Everything You Need to Know About the Health Care Case

By Ezra Klein, The Washington Post

26 March 12

 

Today's the day. The Supreme Court will begin hearing oral arguments as to the constitutionality of various provisions of the Affordable Care Act. Note that phrase: "Various provisions." The Supreme Court is not looking at the act as a whole. Rather, it's considering four separate questions related to separate parts of the law. Here's my colleague Sarah Kliff with a primer of what they are, and why they matter. And after that, a special round-up of news, analysis, and opinion on the subject. And after that, your regularly scheduled Wonkbook:

n Monday morning, at 10 a.m., the Supreme Court of the United States will open oral arguments on the health reform law. The hearing will last six hours and stretch over three days, the longest arguments in 45 years.

One reason these oral arguments will last so long has to do with the variety of the topics that the justices will address. The Court won't consider the Affordable Care Act as one single issue, but rather has broken the case into four, separate issues. Here's a Wonkblog guide to what those issues are, how each side will argue, when it happens, and why it matters. One quick programming note: While the Supreme Court's arguments will not be broadcast live, C-Span has said it will make them available within a few hours of their conclusion each day here.

Anti-Injunction Act

What it is: The Court opens its oral arguments with a debate over whether it can even issue a ruling on the Affordable Care Act since its penalties for not carrying insurance have not come into effect yet. Under a law passed in 1867, the Anti-Injunction Act, a tax cannot be challenged until someone has actually had to pay it. Health reform's penalties don't start until 2015.

What they'll argue: One weird quirk of this provision is that neither the defendants or plaintiffs think it applies: Both sides think the Court should be able to rule right now . So the court appointed an outside lawyer, Robert Long, to argue on their behalf. Long will likely look to the Fourth Circuit Court of Appeals for precedent. It ruled, in September, that the Anti-Injunction Act prevented it from issuing a ruling on the health law.

When it happens: Monday, March 26, 10-11:30 a.m.

Why it matters: The Anti-Injunction Act gives the Supreme Court an opportunity to put off its decision for at least three years, potentially diffusing the law slightly as a 2012 election year issue. This could be a mixed-bag for health care supporters: On the one hand, it gives the law three more years to be implemented. On the other, it would still make the law's fate seem uncertain, and likely extend the national debate around the Affordable Care Act.

The individual mandate

What it is: The most-contested part of the health reform law, the Affordable Care Act's individual mandate requires nearly all Americans to carry health insurance. The legal question centers on whether such a regulation is permissible under the Commerce Clause, which allows the federal government to regulate interstate activity.

What they'll argue: Health reform opponents contend that the decision not to do something - namely, not buy health insurance - is economic inactivity, rather than activity, and therefore not a behavior the federal government can regulate. Health reform supporters argue that the decision to not purchase health insurance has an economic effect. An individual without coverage, for example, may not have the money to pay for an emergency room visit, sticking hospitals or taxpayers with the bill.

When it happens: Tuesday, March 27, 10 a.m. - 12 p.m.

Why it matters: With no penalty for not purchasing health insurance, but a requirement for insurers to accept anyone still standing, many expect the costs of insurance would skyrocket. Congress could, theoretically, replace the individual mandate with another policy that doesn't run afoul of the activity-inactivity distinction but it is unlikely that congressional Republicans would permit such a fix, at least in the near term.

Severability

What it is: The question of whether the health reform law can stand without the individual mandate - in legal parlance, whether the individual mandate is “severable” - is a pretty crucial one. The Supreme Court will hear arguments on if it could strike down that part of the law, while letting the rest of it stand.

What they'll argue: The Department of Justice says that if the court strikes down the mandate, it should also repeal the health reform law's guaranteed issue provision, which requires insurers to accept all customers regardless of their health-care status. The argument there is that the mandate is so integral to making insurance work - by getting the healthy people to sign up - that, without it, insurance markets could no longer accept all applicants. Opponents of the law go even further. They contend that because of how the law was written - without a clause that specifically noted that individual provisions could be severable - that the whole thing should fall with the mandate.

