushed to the autism legislation to force healthcare payment to schools.....you dont need FSA account if the
public schools get legislated healthinsurance payments.....interesting? dont you think? how about that commune?