patient protection affordable care act patient protection affordable care act commonly called affordable care act colloquially united_states federal statute signed law president barack_obama march health care education reconciliation act amendment represents significant regulatory overhaul healthcare system passage act hospitals primary physicians transform practices financially drive better health outcomes lower costs improve methods distribution accessibility enacted increase quality health insurance lower rate expanding public private insurance coverage reduce costs healthcare individuals government introduced mechanisms like subsidies insurance exchanges law requires insurance companies cover applicants new minimum standards offer rates regardless pre existing conditions sex congressional budget office projected lower future spending june united_states supreme_court upheld individual mandate exercise congress power case national federation independent business court held states forced participate expansion penalty losing current funding ruling law implementation continued face challenges congress federal courts state governments conservative advocacy groups labor unions small business organizations june case king supreme_court affirmed law federal subsidies help individuals pay health insurance available states set state exchanges march centers disease control prevention reported average number period january september million fewer average april reported percentage adults dropped quarter quarter overview provisions affordable care act includes numerous provisions took effect policies issued grandfather clause changes insurance standards affected provisions significant reforms took effect january include guaranteed issue prohibits denying coverage individuals pre existing conditions partial community rating requires offer premium price applicants age geographical location regard gender pre existing conditions excluding tobacco use minimum standards health insurance policies established individual mandate requires individuals covered employer sponsored health plan public insurance programs secure approved private insurance policy pay penalty applicable individual financial member recognized religious sect internal revenue service law includes subsidies help people low comply mandate health insurance exchanges operate new avenue individuals small businesses state compare policies buy insurance government eligible plans starting proposed enrollment period november january low income individuals families federal poverty level receive federal subsidies sliding scale purchase insurance exchange section explains provided tax credit gives formula calculation formula changed amendments passed march section apply individual family consumers choose receive tax credits advance exchange send money directly month small businesses eligible subsidies eligibility expanded include individuals families federal poverty level including adults disabilities dependent children law provides income disregard making effective income eligibility limit poverty level furthermore state children health insurance program chip enrollment process simplified national federation independent business supreme_court ruled states opt expansion children permitted remain parents insurance plan 26th birthday regulations implemented include longer live parents dependent parent tax return longer student married prohibited imposing lifetime dollar limits essential benefits like hospital stays new policies issued prohibited dropping sick new insurance plans cover care medical screenings rated level services task force prohibited charging payments insurance services reforms payment system meant promote greater efficiency healthcare delivery system restructuring fee service bundled payments new payment system single payment paid hospital physician group defined episode care hip replacement individual payments individual service providers addition coverage gap commonly called hole shrink closing completely january hospital reduction program established addition social security act effort reduce hospital cost program hospitals higher expected rates decreasing rate businesses employ people offer health insurance time employees pay tax penalty government time employee healthcare tax means commonly known employer mandate july internal revenue service delayed enforcement provision year legislative history background patient protection affordable care act consists combination measures control healthcare costs expansion coverage public private insurance broader eligibility coverage regulated private insurance individual mandate coupled subsidies private insurance means universal healthcare considered best way win support senate included prior reform proposals concept goes conservative heritage foundation proposed individual mandate alternative single health care championed time conservative republican senators market based approach healthcare reform basis individual responsibility avoidance free rider problems specifically emergency medical treatment active labor act requires hospital participating nearly provide emergency care needs government indirectly bore cost ability pay president bill_clinton proposed healthcare reform bill included mandate employers provide health insurance employees regulated marketplace health maintenance organizations republican senators proposed alternative required individuals employers buy insurance ultimately clinton plan failed amid unprecedented barrage negative advertising funded politically conservative groups health insurance industry concerns overly complex failing obtain comprehensive reform healthcare system clinton negotiated compromise congress instead enact state children health insurance program republican alternative introduced senator john health equity access reform today act contained universal coverage requirement penalty individual mandate subsidies state based purchasing groups advocates bill included prominent republicans time affordable care act opposed mandate senators hatch bob bennett kit bond republicans senators supported heart act republican proposal introduced senator don consumer choice health security act contained individual mandate penalty