From the NYT: House Republicans Unveil Plan to Replace Health Law

It begins.

- Click here for the article.

House Republicans unveiled on Monday their long-awaited plan to repeal and replace the Affordable Care Act, scrapping the mandate for most Americans to have health insurance in favor of a new system of tax credits to induce people to buy insurance on the open market.

The bill sets the stage for a bitter debate over the possible dismantling of the most significant health care law in a half-century. In its place would be a health law that would be far more oriented to the free market and would make far-reaching changes to a vast part of the American economy.

The House Republican bill would roll back the expansion of Medicaid that has provided coverage to more than 10 million people in 31 states, reducing federal payments for many new beneficiaries. It also would effectively scrap the unpopular requirement that people have insurance and eliminate tax penalties for those who go without. The requirement for larger employers to offer coverage to their full-time employees would also be eliminated.

People who let their insurance coverage lapse, however, would face a significant penalty. Insurers could increase their premiums by 30 percent, and in that sense, Republicans would replace a penalty for not having insurance with a new penalty for allowing insurance to lapse.

House Republican leaders said they would keep three popular provisions in the Affordable Care Act: the prohibition on denying coverage to people with pre-existing conditions, the ban on lifetime coverage caps and the rule allowing young people to remain on their parents’ health plans until age 26.

Republicans hope to undo other major parts of President Barack Obama’s signature domestic achievement, including income-based tax credits that help millions of Americans buy insurance, taxes on people with high incomes and the penalty for people who do not have health coverage.

Medicaid recipients’ open-ended entitlement to health care would be replaced by a per-person allotment to the states. And people with pre-existing medical conditions would face new uncertainties in a more deregulated insurance market.

The bill would also cut off federal funds to Planned Parenthood clinics through Medicaid and other government programs for one year.

For graphical looks at what will and wont change:

- NYT: The Parts of Obamacare Republicans Will Keep, Change or Discard.
- WAPO: How the House Republicans’ proposed Obamacare replacement compares.

From Politico: Doubts grow that GOP can repeal Obamacare - Probably only Donald Trump can whip the party's warring factions in line, but so far he's sent vague and conflicting messages.

Repeal is tougher than it seems.

- Click here for the article.

Republicans have reached a gut check moment: After spending more than six years vowing to fix the flagging patient that is Obamacare, it’s the GOP’s own repeal effort that’s on life support.

Undoing the health care law despised by conservatives seemed to be a straightforward proposition for the party after it won the White House and retained control of both chambers of Congress. Instead, Republicans are sniping over how much of the law to scrap, what to replace it with and when. At this moment, it's far from a sure thing any plan could get through Congress.

Consider Paul Ryan's feel-good meeting with Senate Republicans on Tuesday. The House speaker trekked across the Capitol to reassure senators that lawmakers are making more progress toward repealing the health care law than the media are reporting.

But not everyone was buying it. Sen. Rand Paul (R-Ky.) left before it was over, having heard enough of a conversation that he says centers around keeping Obamacare's Medicaid expansion intact and creating tax credits that he called a "new entitlement program," though a Republican in the room rebutted the notion that the topic of Medicaid expansion came up in the Tuesday meeting with Ryan.

“I hear things that are unacceptable to me,” Paul said in an interview afterward. “If they don’t seem to care what conservatives think about complete repeal of Obamacare, they’re going to be shocked when they count the votes.”

From the New York Times: Trump’s Health Plan Would Convert Medicaid to Block Grants, Aide Says

Some of my 2305 classes are covering federalism, which includes a discussion of categorical and block grants. Here's a story illustrating the latter.

- Click here for it.

President Trump’s plan to replace the Affordable Care Act will propose giving each state a fixed amount of federal money in the form of a block grant to provide health care to low-income people on Medicaid, a top adviser to Mr. Trump said in an interview broadcast on Sunday.

The adviser, Kellyanne Conway, who is Mr. Trump’s White House counselor, said that converting Medicaid to a block grant would ensure that “those who are closest to the people in need will be administering” the program.

A block grant would be a radical change. Since its creation in 1965, Medicaid has been an open-ended entitlement. If more people become eligible because of a recession, or if costs go up because of the use of expensive new medicines, states receive more federal money.

