The Supreme Court finished its term with its usual dramatic flair with the release of the long-waited decision in Sebelius v. Hobby Lobby Stores (which is consolidated with Conestoga Wood Specialties Corp. v. Sebelius). The two cases represent a classic split in the circuits with the Tenth Circuit agreeing with Hobby Lobby as to the religious claims of the company while the Third Circuit ruled against such claims by Conestoga Wood Specialities Corp. The Court ruled that the Hobby Lobby does have religious rights, but limited the decision to closely-held corporations. Where Citizen’s United recognized that corporations have free speech rights like individuals, Hobby Lobby would do the same thing for religious rights. I will be running a column in the Los Angeles Times in the morning not just addressing this ruling but, once again, highlighting what I consider a far more important case that will be decided just a couple blocks away in the D.C. Circuit — Halbig v. Sebelius. I will be discussing the decisions today at CNN starting at 10 am and continuing to the discussion at 1 pm with Wolf Blitzer.
Hobby Lobby is a fascinating case involving the retail arts and craft chain founded by David Green and owned by his family, which also happen to be Evangelical Christians. The Greens actually do not object to all of the 20 forms of birth control under the ACA. However, they are religiously opposed to supplying four methods: morning-after pills Plan B and Ella as well as two kinds of inter-uterine devices (or IUDs). (The Conestoga company is smaller and owed by Hahn family, who are Mennonite Christians) At a running fine of $100 per employee, Hobby Lobby estimates that the federal mandate would cost it about $1.3 million a day, or roughly $475 million a year.
The religious beliefs of the family are formally integrated into their company: Green family members signed a formal commitment to run the stores according to Christian religious principles, including closing on Sunday, advertising their religious orientation. The company even plays religious music inside their stores.
The Greens challenged the provisions under the and the Religious Freedom Restoration Act, which imposes a high standard of strict scrutiny for the government to meet when a neutral law “substantially burden[s] a person’s exercise of religion”. (Note some amicus briefs suggest that the mandatory plan should also be barred for these purpose under the Establishment Clause). In 2013, United States District Court Judge Joe Heaton granted the company a temporary exemption from the contraceptive-providing mandate. (Conestoga directly raises free exercise arguments).
In an interesting wrinkle, an April article in Mother Jones alleged that Hobby Lobby’s employee retirement plan has more than $73M invested in mutual funds which include manufacturers of some fo the very contraception devices or drugs cited in the complaint.
The decision has sweeping application – well beyond these companies or the 49 for-profit corporations that have claimed such exemptions. The ruling addresses the very essence of a religious claim and the very essence of a corporate entity.
Closely-held corporations are not as limited as it might seem. I agree with Ginsberg that the implications are sweeping. The closely-held corporations represent a huge number of businesses. As I mentioned on CNN, the large corporations are the least likely to demand such exemptions. There are millions of family businesses that may not object not just to the ACA but renew objections to discrimination laws that force such businesses to serve same-sex weddings or engage in other activities that violate their religious beliefs. This is much like Heller and the recognition of individual gun rights. We are still working out the details on how far that goes years after the decision.
This is a major blow to the Administration which in the last ten days have been found to have violated the fourth amendment and privacy and then found to be in violation of the separation of powers and now found in violation of the first amendment and religious freedom.
Samantha:
“The only reason patients died in the VA hospital is because the Iraq and Afghanistan wars have overwhelmed the system.”
I disagree with you on this point. The mandate of the VA is to care for its vets in peace and in war. For instance, 1 in 10 Americans were vets after WWII. The survivors, anyway. And that did not overwhelm the system, which was the precursor for the VA.
We go to war at least once every 10 years, that I can recall. So the VA should have a steady stream of vets to contend with, even in the peacetime in between.
The budget of the VA has been increased each and every year for the past 10 years.
The problem with the VA is the single payer model. Let me explain. It has been discovered that 8 VA salaried cardiologists did the workload of a single private practice cardiologist. Why? Because the private practice cardiologist made more money the more efficiently he worked. It benefitted him to work overtime. Unfireable, unaccountable union employees get paid the same whether they spin around in their chairs or work hard. So how hard do you think they work? Not very, according to this study.
