HHS Awards $53 Million to Help Address Opioid Epidemic

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Yesterday, the U.S. Department of Health and Human Services announced $53 million in funding to 44 States, four tribes and the District of Columbia to improve access to treatment for opioid use disorders, reduce opioid related deaths, and strengthen drug misuse prevention efforts. In addition, funding will also support improved data collection and analysis around opioid misuse and overdose as well as better tracking of fatal and nonfatal opioid-involved overdoses.

“The epidemic of opioid use disorders involving the non-medical use of prescription opioid pain relievers and the use of heroin has had a devastating impact on individuals, families and communities across our nation,” said Substance Abuse and Mental Health Services Administration (SAMHSA) Principal Deputy Administrator Kana Enomoto. “These grants will help address the key elements of the opioid crisis by promoting effective prevention efforts, preventing overdose deaths and helping ensure that people with opioid use disorders are able to receive vital treatment and recovery support services.”

Administered by SAMHSA and the Centers for Disease Control and Prevention (CDC), the funding supports six programs.

The Medication-Assisted Treatment Prescription Drug Opioid Addiction Grants will provide up to $11 million to 11 states to expand access to medication-assisted treatment (MAT) services for persons with opioid use disorder. This program targets states identified as having the highest rates of primary treatment admissions for heroin and prescription opioids per capita, and prioritizes those states with the most dramatic recent increases for heroin and opioids. Awardees are Alaska, Arizona, Colorado, Connecticut, Illinois, Louisiana, New Hampshire, North Carolina, Oklahoma, Oregon, and Rhode Island. (SAMHSA)

The Prescription Drug Opioid Overdose Prevention Grants will provide up to $11 million to 12 states to reduce opioid overdose-related deaths. Funding will support training on prevention of opioid overdose-related deaths as well as the purchase and distribution of naloxone to first responders. Awardees are Alaska, Arkansas, Illinois, Missouri, New Jersey, New Mexico, Oklahoma, South Carolina, Washington, West Virginia, Wisconsin, and Wyoming. (SAMHSA)

The Strategic Prevention Framework Partnerships for Prescription Drugs Grants provide up to $9 million to 21 states and four tribes to strengthen drug misuse prevention efforts. The grant program provides an opportunity for states, U.S. territories, Pacific jurisdictions, and tribal entities that have completed a Strategic Prevention Framework State Incentive Grant to target the priority issue of prescription drug misuse. The program is designed to raise awareness about the dangers of sharing medications and work to address the risks of overprescribing. The program also seeks to raise community awareness and bring prescription drug misuse prevention activities and education to schools, communities, parents, prescribers, and their patients. Awardees are Alabama, Connecticut, Delaware, Georgia, Iowa, Louisiana, Maine, Maryland, Michigan, Minnesota, New Jersey, New Mexico, North Carolina, Ohio, Oklahoma, Pennsylvania, Tennessee, Texas, Utah, Vermont, Washington, West Virginia, and Wisconsin as well as Little Traverse Bay Bands of Odawa Indians, Cherokee Nation, Southern Plains Tribal Health Board, and the Nooksack Indian Tribe. (SAMHSA)

“States are on the frontline of preventing prescription opioid overdoses—“it is critical that state health departments have the support they need to combat the epidemic,” said CDC Director Tom Frieden, MD, MPH. “States can use these funds to develop, implement, and evaluate programs that save lives.”