If Congress decides to create block grants for Medicaid, lawmakers will face thorny questions with huge political and financial implications: How much money will each state receive? How will the initial allotments be adjusted — for population changes, for general inflation, for increases in medical prices, for the discovery of new drugs and treatments? Will the federal government require states to cover certain populations and services? Will states receive extra money if they have not expanded Medicaid eligibility under the Affordable Care Act, but decide to do so in the future?

Ms. Conway, speaking on the NBC program “Sunday Today,” said that with a block grant, “you really cut out the fraud, waste and abuse, and you get the help directly” to intended beneficiaries.

. . . Governors like the idea of having more control over Medicaid, but fear that block grants may be used as a vehicle for federal budget cuts.

“We are very concerned that a shift to block grants or per capita caps for Medicaid would remove flexibility from states as the result of reduced federal funding,” Gov. Charlie Baker of Massachusetts, a Republican, said this month in a letter to congressional leaders. “States would most likely make decisions based mainly on fiscal reasons rather than the health care needs of vulnerable populations.”

Gov. Robert Bentley of Alabama, a Republican, said that if a block grant reduced federal funds for the program, “states should be given the ability to reduce Medicaid benefits or enrollment, to impose premiums” or other cost-sharing requirements on beneficiaries, and to reduce Medicaid spending in other ways.

In Louisiana, Gov. John Bel Edwards, a Democrat, said he was troubled by the prospect of a block grant with deep cuts in federal funds. “Under such a scenario,” he said, “flexibility would really mean flexibility to cut critical services for our most vulnerable populations, including poor children, people with disabilities and seniors in need of nursing home and home-based care.”

Gov. John W. Hickenlooper of Colorado, a Democrat, said that block grant proposals could shift costs to states and “force us to make impossible choices in our Medicaid program.”

“We should not be forced to choose between providing hard-working older Coloradans with blood pressure medication or children with their insulin,” Mr. Hickenlooper said.

For more:

- Wikipedia: Block Grants.
- Wikipedia: Categorical Grants.
- Reason: The Problem With Block Grants.
- Washington Post: The GOP plan to fund Medicaid through block grants will probably weaken it.

From the Washington Post: Trump signs executive order that could effectively gut Affordable Care Act’s individual mandate

- Click here for the article.

President Trump signed an executive order late Friday giving federal agencies broad powers to unwind regulations created under the Affordable Care Act, which might include enforcement of the penalty for people who fail to carry the health insurance that the law requires of most Americans.

The executive order, signed in the Oval Office as one of the new president’s first actions, directs agencies to grant relief to all constituencies affected by the sprawling 2010 health-care law: consumers, insurers, hospitals, doctors, pharmaceutical companies, states and others. It does not describe specific federal rules to be softened or lifted, but it appears to give room for agencies to eliminate an array of ACA taxes and requirements.
However, some of these are embedded in the law, so it is unclear what latitude the executive branch will have.

Though the new administration’s specific intentions are not yet clear, the order’s breadth and early timing carry symbolic value for a president who made repealing the ACA — his predecessor’s signature domestic achievement — a leading campaign promise.

Additionally, the order’s language about easing economic and regulatory burdens aligns with long-standing Republican orthodoxy that the government exerts too heavy a hand on the U.S. health-care system.

- Click here for the text of the order.

For background:

- What is the Patient Protection and  Affordable Care Act?
- What are its main provisions?
- What is an Executive Order?

And for commentary:

- Trump’s Executive Order On Obamacare Means Everything And Does Nothing.
- What Trump's Obamacare Executive Order Means.
- Trump’s executive order on Obamacare, explained by two health policy experts.

From the Houston Chronicle: Woodlands crowd grills Brady over ACA repeal

Repealing Obamacare may not be as popular as some had hoped.

- Click here for the article.

U.S. Rep. Kevin Brady, R-The Woodlands, faced a skeptical and at times testy crowd Tuesday as dozens of people arrived at an afternoon meeting to make sure he knew they would not let the Affordable Care Act end without a fight.

The hourlong session, tucked away in a back meeting room at The Woodlands Area Chamber of Commerce headquarters, was not publicly announced and was billed by Brady's staff as a chance for "local people affected by ObamaCare" to "share their experiences with rising costs and loss of coverage and choice."

Brady, chairman of the House Ways and Means Committee, is a vocal critic of the law known as Obamacare and is among the conservative congressional leaders determined to repeal it quickly and replace at an unspecified later date.

But if he was expecting a completely friendly, like-minded group, he quickly found something else from many in the 50 or so who crowded the room.

