First Edition: March 29, 2012

Today's health policy headlines include reports detailing Wednesday's Supreme Court oral arguments on severability as well as the Medicaid expansion. News coverage also sums up the week's high court activity and looks forward to what might happen next.

Kaiser Health News: Vigorous Questions on Severability, Medicaid On Final Day (Video)
In this Kaiser Health News video, Legal analyst Stuart Taylor, Jr., talks with Jackie Judd about the last 2.5 hours of this historic week during which the justices heard from the opposing lawyers about issues as basic as 'what is liberty?' and whether it's better to 'fix' flaws in legislation or scrap it entirely. Legal analyst Stuart Taylor, Jr., talks with Jackie Judd about the last 2.5 hours of this historic week (3/28). Watch the video.

Kaiser Health News: Minus A Mandate, Health Law Would Still Affect Millions
Kaiser Health News staff writer Julie Appleby reports: "If the Supreme Court strikes down the requirement that most Americans carry health insurance – along with related provisions that insurers must sell to people with pre-existing conditions and not charge the sick more – what's left in the law? Quite a bit, say policy experts – although the changes could make what's left harder to do" (Appleby, 3/28). Read the story.

Kaiser Health News: Transcript Highlights: Wednesday's Supreme Court Arguments
Kaiser Health News has collected highlights of Wednesday morning's Supreme Court arguments, in which justices took on the question of "severability," whether the health law in its entirety should be struck down if the insurance mandate is declared unconstitutional; and the constitutionality of the law's Medicaid expansion. 

Kaiser Health News: Slideshow: Days 1-3: Citizens Gather As Supreme Court Begins Review Of Health Law
This collection of photos taken by Kaiser Health New's Jessica Marcy offers images of what was going on this week outside the Supreme Court, where Americans gathered to express their support or opposition to the law -- or just to see history being made (3/28).

Kaiser Health News: Effort To Pay Hospitals Based On Quality Didn't Cut Death Rates, Study Finds
Kaiser Health News staff writer Jordan Rau reports: "Medicare's largest effort to pay hospitals based on how they perform -; an inspiration for key parts of the health care law -; did not lead to fewer deaths, a new study has found. The study casts doubt on a central premise of the health law's effort to rework the financial incentives for hospitals with the aim of saving money while improving patient care" (Rau, 3/28). 

Kaiser Health News: Capsules: House Debates Ryan Budget: Predictably Partisan; Inside The Courtroom On The Final, Historic Day
Now on Kaiser Health News' blog, Marilyn Werner Serafini reports on the latest developments regarding the Ryan budget plan: "The tone was immediately and undoubtedly partisan Wednesday when the House began considering the Republican-backed 2013 budget resolution that the House Budget Committee recently approved" (Werber Serafini, 3/28).

Also on the blog, Phil Galewitz reports on the last day of the Supreme Court health law arguments: "Chief Justice John Roberts, seated in the center in a high-backed leather chair, quickly brought down the gavel. And the last of four hearings into the 2010 health care overhaul was underway" (Galewitz, 3/28). Check out what else is on the blog. 

The New York Times: On Day 3, Justices Weigh What-Ifs Of Health Ruling
The justices seemed divided on both questions before them: What should happen to the rest of the law if the court strikes down its core provision? And was the law's expansion of the Medicaid program constitutional? The two arguments, over almost three hours, were by turns grave and giddy. They were also relentlessly pragmatic. The justices considered what sort of tasks it makes sense to assign to Congress, what kinds of interaction between federal and state officials are permissible and even the political character of the lawsuits challenging the law (Liptak, 3/28).

The Wall Street Journal: Three Days Of Hearings Yield Five Take-Aways
It is notoriously hard to predict how the Supreme Court will rule on a case based on justices' questioning of attorneys. But with this week's health-care arguments having wrapped up, here is what we know (Radnofsky, 3/28).

The Associated Press/Washington Post: High Court Arguments Suggest Justices Could Produce Split Familiar In Health Debate
The court's decision, due in June, will affect the way virtually every American receives and pays for health care and surely will reverberate in this year's campaigns for president and Congress. The political effects could be even larger if the court votes 5-4 with all its Republican-appointed justices prevailing over all the Democratic appointees to strike down the entire law, or several important parts of it. Not since 2000, when the court resolved the Bush v. Gore dispute over Florida election returns that sealed George W. Bush's election as president, has a Supreme Court case drawn so much attention (3/29).

The Washington Post: Supreme Court's Health-Care Ruling Could Deal Dramatic Blow To Obama Presidency
The Supreme Court's skeptical consideration of President Obama's landmark health-care legislation this week has forced his supporters to contemplate the unthinkable: that the justices could throw out the law and destroy the most far-reaching accomplishment of the Obama presidency. The fate of the Patient Protection and Affordable Care Act is uncertain. … White House officials are refusing publicly to consider that the law might be struck down or to discuss contingency plans, insisting that they do not address hypothetical questions (Gardner, 3/28).