So we have an issue with underperforming, unaccountable employees in the VA system. That was combined with criminal fraud, where patient records were destroyed and they kept a secret waiting list up to 9 months long. There is no excuse for such behavior, including “well, we had a lot of patients.”
This is what comes of getting government union employees involved with your health care. You know the cliche about the DMV employee that doesn’t give 2 cents for you, or their job? Well, that has a basis in fact. I cannot imagine how it must feel to work for the government union with a good work ethic, surrounded by these Monty Pythonesque workers.
RTC:
You are incorrect. The VA’s budget has INCREASED every year for the past 10 years, including under Bush.
Where Bush got involved is he appointed an IG to look into allegations against the VA. The investigation lasted from 2005-2007. My issue with Bush is that by the time he left office, he had not yet implemented all of the IG’s recommendations. That report also verified that the VA was lying about wait times and failing to see vets. It was given to Obama when he took office. My issue with Obama is failing to finish implementing those recommendations, lying that the first he heard about the VA scandal was on the news (despite this report, repeated letters to Congress and from Congress to the White House, etc), failing to take action because he wants to wait for yet another IG before he makes any judgement calls. My issue with Congress is that Democrats voted along party lines to kill a bill that would have allowed us to fire any government union employee responsible for this fraud that killed so many vets. Too many Democrats are in the pockets of unions, bought and paid for. Sorry, but if your fraud which causes the deaths of many soldiers doesn’t get you fired, I don’t know what will. This kind of sums up my issue with unfireable union employees nicely.
There are hundreds of different medicare advantage plans, some pay a hundred percent, some don’t, depending upon how much premium a senior is willing to pay. Even then, not everything is covered and there are plenty of limitations. If a senior takes a Medicare Advantage plan whereby only the government pays for it, that is, he does not pay extra himself, then he is getting a barebones plan, not a gold-plated plan. I know a guy whose premiums are a thousand dollars a month because he wants someone to pay for his aspirin and his visits to a health club.
With Medicare Advantage, Medigap is not needed.
Not all Medicare Advantage is HMO.
Google Medicare Advantage nightmares, something you won’t find in mainstream media.
schulte: There you go again. Obama didn’t name Gen. Shinseki to head the VA because he didn’t care about the the suffering wounded soldiers. He wanted to reward the General with a chance for speaking honestly to congress about the need for higher troop levels than Rummy wanted to send.
Obama didn’t kick any can down the road. Republicans in congress have squeezed the VA’s budget, probably hoping a crisis would develop. Even now, they’re Lindsay Graham and John McCain is saying we can’t afford to fund the VA.
The Republican Party has demonstrated time and again that they are willing to make American people suffer for political gain. They have done this by opposing every measure proposed by the president that might help the economy or create jobs, and they’re doing it with the VA. They’re message is, You peolple are going to suffer until you vote Republican, and then your really going to suffer (because voting for us is affirming how much you love the abuse).
Mike: not only did the Bush administration anticipate high casualties, they ensured it by sending our forces in under-manned and ill-equipped. Combined with much improved battlefield medical treatments, it was a recipe for an overwhelmed healthcare system. That the Bush League defunded the VA guaranteed a crisis.
I think it’s almost giving them too much credit to say they were trying to wage a war on the cheap. There was a saying when I worked for Bechtel, There’s cash in chaos. I believe somehow the top inside investor class, like the Carlyle Group, are profiting from the carnage.
http://youtu.be/u0B6YXjCkw4
The VA is the only truly socialized medicine system in this country and it has worked extremely well over the years. And RTC is correct on the budget cuts during the Bush Administration. Of course, since the prevailing notion was that we would be greeted as liberators in Iraq, I suspect that Bush advisors did not anticipate the degree of carnage that actually ensued and the resulting strain on the VA.
Mike – the Bush advisers warned the Obama people about the waiting lists at the VA and that it was already a big problem they were going to have to deal with. Obama just kicked the can down the road, not caring about the deaths that would occur.
http://youtu.be/_nRF9LaVaLs
Annie: give samantha some credit. if anybody knows about nutshells, it her.