provision subsequently removed mandate bill stating decided government people buy health insurance time proposals republicans raise constitutional issues mandate mark helped develop proposal included individual mandate george bush remarked don remember raised way viewed congressional budget office effectively tax insurance expansion bill enacted state level massachusetts bill contained individual health insurance mandate insurance exchange republican governor vetoed mandate democrats veto signed law implementation health connector exchange individual mandate massachusetts lauded republicans presidential campaign senator jim praised ability good conservative ideas like private health insurance apply need said individual mandate proud massachusetts succeeds implementing model nation year massachusetts reform republican senator bob bennett democratic senator ron introduced healthy americans act featured individual mandate state based regulated insurance markets called state health help agencies bill initially attracted support died committee sponsors sponsors remained congress healthcare debate democrats considering approach basis healthcare reform experts said legislation eventually emerged congress bears similarities bill deliberately patterned state healthcare plan professor economics mit architect massachusetts health care reform advised clinton obama presidential campaigns healthcare issues served technical consultant obama administration helped draft healthcare debate healthcare reform major topic discussion democratic presidential race narrowed attention focused plans presented leading candidates hillary_clinton eventual nominee barack_obama candidate proposed plan cover approximately million americans estimated health insurance point year clinton plan required americans obtain coverage effect individual mandate obama provided rejected use individual mandate general election obama said fixing healthcare priorities won presidency inauguration obama announced joint session congress february intent work congress construct plan healthcare reform july series bills approved committees house_of_representatives senate june september senate finance committee held series meetings develop healthcare reform bill group particular democrats max jeff kent republicans mike met hours principles discussed conjunction committees foundation senate healthcare reform bill universal healthcare stated goals obama administration congressional democrats health policy experts like david argued guaranteed issue require community rating individual mandate ensure adverse selection free riding result insurance death spiral convinced obama necessary persuaded accept congressional proposals included mandate approach taken president congressional leaders concluded progressive plans single act obtain proof support senate deliberately drawing ideas basic outline supported senate majority leaders howard baker bob tom george mitchell bill hoped increase chances garnering necessary votes passage following adoption individual mandate central component proposed reforms democrats republicans began oppose mandate threatened bills contained senate minority leader led republican congressional strategy responding bill calculated republicans support bill worked party discipline prevent absolutely critical everybody proponents bill able tended convey public figured republican senators including supported previous bills similar mandate began describe mandate unconstitutional journalist wrote new_yorker end result policy enjoyed broad support republican_party suddenly faced unified opposition reporter michael cooper new_york_times wrote difficult remember given republicans attack freedom provision president obama healthcare law requiring americans buy health insurance roots conservative thinking reform negotiations attracted great deal attention including deals certain lobby groups advocates law win support groups opposed past reforms sunlight foundation documented reported ties healthcare complex politicians major parties august summer congressional members went districts entertained town hall meetings public opinion proposals tea party movement organized protests conservative groups individuals targeted congressional town hall meetings voice opposition proposed reform bills threats members congress course congressional debate maintain progress legislative process congress returned september president obama delivered speech joint session congress supporting ongoing congressional negotiations emphasize commitment reform outline proposals acknowledged debate quoted letter late senator edward kennedy urging reform face moral issue stake details policy fundamental principles social justice character country november house_of_representatives passed affordable health care america act vote senate passage senate senate began work proposals house working affordable health care america act instead senate took bill housing tax breaks service members united_states_constitution requires revenue related bills originate house senate took bill passed house revenue related modification internal revenue code bill senate vehicle healthcare reform proposal completely content bill bill amended ultimately incorporate elements proposals reported favorably senate health finance committees republican minority senate bill support requiring vote end debate votes necessary passage senate start congress democrats votes senate seat minnesota ultimately won undergoing republican reach votes negotiations undertaken satisfy demands moderate democrats try bring republican senators aboard particular attention given bob bennett mike negotiations continued july sworn office time switched parties disagreements substance bill drafted committee moderate democrats hoped win support august bill come vote kennedy longtime healthcare reform advocate died democrats 60th vote kennedy seat filled attention drawn vote favor draft bill finance committee october explicitly stated mean support final bill paul appointed senator kennedy temporary replacement september finance committee vote negotiations turned demands moderate democrats votes necessary break anticipated republican majority leader harry focused satisfying democratic caucus members came