Politico: Mitt Romney Or Not, GOP Is Coming For 'Obamacare'
With the general election now in sight, Republican strategists and party officials have begun crafting a strategy that puts health care front-and-center in the campaign against President Barack Obama, even if Mitt Romney is at the top of their ticket (Burns, 3/29).

The Associated Press/Washington Post: Obama's Health Care Law Stays In Effect While High Court Weights Its Fate; June Decision Likely
Nothing much changes for Americans' medical care while the Supreme Court mulls the fate of President Barack Obama's health care law. The wait might take three months. Decisions can come anytime, but complex cases argued in the spring often emerge near the end of the session, in late June (3/29).

The Wall Street Journal: Health Case Ripples Outward
Among those set to implement the law, insurers would have to ditch changes to their businesses designed to bring in millions of new customers. Provisions that have already gone into effect, including letting children stay on their parents' insurance plans until they turn 26, would no longer be required. Companies facing the law's requirements would be reprieved, including health firms set to pay new taxes and businesses that would have been required to insure their employees or pay a fee. It is impossible to predict how the court will rule, but skepticism from key justices heightened the possibility the 2010 health overhaul could be overturned in June, when the court is set to announce its opinion (Adamy, Bravin and Mathews, 3/28).

Reuters/Chicago Tribune: White House: No Contingency Plan If Healthcare law Rejected
The White House said on Wednesday that it was not working on contingency plans for President Barack Obama's signature healthcare law, in the event that the Supreme Court struck down all or part of the sweeping reforms. After three days of landmark Supreme Court hearings that raised doubts about the law's fate, White House spokesman Josh Earnest said the administration remains confident that the 2010 reform measure would be upheld when justices issue their ruling toward the end of June (Morgan and Mason, 3/28).

Politico: Justices To Congress: It's In Your Court After Health-Care Ruling
If the Supreme Court undercuts President Barack Obama's health care law, Congress is prepared to do the following: nothing. The justices seemed hot on the idea Wednesday that legislators can clean up whatever mess is left behind if the court strikes down the individual mandate or the whole law (Allen and Dobias, 3/28).

The New York Times: Few Minds Are Changed By Arguments In Court
Three days of sharp debate over the fate of the Obama administration's signature accomplishment seems to have reinforced what many Americans already believe about the health care overhaul, but with an extra dose of repulsion or delight. The arguments before the court that will ultimately decide whether the law is struck down will not have any practical impact until June, when the justices' decision is expected. But many people across the country who paid close attention had already made up their minds, as interviews with nearly three dozen people over the last few days made clear (Saulny, 3/28).

NPR: Supreme Court Cheat Sheet Day 3: Scalia Unplugged
Wednesday's morning arguments were as spirited -; and divided along ideological lines -; as they were during Tuesday's session on the individual mandate (Halloran, 3/28).

USA Today: Analysis: Day 3 Of Arguments In Health Care Case
Two years and six days after President Obama signed the most sweeping overhaul of the nation's health care system since the creation of Medicare and Medicaid, the law itself is on life support. … By the time it was over Wednesday afternoon, virtually everyone following the three-year battle within the three branches of the federal government had a strong opinion on the Patient Protection and Affordable Care Act. Everyone, that is, except for a few justices who hold its fate in their hands (Wolf and Heath, 3/39).

Politico: 5 Supreme Court Takeaways
After three days and six hours of arguments, a core provision in President Barack Obama's signature health law appears to be in serious danger. And Wednesday, it looked quite possible that the entire law could fall. But there's no ruling yet, and oral arguments can sometimes be deceptive. The real action will take place behind the scenes, when justices meet to discuss whether the law should survive (Gerstein and Haberkorn, 3/28).

The New York Times: Parties Brace For Fallout In Court's Ruling On Health Care
For all of the fretting by liberals and the tea-leaf reading by legal analysts about the pointed questioning from the justices about the health law, there is but one certainty: There will be substantial political fallout no matter how the court rules (Zeleny, 3/28).

NPR: Justices Ask: Can Health Law Stand If Mandate Fails?
The major arguments of the day were premised on a supposition. Suppose, asked the court, we do strike down the individual mandate -; what other parts of the law, if any, should be allowed to stand? (3/28).

The Wall Street Journal: Justices Question  Extent Of Federal Power
The Supreme Court ended three momentous days of argument Wednesday over the constitutionality of the Obama administration's signature health-care law, with opponents pushing their rhetoric into fundamental questions about the limits of Washington's power. Conservative justices suggested that if one part of the law is judged unconstitutional, the entire health overhaul with hundreds of provisions may have to fall with it. In the afternoon, the case took a twist that upended expectations, as the conservatives challenged the basis of the federal-state Medicaid program (Bravin, 3/28).

