U.S. Supreme Court has voted to strike down Roe vs. Wade
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The Keckley Report - Paul Keckley
www.paulkeckley.com
Four Supreme Court Decisions in 10 Days reset U.S. Healthcare
June 27, 2022
Four decisions by the Supreme Court in the last 10 days will fundamentally change U.S. healthcare for decades to come:
June 15, 2022: American Hospital Association v Becerra (20-1114) In a unanimous (9-0) decision, the Court found that a reading of the statutory language makes clear that without surveying hospitals as to their drug acquisition costs, HHS may not change drug reimbursement rates for a subset of hospitals. The court noted that this “protects all hospitals by imposing an important procedural prerequisite—namely, a survey of hospitals’ acquisition costs for prescription drugs—before HHS may target particular groups of hospitals for lower reimbursement rates.”
The issue going forward: under what authority and by what mechanisms will HHS and its agencies with responsibility for provider payments (CMS, FDA, IHS, HRSA, et al) modify methodologies to shift payments to its priorities or direct resources to programs it deems appropriate? And the practical implication for providers (hospitals, federal clinics, public health providers, physicians, post-acute and long-term care providers et al) is budgeting for long-term strategic initiatives if HHS is locked into funding and reimbursement methodologies tethered to old business models and faulty assumptions about how care CAN be delivered, by whom and where.
June 21, 2022: Marietta Memorial Hospital Employee Health Benefit Plan et al. V. Davita inc. Et al (20-1641 In a 7-2 decision, SCOTUS said employer health plans can make all dialysis providers out-of-network opening the door for other employers to make similar changes to their health coverage and encourage workers who have kidney failure to drop their private plans and enroll in Medicare. Writing for the majority, Justice Brett Kavanaugh explained that “If Congress wanted to mandate that group health plans provide particular benefits, or to require that group health plans ensure parity between different kinds of benefits, Congress knew how to write such a law. It did not do so in this statute.”
Background: Currently, if a worker has kidney failure and health insurance through a job, employers must cover that person for 33 months — an initial three-month waiting period as the patient qualifies for Medicare and then the next 30 months. During that time, Medicare fills some coverage holes as a backup to the employer, but after that time lapses, Medicare primarily pays the bills, according to the Medicare Secondary Payer Act. Current law says employers “may not differentiate in the benefits it provides between individuals who have ESRD and others enrolled in the plan, on the basis of the existence of ESRD, or the need for renal dialysis, or in any other manner.” Thus, companies can’t design insurance plans that treat people with kidney failure differently than others.
The issue going forward: with employers free to design insurance benefits that encourage sicker/more at-risk workers to enroll in public insurance programs including Medicare, might other costly conditions be added to ESRD as carve-outs that enable employers to limit their financial risk while maintaining the tax deduction for the benefits they provide? Might high risk pregnancies, severe mental health conditions, and others be added to off-load health costs and care management to Medicare/Medicaid? What is the long-term implication for employer sponsored coverage if it’s geared primarily to healthier workers only? And is Medicare funding adequate to add these populations since its solvency is already in question? Should employers and healthy workers pay higher payroll taxes to accommodate this shift?
June 24: Becerra v. Empire Health Foundation (20-1312) Becerra v. Empire Health Foundation concerns the U.S. Department of Health and Human Services' (HHS) 2005 rule that changed how it calculated the annual reimbursement rate Medicare pays to hospitals serving low-income patients. More specifically, the Empire Health Foundation is challenging HHS' use of the phrase "entitled to" instead of "eligible to" when calculating these payments. In a 5-4 decision, SCOTUS held that “those individuals “entitled to [Medicare Part A] benefits” are all those qualifying for the program, regardless of whether they receive Medicare payments for part or all of a hospital stay.” The majority opinion held that “everyone who qualifies for Medicare benefits in the Medicare fraction—and no one who qualifies for those benefits in the Medicaid fraction—accords with the statute’s attempt to capture, through two separate measurements, two different segments of a hospital’s low-income patient population.”