"Don't lie!" shouted Emily Hoppel, a 39-year-old with her 2-year-old son perched on her hip, when Brady moved from one goal of dismantling ACA to another of defunding Planned Parenthood, which he said used taxpayer money for abortion.

From Roll Call: The Convoluted Process for Dismantling Obamacare

A unique take on the bill making process

- Click here for the article.

In the early hours of Jan. 12, the Senate took the first step in the convoluted process of dismantling and replacing the 2010 health care law. To overcome the potential filibuster power of Senate Democrats, GOP lawmakers are relying on budget reconciliation, the same procedural mechanism their counterparts across the aisle used seven years ago to implement parts of the health care overhaul.

The budget reconciliation process is filled with procedural complications — and in this case, political uncertainty — as GOP leaders and President-elect Donald Trump have signaled various ideas about the timing of changes.

The graphic below explains the budget resolution and reconciliation process and how it could play out.

From Roll Call: Why 3 House Republicans Voted Against Repealing Obamacare

We discussed "instrumentalism" in the dual credit classes last week, which is the idea that political behavior has a purpose. Everything that is done, is done for a reason - though that reason might not seem initially obvious.

Here's one author's explanation of why three Republicans in the House of Representatives voted against the vehicle that would have allowed for a repeal of Obamacare - the budget reconciliation process. It should be noted that all three are from states that voted for Hillary Clinton.

- Click here for the article.

House Republican leaders gave their freshmen members a political gift Tuesday: The chance to vote "yes" on a symbolic bill to dismantle the Affordable Care Act.

For three new Republican representatives, however, the repeal vote was an opportunity to vote "no." Republicans Bruce Poliquin of Maine, John Katko of New York and Robert Dold of Illinois were the lone three defections in either party on what's being billed as the chamber's 56th vote since 2011 to undo parts of the 2010 health law.

The defectors' rationale? They might hate Obamacare, but Republicans still haven't put forward a legislative proposal that would act as a substitute in the event the law ever got repealed.

"I am against Obamacare. It is hurting jobs, hurting our families, limiting choices," Poliquin told CQ Roll Call as he left the House floor Wednesday afternoon. "But I need to see a tangible, free-market replacement and this bill does not give us that. I need to see how we're gonna fix this and not just be someone who votes for the 56th time to repeal this.

"Show me a fix," Poliquin said, "and you'll have my support."

Katko went to Facebook to explain his "no" vote: "I am disappointed that the bill taken up by Congress today did not provide a real solution to the rising costs of healthcare, but I will continue to fight for comprehensive, bipartisan healthcare reform for Central New York in Congress."

He added that a campaign promise was to vote against Obamacare repeal votes that did not also include a replacement.

For more on the small number of Republicans voting against the repeal measure click here:

- Mixed Bag of Republicans Vote Against Obamacare Repeal Vehicle.

For future lectures, this article points out some of the caucuses in the House and Senate and the positions they are taking on repeal,.

From the New York Times: Senate Takes Major Step Toward Repealing Health Care Law

They began a process that allows the repeal to be considered as a reconciliation bill which makes it filibuster proof.


- Click here for the article.

Senate Republicans took their first major step toward repealing the Affordable Care Act on Thursday, approving a budget blueprint that would allow them to gut the health care law without the threat of a Democratic filibuster.

The vote was 51 to 48. During the roll call, Democrats staged a highly unusual protest on the Senate floor to express their dismay and anger at the prospect that millions of Americans could lose health insurance coverage.

One by one, Democrats rose to voice their objections. Senator Maria Cantwell of Washington said that Republicans were “stealing health care from Americans.” Senator Ron Wyden of Oregon said he was voting no “because health care should not just be for the healthy and wealthy.”

The presiding officer, Senator Cory Gardner, Republican of Colorado, repeatedly banged his gavel and said the Democrats were out of order because “debate is not allowed during a vote.”

The final vote, which ended just before 1:30 a.m., followed a marathon session in which senators took back-to-back roll call votes on numerous amendments, an arduous exercise known as a vote-a-rama.

The approval of the budget blueprint, coming even before President-elect Donald J. Trump is inaugurated, shows the speed with which Republican leaders are moving to fulfill their promise to repeal President Obama’s signature domestic policy achievement — a goal they believe can now be accomplished after Mr. Trump’s election.

