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How Undoing ‘Obamacare’ Would Harm More Than the Health of Americans

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by Simon F. Haeder for The Conversation

The Affordable Care Act remains on life support after a panel of federal judges ruled on Dec. 18, 2019 that the law’s individual mandate requiring people to buy health insurance is unconstitutional.

The decision hobbles the law in ways that are hard to predict politically, particularly in the upcoming election year. It also raises questions for the 20 million people who gained coverage in the marketplaces and all Americans who gained protections through the ACA.

The ACA’s individual mandate is a foundation of the law. Experts argued that the mandate was the only way to bring healthy people into an insurance pool. That is important to allow insurers to spread the costs among a broad mix of people, not just the sick. It served as a crucial bargaining chip for the Obama administration in bringing insurers on board to support health care reform a decade ago.

As a political scientist and policy scholar who has extensively studied the ACA, I am naturally concerned about the immediate and long-term implications of potentially undoing it. More generally, I am troubled that the ruling portends the undoing of policies supported by a broad coalition of Americans.

Obamacare allows young adults to stay on their parents’ insurance until age 26. fizkes/Shutterstock.comr

The far-reaching effects of the ACA

The U.S. health care system is inherently perplexing, as is “Obamacare.” A recent poll suggested that as many as one-third of Americans don’t know that Obamacare and the ACA are the same.

As a result, most major reform efforts that build upon it are necessarily complex. And because of the inherent partisanship of the U.S. electoral system, opposing parties have strong incentives to misrepresent and further add to the confusion. The ACA serves as a case in point.

Most public attention of the ACA has focused on its insurance coverage expansions. Yet, it has done significantly more than expand insurance coverage to millions; all Americans have benefited.

The insurance marketplaces have allowed tens of millions of Americans to buy health insurance. Expansion of the Medicaid program extended coverage to millions of poor adults. The ACA allows children to stay on their parents’ insurance until they are 26.

The ACA filled in the infamous Medicare Part D donut hole that provided hardship to many retirees and improved the long-term fiscal health of the entire Medicare program. It also included protections and support for breastfeeding mothers and added calorie counts to menus to support healthier life choices.

But also, the ACA added crucial protections for virtually every American. These included the ability to obtain insurance despite suffering from pre-existing conditions, coverage for a minimum number of essential benefits and doing away with annual and lifetime coverage limitations.

Mike Hewitt, a contractor in Austin, Texas, said he was grateful for Obamacare because it provided coverage and treatment for injuries he sustained after he fell off a roof. Eric Gay/AP Photo

What does the recent ruling mean?

The most recent lawsuit originated after Congress essentially repealed the penalty associated with individual mandate as part of the 2017 tax overhaul. Congress left intact the requirement that all Americans obtain insurance coverage, but it reduced the penalty for failing to comply with this requirement to zero. That made the requirement unenforceable.

A slew of Republican governors and attorneys general took advantage of this change to argue that this rendered the ACA’s individual mandate unconstitutional because it no longer could be justified as a tax. Many experts agree that this lawsuit, Texas v. United States, should not have advanced through the court system for a variety of reasons.

Nonetheless, a federal court judge agreed with the plaintiffs and declared the individual mandate unconstitutional in December 2018.

He even went a step further, invalidating the ACA in its entirety. He argued that the individual mandate served as the core feature of the ACA, making it inseverable from the rest, in legal terms. That is, if one provision of a statute is found to be unconstitutional, the entire statute must fall.

A large number of ideologically diverse experts disagreed with the verdict and the underlying reasoning. A coalition led by California quickly appealed the verdict to the 5th Circuit Appeals Court.

The 5th Circuit Appeals Court on Dec. 18, 2019 agreed with regard to the unconstitutionality of the individual mandate. The judges punted, however, on the crucial question of severability by tasking the original judge to reexamine what parts of the ACA should fall with it.

While the verdict left the ACA standing for now, it added potentially years of uncertainty. An ultimate showdown at the U.S. Supreme Court appears inevitable.

A new consensus in health care?

The slew of litigation surrounding the ACA tends to obscure an important development. While Democrats and Republicans have been slugging it out over health reform in Washington, D.C. and the courts, most Americans appear to have long moved on. The status quo in health care has shifted dramatically, and Americans, even if they despise Obamacare in the abstract, do not want to go back to 2009.

