RICHMOND, Va. - The U.S. House of Representatives voted on Wednesday to repeal the health care reform law, 244 to 185. Not just politicians are divided - some polls indicate many voters are still uncertain about the law, especially when it comes to the individual mandate.

Edwin Park, an expert on health policy with the Center on Budget & Policy Priorities, says the individual mandate is an important step in terms of reining in health care costs - primarily because it will make the health insurance pool bigger, with a balance of sick and healthy people.

"Right now, people who are uninsured, if they get sick, end up going to a hospital or an emergency room. Everyone's currently paying for that uncompensated care, through higher premiums."

Park says people will not be required to purchase one particular type of insurance. The mandate can be met in a variety of ways, such as through Medicare, Medicaid or new health insurance exchanges or private insurance. According to the Congressional Budget Office (CBO), only about 1 percent of the population will pay a penalty for not purchasing some sort of coverage, because nearly everyone will be covered under the Affordable Care Act.

Ray Scher, a retired nurse with Anthem in Virginia, says once the Affordable Care Act is fully implemented, the next focus can be to phase out the current "Fee for Service" structure, which means doctors are paid by insurance companies for numbers of visits and for ordering tests. He calls this system wasteful and describes a new pilot plan.

"Under this new plan, providers - a hospital chain or a doctor's practice - will receive a basic amount of money through the patient's insurance. Then they have to provide all the coverage that patient needs for the year when they receive that sum. There won't be this incentive to test, test, test...see people, see people, see people."

Scher says prevention is one of the biggest components of keeping health care costs down. According to the U.S. Department of Health & Human Services, more than 470,000 people in Virginia received at least one preventive care service during the first half of 2012 at no cost to themselves, thanks to the health care law.





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A coalition of Wisconsin groups is asking Gov. Tony Evers to reject bills it contends would make it harder for people struggling to get by to bounce back with the help of certain public assistance programs.

More than two dozen organizations from around the state want the governor to veto a bill requiring BadgerCare recipients to renew their health coverage twice as often. They also want to see him veto a measure limiting unemployment benefits.

William Parke-Sutherland, senior health policy analyst for the group Kids Forward, argued the plans unfairly target people who need some type of public assistance. He added seven of 10 Medicaid recipients are already employed.

"And so, if state policymakers want to support workers, they need to address the real factors that make it difficult and sometimes impossible for workers to take more hours, and to get and keep better jobs," Parke-Sutherland urged.

For example, he noted expanding child care access would be a big help. Business groups supporting some of the bills said they would be more effective in addressing worker shortages. And GOP legislators point to a nonbinding referendum from the April election showing Wisconsin voters agree with the idea of work requirements for certain public benefits.

But skeptics like Parke-Sutherland pointed out there are already checks and balances built into many public assistance programs. He feels it is an attempt to avoid empowering low-income workers who are not getting the necessary benefits from their employers.

"They don't want to pay their workers fair wages, and offer lifesaving benefits like health insurance," Parke-Sutherland contended.

He added most people enrolled in Wisconsin's public assistance programs are white, but restrictions disproportionately affect people of color. In the last legislative session, similar bills were advanced by the Republican-led Legislature and were subsequently vetoed by Evers.


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Groups working to fight poverty in Alabama are urging state senators to approve a bill aimed at lowering food costs for families.

House Bill 479 proposes a gradual reduction in the state sales-and-use tax on grocery items from 4% to 2%, starting Sept. 1.

Carol Gundlach, senior policy analyst for the group Alabama Arise, emphasized the way Alabama taxes food products puts a disproportionate burden on lower- and middle-income working families.

She pointed out recent months of high inflation have made it an even more urgent issue.

"We estimate that people, just on the state sales tax alone, could buy an extra two weeks' worth of groceries if they were not paying the state sales tax for the groceries they do buy.," Gundlach reported.

Alabama, Mississippi and South Dakota are the only states still charging their full state sales tax rate on groceries, according to the Center on Budget and Policy Priorities.

Rep. Danny Garrett, R-Trussville, sponsored the bill, which has passed in the House and awaits a Senate vote.

Gundlach stressed although the measure would not entirely eliminate taxes on groceries, lowering them would be a positive step.

She acknowledged the challenge of completely eliminating taxes on food, since they're currently used to cover state education expenses. However, Gundlach's group thinks the bill presents an opportunity for Alabama lawmakers to responsibly reduce food taxes and explore alternative options for funding schools.

"So, we would like to either get rid of or reduce the federal income-tax deduction in such a way that if anybody gets that tax break, it's going to be the people who are kind-of middle income and need it the most," Gundlach explained.

Alabama is the only state allowing a full deduction for federal income taxes, which reduces taxes for the state's wealthiest population. Gundlach suggested eliminating the deduction could raise millions of dollars for public schools and replace the revenue from the current food tax, without imposing any additional tax burden on low- or middle-income residents.

Rural Nebraska could lose on two fronts if two of Gov. Jim Pillen's budget vetoes are allowed to stand.

Pillen struck down a second year of increases in Medicaid reimbursement rates and millions of dollars for Rural Workforce Housing.

Dr. Jed Hansen, executive director of the Nebraska Rural Health Association, called the veto a "gut punch." He said all of Nebraska's hospitals and nursing homes will feel the effects, but especially those in rural communities, where more than 60% of hospitals operated at a deficit last year.

"So, the narrative the governor had used -- that hospitals were 'better off financially coming out of the pandemic' -- just wasn't true," Hansen asserted. "And especially wasn't true for our rural hospitals."

The Legislature had approved $20 million for rural housing development over the next two years, which the governor also nixed.

Johnathan Hladik, policy director for the Center for Rural Affairs, said a lack of housing is the "number one workforce issue" in the state, noting it is a major reason jobs remain unfilled in Nebraska's smaller towns. He pointed out the higher cost of building in rural areas makes it unlikely developers would start such projects on their own.

"We're talking about standard houses for the workforce to relocate to a community," Hladik explained. "To become employed, contributing members of that community."

With his veto, the governor cited the investments the state has made in affordable housing over the last few years, but Hladik countered it came after years of no support for housing. He maintained the state is still "playing catch-up," with the housing problem far from solved.

Hladik added the program would fund grants to nonprofit development corporations to partially cover the costs of building moderately-priced, owner-occupied houses and rental housing units.

"When you talk about how we populate our rural areas, how we attract people to rural areas, how we fill the open jobs that are in rural areas, this is a narrowly targeted program that has the ability to do that," Hladik contended. "I think it's important that it has our support."

Hansen stressed it is also important to raise the Medicaid reimbursement rate, noting maternal care and behavioral health tend to be heavily Medicaid-dependent, so the services are at particular risk in Nebraska's rural hospitals.

"We feel that those have been areas -- mental health, maternal care, family care -- that have been important to him," Hansen pointed out. "He's expressed that those are values that are important to him. And this veto, we just feel, doesn't line up with that."

A decision about overriding both vetoes is expected on Wednesday.