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Roundtable: Supreme Court Ruling Ensures Coverage for Millions, But Doubts Remain on Quality, Access

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We host a roundtable discussion on the landmark Supreme Court healthcare ruling with three guests: Dr. Oliver Fein of Physicians for a National Health Program, who signed a statement Thursday saying the new law will not remedy the U.S. health crisis; Wendell Potter, a former insurance executive turned whistleblower and senior analyst on healthcare at the Center for Public Integrity; and Jodi Jacobson, the editor-in-chief of RH Reality Check, a website dedicated to covering reproductive healthcare. [includes rush transcript]

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This is a rush transcript. Copy may not be in its final form.

JUAN GONZÁLEZ: On Thursday, President Obama addressed the nation soon after the Supreme Court upheld the Affordable Care Act.

PRESIDENT BARACK OBAMA: Good afternoon. Earlier today, the Supreme Court upheld the constitutionality of the Affordable Care Act, the name of the healthcare reform we passed two years ago. In doing so, they’ve reaffirmed a fundamental principle, that here in America, in the wealthiest nation on earth, no illness or accident should lead to any family’s financial ruin. I know there will be a lot of discussion today about the politics of all this, about who won and who lost. That’s how these things tend to be viewed here in Washington. But that discussion completely misses the point. Whatever the politics, today’s decision was a victory for people all over this country whose lives will be more secure because of this law and the Supreme Court’s decision to uphold it.

JUAN GONZÁLEZ: Meanwhile, Republican presidential candidate Mitt Romney vowed to overturn Obama’s landmark healthcare law if he’s elected in November.

MITT ROMNEY: Obamacare was bad policy yesterday; it’s bad policy today. Obamacare was bad law yesterday; it’s bad law today. Let me tell you why I say that. Obamacare raises taxes on the American people by approximately $500 billion. Obamacare cuts Medicare, cuts Medicare by approximately $500 billion. And even with those cuts and tax increases, Obamacare adds trillions to our deficits and to our national debt, and pushes those obligations on to coming generations. Obamacare also means that for up to 20 million Americans, they will lose the insurance they currently have, the insurance that they—that they like and they want to keep. Obamacare is a job killer. Businesses across the country have been asked what the impact is of Obamacare. Three-quarters of those surveyed by the Chamber of Commerce said Obamacare makes it less likely for them to hire people. And perhaps most troubling of all, Obamacare puts the federal government between you and your doctor.

AMY GOODMAN: On the night before the Supreme Court issued its decision, Mitt Romney said if the court overturned the healthcare law, it would have meant Obama’s first term would have been, quote, “entirely wasted.”

Well, to discuss the landmark ruling and what it will mean for healthcare in this country, we’re joined by three guests. Here in New York, Dr. Oliver Fein, immediate past president of Physicians for a National [Health] Program and the group’s current New York Metro chapter chair. He signed a statement Thursday saying the new law will not remedy the U.S. health crisis.

In Philadelphia, Wendell Potter is with us, senior analyst on healthcare at the Center for Public Integrity, former executive at CIGNA and Humana, and author of Deadly Spin: An Insurance Company Insider Speaks Out on How Corporate PR is Killing Health Care and Deceiving Americans.

In Washington, D.C., Jodi Jacobson is with us, editor-in-chief of RH Reality Check, a website dedicated to covering reproductive healthcare.

We welcome you all to Democracy Now! Let’s start with Dr. Ollie Fein here in New York. The significance of the Supreme Court upholding what is known as Obamacare, the Affordable [Care] Act?

DR. OLIVER FEIN: Well, from our point of view, the question is, how is this going to affect patients? And we think there are three important principles, right? Access to care, cost of care, and, frankly, quality. And this law, when it gets to the issue of access, is only partial in terms of guaranteeing access. Twenty-six million people are going to be left uninsured, according to the Congressional Budget Office, when the law is fully enacted. Yes, there’s an expansion of Medicaid, but, as we know, the Supreme Court curtailed some of the oomph behind that, so that there are some states that probably will not go ahead and make Medicaid available to people at 133 percent of the poverty level. OK? And finally, in terms of quality, yeah, there’s some things in the law—comparative effectiveness research and so on—but really I don’t think we have a system that can, you know, monitor the whole healthcare quality that we have. Right now, if you look at quality studies, they’re mostly done on Medicare data. Why? Because Medicare is available to everybody, all researchers, whereas the private health insurance industry keeps its data essentially private and proprietary. So this law, I think, is a mixed blessing in terms of where it leads the patient, at this point.