The numbers are startling. Virtually all crucial provisions of the ACA are supported by two-thirds of Americans. These include the controversial insurance marketplaces, Medicaid expansion, subsidies to assist lower income Americans to purchase insurance, free preventive care, pre-existing condition protections and requiring larger employers to provide insurance to their employees. Importantly, all of these provisions are also supported by close to 60% or more of Republicans.

However, this new consensus has not made it into the hallways of Congress or the White House. Unable to push through a repeal, Republicans have focused on undoing as much as possible of the ACA through a number of executive actions. Yet they have been unable or unwilling to produce a coherent and comprehensive blueprint for the future of the U.S. health care system.

More noteworthy is the series of legal decisions that have followed the ACA through the courts.

Unable to pass their agenda in Congress, extreme conservatives have made the transformation of the American judicial system a hallmark of their strategy to undo the modern American state and go back to the limited government of the pre-New Deal era. They have been remarkably successful in filling America’s courtroom benches with conservative ideologues.

I believe that Americans should be watching these developments. For many, they are out of line with the government and the policies they prefer. The ACA is just one case in point, but the well-being of millions of Americans are in the balance.

Simon F. Haeder is Assistant Professor of Public Policy at Pennsylvania State University.

The Conversation publishes knowledge-based journalism that is responsible, ethical and supported by evidence from academics and researchers in order to inform public debate with facts, clarity and insight into society’s biggest problems.

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Health

County Hospitals Receive 300 iPads for Patients to See Family

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LOS ANGELES – 300 iPads have been donated to Los Angeles County hospitals to facilitate patient-family communication during the COVID-19 pandemic. The gift is through a partnership with the Annenberg Foundation, Brilliant Corners, and the Los Angeles County Center for Strategic Partnerships.

“The engagement of loved ones during hospitalization has been shown to improve clinical outcomes,” said DHS Director, Dr. Christina Ghaly. “Clinical staff identified a role for virtual visiting through technology in order to facilitate this family involvement. The generous donations by the Annenberg Foundation and MobileDemand will help support this critical element of our patients’ care.” 

Due to the COVID-19 pandemic, patient visitation by family and loved ones is limited at facilities in order to prevent exposure and the spread of disease. While there are some exceptions, such as the birth of a child or death of a patient, visitation is not permitted for the vast majority of patients and not allowed at all for COVID-19 patients. 

The donation provides 300 iPads to ensure patients and their families are able to connect, despite restrictions in access to the hospital. A second donation, by MobileDemand, provides rugged, protective healthcare iPad cases to protect against damage and loss. The rugged case also has an adjustable easel attached, providing effortless viewing for patients who are too weak to hold a tablet. Additionally, it frees health care staff from having to hold the device for patients.

“This is a wonderful example of how philanthropic organizations, nonprofits, government, and businesses can collaborate and meet an immediate need in our community,” said Wallis Annenberg, Chairman, President and CEO of the Annenberg Foundation. “Being able to offer an opportunity for comfort and connection to those suffering and to alleviate some of the stress from our frontline caregivers is of utmost importance.”

While social distancing has been successful in flattening the curve of the COVID-19 surge in Los Angeles County, it is anticipated that it will continue for several months. With this gift, physicians and nurses will be able to place an iPad in the room of COVID and other critically-ill patients for the duration of the admission and reduce potential exposure and use of personal protective equipment going in and out of the room. Having a stationary iPad helps relieve medical staff who would otherwise have to hold the phone for a patient or search for the person’s personal phone. It also will allow patients who do not have a personal mobile device to communicate and “visit” with their family.

The Los Angeles County Department of Health Services (DHS) is the second largest municipal health system in the nation. Through its integrated system of 26 health centers and four hospitals – LAC+USC Medical Center, Harbor-UCLA Medical Center, Olive View-UCLA Medical Center, and Rancho Los Amigos National Rehabilitation Center – and expanded network of community partner clinics, DHS annually provides direct care for 600,000 unique patients, employs over 22,000 staff, and has an annual budget of over $6 billion.

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Processions to Cedars Will Salute Healthcare Workers on National Nurses Day

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The coronavirus (COVID-19) outbreak is putting a strain on essential workers such as first responders and healthcare workers who are on the frontlines in the effort to care for coronavirus patients so the City of West Hollywood is setting out to recognize them in a special way on May 6.