The issue going forward: calculating payments using this expanded definition for the Medicare fraction will expand payments to Disproportionate Share Hospitals and possibly lead to lower payments to non-DSH hospitals.
June 24, 2022: Dobbs v. Jackson Women’s Health Organization (19-1392) By a vote of 6-3, the Court sided with the Mississippi law that bans abortion after 15 weeks of pregnancy. It concluded “The Constitution does not confer a right to abortion; Roe v. Wade, 410 U. S. 113, and Planned Parenthood of Southeastern Pa. v. Casey, 505 U. S. 833, are overruled; the authority to regulate abortion is returned to the people and their elected representatives.” Justice Alito, author of the majority opinion, added “The Constitution makes no reference to abortion, and no such right is implicitly protected by any constitutional provision. “This ruling reversed the 1992 companion precedent known as Planned Parenthood v. Casey, which held that states can’t impose significant restrictions on abortion before a fetus becomes viable for life outside the womb.
And in a separate 5-4 vote, the court overturned Roe v. Wade, with Chief Justice Roberts switching sides arguing the court should not have decided the broader question of whether the Constitution protects abortion at all (Roe v Wade 1973).
The immediate issue is this: how will regulations be set in the 26 states that are likely to ban/limit abortions including 13 that have "trigger laws" making abortion illegal almost immediately. Regulations outlining access to abortion pills from “certified providers”, access to out-of-state abortion services, the role of telemedicine advisory services and criminality risks for providers and enablers are immediate concerns. Lawmakers in at least 20 states have already proposed restrictions or bans on abortion pills (mifepristone and misoprostol) approved by the FDA for ending pregnancies up to 11 weeks and Attorney General Merrick Garland said: "States may not ban Mifepristone based on disagreement with the FDA’s expert judgment." Thus, access to abortion pills may result in a jurisdictional stand-off between the FDA’s approval process and individual state restrictions.
The longer-term impact is more sobering: how will U.S. infant mortality be impacted—already the highest in industrialized nations. How will employers adjust benefits and assess liability risks associated with coverage for their workforce, especially women of childbearing age? How will abortion opponents address the needs of moms and newborns most directly impacted by restrictions? And so on.
My take:
In the near term, these rulings assure that healthcare, especially abortion-rights, will be prominent in Campaign 2022 and in FY 2023 budget planning for Medicare in DC and Medicaid in states. They’ll prompt every employer to revisit the design of their health benefits programs in light of the potential to off-load costs for ESRD workers. They’ll prompt hospitals that do not benefit from DSH reimbursement method changes to find additional areas for operating cost reductions in anticipation of cuts. And they require every state to prepare for disruption in providing abortion services, whether restricted or otherwise.
The longer-term impact is perhaps more impactful than these short-term effects. Supreme Court Justices are appointed for life. The court’s current composition is conservative-leaning and 3 of the 5 are in their fifties: Thomas (74), Alito (72), Gorsuch (55), Kavanaugh (57) and Barrett (50). With that, a number of challenges to the status quo might work their way through this high court’s conservative filter that’s inclined toward individual freedoms, state’s rights, free market capitalism and competition.
It opens the door for big questions that are likely to work their way through in the courts and potentially be decided by SCOTUS:
- Is access to healthcare in America a right or privilege? What do ‘healthcare, access and affordability' mean?
- When does “life” begin? When does a fetus become a person? at 24 weeks per Roe v. Wade? At 15 weeks per Mississippi?
- Is a state’s abortion policy discriminatory against low-income women?
- Is an employer obligated to provide insurance coverage to all employees? Under what terms may costs be shared?
- Is a private hospital obligated to provide a community benefit? services to low-income citizens?
- What role should personal accountability (health habits) play in eligibility for insurance coverage, and should less accountable persons pay more?
- Per Justice Thomas suggestion, which “enumerated rights” have constitutional protections and which don’t? contraception? same-sex marriage?
- And many others.
While Dobbs v. Jackson Women’s Health Organization has garnered the lion’s share of media attention, the four decisions taken together change the immediate and longer-term future of U.S. healthcare.