The action by the Senate is essentially procedural, setting the stage for a special kind of legislation called a reconciliation bill. Such a bill can be used to repeal significant parts of the health law and, critically, is immune from being filibustered. Congress appears to be at least weeks away from voting on legislation repealing the law.

From the Houston Chronicle: Health care system punishes most important doctors

For our look at health care policy in the state.

- Click here for the post.

Torres' job is to keep her patients as healthy as possible, the most important job in American health care. But her industry treats primary care physicians so badly that their numbers are shrinking, and there are consequences for all of us if conditions don't improve.

Stress, bureaucracy and case load have left 64 percent of doctors with a negative view of their industry, according to a survey commissioned by the Physician's Foundation, an advocacy group for doctors. Less than 20 percent of physicians say they can accommodate more patients.

Primary care physicians are particularly unhappy, facing the heaviest paperwork burden and the lowest pay. Forty-four percent of doctors say they plan to retire early, cut back on patients or seek a job that doesn't involve patients.

"We're at the bottom of the payment totem pole, for sure," Torres said. "The amount of work we have to do is far greater than the specialist. We have to do a lot of tedious work."

Torres calculates she works about 70 hours a week, which is typical, according to the survey. More than 80 percent of Texas physicians work more than 40 hours a week, with some averaging 80 hours or more.

Torres is also one of the shrinking number of doctors who operate as small businesses. Only 29 percent of Texas doctors still own their practice, and nationwide the number has dropped to 17 percent as physicians join large partnerships or work as employees of hospitals where patients are too often seen as statistics.

"The key word right now is efficiency. But do you want someone who is going to listen to you and take care of you, or do you want someone who will be efficient?" she said when asked why she doesn't work for someone else. "I may not be doing financially the best that I can do, but I am able to pay my bills, I'm happy with how I take care of the patients, and that to me is the important part."

The Texas Tribune: Texas Asks Feds for Short-Term Medicaid Funds

It would be easier if the state would expand access to health care coverage, but that would mean accepting Obamacare - which the state is unlikely to do.

- Click here for the article.

State health officials confirmed Tuesday they have asked the Obama administration to keep a 15-month lifeline of federal Medicaid money flowing into Texas to help hospitals treat uninsured patients.

That money would offer temporary relief to health care providers who face losing the funds — some $3.1 billion annually — over state leaders' refusal to provide government-subsidized health coverage to low-income adults under the Affordable Care Act, President Obama's signature health law.

Federal officials previously signaled they would stop footing the bill for at least some of Texas’ costs for "uncompensated care" — the burden on hospitals when patients can't pay for their visits. Under the Affordable Care Act, Texas was encouraged to expand its Medicaid program to cover nearly 1 million additional adults living in poverty — a move that would have given more poor patients a means to pay for care. The state’s Republican leadership has vehemently opposed that option, criticizing Medicaid as an inefficient government program.

In a letter dated April 7 and first released to The Texas Tribune on Tuesday, Texas health officials asked the federal government to continue the funding for uncompensated care for one year and to pony up an unspecified prorated amount for an additional three months. It is unclear if the Centers for Medicare and Medicaid Services, which oversee those federal funds, will approve the state's request.

If approved, the funding would briefly extend the life of what was supposed to be a temporary program that safety-net hospitals have relied on for five years to serve poor, uninsured Texans.

Did the process the ACA (Obamacare) took through Congress violate the origination clause?

The Supreme Court declined to take up a case making that argument, so we will never really know.

See:

- Obamacare dodges another bullet at the Supreme Court.
- Appeals court rejects new test of health care mandate.

Article One, Section Seven of the U.S. Constitution states that:

All bills for raising revenue shall originate in the House of Representatives; but the Senate may propose or concur with amendments as on other Bills.

The Affordable Care Act was judged by the Supreme Court - when it found the law to be constitutional - to be a tax. An individual who did not want to have to buy insurance sued saying the law was invalid because it did not follow the proper procedure. Tax bills have to originate in the House, the ACA did not. Lower courts did not buy this argument arguing that the revenue collected is not a tax to be collected for the treasury, but to lay for the programs created by the law. Social Security and Medicare are funded in similar ways.

- Click here for the ruling from the DC Circuit court of appeals.

By not accepting the appeal, the Supreme Court in essence chose to implicitly accept the reasoning of the lower court. There's more to the story - click on the links above to dig into it.

For more on the origination clause, click on these:

- Heritage Foundation.
- Legal Information Institute.
- THE FOUNDERS’ ORIGINATION CLAUSE ANDIMPLICATIONS FOR THE AFFORDABLE CARE ACT.