The Eleventh Circuit Court of Appeals came to an opposition conclusion: It overturned the mandate, but allowed the rest of the law to stand, even the parts that the Justice Department says should have fallen.

When it happens: Wednesday, March 28, 10 - 11:30 a.m.

Why it matters: If the Court finds the individual mandate unconstitutional, then severability will become a key issue in determining how much of the law falls with it. It could decide that just the mandate falls, leaving the insurance industry with a pretty big challenge. Or it could rule that the mandated purchase of health insurance is so critical to the health reform law that if it goes down, it takes other key parts of the Affordable Care Act with it.

Medicaid Expansion

What it is: The health reform law expands Medicaid to cover everyone under 133 percent of the federal poverty line (about $14,000 for an individual) in 2014. Medicaid is run as a state-federal partnership and, right now, states are only required to cover specific demographics, groups like low-income, pregnant women and the blind or disabled.

What they'll argue: The states contend that this provision is too onerous: They'll be responsible for footing part of the Medicaid expansion's bill, and say they can't afford the costs. The federal government, for its part, has centered its argument on the fact that states voluntarily participate in Medicaid. If they don't like the new expansion, they could pull out of the program.

When it happens: Wednesday, March 28, 1-2 p.m.

Why it matters: Since states' participation in Medicaid is voluntary, Supreme Court watchers widely expect the justices to find this part of the law constitutional. There is worry though, that if they were to strike down this part of the law, it could set sweeping new precedent for how state-federal partnership programs function.

Wonkbook's SCOTUS Obamacare Primer

Barnes previews: "The Supreme Court on Monday joins the nation's vitriolic debate over the landmark health-care law and the limits of federal power. And though thousands of pages of legal arguments about the Constitution's history and the court's precedents have landed on justices' desks, the outcome may also hinge on less tangible factors. Public opinion. The nation's volatile political climate. The court's self-consciousness about its own partisan divide. And the pivotal role it plays in deciding the nation's thorniest social issues." Robert Barnes in The Washington Post.

This may be one of the most important cases in history. "American constitutional history has not moved in a straight line, from the Founding to the 21st Century. Its development is a wavering line, with twists and turns that were far from predictable. The amendment process under Article V has followed a meandering path - in fact, the latest amendment, the 27th, dealing with congressional salaries and ratified in 1992, was actually one of the first proposed, in 1789. Meandering, too, have been the Supreme Court's interpretations of what the Constitution ultimately means - for any given day and time...By week's end, America will have witnessed - for most people, from afar, because only a couple of hundred seats are available for those who will see it actually happen - a deeply serious and probably quite revealing conversation about the Constitution and what it might mean 225 years after it was written." Lyle Denniston in SCOTUSblog.

@chucktodd: This spin I'm hearing from both sides about how losing in Supreme Court on health care could be good for them politically I think is bunk

@conncarroll: if Court strikes down Ocare, Romney has easy line to separate himself from Obama: "My law is constitutional. Yours was not."

The story of how the legal challenge to Obamacare went mainstream. "When President Barack Obama signed the health care bill two years ago, the legal challenges to the law were widely belittled as long shots - at best. But as the cases head to the Supreme Court this week, what looked to many like far-out legal arguments to undo 'Obamacare' don't seem so zany anymore...Many legal scholars, including respected conservatives, pooh-poohed the idea that the courts might actually strike down the law or the individual mandate requiring most Americans to get health insurance or pay a fine. Yet on Monday, three days of oral arguments about the law begin at the high court - the most time justices have devoted to a single law since 1966. The challengers' journey from the near-fringe of legal thought to coming within striking distance of knocking out Obama's signature legislative achievement has coupled an intense legal assault with a communications drive to convince elites and the public that the law violates the Constitution." Josh Gerstein in Politico.

