Coverage

There is no question that major changes will have to be made to the U.S. budget in coming years. Surpluses are never expected to return, the debt is projected to climb to unprecedented levels, and major programs are significantly underfunded, leaving participants uncertain about what benefits they will receive in the future.

According to the latest data from the U.S. Census Bureau's annual report on income, poverty and health insurance, the number of people without health insurance increased to 16.7 percent in 2009, up from 15.4 percent in 2008 -- the first time the number of people with health insurance dropped since record-keeping began in 1987.

“The numbers show us that one in six Americans don’t have health care, and that number is largely due to people losing their jobs,” explained the New America Foundation’s Health Policy Program Director, Kavita Patel, in an interview with WTOP. “What health reform will do, although it will take a couple of more years to see some of these changes, is give people some options to buy insurance that is affordable.”

“I know that talk of repeal is something that sounds very interesting as a campaign slogan or a sound bite,” Dr. Patel continued, “but that is not really going to solve the problem. The irony of all of this is that the same things that are distressing us with these numbers that came out today are the very things that we passed health reform to solve.”

Listen to the full interview here.

The latest edition of the Health Wonk Review is up over at the Colorado Health Insurance Insider, hosted by Louise Norris. We've got a pretty straightforward theme this round -- health care costs, politics, and the economics of health care were the themes of the day. Be sure to check out all the great posts, including our own Shannon Brownlee's discussion of Don Berwick and the debate over alternative medicine.

The Great Recession has exposed numerous flaws in our social contract – weaknesses that existed prior to the economic downturn – highlighting the need for changes in our system. This series of policy briefs explores the stresses on our social contract, and the policy changes that must be made to mend it. The six-part series includes:

• Overview: The Great Recession exposes flaws in the American Social Contract.

Medicaid has always been plagued by inequities and inefficiencies due to its dual federal-state character, which diffuses accountability, and because some state governments simply don’t care much about the poor.

New numbers on United States health care spending came out today from the CMS Office of the Actuary. The new estimates are updated to reflect the new health care reform law and a couple other relevant pieces of legislation. The full report, National Health Spending Projections: The Estimated Impact Of Reform Through 2019, is available from Health Affairs (subscription required).

The report has critics of the PPACA on the offensive and proponents of the law on the defensive, but ultimately, the projections aren’t that shocking. The CMS Actuaries predict that national health spending will be 0.2 percent higher and the share of health spending as a percent of GDP will be 0.3 percent higher by 2019 than they predicted in their February report.

“In the aggregate,” Andrea M. Sisko, a CMS economist and the principal author of the report, told the New York Times, “it appears that the new law will have a moderate effect on health spending growth rates and the health care share of the economy.”

This continues our series of posts on the various constitutional challenges to the individual mandate, by Tony Cardona, an attorney who is doing some work with New America's health policy program. Read his post about federal authority and taxation here.

“The Congress shall have Power . . . To make all Laws which shall be necessary and proper for carrying into Execution the foregoing Powers, and all other Powers vested by this Constitution . . .” (U.S. Const., Art. 1, sec. 8, cl. 18)

In their required Contracts courses, first year law students learn “the four corners rule.” It simply means that the language inside the four corners of the contracted document will be the primary source for resolving a dispute. When our Founding Fathers drafted the Constitution, they created a contract with every generation of Americans. The Supreme Court, the interpreters of this contract, look within the four corners of the Constitution to decides whether a federal law -- such as the individual mandate to purchase health insurance -- exceeds the contract’s scope.  A federal action -- such as regulating the health insurance market -- doesn’t have to be mentioned specifically in the Constitution, but it does have to relate to a power enumerated in the Constitution.

Re-posted with clarification about employer-sponsored coverage.

Yes, it is that time of the year, Back To School. Along with the endless flyers announcing sales on packets of pens and pencils is a great deal of confusion around provisions in the health reform law that allow parents to keep their adult children on their health insurance plan, or dependent coverage as it is better known in the policy world.

Here is what I hope is a simple way to think about this for all of the parents and dependents out there, along with some unanswered questions that still need to be sorted out:

Although it is August, there is a flurry of activity in Sacramento where the Schwarzenegger administration and state legislators are hard at work implementing federal health care reform. They are struggling -- yet again -- to come to a compromise to end a standoff over the state budget. Nevertheless, policymakers and advocates took the time to pack a hearing room in the Capitol to learn more about the role of scientific evidence in the delivery of health care.

Tony Cardona, a newly minted lawyer with an interest in health policy, is doing some work for us this summer. Here is the next in his series of posts about legal issues surrounding health reform.

One year ago, Julie Barnes, at the time the deputy director of the New America Health Policy Program, posted on this blog that according to a number of legal analysts, “if [the individual mandate] is drafted under the tax and spend powers, no problema.”

It wasn’t. The mandate was drafted under Congress’ power to “regulate activity that is commercial and economic in nature,” (ACA sec 1501(a)(1)) otherwise known as the commerce clause. Still, at the time the bill was signed into law, the government did not think there would be too much of a problema. (Legally, we mean. Obviously it’s been a political challenge all along).