† There’s Many A Slip ‘Twixt The Cup And Lip: Insurance commissioners in about half the states – including, CA, FL, HI, MI, NE, OK, TX, VA and WY - say they do not have the necessary legal authority to enforce consumer protections that take effect under ObamaCare next month, The New York Times reports:

Under the new federal standards, insurers generally must offer coverage to children under 19 and must allow adult children up to age 26 to stay on their parents’ policies. Insurers cannot charge co-payments for preventive services or impose a lifetime limit on benefits; must allow consumers to appeal a denial of benefits; and cannot rescind coverage, except in cases of fraud or intentional misrepresentation.

States have the primary role in enforcing many of the new standards. If a state fails to enforce a standard, the federal government will step in to do so — as it did in several states after passage of a health insurance law in 1996.

The federal government recently surveyed states to assess their enforcement capabilities, and the results suggest a patchwork of protections. …

Some state regulators said they would ask state legislators to expand their authority by putting the federal standards into state law next year. Others said they would rely on their powers of persuasion, the good will of insurers or general state laws that ban unfair or deceptive trade practices. …

The administration said its general approach was to have “states take a lead role in providing consumer protections, with federal enforcement only as a fallback measure.”

With insurers are already trying to sock it to consumers with hefty rate hikes before the new regs kick in, even officials in NJ, NY, OH and other states who that believe they have the authority to enforce the federal law are waiting for the Department of Health and Human Services to draw a bright line between increases that are “reasonable” and those that are “unreasonable.”

Editorial Note: For her part, Gov. Jan Brewer (R-AZ) says the state does not have the legal authority to compel insurers to follow the federal standards and she has “no plans” to pass the necessary legislation as the state is participating in a lawsuit challenging the Constitutionality of

the federal healthcare law.

† Woman Pretends She Was Kidnapped To Avoid Graduation Party: Nancy Salas, 22, who pretended she had been kidnapped to avoid telling her family she dropped out of UCLA, pleaded no contest to filing a false police report and was sentenced to three years’ probation and ordered to serve 100 hours of community service, The Associated Press reports.

† Updates To Previous Posts (sixth item, Is Obama Already A Lame Duck?): The Washington Post’s Chris Cillizza frames the choice faced by Dem incumbents and challengers as a biological response triggered when survival is at stake:

Fight or flight? … Is the best course to distance oneself from a president whose job-approval rating has sunk below 50 percent and whose appeal to independents has gone missing? Or to embrace him and his policies - the majority of which remain quite popular with the Democratic base that will be essential to any victories that the party claims this fall?  …

Even some Democratic candidates who are being heavily touted by the White House appear determined to keep the president at arm's length. Shortly after Obama played a lead role in helping Sen. Michael Bennet defeat former state House speaker Andrew Romanoff in a Democratic primary fight last Tuesday, Bennet was asked whether he would want the president to campaign with him this fall. "We'll have to see," Bennet told ABC's George Stephanopoulos - a response well short of a ringing endorsement of Obama's political standing.

One senior Democratic consultant suggested that the distance candidates are seeking to put between themselves and Obama is reflective of the ascendance of economic issues in voters' minds. "Barack Obama's economic policy of spending our way out of recession is seen as a failure at best and harmful at worst," the source said. "That should tell candidates in competitive jurisdictions all they need to know about running with the president."  …

"Even if it made strategic sense, it is hard for Democratic incumbents with a voting record to literally distance themselves from the president," said Democratic pollster Fred Yang.

† Updates To Previous Posts (fifth item, How ACORN Got Buried By “Squirrelly Right-Wingers”): The Second U.S. Circuit Court of Appeals upheld the Constitutionality of Congress stripping ACORN of federal funding in reaction to an embezzlement and mismanagement scandal, ruling that it is not a bill of attainder, New York Law Journal reports:

The circuit vacated an injunction issued by Eastern District Judge Nina Gershon, who had found that Congress intended to punish ACORN by withholding appropriations to the activist group, the money that made up some 10 percent of the crippled organization's national budget. …

The panel remanded the case of ACORN v. United States, 09-5172, to Judge Gershon for further proceedings on plaintiffs' claims under the First Amendment and due process clause. …

Judge Gershon issued a preliminary injunction on Dec. 11, 2009, and a permanent injunction and declaratory judgment in favor of ACORN on March 10, finding various appropriations laws unconstitutional.

She found ACORN had standing, and that it was singled out by Congress in a way that (1) fell within the historical meaning of legislative punishment, (2) did not further a non-punitive legislative purpose, and (3) showed evidence of intent to punish. …

Writing for the 2nd Circuit, Judge [Roger] Miner agreed with Judge Gershon that ACORN had standing and that it had, indeed, been singled out by Congress.

But he said, "The withholding of appropriations, however, does not constitute a traditional form of punishment that is 'considered to be punishment per se.'

"Congress's decision to withhold funds from ACORN and its affiliates constitutes neither imprisonment, banishment, nor death," he said. "The withholding of funds may arguably constitute a punitive confiscation of property at some point, but the plaintiffs do not assert that they have property rights to federal funds that have yet to be disbursed at the agency's discretion."

While ACORN and its affiliates said some members of Congress tainted them "with a note of infamy" and encouraged others to shun ACORN, Judge Miner said, "the plaintiffs are not prohibited from any activities, they are only prohibited from receiving federal funds to continue their activities." 

