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What Happens to the Health Care Reform Law After the Election?

As Chris said below, exit polls showed that it wasn’t anger at the new health care law that drove the voting in this election.  But with new Republican majorities in the US House, NC House and NC Senate driven by many people who have said they want to “repeal” the new health care law what can people who care about affordable health coverage expect in the days ahead?  Overall, I really don’t think much is going to change and the main elements of the new law will continue to move forward.  Why?  First, remember that both President Obama and Governor Perdue are still in office, so there is no change in administration either here or in Washington.  Also in NC, Insurance Commissioner Wayne Goodwin, who has been aggressive in reining in insurance costs and getting ready to implement reform was not up for election and remains at the head of the NC agency, the Department of Insurance, that will have the most to do with implementing reform in NC.  In addition:

1.  The elements of the health law already in place are proving to be quite popular.  They include parents being able to keep their kids on their health plans until age 26, cuts in drug costs for people on Medicare, new high risk insurance pools already enrolling hundreds of hard-to-insure people, banning pre-existing condition exclusions for kids, tax credits for many small businesses who offer coverage, and elimination of lifetime limits on health plan coverage.  During the heated election campaigns no one wanted to say just what parts of the health law they would repeal and this is why – people like what is being implemented right now.

2.  Repealing any major part of the health law will increase the deficit and must be paid for.  Yes, this was something missed during the campaign rhetoric too, but Republicans who control the House will have to actually come up with money if they want to repeal any part of the law – full repeal would cost over $100 billion and just repealing the Medicare provisions that reduce the projected increases over ten years in Medicare costs (no, they don’t “cut” Medicare) costs over $400 billion.

3.  Back in Ronald Reagan’s White House, health reform plans were developed that included a major change in how people got coverage that increased their personal responsibility:  the idea that a person couldn’t wait until he or she was sick and in the hospital to buy coverage but rather they should be required to purchase health coverage so it would already be there before they got sick.  The Reagan idea of the individual mandate to buy coverage was passed in the new health reform law and in a surprising twist became one of the provisions those who want to repeal the law complain most about.  The problem with repealing just this provision is that without it the other extremely popular provision in the health law – that insurance companies can’t charge people more because of pre-existing health conditions – must be eliminated as well.  Doing one without the other would be devastating for health insurance companies and the health insurance market and mean skyrocketing health costs for everyone as no one would have any incentive to buy  health insurance until they got sick.  This is simply not going to happen.

4.  Down here in North Carolina, the biggest change will likely be the state giving up authority to the federal government to set up its own health insurance exchange where individuals, small businesses, and members of Congress will buy coverage after 2014.  NC has started planning to set up a NC-based exchange that would include a wide variety of plans, better regulation, and ease of access to help with buying coverage.  However, setting up a state-based exchange will require the NC General Assembly to pass legislation and the prospects for that are unlikely.  This is a shame since NC would give up quite a bit of authority to the federal government about how we do health reform in NC.  If NC hasn’t made substantial strides in setting up its exchange by 2013, the federal government steps in and sets one up for NC residents and members of Congress that meets the basic requirements of federal law for affordability and choice of health plans.   For individual consumers this isn’t necessarily a bad thing, but NC could probably do a more consumer friendly and better job.

5.  Many other parts of the health reform law are already being implemented by various entities in North Carolina.  Hundreds of millions of dollars in grants have already been awarded for new prevention programs and to test new models of delivering health care.  The Department of Insurance has gotten a large federal grant and is starting to set up a new consumer assistance and ombudsprogram modeled on their very popular and successful similar effort for older adults.  NC’s Department of Health and Human Services is already moving to prepare to expand Medicaid coverage in 2014 which will be fully paid for by the federal government and save millions of dollars in uncompensated care costs for hospitals and providers all across North Carolina.

In sum, while Republicans nationally and in NC will try to slow down the pace of reform, the horse is already out of the barn.

42 Comments

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  3. Anne C

    November 3, 2010 at 10:29 am

    I think the Republicans can change some parts of the law but not the major parts such as keeping your child (until age 26) in your policy and admitting patients with pre-existing conditions.

    And most Americans who ask that the law be repealed will also be against taking our provisions such as these.

    Anne C
    NY Health Insurer

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  33. medical assistant

    November 3, 2010 at 9:03 pm

    Its true the GOP can not do much in this regard. However there may be a room for some suggestions and tweaks hear and there. Other than that the plan is a done deal.

  34. Immyid

    November 3, 2010 at 10:36 pm

    This is only partially about the new health care bill. But this is really about consolidating power. Here is what is going to happen:

    1. The NC House and Senate will pass either a bill or resolution requiring the state to join other states’ lawsuits challenging the constitutionality of the federal health care bill. Likely they will pass legislation which will force the Governor to either sign or veto the act.

