Historic overview of the Health Care Law in USA

Theodore Roosevelt, at the beginning of the 20th century had a dream which is to establish health insurance for all citizens of the United States of America. Back then, a great resistance that seemed already an irreconcilable dichotomy appears:the intervention of the government on some topics versus the freedom of choice of citizens in a free market economy.

Theodore Roosevelt thought that no country would be strong whose people are sick and poor. (1)

He drafted a bill in 1915, but opposition from insurance companies, doctors and labors contribute to the failure. At that time they were in opposition of this idea because they were not agree on a compulsory health insurance. It was even called a “paternalistic” reform that would create a state supervision over people’s health.

Franklin D. Roosevelt in the 1930’s established a great plan called the New Deal which included the social security and unemployment insurance for all Americans. He planned a health care reform but its administration was afraid to include a health care reform that would compromise the adoption of the social security bill.

Harry S. Truman had a new idea of what the health care system should be. He thought that everyone should have a health care coverage regardless of his or her employment or non-employment. The opponents to the project called it ‘socialism’ that would consider doctors as slaves, so Truman was never been able to do the reform. He, nevertheless, had focused on the health care for the elderly called Medicare and hospital insurance for aged people. A system of predominant private health insurance offered to the public and public welfares services for the poor was left because of the republican opposition back then. He created federal employees health care benefits program and institutionalized tax break for employers called a sponsored health insurance that cost 150 billions of dollars each year to the government (2).

Lyndon B. Johnson expended Medicare and created Medicaid. Medicare is a federal health care system to the advantage of individuals of 65 years old and over and disabled persons. Medicaid is a federal, state and local funds health care system protection for all ages low-income people (3).

Richard M. Nixon proposed a comprehensive healthcare reform in 1974. He called for building on the existing framework of employer-based insurance and proposed legislation including a mandate on employers to offer coverage. Nixon then resigned.

Ronald Reagan produced expansion of Medicare but it was considered as a catastrophic coverage for senior citizens and prescription drug benefit by the democrats.

William Jefferson Clinton (Bill Clinton) proposed a health-care reform but opposition from the health care industry was strong and republicans won the Senate at the mid-term in 1994 so that the project could not succeed. The critic that has been addressed to Clinton is that he produced a health-care reform behind the scene without preparing and negotiating in advance the project with all the protagonists.

George W. Bush signed the biggest expansions of Medicare since its enactment with the prescription of drug benefit, which is prescription drug coverage; the enrollees pay a co-pay for each prescription, a monthly premium and an annual deductible. The last (4) is an amount that individual pay for eligible medical services. Some costs are deductible as bills for hospitalization, surgery, lab tests, some scans, anesthesia, physical therapy, medical devices like pacemakers, mental health care and chiropractic care.

Barack H. Obama achieved the universal health-care reform via the individual mandate process where each citizen has to subscribe to a health care insurance plan and depending on the plan, they would have to pay premiums based on their income.

The future of the health care reform depends on the new administration’s decisions. On January 13th 2017 New York Time reported that a speedy action has been taking to repeal the Affordable Care Act (ACA). The challenge would be (5) devising their own plan to ensure board access to health care and coverage while controlling costs. Unfortunately, there is no consensus on how to replace the ACA. The opposition warned about the cost  of repealing the law for millions of American.

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References:

1) Www.pnhp.org

2) Landmark: The inside sotry of America’s New Health Care Law: the affordable care act, and what it means for us all, Introduction, Washington Post, April 27, 2010

3) Www.dictionary.com

4) Www.cigna.com

5) ‘House Clears Path for Repeal of Health Law’, New York Time, January 13, 2017

 

 

Pro Bono Work: what does it cover?

This is a very common question that you might think about as a lawyer who will take the bar exam or who already have taken the bar and waiting to fulfill your requirements to be a certificate attorney once and for all.

Pro Bono are nice latin words that translate a notion of helping people in need of legal resources and/or representation and who can’t afford any legal assistance.

Some organizations are specialized in this type of work: Legal Aid, a civil or criminal legal services organization that serves low-income clients, a Public Defender, a Conflict Defender, a U.S. Attorney, a District Attorney or a State Attorney General, etc.

A law student would tipically have opportunities to advocate in fields as family law, children’s issues, consumer fraud, AIDS-related problems, housing, immigration, taxation, environmental law, criminal defense, elder law and death penalty appeals.

In the state of New York, you are required to work 50 hours doing law-related tasks appropriate for lawyer and that require legal skills. If you are not yet certified, you must be careful and avoid unauthorized practice of law.

