Norquist Aims to Stop Internet Sales Tax Legislation


English: Grover Norquist at a political confer...

English: Grover Norquist at a political conference in Orlando, Florida. (Photo credit: Wikipedia)

English: Christopher Hitchens at a party at th...

English: Christopher Hitchens at a party at the house of Grover Norquist following the CPAC convention in January 2004 (Photo credit: Wikipedia)

English: Official photo cropped of United Stat...

English: Official photo cropped of United States Senator and Minority Leader Mitch McConnell (R-KY) (Photo credit: Wikipedia)

Tuesday, 23 Apr 2013 02:07 PM

By David Yonkman, Washington Correspondent  –

Internet sales-tax legislation racing through the Senate is likely to

face roadblocks when it moves to the House, anti-tax activist Grover

Norquist told Newsmax Tuesday.

“The reason we have a House and Senate is when you rush something

through one body, you have a chance to think it through in the other

body,” said Norquist, president of Americans for Tax Reform.“We’re

making the case on the House side of either seriously amending it or

even stopping it.”

The Senate is likely this week to pass the bill, which would greatly

expand the ability of states to collect sales taxes across state lines

on online purchases. Under current law, states can collect sales taxes

from retailers only if they have a physical presence in the state — a

store, warehouse, or office.

The Marketplace Fairness Act would allow states to collect taxes even if

the retailer does not have a physical presence in the state.

That’s just wrong, according to Norquist, who describes the legislation

as a massive expansion of taxing authority over businesses that have no

recourse in the matter.

“You should only be taxing people who can vote for you or against you,” Norquist said.

The Senate voted 74 to 20 on Monday to clear the Internet sales tax bill

for consideration on the floor, but on final passage it will have at

least one high-ranking Republican dissenter.

Senate Minority Leader Mitch McConnell of Kentucky cited the difficulty

for businesses to comply with the different tax codes in all the areas

where their customers reside. McConnell says that creates an enormous

advantage to large retailers who can afford such costs over smaller

businesses.

“If states decide they need this revenue, they should keep in mind the

tremendous burden they’ll be placing on the little guys who do so much

to drive this economy,” McConnell said in remarks on the Senate floor.

“In my view, the federal government should be looking for ways to help,

not hurt, these folks.”

© 2013 Newsmax. All rights reserved.

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Next Stage Of Health Law Triggers Concern, Confusion


Obamacare Protest at Supreme Court

Obamacare Protest at Supreme Court (Photo credit: southerntabitha)

News outlets report on the confusion that continues to surround
the health law, especially as key provisions are about to take effect.
Meanwhile, officials and activists strategize about how to educate
consumers about their options.

Georgia Health News: Concern, Confusion Over The Next Stage Of Reform

In six months, Jimmy Rowalt will no longer have health insurance. For
the past two and a half years, the 25-year-old Athens resident has
worked at Highwire Lounge without worrying about the job’s lack of
health benefits. Now he’s a manager there, working 45 to 55 hours a
week. A rule allowing young adults to remain on their parents’ health
insurance policies until age 26 was one of the first provisions of the
Affordable Care Act to go into effect, in September 2010. … Rowalt’s
options will be meager after his October birthday, when he will be
dropped by his parents’ insurance company (Murphy, 4/22).

CT Mirror: Strategizing On Helping The Uninsured With Health Care Reform

As the country gears up to launch the Affordable Health Act, one of the
most difficult tasks will be to sell it to uninsured people who may have
never heard of the word “co-pay” or know what a primary care physician
is. That was the message of Alta Lash, a Connecticut community organizer
who was one of several speakers from across the nation at a daylong
roundtable discussion Monday on how to promote health equity through
“Obamacare.” The event attracted about 200 policymakers, social workers,
physicians and researchers to the Mark Twain House in Hartford for a
discussion of how to eliminate health disparities through the expanded
coverage that will take effect in January (Merritt, 4/22).

CNN Money: Millions Eligible For Obamacare Subsidies, But Most Don’t Know It

Nearly 26 million Americans could be eligible for health insurance
subsidies next year, but most don’t know it. That’s because relatively
few people are familiar with provisions in the Affordable Care Act, aka
“Obamacare,” that will provide tax credits to low- and middle-income
consumers to help them purchase health coverage through state-run
insurance exchanges (Luhby, 4/23).