The Prescription Drug Overdose: Prevention for States program provides up to $11.5 million in supplemental funding to 14 states. This supplemental funding will support the ongoing work of awardees, allowing awardees to address issues such as high overdose death rates in tribal communities and improve toxicology and drug screening. States can use this funding to enhance prescription drug monitoring programs (PDMPs), further prevention efforts, and execute and evaluate strategies to improve safe prescribing practices. Awardees are California, Colorado, Indiana, Kentucky, New Mexico, New York, Ohio, Oregon, Pennsylvania, Rhode Island, Tennessee, Utah, Washington, and Wisconsin. (CDC)

The Prescription Drug Overdose: Data-Driven Prevention Initiative (DDPI) will award $6 million to 13 states and DC to advance and evaluate state-level prevention activities to address opioid misuse and overdose.
That includes enhancing their ability to:

  • Improve data collection and analysis around opioid misuse and overdose;
  • Develop strategies that impact behaviors driving prescription opioid misuse and dependence; and
  • Work with communities to develop more comprehensive opioid overdose prevention programs.
  • Awardees are Alabama, Alaska, Arkansas, Georgia, Hawaii, Idaho, Kansas, Louisiana, Michigan, Minnesota, Montana, New Jersey, South Dakota, and Washington, D.C. (CDC)

The Enhanced State Surveillance of Opioid-Involved Morbidity and Mortality program is awarding $4.27 million in funds to 12 states to better track fatal and nonfatal opioid-involved overdoses.
States will use the funding to:

  • Increase the timeliness of reporting nonfatal and fatal opioid overdose and associated risk factors;
  • Disseminate surveillance findings to key stakeholders working to prevent opioid-involved overdoses; and
  • Share data with CDC to support improved multi-state surveillance of and response to opioid-involved overdoses.
  • Awardees are Kentucky, Maine, Massachusetts, Missouri, New Hampshire, New Mexico, Ohio, Oklahoma, Pennsylvania, Rhode Island, West Virginia, and Wisconsin. (CDC)

These awards contribute to a total of $52.5 million awarded by CDC for Prescription Drug Overdose and opioids activities in FY 2016.

The funding announced today is part of the U.S. Department of Health and Human Services’ Opioid Initiative, which was launched in March 2015 and is focused on improving opioid prescribing practices; expanding access to medication-assisted treatment (MAT) for opioid use disorder; and increasing the use of naloxone to reverse opioid overdoses. The initiative concentrates on evidence-based strategies that can have the most significant impact on the crisis. But additional funding is necessary to ensure that every American who wants to get treatment for opioid use disorder will have access. Under the President’s FY 2017 Budget proposal, states would be eligible for up to $920 million over two years to expand access to treatment. At this time, Congress has not funded the budget proposal. See here for a state by state breakdown of the President’s budget and, if fully funded, the impact it would have on states’ ability to further expand access to treatment.

More information about SAMHSA grants and the grantees is available at:http://www.samhsa.gov/grants/.

More information about CDC grants and the grantees is available at:
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HHS announces new actions to combat opioid epidemic

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U.S. Health and Human Services (HHS) Secretary Sylvia M. Burwell today announced several new actions the department is taking to combat the nation’s opioid epidemic.

The actions include expanding access to buprenorphine, a medication to treat opioid use disorder, a proposal to eliminate any potential financial incentive for doctors to prescribe opioids based on patient experience survey questions, and a requirement for Indian Health Service prescribers and pharmacists to check state Prescription Drug Monitoring Program (PDMP) databases before prescribing or dispensing opioids for pain. In addition, the department is launching more than a dozen new scientific studies on opioid misuse and pain treatment and soliciting feedback to improve and expand prescriber education and training programs.

“The opioid epidemic is one of the most pressing public health issues in the United States. More Americans now die from drug overdoses than car crashes, and these overdoses have hit families from every walk of life and across our entire nation,” said Secretary Burwell . “At HHS, we are helping to lead the nationwide effort to address the opioid epidemic by taking a targeted approach focused on prevention, treatment, and intervention. These actions build on this approach. However, if we truly want to turn the tide on this epidemic, Congress should approve the President’s $1.1 billion budget request for this work.”

