I’m tired of the Medicare fight. But I’m afraid we’ll have to endure it for at least another 18 months since 2012 election politicking has already started, and Medicare is the hot issue.

If we want to save Medicare, which political party should we trust?

The Republicans say that Medicare will go broke because Democrats are doing nothing to make it solvent. The Democrats say that Medicare will no longer exist if Republicans get their way. Both sides are using the issue to whip up fear among seniors who are on Medicare now, and near-seniors who are looking forward to getting Medicare.

Demagoguery on Medicare is nothing new. In recent history, during the debates on the Affordable Care Act (ACA) in 2009 and 2010, opponents accused supporters of “cutting Medicare.” As with most sound bites, the actual truth was a bit more complex. The ACA cut funds to Medicare Advantage plans, which are optional private insurance plans that seniors can get. They sometimes offer additional benefits such as vision and dental coverage.

(I don’t know exactly why Medicare Advantage came to be, but I do remember that Sr. Catherine Pinkerton, who was NETWORK’s healthcare lobbyist at the time, saw this as a step toward privatizing Medicare and did not approve.)

It turns out that the federal government pays about 11%  more for each Medicare Advantage enrollee than it does for an enrollee in traditional Medicare. This is due to a complicated formula that allowed Medicare Advantage insurance companies to get higher payments than traditional Medicare fee-for-service costs. Most of these overpayments went to the insurance companies, not to additional benefits for the people enrolled. So in an attempt to cut growing Medicare costs, the ACA will restructure payments to Medicare Advantage insurance companies to bring them more in line with traditional Medicare costs. But there were no cuts to basic Medicare benefits in the ACA.

Now the Democrats are saying they want to preserve “Medicare as we know it”, meaning the traditional Medicare plan run by the government. And Republicans want to change Medicare into a plan that would give government subsidies to seniors to buy private insurance. To me, the Republican plan sounds similar to what the ACA did for people under 65 who couldn’t afford insurance: give subsidies to help them buy insurance in the private market. So I’m not sure why Republicans complain so much about the ACA if they like that idea.

I do know why most seniors don’t like the private insurance idea. Seniors typically need more healthcare than younger people do, and it cost them more to get it. The Republican-proposed subsidies would not increase at the same rate that healthcare costs increase. And I’m guessing that seniors would have more “pre-existing” conditions when they retire and therefore have a hard time getting private insurance. Come to think of it, isn’t that why Medicare (as we know it) was put in place to begin with?

Most people agree that we need to find ways to control not just Medicare costs, but healthcare costs in general. The Affordable Care Act has many provisions to experiment with different ways to pay for healthcare services. Some of these have the potential to make our whole healthcare system more effective and efficient.

We should give the ACA a chance to work, and build on what we learn to do more to control healthcare costs for everyone. Other countries have done this, and America should be able to do this too.

I just hope we don’t have to wait another 18 months before we can have a rational discussion on healthcare.

If you would like to read a little more about the current Medicare fight, I recommend this article:http://www.kaiserhealthnews.org/Columns/2011/May/052511cohn.aspx

Over the past 40 years, NETWORK has made healthcare a top priority in our lobby and legislative advocacy work. Eighteen months ago, we were gratified by the passing of healthcare reform. However, we are still working to guarantee that the progress we made is not reversed.

NETWORK’s Executive Director, Sr. Simone Campbell, highlighted the many benefits of the bill and explained why we must continue to work to preserve it in an online interview. She also reiterated that this is a responsible prolife bill that does not subsidize abortions.

Listen to the full interview here.

Already, major improvements have been made in many areas:

• Coverage has already been extended to over one million Americans
• Limitations on obtaining healthcare for those with preexisting conditions are being eliminated.
• Working to ensure that we, as consumers, are not exploited.
• Making sure we do not lose healthcare when changing jobs.

We have much more to look forward to. This bill will promote competition in the market place in order to bring prices down.