    2. The Governor exercises her veto and that becomes an immediate winning issue for the Republican’s candidate for Governor in 2012. Or she signs the bill.

    3. If she signs the bill the NC AG has to make a choice. Any waivering will result in the Legislature taking away the AG’s authority to represent the state. The Legislature will hire and enrich a law firm that is friendly to its party to represent the state (see Arizona re: immigration law).

    4. Or they can go to step 3 immediately.

    5. The state joins the federal lawsuits; but it also files a case in state court once the first elements of the health care bill are implemented. They will challenge the required mandates under the state constitution. The ultimate outcomes don’t matter. This is about positioning for the takeover of council of state offices.

    6. The Legislature will make findings that closing the budget deficit is near impossible in part because of the cost of health care to the state. They will then make the case that the federal mandates in the new health care bill make the state deficit even worse so any belt tightening is really caused by the federal mandates.
    I can go on and on, but this will likely happen here and other states that went GOP state legislature (e.g, Maine). At that point it is only a matter of time for major changes to the existing reform act.

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  36. Cancer Society

    November 4, 2010 at 6:26 am

    Health care is very important during election. This information should be reached to election commiseration.

  37. IBXer

    November 4, 2010 at 10:12 am

    Repeal it. Restore the Constitution to its rightful place… a limit on government.

  38. Julian

    November 6, 2010 at 8:47 pm

    STIMULATING IMMUNE FUNCTION TO DEFEAT THE HUMAN IMMUNODEFICIENCY VIRUS AND OTHER PATHOGENS

    Stimulating defective immune function to perform efficiently is a desirable approach to defeating pathogens. Such stimulation is represented as unavailable, while in truth the immunostimulating properties of lithium and antidepressants were documented many years ago.1-4 A therapeutic claim is reinforced when the mechanism is known. Prostaglandins, when produced excessively, depress every component of immune function, and induce microbial replication. Wherever HIV comes into contact with arachidonic acid, an envelope glycoprotein powerfully converts this precursor to prostaglandin E2, depressing immune function and promoting viral replication, excessive prostaglandin E2 a leading candidate for the immunosuppression that is the hallmark of AIDS.5-7 Antidepressants inhibit the synthesis of prostaglandin E2, antagonize its actions, and stimulate the primary prostaglandin-degrading enzyme.8-10

    Collective evidence shows that lithium has immunostimulating, antiviral, and antibacterial properties, 11 antidepressants immunostimulating, antiviral, antibacterial,1-4 anti-parasite, and fungicidal properties.12-15 Lithium is often effective for bacterial skin infections, aphthous ulcers, cold sores, and genital herpes,11 antidepressants for aphthous ulcers, cold sores, and genital herpes. 11 Tuberculosis, now the #1 killer of the HIV infected, is developing resistance to standard treatment. In the late nineteen forties, physicians working in tuberculosis sanitaria observed patients with elevations of mood and energy. Their charts revealed that all were taking the monoamine oxidase inhibitors isoniazid or iproniazid, an observation from which antidepressant therapy developed. If antituberculotics double as antidepressants, surely antidepressants must double as antituberculotics? The antimalarial properties of antidepressants in vitro are supported by many studies.12 When added to antiretrovirals, antidepressants can reduce HIV viral loads to undetectable.16 The authors of this study attribute this to adherence, seemingly unaware of the antiviral properties of antidepressants. The advantage of immunostimulation is its non-specificity, a stimulated immune system indifferent to antigenicity.

    People with intact immune function are relatively invulnerable to pathogens, compared to those with defective function. Depression is a seldom mentioned cause of defective immunity, although indices of immune function indicate that it does so.17 In a study of 405 HIV-positive gay and bisexual men, those who reported being depressed throughout the eight-year study period, were two-thirds more likely to die than those who were never significantly depressed.18,

    Forty years ago, prostaglandins were shown to regulate immune function, and lithium and antidepressants to inhibit prostaglandins. Gradually, prostaglandins were found to regulate every aspect of HIV replication, and HIV to stimulate prostaglandin E2 production, to a greater degree than other viruses. This prostaglandin, when produced excessively, is thought to be responsible for the immune depression that is the hallmark of AIDS. Twenty five years ago, I believed that lithium and antidepressants could be used as heavy artillery against HIV, but when lithium failed to improve patients with AIDS in two small clinical trials, came to favor antidepressants for this purpose. 19,20,21

    1. Lieb J. Remission of herpes virus infection and immunopotentiation with lithium carbonate: inhibition of prostaglandin E1 synthesis by lithium may explain its antiviral, immunopotentiating, and antimanic properties. Biol Psychiatry 1981; 695-698.

    2. Lieb J. Remission of rheumatoid arthritis and other disorders of immunity in patients taking monoamine oxidase inhibitors. Int J Immunopharmacol 1983; 5(4): 353-357.

