Tag Archives: March Madness

It’s March Madness!

Yep, that’s a shameless bid to appear higher on Google search results, but it’s also a pretty good metaphor for what’s happening in Washington in advance of the Supreme Court oral arguments on the Affordable Care Act–due to be heard March 26, 27 and 28.  Although speculation about how the Justices may rule has been going on for months, the gambling has reached a fever pitch.

ALICIA AULT/IMNG Medical Media

Next week is to Court Watchers as the Final Four is to legions of NCAA Division 1 basketball fans: The brackets have been completed; it’s just a question now of who will come out on top.

Conventional wisdom has the Supreme Court splitting along perceived “party lines” in a 5-4 vote either in favor of upholding the law, or against it.

But with the Justices taking on three separate, major issues within the law, Washington wonks, soothsayers, and legal eagles have gone into a frenzy of handicapping. Not a day goes by without a backgrounder or briefing that professes to have the best read on the tea leaves.

The Court, as is its wont, has shied from the limelight. Until today, it had not even determined how it would accommodate the legions of journalists (myself included) who will descend upon the courtroom to cover the historic arguments. Details are still being worked out, but one thing was not going to change: the Court has steadfastly refused to allow audio or video broadcasts of the proceedings. (Which means there cannot be any contests requiring a shot every time the challengers’ attorney, Paul Clement, utters “individual mandate.”) The Court is even banning–heaven forbid–cellphones. That means no pithy Tweets on Justice Clarence Thomas’ enduring silence.

This morning–at a briefing sponsored by Politico–came new predictions from an estimable panel of D.C. insiders: former U.S. Solicitor General Walter DellingerNeal Katyal, Al Gore’s co-counsel at the Court in Bush v. Gore,  Tom Goldstein, a former Court clerk and publisher of Scotusblog, Kevin Walsh, a former clerk to Justice Antonin Scalia, and Nina Totenberg, the veteran Court correspondent for NPR.

Dellinger, Goldstein and Katyal. ALICIA AULT/IMNG Medical Media

The Justices to watch, said Ms. Totenberg: Anthony Kennedy and Chief Justice John Roberts. They are both widely considered swing votes. Some have also have put Justice Scalia in that camp, “which I personally think is a crock,” Ms. Totenberg said. Mr. Katyal said that Samuel Alito could also be “in play.”

Will politics come into play? Justices “have a grasp of politics that defies imagination in terms of its inaccuracy,” said Ms. Totenberg, who, like the others discounted the idea that the Justices would be influenced–or motivated–to vote in one direction or another based on the prevailing political winds.

The panel was unanimous–except for Ms. Totenberg, who recused herself from making a wager–in its opinion that the Court would uphold the law, most likely in its entirety.

Mr.  Goldstein said he could not effectively imagine a victory by the law’s challengers. If the Justices threw out the Act, it “would lead to probably an array of attacks on different parts of the federal regulatory state because for the first time you would have had five justices that take very seriously limits on congressional power,” he said.

By the end of next week, the Court will likely hold one closed-door conference and a series of votes, said Mr. Walsh.

He and the other panelists went out on a limb, saying that the 5-4 prediction may no longer hold.  Mr. Goldstein said it could even be a 6-3 or 7-2 ruling upholding the law.

So who will write the opinion, expected to be issued in June? Mr. Dellinger predicted that it would be Justice Roberts. Mr. Goldstein, however, said this might be the rare case where the Court issues a per curiam opinionthat is, written in the name of the Court, rather than by any of the Justices. Interestingly, Bush v. Gore was a per curiam decision.

What is your opinion?

Alicia Ault

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Filed under Health Policy, health reform, IMNG, Polls, Practice Trends

March Madness on Match Day: The Policy & Practice Podcast

Medical school seniors participated in the annual ritual known as Match Day last week.  After gambling on various picks of where they’d like to spend their residencies, students around the country simultaneously find out which school has chosen them.  This year, 11% more U.S. medical school seniors chose residencies in family medicine, and 8% more chose internal medicine.  (See our news coverage here.) This may be an indications that seniors envision a brighter future in those specialties as a result of the emphasis given to primary care in health reform.

Via Flickr Creative Commons user ConvenienceStoreGourmet

But they may still face the same nagging payment issue that their forbearers have: Medicare’s Sustainable Growth Rate formula, which has called for huge cuts in pay, year-in, year-out.  The Medicare Payment Advisory Commission (MedPAC) presented its annual March report to Congress last week.  Testifying before the Ways & Means Health Subcommittee, chairman Glenn Hackbarth warned that Congress was running out of options to fix the SGR.

Finally, over in the Senate, Republicans grilled HHS Secretary Kathleen Sebelius about why the Administration had not responded to various congressional requests for information on the sausage-making process that led to the Affordable Care Act.  The GOP has said it was shut out and now it wants to know what went on behind the alleged closed doors at the White House and HHS.

To hear more about these stories, take a listen to this week’s podcast:

—Alicia Ault (on Twitter @aliciaault)

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Filed under Family Medicine, Health Policy, health reform, IMNG, Internal Medicine, Podcast, Practice Trends, Primary care