Reuters/Chicago Tribune: Supreme Court Ends Morning Session On Healthcare Law
The Supreme Court ended its Wednesday morning session of arguments centered on whether all of President Barack Obama's healthcare law must be struck down if the key requirement to have insurance coverage by 2014 is invalidated. The court has one more 60-minute session scheduled on Wednesday, focused on a provision that would expand the joint federal-state program that provides health services to the poor, known as Medicaid. States have argued that to force the expansion would be invalid under the U.S. Constitution (3/28).

NPR: Medicaid Expansion Caps Supreme Court Arguments
The last argument on the Affordable Care Act before the Supreme Court could have consequences far beyond health care. The key issue is whether the health law's expansion of the Medicaid program for the poor unfairly compels the participation of states. Many considered this to be the weakest part of the states' challenge to the health law, and during Wednesday afternoon's arguments, that seemed to be the case (Hensley, 3/28).

The Wall Street Journal's Washington Wire: A Medicaid Twist In Health-Law Arguments
In an interesting turn Wednesday, the Supreme Court's conservative justices repeatedly questioned not just the expansion of Medicaid but the basis for the entire program. That raised the possibility, however remote, of a ruling that would throw out a 47-year-old pillar of the nation's health-care system along with the two-year-old Obama health law (Landers, 3/28).

The Washington Post: On Health-Care Hearing's Last Day, Supreme Court Weighs Medicaid Expansion
The Supreme Court closed an extraordinary three-day review of President Obama's health-care law Wednesday, with its conservative majority signaling that it may be on the brink of a redefinition of the federal government's power. Justices on the right of the deeply divided court appear at least open to declaring the heart of the overhaul unconstitutional, voiding the rest of the 2,700-page law and questioning the underpinnings of Medicaid, a federal-state partnership that has existed for nearly 50 years (Barnes and Aizenman, 3/28).

The Wall Street Journal: Big Case Stirs Up This 'Hot Bench'
Lawyers call a lively group of judges a "hot bench." This one was scorching. Over three days and 6½ hours of arguments, the Supreme Court justices were unusually animated-;jumping in with questions, delivering passionate lectures about liberty and quoting everyone from James Madison to Jack Benny. The tension rose by the day and the hour (Kendall and Bravin, 3/28).

The New York Times: Mr. Health Care Mandate
After Massachusetts, California came calling. So did Connecticut, Delaware, Kansas, Minnesota, Oregon, Wisconsin and Wyoming. They all wanted Jonathan Gruber, a numbers wizard at M.I.T., to help them figure out how to fix their health care systems, just as he had helped Mitt Romney overhaul health insurance when he was the Massachusetts governor (Rampell, 3/28).

The Wall Street Journal: House Votes Down Bipartisan Budget Proposal
The House overwhelmingly voted down a bipartisan budget proposal Wednesday that would have directed lawmakers to reduce the federal deficit by more than $4 trillion over 10 years through a combination of spending cuts and tax increases. … The White House and many Democrats have called for deficit reduction through a combination of targeted spending cuts and large tax increases. Many Republicans, particularly congressional leaders, have said they won't support a deficit-reduction plan that raises taxes, and they have said any deal would require a large restructuring of Medicare and Medicaid (Paletta, 3/28).

Politico: House Crushes Budget Compromise
Republicans pushed toward House passage on Thursday of their new budget plan after crushing a bipartisan alternative Wednesday night and smoothing out internal GOP differences over the handling for future funding for disasters (Rogers, 3/29).

NPR: Romney's Support For Ryan Budget Has Democrats Crying Foul
What they're trying to have, he says, is $500 billion in projected Medicare savings. Those savings are part of the Affordable Care Act, President Obama's health care law. They're achieved through slower payments to hospitals and a reduction in the overpayment of premiums to Medicare Advantage providers. Those savings are something Romney hits President Obama on day after day on the campaign trail. … But here's the rub: The Ryan budget assumes that very same $500 billion cut. Well, "cut" isn't the right word; "savings" is more accurate. The reality is that in real dollars Medicare spending will keep rising -; just not by as much (Keith, 3/29).

The New York Times: Taking Heed Of Criticism, Santorum Tones Down Attacks
He still reserves plenty of derision for Mr. Romney, mocking him repeatedly as the "Etch A Sketch" candidate whose conservative values are malleable and insincere. But in campaign speeches across Wisconsin the past few days he has directed more of that outrage at Mr. Obama, particularly over the issue of government-mandated health care (Peters, 3/28).

The Wall Street Journal's Washington Wire: Democrats Put Billboard In Rep. Ryan's Hometown
With the vote on the House Republican budget scheduled for Thursday, Democrats have posted a billboard in Janesville, Wis., the hometown of Rep. Paul Ryan, chairman of the House Budget Committee, attacking the budget's approach to Medicare (Bendavid, 3/28).

USA Today: Long-Term Care Insurance Policy Costs Rising
Just as aging Baby Boomers are realizing they may need long-term care insurance, the marketplace is shrinking, the cost of premiums is soaring, and providers are altering the policies they offer (Dugas, 3/28).