For more information on the Patient Protection and Affordable Care Act, visit Healthcare.gov. This website offers a wide range of resources explaining the law and allows you to shop comparatively for health insurance.

For the nearly two million college seniors across the country, this spring will be one of the most intimidating, stressful and exciting points in their lives. Years of hard work in the classroom will finally be rewarded in the form of a diploma. Some will choose to continue their education. Some will submit their resumes to job openings, working tirelessly to secure work. Some will be fortunate enough to begin their careers immediately after walking across the graduation stage. However, no one will have to fear losing their health insurance.

One year ago, I found myself in the same whirlwind the Class of 2012 is now absorbed in. I began the process of submitting my resume to numerous organizations. As I started the interview process, I reflected on which path would be the best way forward in my efforts to advocate for those who did not have a voice in their society. Whether it was in the field of communications, grassroots activism, or other non-profit career paths, my first venture into the professional realm post-college would undoubtedly shape the rest of my life. This was a decision that would not weigh lightly on me.

When I found out I had been accepted as a NETWORK Lobby Associate in March 2011, there was no hesitation in my acceptance of the position. This is exactly where I needed to be. Their work was inspiring and shaped the lives of millions of people across the country. Every day, I would be able to work alongside a dedicated staff who would not be idle in the midst of a gridlocked climate that ignored the needs of people in poverty.

Had I graduated a year beforehand, I would not have had this opportunity.

If the Patient Protection and Affordable Care Act had not been signed into law on March 23, 2010, I could have faced a three-month gap in health coverage, as NETWORK’s Associate Program begins on September 1. This provision in the law allows me to stay covered under my parents’ insurance coverage until the age of 26, and now over 2.5 million young adults find themselves with health coverage.

Without healthcare reform, I would have considered other job options first and foremost because maintaining my healthcare coverage would have been a priority. Because I was able to stay under my parents’ health insurance coverage, I was secure in choosing the path that I felt compelled to take based not on health insurance, but on what career would allow me to advocate for issues I care about.

For young adults like myself, this is a personal and moral issue. I’m also not alone in this essential benefit. Before the act passed, 40% of all the uninsured came from the youth population between the ages of 18 and 34. My fellow Associates also understand the moral importance of protecting the law.

“I am so grateful to be able to stay on my parents’ insurance. Individual policies are very expensive compared to group plans, and since I am working a public interest job, paying the lower premium on my parents’ plan has allowed me to stretch my tight finances.  I’ll be going to graduate school in the fall, and the ACA prevents me from being uncovered between the end of my job and the beginning of school, as well as preventing the disruption of switching to the school’s insurance plan. Additionally, unlike my older brothers, I am fortunate to not have to face the uncertainty of not having health insurance during transitional phases from college to the workplace, or while changing employers. My oldest brother had to keep switching insurers, choosing from pricey individual policies that didn’t provide sufficient coverage. Ultimately, without the ACA, young adults who are not at the height of their earning potential are put in a difficult spot.” –Claire Wheeler, NETWORK Lobby Associate

“It is a blessing to not have to worry about having healthcare when my associate program here at NETWORK wraps up later this year. If I was not able to stay under my parents’ insurance while I looked for my next career move, whether it be a new job or a graduate school program, it would be a much more challenging time in my life if I had to worry about how to afford the medical services I rely on.”­ –Matt Shuster, NETWORK Field Associate.

As the Supreme Court debates the constitutionality of the healthcare coverage, we must think of the wellbeing of all those who would not have coverage today without the Affordable Care Act.

We must think of the three-year-old who would not have coverage after her fifth birthday because it would be too expensive. We must think of the college graduate struggling to find a job, unable to visit a doctor because he was unable to stay on his parents’ insurance coverage. We must think of the child denied health insurance because of a condition she was born with. We must think of marginalized families living just above the poverty level who will now have affordable access to healthcare. We must think of the common good, and what it says of our society if the law is overturned.