“Karen S, excellent, nutshell description of Medicare.”
Karen: The failures at the VA stem from the cuts made to its budget during the Bush administration at a time when the number of vets, many seriously wounded and ill, was increasing at astronomical rates, thanks to ol’ Rummy’s decision not to provide armored vehicles and body armor, you kow, because you don’t go to war with army you wish you had, you fight with the army you have.
Frankly, I think Rummy has investments in the technology firms that manufacture the new wave of prosthetic limbs. Yes, I’m saying exposed our troops to danger to increase his profits. But hey, that’s the free market for you.
Sorry, double payer, not single payer. Medicare for All or as its now called National Health Program.
Happypappies,
Medicare Advantage is a HMO like plan run by a private health insurance company, paid for by Medicare. You have co pays for doc visits and medication. But it pays 100%. You do not buy a supplemental policy with this.
Traditional Medicare covers 80%, with this you need to buy a supplemental policy, known as Medigap, which picks up what traditional Medicare didn’t pay.
AARP offers both Medigap and Medicare Advantage plans through United Healthcare.
OK Samantha, you convinced me! Get rid of Medicare Advantage and go with straight government run Medicare. Expand existing Medicare, enroll the population and gmore money via Medicare premiums will help fund the program and then increase taxes on the rich to help, and we have our own American version of Single Payer. You are right, The VA is not Medicare.
LeeJ, You are right. A friend a find had major surgery at Mayo and the bill was $100.
Karen S, excellent, nutshell description of Medicare. Let’s keep in mind the actual distinction between Medicare and the VA system, because it’s the definitions that we interchangeably use that confuse us. Then it is easy to see how simple Medicare really is, as you’ve shown.
The VA hospital is a provider. Medicare is not a provider; hospitals and doctors are the providers. The only reason patients died in the VA hospital is because the Iraq and Afghanistan wars have overwhelmed the system. The private healthcare system, itself, is in mortal danger of being overwhelmed with millions of illegal aliens on Medicaid and fraudulent slackers on disability swampping the system, just as the VA system has been swamped. Once the private system itself is swamped, there will be no place to go except overseas.
Keep in mind that there are special interests that want to do away with the VA system and Medicare, replace it with a Medicare Advantage type of system for everyone. In other words, private insurance companies profiting at the public trough. That’s what these brush fires at the VA hospital are all about, so industry bag men like mccain and his liberal cohorts from the other side of the aisle, can make a better argument to do away with the va hospital — and eventually traditional Medicare.
If you were to do a study on how many people have died on Medicare Advantage, it might well run into the tens of thousands. But no one in the mainstream media is telling you about it. That’s because the media is in on the racket, too, reaping insane profits from Medicare Advantage adverts, which revenue is non-existent with traditional Medicare. By helping discredit the VA system, the media hope to gain even more advert revenue once private insurers take over.
Google search your favorite healthcare provider verses john doe. You will be shocked by just how many lawsuits against seniors have come about as a consequence of Medicare Advantage, because seniors just do not know what claims Medicare Advantage does not pay for. They only see what’s on the glossy brochure, seniors playing golf in sunshine, prancing around in golf carts, cocktails in hand.
Until something better comes along, the only thing prudent for seniors is to stick with traditional Medicare and fortify it with supplemental insurance.
Medicare Advantage is a nightmare, just as is the Affordable Care Act.
Annie I don’t get where you are saying that advantage pays 100 percent because it doesn’t You have to buy extra insurance like AARP or something to pay the other 20%. I know. I am on it.
So if people like Medicare, they like the combination of private insurance that makes them able to afford it.
What’s unbelievable to me is that so many people died in our single payer system, the VA, because their files were thrown out to falsify wait time reporting. And yet Liberals obediently declare that we should make ALL healthcare single payer. What??? How many people have to actually, literally, die on a single payer system before they think, well, gee, maybe I should care a little bit about my fellow man, you know, dying, with a bloated, unaccountable system filled with unfireable employees that don’t give 2 cents if they do a good job?
