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New CBO Report Says the Senate GOP Health Care Would Make Obamacare's Problems Worse

The Republican health care plan wouldn't solve the problems Republicans say they want to solve.

MICHAEL REYNOLDS/EPA/NewscomMICHAEL REYNOLDS/EPA/NewscomIn January of this year, as congressional Republicans were ramping up legislation to repeal, or at least rewrite, Obamacare, Mitch McConnell, the top Republican in the Senate, went on Face the Nation to make his case against the current health care law.

"What you need to understand is that there are 25 million Americans who aren't covered now," he said. "If the idea behind Obamacare was to get everyone covered, that's one of the many failures. In addition to premiums going up, copayments going up, deductibles going up. And many Americans who actually did get insurance when they did not have it before have really bad insurance that they have to pay for, and the deductibles are so high that it's really not worth much to them. So it is chaotic. The status quo is simply unacceptable."

McConnell's case against Obamacare, highlighted at the time by Vox's Ezra Klein, was that it didn't cover enough people, that premiums were too expensive, that out of pocket payments and deductibles were too large, and that the system as a whole, with its unstable health exchanges, was too chaotic. Something would have to change.

McConnell's argument had the virtue of being essentially true. Health insurers have exited the exchanges. Deductibles in Obamacare plans run high. Premiums for typical plans under the law went up 22 percent last year. The current system has increased coverage, but it has not covered everyone, and those who do have coverage have reported frustrations with the expense and limitations of their plans.

At the time, Republicans had not released their own health care legislation, or shared the framework for their plan. But now they have, and it is hard to square McConnell's criticisms of Obamacare with the legislation his office helped produce. According to a Congressional Budget Office (CBO) estimate released this afternoon, the Senate health care bill, the Better Care Reconciliation Act (BCRA), would make every single one of the issues that McConnell mentioned worse.

Essentially, the CBO's report concludes that the Senate GOP's health care bill would not solve any of the problems that Mitch McConnell said he wanted to solve. Like the Senate health care bill itself, it highlights the cynicism and emptiness of Republican thinking on health care policy.

Let's start with coverage.

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D.C.'s Dysfunctional Metro System Is a National Embarrassment

The D.C. Metro has perfected the art of replicating the traffic woes above ground in the tunnels below.

Eric Savage/FlickrEric Savage/FlickrBeginning this week, passengers on the District of Columbia's Metrorail network—the six-line, spontaneous fire-prone train system known here as the D.C. Metro— can expect fare increases and service cuts.

As you might imagine, few in the area are pleased. A few days ago, the Washington Examiner declared that the city's rapid-transit system "is the worst in the world." I'll be generous and not go that far. The D.C. Metro is definitely not the dirtiest system I've ever experienced (I'm looking at you New York City), but the system is hardly a model of success, either. Deferred maintenance, poor planning by the original designers, a dysfunctional governance structure, and general incompetence and negligence on the part of management and staff have taken their toll since its 1976 opening.

All of these problems came to a head in 2009, when a crash near the Fort Totten station in Northeast D.C. killed nine people, including the train's operator, and injured 80. Following the accident, the National Transportation Safety Board (NTSB) released a report that identified failures at almost every level of The Washington Metropolitan Area Transit Authority (WMATA), including actions taken by the train operator, maintenance workers, senior management, and control room operators.

The severity of this incident prompted a $5 billion capital improvement program, with nearly half of the money coming from federal grants. Metro finally had the funds it needed to make significant improvements, but as time dragged on it would become apparent that absent major structural reforms in how the WMATA functioned, that money would not be well spent.

In 2015 another headline-grabbing incident occurred near L'Enfant Plaza, in D.C.'s Southwest quadrant. An electrical malfunction caused a train to get stuck in a smoke-filled tunnel. One woman died and another 86 people were sent to the hospital. With public trust in the system at a new low, ridership dropped significantly.

WMATAWMATA

As someone who has ridden plenty of rapid-tranist systems outside of the U.S., I can attest to just how bad the D.C. Metro compares. Having ridden the Shanghai Metro for the past two years while a student at New York University Shanghai, I can recall a train stopping in between stations only once and for ten seconds at most. By contrast, my morning train into downtown D.C. last Friday stopped a total of five times between stations, the longest delay being almost five minutes. And this isn't event that bad comparitively, according to stories I've heard from longtime residents.

