Republicans officially take control of the House today, and a vote to repeal the health care reform law is at the top of their agenda. But with President Obama in the White House and a Democratic-controlled Senate, any House repeal vote will likely be symbolic — the repeal effort is unlikely to advance any further, and provisions of the law scheduled to go into effect this year will continue on course.

With that in mind, Hari Sreenivasan talks to Kaiser Health News reporter Mary Agnes Carey about some of the changes you might see in 2011. The reporters at Kaiser Health News wrote this detailed review of the upcoming changes. Highlights include:

Medicare Changes

Many of this year’s provisions affect Medicare recipients — and are designed to get them to see a doctor before small problems become big ones.

“There’s going to be a focus on making preventive health services more attractive to Medicare beneficiaries,” says Carey.

On January 1, Medicare started providing preventive care measures, including vaccinations and cancer screenings, for free, and also for the first time offering free annual “wellness exams.”

Many seniors will also be paying less for their prescription drugs this year, as Medicare continues to narrow the “donut hole” in which seniors pay out-of-pocket for drugs. This year, they’ll get a 50 percent off brand-name drugs.

But some seniors will be paying more for their pharmaceutical insurance. Medicare Part D, which covers prescription drugs, will for the first time link premium payments to income. Seniors who make more than $85,000 for individuals and $170,000 for couples will have to pay extra for their Medicare Part D coverage.

Medicare will also be making some changes to the way it pays its providers. To encourage more primary care doctors to see Medicare patients, the program will increase its reimbursement rates for primary care doctors by 10 percent.

This year also begins the reduction in payments to private Medicare Advantage plans — 2011 pay rates will be frozen at 2010 levels, and lower pay rates will begin phasing in in 2012. But next year, Medicare will also start offering bonuses to high-performing plans.

Calorie Counts

Diners will soon know exactly how many calories are in their burger, fries or salad — at least at chain restaurants. By March 23, 2011 (one year after the health reform law was signed), the Food and Drug Administration will issue its final rule specifying how restaurants have to implement a provision of the law that restaurants to post calorie counts and other nutrition facts.

The draft guidance is already available, and it says that restaurants with 20 or more locations will have to provide calorie counts on their menus. Consumers won’t see the changes show up immediately though — the FDA will let restaurants know how much time they have to begin complying with the new rules.

New Rules for Flexible Spending Accounts

If you have an FSA, there’ll be no more using it to buy Tylenol and other over-the-counter drugs — at least not without a doctor’s prescription. In the past consumers could use money set aside in an FSA to pay for both prescription and non-prescription drugs, as of January 1 the funds can only be used with a doctor’s prescription. Other rules remain the same — you can still use FSA money for co-pays, deductibles, and medical devices.

Insurance Rebates

As of January 1, health insurance providers are now required to spend a minimum amount of the money they collect in premiums on providing health care for their customers. For large-group plans, that minimum is 85 percent, for small group plans it’s 80 percent.
Plans that don’t meet the minimum requirement will have to give their customers rebates of the difference. The government has estimated that up to nine million people could be eligible for rebates.

The post Health Care Reform in 2011: What to Watch appeared first on PBS NewsHour.

JUDY WOODRUFF: Now: the next in our series of stories on health reform and the challenges ahead.

Tonight, health correspondent Betty Ann Bowser reports from Northern California on the growing shortage of primary care doctors and one effort to fix that.

DR. ASHBY WOLFE, resident, University of California Davis: Hi, Mrs. Dieder. How are you doing? It’s good to see you.

BETTY ANN BOWSER: Barbara Dieder has congestive heart failure, chronic obstructive pulmonary disease, osteoporosis, and arthritis.That’s a lot for the 80-year-old homebound widow to manage all by herself.So, the frequent visits she gets from medical resident Ashby Wolfe are a big help.

BARBARA DIEDER, 80 Years Old: Yes, I think I’m healthier, because they catch things that are starting to go bad before they get too bad, yes.

BETTY ANN BOWSER: Do you think it keeps you out of the hospital?

BARBARA DIEDER: Yes.

(LAUGHTER)

Yes.

BETTY ANN BOWSER: The University of California’s Medical School at Davis brings Wolfe to Dieder’s home in Sacramento as part of a unique program to increase the number of primary care doctors, by inspiring students to work in the real world in underserved communities.

DR. ASHBY WOLFE: I think, as a family doctor who is training now in the 21st century, it’s becoming much more important for me to be comfortable managing a patient’s medical conditions in a variety of settings.

BETTY ANN BOWSER: But the 21st century is not producing enough family doctors like Wolfe.U.C. Davis health economist Paul Leigh says the problem will get worse when the federal health reform law kicks in fully.

PAUL LEIGH, health economist, University of California Davis:So, we have more than 20 million Americans who now don’t have health insurance who will have health insurance.And once they get health insurance, naturally, they’re going to want to see a primary care physician.

The forecast is, however, that, in the next two or three years, there is not going to see a big growth in the number of primary care physicians.So, there is likely to be a crisis for not enough primary care physicians in a short period of time.

BETTY ANN BOWSER: Dr. Tom Balsbaugh, who runs the U.C. Davis resident program, says, if the problem isn’t solved, health care reform will be in trouble.

DR. TOM BALSBAUGH, residency director, University of California Davis:I don’t think health care reform can work well without a very robust primary care work force.

Here in California, we have about 60 primary care physicians per 100,000 patients. And that’s pretty much the bare minimum to able to provide the care needed for those populations. If — without a significant supply, there will be overcrowding of emergency rooms; patients will be diagnosed with problems later.

BETTY ANN BOWSER: One of the things driving the shortage is money.The average medical student graduates owing more than $200,000 in educational loans.So, having to pay all that back is usually a factor when med students pick a career.

A new study just released here at U.C. Davis in Northern California of 6,000 doctors nationwide found that the specialists, the oncologists, the radiologists, the orthopedic surgeons, made up to 52 percent more money than the primary care physicians, even though the family doctors saw more patients.

PAUL LEIGH: The disparity in wages between specialists and primary care physicians over a lifetime can be $2 million.So, that’s a considerable incentive there for students to choose a specialty over primary care.

BETTY ANN BOWSER: There’s nothing U.C. Davis can do to increase the salaries of family doctors, but using a $1.9 million grant provided under the new health care reform law, the med school will be able to train 10 new primary care physicians.

DR. TOM BALSBAUGH: That would be around 20,000 additional patients would receive a primary care physician from the money included in this grant.

BETTY ANN BOWSER: Community involvement is critical.Residents like Wai-Kui Lee go into high schools to talk to kids about nutrition, sex and drugs.

DR. WAI-KUI LEE, resident, University of California Davis: How many of your classmates do you think smoke?

BETTY ANN BOWSER: The population here at Sacramento High is overwhelmingly Hispanic, African-American, and Asian.

DR. WAI-KUI LEE: It helps us ground ourselves to why we became doctors in the first place.You know, here we are, at critical stages of these young people’s lives, and we’re able to make a huge impact on them.

So, if we’re able to go and teach them some of the things that they need to do in order to go and become healthy and lifestyle changes that they need now, they won’t be the 50-year-old that is coming into my clinic with diabetes who has to have their leg amputated.

BETTY ANN BOWSER: U.C. Davis also sends its residents to work in community health care clinics, like CommuniCare here in Sacramento, where 85 percent of the patients live below the federal poverty level.Nearly three-quarters of the 22,000 people seen here each year are also either uninsured or on Medicaid.

Dr. David Katz is the medical director.

DR. DAVID KATZ, medical director, CommuniCare:Most of the medical care that’s practiced in the United States is not practiced in that academic university medical center.And, so, the importance is to give residents the experience of being out in the community and seeing that family practice can be intellectually stimulating and that it’s really needed.

BETTY ANN BOWSER: Even though he still owes over $300,000 in education loans, Dr. Brenden Tu went to work as a family doctor at CommuniCare, because he likes the variety of patients.

DR. BRENDEN TU, CommuniCare:Some of them are homeless.There’s a lot of psychiatric issues that we deal with, on top of the medical issues, family issues, single — single-income parents, so the — I mean, a whole range of social issues.

BETTY ANN BOWSER: There are provisions in the new health care reform law to encourage more medical students to go into primary care.One will pay off educational loans if young doctors agree to work in the National Health Service.

And there is money for pilot programs to experiment with the way doctors are compensated.Currently, most physicians get paid for each time they perform a service.But support is growing to pay physicians based on patient outcomes, in other words, based on how well the treatment works.

DR. TOM BALSBAUGH: We’re starting to figure out what might be ways to start measuring value vs. quantity of services, and values quality of the care that’s given. I think it will be very necessary to do that, because to provide

care to more people, we have to make our dollars go further.And the way that maybe we can start looking at value are things like comparative effectiveness, using…

BETTY ANN BOWSER: In other words, what works?

DR. TOM BALSBAUGH: Yes, researching what works and what works for the most affordable cost.

BETTY ANN BOWSER: And if that were to happen, most health care experts think more young people like Ashby Wolfe, Wai-Kui Lee and Brenden Tu would choose primary care.

The post In California, Facing Down a Family Physician Shortage appeared first on PBS NewsHour.

JEFFREY BROWN: And we turn to health care reform, after Tuesday’s political storm.

U.S. PRESIDENT BARACK OBAMA: We are done.

(CHEERING AND APPLAUSE)

JEFFREY BROWN: It was a heady, even historic moment last March when President Obama signed his landmark health care bill.

PROTESTERS: Kill the bill!

JEFFREY BROWN: But, ever since, and throughout the campaign that just ended, attacks on it continued.

MAN: If we don’t repeal the health care bill, government will grow, debt will explode, choices will become fewer, and your freedoms will be chipped away.

ACTOR: Gramps is sad.Obama cut $455 billion from his Medicare.

JEFFREY BROWN: What now?Yesterday, the presumptive next House speaker, John Boehner, was talking tough.

REP. JOHN BOEHNER (R-OH), House Minority Leader:We have to do everything we can to try to repeal this bill and replace it with common-sense reforms that will bring down the cost of health insurance.

JEFFREY BROWN: Today, though, Senate Minority Leader Mitch McConnell conceded, that will be difficult.

We may not be able to bring about a straight repeal in the next two years, and we may not win every vote against targeted provisions, even though we should have bipartisan support for some of those efforts.But we can compel the administration officials to attempt to defend the — this indefensible health spending bill.

JEFFREY BROWN: For his part, the president said yesterday he would be open to Republican input moving forward.

BARACK OBAMA: If they want to suggest modifications that would deliver faster and more effective reform to a health care system that, you know, has been wildly expensive for too many families and businesses, and certainly for our federal government, I’m happy to consider some of those ideas.

JEFFREY BROWN: And in an interview with ABC News, current House Speaker Nancy Pelosi said that minor changes could be coming.

REP. NANCY PELOSI (D-Calif.), Speaker of the House:I don’t think they’re going to take health care apart.There are certain parts of it that we all may want to review.When we have this debate piece by piece, I think the American people will see how they like pieces of it and how they relate to each other.

JEFFREY BROWN: On Election Day, national exit polling showed public opinion on health care was split — 47 percent said health care reform should either be expanded or kept the way it is, while 48 percent said it should be repealed.

Health care will be part of the agenda when leaders from both parties meet with the president later this month.

And here to assess the state of play: Ron Pollack, executive director of Families USA, a health care consumer advocacy group, James Capretta, a former budget official for health care during the George W. Bush administration.He’s now a fellow at the Ethics and Public Policy Center.And “NewsHour” regular Susan Dentzer, editor in chief for the journal “Health Affairs.”

Welcome to all of you.

Ron Pollack, you were here when that vote passed in March.You supported the health care bill.What message did the voters send on Tuesday?

RON POLLACK, executive director, Families USA:I think the message from voters was essentially jobs and the economy.They’re terribly concerned about the downturn in the economy and their loss of jobs.And I think that was the predominant theme.

Now, with respect to health care, I don’t think health care was a top issue during the campaign.If you take a look at the preelection surveys that were undertaken by Associated Press, the Kaiser Family Foundation, New York Times, they show that most people want health reform to have a chance to work.

Some of them actually want to build on health reform and make it even better and improve it further.I don’t think there is public support for repealing the legislation.

JEFFREY BROWN: You didn’t hear that.James Capretta, what did you hear?

JAMES CAPRETTA, Ethics and Public Policy Center:I heard a strong sentiment for repeal.You know, it was a front-and-center issue.Many, many candidates, both for the House and the Senate, ran explicitly on repeal and replace.And, by and large, they won.

A plurality in the exit polls show that the public would like to see the bill repealed.The number who actually support the bill as passed is less than 47 percent.It’s a fraction of that, maybe half of that.So, there’s a large number of Americans that are very unhappy, both with the process by which it was passed and the substance of what it is.

With respect to the economy, I think what’s clear is, they are very upset that the majority and the president — in the current Congress — passed and were obsessed with passing their version of health care, as opposed to actually addressing the concerns of the economy and jobs.

JEFFREY BROWN: All right, now, Susan, I’m not going to make you resolve this for us, but the analysis continues, right, of what exactly caused particular elections to go one way or the other.

SUSAN DENTZER, editor in chief, “Health Affairs”: Indeed it does, Jeff. I mean, we’re at the point where we stare into the entrails of the goat and try to figure out what the sign is from the heavens about what the voters really believe. I think what is clear is that the rhetoric has shifted a bit already on the Republican side.

From repeal and replace, you now hear Senator McConnell say, in effect, let’s get rid of the worst parts.That’s different from repeal and replace.And, actually, it has invited the administration to come back and say, all right, let’s start to talk about what you view are the worst parts.

Is it the part that would extend the life of the Medicare trust fund by 12 years? Is it the part that would offer coverage for people who are denied it because of preexisting conditions? Is it the part that would repeal the $15 billion Prevention and Public Health Fund, when we know that 40 — going on 80 percent of Americans are likely to be overweight or obese in the next 30 years, and one out of three Americans will develop diabetes?

So, I think we’re going to now start to get to some specifics about what is really meant by what are the worst parts of the law.

JEFFREY BROWN: All right.

