The IRS is launching a new initiative to inform millions of people who didn’t have health insurance in 2015 about the affordable coverage options they may have for 2017. While the IRS’s efforts have come under fire from some in Congress, federal law clearly requires it to share this information.
Social Security faces a significant — though manageable — long-term funding shortfall, which policymakers should address primarily by increasing Social Security’s tax revenues.
The following is a guest post by Clare Feikert-Ahalt, foreign law specialist for the United Kingdom and a number of Commonwealth jurisdictions at the Law Library of Congress. Clare has previously written many interesting posts, most recently: FALQs: Brexit Referendum and The Case of a Ghost Haunted England for Over Two Hundred Years.
Frequently, the four countries that form the United Kingdom of Great Britain and Northern Ireland – England, Wales, Scotland, and Northern Ireland – do not get recognized as being separate countries, each with their own distinct legal history. Wales is often grouped together with England, when in fact it has a rich and diverse legal history of its own. It has also started to have a steady increase in legislative powers for areas that have been devolved to it as a result of the Government of Wales Act.
Recently, the Law Library of Congress was fortunate to receive a donation of thirteen bound volumes of Welsh Legal History, prepared by the Welsh Legal History Society. These volumes are a valuable contribution to the Law Library’s collection of Welsh legal materials and cover, in detail, a history of the law in Wales. The volumes were presented to the Law Library during a lecture given by Professor Thomas Glynn Watkin.
Professor Watkin provided a fascinating lecture titled Devolution and the Law in Modern Wales. This proved to be both a very relevant and topical discussion of both historical events and the development of modern events in light of the impending exit of the UK from the European Union. Interestingly, particularly in light of the recent EU referendum vote, Professor Watkin noted that the United Kingdom has evolved, either adding or removing a country, approximately once every hundred years.
It is not possible to do justice to Professor Watkin’s fascinating lecture in such a short space or time, so this post will provide only a very brief overview of some of the points raised. Professor Watkin managed to concisely detail the legal history of Wales up to modern times. He noted that the Statute of Wales 1284 provided Wales with its own courts, and thus a distinct legal identity, and that Welsh law was completely replaced with the introduction of English law across Wales in 1535/36. Welsh legislation and English legislation were identical until the Sunday Closing Act was introduced in 1881, which applied only to Wales. This was followed by the Welsh Church Act 1914. These pieces of legislation were the first that saw a movement towards providing a greater voice to the Welsh people. Fifty years later, 1964 saw the creation of the Office of Secretary of State for Wales by Harold Wilson.
Providing Wales with its own legislative assembly was no straightforward matter and in the first referendum, held in 1979, to determine whether Wales should have this legislative body, the vote was overwhelmingly against it. In the second referendum, held in 1997, the vote was closer than the Brexit referendum, with 50.3% of voters in favor of creating a legislative assembly and 49.7% against. The Welsh Assembly was subsequently created by the Government of Wales Act 1999. The areas of competence of the Welsh Assembly were significantly less than the Scottish Parliament, which was created at the same time. Over time, additional areas of legislative competence have been provided to the Welsh Assembly.
The draft Wales Bill, currently before Parliament, is expected to add more areas, although it is not as extensive as many were hoping. Professor Watkin noted that given the timing of the bill during the aftermath of the Brexit referendum, a great deal of uncertainty exists and many believe that the draft bill should be considered after the dust has settled and concrete plans are in place and underway for the UK exit from the European Union. Instead, he said, the bill looks likely to be pushed through and receive Royal Assent shortly.
In five states this fall — California, Arizona, Nevada, Maine and Massachusetts — voters will be deciding whether marijuana should be legal for recreational use. And any of those states that do legalize marijuana will have to wrestle with the question of how to enforce laws against stoned drivers.
It has been legal to smoke pot for fun in Colorado since January 2014, and the state modeled its marijuana driving-under-the-influence law on the one for alcohol. If a blood test shows a certain level of THC, the mind-altering compound in marijuana, the law says you shouldn’t be driving.
It sounds straightforward, but consider the case of Abby McLean, a stay-at-home-mom from the Denver suburbs.