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Travel Bans, Gay Wedding Cakes, Gun Rights, and Border Shootings: Special All Supreme Court P.M. Links

  • Supreme CourtGary BlakeleyToday was the Supreme Court's final day of releasing orders and decisions for the term, and it was a bit of a doozy. Top news: The court allowed most of President Donald Trump's travel ban to take effect except in cases of those who have "bona fide" relationships with the United States. This is not a "ruling," though. It's a temporary lifting of the injunction until they hear the case in October.
  • The Supreme Court also ruled that Missouri cannot refuse to grant public funds to a church simply because it is a religious institution, as this is a violation of the free exercise clause of the Constitution. The case was about whether a church could have access to a grant to help pay the costs of resurfacing a playground.
  • The Supreme Court also decided it will hear whether a baker can, due to his religious beliefs, refuse to bake and sell a wedding cake to same-sex couples.
  • The Supreme Court also decided it would refuse to hear a case from California to rule on whether the Second Amendment protected the right to carry firearms in public.
  • Rather than deciding whether the family of a Mexican teenager killed by a federal agent can sue over a fatal shooting that took place across the U.S.-Mexico border, the Supreme Court kicked it back down to a lower court.
  • The Supreme Court also struck down a law in Arkansas that caused officials to refuse to list both members of same-sex couples as parents on birth certificates. Note that the law does allow for non-biological fathers to be listed as parents in heterosexual cases, so this wasn't a matter of actual genetic parentage.

Follow us on Facebook and Twitter, and don't forget to sign up for Reason's daily updates for more content.

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Jake Tapper: ‘We Are Not the Resistance, We Are Not the Opposition’

CNN anchor warns his fellow journalists that truth, not political positioning, is the best approach in the age of Trump

Not #TheResistance ||| L.A. Press ClubL.A. Press ClubEven before Donald Trump leveled a Jack Lambert-style hit onto the collective psyche of The Fourth Estate, journalism awards galas were schizophrenia-inducing adventures for those of us willing participants who nonetheless maintain a heightened sensitivity to media pomposity and political class elbow-rubbing. It was nearly a lifetime ago, and I still shudder involuntarily at the memory of hundreds of working reporters standing to sing "God Bless America" to Dan Rather back in 2001.

In the two years since Trump's famous escalator ride into national politics, the awards-dinner genre's inherent self-importance and ideological homogeneity has been enough to make even the biggest All the President's Men romantic feel at least a little bit like a staff writer for The Federalist. Last night's entertaining Southern California Journalism Awards, for example, began with a first-person plural statement of professional sympathy from Los Angeles Mayor Eric Garcetti. "I think this is probably [so] well-attended tonight because all of us—no matter whether journalists, or those of us who interact with journalists, who consume the work of journalists—we all feel that there is something bigger under attack than just journalism and news," Garcetti said. "The very values that we stand for, who we are, what we want to be, and whether or not we will come together."

Incredulous-face, ranked: 1) Moynihan, 2) Carlson, 3) Tapper. ||| CNNCNNThis is pretty much boilerplate for political-class gatherings these days. National Press Club Chairman Jeff Ballou spent a good deal of his remarks last night making the defiant claim that "We ARE the Constitution!" Andrea Mitchell in her speech spent paragraphs cataloguing the Trump administration's violations against basic Washington norms and decency. It's not that she's necessarily wrong, it's that it always feels awkward to be in any room, let alone one populated by journalists, where so many people so vigorously agree on political matters.

That's why the speech given by CNN anchor Jake Tapper, who was accepting the L.A. Press Club's President's Award, was so contextually refreshing and I think nationally relevant to the ongoing push-pull between Trump and the media. Tapper warned implicitly against the journalistic first-person plural, and explicitly in favor of the seemingly obvious yet nonetheless timely reminder that "we really need to stand up and make sure that we get our facts right."