The actions announced today build on the HHS Opioid Initiative, which was launched in March 2015 and is focused on three key priorities: 1) improving opioid prescribing practices; 2) expanding access to medication-assisted treatment (MAT) for opioid use disorder; and 3) increasing the use of naloxone to reverse opioid overdoses. They also build on the National Pain Strategy, the federal government’s first coordinated plan to reduce the burden of chronic pain in the U.S.

Actions that are part of today’s announcement include the:

Buprenorphine Final Rule

Expanding access to MAT is one of the three foundational priorities of the HHS Opioid Initiative, and buprenorphine is one of the drugs frequently used for MAT.  The rule finalized today by the Substance Abuse and Mental Health Services Administration (SAMHSA) allows practitioners who have had a waiver to prescribe buprenorphine for up to 100 patients for a year or more, to now obtain a waiver to treat up to 275 patients.  Practitioners are eligible to obtain the waiver if they have additional credentialing in addiction medicine or addiction psychiatry from a specialty medical board and/or professional society, or practice in a qualified setting as described in the rule.

HCAHPS Proposal

Many clinicians report feeling pressure to overprescribe opioids because scores on the HCAHPS survey pain management questions are tied to Medicare payments to hospitals.  But those payments currently have a very limited connection to the pain management questions on the HCAHPS survey.  In order to mitigate even the perception that there is financial pressure to overprescribe opioids, the Centers for Medicare and Medicaid Services (CMS) is proposing to remove the HCAHPS survey pain management questions from the hospital payment scoring calculation. This means that hospitals would continue to use the questions to survey patients about their in-patient pain management experience, but these questions would not affect the level of payment hospitals receive.

IHS PDMP Policy

While many Indian Health Service (IHS) clinicians already utilize PDMP databases, IHS will now require its opioid prescribers and pharmacists to check their state PDMP database prior to prescribing or dispensing any opioid for more than seven days.  The new policy is effective immediately for more than 1,200 IHS clinicians working in IHS federally operated facilities who are authorized to prescribe opioids.  Checking a PDMP database before prescribing an opioid helps to improve appropriate pain management care, identify patients who may have an opioid misuse problem, and prevent diversion of drugs. This policy builds on IHS efforts to reduce the health consequences associated with opioid use disorder. As a part of this work, IHS announced that it would train hundreds of Bureau of Indian Affairs law enforcement officers on how to use naloxone, and provide them with the life-saving, opioid overdose-reversing drug.

New Research Priorities

Research  on opioids conducted and funded by HHS helps the department better track and understand the epidemic,  support the development of new pain and addiction treatments, identify evidence-based clinical practices to advance pain management, reduce opioid misuse and overdose, and improve opioid use disorder treatment – all areas of research that are critical to our national response to the opioid epidemic. HHS will launch more than a dozen new scientific studies on opioid misuse and pain treatment to help fill knowledge gaps and further improve our ability to fight this epidemic. As part of this announcement, the department released a report and inventory on the opioid misuse and pain treatment research being conducted or funded by its agencies in order to provide policy-makers, researchers, and other stakeholders with the full scope of HHS activities in this area. The report will also help these stakeholders and external funders of research avoid unnecessarily duplicating research that is currently underway. For more information, download the HHS infographic on the department’s research priorities.

Prescriber Training RFI

HHS is actively working to stem the overprescribing of opioids in a number of ways, including by providing prescribers with access to the tools and education they need to make informed decisions.  In particular, HHS has developed a number of activities that support opioid prescriber education.  This request for information seeks comment on current HHS prescriber education and training programs and proposals that would augment ongoing HHS activities.

For more information on other actions HHS has taken to address the opioid epidemic, download the department’s new Opioid Epidemic fact sheet.

Department of Health and Human Services Plan to Invest 157 Million into Social Work

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Can social workers’ knowledge of health-related issues be useful in achieving better health outcomes?  The Department of Health and Human Services (HHS) thinks so, and it will provide up to $157 million in funding to 44 bridge organizations over a five-year period to determine how effective these organizations are in connecting consumers of clinical services with social service agencies addressing issues related to clients’ wellbeing.  Funding for the Accountable Health Communities Model will be provided through the Affordable Care Act to assess the efficacy of social work interventions addressing social determinants of health and well as clinical practice.

