Legislative Update: Week of June 25th (Special Edition)

Back in late March the Supreme Court of the United States took up the four suits surrounding the Patient Protection and Affordable Care Act. The four major questions that were considered by the court over the three days were:

1.      Is the penalty fee for not complying with insurance mandate considered a tax and if it is not if the Anti-Injunction Act, which does not allow persons to sue the government over taxes, to have jurisdiction over this penalty?

2.      Is the mandate to purchase health insurance unconstitutional?

3.      If the mandate is determined unconstitutional does the rest of the bill still have standing (severability)?

4.      Does the expansion of Medicaid coerce the States to participate in the expansion?

Today the court renders its decisions on these questions, let's review the opinion:

Chief Justice John Roberts delivering
the Court's opinion (courtsey of AP)

The court today issued its opinion combining all of the cases together and rendered its opinion in National Federation of Independent Business v. Sebelius, Chief Justice John Roberts issued the opinion of the court which affirmed some parts of the act and reversed other parts of the act. Lets break down the issues:

Anti-Injunction Act:

The question that was raised whether the penalty imposed for not buying insurance is protected under the Anti-Injunction Act (AIA). The AIA provides protections to the government limiting the ability of someone to sue the government over taxes. The taxes need to be in effect before a suit may be filed for harm by the tax. Arguments were that since this was a penalty and not a tax the people had the ability to sue before the penalty took effect to stop the future harm it could have caused. Chief Justice Roberts along with Justices Ginsberg, Kagen, Sotomayor and Breyer disagreed with that argument says that the government claims for protection under the AIA was upheld due to the next issue.

Individual Mandate:

Arguments against the mandate claimed that the commerce clause of the Constitution did not give Congress the authority to compel the purchase of goods and services and that the ACA compelled the people to purchase health insurance. The government disagreed with this argument and also argued that Congress also had the authority to mandate the purchase of health insurance since the penalty is a tax to those who do not purchase and Congress has the authority to levy taxes under the Constitution.

The majority of the court agreed that the commerce clause of the Constitution did not have the authority to compel the people to purchase a product but the court did uphold the mandate agreeing with the government's second argument that the penalty was a tax and Congress has the authority to levy taxes and that the government is taxing the people either through the purchase of insurance or those choosing the pay the penalty for not purchasing.  Chief Justice Roberts writes,

"The Federal Government does not have the power to order people to buy health insurance. Section 5000A would therefore be unconstitutional if read as a command. The Federal Government does have the power to impose a tax on those without health insurance. Section 5000A is therefore constitutional, because it can reasonably be read as a tax."

Since the Court ruled that this was indeed a tax the arguments for the AIA issue above by those against the ACA fall.

Severability:

This was a non issue due to the mandate being upheld.

Medicaid:

This section is where those who were against the government actually won their arguments with the Justices. Those against the ACA stated that the Government did not have the ability to "bully" States into the Medicaid expansion by stating their entire funding would be taken away providing the opportunity to be coerced into expanding their Medicaid programs. The Government argued that this was a Government program and Congress had the ability to create any condition and terms for the program it saw fit. The Court disagreed with that opinion. The Court opined that the Government could not keep existing Medicaid funding away from the States that choose not the expand their Medicaid program.

Chief Justice Roberts stated, "The threatened loss of over 10 percent of a State's overall budget is economic dragooning that leaved the States with no real option but to acquiesce in the Medicaid expansion." This now leaves the option to the States whether they choose to expand their Medicaid coverage to the population requirements set in the ACA.

At the end the decision was 5-4 with Chief Justice Roberts and Justices Ginsberg, Breyer, Sotomayor and Kagen concurring and Justices Scalia, Kennedy, Alito and Thomas dissenting.

Chief Justice Roberts finished his opinion with this:

"The Framers created a Federal Government of limited powers, and assigned to this Court the duty of enforcing those limits. The Court does so today. But the Court does not express any opinion on the wisdom of the Affordable Care Act. Under the Constitution, that is the judgment is reserved to the people."