Since it was George Orwell's birthday, Tapper started with that great quote you might have seen online commemorating the occasion:

[citation needed] ||| izquotesizquotes

The main problem here? There's no evidence Orwell ever said or wrote such a thing. Tapper used that fact as a jumping-off point to reflect on how sloppiness, side-taking, and social media are combining to undermine many journalists' anti-Trump goals:

"We need to rise to the moment and make sure that when we quote somebody we know it's actually correct," Tapper said. "We don't need to give the enemies of the Fourth Estate any ammunition. That means we need to be squeaky clean−we're not the resistance, we're not the opposition, we're here to tell the truth, report the facts, regardless of whom those facts favor one way or the other."

Crazy talk! More from Tapper's speech as delivered (you can read the somewhat different version as written here):

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Democrats Accuse Republicans of Mass Murder: New at Reason

The argument carries a powerful emotional charge but it isn't a particularly constructive or clear-minded way to think or talk about writing laws.

Erik McGregor/Sipa USA/NewscomErik McGregor/Sipa USA/Newscom

So the Democrats, after opposing Donald Trump in the 2016 election partly out of what they claimed was concern about his incivility and coarseness, are now pursuing a debate about health care legislation in Washington by characterizing the Republicans who disagree with them about policy details as mass murderers.

Think that's an exaggeration? Hillary Clinton, the Democratic Party's 2016 presidential candidate who remains among its most prominent and mainstream voices, tweeted Friday: "If Republicans pass this bill, they're the death party." Sen. Elizabeth Warren (D-Massachusetts) tweeted, "I've read the Republican 'health care' bill. This is blood money. They're paying for tax cuts with American lives." Ezra Levin, an influential Washington organizer of the resistance to Trump, tweeted Sunday, "TrumpCare will kill tens of thousands of working class people, and with the savings it cuts taxes for billionaires."

This line of argument carries a powerful emotional charge. However, Ira Stoll argues, it isn't a particularly useful, constructive, or clear-minded way to think or talk about writing laws.

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More Americans Support Same-Sex Marriage Than Ever

Republicans nearly at majority approval.

Gay marriagePewAs Gay Pride month draws toward a close, a new poll by the Pew Research Center suggests the fight over same-sex marriage in the United States is over. This is not Roe v. Wade 2.0.

Sixty-two percent of Americans support legal recognition for married gay couples, while only 32 percent opposed, according to the latest poll numbers gathered earlier in June. Gay marriage and homosexuality itself does not represent the cultural divide it used to and is becoming "normalized" in the eyes of most Americans.

It's worth remembering majority support for same-sex marriage recognition surpassed opposition for the first time in 2011. This shift has taken place over just six years.

Pew notes that demographic groups historically more opposed to same-sex marriage have shifted significantly. For the first time a majority of baby boomers support legal recognition. Over the past two years, support for recognition among African Americans has increased from 39 percent to 51 percent. Support from younger white evangelical Christians has jumped from 29 percent to 47 percent in just a year.

In terms of the political fight over who "owns" the LGBT vote, it's worth noting what's going on with Republicans. For the first time, opposition to legal recognition among Republicans and Republican leaners has dropped below the majority. It's nearly split now—47 percent favor recognition while 48 percent oppose it.

That shift in the political winds is very important in terms of how elements of the LGBT movement are attempting to tie it to "The Resistance" and reinforce the idea that the real LGBT political movement leans to the left.

The end result this year has been a purging of actual LGBT people from pride marches for not holding the right views or for being—interestingly enough—members of disfavored groups. A gay supporter of President Donald Trump became a national news story because a pride parade in Charlotte, North Carolina, is refusing to let him participate.

In cities like Minneapolis and Washington, D.C., protesters attempted to block police participation in the parade, in some sort of attempt to draw attention to police abuse. In Chicago, people said they were told they could not wave flags displaying the Star of David and express their Jewish heritage within the parade because it made others uncomfortable.

In each of these cases, people are trying to purge other LGBT participants for reasons that have little to do directly with the gay community. Trying to ban the police was particularly loathsome (and you could tell from responses to the behavior in the media coverage), given that gay people have both been fighting for years to get police to treat them with respect and to serve as openly gay police officers. The political roots of gay pride are deeply embedded in stopping police violence targeting gay people. That's what the Stonewall Riots were about!

