04 20 2015
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  • When should we use military to enforce US goals? NASHUA, N.H. (AP) — Rand Paul lashed out Saturday at military hawks in the Republican Party in a clash over foreign policy dividing the packed GOP presidential field. Paul, a first-term senator from Kentucky who favors a smaller U.S. footprint in the world, said that some of his Republican colleagues would do more harm in international affairs than would leading Democrat Hillary Rodham Clinton. "The other Republicans will criticize the president and Hillary Clinton for their foreign policy, but they would just have done the same thing — just 10 times over," Paul said on the closing day of a New Hampshire GOP conference that brought about 20 presidential prospects to the first-in-the-nation primary state. "There's a group of folks in our party who would have troops in six countries right now, maybe more," Paul said. Foreign policy looms large in the presidential race as the U.S. struggles to resolve diplomatic and military conflicts across the globe. The GOP presidential class regularly rails against President Barack Obama's leadership on the world stage, yet some would-be contenders have yet to articulate their own positions, while others offered sharply different visions. Former Florida Gov. Jeb Bush, whose brother, President George W. Bush, authorized the 2003 invasion of Iraq, declined to say whether he would have done anything different then. Yet Jeb Bush acknowledged a shift in his party against new military action abroad. "Our enemies need to fear us, a little bit, just enough for them to deter the actions that create insecurity," Bush said earlier in the conference. He said restoring alliances "that will create less likelihood of America's boots on the ground has to be the priority, the first priority of the next president." The GOP's hawks were well represented at the event, led by Florida Sen. Marco Rubio and Wisconsin Gov. Scott Walker, who has limited foreign policy experience but articulated a muscular vision during his Saturday keynote address. Walker said the threats posed by radical Islamic terrorism won't be handled simply with "a couple bombings." "We're not going to wait till they bring the fight to us," Walker said. "We're going to bring the fight to them and fight on their soil." South Carolina Sen. Lindsey Graham addressed the question of putting U.S. troops directly in the battle against the Islamic State group militants by saying there is only one way to defeat the militants: "You go over there and you fight them so they don't come here." Texas Sen. Ted Cruz suggested an aggressive approach as well. "The way to defeat ISIS is a simple and clear military objective," he said. "We will destroy them." Businesswoman Carly Fiorina offered a similar outlook. "The world is a more dangerous and more tragic place when America is not leading. And America has not led for quite some time," she said. Under Obama, a U.S.-led coalition of Western and Arab countries is conducting regular airstrikes against Islamic State targets in Iraq and Syria. The U.S. also has hundreds of military advisers in Iraq helping Iraqi security forces plan operations against the Islamic State, which occupies large chunks of northern and western Iraq. Paul didn't totally reject the use of military force, noting that he recently introduced a declaration of war against the Islamic State group. But in an interview with The Associated Press, he emphasized the importance of diplomacy. He singled out Russia and China, which have complicated relationships with the U.S., as countries that could contribute to U.S. foreign policy interests. "I think the Russians and the Chinese have great potential to help make the world a better place," he said. "I don't say that naively that they're going to, but they have the potential to." Paul suggested the Russians could help by getting Syrian President Bashar Assad to leave power. "Maybe he goes to Russia," Paul said. Despite tensions with the U.S., Russia and China negotiated alongside Washington in nuclear talks with Iran. Paul has said he is keeping an open mind about the nuclear negotiations. "The people who already are very skeptical, very doubtful, may not like the president for partisan reasons," he said, and "just may want war instead of negotiations."
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  • Some lawmakers, sensing a tipping point, are backing the parents and teachers who complain about 'high stakes' tests   
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WASHINGTON (AP) -- Medicare's payment system, the unseen but vital network that handles 100 million monthly claims, could freeze up if President Barack Obama's health care law is summarily overturned, the administration has quietly informed the courts.

Although Obama's overhaul made significant cuts to providers and improved prescription and preventive benefits, Medicare was overlooked in Supreme Court arguments that focused on the law's controversial requirement that individuals carry health insurance.

Yet havoc for Medicare could have repercussions as both parties avidly court seniors in this election year and as hospitals and doctors increasingly complain the program doesn't pay enough.