joe connecticut independent democrats ben nelson conservative democrat representing nebraska despite intense negotiations search compromise refused support public option agreeing vote bill provision included majority support congress demand met debate bill supporters importance public option vast majority supporters concluded minor reform overall congressional democrats fight won concessions including allowing states set state based public options vermont green mountain care democrat favor republican opposed white_house moved addressing nelson concerns order win proof support bill point concluded waste time dealing vote draft bill finance committee come intense pressure republican senate leadership final hour negotiation nelson support bill won concessions compromise abortion modifying language bill states right prohibit coverage abortion insurance exchanges require consumers pay procedure pocket state decided amendment offer higher rate nebraska half compromise called repealed subsequent reconciliation amendment bill december senate voted end debate bill vote end bill passed december democrats voting republicans jim vote bill endorsed weeks later january massachusetts republican scott brown elected senate special election replace late kennedy having campaigned giving republican minority 41st vote needed sustain republican special election significant reform debate effects legislative process psychological symbolic importance losing kennedy traditionally democratic massachusetts seat congressional democrats concerned political cost passing bill second effect practical loss democratic complicated reform proponents legislative strategy house brown election meant democrats longer break senate response white_house chief staff argued democrats scale ambitious bill house speaker nancy pushed dismissing scaled approach care obama remained comprehensive reform news anthem blue cross california intended raise premium rates patients gave new line argument nervous democrats scott brown win february president obama laid senate leaning proposal consolidate bills held meeting parties leaders february democrats having lost proof senate having passed senate bill votes december comprehensive reform proponents option house abandon bill affordable health care america act pass senate bill patient protection affordable care act instead health policy experts encouraged house pass senate version house democrats happy expected able negotiate changes house senate conference passing final bill option table bill emerged conference differed senate bill passed senate despite republican house democrats agreed pass senate bill condition amended subsequent bill drafted health care education reconciliation act passed reconciliation process unlike rules regular order congressional budget act reconciliation subject reconciliation limited budget changes procedure pass place bill inherently non budgetary regulations passed senate bill passed reconciliation house democrats demands budgetary changes higher levels different kinds taxes pay nebraska deal mainly involve taxes spending words exactly kinds policies suited reconciliation remaining obstacle pivotal group pro life democrats led initially reluctant support bill group found possibility federal funding abortion significant warrant opposition senate bill included language satisfied abortion concerns include additional language reconciliation bill non budgetary outside process domain instead obama issued executive order principles amendment won support members group assured bill passage house passed senate bill vote march democrats republicans voting day republicans introduced legislation repeal bill obama signed law march amendment bill health care education reconciliation act passed house march senate passed reconciliation march obama signed march impact public policy affordable care act represents significant regulatory overhaul healthcare system passage new_york_times summarized overall impact affordable care act variety dimensions october number persons reduced significantly million people remain enrolled private coverage online qualified federal subsidies help pay qualified subsidies federal exchange subsidies lowered cost average middle income persons don qualify subsidies likely challenges premium costs early tell act affected health outcomes healthcare costs grown slower recent years effect trend unclear healthcare industry generally helped law additional customers law created change number primary mechanisms increasing insurance coverage expanding eligibility include individuals federal poverty level creating state based insurance exchanges individuals small business buy health insurance plans individuals federal poverty level eligible subsidies congressional budget office originally estimated legislation reduce number residents million leaving million residents bill provisions taken effect elderly covered estimate projected law raise proportion non elderly citizens july estimate raised expected number million reflecting successful legal challenge expansion people remain illegal immigrants estimated million roughly million projection ineligible insurance subsidies exempt health insurance mandate remain eligible emergency services provisions emergency medical treatment active labor act citizens enrolled despite eligible citizens covered opting pay annual penalty instead purchasing insurance younger single americans citizens insurance coverage cost household income exempt paying annual penalty citizens live states opt expansion qualify existing coverage coverage states new insurance exchanges believed increasing insurance coverage improve quality life help reduce medical currently leading cause bankruptcy america job lock addition believed expanding coverage help ensure cost controls successfully function healthcare providers easily adapt payment system reforms value quantity costs partially offset example hospitals having charity care having larger stable risk pools distribute costs new regulations guaranteed issue allowing children included parents plans age insurance companies announced stop issuing new child policies children covered parents plans census bureau found number year olds declined people starting january state health