There's something particularly narcissistic about trying to purge your adversaries from your sight by denying them participation in these events and thinking that this is a useful response. There is nothing about purging police from a march that's going to improve the relationship between police and minority communities. Purging Jewish flags is not going to do a single thing to improve the relationship between Israel and Palestine.

That support for gay marriage has so dramatically increased is a direct reflection of the value of participation, not of purging and segregation. LGBT people are increasingly visible in all communities (not just urban enclaves), and the realization that gay marriage helps strengthen families and social stability has undoubtedly contributed to the dramatic drop in resistance to gay relationships.

Activists might want to keep that in mind before trying to deliberately boot people out of the movement.

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The Republican Health Care Dud, Harry Potter, and Supreme Court Shakeup [Reason Podcast]

"Were trying to extend twentieth century or even nineteenth century entitlement spending into the twenty-first century," says Reason's Nick Gillespie about the Senate Republicans' health care legislation. "The demographics don't work, the economics don't work, and nobody will talk about just increasing the supply and variety of health care. It's maddening!"

Peter Suderman joins Nick Gillespie and Katherine Mangu-Ward in a discussion moderated by Andrew Heaton. In addition to making sense of the unimaginative Republican bill and suggesting more radical reforms in place of it, they discuss a new CATO piece about the true number of libertarians in America; the cultural impact of Harry Potter two decades in (and which house Gillespie and Mangu-Ward would would fall into); and who should replace Justice Kennedy on the Supreme Court if he retires.

Audio production by Ian Keyser.

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Why I Microdose Acid: Silicon Valley Entrepreneur Speaks Out: New at Reason

George Burke says taking tiny hits of acid has changed his work, and his life, for the better.

Tech entrepreneur George Burke consumes a tiny amount of LSD (about a tenth of a typical dose) every morning before he goes to work.

He says "microdosing" subtly improves his cognitive functioning.

"I notice that my brain seems to be able to solve problems a little bit better than...before," says Burke, who runs a startup called Fuel that helps its clients custom tailor their diets to their unique genetic makeups.

The use of psychedelics as productivity and creativity hacks is deeply rooted in Silicon Valley culture. Burke was partly inspired to go public about his drug use by the late Steve Jobs, who told his biographer Walter Isaacson, "[t]aking LSD was a profound experience, one of the most important things in my life."

"People have to actually have to step up and state what they've been doing," says Burke.

Reason spoke with Burke and with James Fadiman, a scientist researching the effects of microdosing.

Watch the full video above.

Produced by Zach Weissmueller. Camera Alex Manning. Additional graphics by Meredith Bragg. Music by Kai Engel and Broke for Free.

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Senate Republicans Add Individual Mandate Workaround to Health Care Bill

It's one more way the GOP repeal bill resembles Obamacare.

KEVIN DIETSCH/UPI/NewscomKEVIN DIETSCH/UPI/NewscomDespite being billed as an Obamacare repeal plan, the health care bill released last week by Senate Republicans kept many of Obamacare's core elements in place, including federal regulations restricting health insurers from charging based on preexisting conditions and income-based subsidies for individuals purchasing health coverage on the individual market. But it lacked one of Obamacare's notable features—the individual mandate to purchase health insurance.

From a political perspective, this was not surprising. Republicans have spent the last seven years criticizing the health law's mandate. But as a matter of policy, it was an unusual decision: Over the last several decades, several states have attempted to implement preexisting conditions regulations without a mandate.

Every single one has seen their individual insurance market melt down in the space of a few years. With regulations but no mandate, people wait until they are sick to buy coverage, meaning that health insurers end up covering a smaller group of sicker people. This raises premiums, which pushes healthier people out of the market, which raises premiums further, and the cycle continues until premiums are unaffordable and insurers, unable to make money, leave the market: in other words, a death spiral.

