Obama reaps victory as judges uphold health law (AP)

CINCINNATI – In the first ruling by a federal appeals court on President Barack Obama's health care overhaul, a panel in Cincinnati handed the administration a victory Wednesday by agreeing that the government can require a minimum amount of insurance for Americans.

A Republican-appointed judge joined with a Democratic appointee for the 2-1 majority in another milestone for Obama's hotly debated signature domestic initiative — the first time a Republican federal court appointee has affirmed the merits of the law.

The White House and Justice Department hailed the panel's affirmation of an earlier ruling by a federal court in Michigan; opponents of the law said challenges will continue to the U.S. Supreme Court.

At issue is a conservative law center's lawsuit arguing on behalf of plaintiffs that potentially requiring them to buy insurance or face penalties could subject them to financial hardship. The suit warns that the law is too broad and could lead to more federal mandates.

The Thomas More Law Center, based in Ann Arbor, Mich., argued before the panel that the law was unconstitutional and that Congress overstepped its powers.

The government countered that the measure was needed for the overall goal of reducing health care costs and reforms such as protecting people with pre-existing conditions. It said the coverage mandate will help keep the costs of changes from being shifted to households and providers.

White House adviser Stephanie Cutter called the ruling "another victory" for millions of Americans and small businesses benefiting from the overhaul.

"At the end of the day, we are confident the constitutionality of these landmark reforms will be upheld," she said in a statement.

The law center predicted its case would have a good shot on appeal.

"Clearly our case won't resolve all the issues, because we don't raise the state rights issue, but we are the only one that is currently ripe for Supreme Court review that raises the challenge on behalf of an individual," said David Yerushalmi, an attorney for the law center.

The three-judge 6th U.S. Circuit Court of Appeals panel delivered a lengthy opinion with disagreement on some issues, moving unusually quickly in delivering its decision less than a month after hearing oral arguments.

"Congress had a rational basis for concluding that the minimum coverage provision is essential to the Affordable Care Act's larger reforms to the national markets in health care delivery and health insurance," Judge Boyce F. Martin, appointed by former President Jimmy Carter, wrote for the majority.

A George W. Bush appointee concurred; a Ronald Reagan appointee who is a U.S. district judge in Columbus sitting on the panel disagreed. Judges are selected for panels through random draw.

"If the exercise of power is allowed and the mandate upheld, it is difficult to see what the limits on Congress' Commerce Clause authority would be," warned dissenting Judge James Graham of Columbus. "What aspect of human activity would escape federal power?"

Judge Jeffrey Sutton, the Bush appointee, delivered the decisive vote, although his opinion raised questions and noted the unusual nature of a law directed at someone who chooses inaction, referring to those "who prize that most American of freedoms: to be left alone."

But the government argued that telling someone to buy health insurance, something that virtually everyone needs and is part of a sweeping effort, isn't the same as ordering them to buy a car or a vegetable.

"The novelty of the individual mandate may indeed suggest it is a bridge too far, but it also may offer one more example of a policy necessity giving birth to an inventive (and constitutional) congressional solution," Sutton wrote.

The opinion by Sutton, a well-respected conservative jurist, will be studied closely by other courts, said a law professor at Virginia's University of Richmond.

"His opinion is comprehensive and cautious and careful, but I think it comes out to pretty much the same conclusion as Judge Martin's," Carl Tobias said in a telephone interview.

An attorney for Thomas More said the center expects to appeal. It could ask for the full circuit court to review the case or go on to the U.S. Supreme Court. The 16-seat 6th Circuit has one vacancy.

Among those supporting the center in court documents in the case — titled Thomas More Law Center, et al, vs. Barack Hussein Obama, et al — were Republican presidential candidates Michelle Bachmann and Ron Paul and several other members of Congress including Rep. Jean Schmidt, R-Ohio.

More than 30 legal challenges have been filed over the health care overhaul, some focusing on different issues such as states' rights. Earlier decisions at the U.S. district court level have found Republican-appointed judges opposing and Democrat-appointed judges affirming.

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Associated Press writers Lisa Cornwell in Cincinnati and Ricardo Alonso-Zaldivar and Mark Sherman in Washington contributed to this report.

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Dan Sewell can be reached at http://www.twitter.com/dansewell.