@BuzzFeedAndrew: Imagine a 2008 debate between Obama and Romney with Romney arguing for a mandate and Obama arguing against one. Parallel Universe.

MEET THE SOLICITORS: Donald Verrilli and Paul Clement.

SYMPOSIUMS: The New York Times and The National Review.

CHART: What happens if the individual mandate falls, in one chart.

PROFILE: Meet Justice Anthony Kennedy, the Supreme Court's swing vote.

Five myths about the health-care law: http://wapo.st/GRphTa.

Many lined up for a chance to attend the arguments. "Heading into the first of three days of Supreme Court arguments on Monday, the pavement occupied by the approximately 15 people in line Sunday morning was among the most coveted real estate in Washington. Tickets are scarce even for those connected to the case. And for everyone else, there’s the line. It started with two people who were in line by 9:30 a.m. on Friday, waiting to score one of at least 60 seats made available to the general public for each day of arguments, said Kathy Arberg, a Supreme Court spokeswoman...In Washington, anyone who wants to attend a judicial or Congressional hearing and can afford to spend $36 to $50 an hour can hire professional 'line standers' through companies like Washington Express to do the waiting for them. LineStanding.com, which had people waiting outside the court over the weekend, lets customers choose how early they want their surrogate to arrive, including an option labeled 'please put us at the front of the line.'" Emmarie Huetteman in The New York Times.

GREENHOUSE: The legal question is clear. "Free of convention, and fresh from reading the main briefs in the case to be argued before the Supreme Court next week, I’m here to tell you...The constitutional challenge to the law’s requirement for people to buy health insurance - specifically, the argument that the mandate exceeds Congress’s power under the Commerce Clause - is rhetorically powerful but analytically so weak that it dissolves on close inspection. There’s just no there there." Linda Greenhouse in The New York Times.

SOMIN: The individual mandate is unconstitutional. "The federal government claims that this is a special case because everyone eventually uses health care. But this argument relies on shifting the focus from health insurance to health care. A similar ploy can justify any other mandate, including even the much-discussed 'broccoli purchase mandate.' Not everyone eats broccoli. But everyone surely participates in the market for food. Many also argue that health insurance is special because producers are sometimes required to give free services to the uninsured. But why is this fact relevant to Congress’ commerce power? The usual answer is that failure to purchase insurance thereby has adverse economic effects on producers. But any time someone fails to purchase any product, producer profits are lower than they would be otherwise. The government’s other justifications for the mandate are also essentially rationales for unlimited federal power." Ilya Somin in The New York Times.

BLOOMBERG VIEW: Health care is not broccoli. "Here is where they invoke broccoli. If Congress can force me to buy health insurance, they ask -- and this analogy has actually appeared in a federal judicial opinion -- can’t it also force me to eat broccoli? In a word (or two): Yes and no. Congress could certainly pass a law requiring the consumption of broccoli. And the courts would certainly invalidate it. Without disputing the point that the Constitution grants the U.S. government only limited powers, it is easy to conclude that Congress is well within its authority to enact the individual mandate. Every American, by virtue of his or her existence, is a consumer of health care. The same, sadly, cannot be said for broccoli. Health care accounts for about 18 percent of the economy, and an even larger share of the federal budget. Hospitals and insurance companies and their affiliates operate and treat patients on a national scale and across state lines. Precise figures are unavailable, but broccoli’s role in the U.S. economy is considerably smaller." The editors at Bloomberg View .