SUSAN DENTZER: And then we will see some movement happen.

JEFFREY BROWN: All right, well, that — that puts us forward here as to what might come.

Let me — let me start with you, Ron Pollack, and start on repeal.Let’s stay with repeal for the moment.What — how would it work, and what do you think are the possibilities?

RON POLLACK: Well, repeal is not going to happen.

JEFFREY BROWN: Not going to happen, you don’t think?

RON POLLACK: It’s not going to happen, for a few reasons.Number one, you can’t get repeal through the United States Senate.There are at least 52, probably 53, Democrats in the Senate.They’re not going to vote for repeal.You may need 60 votes in order to pass something that’s so controversial in the Senate.That’s not going to happen.

President Obama still has a veto pen, and he would veto any such legislation.But I think there’s actually something more significant that I think is going to change over time.

And that is that, as more and more people receive the benefits of this legislation, the early provisions, not just the big provisions that get implemented in 2014, things like young adults getting coverage through their parents, children no longer being denied coverage due to preexisting conditions, small businesses receiving subsidies to make coverage affordable, seniors getting money if they’re falling into the doughnut hole, getting tax benefits to help pay for those costs, and, in — in January, they will get a 50 percent discount on prescription drugs.

I think, as more and more of those people receive concrete benefits, they are going to be happy that the legislation passed.Their family will know about it.Their friends will know about it.Their neighbors will know about it.And I think some of the myths that were propagated during the course of the debate will fall by the wayside.

JEFFREY BROWN: All right, now, your turn here, but start with repeal. I mean, do you — they — he’s saying, no way. Do you see any way that that could happen, even with the new political…

JAMES CAPRETTA: Repeal is absolutely a possibility.It’s always been, however, a two-step process.

When they passed this legislation, it was clear there would be two national elections before the main provisions of the bill went into effect in 2014.The voters got to register their views this — just two days ago.They’re going to get another chance in 2012.

I — it’s absolutely certain that the presidential campaign will have health care again as a front-and-center issue.At that point, you will have a possibility for a real debate over what would be the replacement program for what has passed.

JEFFREY BROWN: All right, in the meantime — yes, in the meantime, what — what can opponents do to slow it down or set up roadblocks?

JAMES CAPRETTA: Well, with regard to some of the things that my colleague here has mentioned, the — many of these provisions are very minor in scope in terms of how many people are affected.

By and large, the main effect that’s going to be happening over the next couple of years is large cuts in what’s called Medicare Advantage.Many millions of seniors will get — will see their Medicare Advantage plans actually either close down or lesser benefits than they would have gotten.

Many employers are going to be contemplating large changes in their employer programs because of what’s in the law.They will be communicating a lot to that — their employees.There is going to be instability in the employer market.These provisions will affect many millions of people, many, many more than are covered by these early provisions that have been mentioned.

JEFFREY BROWN: But…

RON POLLACK: You know, we’re talking about instability in the employer market. That’s part of what’s driven the need for health care reform. With each passing year, fewer employers are providing coverage. They’re diminishing what is covered.

JEFFREY BROWN: All right, but let me stop you, because you’re — we’re rearguing the health care bill here.And I’m asking — I’m putting it in the new politics.

I mean, what is — let me go to Susan on this, and then I will come back to you — is that, when you look at the political changes here, are there places where there might be viable places to come together to make some of the changes that we’re talking about here that we heard in the tape?

SUSAN DENTZER: Indeed.I think, as the clip from Speaker Pelosi made clear, there’s agreement across the aisle to get rid of one provision that requires small businesses to report every purchase they make of $600 or more.That wouldn’t take effect until 2012, but it has the small business community up in arms about it, because it would be such a paperwork burden.

There’s pretty clear consensus that will be repealed.It costs about $17 billion to repeal it, so they will have to look around for money to do that.An earlier proposal had been to steal the money out of the Prevention and Public Health Fund, as I mentioned a moment ago.So we will see how that shakes out.

There’s also a proposal afoot to get rid of an independent payment advisory board that would take effect in 2014 that would look to shave money out of Medicare.Now, this is going to produce some real tension within the Republican Party between the deficit hawks in the party and the people who want to buy some support from hospitals or others, particularly in the health care sector, pharmaceutical companies and others, who are fearful of this board.

So, we will have to see how the tensions play out even within the Republican Party on these things.

JEFFREY BROWN: How do you see that playing out?Stay with the political realities here.

JAMES CAPRETTA: Right.Well, I think there are many aspects of the bill that can be addressed, even in the next two years, without full repeal.I think they will pass full repeal in the House, but short of that getting through the Senate and through the president, they can go for a number of things.They can give the states much more authority to be implementer — or to be the drivers of reform, rather than the just implementing what the federal government is telling them to do.

I think they actually could get bipartisan support to actually free up the states, instead of having them really accepting dictates from the federal government.I think there’s an opportunity to stop some of the really bad ideas in the Medicare program.One of our — I have already mentioned cutting Medicare Advantage.That simply puts people back into fee-for-service.

I think you could get bipartisan support around that.I think there are a number of things like that.

JEFFREY BROWN: All right, and a brief last word.I mean, you can maintain what you like about the bill and still have some of these changes?

RON POLLACK: Well, I think there may be some change with respect to malpractice reform. I think there are opportunities for bipartisanship.

But I don’t hear bipartisanship coming from the new leaders.Senator McConnell said his first priority is to defeat President Obama in 2012.That doesn’t sound to me like he’s angling for cooperation.

I think what we are going to see is, I think that Republican leaders are going to try to make sure that the federal government and the states don’t have the resources necessary to implement the legislation, and that may result in a budget impasse.

JEFFREY BROWN: All right. So, this debate clearly continues. Ron Pollack, James Capretta, Susan Dentzer, thanks very much.

JAMES CAPRETTA: Thank you.

RON POLLACK: Glad to be with you.

JAMES CAPRETTA: Thank you.

The post What Does a Republican House Mean for Health Care Reform? appeared first on PBS NewsHour.

GWEN IFILL: The health care reform law reached a kind of anniversary today. Six months since President Obama signed it into law, big new changes are set to take effect. Health correspondent Betty Ann Bowser has the story.

U.S. PRESIDENT BARACK OBAMA: Hello, hello, hello!

CROWD: Hello.

BARACK OBAMA: Good to see you guys.

BETTY ANN BOWSER: The president marked the occasion in a northern Virginia neighborhood today, his goal, to sell the six-month-old law to voters six weeks before the midterm elections.

BARACK OBAMA: What we realized was we had to take some steps to start dealing with these underlying chronic problems that have confronted our economy for a very long time. And health care was one of those issues that we could no longer ignore.

So it was bankrupting families, companies, and our government. So we said we had to take this on.

BETTY ANN BOWSER: At the same time, Mr. Obama acknowledged many Americans still don’t like or don’t understand the new law, and he said he’s partly to blame.

BARACK OBAMA: Sometimes, I fault myself for not having been able to make the case more clearly to the country. We spend — each of us who have health insurance, spend about a thousand dollars of our premiums on somebody else’s care.

BETTY ANN BOWSER: In fact, the latest round of polling underscores that health care reform has yet to win strong support. A new Associated Press survey found 40 percent disapproved, while 30 percent approved. The rest had no opinion.

The effects of those flagging poll numbers have been showing up on the campaign trail. Democrats who voted for reform now face voters unhappy with the changes. Republicans, in turn, have pressed the issue and even talk of repealing the reforms if they take back control of Congress.

REP. JOHN BOEHNER (R-OH), House minority leader: In my opinion, Obamacare will ruin the best health care system in the country — in the world, and it will bankrupt our country.

BETTY ANN BOWSER: In the meantime, most of the major provisions, like coverage for millions of the uninsured, don’t kick into gear until 2014.

But several key reforms focused on the insurance industry take effect tomorrow. As of Thursday, providers will have to stop imposing lifetime caps on coverage. They will be barred from canceling insurance for people who become sick, and from denying coverage to children with preexisting conditions. In addition, young people will be able to stay on their parents’ insurance policies until the age of 26.

The president was also joined today by people who said they will benefit from changes like those. Across the country, the debate continues between those who welcome the new law and those who warn of what’s to come.

Seven-year-old Thomas Wilkes of Englewood, Colorado, will no longer have caps put on his coverage. He’s one of 20,000 Americans the White House says will be helped by the new ban. While he looks perfectly healthy, Thomas need intravenous medications every day to treat severe hemophilia, a deadly blood-clotting disorder.

NATHAN WILKES, father: Most of the cost of our care is in the medication, and this is medication that he needs to survive and live a happy life, a productive life. Without it, he would — he would — he would risk complications of bleeding in his joints, severe arthritis. He would basically become disabled before he’s a teenager.

BETTY ANN BOWSER: Dad Nathan Wilkes says the injections are over $1,000 a day. Without them, he could develop a bleed in some part of his body that could be fatal.

NATHAN WILKES: His cost, depending on the year, could be anywhere from half-a-million to a million dollars a year.

BETTY ANN BOWSER: Thomas has reached the maximum lifetime caps on two different insurance policies, so, at one point, Nathan and his wife, Sonji, were desperate.

NATHAN WILKES: We had social workers saying, well, just get a divorce, because, if you get a divorce, and if your wife doesn’t work, the kids can go on Medicaid, and get coverage that way. And we weren’t about to get a divorce just for the sake of insurance coverage. So, we — I had to quit my job.

BETTY ANN BOWSER: Wilkes finally started his own company and bought a policy that covers Thomas and the rest of the family with a $6 million lifetime cap. Even that will eventually run out, so the Wilkes family is pleased that the new rule will give them more security.

KAREN POLLITZ There will be some important protections that will affect some people very directly.

BETTY ANN BOWSER: Karen Pollitz heads the new Office of Consumer Information and Insurance Oversight for the federal government. She acknowledges that it will take time for the impact of these provisions to be felt by many who will be affected.

KAREN POLLITZ, director, Office of Consumer Information and Insurance Oversight: The protections will roll in as your insurance policy renews or as you buy a new policy.

We are giving people better protection. You know, it’s like putting stronger seat belts in cars or better air bags. You know, we may not use them. We may not all get in the high-speed crashes, but that’s what they’re there for. And I think we all feel a little better knowing that that protection is solid.

MAN: I would like to see you before you see the specialist.

BETTY ANN BOWSER: The White House also says there are other less-well-advertised benefits kicking in that will require insurance companies to pay for a long list of preventative services at 100 percent, including childhood vaccines, mammograms, and yearly checkups.

Insurance companies and other critics of the new law say this provision and others like it will drive up the cost of health insurance even higher.

ED HAISLMAIER, Heritage Foundation: It certainly will increase the cost of health insurance, yes.

BETTY ANN BOWSER: Ed Haislmaier of conservative Heritage Foundation says the increases are to be expected.

ED HAISLMAIER: My gosh, this is more micromanaging and more regulatory than anything I have ever seen any state do when it comes to mandated health insurance benefits. You simply cannot require health insurance to pay for more things and not have the cost go up above and beyond what it is. I mean, it’s just simple. It’s not even economics. It’s mathematics.

BETTY ANN BOWSER: Bethesda, Maryland, small business man Jordan Resnick has seen the math, and he doesn’t like it.

JORDAN RESNICK, small business owner: I think it’s highway robbery.

BETTY ANN BOWSER: Premiums for his family and three full-time employees have gone up more than 50 percent in five years. So, he’s had to drop paying for coverage altogether.

JORDAN RESNICK: The money’s got to come from somewhere, and it’s either going to come from salary or it’s going to come from benefit. So now, instead of us being able to match or give a percentage, we have just elected to say, if you want it, you can pay for it yourself through payroll. We’re just not able to give it anymore and still be able to pay a competitive wage.

BETTY ANN BOWSER: Resnick says he’s not convinced another provision, a tax credit for small businesses, included in the law will help his bottom line.

JORDAN RESNICK: I just hope Congress did the right thing with this bill and did provide some provisions that can help people like me be able to, one, stay in business, and, two, be able to make sure that our employees know that, when they walk out the door that, if something happens, they’re covered.

BETTY ANN BOWSER: Some families are already enthused about another new rule, the one that would guarantee coverage for more than two million young adults under age 26 who can stay on their parents’ plan now.

SUE SNIVELY, mother: This is what I should have done with you when you were little.

BETTY ANN BOWSER: For 22-year-old Tom Purser, who has epilepsy, and his mother, Sue Snively, it’s a big relief.

SUE SNIVELY: Having a kid with these kind of — this kind of health condition over the past several years, and him not being a full-time college student a lot of that time, was going to really make a big difference for us, because it gives us several more years. He’s 22.

We now have, you know, three more full years where he will be able to be covered under my insurance. And that means he can take his time and do school in a way that will hopefully work for him. So, it’s very significant for us.

BETTY ANN BOWSER: Before the new regulation, Purser had to be a full-time student to stay on his mom’s policy. But the threat of seizures has made it hard for Purser to go to college full-time.

TOM PURSER, student: I ended up missing a lot of classes. And then, of course, there were the times when I had seizures in school. And the fact that, you know, I’m insured now, even though I’m not a full-time student, is just awesome for me, because I can take my time, and I can be a student, but not be nothing but a student.

BETTY ANN BOWSER: While the new law will help young adults like Purser and help kids who were previously denied coverage on their parents’ plans, big insurance companies in four states announced in recent days they will no longer sell new separate insurance policies to cover children.

WOMAN: OK. You feeling better?

BETTY ANN BOWSER: Earlier this year, industry leaders had indicated they would comply with portions of the law that relate to children’s coverage, a point Obama administration officials made this week.

But a spokesman for America’s Health Insurance Plans told the NewsHour: “The final regulations that were issued went beyond what was originally discussed and what the industry agreed to.”

BARACK OBAMA: We have got to make the system work better for consumers.

BETTY ANN BOWSER: While the Obama administration and the insurance companies are haggling over implementation of the law, the bigger fight could come next year, if Republicans win control of Congress.

The post Health Reform at Six Months: What Changes Are Taking Effect? appeared first on PBS NewsHour.