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NJ doctors' group suing to block health care law (AP)

NEWARK, N.J. – A federal appeals court hearing arguments Wednesday in a lawsuit challenging the constitutionality of last year's U.S. health reform law focused primarily on whether plaintiffs need to demonstrate they are suffering economic harm now or will when the part of the law mandating that everyone have health coverage takes effect.

The lawsuit was filed last year by New Jersey Physicians Inc., described as an advocate for doctors and patients, and by a patient identified only as John Doe. It challenges the law's requirement that citizens purchase insurance.

The suit was dismissed in December by a U.S. District judge who ruled the patient didn't have standing to sue because he could be covered by an employer's health plan by 2014, when the insurance requirement takes effect.

More than two dozen states have challenged the health care overhaul in similar lawsuits, contending it exceeds the federal government's powers. This week, a New Jersey state lawmaker introduced a bill that would nullify the health care law and fine or imprison any federal employee or contractor who attempts to enforce it.

In arguments before the three-judge panel in Newark on Wednesday, plaintiffs' attorney Robert Conroy said even though the patient in 2014 might have a job that could provide him with health insurance, he should have the right to choose whether or not to accept it without facing a penalty for not doing so, as he would under the law.

"He doesn't want to buy insurance, and he shouldn't be required to buy insurance under the Constitution," Conroy told the judges.

U.S. 3rd Circuit Court of Appeals Judge Michael Chagares noted that not enough is known about the patient's insurance status now, making it difficult to assess how it would be affected in the future.

"We have to satisfy ourselves there's a concrete injury or there's actual harm," he said.

Deputy Assistant Attorney General Beth Brinkmann, arguing for the government, conceded that plaintiffs may have an easier time being granted standing to sue as the time approaches for the law to be implemented. While there is no specific economic impact now, she said, if a person is employed in 2014 and doesn't want insurance, there could be stronger grounds for suing.

"What's the time frame?" Judge Kent Jordan asked. "Six months? A year?"

"A reasonable time" before the law takes effect, Brinkmann replied.

Conroy also argued that doctors such as New Jersey Physicians' head, Mario Criscito, will be harmed by the law because their fees could decrease. The judges questioned whether those claims were too speculative to determine whether the current suit should go forward.

The judges didn't indicate when they would publish a ruling.

Criscito, who was not at Wednesday's arguments, is no stranger to the court system. In March, a federal judge ordered him to pay more than $4 million to a group of cardiologists who accused him of mismanaging their pension fund over a 30-year period ending in 2007. Conroy, who represents Criscito in the matter, said the judgment is being appealed.

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Mladic's poor health should bar extradition: son (Reuters)

BELGRADE (Reuters) – A son of Ratko Mladic said on Friday his family believed the Bosnian Serb wartime general should not be extradited to face genocide charges because of his poor health.

"We are almost certain he cannot be extradited in such condition," said Darko Mladic, who said family members had met Ratko earlier for the first time for many years.

Mladic was later interviewed by an investigative judge at the Belgrade special war crimes court, and is expected to be extradited to face genocide charges at the International Criminal Tribunal for the former Yugoslavia in The Hague.

"He is in very bad shape. His right arm is half paralyzed. His right side is partly numb," Darko Mladic said.

Mladic has received some treatment, Darko said. "But we have asked that he should be transferred to the military hospital and we have sought an independent medical team from Russia to oversee his treatment."

"He recognized us, he is aware that he is in court detention," Darko said.

Asked what it was like to see his father after a gap of so many years, he replied: "Imagine." He declined to comment on his father's whereabouts over the last decade. "This is the first time we see him."

He said a cardiologist and a neurologist had agreed to come from Moscow and help with his father's treatment but added this depended on obtaining the approval of the court.

Mladic, accused of orchestrating the 43-month siege of the Bosnian capital Sarajevo and the massacre of 8,000 Muslim men and boys from the town of Srebrenica in July 1995, was found in a farmhouse owned by a cousin about 100 km (60 miles) from Belgrade.

The arrest on Thursday of Mladic, the last of the three men accused of instigating ethnic cleansing during the 1992-95 Bosnian war, was expected to clear the way for the former pariah state Serbia to join the European Union.