On Wednesday morning, the third day of oral arguments involving the constitutional challenges to the Affordable Care Act, the Supreme Court explored this question: If we find that the “individual mandate” is unconstitutional, does the absence of a severability clause mean that the whole law is unconstitutional?

The coalition of states argued that the failure of Congress to include a severability clause in the law means that, if one clause is stricken, all must be stricken. As such, if the individual mandate, described as the “heart of the law” is found to be unconstitutional, then they must strike the entire ACA.  A well-worded “severability clause” in the law would have definitely preserved the rest of the law if another part were found to be unconstitutional.  Nevertheless, the absence of such a clause does not mean that the Court is automatically obligated to strike the whole law just because one provision is found to be unconstitutional.  The government attorneys argued as much and pleaded with the Court to practice restraint. They argued that, if one part was unconstitutional, then the rest of the law could be left to stand alone. So, oral argument was heard on Wednesday morning regarding this question. Court observers noted that ultra-conservative judges seemed to favor striking the law in its entirety if the individual mandate, called the heart of the law, was found unconstitutional.

An afternoon session was held to ascertain whether the health law’s expansion of the Medicaid program for the working poor compels the participation of states to such a degree as to amount to coercion. The ACA requires those states that are participating in the Medicaid program to increase the amount of income one may earn to 133% of the national poverty level (which is about $23,000 for a family of four) when deciding upon eligibility.

The states contend that they need help with care of their poor residents and they must take federal funding. However, they allege it violates their sovereignty and it is unduly burdensome to increase the amount of people on Medicaid.  Basically, the states argued that the offer of federal monies for Medicaid, which is co-sponsored by the states at varying percentages, is too good to pass up.  As such, they continue, it amount s to a coercive, and therefore, unconstitutional mandate.  However, the “offer you cannot refuse” argument seemed to lack acceptance from the judges. The administration argued that Congress has always been permitted to put conditions upon money awarded to states. Further, they contended, there is no coercion in making the deal so sweet that the states definitely want to take advantage of it. No program in which Congress has attached a condition to release federal dollars has ever been found to be “coercive.” A previous federal program that awarded money for highway construction to states that rose the drinking age to 21 years has been upheld by the Court. This issue seems to be a win for the administration but there are skeptics among pundits.

Lastly, much attention has been given to Justice Anthony Kennedy’s reactions and questions because he is considered a swing vote for the individual mandate issue and the possible death of the whole law if the mandate is found unconstitutional. Kennedy is a Catholic.

Although Solicitor General Donald B. Verrilli was uniformly said to have given a far better performance on this last day than the second day, the ACA is not on certain ground. Verrilli’s closing argument conceded that there was indeed an argument to be made for liberty. He argued that access to healthcare and the freedom from feeling the crushing weight of illness are also forms of liberty which need to be protected.

NETWORK continues to offer its full and prayerful support for the Affordable Care Act of 2010.

Original Post From March 28:

The Supreme Court convened on Monday, March 26, 2012, to hear arguments concerning the constitutionality of two provisions in the much-debated, highly partisan Affordable Care Act. The Court has agreed to hear arguments on four separate issues:

• Is the case too premature to be brought before a court?
• Does Congress have the power to mandate that an individual purchase health insurance?
• Does the expansion of Medicaid unduly burden the states?
• Must the entire law be declared null if one part is found to be unconstitutional?

On Monday, March 26, the Justices heard arguments to determine whether an antiquated tax law would bar the case from even being litigated at present. It was not an issue that was appealed by either the coalition of states or the federal government and it does not have anything to do with the actual law under review. On the contrary, the High Court, of its own accord, requested Robert A. Long, a private attorney, to present the argument that the Anti-Injunction Act bars litigation of this lawsuit because the Act states that one must pay the tax before one can complain about it. Since the penalties will not be due until April of 2015, the argument continues, this case is too premature to be heard. Both parties to the case want the case to be heard and opposed Mr. Long. At the end of the day, most Court observers believed that the Justices will choose to decide the constitutional question of whether Congress exceeded its powers despite arguments that the challenge was brought too soon.