LITHWICK: This is about politics, not law. "The law is a completely valid exercise of Congress’ Commerce Clause power, and all the conservative longing for the good old days of the pre-New Deal courts won’t put us back in those days as if by magic. Nor does it amount to much of an argument. So that brings us to the really interesting question: Will the Court’s five conservatives strike it down regardless? That’s what we’re really talking about next week and that has almost nothing to do with law and everything to do with optics, politics, and public opinion. That means that Justice Antonin Scalia’s opinion in the Raich medicinal marijuana case, and Chief Justice John Roberts’ and Anthony Kennedy’s opinions in Comstock only get us so far. Despite the fact that reading the entrails of those opinions suggest that they’d contribute to an easy fifth, sixth, and seventh vote to uphold the individual mandate as a legitimate exercise of Congressional power, the real question isn’t whether those Justices will be bound by 70 years of precedent or their own prior writings on federal power. The only question is whether they will ignore it all to deprive the Obama of one of his signature accomplishments." Dahlia Lithwick in Slate.

EMANUEL: Even if the Court strikes down the mandate, it won't be the end of health care reform. "What if the Supreme Court declares unconstitutional the Affordable Care Act’s requirement that everyone buy health insurance? What if it strikes down all the act’s insurance provisions, including the requirement that insurance companies cover everyone, regardless of pre-existing illnesses? Would this totally put an end to the health care reforms we have passed in the last three years? Absolutely not. The essence of the case the Supreme Court will begin hearing on Monday is whether, invoking its powers in the commerce clause of the Constitution, Congress can require individuals to purchase health insurance or pay a penalty. I believe the mandate is constitutional, but no matter how the court rules, many health care reforms that were approved by Congress through the Affordable Care Act and other recent bills -- like those to promote electronic health records, encourage coordinated care, reduce medical errors and cut costs -- will proceed." Ezekiel Emanuel in The New York Times.

@sarahkliff: Even puppies want to hear SCOTUS argue health reform. http://pic.twitter.com/7MPFaL17

Top stories

1) House Democrats are set to back a budget with deep cuts. "Despite some deep reservations, rank-and-file House Democrats seem poised to rally behind their party's main alternative to Republicans’ 2013 budget. Although almost 100 Democrats opposed August's debt-ceiling deal over its deep cuts and lack of stimulus spending, many of those same lawmakers appear ready to back Rep. Chris Van Hollen's (D-Md.) coming budget proposal, which will cap discretionary spending at the very same level. The Democrats say their hope to distinguish their party's plan from the Republicans' bill -- combined with the need for party unity in a high-stakes election year -- will likely trump their concerns over the top-line figure expected in the Van Hollen proposal...Van Hollen confirmed that his budget will adhere to the August debt deal, which capped discretionary spending at $1.047 trillion in fiscal year 2013, while using a combination of mandatory spending cuts and tax revenue increases to turn off the BCA's automatic cuts." Mike Lillis and Erik Wasson in The Hill.

2) Rick Santorum won the Louisiana primary. "Rick Santorum won the Louisiana primary on Saturday, boosting his claim as the leader of the conservative wing of the Republican Party even as his odds of beating Mitt Romney in the overall delegate race appear slim. With nearly 95 percent of precincts reporting, Santorum led Romney 49 percent to 27 percent. Former House Speaker Newt Gingrich was third with 16 percent and Rep. Ron Paul (R-Texas) was taking 6 percent...Romney’s defeat represented the latest setback in the South for the front-runner, who has lost primaries in six Southern states this month and also lost a key primary earlier this year in South Carolina. Santorum, meanwhile, can again claim momentum based on a strong showing in a heavily conservative state. He has won seven contests for the Republican presidential nomination this month, including five in the South." T.W. Farnam and Aaron Blake in The Washington Post.

SPOILER ALERT: This one barely matters.

@joshgreenman: YOU GUYS LOUISIANA MATTERS MAYBE

3) Tax expenditures now amount to more than $1 trillion a year. "A congressional report detailing the value of major tax breaks shows they amount to more than $1 trillion a year--roughly the size of the annual federal budget deficit--and benefit wide swaths of the population. The figures could be useful to lawmakers of both parties and President Barack Obama, who are looking for ways to shrink future deficits and offset the anticipated cost of overhauling the much-criticized U.S. tax code, an effort likely to include tax-rate cuts. Both parties are looking to trim or eliminate tax breaks to achieve those goals. Mr. Obama has suggested eliminating breaks for corporate jets and oil and gas companies to reduce deficits...House Republicans proposed in their new budget this week to reduce or eliminate an unspecified array of tax breaks in order to offset the costs of lowering top tax rates for both corporations and individuals to 25% from the current 35%." John McKinnon in The Wall Street Journal.