GWEN IFILL: Now to the continuing fallout over the health reform law.

The battle continues to play out even as the law begins to take effect. In Florida today, a federal judge heard arguments filed by 20 attorneys general who are challenging the validity of the law. And the debate remains alive in the political arena as well.

As the seven-week sprint to the midterms began today with a final round of big primaries, the six-month-old health care law, once sold by Democrats as a political plus, is so far anything but.

(CHEERING AND APPLAUSE)

GWEN IFILL: The latest evidence: a new poll released today by “National Journal” and the Pew Research Center. It shows 45 percent view the law unfavorably, 38 percent favorably. For some Republicans, campaigning against the law has become part of their anti-Washington, anti-big-government pitch.

MAN: I will work to cut spending, lower taxes, repeal Obamacare.

GWEN IFILL: Just last spring, Democrats hoped voters would embrace the issue.

SEN. CHARLES SCHUMER (D-NY): I predict, David, by November, those who voted for health care will find it an asset.

GWEN IFILL: But the president acknowledged last Friday the measure may have turned into a political problem for Democrats.

U.S. PRESIDENT BARACK OBAMA: We’re in a political season where every candidate out there has their own district, their own makeup, their own plan, their own message. In an environment where we’ve still got 9.5 percent unemployment, people are going to make the best argument they can right now.

GWEN IFILL: Opposition to the law is also playing out in the courts and on the floor of the Senate. Today, Nebraska Republican Mike Johanns proposed changing tax-filing requirements for small businesses and allowing some employees to opt out of insurance coverage.

SEN. MIKE JOHANNS (R-Neb.): So, today, are we going to turn our deaf ear to the job creators in America? Are we going to stand with the president, who doesn’t want anybody fiddling with his health care reform, or are we going to stand with small businesses?

GWEN IFILL: Florida Democrat Bill Nelson said Johanns’ approach would undercut the law’s intent.

SEN. BILL NELSON (D-Fla.): Now, what the senator from Nebraska is doing is, he is driving a stake into the heart of the health insurance reform bill by taking two million people out of that pool that are uninsured that otherwise would be getting health insurance.

GWEN IFILL: Both Johanns’s amendment and Nelson’s alternative failed.

Part of the problem: Several of the law’s key provisions do not take effect until next week, among them, children with preexisting health conditions will no longer be denied coverage, and young adults under the age of 26 will be able to stay on their parents’ health plan. Insurance plans won’t be able to drop coverage when people get sick. And lifetime limits on coverage will be lifted. The biggest changes, which would require coverage for tens of millions of Americans, won’t take effect until 2014.

For more on all this, we turn to Karen Tumulty, a political reporter for The Washington Post who’s been spending time on the campaign trail, and NewsHour regular Susan Dentzer, who is editor in chief for the journal “Health Affairs.” She’s been spending time tracking the rollout of the new law.

Karen Tumulty, we just saw Chuck Schumer back in March say: I’m — I am convinced — I am certain that we’re going to be able to run on this. He said it better than I did.

What happened?

KAREN TUMULTY, national political correspondent, “TIME”: The exact opposite of what the Democrats were hoping for.

Back in June, the Gallup poll was suggesting that Americans were pretty evenly divided over the health care law. In fact, there was a 3 percent margin more people supporting it than opposed it. Now, in late August, the most recent Gallup poll suggests that the opposition is now 17 percentage points greater than the support for this bill.

And I think one of the reasons is that this bill fits into the larger narrative of this election year. It’s exhibit A, essentially, in the Republicans’ case that the Obama administration and that the Democrats who have been in charge of Capitol Hill have been guilty of expanding government too much and of overreach. And, again, that is — it — it — this becomes the — the single key piece that is driving that narrative.

GWEN IFILL: So, who is running against it? And who is running away from it, I guess?

KAREN TUMULTY: Well, interestingly enough, you do hear a lot of the — it feels like some of the Democrats who are talking about it the most are in fact the Democrats who voted against it.

And you’re also — a couple of weeks ago, I was in Wisconsin, where, suddenly, Russ Feingold, the senator, finds himself under challenge from an opponent who had never even been in politics before May, who now has a decent shot at beating him. And he argues that the reason is…

GWEN IFILL: His name is?

KAREN TUMULTY: Ron Johnson, a businessman from Wisconsin, claims that the reason he decided to run was because of this bill, which he calls: the single greatest assault on our personal freedom in my lifetime. It is — really, again, plays into the whole narrative that the Republicans have built.

GWEN IFILL: Susan, what has changed and what hasn’t changed about people? Is it people’s understanding of what is in the measure? Or is it just being used for, I guess, political — the details of the bill being used for political advantage?

SUSAN DENTZER, editor in chief, “Health Affairs”: I think Karen is right. I think the overall change here, if it is a change — and it’s really just a worsening of the problem — is that the economy is so dominant now in the various races, if you look at voter sentiment, how voters feel about issues, health reform is a distant third, after the economy and jobs and dissatisfaction with government in general.

So, it’s — there’s just not enough in health reform at the moment to break through any of that for the people who are opposed to it. Another point I would make is, this is still very partisan — 68 percent of Democrats still very supportive of health reform, 77 percent of Republicans violently opposed to health reform.

GWEN IFILL: So, let’s talk about truth-squadding. What has actually happened since this bill passed — was enacted six months ago that people can point to and say, my life is better because of this health care law?

SUSAN DENTZER: Well, as the piece noted, as of six months after enactment, which happens to be September 23, a number of provisions relating to insurance market reform go into effect. And those will help people. Now, mind you, they will help people who already have coverage, because they amend the terms of existing coverage. And, also, for many people, they won’t really feel the effects until January 1, when new plans go into effect.

So, for example, if you are relieved that your plan is now no longer going to have annual limits or will have restricted annual limits, and no lifetime limits anymore, you won’t really necessarily feel that relief until January, when all of that actually goes into effect, because your new plan year takes effect.

Those kinds of things are important, but they tend to benefit people who already have coverage. As the piece noted, the big bang when you start to roll out subsidies to help people who don’t have coverage, all of that doesn’t take effect until 2014. In the end, if you look at the Kaiser tracking poll, the most persuasive number, I think, is that 51 percent of Americans are disappointed now in health reform, because not that much has happened.

GWEN IFILL: And, yet, Karen, and, yet, last August about this time, incredible uproar, lots of town hall meetings taking down this bill, saying it was socialism. We didn’t hear that this year.

KAREN TUMULTY: No, we didn’t. And it was really interesting, at least in the places where I was going to these town halls, the kinds of questions that people were asking. You’re right. People were not screaming socialism and death panels. They were asking questions like, you know, I have a small business. And, suddenly, you know, I’m going to have to provide — what is this going to do to me?

And I don’t think that, until people feel this law fully implemented, not just the expansion of coverage that comes in a few years, but whether it lives up to its promise of transforming the health care system, of reining in some of these forces that have been driving everyone’s costs through the roof, not until people see whether that is working — and that could be decades away — are they really going to, I think, know whether this is a bill, a law that has helped more people or hurt more people.

GWEN IFILL: I think the supporters of this law would have said, of course we knew it was going to take time to roll out. But in the time that it’s taking to roll out and be felt, what real possibility is it that efforts to repeal all or part of it are serious?

SUSAN DENTZER: Well, the efforts are very serious. Whether they result in serious ends remains to be seen. It’s very clear that the Republican strategy is to pick away at various sources of revenue that finance the legislation. That was part of the dance this week. If the House — if the Republicans take back the House or increase their margins in the Senate, you will see more of the same.

Of course, as long as President Obama is in the White House, he would presumably veto all of that legislation. So, we don’t expect much. But, of course, all of this is sort of gearing up a general aura of dissatisfaction with the legislation that could build on itself and perhaps help the Republicans in 2012.

GWEN IFILL: Let’s take that general aura of dissatisfaction and kind of flip it on its head.

How do you take away something from people that they already have? Is the White House perhaps counting on the fact that, now that this is law, they can talk all they want about rolling it back, but that’s harder to do than getting it in the first place even?

KAREN TUMULTY: I agree. I think that if this becomes a debate over repealing this law, it becomes a completely different kind of debate.

But a lot of the issue, I think, is going to be shaped and framed around how well this law is implemented over the next few years. If, as the government, both the state governments and the federal government, come — come up with unanticipated consequences, glitches in the law that they didn’t expect, if they are able to sort of fine-tune it, and make the implementation more smooth than a lot of people expect it to be, I think that that, too, will also gradually make people feel more comfortable with the law.

GWEN IFILL: And how much is this not really playing out so much in Washington as it is on the state level or even in these individual congressional races, which sometimes actually feel like local races?

SUSAN DENTZER: Well, there is a lot of tension at the state level, where, as in many states, as we see, you have attorneys general suing to undermine the law and essentially have provisions of it declared unconstitutional cheek by jowl with people who are in charge with planning for the implementation, setting up the health insurance exchanges, figuring out what rules they now need to enforce some of the new provisions on insurance companies.

So, they’re all kind of looking over their shoulders, saying, well, what the heck is happening, and worrying about what the tendency is going to be over time. I think, on balance, what the Democrats are hoping is that, as more and more of these provisions roll out, and because they are so interdependent, it will just frankly get harder to start to take this all apart, and people will start to see, bit by bit, some additional benefits.

The preexisting condition restrictions program — or preexisting conditions program, rather, which enables people now who couldn’t get coverage at all because of chronic illness or other things, people — you know, a few more thousand people get coverage under that, it’s a lot harder to take that away.

GWEN IFILL: It sounds like we have a long-term challenge and a short-term, the short-term between now and November.

Thank you both very much.

SUSAN DENTZER: Thanks, Gwen.

KAREN TUMULTY: Thank you.

The post Ahead of Elections, Lawsuits Revive Debate on Health Reform appeared first on PBS NewsHour.

BETTY ANN BOWSER: It’s been just over four months since President Obama signed the health reform bill into law. But it remains under attack across much of the country.

At least 20 more states are now challenging the constitutionality of the new law, either in court or on the ballot. In Virginia today, a federal judge allowed the first lawsuit to go forward by denying a motion from the Justice Department to dismiss a case filed by the state’s attorney general. It argues the law is unconstitutional because it requires most Americans to buy insurance.

Tomorrow, voters in Missouri will decide whether to pass Referendum C, which would make it against the law to require people to buy insurance.

For its part, Democrats and the Obama administration are trying to persuade Americans that health care reform will be a major improvement.

WOMAN: How are you this morning?

BETTY ANN BOWSER: The latest announcement, a new report that says the law will save Medicare $8 billion over the next few years and $575 billion over the rest of the decade.

So far, some portions of the law are already taking effect or will begin to do so this fall, including stopping insurance companies from excluding coverage for children with preexisting conditions, allowing young people to stay on their parents’ insurance until age 26, giving $250 rebate checks to seniors to buy prescription drugs, and issuing new rules to allow people to appeal claims that have been denied by insurance companies.

By 2014, the administration says it expects 26 million more Americans to have insurance. Much information about the law’s impact can be found on HHS’ new Web site. And, last week, the president touted the law’s benefits.

President of the United States BARACK OBAMA: That’s why we passed this reform, to put Americans in control of their health care. No matter your age or situation, there’s something for everyone at healthcare.gov.

MAN: We have looked at your blood pressure today, and it is great.

BETTY ANN BOWSER: But there still is plenty of resistance and skepticism.

WOMAN: Lift it up again straight.

BETTY ANN BOWSER: Polls show many Americans are wary or opposed to the law, although numbers have slightly improved. Heading into the midterm elections, Republicans are arguing that many Americans don’t like the law.

This was Senate Minority Leader Mitch McConnell last week at an event in Kentucky.

SEN. MITCH MCCONNELL (R-KY), Minority Leader: We jammed health care through on a totally partisan basis, in spite of widespread public outrage. So, there’s a serious and sustained disconnect between some in Washington and the rest of the country on issues that have a major impact on people’s lives.

BETTY ANN BOWSER: Republicans are hoping to keep health care reform front and center. And they say, if they pick up enough seats, they will push for repeal of the legislation.

JUDY WOODRUFF: We take a closer look now at these developments and the battle over the law with the secretary of health and human services, Kathleen Sebelius.

Madam Secretary, thank you for being with us.

U.S. Health and Human Services Secretary KATHLEEN SEBELIUS,: Good to be with you, Judy.

JUDY WOODRUFF: So, four months in after the law passed, and still such vehement opposition out there. Half the states are trying to repeal this in one form or another. How do you explain this?

KATHLEEN SEBELIUS: Well, I think, first of all, this has been a long and very partisan debate, full of lots of misinformation.

So, there are a lot of people who still don’t know what’s in the law, don’t know what exactly it means to them and their families. And what we’re trying to do is actually get information, get some tools, as the president said, whether it’s the new Web site, healthcare.gov, which is really pretty dazzling — it gives people information that they have never had before in one place — or, you know, mailing information to seniors.

Once people know what the law means to them and their families, that their adult child stays on their plan, or that no longer will a child with a preexisting condition be able to be kicked out of an insurance plan by insurers, they become much more enthusiastic about what actually the Affordable Care Act does.

JUDY WOODRUFF: Well, I want to ask you about that, because the president did say that in the run-up to the passage of this legislation. He said, once people knows what’s in here, they are going to like it.

But the polls still show, yes, there is some more support, but over 50 percent of seniors still say they are disappointed in this law.

KATHLEEN SEBELIUS: Well, when you think about what happened to seniors during the course of this debate, it borders on outrageous.

Senior, I would say, were really targeted with a whole series of misinformed statements that were designed to scare them about the law, to get them to actually call on their members of Congress and Senate to stop it, starting with everything from death panels, which still most seniors think are part of the Affordable Care Act.

JUDY WOODRUFF: Is that right? Most seniors still think that?

KATHLEEN SEBELIUS: Absolutely. The recent polling says that seniors think this actually was passed into law. Seniors think that there is a change in their guaranteed benefits under Medicare.

Nothing could be further from the truth. The guaranteed benefits are not only stronger than ever. We’re going after fraud and abuse in a way that has never been focused on. And the Medicare solvency is much stronger than it was before the law was passed.