This afternoon, Senate Republicans updated their health care bill, the Better Care Reconciliation Act (BCRA), to include a provision that is not a mandate, but is intended to act as a substitute for it. It's a backdoor mandate—a workaround designed to fulfill the same function. It's another sign of how much of Obamacare's individual market design Republicans have borrowed for their own bill.

Instead of a fine for going uncovered, as in Obamacare, the Senate GOP bill now includes a continuous coverage provision: Anyone who goes without coverage for more than 63 days must wait six months before getting coverage again. The goal, as with the mandate, is to create an incentive for health people to buy coverage and maintain it, by penalizing if they don't.

It doesn't take too much work to imagine how a provision like this might end up being weakly enforced, if only for political reasons.

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What Are The Benefits of Lyft Shuttle? Listen to Ed Krayewski on AirTalk

89.3 KPCC in Los Angeles at 2:30 p.m. ET

wirednerd/flickrwirednerd/flickrLyft's roll out of a pilot program called Lyft Shuttle, where vehicles follow set routes, picking up and dropping off people at pre-designated stops, was panned by some critics as an unnecessary re-invention of the city bus. But it's not—instead, LyftShuttle offers another choice than the city bus. When it heads to areas not currently served by city buses, it'll offer a service that didn't exist before. Either way, it can exert competitive pressures that could prompt public transit agencies to do better in order to keep up. It could even lead to a regulatory environment where more competitors can enter the market, benefiting many people.

I'll be on AirTalk on 89.3 KPCC in Los Angeles at 11:30 a.m. Pacific Time (2:30 p.m. ET) to talk about this with guest host Libby Denkmann and Slate's Henry Grabar, who will voice criticisms of the Shuttle to which I'll respond. You'll even be able to call in to ask questions! Tune in if you're in Southern California, maybe stuck in late morning traffic, or listen live online.

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Trump's Travel Ban Is Headed to the Supreme Court

SCOTUS agrees to hear travel ban cases, will schedule oral arguments for October.

Fred Schilling, Collection of the Supreme Court of the United StatesFred Schilling, Collection of the Supreme Court of the United StatesToday the U.S. Supreme Court agreed to hear consolidated oral arguments in the cases of Trump v. International Refugee Assistance Program (IRAP) and Trump v. Hawaii. At issue is whether President Donald Trump's controversial executive order banning travelers from six majority-Muslim countries violates the Establishment Clause of the First Amendment and/or exceeds the president's lawful powers under federal immigration law.

The Supreme Court says it will schedule oral arguments "during the first session of the October Term 2017."

These cases raise fundamental questions about the reach of executive power, the meaning of federal immigration law, the scope of the Establishment Clause, and about the role of the courts in policing the boundaries.

According to the Trump administration, not only did Congress give the president vast leeway to control what happens at the border, the executive branch is entitled to overwhelming judicial deference in all matters dealing with national security. According to the state of Hawaii and to the International Refugee Assistance Program, Congress did not authorize Trump's approach and Trump should get no deference from the courts because he is using government power to heap disfavor on Muslims.

Until now, the Trump administration has mostly lost on this matter in federal court. In May, the U.S. Court of Appeals for the 4th Circuit, in IRAP, issued an injunction blocking enforcement of the executive order on the grounds that the legal challengers were likely to prevail in their Establishment Clause challenge. Then in June, the U.S. Court of Appeals for the 9th Circuit, in Hawaii, issued an injunction blocking enforcement of the executive order on the grounds that Trump was exercising powers that federal law did not properly delegate to him.

But today the Supreme Court partially lifted those injunctions, allowing the executive order to go into effect in certain limited circumstances. Specifically, in an unsigned per curiam opinion, the Court lifted the injunctions "with respect to foreign nationals who lack any bona fide relationship with a person or entity in the United States." That is a small victory for the Trump administration.

However, the Court left the injunctions in place with respect to foreign nationals "who have a credible claim of a bona fide relationship with a person or entity in the United States." The Court explained, "a foreign national who wishes to enter the United States to live with or visit a family member...clearly has such a relationship.... So too would a worker who has accepted an offer of employment from an American company or a lecturer invited to address an American audience." That is a sizable loss for the Trump administration.