For the entire opinion from the court click here.

Legislative Update: Spring Wrap Up

Now that the legislature has moved into a summer session calendar it’s time to wrap up on some of the issues that have been on the radar of the Medical Society, let’s review:

Budget:

This year saw another cut scheduled for Graduate Medical Education with the introduction of the Governor's budget recommendation. Governor Snyder wanted to take $17 Million out of the program for other uses, the legislature in some ways disagreed with that recommendations and only took $8.5 Million which was much better than what the Governor has recommended. Primary care physicians will now start to see an increase in Medicaid rates thanks to the Affordable Care Act providing an increase in Medicaid funding to the tune of $281 Million. Included in Medicaid now is payment for services surrounding Autism and OB/GYN's receiving a small bump in their reimbursement rates. We now look to find a way to restore the $8.5 Million that was cut from GME in the coming months.

Helmet Law:

This spring the long battle to keep helmets on motorcyclists was finally lost with the Senate pushing the repeal of the helmet requirement for all motorcyclists in Michigan. As disappointing as this development was MSMS continues to push for the safety of all motorists on the roads, motorcyclists or not and is pushing for the tracking of individuals that were involved in accidents and whether a helmet was used to see if personal freedom is really worth the safety of all.

Medical Marihuana:

MSMS worked with members in the House and the House Judiciary committee to help create a narrow definition of what a patient-physician relationship is when concerning Medical Marihuana. The statute currently in place provided no direction on that relationship leaving many ambiguities when dealing with Marihuana. This definition now provides protections to both patient and physician when dealing with certification for the substance. This bill was sent to the Senate where it is in the Senate Judiciary committee awaiting a vote to the Senate floor.

Abortion:

Before the House left for the summer they attempted to jam a package of bills through the House that dealt with four issues supported by right to life. These issues ranged from the banning of the practice of tele-abortions to requiring increased levels of liability coverage for those who perform a certain amount of abortions. This was a heated issue between those for and against leaving for one interesting committee meeting where then the bills were voted out of committee on the same day as the hearing, which is uncommon for this legislature. This practice left some with a sour taste in their mouths leaving for nothing short of a floor fight which left some members without speaking privileges after the debates on the House floor. The main bill of the package was passed out sent to the Senate, where it is unknown if the Senate even wants to address this hot potato.

Autism:

A small victory but one that could lead to total mental health parity, the legislature finally required that health insurers, private and public, cover the costs associated with Autism. Those who were against providing the coverage were finally able to come to a compromise with the help and encouragement of the Lieutenant Governor. This issue has been close to him since he was a member of the House, so it was fitting that he signed the bill the put this into law. MSMS hopes that this issue will not stop here and the fight will continue until we get total mental health parity.

Tort Reform:

MSMS over the past month has started to push tort reforms for the purposes of finding ways to increase access to patients all over Michigan who need the care. With the Affordable Care Act reforms hanging the balance, the increase of patients who cannot gain access just by the sure numbers of physicians are staying stable while the demand rises sharply, we find that there is simply not enough in the workforce to meet the demand. With the reforms it would make Michigan a more attractive place to practice medicine providing more opportunities for physicians to come and practice here, answering the question of how we address those who need the care and can't find it. The bills started in the Senate and still await a vote from the Senate Insurance committee. MSMS is hopeful that the legislation will be move soon to help those patients who need it the most.

MSMS now looks towards the fall where issues like tort reform, auto insurance reform, and others still linger from the spring session. Once the legislature gets back into session, MSMS will continue to cover all of the activity for you. Just go to http://www.msms.org/advocacy to stay up to date with all that is happening in Lansing and beyond. The Legislative update will be back in July to cover the one session day scheduled for the legislature.