JUDY WOODRUFF: Well, I want to ask you about that in a minute. But today’s ruling by a Virginia judge, saying that this — this challenge to the constitutionality of the law can go forward, what about the argument that is being made that it’s not constitutional to tell people they must buy health insurance?

KATHLEEN SEBELIUS: Well, I think, when you think about it, Judy, first of all, it’s not a surprise that the ruling came today.

I mean, what it basically does is, now there can be a debate on the merits of the case. So, it’s really a threshold argument: Did the attorney general have standing to go ahead?

JUDY WOODRUFF: What do you mean it’s not a surprise it came today?

KATHLEEN SEBELIUS: Well, I think that, being portrayed as somehow a major ruling, all the judge said is, come to court and then talk about the merits of the case.

We’re convinced that there are — strong constitutional basis for this. And the interstate commerce, which is the purview of the federal government, governing business that travels back and forth across states, when you think about health care, there is a lot of interstate commerce. A lot of the health markets are regional.

And people pay — taxpayers pay for every dollar of uncompensated care. For everyone who comes through an emergency room door, that goes on to the backs of taxpayers and lots of people who pay insurance policies and pay more for those who are uncompensated.

JUDY WOODRUFF: Well, meanwhile, you have Republicans who are saying, whatever happens in the courts, they’re going to continue to try to chip away at this legislatively. They’re going to try to deny funding for big chunks of this.

Do you ever worry that you are out there trying to defend something that’s going to be hollowed out?

KATHLEEN SEBELIUS: Well, I hope we are able to engage in a straightforward manner this fall in that debate.

I think it’s fine for Republicans to go to their constituents and tell parents who have a child under the age of 26, your son or daughter, we want to take back their right to enroll in your insurance policies. We want to make sure that insurance companies, Mr. Republican Congressman or Congresswoman, are going to be able to kick your sick child out of a plan. We want to make sure that seniors will not see their prescription drug doughnut hole closed over time.

That’s a debate I welcome and I hope that we are able to talk about. Repealing this bill means taking benefits away from lots of Americans who are really relying on this change, once and for all, to get some tools into their own hands.

JUDY WOODRUFF: On the savings that you have been talking about today that will be realized for Medicare, Republicans like Charles Grassley — you have got — and the insurance industry now saying the cuts that will come to private Medicare plans will result in huge increases in premiums for seniors, which will then force them to give up their Medicare.

KATHLEEN SEBELIUS: Well, I don’t think that’s accurate, first of all. The data shows that about a fourth of Medicare beneficiaries choose Medicare Advantage plans. We have more companies offering Medicare Advantage right now than we have ever had before. We anticipate…

JUDY WOODRUFF: These are the private…

KATHLEEN SEBELIUS: These are the private choices. So, you can either choose traditional Medicare or a Medicare Advantage plan.

But we have overpaid by about 14 percent. And everybody else in Medicare pays for that overpay — pays more for their Medicare policies, no additional health benefits to the people who choose. And all we’re saying is, gradually, over time, that overpayment should stop. We think there’s going to be plenty of choices.

JUDY WOODRUFF: And what is going to happen to those seniors who are in these plans?

KATHLEEN SEBELIUS: They will absolutely have the choice of those plans. Those plans will stay in effect. They will stay in the market.

In fact, the Centers for Medicare Services has issued a notice to companies, saying there will not be a cut next year. There will be a flat line for Medicare Advantage plans, so come in with your package of proposals. Come in with your bid.

But we think there are going to be plenty of options for seniors who want to continue in a Medicare Advantage plan.

JUDY WOODRUFF: Let me ask you about another headache out there, and that is Medicaid funding for individuals, the poor. A number of states, governors are coming to you, to the Obama administration, saying, wait a minute, this law means that we don’t have the flexibility to deal with these rising Medicaid costs. Our budgets are being stretched and strapped.

What are you saying to the states that are struggling with this right now?

KATHLEEN SEBELIUS: Well, first of all, as you know, I was one of them, until very recently, governor of a state, watching the Medicaid budget.

And this is a federal-state partnership, no question about it. I mean, the first thing we need to do is get Congress to act on the extension of the assistance for Medicaid programs across the country. That’s been pending now for months and months and months, and tonight again came a near vote in the Senate. It’s now been pushed off to Wednesday.

But that’s a huge step forward for states, to pass the FMAP, the federal matching plan. Secondly, in 2014, when the Affordable Care Act has an expanded Medicaid opportunity for lots of adults who don’t qualify, it’s paid for 100 percent by federal funds for the first four years and then gradually recedes to a 90 percent federal funding.

So, this is a huge number of people who currently are coming through the doors of emergency rooms in states. States are picking up costs for all kinds of health-related costs. And the federal government is saying, we think we should cover everyone, and we think we are going to pay for it, states, and help you in this partnership.

JUDY WOODRUFF: So many, many questions out there. And we thank you for dealing with some of them with us. Secretary Sebelius, thanks so much.

KATHLEEN SEBELIUS: Sure.

The post Sebelius: Health Reform Misinformation Persists; Medicare Solvency Now Stronger appeared first on PBS NewsHour.

JIM LEHRER: Now: a health reform update on coverage for the uninsured.

New programs are taking effect in states this summer to provide insurance for some who have not been able to get coverage at all. But there are questions about just how effective they will be.

“NewsHour” health correspondent Betty Ann Bowser reports.

Our Health Unit is a partnership with the Robert Wood Johnson Foundation.

BETTY ANN BOWSER: On the outside, 58-year-old Carolyn Eaton looks like the picture of health. She eats right and keeps in shape by taking daily walks with her dog Mischa near her apartment in Northern Virginia.

But, on the inside, Eaton is fighting a serious heart condition called cardiomyopathy that weakens her heart. Equally important, it also makes her uninsurable.

CAROLYN EATON, uninsured: It’s frightening right now because my health is pretty stabilized. The only thing that I’m worried about is if I have a catastrophic event. What if I have a heart attack?

I really love this picture of Trey.

BETTY ANN BOWSER: Eaton has had no health insurance since last fall because of her preexisting condition.

The federal government estimates that hundreds of thousands of Americans share her dilemma and are denied insurance coverage because of health problems. Bush, starting this summer, they will be able to apply for temporary coverage through the preexisting insurance plan. It’s part of the new health care reform law passed in March.

The plan is designed to provide coverage until 2014. That’s when the broader rules that will forbid insurance companies from denying coverage to all individuals with health problems kick in.

Richard Popper heads the new program for the Department of Health and Human Services.

RICHARD POPPER, Office of Consumer Information and Insurance Oversight, Department of Health and Human Services: The preexisting condition insurance plan is designed to provide immediate coverage, access to coverage for people who are locked out of the insurance market.

BETTY ANN BOWSER: Popper, who ran the Maryland state high-risk pool before he took his post at HHS, estimates as many as 400,000 Americans may enroll in the new federally funded program.

MAN: So, then you talk directly to the radiation oncologist.

BETTY ANN BOWSER: Twenty-nine states and the District of Columbia will run their own high-risk programs using their share of a $5 billion federal pool of money set aside. Twenty-one others have opted out. In those states, HHS will run the pools through a third-party administrator.

To qualify, applicants must be an American citizen, have been denied coverage by an insurer because of a medical condition, and be uninsured for at least six months.

For Eaton, all of this can’t come soon enough. Right now, she’s stuck paying out of pocket for her medical care and prescription medication, which she estimates total $8,000 a year.

CAROLYN EATON: It’s time for me to see my cardiologist again. I should have another echocardiogram. That’s going to be $1,200. In the back of my mind, there’s always that fear. You know, if I have a twinge in my heart or one day I might be feeling a little less energetic, then I’m always thinking, oh, God, I hope I’m OK. I hope this isn’t the beginning of something that is not going to be affordable to me.

BETTY ANN BOWSER: People who sign up can be charged no more than what healthy people pay for insurance coverage in their state. But the federal government will pay the difference between that and the actual cost of the premiums. Dollar amounts will vary from state to state.

DR. BILL HAZEL, Virginia secretary of health and human resources: The money that we believe that the federal government would provide us to operate the program wouldn’t last the period needed.

BETTY ANN BOWSER: Virginia’s secretary for health and human resources, Dr. Bill Hazel, says that’s why his state decided not to participate.

DR. BILL HAZEL: We went to our carriers, our vendors, and said, OK, how much would it cost if we were following the new rules, if this were to be a high-risk pool? And the answer roughly was $500 per member per month, which is about $6,000 per every individual in the plan per year.

BETTY ANN BOWSER: Hazel and his staff did projections based on a scenario of 10,000 Virginians buying in.

DR. BILL HAZEL: And if 10,000 people signed up for this, and if 10,000 signed up for it at $6,000 per year, we would run out of money in 22 months. And we didn’t need to go any further than that.

We felt that that amount of money wouldn’t cover even a small number of people with preexisting conditions coming in to a high-risk pool. So, what would then happen to Virginia when the money runs out?

BETTY ANN BOWSER: What would happen?

DR. BILL HAZEL: Well, that’s what we don’t know.

BETTY ANN BOWSER: Running out of money from the federal government is the main reason most states have given for opting out of the high-risk program. So, under the new law, it’s now up to the Department of Health and Human Services here in Washington to develop coverage for people who live in those states and are hard to insure.

Even the nonpartisan Congressional Budget Office reported recently that the funding available for subsidies wouldn’t be sufficient to cover the costs of all applicants through 2013. And the CBO predicted HHS would have to use its authority under the law to limit enrollment in the program.

Popper says he thinks the $5 billion is adequate.

RICHARD POPPER: We have ways of managing that money to make it last. We can adjust some of the cost-sharing. We can shift money between the states, because, in some states, you could have very dramatic enrollment growth, in other states, not so dramatic, because of the nature of their marketplace. And we can also take a look at the way the premiums are calculated.

BETTY ANN BOWSER: But the premiums, even with the federal government paying a substantial part of the cost, may be too high for some people to afford. HHS estimates premiums will run between $140 and $900 a month.

Deborah Chollet is a health insurance expert and senior policy fellow at Mathematica Policy Research in Washington. She says who will be able to afford the program is a big unanswered question.

DEBORAH CHOLLET, senior policy fellow, Mathematica Policy Research: There’s really no good way to know. I think when people apply to the high-risk pool, even though it will be subsidized substantially, even though it is unique, and that the premiums will be at market rates for healthy people, I think they will still be amazed at how expensive it is.

BETTY ANN BOWSER: But HHS’s Popper says the program is designed to be a temporary one.

RICHARD POPPER: It’s not a solution for everyone, because there are still a lot of issues and challenges in the insurance marketplace, but it’s designed to be a bridge until 2014, when the more significant and larger health reforms take effect.

BETTY ANN BOWSER: According to a new HHS Web site, the estimated premium for a 50-year-old will be between $440 and $538 a month in Virginia.

But Carolyn Eaton is not convinced her premiums will be that low.

CAROLYN EATON: I’m really interested in finding out how much the premiums are going to be, what the deductibles are going to be. Basically, I want to know if that’s going to be affordable to me.

BETTY ANN BOWSER: Eaton says she’s praying the preexisting condition insurance plan will get her to 2014.

The post High-Risk Patients, States Prepare for New Insurance Rules appeared first on PBS NewsHour.

JUDY WOODRUFF: It’s been almost three months since the president signed a new health care reform law. And, today, he was out making the case for its merits.

“NewsHour” health correspondent Betty Ann Bowser has the story. The Health Unit is a partnership with the Robert Wood Johnson Foundation.

U.S. PRESIDENT BARACK OBAMA: Just two generations ago…

BETTY ANN BOWSER: The president hosted a tele-town hall meeting in suburban Washington, where he addressed the concerns of seniors, one of those groups of voters most worried about how the health care overhaul will affect them.

BARACK OBAMA: What you need to know is that the guaranteed Medicare benefits that you’ve earned will not change. This new law gives seniors and their families greater savings, better benefits, and higher-quality health care.

BETTY ANN BOWSER: The legislation which Mr. Obama signed into law in March extends health coverage to 32 million uninsured Americans by 2014, mandates most people buy insurance or pay a fine, sets new regulations on insurers, and provides subsidies and Medicaid expansion to millions of individuals. It will also cut some $500 billion in future Medicare spending, something that has seniors very concerned.

Today’s town hall was the first of many events aimed at winning over a skeptical American public between now and midterm elections. Democrats and allies of the Obama administration are raising $25 million to set up a new tax-exempt group to head off criticism that might impact candidates in November.

A key part of the strategy is showing Americans how the law will benefit them. The president told seniors today the first batch of $250 rebate checks are being mailed to help millions of them when they fall into the coverage gap known as the doughnut hole.

BARACK OBAMA: It’s being phased in, but, by 2020, this law will close the doughnut hole completely. The doughnut hole will be gone. It will be gone.

BETTY ANN BOWSER: Seniors aren’t the only ones unsure about new law. Recent polls show more than 50 percent of Americans don’t like it. However, most people don’t want to repeal the legislation. That is something Republicans are trying to do in at least 30 states.

While much of the new law takes effect in 2014, the administration is already beginning to roll out some of its provisions, including a high-risk pool for those who are hard to insure. And most major insurance companies have agreed to allow parents to keep children on their insurance policies until they turn 26.

JUDY WOODRUFF: And more now about some of those changes that are already taking place or will be in the next several months.

Susan Dentzer is with us once again. She’s the editor in chief of the journal “Health Affairs” and an occasional analyst for the “NewsHour.”

It’s good to have you back with us.

SUSAN DENTZER: Great to be back, Judy.

JUDY WOODRUFF: Before anything else, let me ask you about something the president said. He said to these seniors today, “I want to assure you that your Medicare benefits are not going to change.”

At the same time, we are reporting there’s going to be a $500 billion cut in Medicare benefits in the future. How do you reconcile that?

SUSAN DENTZER: Not a cut in benefits. The $500 billion, people should understand, is a $500 billion slowdown in the rate of growth. Medicare spending is still going to grow substantially.

