The Center for Public Integrity

The House of Representatives voted for the 33^rd time last week to repeal ObamaCare, and for the 33^rd time it was an exercise in futility. The Senate will ignore the House vote and allow the reform law to move forward, just as the Supreme Court did last month.

House members are well aware of all that, so the vote was all for show. And GOP leaders have no intention of repealing the Affordable Care Act because their friends in the health insurance industry are counting on major provisions of the law going forward, especially the expansion of Medicaid. Don’t be fooled by Republican governors like Florida’s Rick Scott and Texas’ Rick Perry, who are saying they’ll opt out of the Medicaid expansion now that the Supreme Court says that’s allowable. When the Feds start doling out billions in 2014 to bring an additional 16 million Americans into the Medicaid program, they’ll be on board. Trust me.

Want proof that Big Insurance has figured out how to make a lot of money off reform? Last Monday WellPoint announced it will pay nearly $5 billion to buy the country’s largest private Medicaid managed care company, AmeriGroup. Rest assured that lobbyists for WellPoint and other firms wanting to get their hands on that new Medicaid money will have a “here’s how it has to be” talk with their buddies on Capitol Hill.  

If you look at recent quarterly earnings reports from the big five for-profit insurance companies (UnitedHealth, WellPoint, Aetna, Cigna and Humana), you’ll see that the biggest growth in their membership has come not from the private sector but from public programs like Medicare and Medicaid.

WILLIAMSBURG, Va. (AP) — Millions of uninsured people may have to wait until after Election Day to find out if and how they can get coverage through President Barack Obama's health care law.

More than two weeks after the Supreme Court gave the green light to Obama's signature legislative achievement, many governors from both parties said they haven't decided how their states will proceed on two parts under their control: an expansion of Medicaid, expected to extend coverage to roughly 15 million low-income people, and new insurance exchanges, projected to help an additional 15 million or so purchase private insurance.

In some states, such as Colorado, Oklahoma and Wyoming, governors said they're crunching the numbers to determine what's best for their residents. But in other states, including Virginia, Nebraska and Wisconsin, Republican governors said not to expect a decision before Obama and Republican challenger Mitt Romney square off in November.

If Romney wins, the argument goes, he'll work to throw out the health care overhaul, and the issue will be moot.

"I don't think I can look the taxpayers of Virginia in the eye and say I'm going to spend a lot of your money building exchanges that four months from now I may not need," Gov. Bob McDonnell, R-Va., said on the sidelines of the National Governors Association meeting.

Although the high court upheld the requirement that individuals either have insurance or pay a fine, the justices undercut Obama's plan to get almost all Americans insured, ruling that states can opt out of the expansion of Medicaid, the government-run insurance plan. People earning up to 138 percent of the federal poverty level qualify for Medicaid under the health care law, except in states that reject the expansion.

DALLAS (AP) — Texas, the nation's most active death penalty state, announced Tuesday that it would become the latest to switch to single-drug executions amid a drug shortage that has left states scrambling for acceptable alternatives.

The Texas Department of Criminal Justice said it will begin using a single dose of the sedative pentobarbital to carry out death sentences. It had been using that drug in combination with two others, but its supply of one of the other drugs expired.

Texas began using pentobarbital last year after another drug, sodium thiopental, became unavailable when its European supplier bowed to pressure from death penalty opponents and stopped making it. But pentobarbital is now in short supply after its Danish manufacturer said it would try to prevent its use in executions.

An Oklahoma inmate asked a federal court on Tuesday to halt his upcoming execution because that state has only one dose of pentobarbital left. A lawyer for Michael Hooper said Oklahoma has no backup plan if the drug fails to render Hooper unconscious, and that creates a risk of cruel and unusual punishment.

Texas officials said in May that they have enough doses of pentobarbital to carry out 23 executions. No one has been executed in the state since.

In the three-drug cocktail, Texas officials administered 5 grams of the drug — about 3.4 ounces — to render the inmate unconscious, followed by the muscle relaxant pancuronium bromide and potassium chloride to stop the heart. Pancuronium bromide is the drug that expired.

Department of Criminal Justice spokesman Jason Clark said officials didn't expect the dose of pentobarbital needed to change with the new procedure.

Four other states — Arizona, Idaho, Ohio and Washington — have used a single drug to carry out executions, according to the Death Penalty Information Center. Ohio was the first to use just pentobarbital, during a March 2011 execution.

MIAMI (AP) — Firms that are paid tens of millions of dollars to root out Medicare fraud are bidding on contracts to investigate companies they are doing business with — sometimes their own parent companies, according to a government report released Tuesday.

Two-thirds of the companies that bid on contracts during a nearly year-and-a-half time period beginning in October of 2010 had financial ties to claims processors — and in some cases also processed Medicare claims themselves, according to the study by the U.S. Department of Health and Human Services' inspector-general. The report blames what it calls a flawed bidding system and an inadequate conflict-of-interest policy.