From the Texas Tribune: Court to Decide if Autopsy Counts as Health Care

Here's a story that merges our upcoming look at the Texas Judiciary - including the consequence of an elected judiciary - with our past look at Article 3 of the Texas Constitution. It also continues our ongoing look at cases that involved interpretations of the Texas Constitution - which is apparently not as clearly written as we might suppose.

The question posed is the extent of the protections that doctors and hospitals have as a result of the passage of tort reform - which was added to the Texas Constitution in 2003.

- Click here for the story.

Eleven years after a man's unexplained death in a Katy hospital sparked a lawsuit involving allegations of malpractice, deception and theft of a human heart, the bizarre case has made its way to the Texas Supreme Court, which will answer a simple yet macabre legal question: Does an autopsy fall under the definition of health care?

If the high court says yes, critics say it would be the latest decision by conservative justices broadening a landmark state law that makes it tougher to sue doctors and hospitals for alleged wrongdoing. Supporters of the legal challenge — brought on an appeal by Christus Health, then owner of the Christus St. Catherine Hospital in Katy — say Texas voters approved sweeping tort reforms in 2003 to limit lawsuits against health care providers, and that autopsies on dead patients are a valid part of the medical care hospitals provide.

The case traces back to the morning of Jan. 22, 2004, when Linda Carswell's husband, Jerry, admitted with kidney stones, was found dead in his hospital bed. Carswell wondered if his death was due to a narcotic the hospital had administered. Carswell has said she asked for an independent autopsy, but her husband's autopsy was performed by a separate hospital under the same ownership as Christus St. Catherine Hospital — a fact she said she did not know at the time. That autopsy, which was inconclusive, did not include a toxicology test, which Carswell said could have shed light on whether the narcotic had killed her husband.

Further complicating matters, the examiner who performed the autopsy also allegedly removed the dead man’s heart without Carswell’s consent. The hospital fought not to release the organ, saying it could be important evidence that would show Carswell's husband died of a heart attack.

After an appeals court ordered the hospital to release the heart to Carswell, a separate forensic biologist said it contained no human DNA — either because of the way it was preserved, or because there was a “real possibility that the heart submitted was not human,” according to court documents.

A jury sided with Carswell, who says she was misled by Christus Health about the autopsy’s independence and scope, and awarded her a rare $2 million fraud judgment against the health care provider. Christus Health appealed the case and is still fighting it, although it sold Christus St. Catherine Hospital to Houston Methodist in 2014.

A spokeswoman for Christus Health declined to comment for this article. But in court briefings, lawyers representing Christus Health asked the Texas Supreme Court to weigh in on whether Carswell's case should have fallen under the Texas Medical Liability Act. That law, the health care provider argues, defines the nebulous term “health care” broadly enough to include autopsies — which would render Carswell's suit moot because she did not meet the legal requirements to sue.

For background:

- Section 66 of Article 3 of the Texas Constitution.
- Analysis of Amendment No. 12 - the Tort Reform Amendment.
- The Texas Medical Liability Act.
- Wikipedia: Medical Malpractice in the United States.
- Wikipedia: Tort Reform.
 

A federal district judge allows another lawsuit against the Affordable Care Act to go forward

ScotusBlog describes the case - and states that it breaks new Constitutional ground. This should be of interest to 2305 students who are starting to dig into Article One of the U.S. Constitution. It involves who controls the national purse strings. this story also illustrates the checks and balances - albeit one of the more unusual ones.

- Click here for the article.
- Click here for the ruling.

It looks at a key part of Article One - one we talked about in class last week, the appropriations clause - and asks whether the House of Representatives has standing to sue the executive branch in how it is implementing the law it passed a few years back.

From the decision: 

Article I of the United States Constitution established the Congress, which comprises a House of Representatives and a Senate. U.S. Const. art. I, § 1. Only these two bodies, acting together, can pass laws—including the laws necessary to spend public money. In this respect, Article I is very clear: “No Money shall be drawn from the Treasury, but in Consequence of Appropriations made by Law . . . .” U.S. Const. art. I, § 9, cl. 7.