New York State courts give examples of activites that would fall into that category:

  • assisting attorney with trial preparation
  • helping litigants prepare for court appearances
  • engaging in witness interviewing and investigation
  • drafting court or transactional documents
  • engaging legal research directly related to client representation
  • perform law-related assignement
  • make court appearances authorized under student practice orders issued by the Appellate Division of the New York State Court

Your work must be performed under the surpervision of an attorney in good standing and with the appropriate licensing or by a judge. She or He will certify the hours spent on pro bono work on an Affidavit Form of compliance. https://www.nycourts.gov/attorneys/probono/AppForAdmission_Pro-BonoReq_Fillable.pdf

The projects are also mentionned:

  • assiting low-income persons, typically while working in non-profit organizations or law firms performing pro bono work
  • represent person with disabilities
  • representing victims of domestic violence, in housing matters, access to health care or educational services, incarcerated persons, applicants at public assistance hearings
  • advocate for victims of alleged human rights violations or protection of civil liberties

Performing pro bono work with clients does not mean that you will not be paid at all, whereas all your clients in these type of projects will not pay any fees.

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Supreme Court strikes down an abortion texan law: highlights from the decision

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The Supreme Court on Monday struck down a Texas law regulating the state’s abortion clinics, concluding the rules were an “undue burden” on a woman’s right to terminate her pregnancy.

The justices, voting 5-3, struck down a Texas law signed by then-Gov. Rick Perry in 2013 that requires abortion clinics to meet the standards of ambulatory surgical centers and mandates that physicians performing the procedure maintain admitting privileges at a hospital within 30 miles. Abortion-rights advocates said the law would cause every clinic outside major cities to shut down, eliminating ready access to the procedure for women across the vast state. Texas disputed that impact and argued that the standards were intended to increase the health and safety of abortion patients.

Justice Stephen Breyer, who wrote the opinion, was joined by Justices Anthony Kennedy, Ruth Bader Ginsburg, Sonia Sotomayor and Elena Kagan. Chief Justice John Roberts and Justices Clarence Thomas and Samuel Alito dissented.

Below are excerpts from the majority opinion, the concurring opinion by Justice Ginsburg and dissenting opinions by Justices Alito and Thomas:

The Majority Opinion

Justice Breyer opens his 40-page opinion by summarizing the holding:

We conclude that neither of these provisions offers medical benefits sufficient to justify the burdens upon access that each imposes. Each places a substantial obstacle in the path of women seeking a previability abortion, each constitutes an undue burden on abortion access, and each violates the Federal Constitution.

The evidence shows that the requirements in the law constitute an “undue burden,” writes Justice Breyer:

In our view, the record contains sufficient evidence that the admitting-privileges requirement led to the closure of half of Texas’ clinics, or thereabouts. Those closures meant fewer doctors, longer waiting times, and increased crowding. Record evidence also supports the finding that after the admitting-privileges provision went into effect, the “number of women of reproductive age living in a county . . . more than 150 miles from a provider increased from approximately 86,000 to 400,000 . . . and the number of women living in a county more than 200 miles from a provider from approximately 10,000 to 290,000.”

The majority sees a “virtual absence of any health benefit” stemming from the restrictions:

We recognize that increased driving distances do not always constitute an “undue burden.” But here, those increases are but one additional burden, which, when taken together with others that the closings brought about, and when viewed in light of the virtual absence of any health benefit, lead us to conclude that the record adequately supports the District Court’s “undue burden” conclusion.

Such abortion restrictions, writes Justice Breyer, wouldn’t prevent another scandal like the one surrounding Philadelphia abortion doctor Kermit Gosnell:

[T]he dissent points to the Kermit Gosnell scandal. Gosnell, a physician in Pennsylvania, was convicted of first-degree murder and manslaughter. He “staffed his facility with unlicensed and indifferent workers, and then let them practice medicine unsupervised” and had “[d]irty facilities; unsanitary instruments; an absence of functioning monitoring and resuscitation equipment; the use of cheap, but dangerous, drugs; illegal procedures; and inadequate emergency access for when things inevitably went wrong.” Gosnell’s behavior was terribly wrong. But there is no reason to believe that an extra layer of regulation would have affected that behavior. Determined wrongdoers, already ignoring existing statutes and safety measures, are unlikely to be convinced to adopt safe practices by a new overlay of regulations. Regardless, Gosnell’s deplorable crimes could escape detection only because his facility went uninspected for more than 15 years.

The majority disagrees that the burden could be eased by hiring more physicians:

The dissent takes issue with this general, intuitive point by arguing that many places operate below capacity and that in any event, facilities could simply hire additional providers. We disagree that, according to common sense, medical facilities, well known for their wait times, operate below capacity as a general matter. And the fact that so many facilities were forced to close by the admitting privileges requirement means that hiring more physicians would not be quite as simple as the dissent suggests. Courts are free to base their findings on commonsense inferences drawn from the evidence. And that is what the District Court did here.

• In a brief concurrence, Justice Ginsburg says it “is beyond rational belief that H. B. 2 could genuinely protect the health of women.”

The Dissents

Justice Alito penned a 43-page dissent and was joined by Chief Justice Roberts and Justice  Thomas.