JUAN GONZÁLEZ: And how big is this issue of the court ruling that the government could not penalize states that don’t expand their Medicaid, their Medicaid coverage of the poor? Does that mean that there will be significantly many more millions that do not end up being—having health insurance?

DR. OLIVER FEIN: I think it may mean that people who don’t have access today will not necessarily have it tomorrow. For instance, we were just talking to our folks in Alabama. In Alabama right now, anyone who is childless between the ages of 19 and 64 has no access to Medicaid, irrespective of their income, OK? They just don’t qualify. Under this law, it would have been possible for people up to 133 percent of the poverty level to gain coverage in Alabama, but that’s not going to happen unless the state decides to accept, you know, the option.

AMY GOODMAN: Jodi Jacobson of RH Reality Check, can you weigh in on this issue of Medicaid, what it means, what the Supreme Court did yesterday?

JODI JACOBSON: Well, I mean, basically, yes, the states now have the option of not accepting Medicaid dollars from the federal government. And if they don’t, that will be a tragedy for the people who would otherwise qualify for healthcare. And obviously, also, because this is such a political issue and because we’ve seen some states willingly cutting off, for example, poor women and immigrants from healthcare, we can expect that this will continue to be politicized. For example, Texas is already making noise about not accepting those federal dollars. But the fact is that the federal government, up front, is going to be paying 100 percent of those costs in the first couple of years and then a decreasing amount over time.

And, you know, you have to look at the economic costs of not insuring that everybody has healthcare, which are huge. We’re paying a huge amount of money now—effectively, a tax—because people don’t have access to healthcare, because they are going to emergency rooms. So, we may see some states continue this politicization of healthcare, in sort of spite of, you know, the fact that the federal government is offering them funding. But I would say that over time, economically, those states are going to be hurt by those decisions.

AMY GOODMAN: You particularly focus on women, saying that this will leave them particularly vulnerable.

JODI JACOBSON: Yes, because women make up the majority of the Medicaid population, for example. Women make up 70 percent of those covered by Medicaid over the age of 14. And so, if women are not going—if states like Texas, for example, are not going to be accepting Medicaid dollars for expansion of their program, then you’re disproportionately affecting poor women. There are estimates out there that if the 26 states that brought the lawsuit don’t take on that Medicaid expansion, then we’re looking at eight-and-a-half million people who will remain without care that could have been provided care, because they will not meet the criteria of being able to participate in the exchanges, but they will not meet the old criteria of being able to be in the traditional Medicaid program.

JUAN GONZÁLEZ: And I wanted to ask Ollie Fein about these exchanges, because these obviously would now go into effect with the Supreme Court upholding the law. But already, some governors—Scott Walker in Wisconsin, Republican governor, has said that he’s going to wait. I think there’s a six-month deadline before which all the states have to certify that they have—their plans are in place. And Scott Walker is saying now he’s going to wait ’til after November, the November election, to decide what Wisconsin is going to do about its exchanges.

DR. OLIVER FEIN: Yeah. OK, well, I mean, if in fact Wisconsin doesn’t put in an exchange, the law says that the feds will go ahead and put it in for them. What he’s banking on is obviously that the election will turn out to, you know, favor Mitt Romney, and therefore they will not—the Republicans will try to repeal this law and that the exchanges will not become a reality. I think, you know, that’s a—you know, a way of politicizing this issue, without question. The exchanges are likely to go into effect in almost all states.

AMY GOODMAN: During the Democracy Now! special that we broadcast yesterday, from the steps of the Supreme Court we spoke to Dr. Margaret Flowers, among many single-payer activists in D.C., standing in front of the Supreme Court, president of Physicians for a National Health Program, now pediatrician. This was her reaction as she heard, minutes before, the decision hand down upholding the ACA, the Affordable Care Act.

DR. MARGARET FLOWERS: We’ve got to stop making this political. We’ve got to start talking about the truth. Maybe you’re expanding some coverage to more people. What kind of coverage are they getting? They’re getting Medicaid. That’s very poor coverage. They’re getting private insurance that’s skimpy, that will still leave them bankrupt when they have a serious illness. When we accept working within the framework that is handed to us, we will not get to where we need to be. We must demand that Congress and the White House drop two words from the current Medicare Act, expand Medicare to every person in this country and then improve that. Until we do that, we’re not going to have a universal, high-quality healthcare system in this country. This has got to be about policy and not politics.