If you really care about the poor, you won’t send them to a single payer system that was just revealed to have caused the death of a lot of vets who served our country. And you won’t send the rest of us, either.
Government unions provide employees that get paid the same for sitting in their chairs spinning in circles, and working hard all day. Sure, there are some good eggs in the system, but the system does not promote those good eggs. They have to see coworkers who do terrible jobs get paid the same, and keep their jobs. So why bother?
Medicare is not a single payer system. It functions like any insurance, actually with really high copays. For instance:
“Medicare Part A pays all covered hospital, skilled nursing facility and home health care benefits for each benefit period except for the deductible. For 2011, the deductible is $1,132 for any hospital stay 60 days long or less. For any hospital stay lasting longer than 60 days, a Medicare copayment will apply. For stays lasting 61 to 90 days, you will have to pay a Medicare copayment of $283 per day. For stays of 91 to 150 days, you will have to pay $566 per day. For any hospital stay that lasts longer than 150 days within a single benefit period, you will be required to pay the full cost for each day after the 150th day. For people on Medicare who receive care in a skilled nursing facility, a Medicare copayment of $141.50 per day will apply to days 21 through 100. Medicare will cover days 1 through 20 in full. You will be required to pay in full any days after the 100th day.”
“Medicare Part B includes a yearly deductible of $162 in 2011. This deductible will be applied to health care costs that involve physician services, outpatient hospital services, certain home health services, and durable medical equipment. Once the deductible is met, you will be required to pay only 20% of the Medicare-approved amount charged by providers for your health care services. In 2011, because of the new health care law, many preventive services will be provided at no cost to you. These free benefits will not be affected by the deductible.”
It is really expensive to get hospitalized with only Medicare Part A. That is why people have to get supplemental gap insurance. What senior can pay for $566/day for a hospital stay over 91 days?
It is not a single payer (a common misconception). There are 2 payers – Medicare and you. And if you have gap insurance, there is more.
A single payer has no copays or deductibles. Only one entity pays.
The VA is a single payer system. They are now allowing vets to go to private providers to finally get good quality care so they won’t die on waiting lists any longer. Not exactly a great testament to single payer. But why not repeat a failed experiment and hope and pray it miraculously turns out better? Oh, wait. If we further disrupt the health care industry into single payer, what private providers can we go to when we start dying in waiting lists?
http://open.salon.com/blog/kanuk/2011/11/14/medicare_is_not_a_single-payer_system_get_it
Bigfatmike my point was that Hobby Lobby and their Freedom of Religion claim on the IUD being dangerous to the Mother and the Fetus was valid
I don’t know where you got your info re medicare payments for inpatient stays. The last time I was hospitalized I was in for a month, something went wrong in surgery and I needed ICU etc. I received a bill for 138,000$ Medicare paid all but 800$ which was picked up by my supplemental BC/BS
My current deductible for B is 150$ for the year and has been for a nuber of years.
(anecdotal but I coubt I am the only person for whom they paid almost 100%)
Big fat mike, there is no competition between insurance companies competing for medicare dollars. Government insurance premiums to insurance companies are static. What insurance companies are doing, instead, is competing for seniors. If they can snag a stupid senior, then they will get the premiums from the government. It’s not like they’re giving the government a lower bid in order to get the business. They can only make a profit by limiting claims to seniors. Period. That’s hardly market economy competition. Medicare is not complicated. Do you have any idea what the annual premium amounts to that the government gives to insurances companies for Medicare Advantage, per senior? You can figure it out by dividing the Medicare budget by the number of seniors on Medicare / Medicare Advantage. Otherwise, it’s a tightly guarded secret, politicians too embarrassed to have the public know. The only reason seniors sign up for Medicare Advantage, is because they think they are getting something more then they can get from traditional medicare. Collectively, its mathematical impossible for Medicare Advantage seniors to benefit more than 80 percent of total Medicare Advantage premiums, because the insurance companies keep 20 percent. And if Medicare Advantage does not pay your claim, you are on your own. That is why mayo clinic opted out.