National Nurses Day is a day of recognition to celebrate and honor the contributions that nurses have made and continue to make in our communities and throughout the nation. National Nurses Day is celebrated annually on May 6, which marks the beginning of National Nurses Week, a week-long celebration to raise awareness of the value of nursing and educate the public on the role nurses play in meeting the healthcare needs of Americans. National Nurses Week concludes on May 12, the birthday of Florence Nightingale, or as she was more commonly known, “The Lady of the Lamp” and founder of modern nursing.

The West Hollywood Sheriff’s Station of the Los Angeles County Sheriff’s Department is coordinating two motorcades to honor healthcare workers on Wednesday, May 6, 2020, which is nationally recognized as National Nurses Day. The processions will begin at 9:45 a.m. and at 7:15 p.m. on Santa Monica Boulevard at La Cienega Boulevard and the motorcades will head west and then travel southbound on N. San Vicente Boulevard passing multiple medical center locations in West Hollywood en route to a destination outside the emergency room entrance of Cedars-Sinai Medical Center on Gracie Allen Drive. First responders will briefly stop, exit their vehicles and applaud healthcare workers while wearing face coverings and practicing appropriate social distancing.

“Our nurses and healthcare workers are nothing short of heroes,” said City of West Hollywood Mayor Pro Tempore Lindsey P. Horvath. “The coronavirus pandemic has reminded us just how critical their work is to our everyday health and safety. This National Nurses Day means so much more to all of us — the City of West Hollywood and our LA County Sheriff’s West Hollywood Station and LA County Fire Stations; the City of Beverly Hills and Beverly Hills Police and Fire; the City of Los Angeles and LAPD and LAFD; the California Highway Patrol, and more — and we will honor these heroes in a special way for the care that they provide, which often goes unseen and unrecognized, in carrying us through this crisis.”

“As the worldwide response to the novel coronavirus (COVID-19) continues, the critical importance of nurses in our society has been brought sharply into focus,” said City of West Hollywood Councilmember John Heilman. “More often than not, when a coronavirus patient ends up in a hospital, it is the nurses at the frontlines who are responsible for their care and treatment, putting themselves at risk in the process. We can’t say ‘thank you’ strongly enough.”

The City of West Hollywood encourages residents and community members to participate during this day of celebration while still adhering to LA County Safer At Home Orders and social distancing requirements. Suggested forms of participation include amplifying posts on social media channels, making yard or window signs and banners, participating in a coordinated daily applause or shout out for nurses and healthcare workers, and donating to organizations that are addressing the emerging needs of nurses and healthcare workers during the coronavirus (COVID-19) health pandemic.

According to the American Nursing Association, nursing is the nation’s largest healthcare profession, with more than four million registered nurses in the United States. Registered nurses comprise one of the largest segments of the U.S. workforce and are the primary providers of hospital patient care, delivering most of the nation’s long-term care. In nursing, where workers are on the front lines of patient interactions, women make up more than 85 percent of the workforce. This year, with the onset of coronavirus, nurses have stepped up and shown the incredible impact they have on our healthcare system. It is more important than ever that we recognize National Nurses Day and celebrate the significance of nurses every day.

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Texas & California Wet Markets Show Full Extent of Vile Conditions

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Texas & California Wet Markets Show Full Extent of Vile Conditions

(TMZ) — It’s becoming more clear by the day that wet markets are NOT just a China problem — it’s an American problem too … just take a look at these latest clips from Texas and California.

TMZ has gotten a hold of even more graphic videos of two different live animal shops in TX and CA — where people pick out the animal, have it slaughtered on the spot and then sold to them right then and there — and you see the mixed-in livestock runs the gamut.

There are pigs in pens, goats and sheep hoarded together … and, of course, as we’ve seen in New York and elsewhere — chicken and rabbits cooped up in cages — all in the same area within earshot of each other, and all getting butchered.

Ya got pigs hanging from hooks out in the open, chicken beaks, feathers and guts all over the floor and in an exposed trash can — this while customers (including kids) come in and browse the freezer for whatever cuts of meat they want. It’s downright dirty and gross.

As we’ve been told by the experts, these one-stop-shop slaughterhouses/storefronts can be breeding grounds for disease — including new viruses, like COVID-19, which supposedly got started at a wet market in China.

We already know of lawmakers in Cali and New York working to get these things shut down, but it’s pretty apparent there needs to be federal legislation rolled out to address this. Can’t call the kettle black when we’re swimming in the freakin’ pot.

Tune in to TMZ on TV weekdays Monday through Friday (check syndicated/local listings)

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