AMY GOODMAN: Dr. Margaret Flowers, we—

DR. MARGARET FLOWERS: And I’m so disappointed to hear them.

AMY GOODMAN: Dr. Margaret Flowers, when you say drop two words, those two words: “over 65”?

DR. MARGARET FLOWERS: Right, yeah, drop them. Expand Medicare to every person in this country immediately. Then we will have a universal healthcare system that’s publicly financed, that’s about health. Right now, what we’ve done is we’ve further privatized our healthcare system. We’ve gone in the wrong direction. And if this was passed by Romney, you would have had the same people sitting there opposing it. This is the Romney bill passed by Obama. We’ve got to stop making this about politics. It’s got to be about what’s best for the American people. We have to demand healthcare for every person in this country—

AMY GOODMAN: And, Dr. Margaret Flowers—

DR. MARGARET FLOWERS: —not just a few more.

AMY GOODMAN: Dr. Flowers, just before you go, what is your plan right now? You have Justice Roberts voting to save the ACA. He joins the more progressive elements of the church—of the Supreme Court, and they have upheld this. So what is Physicians for a National Health Program going to do right now?

DR. MARGARET FLOWERS: We’re going to do what we do every single day: we’re going to continue to educate and push for a national Medicare for All. We’re going to continue to advocate on behalf of every person and demand what we—what every other industrialized nation has: a universal healthcare system. We won’t stop until we achieve that.

AMY GOODMAN: That’s Dr. Margaret Flowers, a pediatrician and a member of Physicians for a National Health Program, standing outside the Supreme Court. She had just gotten word that the Affordable Care Act had been upheld.

Wendell Potter, I wanted you to respond to Dr. Flowers. Wendell Potter, you’ve been chief spokesperson for CIGNA, also worked with Humana. You wrote Deadly Spin: An Insurance Company Insider Speaks Out on [How] Corporate PR is Killing Health Care and Deceiving Americans. You’re a chief insurance whistleblower. Your thoughts on what happened yesterday and what Dr. Flowers is saying?

WENDELL POTTER: Well, what happened yesterday, in my view, was a huge victory for Americans. Dr. Flowers and Dr. Fein are both friends of mine, but we can’t—we’re living in a fantasy world if we think that it’s possible for us to stop making this political. We live in a political world. I’ve heard others who have said in the past that we need to separate the policy from the politics, and that is not the way the world operates. We got all that we could get out of Congress during the healthcare reform debate, because the people that I used to work for, the insurance industry and other special interests, are so entrenched in Washington that they control the political agenda. So you cannot separate politics from policy.

We can view this as a glass half-empty and say this is bad, if we want to, but it brings people into coverage who wouldn’t have coverage otherwise. I have met people who have thanked me for what I have done and who have said that they are alive today, already, because of the Affordable Care Act. To me, if one person is alive today because of the Affordable Care Act, it is worth what we have done. And this will save many, many, many lives going forward. We have to see this as the end of the beginning of reform. This certainly is not perfect. I’ve said that, and I agree with Drs. Fein and Flowers and many others, including those at Health Care for America Now and many others who have fought to try to get this legislation passed and to, you know, withstand this constitutional challenge. They agree that we need to do more than what we’ve gotten, but we’ve got to stop somewhere. And if we had lost this, we would be—we would be even worse than where we began in 2008 and 2009.

JUAN GONZÁLEZ: And, Wendell Potter, the exchanges that are going to be set up under this system in various states, with your long experience in the insurance industry, does the industry look at these exchanges warily as a possible birth of an alternative to their kind of insurance?

WENDELL POTTER: Oh, absolutely. The industry was not at all happy about the exchange in Massachusetts, the Connector, as it’s called, and they’re very, very concerned about the exchanges as they’re being set up in the other states, in the various states. They want to try to control the boards of the exchanges, and they will, as best they can, in some states. So they are—they’re very wary of this. They know that they will need to participate in those exchanges, but they don’t know how much of an advantage they will have over the competitors. So this is a brand new world for them. They’ll try to control it as much as they can, but some states are not going to let them, like California, for example, is not letting any healthcare executive or insurance executive serve on any kind of management or board position for the exchange. So, the exchanges really can help us get closer to single payer, because like Vermont is doing, for example, they have to, like every other state, set up an exchange, but Vermont sees that as a stepping stone toward having a single-payer system.