The study looked into bids from about 100 potential contractors and subcontractors and found nearly 2,000 relationships that posed potential conflicts. For example, one company submitted a bid to investigate Medicare fraud even though its parent company provided two types of Medicare coverage in all 50 states.

Medicare fraud contractors are often tied to a large number of providers, but the report doesn't break the numbers down by each contractor.

The federal government requires Medicare fraud contractors to identify their potential conflicts and their financial interests in other companies when submitting bids, but the report found they often failed to provide all the information. Even when they did, it was sometimes inconsistent or unclear, according to the study, which urged federal health officials to adopt formal, clear guidelines for companies to follow when submitting bids.

Tuesday's report examined only companies bidding on Medicare-fraud contracts, not those with existing contracts. But a 2011 congressional survey of companies providing Medicare reimbursements revealed that some had financial relationships with the contractors investigating them.

DALLAS (AP) — Gov. Rick Perry said Monday that Texas won't establish an online marketplace for patients to shop for insurance or expand Medicaid, two key elements of the federal health care overhaul.

In a letter sent to U.S. Health and Human Services Secretary Kathleen Sebelius, Perry said both elements "represent brazen intrusions into the sovereignty of our state."

"I will not be party to socializing health care and bankrupting my state in direct contradiction to our Constitution and our founding principles of limited government," Perry said in a statement.

The Supreme Court upheld most of the federal health care law last month, although it said the federal government can't withhold states' entire Medicaid allotment if they don't expand Medicaid, the health insurance program for the poor and disabled. If states choose not to set up a health care exchange, an online service for people to comparison shop for insurance, the federal government will establish one for them.

About 6.2 million Texans — a quarter of the state's population — are uninsured.

Expanding Medicaid would add millions of people "into the already unsustainable Medicaid program, at a potential cost of billions to Texas taxpayers," said Perry, a Republican. The Texas Health and Human Services Commission has estimated the Medicaid expansion would cost the state $27 billion in the first 10 years, a number many Democrats dispute.

The state has estimated about 2 million people would be added to the Texas Medicaid rolls in the first two years if it went ahead with the expansion.

Texas House Speaker Joe Straus, another Republican, said he hoped voters would address the issue by electing Republican presidential candidate Mitt Romney, who has promised to repeal the health care law. He would not say what he thought the state would do if President Barack Obama is re-elected.

WASHINGTON (AP) — An AIDS-free generation: It seems an audacious goal, considering how the HIV epidemic still is raging around the world.

Yet more than 20,000 international HIV researchers and activists will gather in the nation's capital later this month with a sense of optimism not seen in many years — hope that it finally may be possible to dramatically stem the spread of the AIDS virus.

"We want to make sure we don't overpromise," Dr. Anthony Fauci, the National Institutes of Health's infectious disease chief, told The Associated Press. But, he said, "I think we are at a turning point."

The big new focus is on trying to get more people with HIV treated early, when they're first infected, instead of waiting until they're weakened or sick, as the world largely has done until now. Staying healthier also makes them less likely to infect others.

"It saves lives of people who are infected, and it saves lives of people by not allowing them to get infected," Fauci explained.

That's a tall order. But studies over the past two years have shown what Fauci calls "striking, sometimes breathtaking results," in preventing people at high risk of HIV from getting it in some of the hardest-hit countries, using this treatment-as-prevention and some other protections.

Now, as the International AIDS Conference returns to the U.S. for the first time in 22 years, the question is whether the world will come up with the money and the know-how to put the best combinations of protections into practice, for AIDS-ravaged poor countries and hot spots in developed nations as well.

"We have the tools to make it happen," said Dr. Elly Katabira, president of the International AIDS Society, which organizes the world's largest HIV conference, set for July 22-27. He points to strides already in Botswana and Rwanda in increasing access to AIDS drugs.

Back during the debate on the Clinton health care reform proposal, insurance executives tried to convince lawmakers that they were on the same side of health care reform as consumers were, so they embraced the idea of “community rating” in which insurers charge everyone in a given community the same premium regardless of age, gender or health status. In testimony before a House committee in 1993, the president of Cigna’s health care business assured lawmakers that all the big insurers were on board with a return to community rating.

Fast forward nearly two decades and you’ll find that insurance executives have changed their tune, now that they’re actually being required to go back to the good old days when community rating was the norm. Today’s health insurers want nothing to do with it. There’s just not enough profit in it.

Community rating was the original way insurance companies set prices for their policies. The practice began in the late 1920s when the administrator of Baylor University Hospital in Dallas came up with a strategy to deal with his hospital’s mounting expenses. His idea was to have groups of local residents, beginning with the city’s teachers, pay fifty cents a month and receive up to 21 days of hospital care — if needed — during any year. If you were a 21-year-old man who was as healthy as a bear, you paid the same each month as a 42-year-old woman who was not nearly as healthy. It made everybody happy, subscribers and cash-strapped hospital officials alike. Pretty soon, other hospitals began offering similar plans. Eventually they were united under a common name — Blue Cross — and they were all operated on a nonprofit basis.