It’s a new day.
Paul
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Tbh, I just have more things to do than to be on a message board all day everyday. I came on to see how the woke adult males were taking the news.
Your write up isn't a great depiction of what is actually occurring so after skimming a little, had to TLDR
'Full House' star Jodie Sweetin shoved by police during Roe v. Wade reversal protest
Jodie Sweetin was shoved by police while protesting Roe v. Wade's reversal in Los Angeles.
Rita Moreno recalls botched abortion after Roe v. Wade is overturned
Rita Moreno, who survived a botched abortion before it was legalized, says she is frightened and horrified by the Supreme Court's decision overturning Roe vs. Wade.
These idiots will neveraddress that this is the logical conclusion to this kind of erosion of rights. They just always duck that reality and hit their lil Fox News talking points
Lol you missed the sarcasm bruh. Good points tho.
Its so weird that you’re trying to appropriate DuBois lol. Dude was a nuanced, careful thinker and Civil Rights legend with a scathing leftist critique of institutional and moral failures of this country. He definitely wouldn’t be dapping up with a bunch of weirdo “manosphere”, auth-right idiots online lmao. Especially in the context of hard won Civil Rights being rolled back in 2022.
All these fucking hypocrite religious weirdos up in here are such a trip
No empathy, no decency, no courage… but they’re Godly tho!
Your views are so fucking incoherent. You claim to have a socialist critique but you’re against freedom for gay folks? No wonder you’re so confused on this issue bruh, you don’t have a coherent world view
Log out for a while and develop one. Posting tweets all day can’t substitute for critical thought and it shows.
Paul Walker's daughter Meadow shares abortion experience while condemning Roe v. Wade reversal
Meadow Walker, the daughter of late actor Paul Walker, shared her own abortion experience while condemning Roe v. Wade's reversal.
Lizzo and Live Nation pledge $1 million to support abortion access
Lizzo announced on social media that she and Live Nation will donate $1 million to support access to reproductive health care following the Supreme Court's decision on Friday overturning Roe v. Wade.
You're all over the place slow down..Its so weird that you’re trying to appropriate DuBois lol. Dude was a nuanced, careful thinker and Civil Rights legend with a scathing leftist critique of institutional and moral failures of this country. He definitely wouldn’t be dapping up with a bunch of weirdo “manosphere”, auth-right idiots online lmao. Especially in the context of hard won Civil Righ
All these fucking hypocrite religious weirdos up in here are such a trip
No empathy, no decency, no courage… but they’re Godly
Your views are so fucking incoherent. You claim to have a socialist critique but you’re against freedom for gay folks? No wonder you’re so confused on this issue bruh, you don’t have a coherent world view
Log out for a while and develop one. Posting tweets all day can’t substitute for critical thought and it shows.
1) you seem to want it to be one way when I've clearly stated my stance. I'm not dapping anybody up. They are all shit. I don't participate in the farce not choose sides. I posted dubois because his thoughts would be looked down upon on this board where it's vote or die. Can you not see the correlation?
2) where did I say I was against freedom for gays? I posted a tweet..that isn't me tweeting. You have to slow down and digest and not just ramble on emotionally
LOL, this is what y’all do. Just post some shit and then walk it back when you’re challenged. No intellectual courage or conviction. No ability to really articulate and defend your poorly constructed arguments. I’m not gonna keep replying if this is the best you’re capable of @Supersav . Lol @ the “emotional” stuff, y’all weirdos are a trip
Hollywood reacts to Supreme Court decision to overturn Roe v. Wade: 'This is actually happening'
Taylor Swift, Barack and Michelle Obama, Shonda Rhimes, Bette Midler, and more speak out against the Supreme Court's decision to overturn Roe v. Wade.