4) The prospect of the gas tax expiring is hanging over the highway bill debate. "The political debate over gas prices appears to be complicating Democratic efforts to compare the standoff over federal transportation spending to last year’s shutdown of the Federal Aviation Administration. With gas prices on the rise, some Republican strategists think voters might welcome at least a temporary 18.4 cent-per-gallon break on the cost of filling up their gas tanks...Few people in Washington are arguing that Congress should eliminate the gas tax altogether. But if lawmakers do not agree on at least a temporary extension that is what would happen on March 31 until lawmakers end their logjam. Most observers expect the impasse will end before it gets to that point. But in the run up to the deadline, Democrats have been raising the specter of an interruption and blaming Republicans for the possibility." Keith Laing in The Hill.

5) There's no evidence that inflation is poised to become a problem anytime soon. "The Federal Open Market Committee said in a statement at the conclusion of its March 13 meeting in Washington that...oil will 'push up inflation temporarily, but the committee anticipates that subsequently inflation will run at or below the rate that it judges most consistent with its dual mandate' of promoting maximum employment and stable prices. The bond market agrees. The five-year, five-year forward breakeven rate, which projects the pace of consumer price increases starting in 2017, ended last week at 2.73 percent. While the measure, which the Fed prefers to look at in determining inflation expectations and monetary policy, is up from this year’s low of 2.37 percent on March 5, it’s in line with the average over the past decade. It’s also below the 3.63 percent level reached in the wake of Lehman Brothers Holding Inc.’s collapse on speculation the Fed would flood the economy with cash and spark runaway inflation." Daniel Kruger and Liz Capo McCormick in Bloomberg.

Top op-eds

1) SUMMERS: Don't wind down stimulus until the recovery has taken hold. "For the first time in five years a resumption of growth significantly above the economy’s potential now appears to be a substantial possibility. Put differently, after years when the risks to the consensus modest growth forecast were to the downside, they are now very much two-sided...What are the implications for macroeconomic policy?...The right approach is policies that commit to normalizing conditions but only when certain thresholds are crossed. The Federal Reserve might commit to maintain the current Fed funds rate until some threshold with respect to unemployment or expected inflation is crossed. Commitments to fund infrastructure over many years might include a financing mechanism such as a gasoline tax that would be triggered when some level of employment or output growth has been achieved. Tax reform could phase in new rates in pace with the rising economic performance." Lawrence Summers in The Washington Post.

2) KRUGMAN: Beware of crony capitalism. "Florida’s now-infamous Stand Your Ground law, which lets you shoot someone you consider threatening without facing arrest, let alone prosecution, sounds crazy -- and it is. And it’s tempting to dismiss this law as the work of ignorant yahoos. But similar laws have been pushed across the nation, not by ignorant yahoos but by big corporations. What is ALEC? Despite claims that it’s nonpartisan, it’s very much a movement-conservative organization, funded by the usual suspects: the Kochs, Exxon Mobil, and so on. Unlike other such groups, however, it doesn’t just influence laws, it literally writes them, supplying fully drafted bills to state legislators...We seem to be turning into a country where crony capitalism doesn’t just waste taxpayer money but warps criminal justice, in which growing incarceration reflects not the need to protect law-abiding citizens but the profits corporations can reap from a larger prison population." Paul Krugman in The New York Times.

