One year ago today, President Obama signed the Patient Protection and Affordable Care Act (PPACA), the great federal restructuring of U.S. health care. The law’s value in protecting patients is suspect, and it’s doing little to make health care affordable. So, after a year of implementation what has been the real effect?

PPACA: Neither Protective, Nor Affordable

We know that the promise of being able to keep our health plan if we like it was an empty one, and even the Administration’s own actuary admits this fact. When asked during a hearing in the House Budget Committee whether the health care law really allows people to keep the plans they like, Rick Foster stated that claim was “not true in all cases.”

We also know the bulk of the funding for the new entitlement program is based on fuzzy math at best and outright deception at worst. In a stunning admission before the House Energy and Commerce Committee, the Secretary of Health and Human Services admitted the Administration is counting reductions in Medicare spending as a credit to extending the solvency of the program while also using the same funds to “pay for” a large portion of the expected costs of PPACA. This double-counting allowed the Administration to claim the legislation would save the nation more than $100 billion over the next 10 years — a statement with as much veracity as the promise our health plans wouldn’t change.

As the law enters its second year of implementation, the National Association of Manufacturers will be watching several issues sure to emerge in 2011: the essential benefits package and accountable care organizations (ACO). The essential benefits package defines for all Americans what coverage must purchase in order to avoid penalties under the law. It’s easy to predict how this will turn out: All single men will have to buy a plan that covers pre-natal and post-natal care and all single women will have to have a policy that covers prostate cancer. This is not to say these aren’t important things to cover, but the inequity is clear.

What’s also clear is how the process of determining what is an essential benefit will be manipulated by well-meaning interest groups that will gauge their importance and influence on policymakers based on whether their particular disease category is included as an essential benefit. Special-interest coverage is hardly a strategy for controlling health care costs.

While accountable care organizations (ACOs) seem to be an attractive idea in some health care policy circles, there are some (this author included) who believe the consolidation and integration of hospitals and physician practices could do irreparable harm to competition in the marketplace. ACOs may work fine in a single-payer system like Medicare, but it could wreak havoc on negotiations for payment rates and the establishment of networks in a private market which depends on competition in order to arrive at a mutually agreed upon price for services. In small to medium-sized communities, this consolidation could lead to oligopolies or monopolies in health care services. Such an outcome would raise prices and make care less affordable.

Many proponents believed, and continue to believe, Americans will warm to the law once they see all the great things and reap all the rewards of the centralized command-and-control this law will bestow upon us. The results so far leave us cold. (continue reading…)

U.S. District Court Judge Roger Vinson of the Northern District of Florida has struck down the entire Patient Protection and Affordable Care Act as unconstitutional. In his ruling, available here, Judge Vinson held that the Commerce Clause does not give Congress the authority to regulate “inactivity,” the authority claimed to apply the individual mandate.

His ruling does not suspend implementation of the law, however.

This is the suit brought by the states — originally 20, now up to 26 — and the National Federal of Independent Business. The NFIB issued a release, “Judge Rules Healthcare Law Unconstitutional: NFIB, 26 states prevail in lawsuit against federal healthcare law“:

Washington, D.C., January 31, 2011—In a highly anticipated decision in the lawsuit brought by the National Federation of Independent Business and 26 states, federal district Judge Roger Vinson ruled today that the individual mandate in the healthcare law is unconstitutional and that this provision can not be severed from the rest of the healthcare law.

“NFIB is extremely pleased with Judge Vinson’s decision,” said Karen Harned, executive director, NFIB Small Business Legal Center. “NFIB joined this case to protect the rights of small-business owners to own, operate and grow their businesses free from unnecessary government intervention. The individual mandate, which forces citizens to purchase government approved health insurance, undermines this core principle and gives the federal government entirely too much power. We are delighted Judge Vinson agreed with NFIB and the states on this critical issue.”

Media coverage immediately jumped to the political implications of the decision, but the judge’s ruling warrants close reading before the specularama takes over. John O’Brien at the Chamber-backed Legal Newsline does so in his report, “Judge strikes down ObamaCare in ‘difficult decision’.” He cites key passages in which Judge Vinson explains why he struck down the entire law and not just the individual mandate.

Because the mandate is too integral a part to be separated, Vinson voided the entire legislation. He called it “a difficult decision to reach.”

“If Congress intends to implement health care reform — and there would appear to be widespread agreement across the political spectrum that reform is needed — it should do a comprehensive examination of the Act and make a legislative determination as to which of its hundreds of provisions and sections will work as intended without the individual mandate, and which will not,” he added. (continue reading…)