(Reporting by Aleksandar Vasovic; Writing by Maja Zuvela; Editing by Tim Pearce)

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Mitt Romney’s authenticity appeal on health care

Former Massachusetts governor Mitt Romney used a speech on health care today in Michigan to send a broader message about his commitment to authenticity in the 2012 presidential race.

Speaking to a small group of invited guests and reporters at the University of Michigan this afternoon, Romney, as expected, refused to apologize for signing a health care law in Massachusetts that has drawn unfavorable comparisons among Republicans to the national law put in place by President Obama.

“It wouldn’t be honest,” Romney said about calls for him to apologize for the Massachusetts law. “ I did what I believed was right for the people of my state.”

Later, Romney noted that his current health care proposal was very similar to what he proposed during the 2008 campaign despite the fact that his experience in Massachusetts had gone from a political positive to a negative over the past three plus years. “I am not adjusting the plan to reflect the political sentiment,” Romney said.

After walking the audience through the “why” of the Massachusetts plan, Romney acknowledged that “that explanation is not going to satisfy everybody” and added: “I respect the views of people who think we took the wrong course.”

But, it wasn’t just the words Romney used that aimed to push the authenticity narrative.

He spoke without a prepared script and without a TelePrompter, choosing instead to use a PowerPoint presentation to make his case. He wore no tie. He was accompanied to the speech by just three staffers.

The entire presentation screamed openness, pushing the idea that Romney is someone willing to be transparent about what he believes and why he believes it.

All of that is in striking contrast to the way Romney ran in 2008 when his flip-flops on social issues created a destructive storyline that he lacked conviction on any issue — choosing only to take the politically expedient path in every situation.

He and his political team have clearly made the calculation that the only strategic path for Romney to win the nomination is to “let Mitt be Mitt” — to embrace rather than run from his past records and statements.

That approach is not without political peril. Even before he spoke today, Romney was already faced with a quote from the 1990s unearthed by a liberal Massachusetts blog in which he expressed support for the idea of a federal mandate that would require everyone to purchase some form of health insurance, a major no-no for conservative voters.

And Romney’s opponents for the 2012 GOP nomination will spend untold hours combing through his record to find other instances where, on health care and other issues, he has contradicted himself to try and play up the flip-flop narrative.

But today’s speech was a clear attempt by Romney’s campaign to send the field a message: Romney is done running from his record. The question in the days, weeks and months to come is whether that strategy is the right one.

View Romney’s presentation:

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Romney leads the GOP field on health care — at least in the real world

What makes Mitt Romney’s health-care troubles particularly perverse is that, by all rights, he’s the one candidate in the Republican field who’s really accomplished something on the issue. This graph uses data from the Kaiser Family Foundation to chart the number of uninsured in each Republican contender’s home state. In states where there are two likely Republicans — say, Minnesota, where both Tim Pawlenty and Michele Bachmann receive their mail, or Texas, which elected both Ron Paul and Rick Perry — I’ve grouped them together. Look who comes out ahead. And not by a little:

Moreover, Donald Trump can’t be blamed for New York’s rate of uninsurance. Tim Pawlenty hasn’t done much to change Minnesota’s health-care system one way or the other. But Massachusetts’s leadership on this graph is substantially due to decisions Romney made as governor. Romney doesn’t look good because the Dukakis administration did the work for him, though the Dukakis administration did pass some important health-care reforms. Romney looks good because he achieved something important.

Romney’s record looks worse, it should be said, if you focus on costs. Massachusetts had the highest per-person costs when Romney took office and it has the highest per-person costs now. His reforms largely dodged the cost issue, arguing that access was a necessary precondition for cost control, and so it needed to be done first. In the individual and small-group markets where his reforms focused, however, insurance has become, on net, more affordable.

To his credit, though, the theory that expanding access can align the political incentives toward cost control is largely working out. The reforms gave the Massachusetts political establishment something to protect, and so they’ve begun focusing seriously on the sort of real cost controls needed to make near-universal coverage sustainable. The Patrick administration has proposed one of the most far-reaching cost control efforts ever seen on the state level, and the state’s largest health insurer is carrying out the most promising payment experiment we’ve seen in some time. Romney has a lot to be proud of, even if he’s not supposed to say so.

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