The federal government’s interest in the social determinants of health was underscored at the 2013 White House briefing hosted by the Council on Social Work Education (CSWE) entitled: Addressing the Social Determinants of Health in a New Era: The Role of Social Work Education. The focus of the briefing was the need to prepare the next generation of social workers for healthcare reform spurred by the Affordable Care Act’s emphasis on integrative healthcare models.

One panel on New Expectations for Health Care focused on what the new era of health care will look like with respect to integrated care, interprofessional health care teams, and consideration of social determinants of health.  Panelists emphasized the importance of linkages and connectors between the community and health care providers and the value of social workers in making those connections.

The Center for Medicare and Medicaid Services (CMS) will implement and test a three-track model of service delivery.  The first track (Track 1 Awareness) will focus on a participating organization working to increase awareness among community residents through referrals and information dissemination.  Track 2 (Assistance) will rely on navigators to actively assist high-risk resident in connecting with available resources in the community.

The third track (Track 3 Alignment) will involve organizations working to align community partners to ensure services are beneficial and accessible to community residents.  Funds are not allowed to be spent of the services required by consumers.  CMS will award 44 cooperative agreements ranging from $1 million for a Track 1 initiative to $3.5 million for a Track 3 initiative.

All participating organizations are expected to identify and partner with clinical delivery sites (CDS).  They must conduct comprehensive social needs screenings, make referrals for eligible Medicare and Medicaid beneficiaries, and connect community residents with specific unmet health-related social needs to community service providers that might be able to address those needs.

Track 3 organizations must also align effective partners to maximize community capacity to address health-related social needs in the core areas of housing instability and quality, food insecurity, utilities, interpersonal violence and transportation shortages.  Applicants will partner with state Medicaid agencies, clinical delivery sites, and community service providers and are responsible for coordinating community efforts to improve linkage between clinical care and community services.

Eligible applicants include community-based organizations, healthcare provider practices, hospitals and health systems, institutions of higher education, local government entities, tribal organizations and for-profit and not-for-profit local and national entities from all 50 states, U.S. Territories, and the District of Columbia.  CMS will award renewable one-year cooperative agreements to successful applicants.

Organizations may apply for funding in one or two tracks, but will be selected to participate in a single track only that will run for a five-year period.  Detailed information about the various track can be obtained from the Funding Opportunity Announcement (FOA).  Interested organizations have until February 8 to submit and non-binding Letter of Intent (LOI).  CMS will be accepting applications until March 31, 2016.

Questions about the model and applications can be submitted toAccountableHealthCommunities@cms.hhs.gov. Interested parties can register for a January 27 webinar on the application process.

President Obama, A Social Worker Is Your Ideal Poverty Czar

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Last week, President Barack Obama once again did the unusual by participating in a panel discussion as part of Georgetown University’s Catholic-Evangelical Leadership Summit on Overcoming Poverty. It was a rare setting for a sitting president but proved to be an interesting exchange of ideas with a couple of thought leaders on the subject of why so many (45 million below the poverty threshold) have so little in the land of plenty.

Moderated by Washington Post columnist E. J. Dionne, the discussion included Harvard professor Robert Putnam, and American Enterprise Institute’s president Arthur C. Brooks. Putnam’s latest book, “Our Kids: The American Dream in Crisis,” has renewed interest in the numbers of American children who are mired in poverty with bleak hopes for the future. Brooks has captured the imagination of many with his own brand of compassionate conservatism which sees free enterprise’s most important work as not generating wealth but creating opportunities for the poor.