McLean, 30, was driving home from a late dinner with a friend two years ago when she came upon a DUI roadside checkpoint.
“I hadn’t drank or smoked anything, so I was like, ‘Let’s go through the checkpoint,'” she recalled.
McLean is a regular marijuana user but she insists she never drives while high.This story is part of a partnership that includes Colorado Public Radio, KPCC, NPR and Kaiser Health News. It can be republished for free. (details)
Still, the officer at the checkpoint told her he smelled marijuana and that her eyes were bloodshot. Eventually he whipped out handcuffs, and McLean said she started to panic: “Like, massive panic attack. And, ‘Oh, my God, I have babies at home. I need to get home. I can’t go to jail!’ ”
She didn’t go to jail that night, but she got home hours late. A blood test later revealed McLean had five times the legal limit of THC allowed in Colorado, which is five nanograms of THC per milliliter of blood.
It may sound like an open and shut case that could have resulted in any number of penalties. But McLean’s attorney, Nadav Aschner, had a field day in court with Colorado’s marijuana intoxication limit.
“Even the state’s experts will say that number alone is something, but generally not enough, and we really hammered that home,” he said. Aschner got a hung jury and McLean pleaded to a lesser offense.
Still, McLean’s trip through the criminal justice system is emblematic of numbers that suggest a sharp increase in marijuana DUI arrests in Colorado. So far this year, State Patrol data show that total DUI citations this year rose to 398 through early July, compared with 316 in for the same period 2015.
It turns out, measuring a person’s THC is actually a poor indicator of intoxication. Unlike alcohol, THC gets stored in your fat cells, and isn’t water-soluble like alcohol, said Thomas Marcotte, co-director of the Center for Medicinal Cannabis Research at the University of California, San Diego.
“Unlike alcohol, which has a generally linear relationship between the amount of alcohol you consume, your breath alcohol content and driving performance, the THC route of metabolism is very different,” Marcotte said.
That’s why adapting drunk driving laws to marijuana makes for bad policy, said Mark Kleiman, a professor of public policy at New York University. “You can be positive for THC a week after the last time you used cannabis,” he said. “Not subjectively impaired at all, not impaired at all by any objective measure, but still positive.”
Still, Colorado and five other states have such laws on the books because pretty much everyone agrees that driving stoned can be dangerous, especially when combined with alcohol.
What police say they really need is a simple roadside sobriety test. Scientists at UCSD are among researchers working on several apps that could measure how impaired a driver is. One has a person follow a square moving around a tablet screen with a finger, which measures something called “critical tracking.” Another app measures time distortion, because things can slow way down when a person is high.
The THC route of metabolism is very different.Thomas Marcotte
Those tests are still experimental.
Denver District Attorney Mitch Morrissey said the uncertainty doesn’t mean Colorado should throw out its THC blood test. He said it may not be perfect, but it gives juries another piece of evidence to consider at trial.
“I think that putting in a nanogram level makes sense,” said Morrissey. “I can’t tell you what level it should be. I don’t think Colorado’s is right. I don’t think it should be as high as it is. I think it should be lower.”
Morrissey remembers trying alcohol DUI cases as a young prosecutor. The science wasn’t settled then either, the blood alcohol standard was about twice as high as it is now, and it took years for it to be lowered.
“I think that has to do with better testing better technology,” which Morrissey said will improve eventually for marijuana too.
In the meantime, some regular marijuana users, like Abby McLean, are scared to drive for fear of failed blood tests.
“I haven’t gone out really since then, because I’m paranoid to run into the same surprise, ‘Oh oh, there’s a DUI checkpoint.'”
The list of preventive services that women can receive without paying anything out of pocket under the health law could grow if proposed recommendations by a group of mostly medical providers are adopted by federal officials later this year.
The draft recommendations, which are open for public comment until Sept. 30, update the eight recommended preventive services for women. That list was developed by the Institute of Medicine — now called the National Academies of Sciences, Engineering, and Medicine — to build on existing recommendations and fill in gaps that weren’t addressed in the health law. Under the IOM list, which took effect in 2012, most health plans are required to cover well-woman visits, screening and/or counseling for sexually transmitted infections, domestic violence and gestational diabetes as well as breastfeeding support and supplies.