Legislative Update: Week of June 11th

As time winds down on the legislative calendar with the summer break coming at the end of Thursday, the activity in both chambers ramped up with the chambers considering school retiree reform, tax reform, the new bridge to Canada, abortion and more. Let's review the activities of the final week before summer break:

House:

With session times being set to earlier times this week, most House committees did not meet this week.

The full House considered several issues this week but one of the most controversial came from the House Health Policy committee, the abortion omnibus, House Bill 5711. This bill was the main part of the three bill package that addressed several issues that Right to Life Michigan considered important to consider. Debate on the floor was emotional, heated, and provided for several gavels from the speaker for inappropriate remarks. Several members from both sides of the aisle had commented on their desire not to vote on the legislation stating that it went way to far based on the comments of supporters of the package said were a problem. After the debate, the House did vote on 5711 with it passing 70-39 (Roll Call # 448).

Senate:

The Senate did have committees this week but were very limited in the time they had to meet. The Senate Insurance committee continued again to take testimony on the Patient's First Reform package. Many stories were with the committee that said their physician had some if not all of the responsibility in their stories and how the package would not allow the physician and those who were wronged to receive the justice they deserve. At the end of the committee they did not take a vote on the package, with it now moving into the summer months.

The Senate Judiciary committee considered and took testimony on several items concerning Michigan's Medical Marihuana program including the MSMS supported House Bill 4851 which defines the patient/physician relationship when dealing with medical marihuana. It is unknown when the committee is expected to vote out the legislation. The Senate Health Policy committee also met to consider Senate Bill 975 which provides an opportunity for a health professional if they choose not to treat based on religious objections to what treatment is required. The committee just took testimony on the legislation similar to what they did last week on the nursing scope expansion bill. It is unknown when the committee will consider the legislation again.

The Senate floor was less lively than the House's this week but they did move a two pieces of legislation that is supported by MSMS. Senate Bills 402 and 403 that provides protections for physicians to voluntarily report patients to the Secretary of State if they believe in their professional judgment that the patient is impaired and not able to drive. Physicians are not making the decision whether the patient can drive or not, that is the duty of the Secretary of State, but it allows them to report and have liability protections for reporting to the Secretary of State. These bills were voted out of the Senate and sent to the House for their consideration.

Now the legislature goes on break until July 18th where they will meet for one day. The MSMS Legislative blog will be taking a break until the Legislature comes back into session unless there is breaking election news to post. Stay with the MSMS advocacy section of the website at http://www.msms.org/advocacy. Also with elections right around the corner your support of the candidates helps keep things like tort reform intact. Go to http://www.mdpac.org to see how you can help!

Legislative Update: Week of June 4th

This week saw the Senate concentrating on finishing up the budget, making this two years in a row that the budget for the state has been finished before the annual summer recess. The House concentrated on its income tax relief package at the beginning of the week and passing more education reforms by the end of the week. Lets take a closer look though at items that have an impact on medicine:

House:

The House Health Policy committee met this week to consider House Bill 5711, 5712, and 5713 which amend the public health code to cover several changes concerning abortion. As with abortion, testimony was very emotional, with the Michigan chapter of Right to Life starting out the testimony. 5711 is an omnibus bill that took four pieces of legislation and smashed them together creating a bill that dealt with fetal remain disposal, liability coverage for those preforming a abortion, and two with coercion and being forced into an abortion. Dr.Matthew Allswede, a obstetrician and President of the Michigan chapter of the American Congress of Obstetricians and Gynecologists testified summing up that with the passage of these bills they face threatening further growing the need for obstetricians in the state. Some members of the committee from both sides of the aisle had issues with the legislation but at the end of the day were forced to vote the legislation out of committee. The bills now await action on the House floor which will happen next week.

The House Judiciary committee was scheduled to meet but was canceled due to the impending problems with Detroit lighting. Hopefully the committee will meet this coming Thursday, pending any other reasons to postpone the hearing.