    3. Rosenthal S, Fitch W. The antiherpetic effects of phenelzine. J Clin Psychopharmacol 1987; 7(2):119.

    4. Murphy D, Donnelly C, Moskowitz J. Inhibition by lithium of prostaglandin E1 and norepinephrine effects on cyclic adenosine monophosphate production in human platelets. Clin Pharmacol Ther 1973; 14(5):810-814.

    5. Lee R. The influence of psychotropic drugs on prostaglandin biosynthesis. Prostaglandins 1974; 5(1):63-68.

    6. Manku MS, Horrobin DF. Chloroquine, quinine, procaine, quinidine and clomipramine are prostaglandin agonists and antagonists. Prostaglandins 1976; 12: 789-801.

    7. Mak O, Chen S. Effects of two antidepressant drugs imipramine and amitriptyline on the enzyme activity of 15-hydroxyprostaglandin dehydrogenase purified from brain, lung, liver and kidney of mouse. Prog Lipid Res 1986; 25: 153-155.

    8. Fernandez-Cruz E, Gelpi E, Longo N, Gonzalez B, de la Morena, MT, Montes, MG,
    Rosello , J, Ramis I,Suarez A, Fernandez, A. Increased synthesis and production of prostaglandin E2 by monocytes from drug addicts with AIDS. AIDS 1989; 3: 93-96.

    9. Wahl L, Corcoran M, Pyle S, Pyle SW, Arthur LO, Harel-Bellan A, Farrar WL. Human immunodeficiency virus glycoprotein (gp120) induction of monocyte arachidonic acid metabolites and interleukin 1. Proc. Natl Acad. Sci. USA 1989; 86:621-625.

    10. Dumais N, Barbeau B, Olivier M, Tremblay MJ. Prostaglandin E2 up-regulates HIV-1 long terminal repeat-driven gene activity in T cells via NF-kappa B-dependent and–independent signaling pathways. J Biol Chem 1998; 273(42): 27306-27314

    11. Dutta P, Pinto J, Rivlin R. Antimalarial properties of imipramine and amitriptyline. J Protozool 1990; 37(1): 54-58.

    12. Lieb,J.”The immunostimulating and antimicrobial properties of lithium and antidepressants.” J Infection (2004) 49; 88-93

    13. Lass-Florl C, Dierich MP, Fuchs D, Semenitz E, Ledochowski M. Antifungal activity against Candida sp. by the selective serotonin reuptake inhibitor sertraline. Clin Infect Dis 2001; 33(12):E135-136.

    14. Munoz-Bellido J, Munoz-Criado S, Garcia-Rodriguez J. Antimicrobial activity of psychotropic drugs: selective serotonin reuptake inhibitors. Int J Antimicrob Agents 2000; 14(3): 177-180.

    15. Tsai A, Weiser S, Petersen M, Ragland K, Bangsberg D. Effect of antidepressant medication treatment on ARV adherence and HIV-1 RNA viral load in HIV+ homeless and marginally housed individuals. In: Program and abstracts of the 16th Conference on Retroviruses and Opportunistic Infections; February 8-11, 2009; Montréal, Canada. Abstract 584

    16. Frank M, Hendricks S, Johnson D, Wiesler J L, Burke WJ. Antidepressants augment natural killer cell activity: in vivo and in vitro. Neuropsychobiology 1999; 39(1):18-24.

    17. Mayne TJ, Vittinghoff E, Chesney MA, Barrett DC, Coates TJ. Depressive affect and survival among gay and bisexual men infected with HIV. Arch Intern Med. 1996 Oct 28; 156(19):2233-8.

    18. Lieb,J.”Stimulating immune function to kill viruses.” (And bacteria, parasites, and fungi). 2009, Amazon

    19. Evans DL, Ten Have TR, Douglas SD, Gettes DR, Morrison M, Chiappini MS, Brinker-Spence P, Job C, Mercer DE, Wang YL, Cruess D, Dube B, Dalen EA, Brown T, Bauer R, Petitto JMAssociation of depression with viral load, CD8 T lymphocytes, and natural killer cells in women with HIV infection. Am J Psychiatry. 2002 Oct; 159(10):1752-9.
    20. Evans DL, Lynch KG, Benton T, Dube B, Gettes Tustin NB, Lai JP, Metsger D, Douglas SD Selective serotonin reuptake inhibitor and substance P antagonist enhancement of natural killer cell innate immunity in human immunodeficiency virus/ acquired immunodeficiency syndrome. Biol Psychiatry 2008 May 1:63(9):899-905. Epub 2007 Oct 22.
    21. Benton T, Lynch K, Dube,B, Gettes DR, Tustin NB, Lai JP, Metsger DS, Blume J, Douglas SD, Evans DL. Selective Serotonin Reuptake Inhibitor Suppression of HIV Infectivity and Replication Psychosom Med 2010 Oct 14 {Epub ahead of print}