This is part of Kaiser Health News‘ Daily Report – a summary
of health policy coverage from more than 300 news organizations. The
full summary of the day’s news can be found here and you can sign up for e-mail subscriptions to the Daily Report here. In addition, our staff of reporters and correspondents file original stories each day, which you can find on our home page.

Competition Key Ingredient To Success Of State Health Exchanges


Stateline reports that even some of the strongest health exchange
enthusiasts are concerned that some states will still only have limited
insurance choices for consumers. Meanwhile, in other news, the Arkansas
Medicaid expansion model gains momentum, Florida’s efforts face
continued complications, Arizona’s expansion standoff continues and the
Missouri Senate rejects the concept. Also, the shape of Ohio’s
compromise exchange is beginning to emerge.

Stateline: Lack Of Competition Might Hamper Health Exchange

The White House sums up the central idea behind the health care
exchanges in the new federal health law with a simple motto: “more
choices, greater competition.” But even some stalwart supporters of the
Affordable Care Act worry that in many states, people won’t have a lot
of health insurance choices when the exchanges launch in October. Health
economists predict that in states that already have robust competition
among insurance companies—states such as Colorado, Minnesota and
Oregon—the exchanges are likely to stimulate more. But according to
Linda Blumberg of the Urban Institute, “There are still going to be
states with virtual monopolies” (Vestal, 4/23).

Health News Florida: ‘Private Option‘ Plan, Florida Model, Passes In Ark.

Arkansas’ state legislature passed a model plan to expand Medicaid last
week, even though its Legislature is dominated by Republicans and the
measure had to pass by a three-quarters vote, the Associated Press
reports. The Arkansas plan is the model for Florida state Sen. Joe
Negron’s plan, which would accept an estimated $51 billion in federal
funds over 10 years to expand insurance to about 1 million of the
state’s low-income uninsured (Gentry, 4/22).

Miami Herald: Legislators Poised To Adjourn With No Medicaid Plan

As the clock winds down on the legislative session, Florida lawmakers
are sending signals that they are likely to adjourn without resolving
the issue of whether to accept federal Medicaid money to insure the
state’s poorest residents. “It’s not something you put together in a
week,”’ said Sen. John Thrasher, R-St. Augustine, chairman of the Senate
Rules Committee and a close adviser to Senate President Don Gaetz.
“It’s a very big, complicated issue and these issues take some time.” He
said he does not expect there would be political repercussions if the
Republican-led Legislature waits another year (Klash, 4/22).

Arizona Republic: Brewer, GOP In Medicaid Standoff

Three months after she stunned political observers and made her case for
expanding Medicaid coverage in Arizona, Gov. Jan Brewer is no closer to
reaching agreement with Republican legislative leaders on the issue,
which has driven a wedge through GOP ranks and is delaying work on the
state budget. By most accounts at the Capitol, Brewer has just enough
votes in the House and Senate to get expansion approved. Even some
lawmakers who oppose the plan predict it eventually will pass, owing in
large part to the power of the governor’s veto pen and her reputation
for tenacity, as well as pressure from top-flight lobbyists and
heart-tugging health-care crisis stories (Reinhart, 4/22).

The Associated Press: Mo. Senate Votes Down Federal Medicaid Expansion

Republican senators have made it clear that there will be no Medicaid
expansion in Missouri this session. The Republican-led Senate voted down
a Democratic attempt Monday night to insert $890 million of federal
funds into Missouri’s budget to expand Medicaid eligibility to an
estimated 260,000 lower-income adults (4/23).

Cleveland Plain Dealer: Ohio’s Medicaid Expansion Alternative Could Use Private Insurance

For the first time since Gov. John Kasich won national attention by
supporting Medicaid expansion, a clear picture is emerging on how the
Republican governor’s compromise with federal regulators could work.
Some uninsured Ohioans would be enrolled in the state’s traditional
Medicaid program, while others would sign up for private health
insurance using federal funding, said Greg Moody, director of Ohio’s
Office of Health Transformation. The proposal, which Kasich hopes to
sell to GOP lawmakers reluctant to support an outright Medicaid
expansion, has been dubbed “The Ohio Plan.” And it differs from the
standard federal expansion program on one crucial point: It puts some
enrollees in the private insurance market (Tribble, 4/22).

