A federal judge in Virginia has ruled that healthcare reform is unconstitutional and expects the Obama administration to honor that ruling while it’s being appealed. But states and private companies are continuing to plan and budget for it nonetheless.
The court ruled that Congress exceeded its constitutional powers in compelling Americans to buy health insurance. Judges elsewhere have ruled the law is valid or dismissed the cases on procedural grounds, while a judge in Florida will hear another case later this week.
In the meantime, though, employers and healthcare companies have to continue adjusting to the reform law’s many provisions. States will continue to set up their health insurance exchanges, and they’ve already budgeted for the additional 16 million people who will qualify for Medicaid under the law. And the Obama administration is unlikely to stop what it’s doing, since many of the provisions won’t take effect until 2014.
A key of the lawsuit is “economic inactivity.” The ruling says that while Congress can regulate interstate commerce, it can’t regulate…well, non-commerce, in this case the decision not to buy health insurance. The judge’s decision is online. (Politico, Wall Street Journal, Associated Press, MSNBC)
*This blog post was originally published at ACP Internist*
Flush from their big win in the midterms, the Boehners are vowing to repeal and replace the Big O’s health reform law. They pose a legitimate threat, but an even larger one lies in the courts, where suits challenging the constitutionality of the law have been popping up like fireflies on a late August night.
In Virginia for example, Republican-appointed Federal District Court Judge Henry Hudson has indicated that the Individual Mandate — a key provision of the law that has been challenged in a suit filed in his court by the state’s Republican Attorney General — might not pass his sniff test.
Hudson said he’d rule on the matter this month. If he deems the provision to be unconstitutional, he might (it’s unlikely, but he might) enjoin the law altogether until higher courts rule on the matter. Holy Kazakhstan, Batman!
An official at Camp Obama, who spoke with the New York Times under the condition that his name not be WikiLeaked, acknowledged that Hudson’s thumbs appear to be pointing downward, indeed. Read more »
*This blog post was originally published at Pizaazz*
Since March I’ve been working out with a fitness instructor. She is the toughest, most motivated coach I’ve ever known. Sadly, today was our last day together because she’s beginning maternity leave and I’m moving out of the area. I was reflecting on what made her such a great trainer, and I think the essence was her undying belief in everyone’s ability to improve. Each exercise was a chance to do better than last time — to perfect one’s form, do one more repetition, or to slow the speed of a lift or increase the resistance involved.
She never let me slack — she told me she believed in me, that I could do better, and that she didn’t care how many reps I did, I had to do them the right way. There were times that I just wanted an “easy” workout, or when I’d ask for understanding: “Klaudia, can we ease up on the cardio a bit today, I just ate lunch?” I’d ask. “That’s okay,” she’d smile, “I have a bucket for you right here if you need it.”
Frequently she’d time me racing repeatedly up and down seven flights of stairs… Read more »
Some states are finding it tough to retain physicians. Take Virginia for instance:
A recent study found Virginia retains only 35 percent of its medical school graduates and ranks 31st among other states in retaining doctors.
In 2008, Virginia spent more than $50 million from the general fund to support medical education and had nearly 600 new physicians graduate from Virginia’s four medical schools.
Despite this, Virginia still struggles to retain medical graduates, with less than 25 percent of Virginia’s physicians graduating from medical schools in the Commonwealth.
Some feel incentives might work:
Dr. Greenawald says other states including North Carolina have incentives to keep medical students in state. He hopes Virginia considers following suit. Dr. Greenawald also said the over burden of paperwork and insurance company oversight have taken doctors away from what they love doing which is providing care to patients. He said that’s prompted many doctors to retire early.
I’m not so sure. Until more medical students feel primary care is worth the effort, the mass exodus to specialties (and the out-of-state training that is often required) will continue.
-WesMusings of a cardiologist and cardiac electrophysiologist.
*This blog post was originally published at Dr. Wes*
There hasn’t been much discussion about serious tort reform in the current healthcare reform debate. That’s probably because most policy experts don’t believe it will make a significant dent in healthcare costs. I happen to believe that tort reform would be a huge boon for healthcare (just ask Ob/Gyns in Texas) and save a lot in defensive medicine practices and unnecessary testing, but even if I’m wrong and it wouldn’t result in cost-savings, there’s another issue at play: access to primary care physicians.
We all agree that we’re in the midst of a major shortage in primary care physicians. Many different solutions have been proposed – everything from “let the nurses do it” to forgiving medical school loans to physicians who choose primary care as a career. However, solving the PCP shortage isn’t just about recruitment, it’s about retention. And with up to a half of PCPs saying that practice conditions are so unbearable they’re planning to quit in the next 2 years – Houston, we have a problem. Read more »