3) PEARLSTEIN: We don't need to choose between equality and efficiency. "In 1974, the late, great economist Arthur Okun gave a series of lectures in which he argued that there was a 'nagging and pervasive trade-off' between economic equality and economic efficiency...Four decades later, however, Okun’s 'big trade-off' has been hijacked by Ryan Republicans eager to use it as a rationalization for tax cuts for the rich and service cuts for the poor. Ignoring Okun’s premise that society wants both fairness and economic growth, Republicans have not only elevated growth as the sole objective of economic policy, but declared that fairness is everywhere and always a deterrent to growth. For them, the relationship is perfectly linear: If some inequality is required to increase economic growth, as it surely is, then more inequality must always beget even more economic growth. Or maybe not. What if the relationship between inequality and economic growth is more complicated than that?" Steven Pearlstein in The Washington Post.

4) BARRO: The Ryan tax plan isn't actually a plan. "Paul Ryan’s House Republican budget proposal is out. And the plan has ambitious goals, including a reduction of the six income tax rates we have today to just two--10 percent and 25 percent--with the revenue loss offset by an expansion of the tax base. Ryan’s plan has been roundly mocked because it makes no specification as to how the tax base will be expanded...There is, in principle, such a thing as non-vacuous vagueness. Unfortunately, Ryan’s plan is vacuously vague. It would be fine to set out broad principles for tax reform and say that the details will have to be the result of a negotiation. The problem is that Ryan has decided that some details can be set out now--most importantly, the rates of 10 percent and 25 percent. But the purpose of the tax code is to raise revenue for the federal government. If we don’t know how much base expansion we can get out of a political negotiation, how do we know we can get the top rate all the way down to 25 percent? The answer, of course, is that we don’t." Josh Barro in Forbes.

5) KOLBERT: Gas prices should be higher. "When it comes to gas prices, it’s been clear for, well, let’s just say forever that the cost of gasoline in America is actually too low. Cheap gas generates sprawl and traffic. It discourages the use of mass transit and the development of alternative fuels. It contributes to regional smog and to global climate change. The easiest and most obvious solution has long been to raise the federal gasoline tax, which now stands at only 18.4 cents a gallon. Among economists, there’s widespread support for this idea, including from Greg Mankiw, a Harvard professor who happens to be a top adviser to Romney. Writing in the Times earlier this year, Mankiw observed, 'Economists who have added up all the externalities associated with driving conclude that a tax exceeding $2 a gallon makes sense.' He went on, 'By taxing bad things more, we could tax good things less.'...What the country needs--and has always needed--is an energy policy that, instead of pandering to Americans’ sense of entitlement, would compel us finally to change our ways." Elizabeth Kolbert in The New Yorker.

Electropop interlude: Passion Pit plays "Sleepyhead" live on KEXP.

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Still to come: The Fed won't take action on inflation soon; the GOP is on the same page when it comes to Medicare reform; the Justice Department is cracking down on antitrust; regulatory failings contributed to a mine disaster; and a pug tries to sneak away.

Economy

CEO pay didn't go up much in 2011. "For big companies, 2011 was a good year. For their CEOs, it was surprisingly mediocre. Despite fairly significant gains in companies' profit and revenue, total direct compensation for 65 CEOs in place at least two years rose just 1.4% last year, according to preliminary results from a survey by The Wall Street Journal and Hay Group. That's down sharply from an 11% increase in 2010, according to that year's Journal/Hay Group survey of 350 companies. Total direct compensation includes salary, all bonuses, and the value of stock and stock-option grants at the time of the grant. The preliminary results highlight how corporate directors, under new scrutiny from shareholders, are tying more CEO pay to corporate performance. When companies miss targets, directors are holding the line." Scott Thurm in The Wall Street Journal.