AMY GOODMAN: We’re going to talk about Vermont in a minute. We’re going to go to Vermont to speak to the head of the health division in the state government. But I wanted to talk about how media outlets got it wrong yesterday, for a bigger reason than, oh, a joke. But the media outlets incorrectly reported that the Supreme Court had struck down the individual mandate at the heart of the healthcare reform. Let me play a clip from CNN’s Wolf Blitzer interviewing John King just after the ruling came down.

WOLF BLITZER: John King is outside the Supreme Court watching all of this unfold. What a setback, John, this would be for the president, for the Democrats, those who supported this healthcare law, if they rule that the individual mandate is in fact unconstitutional. Then it raises questions about any of this healthcare reform law.

JOHN KING: Wolf, the individual mandate is the centerpiece of the policy, meaning the mandate requiring most Americans to purchase insurance is where the money comes from. It’s how you expand access. The administration has said it could possibly try to keep parts of the law viable, but it is the money—most of the money comes through that individual mandate requiring people to purchase health insurance. The court striking that down that mandate is a dramatic blow to the policy and to the president, politically.

AMY GOODMAN: CNN later apologized for reporting it wrong, and this was over many, many minutes. Fox also incorrectly reported the Supreme Court had struck down the individual mandate.

BILL HEMMER: We have breaking news here on the Fox News Channel: the individual mandate has been ruled unconstitutional. This was a part of the law that was at the center of the oral arguments three months ago on this day, when the justices hammered away at the White House and the administration’s attorney, questioning the validity of the individual mandate and asking the following pointed question: if you can legislate healthcare, where can the federal government be stopped? Shannon Bream is live outside the Supreme Court now with more. Shannon, good morning there.

SHANNON BREAM: Good morning. We have just gotten the opinion. I’m just getting a first look at it. It is authored by the chief justice, John Roberts. He has language specifically going to the Commerce Clause and whether the mandate is OK or not under the Commerce Clause, Congress’s power. He says this “compels individuals to become active in commerce by purchasing a product, on the ground that their failure to do so affects interstate commerce.” He says, “The individual mandate … cannot be sustained under Congress’s power to 'regulate Commerce.'” That means the mandate is gone.

AMY GOODMAN: The errors made waves throughout the media world Thursday, with a leaked email even showing an Associated Press editor telling his staff to, quote, “stop taunting” CNN and others who made mistakes. A photo that went viral online visually shows President Obama as Harry Truman proudly displaying the CNN homepage on his iPad. In fact, I think it—wasn’t it a Daily News photographer, who—

JUAN GONZÁLEZ: Yes, yes. Yes, it was.

AMY GOODMAN: Now, but this goes to a bigger point, which is the way the media has covered this whole healthcare debate. I mean, this is very interesting, you know, that President Obama thought it went down, because he was watching CNN. Now, if he had watched Democracy Now! when we did our live broadcast yesterday, we got it right, from the beginning. And one of the ways we’re getting it right, credit goes to SCOTUSblog, which is Supreme Court of the United States, superb blog, that they had people inside who understood, right? That’s a very big difference these days.

But the issue of how this whole discussion has been couched, Dr. Ollie Fein, I think if it was the other way, if they had struck down the law and somehow word had gotten out that they had upheld it, people like John King might have said, “Wait, I want to double-check that.” It was so—the way the language has been used to describe government-run healthcare, as opposed to Medicare for all, which would be very popular, it just created this immense avalanche that led people not to question at the end.

DR. OLIVER FEIN: Yes. And, you know, this whole issue of a Medicare-for-all type of program, you realize, was never allowed on the floor of Congress. There was never a debate within any of the committees about literally a Medicare-for-all type of approach. You’re well aware that when we attempted to make that case in the Finance Committee, eight people were arrested for trying to provide that kind of testimony. The private health insurance industry has been enormously successful in controlling the debate about this law. And that’s really, you know, its major—it seems to me, its major fault at this point.

JUAN GONZÁLEZ: You know, but on this reporting thing, I think it’s also symptomatic, these reporting errors, of just a media world now that values being first over being right, because if that reporter was holding up the decision—


JUAN GONZÁLEZ: —reading the first few paragraphs—

AMY GOODMAN: What was she reading?