    The innovation is a victim of pandemic medical corruption. Five hundred years ago, Francis Bacon warned that corrupting a medical innovation could permanently damage society.
    British Medical Association
    An introduction to the right to health
    30 August 2006
    What is the right to health?
    Article 12 of the International Covenant on Economic, Social and Cultural Rights (ICESCR) defines the right to health as >’the right of everyone to the enjoyment of the highest attainable standard of physical and mental health’. Like other human rights, it has a particular concern for the disadvantaged, the vulnerable and those living in poverty. The right requires an effective, inclusive health system of good quality. The right to the highest attainable standard of health is codified in numerous legally binding international and regional human rights treaties. The right, or other health-related rights, is also enshrined in over 100 constitutions worldwide.

  39. hsr0601

    November 8, 2010 at 9:24 am

    While world-wide Stimulus Package got positive review generally, why is the D.S alone critical of it ?

    1. Audacity of Nope extracted exceedingly low possible jobless rate compared with the extremely critical market situation, while D.S. economy was held hostage by Audacity of Nope, and time was running out.
    Prior to the full recovery, the Stimulus Package was all about Lehman Brothers or not of D.S. economy.

    2. Last year, Warren buffet warmed in an interview with NBC that the D.S. economy was in free fall. Plus, tragically, the Japan economic leader committed suicide before the strong export report, last year.
    As we know, blocking Free Fall From Cliff requires multiple efforts.

    3. Global austerity policy dealt a harsh blow to the burgeoning economic activity. By ruling out this critical factor, Power-only party of objection for objection & Almost Dead Media led Independents to Fuel reps Gains.

    4. As a groundwork, the Stimulus Package alone can’t complete a perfect building. Sadly, extension of oil wars displaced Energy Independence or A Jobs law, empowering the war party and leaving healthcare law near demise before survival. Accordingly, the Stimulus Package lost momentum creating Synergy.

    5. The most efficient deficit-cut way of government would be slashing the destructive war & military waste.
    Slashing the destructive war & military waste alone supposedly could be enough to balance the budget.
    Regrettably. opponents are instead critical of sound investments. ( Depression : New Deal = Great Recession : Stimulus Package (Groundwork) )

    6. I think Corrupt Money & Almost Dead Media led Independents to Fuel the no idea’ Gains. That explains why Moneycracy & Money-driven media call for urgent overhaul.

    7. Amid Massive Lay-off Panic, Change & Healthcare for all, After Stimulus Package, Opposition from lots of the Ungrateful.
    Taking advantage of benefits from Stimulus Package, Corrupt Money & Almost Dead Media & Power-only party turned U.S. into D.S.

    8. Over the duration of healthcare debate, using the preliminary cost analysis of CBO, the reps opposed the public option stubbornly, but
    after the release of final score, they have been defiant on the referee.

    ** Chanting deficit :

    a. Amid chanting deficit, the same old failed policy.

    b. Amid chanting deficit, hands-off approach over huge trade deficit from oil money spill & trade imbalance with China from remorseless health care premium.

    c. Unfortunately, as a direct consequence of remorseless health care premium, numerous folks have no choice but to hang onto affordable offerings, since one in two households is said to face a hard decision between necessity & drug.

    d. Inaction cost in relation to health care reform totals $9trillion over the next decade.

    e. Over the next 10 years, total Bush tax cut costs will equal $3.9 trillion, …. the tax cuts would increase deficits by nearly $4 trillion between 2005 and 2014.

    9. Title : A businessman is angry at his lost cash bag.

    A businessman is drowning in the ocean.

    Stimulus : we should rescue him immediately.

    Power first : Nope ! How do we pay for it ?, Just let him go under much like Lehman Brothers.

    Stimulus : He is dying right now.

    Power first : Nope ! You can’t save his money bag.

    Stimulus ( clock is ticking ) : : We can do everything.

    Go under : We are serious about jobs. Where are jobs ?, echoed by the angry businessman.

    10. Former President Bill Clinton said “It took me four years to balance the budget, then I gave you four surpluses, paid $600 billion down on the national debt,”

    And I’d say : It took 8 years for the Bush mishandling to get a final verdict.
    Let’s not fall for the outrageous claim : Heal the 8 year-long chronic disease quickly, but do not see a doctor, adding to the deficit.

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  42. Spina Bifida

    July 11, 2011 at 1:15 pm

    I just hope that children will be allowed to remain covered under their parents’ insurance plan. I anticipate that these reforms will benefit the tens of thousands of children and young adults living with Spina Bifida, as well as the more than 1,500 children born with this birth defect each year.