Notably, Justice Clarence Thomas, joined by Justice Samuel Alito and Justice Neil Gorsuch, wrote separately to argue that the injunctions should be lifted "in full." This suggests those three justices may be inclined to ultimately rule in favor of the Trump administration. After all, if they think they might rule against the executive order in October, why would they want to let the order go into full effect right now? It also raises the interesting possibility that Chief Justice John Roberts and Justice Anthony Kennedy may be more inclined to ultimately rule against Trump.

One thing is certain: This fall Donald Trump will face the first major test of his presidency before the U.S. Supreme Court.

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Reason Wins 5 Southern California Journalism Awards

Everything from best political/government reporting to best satire, plus 5 silver medals and 9 bronzes

Hardware ||| Matt WelchMatt WelchLast night, the Greater Los Angeles Press Club held its 59th annual Southern California Journalism Awards, honoring works prepared in 2016 by journalists and organizations working between San Diego and Santa Barbara, and handing out special honors to more national figures as well. So it was that in an evening kicked off by Los Angeles Mayor Eric Garcetti and closed by longtime NBC News reporter/anchor Andrea Mitchell (with some Jake Tapper and Conan O'Brien in between), the very first professional award presentation included a large-screen image of Andrew Heaton as Captain James T. Kirk, nurturing a tribble.

This was, ladies and gentlemen, the Best Humor/Satire Writing of 2016, of any type and in any venue ("cross-platform," for short)—"Star Trek: The Libertarian Edition," by Austin Bragg, Meredith Bragg, and Andrew Heaton:

The judges said: "Austin Bragg is absolutely hilarious, and his satiric self-deprecating look at Libertarianism though the lens of Star Trek has gone where no other humor entry has gone before. Hysterical in any star system. We watched it several times and saved it for future views."

Another cross-platform winner was Anthony L. Fisher, for Best Political/Government Reporting, with his "Why It's So Hard to Stop Bad Cops From Getting New Police Jobs: Efforts to track decertified cops are stymied by police union pressure and local control." Said the judges: "This was a remarkably diverse and very interesting field of contenders. But Anthony Fisher's exploration of the political and governmental hurdles which can keep bad cops on the street rose to the top. It was meticulously researched and reported without being dry. The clarity of Fisher's writing took what could have been a dense—or a sensational—topic and instead turned into a thoughtful analysis. It is a take on policing that has not received as much attention as pieces on police abuses, even though Fisher's story certainly shed light on how an officer could escape consequences for such abuses. A clear public service to Fisher's readers."

A third top-performing cross-platformer was Glenn Garvin for Best Criticism on Books/Art/Architecture/Design, with "Was Patty Hearst Brainwashed? A new look at an old kidnapping case misses one of the most important elements of the story." The judges ruled: "Garvin's well-written and snarky criticism of Toobin's book on Patty Hearst and questioning of conventional views as to whether Hearst became a real revolutionary or feigned being one results in his provocative observation that she may have been 'brainwashed' like Korean War soldiers."

The great Reason Science Correspondent Ronald Bailey won Best Magazine Column, for "Poverty Is Deadly: Why is the death rate for young white Americans rising?" Judges mused: "Mortality and life expectancy. By no means are they frequent topics for discussion—or even reflection. But Ron Bailey brings them to the forefront in his well-researched, thoughtful column on rising middle aged mortality rates, along with some intriguing conjecture about possible reasons for the trends. Our compliments to Ron for his fascinating column about a 'literally' deadly serious topic."

And rounding out our first-place prizes was Best TV Documentary Under 25 Minutes, by Justin Monticello, Alex Manning, and Zach Weissmueller, for "This L.A. Musician Built $1,200 Tiny Houses for the Homeless. Then the City Seized Them." It was a special treat to watch a particularly damning clip from that knowing that Mayor Garcetti and his staff might still be in the room:

"Excellent storytelling," deemed the judges. "Presented both the city's effort and this citizen's effort. We enjoyed learning about this big hearted, conversation-starting, empathetic problem-solver."

Reason also racked up five second-place finishes and nine thirds.