Arguments concerning the constitutionality of issues within the Affordable Care Act were slated for Tuesday and Wednesday.

On Tuesday, the Justices heard arguments related to the constitutionality of the mandate that all persons must purchase insurance by August 2014. Failure to purchase insurance would result in the levy of monetary fines that would be due with one’s income taxes by April 15, 2015. Specifically, the Court must answer the question, “Does Congress have the power, under the powers of commerce regulation, to mandate individuals to purchase insurance?”

The 26 plaintiff states, led by Florida, and one business, argued that mandated insurance is an overreach of governmental powers. They maintain that individuals should not be forced to buy insurance because it is a “product that they may not want or need.” Paul Clement, lead attorney for the individual states’ case, reasoned that many things are good for one’s health but individuals should not be forced to purchase them.  Clement also contended that it was a violation of privacy and a slippery slope to mandate what products a citizen must purchase. Solicitor General Verilli, arguing for the government, stated that the law merely regulates a commerce that already exists and is universally used. Unlike a refusal to purchase broccoli, those who do not purchase insurance will, nevertheless, eventually utilize healthcare systems. Delayed diagnoses and treatment result in higher costs for emergency and complicated care that may have been avoided with preventive or early treatment.

Court observers gave mixed opinions regarding possible rulings individual Justices may make, citing strenuous questioning of the Solicitor General by the Justices.

On Wednesday, the two hearings scheduled will address whether the entire ACA must be voided if the individual mandate is found unconstitutional and whether the expansion of Medicaid coverage to those living at 133% of poverty level unduly burdens the states*.

The Court must publish its rulings by June 30, 2012.

NETWORK continues to offer its full support of the Affordable Care Act.

*NETWORK took a leadership role in organizing the distribution and signing of an amicus brief concerning Medicaid expansion, which was filed in the U.S. Supreme Court.

This week began with Monday’s news about lawsuits being filed by a group of Catholic dioceses, universities and others challenging HHS regulations that insurers cover contraception. Because of NETWORK’s long history of working on healthcare issues, our Executive Director, Sister Simone Campbell, was immediately asked to comment, and she appeared that evening on Hardball with Chris Matthews to present her views.

Today, an op-ed by Cardinal Donald Wuerl appeared in the Washington Post. In it, he claimed that the lawsuits are not about money or even about contraception. They are, he stated, about “religious freedom” and the Bill of Rights.

Are they really about religious freedom – or are they about something else? Many believe that politics and power are actually at the heart of this battle.

When the administration first proposed the insurance mandate regarding contraception a few months ago, NETWORK stood with other Catholic groups and individuals in opposition. The administration quickly proposed an accommodation that would address some of the earlier problems regarding conscience protections. We then expressed our gratitude that “through thoughtful consideration of the competing needs of people of different faith perspectives the administration has found a way to honor faith-based conscience objections.” We have also continued to support ongoing negotiations as details are ironed out.

Why, then, were the lawsuits filed this week, many months before the regulation is even to take effect and while negotiations about the administration’s proposed accommodation are still going on? Why do so many conservative pundits stubbornly refuse to admit that this accommodation was even made – or that negotiations about its details continue to this day? Questions to ponder.

Also, we cannot ignore the fact that the Bishops are about to begin their highly financed, PR-driven “Fortnight for Freedom” campaign next month. A little publicity this month regarding the lawsuits can’t hurt.

And it is no coincidence that this is an election year.

Commonweal’s recent editorial about the Bishops’ campaign raises an important point: “This initiative is being launched during an election year in which one party has assumed the mantle of faith and charges the other with attacking religion. The bishops need to do much more to prevent their national campaign from becoming a not-very-covert rallying point for the Republican Party and its candidates.”