It was a bold move for President Obama to put himself on the proverbial hot seat because his administration has garnered criticism from those who believe he could do more for the poor. This appearance prompted Martin Luther King, III to renew his call for a “poverty czar” to coordinate poverty reduction efforts across agencies. King was among those who called for the appointment of a poverty czar during the run up to the 2008 presidential elections. Candidate Obama was noncommittal then, however, candidate Hillary Clinton embraced the idea. Appointing a poverty czar this late in President’s tenure does not seem likely, yet those living below the poverty line can use all the help available.

What other profession equips you with the knowledge and skills needed to bring people together to address issues of great magnitude such as poverty? At the top of the list would be Oakland, California Congresswoman Barbara Lee, who currently chairs the Democratic Whip Task Force on Poverty, Income Inequality, and Opportunity. She is the co-founder and co-chair of the Out of Poverty Caucus and chair of the Congressional Social Work Caucus.Should the President decide to appoint someone as poverty czar, it would be wise to consider a social worker for the position. Who else would you appoint? Who better understands the many dimensions of poverty than a social worker?

Reducing and eliminating poverty has been at the forefront of Congresswoman Lee’s legislative agenda. One of the first bills she introduced in the 114th Congress in January was H.R. 258—the Half in Ten Act of 2015 that would establish a Federal Interagency Working Group on Reducing Poverty within the Department of Health and Human Services (HHS) that would develop a national strategy to reduce the number of persons living in poverty in America by half within 10 years after release of the 2014 Census Report on Income and Poverty in the United States. She also sponsored H.R. 1305—the Income Equity Act of 2015 that would address escalating income inequality by denying employers tax deductions on excess compensation. However, Congresswoman Lee has much unfinished business as a Member of Congress and may wish to remain.

One might think retiring Senator Barbara Mikulski would consider taking on the challenge of being poverty czar but that’s probably not in the cards as newly-elected Republican Governor Larry Hogan could appoint a Republican as her replacement diminishing the Democrats very good chance of recapturing the Senate in 2016. Should the President look off the Hill, there are several highly qualified social workers who would fill the role of poverty czar.

Michael Sherraden, the George Warren Brown Distinguished University Professor at Washington University in St. Louis is director of the Center for Social Development and has done extensive research on asset development for the poor. Jane Waldfogel, professor of social work and public affairs at Columbia University, played a significant role in crafting policies that help cut Britain’s child poverty rate in half.

Social workers have provided significant leadership for the federal government, most notably Frances Perkins and Harry Hopkins who were key administrators for President Franklin Delano Roosevelt during the implementation of the New Deal. Social workers are uniquely trained to understand poverty and address it roots causes. If President Obama decides to appoint a poverty czar, he should have social workers at the top of his list.

As Arkansas Outlaws Re-homing, Other States Might Follow Suit

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Re-homing, a practice which consists in transferring a child’s custody to non-family members without the oversight of child welfare or judicial authorities, became a nationwide issue after Reuters published an investigation in September 2013. The 18-month investigation revealed that parents used Internet discussion groups to give away their adopted children and sparked heightened debate across the country. In May 2014 the U. S. Department of Health and Human Services (DHHS) sent a Memorandum to state child welfare authorities encouraging an overhaul of legislations to “adequately address the implication of re-homing” and putting an emphasis on post-adoption services.

So far, only five states – Arkansas, Colorado, Florida, Louisiana and Wisconsin – have regulated it. Since February, lawmakers in Maryland, Nebraska, New York and North Carolina are discussing bills to address re-homing.

At the beginning of April, Arkansas became the fifth state to have regulated the practice when its Governor, Asa Hutchinson, signed two bills to this effect.

The first law, signed on April 2, ensures post-adoption services to families and the screening of prospective guardians. The second, signed four days later, makes re-homing a felony punishable by up to five years of prison and a maximum fine of $5,000.

The laws were speedily adopted in the wake of a dramatic re-homing case which involved Arkansas State Rep. Justin Harris. In February, Harris admitted to have given away two adopted daughters bypassing child welfare authorities. The eldest child, 6 years old, was eventually sexually abused by the man to whom Harris had transferred the custody.