Top GOP appropriators are proving key to moving the Ryan plan. "The Speaker has a lot riding on the House GOP’s new budget resolution that was crafted by Rep. Paul Ryan (R-Wis.). The measure is scheduled to be voted on Thursday, and Boehner and his lieutenants are working to produce a strong unified GOP front. Earlier this month, Republican appropriators were pushing for spending levels that matched the levels in the bipartisan debt-ceiling measure that was signed into law last summer. But conservatives balked and Republicans leaders agreed to embrace caps of $1.028 trillion, instead of $1.047 trillion that was included in the Budget Control Act (BCA). Republican appropriators were not pleased. Yet, when it came time on Wednesday for the three appropriators who sit on the Budget Committee to cast their votes for the policy roadmap, Reps. Tom Cole (R-Okla.), Mike Simpson (R-Wyo.) and Ken Calvert (R-Calif.) did not waiver in their support. Their backing was crucial as the Budget panel cleared the resolution by one vote." Molly Hooper in The Hill.

Sales of new homes dropped again. "Sales of new homes in the U.S. fell for the second consecutive month in February, an indication that the housing market remains shaky in the aftermath of a severe bust. New-home sales decreased by 1.6% to a seasonally adjusted annual rate of 313,000 from January, the Commerce Department said Friday. It was the second-straight monthly decline and the lowest reading since October 2011. The results were worse than expected. Economists surveyed by Dow Jones Newswires had forecast sales last month would climb by 1.2% to an annual rate of 325,000. In addition, January's sales were revised downward to 318,000 from an initially reported 321,000. That was a decline of 5.4% from December. However, new-home sales were up 11.4% compared with February 2011. And prices have stabilized: The median price of a new home was $233,700 last month, up 6.2% from February 2011." Alan Zibel and Jeffrey Sparshott in The Wall Street Journal.

Dodd-Frank has spurred big banks to reorganize. "When Deutsche Bank reorganized its U.S. operations this week in response to new banking rules, it was the latest manifestation of what both supporters and opponents of the Dodd-Frank regulatory overhaul predicted would happen: The law has pushed big banks to reorganize -- to comply with the new rules on Wall Street, as well as to avoid their impact. Many of the most dramatic changes under Dodd-Frank won’t take effect for months or years. But the biggest financial firms in the United States have already started overhauling and reshuffling their operations in anticipation of the new regulatory regime. Deutsche Bank and London-based Barclays have moved their commercial banks from their U.S. subsidiaries into their global firms to avoid new, more stringent capital requirements -- even though they don’t go into effect until July 2015." Suzy Khimm in The Washington Post.

Some central bankers are warning against expansionary monetary policy. "Three global central-bank leaders warned that decision makers needed to be on alert for an array of risks associated with their easy-money policies. Most notably, the three--Bank of Japan governor Masaaki Shirakawa, former European Central Bank president Jean-Claude Trichet and Jaime Caruana, who runs the Bank for International Settlements--all cautioned in different ways against banks and governments taking advantage of low interest rates to avoid taking hard steps to repair their own finances after years of aggressive borrowing...The comments came at a conference organized in Washington by the Federal Reserve to examine the far-reaching challenges central banks confront in the wake of the 2008 financial crisis...The Federal Reserve is several months into a $400 billion program known as 'Operation Twist' in which it is buying long-term government bonds from investors and selling short-term debt." Jon Hilsenrath in The Wall Street Journal.

Awesome inventions being awesome interlude: A pair of turntable that draw patterns.

Health Care

The GOP is united behind Paul Ryan's Medicare plan. "Congressional Republicans recognize that the $3.5 trillion budget proposal the GOP-led House is expected to adopt this week remains fraught with political peril, but they also believe they now know how to blunt Democratic attacks on its Medicare overhaul components...They have a new strategy to try to neutralize the Democrats’ Medicare assault, arguing that their plan is the only way to save the federal retiree program and is based on bipartisan ideas for change. Under Ryan’s plan, the Medicare eligibility age would slowly rise to 67. Those who turn 65 after 2023 would receive government assistance buying a private health insurance plan, but the spending would be capped, meaning costs could be shifted to seniors as insurance costs rise. This year’s proposal contains a small twist from last year’s: Seniors could opt to use their capped spending toward a traditional fee-for-service model." Rosalind Helderman and Paul Kane in The Washington Post.