I've articulated my argument. I posted dubois thoughts and we agree. Do you?LOL, this is what y’all do. Just post some shit and then walk it back when you’re challenged. No intellectual courage or conviction. No ability to really articulate and defend your poorly constructed arguments. I’m not gonna keep replying if this is the best you’re capable of @Supersav . Lol @ the “emotional” stuff, y’all weirdos are a trip
Even you providing them the direct quotes indicating the reason for Planned Parenthood, they will still cape for Caucasian women. What kind of brainwashing is that?
I brought up this scenario with someone who is very reasonable and she STILL finds issue with women being responsible for their bodies. Women are the gatekeepers to their vaginas (yes, rapes occur pls do not make this a talking point).
This govt supports the separation of a father from his kid. Women are rewarded for keeping them separated in low income areas.
So many okiedokes in the black community but ppl have been trained to value these traps, even the intelligent individuals on this board.
It's like chitlins, the worst part of the worst animal to eat has been turned into a highly valued delicacy.
I think it’s disingenuous to pretend that DuBois would hold the exact same opinion in the current context of established Civil Rights law being rolled back by fascists. Dude died right before the Civil Rights and Voting Rights Acts were passed. Given his deep empathy and careful thinking, I’d find it hard to believe that he spend all day posting tweets finding common cause with authoritarian morons lol. He’d probably have something interesting to say, certainly something more interesting and nuanced than the bullshit you’re posting here, which is indistinguishable from the Breitbart level commentary our resident weirdo conservatives are pumping out (and which you’re co-signing lol).
Not only do I believe that Democrats won't expand the Court, I also believe that Republicans, should they regain power, will absolutely expand it. And all of their followers that have been screaming and crying about how unfair it would be will go dead-ass silent about it.I forgot that Amy Coney Barrett was put on the court 8 days before the election..
Dems need to get rid of the filibuster and expand the courts. Weak Dems won't do it though but I bet if it was the other way around the Republicans would.
I feel like after attending freak nik, Caribana and the Puerto Rican Day parades at they peak as a young man?
And being a major contributor on the site for well over a decade?
I am the absolute last person to comment or judge what and how women protest or use their bodies.
Let these women have they say.
Establishment Dems be like…
Meanwhile Republicans attempt to govern towards their terrible ambitions as if they were the team assembled by Arnold in Predator. Niggas have Gatling guns and everything… while Dems are waxing their mustaches and discussing civility and the Queensbury Rules.
He died a socialist in Ghana basically exiled but you think he'd be fighting for the democrats lmao..you got it
Who said he’d be fighting for the Dems? He’d have a more interesting, nuanced and coherent take than you though for sure partner. Keep posting your lil tweets! lol
Because Democrats as a unit do not have sweeping goals like Republicans do. It's a lot easier to be wholesale oppressive and restrictive than it is to exact actual positive change.
Which is not me giving Dems a pass. Their main thing is "fighting the tyranny of the GOP", and it's the only thing they seem to agree on. I know they've had to try and fix a lot of the damage of the previous administration and all of that, but they absolutely could get more done if they chose to. They don't want to upset the middle of the road voters by being extremists.
Meanwhile, Republicans are literally stripping people's rights away, and those same middle-road voters are backing them because "at least they do something". Humanity as a collective group is very bad at decision-making.
Damn.
But he wouldn't agree with you..that's all that matters
Seriously let them and Florida go but let us get the black people out first.
This is a real ass post. Republicans play the long game and for the most part they stay on brand. Anyone step out of line they get primaried. Trump should've had one Supreme Court pick. But the Republicans denied Obama his Merrick Garland pick over some shit that isn't even an official rule. Only to double back on that shit four years later. RBG with her failing health should've retired during Obama's 2nd term.
We can downplay Trump as the idiot he is but that idiot got three fucking SC justices on the bench and dems weren't forward thinking enough to stop it before it happened and too afraid to do anything about it now (expanding the court).
This wouldn't go how they think it would. Whole digital infrastructure would be down on day one. How tf they gon export that oil since succession is an act of war and there's probably be a blockade in the Gulf.
I do (jokingly) agree with your point though. We should give Texas back to Mexico and tell Spain we're sorry and hand back over Florida.
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