This was the tenth re-homing case in two years occurred in Arkansas that the local child welfare authorities were aware of.

“The story in Arkansas and other stories that have been in the media recently about re-homing tells us that many adoptive parents are struggling to meet the emotional or behavioral needs that come out after they have adopted a child,” said JooYeun Chang, associate commissioner of the Children’s Bureau at the U.S. Department of Health and Human Services (DHHS), in an interview.

One study reported that only 26 percent of adoptive families in the United States felt they received quality mental health services. Parents engaging in re-homing often mention the lack of support as a reason for their actions.

Acknowledging the high vulnerability of children in rehoming cases and the inadequate support available to families overwhelmed by children with behavioral problems, Chang underscored the federal government intention to change the situation. “This is an important policy change that really needs to happen. The President 2016 budget contains a proposal that would guarantee federal funding for prevention and post-placement services.”

The proposal Chang refers to involves $587 million over the next ten years to help state agencies offer adoptive parents crisis counseling and other support. “Maybe States will not have all of the prevention and post-adoption services ready at year one. But over time if there is a dedicated federal funding stream that is going to support these types of activity, States will continue to build their capacity to provide them,” Chang said.

Stephen Pennypacker, a senior child welfare expert and President of the Partnership for Strong Families, welcomed the federal proposal as a rare intervention on the front and back-end of child protection services. “These services are integral to prevent abuse from ever occurring. Some adoptive parents legitimately reach our for assistance and try to get help but then, because they are either unable to get it or the help that they access is inadequate, they turn to self-help remedies like re-homing. When an adoptive family starts to struggle we need to have something available to them rather than having to turn to the Internet or some other ways to make a child placement”.

Some doubt whether the proposed funding alone can prevent re-homing. “Enhanced support for adoptive families is certainly positive,” said Jacqueline Bhabha, professor of the practice of health and human rights at Harvard School of Public Health. “Whether it will have any impact on re-homing is not clear however. This will depend on targeted risk assessment and careful monitoring of at risk families and adoptive children that may well tend to fall under the radar normally.”

A leading expert in the field of children’s rights, Professor Bhabha stressed the importance of more progressive policies in the whole adoption system, in particular as regards international adoptions, and the need to improve the scrutiny of parents’ suitability and children’s adoptability. “Even before you get to the re-homing, if you look at the homing there are a lot of practices that are very troubling. Families which are not well qualified to be adopting are allowed to adopt. Much more supervision is needed.”

Progress in U.S. legislation and policy might have positive repercussions in Canada too, where cases of private rehoming, including across the border, have occurred in the recent past. “The U.S. is providing needed leadership that Canada should emulate to develop a more serious incentive program and also ensure better surveillance and monitoring of children’s rights,” said Mary-Ellen Turpel-Lafond, British Columbia Representative for Children and Youth. Warning about the risks that re-homing can pose to children, she advocated a stronger focus on children’s rights and pointed at European initiatives “which appear to be more understanding of the possibility of systemic exploitation”.

In Europe, where no re-homing case has been reported, states are required to act in the best interests of the child in all child matters. In Germany, a federal country, “nobody can relinquish his parental rights without the authorisation of youth welfare and judicial authorities. Post-adoption services and supervision are obligatory,” said Tanja Schwarz, a German family lawyer.

Officials at the Government Accountability Office confirmed that they expect to publish a study this fall on state and federal laws governing this practice.

When asked whether there is a need for further federal intervention to ensure uniform laws on re-homing across the country, Chang said that “the current definition of abuse and neglect is broad enough to include re-homing. It is up to the State to enforce both criminal and dependency laws.”

Will the Supreme Court Deal a Fatal Blow to ObamaCare?