In papers filed with the Supreme Court, administration lawyers have warned of "extraordinary disruption" if Medicare is forced to unwind countless transactions that are based on payment changes required by more than 20 separate sections of the Affordable Care Act.

Opponents say the whole law must go. The administration counters that even if it strikes down the insurance mandate, the court should preserve most of the rest of the legislation. That would leave in place its changes to Medicare as well as a major expansion of Medicaid coverage.

Last year, in a lower court filing on the case, Justice Department lawyers said reversing the Medicare payment changes "would impose staggering administrative burdens" on the government and "could cause major delays and errors" in claims payment.

Former program administrators disagree on the potential for major disruptions, while some private industry executives predict an avalanche of litigation unless Congress intervenes.

AARP says it's concerned. If doctors became embroiled in a legal battle over payments, then "a general concern would be that physicians would cease to take on new Medicare patients, as well as potentially have issues seeing their current patients," said Ariel Gonzalez, top health care lobbyist for the organization.

Medicare payment policies are set through a time-consuming process that begins with legislation passed by Congress. Even if the law were completely overturned, the government still would have authority under previous legislation to pay hospitals, doctors, insurance plans, nursing homes and other providers.

"There is an independent legal basis to pay providers if the Supreme Court strikes down the entire law," said Thomas Barker, a former Health and Human Services general counsel in the George W. Bush administration.

But reversing the new law's payment changes from one day to the next would be a huge legal and logistical challenge, raising many questions. How would Medicare treat payments made over the last two years, when the overhaul has been the law of the land? Would providers who have received cuts subsequently have a right to refunds?

"Medicare cannot turn on a dime," said former administrator Don Berwick, Obama's first Medicare chief. "I would not be surprised if there are delays and problems with payment flow. Medicare has dealt with sudden changes in payment before, but it is not easy."

It's not just reimbursement levels that would get scrambled, Berwick said. The law's new philosophy of paying hospitals and doctors for quality results, rather than for sheer volume of tests and procedures, has been incorporated in some payment policies.

Tom Scully, who ran Medicare during former President George W. Bush's first term, does not foresee major problems, although he acknowledges it would be a "nightmare" for agency bureaucrats.

"It is highly unlikely in the short term that any health plan or provider would suffer," said Scully. "They're probably likely to get paid more going forward. If you look at the way the law was (financed), it was a combination of higher taxes and lower (Medicare) payments. That's what you would be rolling back."

The White House declined to comment.

Administration officials say they are confident the entire law will be upheld by the Supreme Court, and there's no contingency planning to address whether all or parts of it are struck down. Sharp questioning by the court's conservative justices during public arguments has led many to speculate that at least some parts of the law will be struck down.

Opponents of the law argue that Congress overstepped its constitutional authority by requiring most Americans to have health insurance, starting in 2014. The administration says the mandate is permissible because it serves to regulate interstate commerce, underpinning another provision of the law that requires insurance companies to accept people in poor health. A decision is expected by early summer.

Former officials say it's likely that some form of high-level assessment and planning is going on within the administration. It has happened in the recent past.

Last year, when the GOP-led House threatened to block funding for carrying out Obama's law, Health and Human Services Secretary Kathleen Sebelius wrote to Congress outlining potential consequences. She said the administration might have to suspend payments to Medicare Advantage plans, popular private insurance alternatives that cover about one-fourth of all beneficiaries. That would have sent millions of seniors back into traditional Medicare, scrambling to find new doctors and coping with higher out-of-pocket costs.

Scully dismissed the notion that private Medicare plans would be jeopardized if the Supreme Court throws out the law.

"The idea that Medicare Advantage plans would shut down and patients would be thrown into the street is just people making up arguments to stir the pot," he said.

Repeal of the law would also mean that seniors would lose some new benefits, including the closing of the prescription coverage gap called the "doughnut hole," and no-charge preventive services such as an annual wellness physical.

"There is no doubt that striking down (the) Medicare provisions would be enormously disruptive for patients, physicians, hospitals and countless other providers and suppliers," said Rep. Sander Levin, D-Mich., ranking Democrat on the House Ways and Means Committee, which oversees the program.

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