This is part of Kaiser Health News‘ Daily Report – a summary
of health policy coverage from more than 300 news organizations. The
full summary of the day’s news can be found here and you can sign up for e-mail subscriptions to the Daily Report here. In addition, our staff of reporters and correspondents file original stories each day, which you can find on our home page.

John Kasich

John Kasich (Photo credit: Wikipedia)

States Boost Laws, Regulations Governing Abortion


English: Histogram of abortions by gestational...

English: Histogram of abortions by gestational age for the United States in 2004. Horizontal axis is weeks and vertical axis is thousands of abortions. Data is taken from the Centers for Disease Control and Prevention.http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5609a1.htm#tab6 Updated version of Image:US abortion by gestational age 2002 histogram.svg, but data is almost identical. (Photo credit: Wikipedia)

Time series of induced abortions in Norway

Time series of induced abortions in Norway (Photo credit: Wikipedia)

Topics: Delivery of Care, Women’s Health, Politics, States

Apr 01, 2013

States have passed a record number of abortion bills since 2011, including curbs on clinics and chemically induced abortions, and in North Dakota, a ban on abortions as early as six weeks. On the other side, New York and Washington are weighing measures to ensure abortion rights.

The Wall Street Journal: States Harden Views Over Laws Governing Abortion
States are becoming increasingly polarized over abortion, as some legislatures pass ever-tighter restrictions on the procedure while others consider stronger legal protections for it, advocates on both sides say. … At the same time, Washington state is weighing a measure that would require all insurers doing business in new health insurance exchanges created by the Affordable Care Act to reimburse women for abortions. And New York Democratic Gov. Andrew Cuomo is seeking to update his state’s laws to clarify that women can obtain an abortion late in pregnancy if they have a medical reason (Radnofsky, 3/31).

The Associated Press: Abortion Clinics Need License, Check For Coercion
Michigan abortion clinics will need a state license and must check to make sure women are not being bullied or pressured into getting an abortion under a new law that took effect Sunday. Other regulations make clearer the proper disposal of fetal remains, after anti-abortion advocates expressed concern some were not disposed of with dignity (Eggert, 3/31).

In Montana, lawmakers are seeking to cut funding to some organizations that provide women’s health care.

The Associated Press: Women’s Health Funding Faces Cuts: House Budget Excludes $4.5M For Title X Funds
When Jennifer Strickley first learned she had ovarian cancer, it was Planned Parenthood that detected the disease. She had been going to a clinic in Billings (Montana) for about a decade, as the discounts on Pap tests, contraception and regular checkups provided an essential break for the single mom working without health insurance as a waitress to support her two kids … Strickley is one of 26,000 Montanans who rely upon clinics that receive federal family planning and preventive health funds in the form of Title X. … But the Montana House unanimously passed a state budget that excludes these funds — some $4.5 million — accounting for 30 percent of the budgets for 20 community clinics and five Planned Parenthood Clinics in the state (4/1).

This is part of Kaiser Health News‘ Daily Report – a summary of health policy coverage from more than 300 news organizations. The full summary of the day’s news can be found here and you can sign up for e-mail subscriptions to the Daily Report here. In addition, our staff of reporters and correspondents file original stories each day, which you can find on our home page.

No Rate Shock Seen In Proposed 2014 Premiums In Vermont


English: Barack Obama speech "Fighting fo...

English: Barack Obama speech “Fighting for Health Insurance Reform” delivered 8 March 2010 (Photo credit: Wikipedia)

By Phil Galewitz

April 1st, 2013, 12:55 PM

After years of anticipation, Vermont became the first state Monday to publish proposed 2014 individual health insurance rates under the federal health law. Despite Republican and insurers’ predictions, there was no “rate shock” in the new premiums, according to the Vermont governor’s office and insurance representatives.

Blue Cross and Blue Shield of Vermont and MVP Health Care submitted plans with monthly premiums that range from an average of $265 for catastrophic coverage for young adults to $609 for platinum coverage, which has the lowest cost-sharing among four categories of plans.

“We think this is a positive development for folks who were worried about what rates would look like in 2014,” said Kevin Goddard, spokesman for Blue Cross and Blue Shield of Vermont, which is the state’s dominant commercial carrier, controlling about two-thirds of the market. He confirmed rates are similar to what the company now offers.