Through this lawsuit, the House of Representatives complains that Sylvia Burwell, the Secretary of Health and Human Services, Jacob Lew, the Secretary of the Treasury, and their respective departments (collectively the Secretaries) have spent billions of unappropriated dollars to support the Patient Protection and Affordable Care Act. The House further alleges that Secretary Lew and Treasury have, under the guise of implementing regulations, effectively amended the Affordable Care Act’s employer mandate by delaying its effect and narrowing its scope.  

The Secretaries move to dismiss, arguing that the House lacks standing to sue. They argue that only the Executive has authority to implement the laws, and urge this Court to stay out of a quintessentially political fight in which the House is already well armed. The House opposes, adamant that it has been injured in several concrete ways, none of which can be ameliorated through the usual political processes. The only issue before the Court is whether the House can sue the Secretaries; the merits of this lawsuit await another day

And the judge says it can go forward with that issue.

ScotusBlog explains the nuances of the House of Representatives complaint:

As part of the ACA’s policy of helping millions of lower-income Americans to obtain health insurance at affordable rates, the law has a variety of subsidy provisions. The Supreme Court in June upheld the system that provides lower-income consumers with a form of tax credit to help them afford policies that are sold on insurance marketplaces (or “exchanges”); that financial provision is not at issue in the House’s lawsuit. But the lawsuit explicitly targets a mechanism to encourage health insurance companies to reduce the costs of coverage for lower-income individuals.

The House claimed in court that, although Congress has in fact voted the funds to pay for the subsidy system keyed to the insurance exchanges, it has never approved any funds to cover the expense of the cost-sharing approach — technically, the “cost-sharing offsets.” The ACA required insurance companies taking part in the new program to specifically reduce the co-pays charged to consumers when they visit doctors’ offices or other health facilities. The federal government then steps in to reimburse the insurers for absorbing those costs.

In going to court, the House contended that the Obama administration has asked for, but never obtained, actual legislation appropriating those reimbursement funds, but instead has simply taken the money out of accounts at the Treasury and sent checks to the insurers. This, it argued, was a direct violation of the Constitution’s command that no federal funds may be spent unless approved, in advance, by Congress.

The administration has argued in response that the ACA itself provided all the authority that the government needed to finance the cost-sharing provision, so there was no need to ask Congress explicitly to put up the money. Officials also have disputed the House claim that they did, in fact, ask for appropriations.

The Supreme Court rules on Obamacare (again) and on housing discrimination

More on this later - some students are writing on these topics, so heads up if you are.

King v. Burwell: The court ruled 6-3 that federal subsidies to state insurance exchanges were legal under the wording of the ACA.

Texas Department of Housing and Community Affairs v. Inclusive Communities Project:  The court ruled 5-4 that a non-profit group could sue the state of Texas under Fair Housing Act for disparate treatment.

Clarity to follow, but you might want to check these sites out for now:

- ScotusBlog: Texas Department of Housing and Community Affairs v. The Inclusive Communities Project, Inc.
- ScotusBlog: King v Burwell.
- Oyez: Texas Department of Housing and Community Affairs v. The Inclusive Communities Project, Inc.
- Oyez: King v Burwell.

End of life care in the Texas Legislature

At least one 2306 student is interested in looking at how the Texas Legislature dealt with end of life care.

- Click here for info from the Texas Tribune's Texas Legislative Guide.

According to the Texas Tribune, there was little activity on that front and nothing actually passed with the exception of a bill that "would allow terminally ill patients who have exhausted other treatment options to try experimental drugs that have passed at least the first of three FDA trial phases." This is called a "right to try bill." As of this writing it is sitting on the governor's desk for a possible signature or veto.

- Click here for the legislative history of HB 21.
- Click here for an analysis of the bill.
- Texas Tribune: Lawmakers Push "Right to Try" Experimental Drugs.
- Texas Tribune: House Backs Bill Pushing "Right to Try" Experimental Drugs.

Two bills related to end of life care for pregnant women did not go far. The bills offered competing proposals about the status of pregnant women who are on life support. One would have allowed the family to take her off life support, while the other would have mandated she be kept alive until the child was born.

Here are the two bills:

- HB 1901.
- HB 3183.

And two stories related to the proposals. including the incident that has driven each bill:

- Texas Tribune: Lawmakers Consider End-of-Life Care for Pregnant Women.
- Texas Tribune: Competing Bills Filed Over End-of-Life Care for Pregnant Women.

Other states are far more involved in end of life issues, including questions related to the degree of control people should have other these decisions. Perhaps the most controversial of these is the question about whether there is a right to die, and whether people have the right - as a result - to have assistance in suicide should they have a terminal disease.