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Georgia's Health Care Regulations Limit Access to Women's Health

State Supreme Court will hear challenge to Certificate of Need laws on Monday.

BSIP/NewscomBSIP/NewscomThe Georgia Supreme Court on Monday will hear oral arguments in a case challenging state regulations that limit access to essential health care for women and babies.

In Georgia, as in other states with Certificate of Need laws on the books, health care providers have to get permission from state bureaucrats before opening or expanding their medical facilities. In theory, these laws exist to allow the state to balance the needs of the public with the interests of hospitals and other health care providers, but in reality they often allow larger providers to veto unwanted competition.

In 2016, the Federal Trade Commission and the U.S. Department of Justice issued a joint statement calling for state governments to roll back CON laws in order to free health care markets and lower prices.

"CON laws raise considerable competitive concerns and generally do not appear to have achieved their intended benefits for health care consumers," the agencies concluded, warning that these laws have been exploited by competitors seeking to protect exclusive markets by raising the cost of entry.

That's what Dr. Hugo D. Ribot Jr. and Dr. Malcolm Barfield, owners of the Women's Surgical Center, LLC, say happened to them.

The two doctors perform hundreds of non-emergency outpatient OB/GYN surgeries every year. They wanted to add a second operating room—with the intention of renting it out to other surgeons who needed space—in order to serve more patients.

Three hospitals, including the Cartersville Medical Center, located across the street from the Women's Surgical Center, objected to their CON application. The Georgia Department of Community Health sided with the hospitals and denied the application.

The two doctors, represented by attorneys from the Arizona-based Goldwater Institute, a free market law firm, are asking the Georgia courts to strike down Georgia's medical CON laws so that licensed doctors are able to offer their services to the public without first complying with anti-competitive restraints.

Lower courts have upheld the state's CON laws, which have come under attack in recent years across the country. Many states added CON laws to their books in the 1970s, when they were mandated by Congress as part of an ill-advised effort to reduce health care costs. Congress reversed the mandate in the 1980s after the Congressional Budget Office found that CON laws often had the opposite effect on prices and the availability of care.

But more than 30 states still require medical providers to get state approval before opening new facilities or expanding existing ones. Those laws persist because of legislative inertia and because of the influence of the special interests—hospitals, mostly—that benefit from a time-consuming and bureaucratic process that blocks potential competition.

The consequences can be disastrous. In January, Reason reported on the years-long fight between two Virginia hospitals over the construction of a new neonatal intensive care unit. While the regulators were deliberating, a baby died at a hospital that had sought to build an NICU that might have saved the child. After the death, the state Department of Health still refused to grant a CON to the hospital.

The costs of CON laws aren't always obvious. In a paper published last year by the Mercatus Center at George Mason University, Thomas Stratmann and Davild Wille argue that hospitals in states with CON laws have higher mortality rates than hospitals in non-CON states. The average 30-day mortality rate for patients with pneumonia, heart failure, and heart attacks in states with CON laws is between 2.5 percent and 5 percent higher even after demographic factors are taken out of the equation.

Dumping Georgia's CON laws would allow Ribot and Barfield to expand their practice, giving women in Fulton County, Georgia, more options and greater access to non-emergency OB/GYN surgical care. If the state Supreme Court decides to keep those laws on the books, hospitals will win and women and babies will lose.

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Clarence Thomas and Neil Gorsuch Blast SCOTUS for Refusing to Hear Major Second Amendment Case

"I find it extremely improbable that the Framers understood the Second Amendment to protect little more than carrying a gun from the bedroom to the kitchen."

Fred Schilling, Collection of the Supreme Court of the United StatesFred Schilling, Collection of the Supreme Court of the United StatesToday the U.S. Supreme Court declined to hear a major case out of California that asked whether the Second Amendment right to keep and bear arms includes the right to carry firearms in public. By refusing to get involved, the Court left in place a ruling by the U.S. Court of Appeals for the 9th Circuit that denied constitutional recognition to the right to carry.

Writing in dissent, Justice Clarence Thomas, joined by Justice Neil Gorsuch, blasted the Court for its failure to act and for its "distressing trend" of treating "the Second Amendment as a disfavored right."