Senate:

The Senate Health Policy committee met this week, although very briefly, considered and took testimony on Senate Bill 481 which would increase the scope of practice for advance practice nurses. MSMS stands adamantly opposed to the expansion and expressed those concerns with the committee. Since the committee was short on time no action was taken on the legislation and it rumored to be reworked in a way that physicians could consider. Once we have more information, we will be sure to share it, as for now we stand ready to work with the committee and fight irresponsible expansion of scope.

The Senate Insurance committee was also short on time this week but continued taking testimony on the Senate version of the Patients First Reform package (SB 1115-1118). It is also rumored that the committee could consider taking a vote next week on the legislation. Stay tuned for updates.

Elections:

The race for congress in Michigan's 11th district just got dicier as the Secretary of State finds that the signatures to get on the primary ballot may have been forged by someone in Rep. McCotter's campaign therefore not making him eligible for the ballot, leaving a virtual unknown running as the Republican front runner. Former Michigan Senator Nancy Cassis as committed to running a write-in campaign to hopefully win the primary ballot. If this happens, it will be the first time that this has been successful in Michigan for that particular office. Things will now heat up in Michigan's 11th.

On a personal note we at MSMS want to offer our condolences to Senator Goeff Hansen and his family with the loss of their son. All of us at MSMS offer our thoughts and prayers through this difficult time.

Continue to stay with MSMS Legislative Update to gain all the information happening at the capitol and more go to http://www.msms.org/advocacy.

MDPAC needs your help to keep Michigan's tort reform intact! Support MDPAC today at http://www.mdpac.org.

Legislative Update: Week of May 28th

This week saw a flurry of budget activity this week with conference committees meeting throughout the Tuesday, Wednesday, Thursday period. The House also took the time to push a cut in the Michigan income tax that was scheduled to come at the beginning of next year ahead of schedule. The House spent most of Thursday night in session, passing all but the education budget, scheduling an unusual Friday session day for the House. Lets review the rest of the week in Lansing:

Senate:

The Senate Insurance committee continued taking testimony on Senate bills 1115-1118, the Patients First Reform package that amends Michigan's tort reform to protect access to Michigan's patients. MSMS testified last week in the committee, coverage on that can be found in last week article. The committee is expected to take a vote on the legislation this coming Tuesday. The Senate Health Policy committee scheduled a hearing for Thursday to take up Senate bill 481 which would expand the scope of practice and provide independence for advance practice nurses. Due to the budget, the committee was cancelled and scheduled for this coming Wednesday at 9:00am.

House:

The House worked long through the week, even into Friday working on the budget. While waiting for the conference committees to come to a conclusion they had the ability to work on some of the other lingering issues. The House did pass House bill 5338 which would amend the public health code to allow the Director of the Department of Community Health to issue orders to place designer substances on the controlled substances list i.e. K2. As mentioned before the House did pass their version of tax relief by upping the time when the rollback of the income tax would take effect.

Budget:

Budget was the main story this week. The Senate passed through all of its individual budget conference reports and the government omnibus that included everything but education funding. The House did the same with the government omnibus but had to wait until Friday's session to pass the education omnibus or "school bus" as it was affectionately called.

The Department of Community Health budget saw some good come out of the conference report. First the legislature rejected the $17 million cut to GME suggested by the governor; rather the legislature funded it with an extra $8.6 million more than what the governor had proposed and a victory from looking at such a substantial cut. Primary care physicians are going to see a rise in their reimbursement rates from Medicaid as $281 Million of federal funding was put into Medicaid to raise the rates for primary care (excluding ER physicians and some OB services) to Medicare rates. This change was a part of the Affordable Care Act. Investments in Health Kids Dental, Medicaid coverage for Autism, and Health Michigan Fund were all positive and more than had expected. The budget now goes to the Governor for his signature.

For the latest legislative news and activity check out http://www.msms.org/advocacy. Help support those who support you, go to http://www.mdpac.org to find out how you can help!