Justice Alito says the Texas law as a reasonable response to the Gosnell scandal:

If Pennsylvania had had such a requirement in force, the Gosnell facility may have been shut down before his crimes. And if there were any similarly unsafe facilities in Texas, H. B. 2 was clearly intended to put them out of business.

The dissenters dispute that the evidence shows the restrictions at issue led to the closure of abortion clinics:

At least nine Texas clinics may have ceased performing abortions (or reduced capacity) for one or more of the reasons having nothing to do with the provisions challenged here….Precise findings are important because the key issue here is not the number or percentage of clinics affected, but the effect of the closures on women seeking abortions….Petitioners—who, as plaintiffs, bore the burden of proof— cannot simply point to temporal correlation and call it causation.

Likewise, Justice Alito writes, the evidence that demand exceeds capacity is thin:

Petitioners offered scant evidence on the capacity of the clinics that are able to comply with the admitting privileges and ASC requirements, or on those clinics’ geographic distribution. Reviewing the evidence in the record, it is far from clear that there has been a material impact on access to abortion.

 The high court should have taken steps to “separate any bad provisions from the good,” rather than striking the provisions wholesale, Justice Alito writes:

By forgoing severability, the Court strikes down numerous provisions that could not plausibly impose an undue burden. For example, surgical center patients must “be treated with respect, consideration, and dignity.” That’s now enjoined. Patients may not be given misleading “advertising regarding the competence and/or capabilities of the organization.” Enjoined. Centers must maintain fire alarm and emergency communications systems, and eliminate “[h]azards that might lead to slipping, falling, electrical shock, burns, poisoning, or other trauma.”  Enjoined and enjoined.

 Justice Alito concludes that majority’s refusal to parse the law reflects its partiality:

When we decide cases on particularly controversial issues, we should take special care to apply settled procedural rules in a neutral manner. The Court has not done that here.

• Justice Thomas authored a 16-page dissent of his own. Invoking the late Justice Antonin Scalia, he accuses the majority of “bending the rules,” quoting from a Scalia dissent in the 2000 case Stenberg v. Carhart:

Today the Court strikes down two state statutory provisions in all of their applications, at the behest of abortion clinics and doctors. That decision exemplifies the Court’s troubling tendency “to bend the rules when any effort to limit abortion, or even to speak in opposition to abortion, is at issue.”

Monday June, 27th 2016

Source: Gershman/Palazzolo, Wall St Journal

To learn more about the abortion law in Texas: http://www.kvia.com/news/texas-abortion-providers-ask-scotus-to-review-restrictions/35084042

 

Merrick Garland, the new Supreme Court justice nominated by President Obama

Merrick Garland is a judge on the U.S. Court of Appeals. He supervised the prosecution of the Oklahoma City bombing and Unibomber case.

Merrick Garland was born on November 13, 1952 in Chicago, Illinois. He graduated from Harvard Law and became Special Assistant U.S. Attorney General for the U.S. Department of Justice. In private practice he supervised the prosecution of the Oklahoma City bombing and Unibomber cases. Garland currently serves on the U.S. Court of Appeals for the District of Columbia Circuit.

Profile

Born Merrick Brian Garland on November 13, 1952, in Chicago, Illinois, to parents Cyril and Shirley Garland. His father founded Garland Advertising in the city, while his mother became director of volunteer services at the Council for Jewish Elderly. Garland grew up in the upper middle-class suburb of Lincolnwood, Illinois, where he attended Niles West High School. Garland excelled academically, becoming a member of the Presidential Scholars Program and a National Merit Scholar before his graduation in 1970.

Garland attended Harvard College after high school, quickly rising to the top of his class and becoming an editor for The Harvard Law Review. In 1974 he was named valedictorian of his graduating class, and earned a bachelor’s degree in Social Studies. He then set his sights on law school, graduating with a Juris Doctor from Harvard Law in 1977.

Following his matriculation, Garland clerked for Judge Henry Friendly of the United States Court of Appeals for the Second Circuit and U.S. Supreme Court Justice William J. Brennan, Jr. In 1979, Garland was tapped for a position as Special Assistant U.S. Attorney General for the U.S. Department of Justice. He served in this capacity until 1981, then entered private practice at Arnold & Porter in Washington, D.C., where his responsibilities included the supervising the prosecution of the Oklahoma City bombing and UNABOM cases. For his efforts, he was named as a partner to the firm in 1985.

Garland left the private sector in 1989 to serve as an Assistant U.S. Attorney for the District of Columbia. After a brief return to Arnold & Porter in 1992, Garland was named as Deputy Assistant Attorney General in the Criminal Division of the U.S. Department of Justice. He was promoted to Principal Associate Deputy Attorney General, and served in this capacity until his appointment as U.S. Circuit Judge during the Clinton administration in 1997.

Garland continues to serve on the U.S. Court of Appeals, but he has recently come to national attention as a possible candidate for the U.S. Supreme Court vacancy that will be left by Justice John Paul Stevens in 2010.

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