In addition, most health plans must cover, without cost sharing, all methods of contraception that have been approved by the Food and Drug Administration. That controversial requirement led to numerous lawsuits by religious institutions and employers that object to providing such coverage, including several cases that reached the Supreme Court.Insuring Your Health
KHN contributing columnist Michelle Andrews writes the series Insuring Your Health, which explores health care coverage and costs.
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When it developed the initial list, the IOM advised that the guidelines be reviewed and updated at least every five years in order to stay current with scientific evidence. This year, the review panel also weighed in on breast cancer screening, coverage of follow-up testing or procedures as part of the preventive services and male methods of birth control.
The proposed new recommendation would allow women at average risk for breast cancer to begin screening as early as age 40 and receive a mammogram every one or two years. That is a more liberal standard than the guidelines that insurers rely on for free screening from the U.S. Preventive Services Task Force, which recommends women generally be screened every other year starting at age 50.
“We have really confused the heck out of women,” said Dr. Hal Lawrence, executive vice president and chief executive officer of the American Congress of Obstetricians and Gynecologists. “Do I start at age 40, do I start at 50, do I do it every year or do I do it every other year? We wanted to get some uniformity.”
ACOG was awarded a 5-year grant to manage the review process, working in conjunction with a steering committee of nearly two dozen provider groups from different women’s health disciplines.
In addition to the breast cancer screening itself, the ACOG working group proposes that if imaging tests, biopsies or other interventions are required to evaluate the mammogram findings that those be considered an integral part of the screening, which would mean they would be provided without charge to women.
Such follow-up care emerged as a theme from the panel: If additional testing or procedures are necessary following a preventive service, it should be covered as part of the service. The recommendations also clarify that some of the preventive services may require more than one visit and provide other specifics on coverage requirements.
“It’s critically important for plans and people to recognize that the well-woman visit [required under the current guidelines] could happen in multiple places and require multiple visits,” said Mara Gandal-Powers, senior counsel at the National Women’s Law Center, which participated in the ACOG working group. “If you’re a woman who needs a Pap test and a colonoscopy, you’re probably not getting them from the same providers and you’re hopefully not getting them at the same time.”
The recommendations’ specificity is important: The original IOM guidelines left implementation details vague, leading to scuffles between patient advocates and insurers over precisely what was covered, and that ambiguity required ongoing guidance from the federal government. For example, if a plan covers oral contraceptives without cost sharing, could it charge for other hormonal methods such as the contraceptive patch? Answer: No.
“It’s helpful to get the real-world piece,” said Dania Palanker, assistant research professor at Georgetown University’s Center on Health Insurance Reforms. “For insurers, what do we mean when we say you have to cover a service?”
A spokesperson for America’s Health Insurance Plans said that the trade group will likely submit comments on the proposed recommendations and declined to comment before then.
The working group recommended expanding the scope of what’s covered without cost sharing in some important ways. The contraceptive coverage requirement, for example, would cover over-the-counter methods of birth control without a prescription and allow women to receive a full-year supply of contraceptives all at once, which has been shown to improve adherence.
The ACOG group also proposes covering contraception methods used by men, including condoms and vasectomy.
“The best contraceptive method for a woman at a particular time may be her partner,” said Adam Sonfield, a senior policy manager at the Guttmacher Institute, a reproductive health research and policy organization.
The working group will submit its final recommendations to the Health Resources and Services Administration, part of the Department of Health and Human Services, by Dec. 1, and HRSA will make the final decision on adoption of the recommendations. If adopted before the end of the year, they would go into effect for most plans at the beginning of 2018.
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As a congressional task force studies proposals to boost economic growth in Puerto Rico, tax relief for low-income working families — delivered through an Earned Income Tax Credit — should be a key component of such a package.
Young people with disabilities are likelier to be “food insecure,” or have trouble affording adequate food, than other young people, two recent studies show. These studies echo earlier findings that working-age adults with disabilities also are likelier to be food insecure. Having a family member with a disability can both raise costs and lower earnings, making it harder to meet basic needs such as food.