For the last couple of decades, Medicare has grown 4 percent per year per beneficiary. In the future, it will grow 2 percent per year per beneficiary. So, spending is still going to go up, including for benefits. It’s just that hospitals in particular aren’t going to see their payments rise as quickly as they would have otherwise.

And there will be other entities that won’t be paid quite as much as well, particularly entities that operate so-called Medicare Advantage plans. Their payment is going to change.

JUDY WOODRUFF: An important distinction here.

SUSAN DENTZER: An important distinction. And we don’t know, frankly, what that means for benefits. But when the president said, your guaranteed benefits won’t change, he’s correct. It’s some of the extras that some of these plans have provided that may or may not change. But, quite honestly, we won’t know that for several years.

JUDY WOODRUFF: Now, today, the president talked about, Susan, those $250 rebate checks. Who is going to get them, and how significant is that?

SUSAN DENTZER: Everyone who has drug spending high enough to fall into the so-called doughnut hole will qualify — will qualify for a check.

That means people who have total drug costs this year of $200 — excuse me — $2,830. So, what happens with this program is, first, you pay a $310 deductible. Then, from $310 up to $2830, the government pays three-quarters of your drug bills. You pay a quarter. Then it stops until you get total drug costs of $4,550.

This was not a huge innovation in benefit design. It was just a big hole to save a lot of money on the part of the government. So, what happens is, when you hit that $2,830 total drug spending now, you will get this $250 rebate check, which, of course, will just help a little bit, while you get through that doughnut hole. And then, when you get through the doughnut hole, you get broad coverage once again.

JUDY WOODRUFF: It’s a little bit, but they’re trying to get it out there quickly with these checks.

SUSAN DENTZER: That was the point. And, as was said, by 2020, the doughnut hole disappears altogether.

JUDY WOODRUFF: Now, let’s move on to another feature of health care reform moving — coming on stream. And that is expanding insurance coverage for children all up to the age of 26.

SUSAN DENTZER: That’s right. A number of the insurance provisions take place right away or very soon. And, as of September, essentially, all insurance plans were going to be required to offer coverage for dependents up to the age of 26.

Now, about 65 insurance companies stepped forward in advance of September and said, we’re going to do that now, particularly as people are leaving college or leaving school and going off health plans they might have in college and now are going to be able to enroll in their parents’ plans. So, this will start to phase in across the country.

If you’re an employer-provided insurance, particularly if your employer self-insures, it may not be the case that a child can be covered until January, when — which is typically when the new plan year starts. But, essentially, from now through January, we’re going to see a lot of younger adults becoming covered under their parents’ plans.

JUDY WOODRUFF: So, some movement in that area.

And, then, Susan, the so-called high risk pools, this is establishing insurance coverage for people with preexisting medical conditions, there’s some movement in that area.

SUSAN DENTZER: That’s right.

There are at least five million to seven million Americans who lack insurance now primarily because they have preexisting medical conditions. Usually, these are chronic conditions that are high-cost. And because the full-blown coverage plan doesn’t phase in until 2014, the government set aside $5 billion to either help states provide coverage for this population in so-called high-risk pools, or, if states didn’t want to do that, the federal government was going to come in and do it for them.

So, we now have that money on the table. And about 30 states have signaled that they want to take advantage of the money and use that to basically create their own pools, or augment, change some of their existing ones. There are another 20 or so states that have said, thanks, no — but no thanks. So, we honestly don’t know how many people are going to be able to be covered through them.

A bigger issue is whether there is enough funding appropriated for this purpose. And, in fact, $5 billion, by some estimates, may mean that only a couple of a hundred thousand people will be able to be covered under this.

JUDY WOODRUFF: Out of a potential much larger group.

SUSAN DENTZER: Five million to seven million. So, it may be — it may well be the case that Congress is going to have to go back at some point and reexamine the funding or some of the provisions that are required of this high-risk coverage, because the coverage has to be relatively generous under this federal program compared to what it is under many existing state programs.

JUDY WOODRUFF: Susan, you watch this whole area so closely. There — you were telling us earlier today there are other things happening now in the health care delivery realm, beyond the things that we have just talked about.

SUSAN DENTZER: That’s absolutely right.

One of the most important goals of the legislation is to bend the cost curve, basically slow the rate of growth of overall health spending, and achieve more value for the dollars that we spend on health care. So, a lot of this is going to be accomplished by reforms of the health care delivery system.

So, you’re — Americans are going to start to hear about concepts like accountable care organizations and the medical home, new features, new ways of organizing health care that the — that the new law allows and indeed in some senses compels to happen.

So, there’s a lot of ferment now in the hospital sector in particular, as people are looking at this, thinking, how should we reorganize ourselves for the new delivery systems and the new payment systems? And that’s going to have an impact on the way many Americans receive their health care, and hopefully for the good.

JUDY WOODRUFF: In just a very few seconds, there are a number of people who don’t like this, a number of attorneys general, states around the country, that are trying to repeal it in several states.

Can you give us just a quick sense of where those legal moves stand?

SUSAN DENTZER: Most of those cases have targeted the so-called individual mandate, which is the provision that will take effect in 2014 that compels people to have health insurance or pay a penalty.

And many of the states’ attorneys general argue that that’s unconstitutional. There’s a lot of difference of opinion on that, though. And I think the preponderance of the constitutional thinking is that, actually, the federal government is allowed to do this under the clause of the Constitution which gives it the right to regulate commerce among the states.

But, of course, that will be up to the courts. And we will see what happens.

JUDY WOODRUFF: The health care reform conversation keeps going on.

SUSAN DENTZER: It does indeed.

JUDY WOODRUFF: Susan Dentzer, thank you for helping make it all clearer for us.

SUSAN DENTZER: Thanks, Judy.

The post Obama Touts Health Care Reform Progress as Election Looms appeared first on PBS NewsHour.

JUDY WOODRUFF: And speaking of obesity, we turn next to a campaign in the U.S. to reduce the problem among children. That’s a signature issue for first lady Michelle Obama.

Yesterday, she made a public recommendation — made public recommendations from a federal task force on how to tackle the epidemic. She called for government help in reducing sugar in children’s diets, increasing the number of fruits and vegetables they eat, working to open larger grocery stores in under-served areas known as food deserts, and boosting the number of kids in physical education classes.

The first lady said those goals were achievable.

MICHELLE OBAMA, first lady: We just need everyone to do their part. And it’s going to take everyone. No one gets off the hook on this one, from government to schools, corporations to nonprofits, all the way down to families sitting around their dinner table.

JUDY WOODRUFF: NewsHour health correspondent Betty Ann Bowser has been looking into how one state with a big problem is trying to make some big changes.

Here is the first of two reports she will file from Mississippi.

The Health Unit is a partnership with the Robert Wood Johnson Foundation.

BETTY ANN BOWSER: The state of Mississippi is doing battle with one of its most cherished culinary traditions, fried food. And front line in this war against fat is the state’s public schools.

Kids in Mississippi are the most obese in the nation. So, in January, using federal and private money, 94 of the state’s 1,055 schools got rid of the food fryers in their cafeterias, and replaced them with special combination steam ovens that don’t use any kind of cooking oil.

Out went the deep-fat fried chicken and pork chops. In came potatoes the look like french fires, but are now baked, instead of cooked in fat. The move didn’t sit well with a lot of the teenagers at M.S. Palmer High School in the Mississippi Delta town of Marks.

What we heard from students Laquon Smith and Brandi Thompson was typical.

LAQUON SMITH, student, M.S. Palmer High School: It’s just — it’s nasty, just nasty. I don’t like it.

BRANDI THOMPSON, student, M.S. Palmer High School: I understand the part about us being healthy, but the food they cook, we don’t eat, because everybody can’t cooked baked food the same. And it just don’t taste right.

BETTY ANN BOWSER: Obesity is not just a Mississippi problem. The CDC says 30 percent of all American children between 2 and 19 are too heavy or obese, triple the number of 30 years ago.

And according to a new report published this month, the percentage of obese girls increased more than twice as much as it did for boys among middle and high school kids. And between 2003 and 2007, black and Hispanic kids were twice as likely as their white counterparts to be overweight and obese.

But nowhere are the numbers more sobering than in Mississippi, where 44 percent of kids aged 10-17 are considered overweight or obese, compared to nearly 32 percent nationwide. That extra weight puts them at risk for diabetes, high blood pressure, stroke, cancer, and other causes of premature death when they grow up.

DR. LAWRENCE COUNTS, Aaron E. Henry Community Health Services Center: I have seen numerous patients that have had a lot of ill effects from carrying too much weight. It over — overlaps into a lot of diabetes and hypertension, high cholesterol.

BETTY ANN BOWSER: Dr. Lawrence Counts is an internist at a community center in nearby Clarksdale, where some obese kids go for treatment. He says some of them develop serious medical problems as early as the teen years.

DR. LAWRENCE COUNTS: I have seen them progress to actually end stage renal disease. I have seen them progress to actually have a heart attack at the age of 28. And that’s hard to imagine, a 25, 28-year-old having a heart attack, but I have patients that are like that. And that’s scary.

BETTY ANN BOWSER: It’s estimated more than 50 percent of obese children will become obese in adulthood. Last year alone, treating adult obesity-related illnesses cost near $147 billion.

Mississippi already has the highest rate of obese adults in the nation. It’s a problem those who serve as role models struggle with, like Kirkpatrick Elementary School principal Suzanne Walton in Clarksdale.

SUZANNE WALTON, principal, Kirkpatrick Elementary School: I have been diagnosed obese. My husband has just been diagnosed diabetic. And so, together, we’re changing the way that we eat and prepare foods. And we both can tell the difference already.

BETTY ANN BOWSER: Walton says she will do whatever it takes to promote her kids’ health. She has won grants from several foundations to pay for this playground exercise equipment and to bring in a yoga teacher twice a week.

Students are also screened for body mass index, or BMI, which determines what a healthy weight is for each child.

MAN: And we just need to work on it a little bit, so we can knock your — the number down, and then you will be more healthier.

SUZANNE WALTON: We are beginning to see a small difference. I think it’s going to take some time, but I think we will — eventually, we will make a difference with these children.

BETTY ANN BOWSER: And Kirkpatrick isn’t the only school making the effort. In 2007, Mississippi passed a law requiring public schools to provide 45 minutes of health education instruction and 150 minutes of physical activity each week for grades K-8. Until then, gym class had been optional.

And lower-calorie, lower-fat foods are replacing some of the high-starch lunchroom staples. But food service managers in poor counties like Quitman have a hard time finding a way to bring the more expensive fresh fruits and vegetables into their cafeterias.

And this is what Walton and other community leaders are up against. We visited this buffet nearby. It featured home-style Southern cuisine, fried chicken and pork chops, vegetables cooked in bacon fat, hot cornbread and rolls slathered in butter.

DR. AL RAUSA, Mississippi State Department of Health: Culturally, this is fat heaven. If it’s not greased or cooked in fat or fried, it’s not edible.

BETTY ANN BOWSER: Dr. Al Rausa is the state’s health officer for 18 counties in Northwest Mississippi.

DR. AL RAUSA: Today, you know, we have an abundance of processed food. In the whole United States, our country has — each individual has 3,500 calories available every day. That’s what we have in food in the pipeline. And we only need 1,200 for what we do. It’s devastating, if you constantly consume excess calories. And most of those are going to come from the processed food that are rich in calories.

BETTY ANN BOWSER: More than 97 percent of children in Quitman County and surrounding areas come from families that have incomes so low, their kids qualify for the federal government’s free school breakfast and lunch programs. That means two of their daily meals are eaten at school.

WOMAN: I stay within my abilities.

BETTY ANN BOWSER: Deloris Clayton is the health teacher at Palmer High School.

DELORIS CLAYTON, health teacher, M.S. Palmer High School: You have got to be honest. This is the only food our kids get is here at school. You may not believe it, but it’s not always at home for them. And I have heard kids say, well, I will just eat at school. You know, they may not like even what they have at home. And some of them just don’t have it, period.

BETTY ANN BOWSER: But some kids are trying to change. Seventeen-year-old Victoria Crawford is a junior at Palmer High. She’s dropped two clothing sizes since she started paying attention to her diet.

VICTORIA CRAWFORD, Student, M.S. Palmer High School: I feel great. I can — I can — I like — I just walk and I enjoy it, because I didn’t even like to be outside in the sun, or just because it would be too hot or it would just wear me down. But now I just love being out more than I used to.

BETTY ANN BOWSER: Victoria got the whole family into the act, including her grandmother, 63-year-old Freddie Johnson, who does most of the family’s cooking.

FREDDIE JOHNSON, grandmother: And I went to the doctor, like, in January. And I went back again in March, I had lost 11 pounds. I said, wow, I like this. And it made me feel good. And you know, I have more energy and stuff like that. I get around better. My back don’t bother me.

BETTY ANN BOWSER: Mrs. Johnson also no longer needs medication to control her high blood pressure.

FREDDIE JOHNSON: If we just start here, and by Victoria getting our weight down, and myself, at the age I am, getting my weight down, and then — and seeing how active I am, somebody else going to catch on, too.

BETTY ANN BOWSER: But, despite a changing tide in this one household and in schools across the state, health officials acknowledge their war against fat is going to take time. It will be an uphill climb.

JUDY WOODRUFF: Betty Ann’s next story looks at so-called food deserts in Mississippi, where large grocery stores are few and far between.

The post Mississippi Wages Fried Food Fight Against Childhood Obesity appeared first on PBS NewsHour.

GWEN IFILL: Now we continue our spotlight series here in Florida focusing on health care.

“NewsHour” health correspondent Betty Ann Bowser begins by introducing us to four individuals who have been watching the debate closely.

BETTY ANN BOWSER: Florida ranks second in the nation in the number of people on Medicare, with just about three million enrollees.

But Americans of all ages are eternally drawn to the Sunshine State for its casual way of living. Older Americans may come to Sun City Center, 25 miles south of Tampa. Life’s easy here: lie by the pool, take in a leisurely came of bridge or canasta.

Dee and John Williams moved down for their golden years, which they now see threatened by the new health care law.