“These rates are comparable to what’s on the market today and that’s good news,” said Robin Lunge, director of health reform in the Vermont governor’s office. She said it’s difficult to do an apples-to-apples comparison because of the many benefit changes required under President Barack Obama’s health overhaul.  These changes, which take effect Jan. 1, include an end to annual lifetime limits in policies and a prohibition on denying coverage to people with medical problems.

Vermont may not be the best barometer of the impact of the heath overhaul on premiums, however,  because the state already prohibits insurers from using health status to determine an individual’s premiums. It is one of only seven states in the country which have so-called community rating regulations.

Vermont also requires prices to be the same regardless of person’s age. Two of the health law’s biggest changes include prohibiting insurers from using health status to determine premiums and prohibiting insurers from charging older people more than three times the rates of younger people.

Insurance industry predictions of rate shock are more likely in the majority of states that currently allow insurers to set premiums based on an individual’s health status, Goddard said.

Starting Oct. 1, individual and small group coverage in the state will be sold on a new online health insurance marketplace as required under the Affordable Care Act. Health insurers nationwide have just begun submitting their pricing and benefit information to states and the federal government for policies which will be sold in the marketplaces, or exchanges. Most people who buy on the new marketplaces are expected to be eligible for government subsidies.

Vermont insurance regulators still must approve the insurers’ proposed rates. In January 2013, the state approved about a 10 percent rate increase on the individual market after carriers asked for about a 13 percent increase, Lunge said.

All the health plans in the new marketplaces are standardized into platinum, gold, silver and bronze categories depending on their actuarial value so consumers have an easier time comparing.

The Vermont 2014 annual premiums for bronze plans range from $4,200 to $4,440, compared to a Congressional Budget Office estimate of $4,500 for an individual, according to Carolyn Pearson of consulting firm Avalere Health.

Mary Eversole, executive director of the Vermont Insurance Agents Association, said she was surprised the rate increases were not higher. At first blush, she said the 2014 proposed rates appear to be about 10 percent higher than this year. Premiums for the gold and platinum  policies appear lower than similar products, but silver and bronze policies are higher.

Officials from MVP were not available for immediate comment.

Federal Agency Issues ‘Fraud Alert’ About Physician-Owned Distributorships


English: Tennessee Valley Authority Office of ...

English: Tennessee Valley Authority Office of Inspector General Seal (United States). (Photo credit: Wikipedia)

English: Federal Communications Commission Ins...

English: Federal Communications Commission Inspector General badge (USA). (Photo credit: Wikipedia)

Topics: Marketplace

Mar 27, 2013

The Health and Human Services inspector general said these commercial ventures, which are widespread in the fields of orthepedic and spine surgery, are “inherently suspect.”

The Wall Street Journal: Warning Over Doctor-Run Groups
A federal agency issued a special fraud alert about physician-owned distributorships—commercial entities run by doctors that have proliferated in the fields of orthopedic and spine surgery—calling them “inherently suspect” and warning they “pose dangers to patient safety” (Carreyrou, 3/26).

Bloomberg: Doctor-Owned Device Suppliers Deemed Inherently Suspect
Doctor-owned businesses that act as middlemen between medical device makers and hospitals are “inherently suspect” and some of their practices may violate U.S. anti-kickback laws, a government inspector general said. Daniel Levinson, the inspector general for the Health and Human Services Department, today issued an unusual “special fraud alert” about so-called physician-owned distributorships, or PODs (Wayne, 3/26).

Arkansas Medicaid Plan, Born Of Necessity, Shakes Things Up


English: Great Seal of the State of Arkansas

English: Great Seal of the State of Arkansas (Photo credit: Wikipedia)

By Julie Rovner, NPR News

March 26th, 2013, 9:13 AM

This story comes from our partner ‘s Shots blog.

Since the Supreme Court made the� Medicaid expansion under the federal health law optional last year, states’ decisions� have largely split along party lines. States run by Democrats have been opting in; states run by Republicans have mostly been saying no or holding back.

Illustration by Darwinek via Wikimedia Commons

But now Arkansas – at the suggestion of the federal government – has suggested a� third option: Enroll those newly eligible for Medicaid in the same private insurance plans available to individuals and small businesses.

And some think that could shake things up. A lot.

The Arkansas proposal was crafted as much out of political necessity as from substantive desire, says Andy Allison, the state’s Medicaid director.

