- The Washington Times - Monday, December 19, 2011

The Supreme Court has agreed to hear challenges to the Affordable Care Act in late March - nailing down at least one absolute for the controversial health care overhaul that has been mired in a tug of war between critics looking to dismantle “Obamacare” and supporters fighting to protect the president’s signature legislative victory.

The court announced Monday morning the three-day hearing will take place March 26-28.
A few hours later and just down the street, Health and Human Services Secretary Kathleen Sebelius unveiled 32 health care providers that have been selected to become Accountable Care Organizations (ACOs) - the new models created under the law that are intended to cut costs and improve efficiencies.

But while the administration rolled out another new component of the health care overhaul, Republicans were busy last week taking another run at stripping funds from the act.

Looking for cash to offset the proposed extension of the payroll-tax cut, House Republicans passed a bill that would have cut more than $25 billion from the act by allowing the federal government to reclaim more overpayments of insurance subsidies, cutting a fund for “evidence-based” prevention programs, repealing provisions in the law that hurt physician-owned hospitals and reducing some Medicaid spending.

The effort died in the Senate, but the latest attempt to “starve” the president’s health care overhaul illustrates how the act continues to divide state and federal lawmakers, with both sides anxiously awaiting the Supreme Court ruling.

Last month, the court announced it will take up a lawsuit brought by 26 states and the National Federation of Independent Businesses (NFIB), who have accused Congress of overstepping constitutional boundaries by mandating that individuals must obtain health insurance and requiring states to massively expand expensive Medicaid programs as part of the health care overhaul.

The court will rule on four key questions: whether the individual mandates are constitutional, whether the Medicaid expansions are constitutional, whether challenges to the law are premature under a provision known as the Anti-injunction Act and whether overturning the individual mandate would topple the entire law.

The justices have scheduled arguments on the Anti-injunction Act for March 26 and arguments on the individual mandate for March 27. On the final day of oral arguments, March 28, they will hear arguments pertaining to the Medicaid expansion and whether the rest of the law can stand without the individual mandate.

While the court usually allots far less time for oral arguments, the fact that it has scheduled three days for the health care lawsuit indicates the intense legal debate and high political stakes at play.

The hearing will take place a few days after the second anniversary of the Affordable Care Act, passed in March 2010.

Justices had their pick of cases from among three appeals courts that have ruled on the merits of the challenges. They chose the case from the 11th U.S. Circuit Court of Appeals, which struck down the individual mandate, but upheld other parts of the law, including the state Medicaid expansion.

“We’re really looking forward to arguing this case, and we have all the confidence in the world in our standing in it,” said NFIB spokeswoman Cynthia Magnuson.

But the Obama administration is just as confident that the Supreme Court will uphold the law, with Mrs. Sebelius continuing to unroll new programs created by it every month.

In the most recent announcement on Monday, the agency named 32 health care providers it had selected from among 160 applicants, allowing them to participate in a pilot program to test whether using new payment models can cut costs for Medicare. The providers will try to save money by encouraging doctors, hospitals and specialists to better coordinate patient care and thereby cut down on hospital readmissions, emergency-room visits and other expensive services.

Officials estimate the pilot ACOs could save Medicare $1.1 billion over five years. Organizations that do succeed in improving the health of patients and cutting costs will be able to move away from using Medicare’s traditional fee-for-service model and instead use a model based on the level of service provided.

“They will transform their practices to emphasize prevention, improve care coordination, cut waste and put a greater focus on patients’ needs,” Mrs. Sebelius said. “These pioneer Accountable Care Organizations will improve care for over 860,000 Medicare beneficiaries.”

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