DEE WILLIAMS, retiree: Solve the problem that exists, but leave the rest of us alone.

Thirty-seven-year-old allergist Dr. Mona Vishin Mangat thinks the new law will solve insurance problems for millions of Americans.

DR. MONA VISHIN MANGAT, physician: It’s going to make health care affordable. It’s going to make it so that, I think, you know, upwards of 94 percent of the population will be covered.

BETTY ANN BOWSER: Orlando small company owner Jerry Pierce worries the new law will harm his business.

JERRY PIERCE, small business owner: I think that, reading the law, reading what was signed on that bill, I would say we’re headed into huge, huge bureaucratic problems.

BETTY ANN BOWSER: And 58-year-old Ronni Drimmer hopes the new law will make it easier for her to find reasonably priced insurance, even with her preexisting condition.

RONNI DRIMMER, self-employed: I hate paying this bill. I mean, it’s way too much money. It’s very stressful for me.

BETTY ANN BOWSER: These are just a sampling of the millions of Floridians who have vested interest in the new health care reform law and a range of opinions, from high hopes to predictions of doom.

A typical morning at the Williams’ household in Sun City Center can be defined by a warm cup of coffee and a morning newspaper. By mid-morning, 81-year-old Dee and her 80-year-old disabled husband, John, are usually out and about, many mornings heading to the rec center for a workout.

John suffered a fall a few years ago that left him with a brain injury and limited mobility.

DEE WILLIAMS: Yes, he learned everything from scratch, talking, eating.

BETTY ANN BOWSER: Since then, it’s been one medical crisis after another, three heart bypass surgeries and a pacemaker, all paid for by Medicare and their supplemental insurance.

And even though there is nothing in the law that calls for establishing panels that will decide which seniors get health care and which ones don’t, Dee believes that will happen.

DEE WILLIAMS: Well, they talk about it on talk radio every day, that there will be a committee that will decide — for some of us older ones that have these huge health problems, they’re going to look at the actuarial tables. Is he going to — is he or she going to live long enough to justify this cost?

PROTESTER: How can we be expected to support or to vote against a bill that we have never been shown?

BETTY ANN BOWSER: Last year, Dee joined the Tea Party movement and went to Washington, along with thousands of others, to protest health care overhaul efforts.

DEE WILLIAMS: I believe the way they do. And I want less government. I want less spending. I want less taxes. And I want more freedom.

Hello.

BETTY ANN BOWSER: Saint Petersburg allergist Dr. Mona Vishin Mangat couldn’t feel more differently. She’s a member of Doctors For America, a grassroots group that lobbied for a single-payer system during the health care debate.

DR. MONA VISHIN MANGAT: I’m extremely pleased with the bill. I think it’s a very good bill. Obviously, it could be better, but I think it’s a step in the right direction. It really gets us a lot closer to insuring more Americans. It gets us closer to having — you know, stopping insurance companies from these malicious practices that I just think were very arbitrary.

WOMAN: But this one strictly is for fetus. So, you have — you can’t do that for a child, right?

BETTY ANN BOWSER: Three years ago, Dr. Mangat opened her private practice, thinking she would have quality time with her patients. But insurance company mandates and paperwork are taking up too much of her time.

DR. MONA VISHIN MANGAT: Let’s take, for example, a new patient that will come to my office. So, that patient will call and say, “I have Aetna.”

So, that sets a whole series of things into motion. Not only does she first have to find out if that insurance is active. She has to find out, is there a preexisting clause in that insurance? So, each step requires — each patient requires a phone call, where you sit on hold for, you know, probably 30, 40 minutes trying to get the information. So, then I see the patient, and then I’m restricted in how I treat them.

BETTY ANN BOWSER: She says it’s frustrating that she can’t afford to offer health insurance to her three employees, one of whom has a preexisting condition.

DR. MONA VISHIN MANGAT: It’s extremely frustrating, and basically that — you know, I tried to do that. I tried to give it to them. But the options were unaffordable.

BETTY ANN BOWSER: Seventy-five miles away, in Orlando, Jerry Pierce thinks it’s government paperwork and bureaucracy that are going to harm his business. The restaurant supply company he owns has recently grown into a worldwide Internet company, with 50,000 customers in 100 countries.

Currently, health insurance takes up 10 percent of his $1 million-a-year payroll. But he says he faces a growing problem trying to find affordable coverage, because of what he sees as the lack of competition among insurance companies. Florida is one of those states that has a limited number of insurers in the marketplace.

JERRY PIERCE: It’s very non-competitive when you have approximately five insurance companies that provide the insurance, a major part of the insurance in the state of Florida, and you have roughly over 400,000 small companies. There’s very little negotiating power that 400,000 small businesses have to shop for insurance against five insurance companies. It just doesn’t work.

BETTY ANN BOWSER: The new law does provide tax credits to small businesses with less than 50 employees. But Pierce doesn’t think that will outweigh what he sees as the downside of the law.

JERRY PIERCE: The amount of bureaucracy in the first few paragraphs that I have read of this new bill that has just been signed into law is absolutely incredible. It’s off the charts.

I encourage everybody to read it, because it’s — it’s — it’s unbelievable, the amount of bureaucracy and checking and rules and regulations for every level of our society.

Ronni Drimmer spends more than $700 a month on health insurance. In 2007, she was diagnosed with an autoimmune condition called Crohn’s disease that, in most states, would have made her uninsurable. But the state of Florida requires insurance companies to offer coverage to self-employed residents, even with preexisting conditions. So, she has insurance. However, she believes the insurance company is trying to price her out of the market.

RONNI DRIMMER: Every year, it goes up, and I would say, on average, 20 percent or more. I mean, I get less and less, you know, choices. I — I can’t just switch to another insurance company.

I can’t get insurance as an individual at all. You know, I have preexisting conditions. Forget about it. There is no insurance for me.

BETTY ANN BOWSER: After several of Drimmer’s business ventures failed, she began to earn money by caring for seniors, which provides an income around $30,000 a year. She worries all the time about what’s going to happen to her health care if something goes wrong.

RONNI DRIMMER: It’s very upsetting. But, you know, what am I going to do? I have to deal with it. I don’t know. But it does. It stresses me out a lot.

BETTY ANN BOWSER: Drimmer says she actually voted for President Obama solely on his plan to reform health care. She wanted the bill to go further.

RONNI DRIMMER: You know, I’m not a genius, but I don’t see where the competition is going to be to, you know, to control the cost. You know, I thought the public option made sense. I was all for the public option.

I would have liked to have seen something better set up for people like me sooner than 2014. I don’t — I don’t feel secure about the whole bill.

BETTY ANN BOWSER: So, like a lot of Americans, these four Floridians are waiting and wondering what will happen in 2014 when the major portions of the bill will kick in.

The post Health Reform Law Remains a Hot Topic in Florida appeared first on PBS NewsHour.

JIM LEHRER: Now to our second look at how voters see the new health care law.

Last night, Spencer Michels reported on what a Republican House member is hearing in his Northern California district.

Well, tonight, “NewsHour” health correspondent Betty Ann Bowser follows a Virginia Democrat.

BETTY ANN BOWSER: Charlottesville business owner Mimi Hyde is glad her congressman backed the new health care reform law. In fact, she recently volunteered to be his poster girl for the overhaul because of her skyrocketing health insurance costs.

MIMI HYDE, owner, The Needle Lady: For me, it is just getting insupportable. And I really could have put two kids in college, what I paid in policies vs. what they paid out for me.

BETTY ANN BOWSER: Hyde, a single mother of four, is self-employed. She runs a knitting and needlepoint store on the historic Downtown Mall.

MIMI HYDE: For myself and four kids, all healthy, it was $400 a month. Three years later, nobody’s sick, no medicines, no chronic illness, it was $1,300 a month.

BETTY ANN BOWSER: And what is it now?

MIMI HYDE: Fifteen — just under $1,500 a month.

BETTY ANN BOWSER: So, what do you think of this new health care reform law?

MIMI HYDE: I would have liked to see it go a little further, but, you know, I am happy to have a beginning. I think I am tired of hearing everybody talk about how they don’t want the government running their health care. Well, Anthem has been running my health care for eight years, and doing a lousy job of it. And it’s expensive. And I get less and less for it.

BETTY ANN BOWSER: Hyde’s representative in Washington is Democrat Tom Perriello. The 36-year-old Yale-trained lawyer from Ivy, Virginia, won one of the closest congressional races in the nation in 2008, winning Virginia’s 5th Congressional District by just 727 votes.

Voters here have mostly leaned Republican in recent years. They backed Republican Senator John McCain in the presidential election. Perriello has found himself the target of conservative ire in the health care reform debate.

There have been small protests at his Charlottesville office. And vandals attacked his brother’s home shortly after he cast his vote in favor of the overhaul package, which became law last month.

Perriello says the new law will help many of his 700,000 constituents like, Mimi Hyde.

REP. TOM PERRIELLO, D-Va.: Health care, for some of us, was not an ideological fight. It was about economic relief to working and middle-class families, seniors who are struggling. If we can save them a little money, that’s a really big deal for people.

BETTY ANN BOWSER: Perriello’s district is Virginia’s largest. It stretches from the liberal city of Charlottesville in the north, east to the edges of metropolitan Richmond, and south to the more conservative and economically-challenged areas like Danville, near the North Carolina border.

Opposition to the new health care law among conservatives in the 5th is so strong that seven Republicans have lined up to run against Perriello this fall. And political observers suggest it could be a tough race for him.

REP. TOM PERRIELLO: A small, but vibrant crowd here in Charlottesville

BETTY ANN BOWSER: So, while home from Washington, he’s set out to explain to voters what he thinks are the overhaul’s good points.

REP. TOM PERRIELLO: We are extending the solvency of the Medicare trust fund by about a decade. We’re closing the prescription doughnut hole. We’re trying to further reimburse primary care docs for being part of the Medicare system. And we want to reduce some of those out-of-pocket expenses that our seniors pay.

BETTY ANN BOWSER: While many seniors in nationwide surveys have expressed concern about the new law, Perriello didn’t have to work too hard at a town hall meeting at the senior center in Charlottesville. It’s a city where 80 percent of the voters backed him in the 2008 election.

MAN: A real step in the direction that we all need to go.

BETTY ANN BOWSER: As Perriello fielded questions — some over the telephone — it was clear many simply didn’t understand how they would be affected by the law.

DARLENE DOSS, Business Owner: We run a small business of six to eight, sometimes 10 employees. Where are we going to gain anything from the new health care plan?

REP. TOM PERRIELLO: Start retroactive to January 1 of this year, your company would be eligible for a 35 percent tax credit to cover the premiums that you’re paying for your employees.

BETTY ANN BOWSER: Head south outside of Charlottesville, and the political landscape changes dramatically.

Much of the 5th Congressional District in Virginia is made up of areas like this, rural areas. And, as you move away from the population centers in the north near Charlottesville, towards the North Carolina border, the new health care law becomes increasingly unpopular.

Along the banks of the James River in Lynchburg…

THOMAS JOHNSON, owner, Thomas A. Johnson Furniture Company: How’s it going?

BETTY ANN BOWSER: … Thomas Johnson has plans to expand his furniture company, in spite of the economic downturn.

THOMAS JOHNSON: The big plan is that I want to establish a manufacturing industry, at a time when that industry is dying.

BETTY ANN BOWSER: Johnson, who settled in the U.S. from Ghana nearly 20 years ago, currently employs about 10 full-time workers. But he doesn’t offer health insurance, because he says it’s too expensive. He thinks the new law will hamper his plans to hire 100 workers.

THOMAS JOHNSON: We are today in global market system, which means that somebody else is doing somewhere very cheap, sending them to the United States. So, if I am going to compete on a global market, then we have to level the playing field and make it in a way that I can make profit, to be able to afford health care. But if I am going to be forced to provide health care, with no profit margin, I think the company will crash.

BETTY ANN BOWSER: And Johnson says he’s not happy his congressman voted yes for health care reform.

THOMAS JOHNSON: If he had listened to his constituents, I think he would have made a better judgment.

BETTY ANN BOWSER: Perriello’s theory is that the political left and right are no longer so engaged on health care as they were during the debate.

REP. TOM PERRIELLO: And I think that those who are really passionate on either side have faded a little bit, and now the people in the middle are getting their turn to say, all right, walk me through it.

This is the law of the land now. And people get pretty excited when you go through things like extending the Medicare trust fund and bringing the cost of drugs down, allowing people into these exchanges to get cheaper health care, tax credits to small business. So, what you see is sort of a revival of the moderates in this debate. And I think people are liking what they see so far.

BETTY ANN BOWSER: That remains to be seen. But Perriello has his sights set squarely on motivating what he thinks is crucial: the political middle.

The post Virginia Voters Examine Health Reform appeared first on PBS NewsHour.

JIM LEHRER: Now: reaction to the new health care law from voters.

This week, our correspondents spent time with two members of Congress who went home during the spring recess.

Tonight, “NewsHour” correspondent Spencer Michels reports from California.

SPENCER MICHELS: The old gold mining town of Rough and Ready lies in the heart of one of California’s most conservative congressional districts.

In these parts, health care reform is a hot topic. Republican Tom McClintock, who represented a Southern California district in the state legislature, today represents this Northern California district in Congress, winning a close race in 2008.

Home from Washington, the congressman traveled to Rough and Ready’s Grange Hall to see what his constituents were thinking about the new health care reform law, and to explain his own opposition to it.

REP. TOM MCCLINTOCK, R-Calif.: Let me just get a straw poll here. How many of you are in favor of the bill that just passed the Congress and was signed into law? OK. OK. And how many of you are opposed to it? OK. Well, that’s pretty much the reaction we are getting all across the district.

SPENCER MICHELS: McClintock’s district runs from suburban Sacramento, east to Lake Tahoe, and north to the Oregon border. It’s mostly rural, growing fast. Republicans outnumber Democrats by 15 percent, though the gap is getting smaller, as more people move here.

At the town hall meeting, he attacked the new health care law for requiring people to have health insurance and because, he says, insuring those without insurance will cost too much.