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All eyes are on Republicans gaining control of the Senate and affirming their commitment to repealing the Affordable Care Act as known as ObamaCare. However, the decision by four Supreme Court justices to hear arguments in King v. Burwell challenging premium subsidies on healthcare exchanges operated by the federal government could deal a blow to the ACA if the Supreme Court rules against the subsidies. The Internal Revenue Service provides subsidies in the form of tax credits to consumers purchasing health insurance under the Affordable Care Act whose incomes are below 400 percent of the poverty threshold. However, opponents of the law say that wording in the ACA stipulates that these subsidies can only be provided to consumers purchasing health insurance on exchanges “established by states” and that they are not available to people purchasing health insurance on federally managed exchanges.

To date, 13 states and the District of Columbia have established their own exchanges. There are an additional 18 states that have established exchanges in some form of partnership with the federal government. The remaining 19 states are those who have refused to participate in the process and have exchanges run exclusively by the federal government. Much is at stake. According to the Department of Health and Human Services (DHHS) 86 percent of people enrolled through federally operated exchanges rely on the subsidies to reduce their premiums to an affordable level. The Urban Institute estimates 7.3 million people could lose $36.1 billion in subsidies if the Supreme Court strikes them down.

The Supreme Court’s decision to hear the case surprised many because traditionally the Court will only take up a case if there is a split on the issue at the Circuit Court level. The U.S. Court of Appeals for the Fourth Circuit upheld the legality of the subsidies for federally managed exchanges in its ruling in King v. Burwell. However, in another challenge, Halbig v. Burwell, a three-judge panel of the U.S. Court of Appeals for the District of Columbia Circuit ruled against the use of the subsidies. Judge A. Raymond Randolph, appointed by President George H. W. Bush in 1990, and Judge Thomas B. Griffith, appointed by President George W. Bush, voted against the subsidies.

Judge Harry Edwards, appointed by President Jimmy Carter, voted to uphold the subsidies. At the request of the Obama Administration, the full court agreed to revisit the decision. With seven of the 11 authorized judges currently on the court appointed by Presidents Clinton and Obama, it seems likely the full court would support the subsidies effectively eliminating the split. The Supreme Court however decided to revisit King, despite the Obama Administration’s request that it wait for the decision by the full D.C. Circuit Court.

Hardline conservatives saw last week’s evisceration of Democrats during the midterm elections as a fatal blow to Barack Obama’s presidency. They believe he is a lame duck who is weakened both domestically and internationally. They see the Affordable Care Act, which they derisively coined as “Obamacare”, as his only significant legislative accomplishment and it sticks in their collective craw. Although the law remains unpopular with 53 percent of respondents in the Gallup Poll having a negative view of the ACA while 41 percent views the law favorably, it is losing ground as an important concern for the public. According to exit polls most voters in the 2014 midterm election—59 percent—said their vote had nothing to do with the Affordable Care Act compared to 28 percent who cast ballots to express displeasure with the law. During the 2010 midterms 45 percent said they cast their ballots as an expression of their displeasure with the law.

Doomsday forecasts about the Supreme Court’s ruling on subsidies in the Affordable Care Act may very well be overblown. Over at the Washington Center for Equitable Growth—my favorite blog by the way—economist Brad DeLong says even if the Supreme Court rules against federal subsidies, conservatives may not get the results they desire. He believes the 31 states with either state-run exchanges or working in partnership with the federal government will largely be unaffected. He wonders if politicians in the 19 states with exchanges solely operated by the feds will be willing to deny their middle class residents nearly $40 billion in subsidies to purchase health care insurance.

I believe the Affordable Care Act is here to stay. Republicans will waste their time and taxpayers’ money on fruitless attempts to repeal the law knowing full well a law repealing the ACA cannot get past the President’s veto pen and may not get out of the Senate without relying on budget reconciliation as a strategy which is a recipe for disaster. Then imagine what Republicans would do if they could repeal the Affordable Care Act. They have no credible idea about what they would do to replace it.

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