Another conservative judge ruled today that the Affordable Care Act is unconstitutional. All of it. The mandate. The exchanges. The expansion of Medicaid. The protections for people with pre-existing conditions. The whole shebang. The judge’s order doesn’t explicitly stay the law, which means that implementation will will continue as this case and others like it wind their way up to Justice Kenn–er, the Supreme Court. As Politico points out, several states that are parties to the litigation against the ACA are busy implementing the law and requesting federal grants to assist their implementation efforts. As I’ve said before, these implementation efforts are likely to be near completion in most states by the time the high court decides on the merits of the challenges against the law. I have a hard time imagining the Court nullifying the law and leaving the policy landscape in chaos, but smarter people than me have tried to second-guess the Court and made to look like fools.

A group of Minnesota health plans and hospitals has unveiled a proposal to trim Medicaid costs through service cuts and tax hikes. They recommend scaling back certain optional services that Minnesota currently offers under its Medicaid program, such as dental care. Waivered services for the elderly and people with disabilities would also be reduced (waivers pay for things like home modifications and attendant care). The proposal suggests that people with disabilities should be moved into managed care as a further cost-saving measure. “Sin taxes” on alcohol and tobacco would generate additional revenue.
The health plans already serve tens of thousands of Medicaid enrollees, so their ideas will carry substantial weight at the Legislature. But there are a lot of bitter pills in this proposal. Republicans are bound to reject anything resembling a tax increase and disability advocates will vehemently oppose any effort to move people with disabilities into managed care. Already, health plans are being accused of plotting ways to add more publicly funded customers to their rolls. I don’t like most of the ideas contained in the proposal, but the document does serve an important function. It articulates the severity of the cuts that will be necessary to reduce health care spending, even with some additional revenue tools. Perhaps it will prompt our elected leaders to start a frank and specific debate on our health care priorities.

I’m preparing to watch the State of the Union speech, although I probably won’t remember most of it a month from now. These speeches rarely change the national political narrative and most of the policy proposals set forth tonight will never amount to anything. It’s mostly spectacle and ritual and not nearly as interesting as any given day in the British Parliament. Nobody will interrupt Obama to ask a question and Democrats won’t jeer the House Republican majority. It will all be very stiff and civil and ultimately forgettable. But I’ll still watch; I’m curious to see whether Michelle Bachmann and Keith Ellison will sit next to each while exchanging awkward glances throughout the whole speech.

The Man is always trying to keep us gimps down. Case in point: a British man can’t use his all-terrain wheelchair on public roads because government officials have classified it as a tank. Little do they know that they will be seeing many more of these “tanks” once the revolution is in full swing. One can only imagine what those dull bureaucrats will think of the giant robots we’re currently constructing at an undisclosed location in the British countryside. They are most certainly not street legal. Admittedly, we should have been more discrete about showing off our military hardware, but we didn’t think anyone would actually figure out their true purpose.

I must speak to my minions. It may be time to accelerate our plans.

While I was working on matters related to health care reform, House Republicans made good on their campaign promise to repeal the Affordable Care Act. As expected, Republicans didn’t offer any alternative bill to replace the current law and made only vague assurances that they would study the issue further in committee. I’d be stunned if the House even bothers to pass any sort of substantive health care bill in the next couple years. As I’ve said many times before, most conservatives have no interest in addressing issues related to health care access (other than to tinker around the edges of the problem by offering false solutions such as letting people buy insurance across state lines).

Today’s vote is little more than an exercise in symbolism as the repeal bill won’t get past the Senate, much less the President. The real battle will come over the regulations and funding related to the ACA’s implementation. It will require both sides to pore over spreadsheets and pages of the Federal Register, activities which are far less sexy than mugging for the cameras on the House floor. Republicans are going to have to become nerds if they hope to slow or stop implementation of the law. And that doesn’t seem consistent with the dumbed-down philosophy of governance they so regularly espouse.