REP. TOM MCCLINTOCK: The notion that, somehow, we can provide free health insurance for 32 million people without adding to the deficit or costing taxpayers is simply absurd.

SPENCER MICHELS: Audience members, many on Medicare, were concerned that provisions in the new law designed to cut wasteful spending in Medicare could actually cut their benefits.

MAN: So, where does that leave the people — and there’s a fair majority in this room — that will be affected by this? Where does that leave them?

REP. TOM MCCLINTOCK: As a matter of simple practical fact, they are not going to cut a half-a-trillion dollars out of the Medicare system, because the Medicare system cannot begin to bear such a cut. What they are going to do is take it out of the — the national treasury, which means out of your pocket as a taxpayer.

SPENCER MICHELS: McClintock says he’s encouraged by what he’s been hearing from his constituents.

REP. TOM MCCLINTOCK: The first town hall that I did was in August. And I would say the audience split about 25 percent in favor of Obamacare and about 75 percent opposed.

As the summer entered the fall, those numbers in support of the Obama plan dwindled to the point that, as you saw today, we had one or two people in support and everybody else in opposition.

SPENCER MICHELS: Rough and Ready residents Don and Edith Davis were part of that opposition. They said they feared a government health czar would deny them medical treatment, even though the law has no such czar, and proponents say it won’t deny treatment.

EDITH DAVIS, Health Care Reform Opponent: Don has had two knee replacements. I immediately thought, when health care passed, thank God he has them now, because, when the Obama health care comes into, you know, being, would he, by some health czar in Washington say, uh-uh, he’s too old; we can’t spend that kind of money?

SPENCER MICHELS: This wasn’t the first time that residents of Rough and Ready have been frustrated with government. In 1850, Rough and Ready seceded from the Union over taxes on gold mining. Four months later, they rejoined the Union.

This time, it appears the divide over health care reform won’t heal that quickly. There are plenty of reform supporters, even in this Republican district. At an urgent care clinic in nearby Grass Valley, director Dr. Roger Hicks said he sent e-mails and called McClintock’s office during the health care debate, and received no response.

At the clinic, he says, he gets a different sampling of opinion than the congressman does. One-third of his patients are uninsured.

DR. ROGER HICKS, Yuba Docs Urgent Care: Ninety-nine out of 100 of the people that I talk to here are in favor of this health care reform. And I talk to everybody about it, because it comes up frequently when I’m seeing patients. You know, I say, well, this is what you need. You need this test. And they say, well, I can’t afford it.

SPENCER MICHELS: Hicks is convinced the new law will make a difference.

DR. ROGER HICKS: It is going to change, because 32 million people that were uninsured are now going to have insurance. So, you know, they won’t be making decisions about whether they should go to the hospital because of their chest pain based on money.

SPENCER MICHELS: Dr. Hicks says he is also a small business man, and health reform will save him money with tax credits for insurance premiums.

But, at the nearby Nevada County Contractors Association, Congressman McClintock talked with builders who didn’t share that optimism.

BRUCE IVY, California: You know, the cost of health care is so uncertain, it’s created a lot of angst and anxiety out in the community.

REP. TOM MCCLINTOCK: Yes.

BRUCE IVY: A lot of our clients are holding back making investments because they just don’t have security in what’s going to come down. And what we saw happen in Washington, D.C., was disheartening.

DANIEL SWARTZENDRUBER, California: So what is your outlook on how the health care situation is going to affect the elections here come next November?

REP. TOM MCCLINTOCK: Republicans are going to get a second chance. And Republicans are beginning to realize, this time, we have got to be worthy of it.

Governments are instituted among men, deriving their just power from the consent of the governed.

SPENCER MICHELS: McClintock is facing a poorly financed opponent in the Republican primary and a little-known Democrat in November. Based on what he’s seen and heard this week, he believes his constituents support his position on the new health care law. And that, he thinks, can only help him win reelection.

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JUDY WOODRUFF: The debate over the merits of health care reform may be over here in Washington, but a different sort of debate is taking shape around the country over the question, is it constitutional?

Well before President Obama signed the national health care overhaul into law, opponents at the state level were preparing a challenge in federal court. Florida’s attorney general, Republican Bill McCollum, has been joined by his counterparts in 13 other states. All but one are Republicans, and several are running for governor.

The crux of their case: The mandate that Americans buy insurance is a violation of the U.S. Constitution’s Commerce Clause.

BILL MCCOLLUM, Florida attorney general: The freedoms of Americans, and particularly in my state of Florida, were impaired by this bill. And it forces people to do something in the sense of buying a health care policy, or pay a penalty, a tax or a fine, that simply, the Constitution doesn’t allow Congress to do.

JUDY WOODRUFF: Under the law, most Americans must have health insurance by 2014, or pay $95 or 1 percent of their income, whichever is greater. By 2016, the penalty increases to $695 or 2.5 percent of income.

On Tuesday, more than 250 people rallied in Montgomery, Alabama. They called for amending the state constitution to supersede the federal plan. More than 30 other states are considering similar opt-out clauses.

And Virginia has already passed one. Because of that, Virginia’s attorney general, Republican Ken Cuccinelli, has filed a separate lawsuit against the federal government.

KENNETH CUCCINELLI, R, Virginia attorney general: I’m doing exactly what I said I was going to do when I ran for office. And I got more votes then anybody ever running for attorney general before in Virginia history. The people of Virginia knew what they were getting when they elected me.

JUDY WOODRUFF: When President Lyndon Johnson signed Medicare into law 45 years ago, it, too, ran into opposition from the states, in some cases because it required racial integration of publicly funded hospitals.

Those challenges failed, and many legal scholars say this new batch of state lawsuits will fare no better. And, at the White House, presidential aides maintain none of the cases bears any legal merit.

ROBERT GIBBS, White House press secretary: For many decades, the Supreme Court has recognized Congress’ authority, under the Commerce Clause, to regulate activities relating to interstate commerce. My advice from counsel is that we will win these — we will win these lawsuits.

JUDY WOODRUFF: There’s also pushback from within some of the state governments that are suing. Michigan Governor Jennifer Granholm, a Democrat, defended the health care reform law yesterday.

GOV. JENNIFER GRANHOLM, D-Mich.: I think so many people oppose it because they’re not sure what’s in it, and because, understandably, it is complicated.

JUDY WOODRUFF: And some in cash-strapped statehouses are wary of taking away the new health benefits or of funding a long legal battle when budgets are tight.

CEDRIC RICHMOND, D, Louisiana state representative: One, it’s not in the best interests of the state. Two, it won’t be successful. So, don’t waste our time and resources. And why don’t we let our Louisiana citizens start to benefit from this legislation?

JUDY WOODRUFF: The states’ lawsuits are expected to end up before the U.S. Supreme Court.

And we join that legal debate now with David Rivkin, a Washington, D.C., litigator and a former counsel with the Reagan and Bush administrations. He is assisting the 14 state attorneys general with their constitutional challenge. And Richard Cordray, Ohio’s attorney general, who this week announced that he believes these lawsuits have no merit.

Gentlemen, thank you both for being with us.

DAVID RIVKIN, former associate White House counsel: Good to be with you.

JUDY WOODRUFF: And, David Rivkin, I’m going to start with you, because you are representing the people who are putting the challenge forward.

As I understand it, two main arguments here, one of them is that you believe it’s unconstitutional to require people to buy insurance. Why is that unconstitutional?

DAVID RIVKIN: It’s unconstitutional both as a matter of fundamental principle and relevant case law.

As a matter of fundamental principle, the Constitution — a key aspect of our constitutional architecture is that the federal government is a government of limited and enumerative powers. That point was made by James Madison in The Federalist Papers, who said that the powers of the federal government are few and well-defined. The powers retained by the states are numerous and indefinite.

If you have an infinitely broad Commerce Clause under which Congress can legislate, it would absolutely eviscerate state authority to have any independent regulation. And there’s cases, very recent cases, 5-4 decisions, including Lopez, which struck down the violence — Gun Free School Zone Act, and Morrison, that struck down key portions of the Violence Against Women Act, that says very clearly in an opinion both written by O’Connor and Justice Kennedy, who’s still in the court.

JUDY WOODRUFF: These are recent cases before the court.

DAVID RIVKIN: Very recent cases that indicate that there have been to be meaningful limitations on the scope of Commerce Clause. Otherwise, it would follow the rest of the Constitution.

JUDY WOODRUFF: And you’re arguing that this requirement people buy insurance exceeds that requirement?

DAVID RIVKIN: Absolutely, because it doesn’t regulate economic activities.

JUDY WOODRUFF: Well, let me turn…

DAVID RIVKIN: It compels people to engage in behavior they do not desire.

JUDY WOODRUFF: All right.

All right, let me turn to Attorney General Cordray in Ohio.

Why do you believe that is not — that it is constitutional?

RICHARD CORDRAY, Ohio attorney general: Well, David is a topflight lawyer. I have read what he’s written on the subject. And he makes very creative arguments.

But you would have to find activist judges willing to tear up decades of settled precedent for these claims to succeed. The reality is that, for 70 years, since the Depression, the court has been very permissive in terms of letting Congress regulate interstate commerce.

And, of course, many things have become interstate national commercial problems, such as health insurance, which is a national market, and something that can’t be regulated very well on a piecemeal basis, which is why Congress stepped in here.

JUDY WOODRUFF: All right. If that’s the case…

DAVID RIVKIN: All right. Two points.

Nobody disputes that Congress can regulate the market, business of buying insurance, the terms of insurance, the conditions of insurance. What we’re talking about here, though, is compelling people to purchase something they do not desire, merely because it has an economic footprint.

But let me reiterate the point powerfully articulated by Justice Kennedy, who is likely to be the swing justice here. There have to be meaningful limitations under the Commerce Clause. If you say, as my colleague General Cordray says, that because a failure to purchase insurance has an economic impact, there’s literally no activity known to man that wouldn’t have some economic impact that, in the aggregate, would impact interstate commerce.

It has to be an activity. In both…

JUDY WOODRUFF: So, it — so, you’re saying it boils down, at least in part, to whether this is an economic activity requiring…

DAVID RIVKIN: As distinct from something — as distinct from something that has an impact. In the two leading cases…

JUDY WOODRUFF: But let me — let me just turn back to the attorney general, Mr. Cordray.

Can you respond to that particular part of his argument?

RICHARD CORDRAY: Yes.

The court has said clearly that, if an activity has significant economic impact — such as, in 2005, the court upheld Congress’ ability to prohibit someone from growing and using marijuana for their personal use, no economic transaction whatsoever, but they said it could affect the marketplace — that’s good enough to be part of the Commerce Clause.

The other point is, David says that you can’t compel someone to buy a product or to pay for health insurance. But, in fact, the first Congress — James Madison was part of it — passed a bill that required anybody who was going to serve in a militia to purchase a gun, gunpowder, knapsack, and — and ammunition to be able to serve.

And then, in 1798, the Congress, with many of those same founders in it, passed a relief act for injured sailors which required them to pay out of their wages toward a rudimentary form of health insurance before there were any insurance companies.

So, this is longstanding historical precedent for this sort of thing.

JUDY WOODRUFF: You want to…

RICHARD CORDRAY: And, in fact, I think the arguments are quite out of step with modern jurisprudence.

JUDY WOODRUFF: You want to respond to that very quickly? And then I want to get to the other argument you’re making.

DAVID RIVKIN: Very quickly, in Gonzales vs. Raich, the activity involved, growing marijuana at home in a bathtub for personal consumption, had no profit motive. But it was the same activity as growing marijuana plantation-type setting, interstate, in parks and selling it.

The same was true in the wheat case, Wickard v. Filburn. Before you aggregate — where General Cordray is wrong, before you aggregate the impact, it has to be an economic activity, not necessarily one with a profit motive, but an economic activity.

And, again, what he does…

JUDY WOODRUFF: So…

DAVID RIVKIN: … he reads out of existence Lopez and Morrison, which is ’95 and 2000 case, where the court said very clearly there have to be meaningful limitations.

JUDY WOODRUFF: So, clearly, this is going to come down to case law, precedent, interpretation of the Commerce Clause.

Let me ask you, though, both of you, quickly, though, about the other argument that you make, David Rivkin, and that is, it’s unconstitutional to require states to set up these insurance exchanges for people who don’t have insurance.

Can you briefly explain to us why?

DAVID RIVKIN: Right.

There’s a whole line of cases that is basically rooted in the 10th Amendment that talks about states, again, retaining viable independent authority which stands for (INAUDIBLE) opposition and it’s called New York vs. United States — the other case is called Printz — where you cannot co-opt states.

You cannot commandeer, which is a term of art, state officials to perform tasks for the federal government. That’s a very well established line of cases. Aside from insurance exchanges, this statute would compel Florida and other states to spend billions of dollars of their limited resources, taking them away from environmental protection, taking them away from — from schools.

That is not — even if you didn’t have a mandate, that part of a statute alone is clearly unconstitutional.

JUDY WOODRUFF: OK, well, then it’s two points. But — so, let me come back to the requirement, Mr. Cordray, that states set up these insurance exchanges for individuals who don’t now have insurance.

RICHARD CORDRAY: Yes, I agree with David there on the case law, but that’s not, in fact, what this legislation does.

It doesn’t require the states to set up the exchanges. It gives them an option. They can set up the exchanges. If they don’t, the federal government then has the responsibility to step in and set those up itself. And that’s how the bill operates, very similar to the Medicaid program. That’s a voluntary program. All the states participate.

They don’t have to. If they do, they get federal funding and they cooperate with the federal government in the program. That’s the spending David’s talking about. It’s the Medicaid program. And states have the option to participate or not as they please. They typically find it beneficial to their citizens, and so they do so.

DAVID RIVKIN: Very important to underscore, Medicaid began as a voluntary effort. We would argue and are arguing that, at this point in time, you can not opt out of Medicaid. It is not a viable choice for any responsible government.

Why? It would absolutely destroy the infrastructure.

JUDY WOODRUFF: But there’s not a — but that’s not a change in this law.

DAVID RIVKIN: No. It is…

JUDY WOODRUFF: They’re expanding the number of people who would be eligible for Medicaid.