Early signs are not entirely promising. Some prominent Bishops have been quoted making highly disparaging comments about President Obama, with Bishop Daniel Jenky even comparing him to Hitler and Stalin. Cardinal Timothy Dolan went on CBS news this week, where he described the Church’s “horror” at “straightjacketed, handcuffing” and “strangling” religious exemptions in the administration’s HHS proposal.

But, thank God, we have also learned that some Bishops are expressing serious reservations about current tactics. E.J. Dionne gave hope to many Catholic moderates in an op-ed this week. Describing the lawsuits filed on Monday, he wrote, “But the other side of this news was also significant: That the vast majority of the nation’s 195 dioceses did not go to court. It turns out that many bishops, notably the church leadership in California, saw the litigation as premature.”  And referencing the “Fortnight for Freedom,” he noted that “there are reports that some bishops will play down or largely ignore the Fortnight for Freedom campaign, scheduled for June 21 to July 4, in their own dioceses. These bishops fear that it has become enmeshed in Republican election-year politics and see many of its chief promoters, notably Archbishop William E. Lori of Baltimore, as too strident.”

So where do we go from here? Can Catholics come together again to focus more strongly on our Gospel mission, or will our Church become more and more caught up in conservative Republican efforts to deny President Obama a second term?

Time will tell, and prayers are needed.

It’s hard to believe that just a few months ago I was sitting in a college classroom taking a course on Politics and Public Health Advocacy, while today I’m using the knowledge and tools I gained from my public health courses everyday as part of my role at NETWORK. As a public health student, I was riveted by the debate that occurred as the Affordable Care Act (ACA) made its way through Congress, and I joined many in celebration when such an historic piece of legislation was finally passed and later upheld by the Supreme Court. Yet, despite the great strides made by the ACA, public health and healthcare advocacy does not end with its passage. There is still so much to do in order to ensure that all Americans have access to quality, affordable healthcare.

One particular area for continued advocacy is the Medicaid expansion, which was essentially made optional for states by the Supreme Court’s ruling on the ACA. The expansion calls for extending Medicaid eligibility to all individuals under the age of 65 with incomes up to 133% of the poverty line, which would result in millions of newly insured individuals. As a public health student I spent time volunteering in a safety net health clinic, whose resources and dedicated staff were stretched thin trying to meet the needs of all of their uninsured patients. For many others who are uninsured, a hospital emergency room is their only source of care. For those without insurance, easily treatable, or even preventable illnesses quickly grow into major health crises, as seeking out medical care is postponed as long as physically possible.

A healthcare system that leaves so many uninsured has very serious consequences—life and death consequences, in fact. Each year in the United States, approximately 45,000 deaths are associated with a lack of health insurance. Overall, uninsured adults under the age of 65 have a 40% higher risk of death than those who are insured. Several states have previously expanded their Medicaid programs, and a recent study finds that in three of these states—New York, Maine and Arizona—the Medicaid expansions were associated with 6.1% fewer deaths. A similar study out of Oregon found that not only did those on Medicaid report better health, but they also experienced improved financial security. This is what is at stake with the Medicaid expansion.

However, despite the benefits of expanding Medicaid, and despite 100% of the costs of the expansion being financed by the federal government until 2016, gradually decreasing to 90% in 2020 and after, many stateshave indicated they will refuse the expansion, while still others have yet to decide. Clearly, the struggle for quality, affordable healthcare is not over.

From studying public health at a Jesuit university, I learned to critically evaluate healthcare policy for its impact on the most marginalized in society, so I am honored and excited to continue to advocate for those on the margins in my work with NETWORK on the Medicaid expansion.

NETWORK will be working closely with our members and allies in states across the U.S. to convince governors to accept the Medicaid expansion. We invite all nuns, and anyone else who wants to “get on the bus” with us, to form teams of activists to lobby your governors to support the Medicaid expansion in your state. We have put together a Medicaid expansion toolkit that provides information on the Medicaid expansion, how to lobby your governors, and how to publicize your actions. Email me at [email protected] if you want to get involved or have any questions!