“I think this is likely to be the only way that expansion or coverage for this population could occur,” he says.

There are two reasons for that. One is that the state has a Democratic governor (Mike Beebe, now serving his second term), but a heavily Republican state legislature, which has� not looked favorably on expanding Medicaid.

A second reason is that few adults currently qualify for Medicaid in Arkansas. And those who do have to be really poor, says Allison: “We cover just at 17 percent of the poverty level for those who are parents and we don’t cover childless adults unless they have a disability.”

For the record, 17 percent of poverty is less than $2,000 a year. Expanding Medicaid under the Affordable Care Act to 133 percent of poverty — about $15,000 — could potentially add as many as 250,000 Arkansans to the rolls.

But what was a political nonstarter gained new life when someone suggested the idea of enrolling those new people in the same private plans individuals and small businesses will be purchasing — the� new marketplaces, called exchanges.

So far the state has gotten a� tentative go-ahead from the U.S. Department of Health and Human Services. That’s caught the attention of several other Republican-run states that had been holding out on the Medicaid expansion, including Ohio, Florida, and even Texas.

But experts insist the proposal is hardly as new as some have suggested.

“The authority to use Medicaid funds to buy insurance has been in the law since it was first enacted,” said� Sara Rosenbaum, a law professor and Medicaid expert at the George Washington University.

Still, when the Arkansas arrangement first went public about a month ago, there was some immediate hand-wringing about its potential cost.

“We have to … recognize that it will cost more,” said� Austin Frakt, a Boston University health economist. “You don’t get something for nothing.”

But Frakt concedes that paying somewhat more — how much more remains a subject of contention — might not be all bad.

“One of the basic critiques of the Medicaid program is they pay providers too little and that’s why too few of them participate,” he said.

So putting people in private plans with higher provider payments could help address those access problems.

Meanwhile, Medicaid watchers say proposals like the one in Arkansas could solve other problems — for the new Medicaid recipients and for the others who will be buying coverage in the new exchanges.

One potential problem the private plans could address is called� churning. It happens when a person’s income is near the threshold between qualifying for Medicaid and qualifying for� federal help to buy private coverage.

Imagine, says Rosenbaum, someone working 30 hours a week in the summer, whose hours are cut back so they qualify for Medicaid part of the year, then expanded, pushing them back out of the program.

“And you get a letter saying, ‘Now you’re earning more money, so now you have to leave your plan. You and your kids have to leave your doctors; you have to pick a new plan.’ And then in winter, if your hours drop back down, you get another letter saying, ‘Oh, sorry, you have to leave your plan, [and] your doctors,’ ” she says. “Those people could be forced to change plans multiple times a year.”

Rosenbaum says enrolling Medicaid beneficiaries in plans in the exchange instead could protect as many as 28 million people a year from churning if their income does get too high.

“Your plan will stay your plan, your doctors will stay your doctors,” she said. Basically the “bank of Medicaid” and the “bank of the exchange” will have a conversation with each other about who pays the bills. And your premium may be a little bit different and your co-pays may be a little bit different, but your healthcare won’t be interrupted.”

And it’s not just those on Medicaid who could benefit.

Many of the new Medicaid enrollees will be relatively healthy, relatively young people with relatively low insurance costs. They could help bring premiums down for those in the exchanges who are older and sicker.

“It’s the woman who’s 32 working at Wal-Mart with a couple of kids who we really need in the exchange,” Rosenbaum says. “And so if we buy her in and keep her in, it’s going to be that much better off for the 55-year-old woman who is sick and unable to work and needs coverage through the exchange because of a lot of health conditions. ”

Still, one of the fundamental appeals of putting new Medicaid enrollees in private plans remains political.

“I think in states where the resistance to the Medicaid expansion was based primarily on ‘This is a big government program that we can’t make any bigger,’ finding a way to do the expansion through private coverage will open a door to a conversation that was otherwise not taking place,” said Alan Weil of the� National Academy for State Health Policy.

What remains a key issue for many states, however, is that the federal government hasn’t yet said exactly how much states can spend on the private plans — only that what they spend to enroll Medicaid beneficiaries in the plans should be “comparable” to what they would have spent otherwise.

Health and Human Services Secretary Kathleen Sebelius says officials will spell out more details on that issue “in the very near future.”