DAVID RIVKIN: With respect, they’re changing Medicaid in a way that would swamp Medicaid rolls, costing billions of dollars — quite aside from insurance exchanges — costing billions of dollars in state revenue — and, remember, states cannot print money, like the federal government — having the states hire thousands of people to administer it.

JUDY WOODRUFF: OK.

DAVID RIVKIN: Large chunks of a state, of this whole regulatory edifice, cannot be opted out of.

JUDY WOODRUFF: All right.

Mr. Cordray, do you want to respond to that?

RICHARD CORDRAY: Yes, I understand. Sure.

I understand the argument, but I think you’re right, Judy, to point out the argument is one that the Medicaid program itself now is unconstitutional, because states really, effectively, need to participate in it.

But why do they need to participate if it? Because they realize that it’s helpful and useful to their citizens. They don’t really think they could do without it. But that’s a — that means they’re all making the same choice. It doesn’t mean they don’t have a choice.

JUDY WOODRUFF: Finally, to David Rivkin, what one hears about many of the legal opponents is that, truly, what this is all about is an opposition to health care reform, and this is just another way of trying to undermine it.

DAVID RIVKIN: This is unfortunate. There are many worthwhile policy causes, including carrying guns near schools, after 9/11, increasing our ability to surveil the enemy, where, no matter how meritorious your policy goals are, you have to make sure you do it in a way that is consistent with our constitutional architecture.

This is the American way. I, frankly, don’t understand the argument that, because health care reform is a good thing, which I would stipulate, that challenging it somehow is wrong. These are serious arguments.

The Washington Post editorial page, which is hardly known…

JUDY WOODRUFF: And you said you believe health care reform is a good thing?

DAVID RIVKIN: Of course. It’s the question of how it’s being done from a constitutional perspective.

Let me just say, Washington Post editorial page, that is not liberal at all, said, it’s a serious lawsuit; it has merit; it ought to be seriously considered.

JUDY WOODRUFF: And, Attorney General, Mr. Cordray, what about this notion this, whatever the merits, it must be challenged on these legal points?

RICHARD CORDRAY: Well, we work very hard in the courts to protect the states’ rights. We were in the Supreme Court week before last protecting our revenue system against the federal courts.

I argued a case personally last fall protecting our criminal justice system against what we thought was a misguided federal ruling that upset a death sentence. But the bottom line is, in many cases, these are policy disagreements. They’re deeply held. They’re — they’re very emotionally held, but those things should be hammered out in the political arena.

We shouldn’t run to the courts and bring litigation to solve these problems. And we don’t think this is a good use of taxpayer resources here in Ohio.

JUDY WOODRUFF: Richard Cordray, who is the attorney general for the state of Ohio, David Rivkin here in Washington, gentlemen, we appreciate it.

Thank you both.

DAVID RIVKIN: Good to be with you.

The post Health Care Reform Challenges Continue from Many States appeared first on PBS NewsHour.

JIM LEHRER: The president checked off two major items on his domestic agenda today. In a single signing, he finished work on the health care overhaul and a sweeping remake of student lending.

“NewsHour” correspondent Kwame Holman begins our coverage.

KWAME HOLMAN: Today’s ceremony came with less fanfare than last week, when Mr. Obama signed the main health care overhaul bill.

U.S. PRESIDENT BARACK OBAMA: Today, we mark an important milestone. But, more broadly, this day affirms our ability to overcome the challenges of our politics and meet the challenges of our time.

KWAME HOLMAN: The new measure includes a number of fixes to the health care law. Among them, it expands insurance subsidies for low- and middle-income families, and adds more Medicaid funding for all of the states.

But the president also said on NBC’s “Today Show” that more changes will be needed down the road.

BARACK OBAMA: I think it is a critical first step in making a health care system that works for all Americans. It’s not going to be the only thing. We’re still going to have adjustments that have to be made to further reduce costs.

KWAME HOLMAN: The secretary of health and human services, Kathleen Sebelius, already is making an adjustment to resolve one dispute. She’s issuing regulations to make sure children with preexisting medical problems are not denied coverage. The insurance industry agreed last night not to fight the move.

In the meantime, the administration will be touting the other new law included in the bill-signing.

The setting for today’s event was Northern Virginia Community College just outside Washington. The president chose it to highlight the largest rewrite of student lending in four decades. It’s attached to the health care fixes bill, and it makes the government, not banks, the primary lender for college students.

The vice president’s wife, Jill Biden, teaches at the college.

JILL BIDEN, wife of Vice President Joe Biden: All of us here today know that higher education is essential to the success of our children and vital to the economic future of our country.

KWAME HOLMAN: Mr. Obama said cutting out banks as the middlemen will save $68 billion in fees over 10 years. Some of the savings will go to help community colleges and historically black institutions. The rest will fund additional Pell Grants for needy students.

BARACK OBAMA: Those are billions of dollars that could have been spent helping more of our students attend and complete college, that could have been spent advancing the dreams of our children, that could have been spent easing the burden of tuition on middle-class families. Instead, that money was spent padding student lenders’ profits.

KWAME HOLMAN: The government will assume formal control of the student lending program in July.

JUDY WOODRUFF: Jeffrey Brown takes a closer look at the new law on student loans.

JEFFREY BROWN: And, for that, I’m joined by Jeff Selingo, editor of “The Chronicle of Higher Education.”

Welcome to you.

JEFFREY SELINGO, “The Chronicle of Higher Education”: It’s good to be here.

JEFFREY BROWN: So, the major shift is who makes the loan?

JEFFREY SELINGO: Yes.

So, now it’s going to be basically the federal government. The banks who used to give these loans out through subsidies given by the federal government will be out of the system now.

JEFFREY BROWN: And what’s the process? If you’re an individual student or a family applying to college, how’s it work?

JEFFREY SELINGO: The process is really not going to change, even though the federal government is now the direct lender.

Students would fill out the federal application for student aid. The schools will give them financial aid packages that include federal loans. In the past, they used to get a list of lenders. Now that lender is going to be the federal government.

JEFFREY BROWN: The big change here and a lot more money coming into the Pell Grant program. Now, explain what that is…

JEFFREY SELINGO: Yes.

JEFFREY BROWN: … who it serves.

JEFFREY SELINGO: The Pell Grant program is the federal government’s main student aid program for low-income students. Students with family incomes up to about $50,000 are eligible for some sort of — some sort of Pell Grant.

And the big winner here is the Pell Grant program. So, most of the savings from this bill will go to increase the Pell Grant over the next 10 years about — to about $6,900 by the end of the decade from about $5,550 right now.

JEFFREY BROWN: So, the — so, individual Pell Grants can — will go up over time…

JEFFREY SELINGO: Yes.

JEFFREY BROWN: … but not all that much.

JEFFREY SELINGO: no, not at all that much. In fact, President Obama really wanted it to go up by about another $1,000. When he first proposed this plan a year ago, the savings from this switch in direct lending was supposed to be a lot more.

Over the course of the year, the Congressional Budget Office kept coming out with estimates, and those estimates kept going down. And, as a result, the Pell Grant increase is not as generous as it was going to be.

JEFFREY BROWN: So, for the majority of students, will they see any immediate changes, either in process or — or content?

JEFFREY SELINGO: They’re not supposed to. You know, the federal government is supposed to deliver student loans just like the banks did.

JEFFREY BROWN: That’s what they say they’re going to do.

JEFFREY SELINGO: That’s what they say they’re going to do.

JEFFREY BROWN: So, that’s the issue.

JEFFREY SELINGO: Yes. You know, the banks really fought this proposal. You know, they still wanted to be in the business. And they still wanted to get these government subsidies. And their claim was that the government can’t deliver the service as well as they could.

Only time will tell.

JEFFREY BROWN: And what about in any impact on the interest rate?

JEFFREY SELINGO: Again, the banks said, because of the subsidies, they were able to have a lot more flexibility in the services that they offered to students. Under this plan, there is going to be no competition. And Congress sets the — sets the interest rate.

JEFFREY BROWN: One area that does see change is for people having to pay back their loans.

JEFFREY SELINGO: Yes.

JEFFREY BROWN: So, there are some provisions there to help them.

JEFFREY SELINGO: Yes.

Basically, for students who are not in very high-paying jobs, right now, they’re basically — they — they’re limited to about 15 percent of their discretionary income goes to their monthly payments. That’s now going to decrease to about 10 percent. And the loans would be forgiven after 20 years, instead of the current 25.

So, it’s going to be a much more generous offering to students in low-income jobs.

JEFFREY BROWN: So, the idea to help people once they’re done with school pay back their loans?

JEFFREY SELINGO: Yes. Yes.

JEFFREY BROWN: The — the big overarching question, I guess, for a lot of people, there’s still this continuing rise in tuition, right, for private and public colleges.

JEFFREY SELINGO: Yes.

JEFFREY BROWN: Does this make a dent? In what ways might this make a dent, if any?

JEFFREY SELINGO: Well, in some ways, the increase in the Pell Grant will help poorer students pay for college.

But one of the concerns by people against this bill was that colleges would just be encouraged to increase their tuition by even higher amounts, knowing the federal government was there with more money.

JEFFREY BROWN: So…

JEFFREY SELINGO: So, it could be just continued increases in college costs.

JEFFREY BROWN: All right.

Jeff Selingo, “Chronicle of Higher Education,” thank you very much.

JEFFREY SELINGO: It was good to be here. Thanks.

The post New Law Changes Student Loan Landscape appeared first on PBS NewsHour.

JIM LEHRER: There was a last extra lap today on the road toward health reform. The Senate passed a bill reshaping parts of the new overhaul law. It is set for final approval in the House some time tonight.

Ray Suarez has our report on the endgame and the continuing aftermaths.

RAY SUAREZ: After working late into the night, the Senate was back this morning to take up dozens more Republican amendments. Those ranged from protecting doctors doing pro bono work from lawsuits…

SEN. JOHN ENSIGN, R-Nev.: We talk about making health care more affordable. Well, one of the ways to do that is to encourage people to give away health care.

RAY SUAREZ: … to allowing Americans to purchase insurance across state lines.

SEN. JIM DEMINT, R-S.C.: Yet, the laws of land have actually created state-by-state monopolies that have not been responsive to American people and have run up costs.

RAY SUAREZ: All those amendments failed with the Democratic majority.

WOMAN: The yeas are 39 and the nays are 56. Three-fifths of the senators duly chosen and sworn not having voted in the affirmative, the motion is not agreed to.

RAY SUAREZ: The final vote, along party lines, came early in the afternoon.

U.S. VICE PRESIDENT JOSEPH BIDEN: In this vote, there are 56 yeas, 43 nays. The bill, as amended, is passed.

RAY SUAREZ: Senate Majority Leader Reid heralded the passage moments after.

SEN. HARRY REID, D-Nev., majority leader: This, of course, was a health care bill. It was also a jobs bill, an economic recovery bill. It was a deficit-reduction bill. It was an anti-discrimination bill. It was truly a bill of rights. And now it is the law of the land.

RAY SUAREZ: The changes the Senate passed today are revisions to the bill President Obama signed Tuesday. They include expanded Medicaid funding for the states, higher taxes on upper-income Americans, and improved drug coverage under Medicare.

The bill was then returned, again, to the House for final approval. After Sunday’s climactic tally in the House, another vote was necessary because Republicans found technical problems with at least two provisions.

House Republicans, including Minority Leader John Boehner, stayed on message, continuing their resistance to the reform law they still call a bill.

REP. JOHN BOEHNER, R-Ohio, house minority leader: Now, the tax hikes, the Medicare cuts, the job-killing mandates, the accounting gimmicks, the backroom deals, we’re going to fight to repeal them at every single turn. And the fact is, this bill should be repealed and should be replaced with commonsense steps.

RAY SUAREZ: And Democrats, led by House Speaker Nancy Pelosi, responded.

REP. NANCY PELOSI, D-Calif., speaker of the house: You have insurance, you get sick, you get dropped. That’s not called insurance. Again, they can’t rescind your policy on your way to the operating room.

RAY SUAREZ: At the same time the Senate passed the bill, President Obama was in Iowa City, Iowa, rallying support for the overall reform.

Today, the president responded to Republicans who vowed to run on a platform of repealing the law in the midterm elections.

U.S. PRESIDENT BARACK OBAMA: This is all — this is the reform that some folks in Washington are still hollering about, still shouting about. Now that they passed it, now that we passed it, they’re already promising to repeal it. They’re actually going to run on a platform of repeal in November. You have been hearing that.

And my attitude is, go for it.

RAY SUAREZ: Protesters were out in force.

PROTESTER: I’m tired of what Obama is doing to our country.

PROTESTER: Trying to take our private property, and I’m not OK with that.

RAY SUAREZ: That anger has caused some to take it a step further. Several Democratic lawmakers had rocks and bricks thrown at their local offices.

This afternoon, there were reports Representative Anthony Weiner’s office in New York received a letter containing white powder. At least 10 Democratic House members have been offered stepped-up security.

MAN: Congressman Stupak, you baby-killing mother (EXPLETIVE DELETED), I hope you die.

RAY SUAREZ: Democratic Congressman Bart Stupak was one of the targets. He and six others provided the votes to pass health care reform.

And even on Sarah Palin’s Facebook page, rifle crosshairs mark the districts of 17 Democratic members of Congress she wants to see defeated.

REP. NANCY PELOSI: But those expressions and those acts of vandalism and those threats of — of more have no place in a civil debate in our country.

RAY SUAREZ: Tim Kaine, the Democratic National Committee chair and former governor of Virginia, asked supporters in an e-mail today for $25 or more to help defend lawmakers from the threats.

Republican Eric Cantor surprised people when he said shots were fired into the unmarked offices of two of his longtime strategists. Richmond police say the bullet had been randomly fired skyward.

REP. ERIC CANTOR, R-Va., house minority whip: Let me be clear. I do not condone violence. There are no leaders in this building, no rank-and-file members in this building that condone violence, period. I have received threats since I assumed elected office. It is reckless to use these incidences as media vehicles for political gain.

RAY SUAREZ: The bill is expected to pass the House this evening.

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