According to Thomas, "the Framers made a clear choice: They reserved to all Americans the right to bear arms for self-defense. I do not think we should stand by idly while a State denies its citizens that right, particularly when their very lives may depend on it." Thomas added, "even if other Members of the Court do not agree that the Second Amendment likely protects a right to public carry, the time has come for the Court to answer this important question definitively."

Thomas offered a sharply worded case for why the Court should have taken up the question. Federal circuits, he pointed out, have reached different conclusions and are therefore irrevocably split on this pressing constitutional matter. "This Court has already suggested that the Second Amendment protects the right to carry firearms in public in some fashion. As we explained in Heller, to 'bear arms' means to 'wear, bear, or carry upon the person or in the clothing or in a pocket, for the purpose of being armed and ready for offensive or defensive action in a case of conflict with another person.'" As Thomas observed, "I find it extremely improbable that the Framers understood the Second Amendment to protect little more than carrying a gun from the bedroom to the kitchen."

Today's case, known as Peruta v. California, centered on a state law that says that conceal-carry permits will only be issued to those persons who have demonstrated to the satisfaction of their local county sheriff that they have a "good cause" for carrying a concealed firearm in public. What counts as a "good cause?" In the words of one San Diego official, "one's personal safety is not considered good cause" in and of itself.

What this means in practice, as one earlier court ruling observed, is that "in California the only way that the typical responsible, law-abiding citizen can carry a weapon in public for the lawful purpose of self-defense is with a concealed-carry permit. And, in San Diego County, that option has been taken off the table."

Despite the strenuous protest of Justice Thomas and Justice Gorsuch, that option remains off the table thanks to the Supreme Court's inaction today.

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Supreme Court to Hear Case on Gay Wedding Cakes

Can states force religious bakers to provide services to same-sex couples?

wedding cakeJonathan Alcorn/ZUMAPRESS/NewscomIs a wedding cake speech? When a baker makes a wedding cake, is he or she declaring support for the couple's marriage? Can a baker decline to bake a cake for a gay couple (and defy a state's anti-discrimination laws) because he or she objects to same-sex marriage on religious grounds?

Today, the Supreme Court announced they would be taking up a case that may answer these questions for anyone who provides services for gay weddings. This is likely to be a case with a narrow ruling about religion and compelled speech and what constitutes an artistic expression. Don't expect a broad ruling that would change the nature of state-level public accommodation laws one way or the other.

In Masterpiece Bakeshop Ltd. Vs Colorado Civil Rights Commission the owner of a bakery in Lakewood, Colo., declined to bake a wedding cake for a gay couple because he had religious objections to same-sex marriage. In 2014 he was ruled to have violated the state's anti-discrimination laws on public accommodation.

He is one of a handful of similarly-minded business owners who offer their goods and services to weddings but oppose same-sex marriage recognition. We've seen other cases involving bakers, florists, photographers, and owners of private wedding venues.

The Supreme Court had previously turned away challenges to state-level antidiscrimination laws, but the court has been sitting on this case for months without deciding one way or another if they'd take it. Today was the last day in this session for the court to report out whether they would grant the case. After months of rescheduling, they've decided that they will.

The case will in all likelihood be very narrowly focused on whether the free speech and free religion rights of bakery owner Jack Phillips have been violated. The Supreme Court will have to consider whether the making of a wedding cake is a form of artistic impression and whether, therefore, laws forcing Phillips to serve same-sex couples constitutes compelled speech.

Historically, as I explained about these cases in 2015, courts have not determined cakes themselves to be expressive activity (therefore not protected speech). But text, writing, and imagery placed on the cake can be considered speech, and a bakery cannot be forced to communicate text or images they deem offensive. The question is whether the creation of a wedding cake itself is a form of speech.

Libertarians hoping for a broader ruling related to whether public accommodation laws violate the free association rights of business owners will probably be disappointed. There is zero chance this court is going to rule in such a way that alters state-level public accommodation laws. This case will mostly revolve around whether the activities of people like bakers and florists are considered artistic speech and therefore are possibly exempt from such laws.

Read more about the case itself from SCOTUSblog here.

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