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 bipartisan group of lawmakers in Congress is joining advocates for energy assistance across the country to warn a dangerous situation is brewing for low-income households.

Federal staffing cuts have stalled the distribution of key funding. The Trump administration's layoffs of 10,000 Health and Human Services workers include the entire office overseeing the Low Income Energy Assistance Program, which gives eligible households a break on their monthly bills to avoid utility shutoffs.

Mark Wolfe, executive director of the National Energy Assistance Directors Association, which works with states on the issue, said the layoffs have blocked the latest round of aid from getting to them.

"Many states have told us that they've either run out of money or they're very close to it," Wolfe reported. "They need these additional funds to help families pay off the remaining winter heating bills or get ready for summer cooling programs, or both."

Minnesota is among the states to report an imminent "zero balance" if action is not taken soon. It has been more than two weeks since the layoffs were announced and Wolfe noted there is no word on funding status. Congress had authorized $378 million to round out the current cycle.

Thirteen U.S. senators have signed a letter asking the administration to get LIHEAP staff back in place and the money moving again.

Wolfe stressed keeping energy bills current is about more than staying cool when the temperature spikes. He noted utility shutoffs can produce dire consequences for some households.

"The loss of access to refrigeration, for example, you can't keep your food safe, or some medications need to be refrigerated," Wolfe outlined.

There was added pressure this past winter on some state programs where there were much colder temperatures. Each year, LIHEAP helps more than 6 million low-income households and seniors on fixed incomes across the country cover their energy bills.


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According to state data, as Medicaid and the Supplemental Nutrition Assistance Program, or SNAP, face cuts, Michigan's most vulnerable stand to lose the most.

In the Great Lakes state, more than 2 million people count on Medicaid, and more than 1 million of them are kids. When it comes to putting food on the table, more than 1 million Michiganders rely on SNAP benefits, including one in four children.

Amber Bellazaire, senior policy analyst with the Michigan League for Public Policy, emphasized the ripple effects of these proposed cuts could create widespread challenges, even for those not directly enrolled in Medicaid or SNAP.

"If a rural hospital closes because they're operating on razor-thin margins and have lost a significant amount of their funding, because of Medicaid cuts, that hospital closes not just for Medicaid enrollees but for all folks in that community," she explained.

Supporters of the cuts contend that these programs place a heavy burden on the federal budget, discourage work and self-reliance, and are susceptible to fraud and abuse.

MLPP reports that Medicaid is relied on across all Michigan counties and congressional districts, especially in rural and northern areas. The state also ranks high for SNAP participation among veterans, with 41,000 enrolled.

Bellazaire noted that the proposed cuts won't make health care more efficient or affordable - and if she had a seat at the table where budget decisions are made, she'd offer a more balanced perspective.

"I think that there is opportunity to discuss the balance between fiscal responsibility and protecting and improving upon the successes that we've seen come from the Medicaid program and Medicaid expansion," she continued.

Those in favor of the cuts maintain that private markets and local solutions are more effective than government run programs - and states should have more control over program management, rather than relying on the federal government.

Maryland state lawmakers ended this year's session addressing a major budget shortfall and countless other issues in the state. But their work might not be over for the year.

Through a combination of tax hikes and spending cuts, lawmakers passed a balanced budget, despite a $3.3 billion budget deficit. Maryland taxpayers who make more than $500,000 a year will pay more in taxes, along with higher taxes on sports betting and marijuana sales.

Brenda Wintrode, state politics reporter with the Baltimore Banner, said lawmakers had to tackle multiple pressing issues for the state.

"The budget took the oxygen out of the session," she said. "It took up all the space. They had an energy crisis to resolve, which they did pass a sweeping energy package to try to make some room for more energy production in the state."

The legislature passed a major energy initiative meant to ramp up energy production through nuclear, natural gas, solar power and battery storage, along with a small rebate for electric bills. Lawmakers also made more than $2 billion in spending cuts.

Republicans in the state, however, objected to tax hikes to balance the budget. But despite the end of the regular session, Wintrode says there might be more work to do this year. All eyes are on Washington as President Donald Trump's cuts to the federal workforce and spending could impact the state.

"They have a balanced budget that is going to meet where we are as a state in this moment to get us through the end of the federal government's fiscal year. They are not ruling out having a special session, possibly coming back in October after the federal government looks at what it's going to be doing," she continued.

A report by Moody's Ratings finds Maryland faces the greatest risks of any state from federal spending cuts.


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