The recent case of Brittany Maynard last year brought this to the public agenda. Only five states recognize a right to die, these are Vermont, Montana, Oregon, Washington, and New Mexico. It would be interesting to analyze why Texas is resistant to these laws - I would suspect religious objections matter.

That doesn't mean that there might be efforts to bring items like this to the legislature in the future though. Apparently the bulk of spending on health care happens in the final years of life, which means that if this is phrased as a spending issue, it may have traction.

Update: I missed this one: HB 3074.

Here's info from Wikipedia:

In 2015, the Texas Legislature unanimously passed HB 3074 by State Representative Drew Springer (R-Gainesville), a bill to stop dehydration and starvation of persons with disabilities by reforming the aspect of the statute which allowed healthcare providers to remove artificial nutrition and hydration against a patient's wishes. HB 3074 is the first reform effort to garner universal support from advocacy groups and boasted 4 joint authors and 81 co-authors in the House of Representatives. It was unopposed in the House and Senate and awaits the governors' signature. It is the first reform to the Texas Advance Directives Act since 2003.

Regarding King v Burwell

ScotusBlog has a variety of takes on the latest Supreme Court challenge to the ACA.

- Click here for the main page.

I want to go over this in today's 2305:

- Will concern for states’ rights win out in subsidies battle? Today’s argument in Plain English.

On the origins of a Supreme Court case

Vox explains how King v Burwell came to be.

- Click here for the article.

A lawyer, a law professor, and a libertarian spent the last three years struggling to convince first themselves and then national Republicans that a "glitch" in the Affordable Care Act could be the law's undoing.

This week they can drop the sales pitch. The Supreme Court will hear oral arguments in the case, King v. Burwell, on Wednesday, which will decide whether the Obama administration has the legal authority to dole out billions in tax subsidies to Obamacare enrollees.

Unlike the last time conservatives took Obamacare to the Supreme Court — when the Republican party, major activists, and 26 attorneys general joined forces — the new challenge has a more surprising backstory for a big case. It is the result of the key players working loosely, overcoming lawsuit fatigue in conservative circles, pushing an argument that seems more technical than substantive, and even a bit of luck.

"I think people imagine a eureka moment. It was nothing like that."

"There is nothing very organized about it," Michael Greve, a law professor at George Mason University who supports the case, has written. "The litigation has no single mastermind or man behind the curtain. The campaign is the product of a loose conservative-libertarian infrastructure."

The case is now in front of the Supreme Court, despite the unusual route it took. So while supporters might have viewed it as a nonsense legal challenge — never taking it as seriously as the individual mandate case — they still find themselves back where they were three years ago: fearing that the law could fall apart with just one court decision.

Will Texas join other states in expanding Medicaid under the Afforable Care Act?

A board handpicked by Governor Perry thinks Texas should.

- Click here for a Texas Tribune article in the subject.

Comment: I bet Perry supports the move. He's done running for office in the state and wants to position himself for a run for the presidency. This type of shift to the middle will increase his base of supporters. It's like Lyndon Johnson and civil rights.

Vox Explains King v. Burwell

Here's more from ScotusBlog.

Burwell v. Hobby Lobby Stores, Inc.

One of the major news items this week was the Supreme Court's 5-4 ruling that a privately (or closely) held corporation could use religious reasons to opt out of providing birth control as part of its health insurance package.

The decision has kicked up a predictable fuss, and hits some of the topics covered in 2305's sections on civil liberties and specifically religious liberty - where we dig into the court's decisions regarding the establishment and free exercise clauses. The case mostly hits on the impact on 1993's Religious Freedom Restoration Act, as well as the status of corporations under the Bill of Rights.

I'll post commentary about these separately, but as always ScotusBlog is the go to place for facts about the case itself.

- Click here for their post on the case.

Here is the basic decision the court made: As applied to closely held corporations, the regulations promulgated by the Department of Health and Human Services requiring employers to provide their female employees with no-cost access to contraception violate the Religious Freedom Restoration Act.

2305 students should note the role the Religious Freedom Restoration Act (RFRA) has played in establishing what types of accommodations governments have to make to people based on religious viewpoints.

Here are a few links related to RFRA:

- Wikipedia: RFRA.
- What is RFRA and why do we care?
- The Religious Freedom Restoration Act and complicity in sin.
- DOJ: RFRA.