@meredithshiner: McConnell says debt/budget "certainly not" as big of an issue as #HCR this election -- wonder if this reflects last summer's bruising fight

Q&A: Sarah Kliff talks to Don Berwick about the future of healthcare.

Domestic Policy

The Justice Department is taking a hard line on antitrust. "The Justice Department's top antitrust official says she won't stand by quietly if companies make agreements with rivals on price, signaling a stern stance as the department conducts a high-profile probe into electronic-book publishing. Without mentioning Apple Inc. or the five publishers that are the target of the investigation, Sharis Pozen says she won't hesitate to act against 'collusive behavior at the highest levels of companies.'...Ms. Pozen's pointed comments come as she prepares to step down as acting antitrust chief next month. The White House has nominated William Baer for the post, but it isn't clear if he will be confirmed by Congress before the presidential election in November. The Justice Department is on an antitrust winning streak. It successfully blocked AT&T Inc.'s proposed $39 billion acquisition of T-Mobile USA late last year and prevailed against H&R Block Inc. in a proposed merger of tax preparers in the department's first successful antitrust trial in eight years." Thomas Catan in The Wall Street Journal.

Many businesses fear postal cuts. "As Congress begins work this week on legislation to shore up the finances of the debt-ridden post office, companies representing a cross-section of American business are spending millions of dollars lobbying lawmakers to oppose or support various proposals to keep the agency afloat. In total, lobbying disclosure records show that companies and unions with a stake in a postal overhaul have spent nearly $300 million in the last three years as the financial condition of the post office has worsened, though it is not known how much of that was spent specifically on postal issues. The service is the backbone of a mailing and shipping industry that employs more than 8.5 million people and supports almost $1 trillion in economic activity every year. The service itself employs 574,000 people. Nearly every business relies on the post office to deliver packages, advertise services and send out bills. This postal supply chain supports millions of American jobs in fields as diverse as banking, agriculture, media and manufacturing." Ron Nixon in The New York Times.

Adorable animals feeling guilty interlude: A pug tries to sneak away inconspicuously.

Energy

Major regulatory failings may have led to a deadly mine blast. "A report by the National Institute for Occupational Safety and Health found that better enforcement by government mine safety regulators could have mitigated--and possibly prevented--a 2010 mine explosion that killed 29 workers. The accident at Massey Energy Co.'s Upper Big Branch mine in Montcoal, W. Va., was the worst U.S. mining disaster in four decades. Shortly after the accident, Labor Secretary Hilda Solis charged NIOSH with assessing the federal Mine Safety and Health Administration's oversight leading up to the explosion. 'If MSHA had engaged in timely enforcement of the Mine Act and applicable standards and regulations, it would have lessened the chances of--and possibly could have prevented--the UBB explosion,' a four-member panel of NIOSH investigators concluded in a 26-page report made public Friday." Kris Maher in The Wall Street Journal.

The state of the electric car is not so strong. "The future would appear bright for the electric car. Gasoline prices are high. The government is spending billions on battery technology. Auto companies are preparing to roll out a dozen new electrified models. Concern is growing about the climate impacts of burning oil. And tough new fuel economy standards are looming. Yet the state of the electric car is dismal, the victim of hyped expectations, technological flops, high costs and a hostile political climate. General Motors has temporarily suspended production of the plug-in electric Chevy Volt because of low sales. Nissan’s all-electric Leaf is struggling in the market. A number of start-up electric vehicle and battery companies have folded. And the federal government has slowed its multibillion-dollar program of support for advanced technology vehicles in the face of market setbacks and heavy political criticism." John Broder in The New York Times.

@mattyglesias: "in liberalised energy markets, building nuclear power plants is no longer a commercially feasible option: they are simply too expensive"