† Updates To Previous Posts (fifth item, Is This Any Way To Run A Transition?): Gen. David Petraeus is doubling down on the losing hand that Gen. Stanley McChrystal has dealt our troops in Afghanistan with his ridiculous rules of engagement, but to what avail? Not only we are needlessly sacrificing troops, but we get no credit for our restraint. Instead, paradoxically, every time an insurgent kills an Afghan civilian U.S. and coalition forces are blamed, reports The Washington Post:

Although NATO forces have largely made good on the pledge last year from Gen. Stanley A. McChrystal to decrease civilian casualties caused by their actions, the Taliban have ramped up their aggression, killing 920 civilians this year through suicide bombings, targeted assassinations and improvised explosive devices.

U.S. and NATO officials have used the figures to denounce the Taliban to win popular support for an increased presence that aims to clear out Taliban strongholds this fall. But ordinary Afghans have largely rejected this good guy-bad guy narrative and continue blaming the civilian deaths on the international forces, said experts who have studied the issue.

"What we found was that regardless of the region, province, education level or political views, in many cases Afghans blamed international forces as much as the insurgents for the increase," said Erica Gaston, a human rights lawyer focusing on civilian casualties for the Open Society Institute who recently interviewed 250 Afghans.

Afghans contend that the troops are not doing enough to protect them; that foreigners are ensconced behind fortified walls and bulletproof vehicles while residents are out in the open; and that the presence of foreigners in their neighborhoods brings unwanted attention from insurgents. …

"A lot of Afghans will come to coalition forces alleging civilian casualties that we caused. This is to be expected. We are the only identifiable force. The insurgents aren't," said Lt. Campbell Spencer, who works with the military's Civilian Casualty Tracking Cell. "We provide medical services and compensation payments as well."

Against this backdrop, now that he’s had six weeks to evaluate the situation in Afghanistan, The WaPo asked  Gen. David Petraeus whether “the counterinsurgency strategy, which emphasizes protecting the civilian population, can be effective in a country where many people regard the insurgents more as miscreant relatives than an existential threat”:

Petraeus refrained from an unequivocal endorsement.

"The enemy has shown himself to be resilient," he said. "The enemy does fight back. He is trying, in his assessment, to outlast us."

† Updates To Previous Posts (sixth item, Reality Check: Part IV): Washington Post political handicapper Chris Cillizza writes that the results of a Gallup study correlating a President’s approval rating with how his party fares in midterm elections “have to be worrisome for Democrats with just 81 days before the 2010 vote”:

In the seven midterm elections since World War II in which the president's approval rating was under 50 percent in the run-up to the vote, his party lost an average of 36 House seats. By contrast, presidents with approval ratings over 50 percent see their party shed an average of 14 seats.

In the most recent Gallup daily tracking poll, Obama's approval stands at 46 percent, and it has hovered between 44 percent and 47 percent for much of the last three months. …

If the 2010 election plays out to historic norms then, a 36-seat loss would keep Democrats in control of the House by a meager three seats - a scenario as nightmarish (or perhaps even more so) for the party in the run-up to the 2012 presidential race than losing control entirely.

Why? Such a narrow majority would virtually ensure gridlock far worse than what we have witnessed in the first two years of the President's term. And, Democrats would still have to deal with the political reality that they are the majority party - and, as such, the side expected to get things done in Washington.

Most Democratic strategists we talk to still argue that being in the majority even by a few seats is better than the alternative - due at least in part to the likelihood that Republicans would use their subpoena power to tie the Obama Administration in knots.

Whether Dems hang on to a bare majority or not, they loooosers either way. Personally, The Stiletto would like to stop the Obama administration in its tracks with subpoenas and filibusters so she’s hoping for a Repub majority. 

† Updates To Previous Posts (last item, Nationalized Healthcare Always Leads To Rationing): An analysis of data from the National Hospital Ambulatory Medical Care Survey for the years 1997 through 2007 by researchers from the University of California, San Francisco shows that adults on Medicaid preferentially used hospital emergency rooms for health care that could have been managed in a primary care clinic, reports USA Today:

The researchers classified emergency departments as "safety-net facilities" if more than 30% of all visitors were on Medicaid; if more than 30% of visits were by people without health insurance; or if more than 40% of visits were by Medicaid and uninsured patients.

The number of emergency departments designated as "safety net" centers increased from 1,770 in 2000 to 2,489 in 2007, the researchers found.

They found that during the time period studied, annual emergency department visits went from about 94.9 million to 116.8 million, an increase of 23%, which is almost twice what was expected based on population growth, they said. …

But there could soon be a problem with demand and supply: At the same time that ER visits mushroomed, the number of emergency departments fell by 5%, the researchers noted.

Moreover, visits among people receiving Medicaid went from about 694 visits per 1,000 people to about 947 visits per 1,000 people, while visits by adults with private insurance, no insurance or Medicare remained stable, they found.

Because of increased volume, median wait time for treatment increased from 22 to 33 minutes during the study period.

The researchers point to access to primary care driving the trend, and call for additional research to determine whether it’s because primary care physicians are not accepting new patients with Medicaid or there are too few primary care physicians.