JUAN GONZÁLEZ: —had read a few more pages, she would have—

DR. OLIVER FEIN: She would have understood.

JUAN GONZÁLEZ: She would have understood that the court was merely ruling that under the Commerce Clause, the penalty could not stick, but that as a tax, the government could require it. So it was merely a question of reading a few more pages, and she didn’t have the time, with the pressure from her editors to get it first.

But, you know, I’d like to ask Wendell Potter about this whole issue of cost under the new healthcare plan. How—to what degree will cost be reined in, the increasing cost of health insurance? And many critics are saying it’s not going to have a major impact on the rising costs.

WENDELL POTTER: Well, not as much as—not as much as if we did have a single-payer system, there’s no doubt about that in my view. But it will help. It will curb the increase in premiums in ways that we—without the law, we would not have seen. When we have the exchanges up and running in the states, there will be a level of competition that we haven’t seen before, and people will be able to make some comparisons with plans that they’ve not been able to get before. We’ve not been able to get a lot of information at all from insurance companies that enable us to make informed decisions. Also, insurance companies will now have to spend 80 percent of what we pay in premiums on our healthcare, and if they don’t, they have to rebate premiums back to us. So it does a lot of things that people are not quite aware of, and we’ll have to see exactly how effective they are. And one—to one extent, we’ll never know exactly what the effect has been, because, without the Affordable Care Act, I can assure you that premiums will continue to go up very, very rapidly.

But also, the point here also is important that we can’t just look at premiums, either. We have to look at the total cost of what people are going to be paying for care, even if they’re insured. That includes what they pay out of pocket. And the Affordable Care Act, while it does allow high-deductible plans to continue, at least puts a cap on how much we are having—will have to spend out of our own pockets before our insurance will kick in.


DR. OLIVER FEIN: Yeah, I was going to say, it’s precisely the calculation that what the patient—that’s the, you know, person who’s insured—is going to have to pay that is really at issue. And I worry, in this law, that what’s going happen is that more and more people will become underinsured, that the deductibles will go up, that the co-payments will go up, and that people who are presently getting really good insurance through their employer may find that their employer begins to shift more and more of those costs onto, you know, the worker.

AMY GOODMAN: We have to break. When we come back, we’re also going to be joined by the head of the health program in Vermont, which is poised to become the first single-payer state. Stay with us.


AMY GOODMAN: It’s the morning after. It’s the morning after the Supreme Court upheld President Obama’s Affordable Care Act. We are joined by Jodi Jacobson of RH Reality Check; and Wendell Potter, insurance industry whistleblower; Dr. Oliver Fein, past president of Physicians for a National [Health] Program. I wanted to turn to—back to Jodi to ask about the issue of the right-wing attacks on healthcare, especially around women. There was a lot of discussion around abortion outside the Supreme Court with the hundreds of people that were there. How does this law impact women’s healthcare?

JODI JACOBSON: Well, on the whole—I mean, first of all, I am unequivocally in agreement with the issue of the single-payer piece and that we should be striving toward that, and this is a first step forward toward what we really need. But for women, this law is, without question, a gain, because 45 million women have already received coverage of things like pap smears and cervical cancer—cervical cancer screening, breast cancer screening, other forms of reproductive healthcare without co-pay. There’s already been an increase for women in access to all sorts of healthcare that they need because they are women. And what this law does is it removes gender discrimination in healthcare pricing. It enables women to get access to care. As of August, women will be able to get access to contraception without a copay or without deductibles, just like any other prescription that might be treated under their plans. So, for women, on the whole, the law is a win. And while we have a lot further to go, there’s no question: it’s beneficial for women.

Of course, under the whole debate around the law, women lost access to insurance coverage for safe abortion care. And in many states—not surprisingly, many of the states that also sued the federal government about the healthcare law—state legislatures and governors are trying to take steps backward in denying women access to care. So I think it won’t be unrelated when we see who’s willing and not willing to, for example, expand Medicaid coverage as to who’s also trying to strip women of their reproductive healthcare. The state of Texas being one example where the state legislature has tried to both deny funding to Planned Parenthood clinics, even though they’re not providing abortions, to diminish the amount of funding for public funding for contraceptive delivery and for pap smears and breast exams. All of these things directly impact women, and all of these things are at the political core of some of the debates also around what the United States Conference of Catholic Bishops is continuing to contest about the law. They just don’t want women to have access to reproductive healthcare.

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