insurance exchanges required offer child coverage option eligibility available million individuals federal poverty level law workers employers offer affordable coverage eligible subsidies exchanges eligible law definition cost employer based health insurance exceed worker household income january internal revenue service ruled cost covering individual employee considered determining cost coverage exceeded income cost family plan higher ruling means higher costs considered extra push cost coverage income threshold new_york_times said leave million americans unable afford family coverage employers plans ineligible subsidies buy coverage multiple studies surveys indicated number fallen expanded eligibility health insurance exchanges established changes took effect january commonwealth fund reported july additional million people aged obtained health insurance roughly working aged population reported april rate adults fell corporation reported march enrollment employer sponsored insurance plans increased million enrollment increased million individuals lose coverage period authors found million people covered state federal called insurance exchanges million people previously individual market insurance period question survey tell group lost insurance cancellation simply felt cost high overall number small representing percent people ages data august showed million people enrolled marketplace paid study found result dependent coverage provision allowing young adults stay parents plans age young adults likely insurance primary care doctor report having excellent health study found provision reduced body mass index young adults scholarly review accomplishments barack_obama presented data showing succeeded sharply increasing insurance coverage law wrote rate declined decline occurring law main coverage provisions took effect insurance exchanges individual mandate act establishes state based health insurance exchanges exchanges regulated online administered federal state government individuals small business purchase private insurance plans starting october coverage beginning january individuals federal poverty level purchase insurance plans exchange eligible receive federal subsidies help pay premium costs exchanges form websites private plans allowed sale regulated comparable consumers able visit websites ring center compare plans offer fill form government determine eligibility subsidies purchase insurance choice options available limited open enrollment periods open enrollment period october march time individuals generally purchase insurance exchange following open enrollment period subsequent years open enrollment period start october end december despite controversy members congress staff participate system required obtain health insurance exchanges plans approved bill instead federal employees health benefits program currently use insurance exchanges method designed create market private insurance way addresses market failures high number medical coverage limits inflation regulation approved plans meet certain standards allowed sold exchanges prohibited denying insurance consumers basis pre existing conditions methods employed plans affordable subsidies provided eligible regulations intended reduce prices competition plans prices transparent price comparisons accessible consumers online information federally approved multi state plans phased state exchanges help guarantee options price regulations implemented including minimum medical loss ratio partial community rating prevents price discrimination individuals market plans premium increases poor sick individuals expensive cover motivated profit economics insurance specifically risk insurance pool providing net offset net pay outs regulations enabled function individual mandate requirement buy insurance pay penalty limits open enrollment healthy people got sick situation raise afford remaining relatively expensive population create vicious cycle people drop coverage result known insurance death spiral alternatively process settle stable relying relatively high coverage illness medical bankruptcy absence mandate likely caused exchanges malfunction ultimately perform similarly current private insurance market according supporters based studies health concluded conversely inclusion mandate increases size diversity population risk pool spread cost insurance sustainable manner policy experience new_jersey hand massachusetts offers evidence outcomes september congressional budget office estimated nearly million pay penalty law setting exchange gives state partial discretion standards prices insurance aside set example exchange able determine plans sold excluded exchanges adjust limits negotiations private prices offer able impose higher state specific coverage requirements including plans offered state prohibited covering abortion making procedure pocket expense mandated cover physician determines medically necessary case federal subsidies prohibited fund procedure state set exchange lose discretion responsibility set exchanges states federal government department health human services assumes authority legal obligation operate functions federally facilitated exchanges states district_of_columbia plan operate state based exchanges seven partnership federal government arrangement retain management federal government functions remaining states default federally facilitated exchanges law designed flexible allowing states onwards apply state innovation federal government allows experiment state based system condition meets certain criteria obtain state pass legislation setting alternative health system provides insurance comprehensive affordable covers residents increase federal deficit provided state meets conditions receiving exempt states central requirements including individual mandate provision insurance exchange employer mandate state receive compensation equal aggregate federal subsidies tax credits residents employers eligible plan paid structure state plan vermont state republicans small minority enacted green mountain care state based single system intended pursue implement december vermont decided pursue single system implementation early implementation efforts healthcare exchanges especially exchanges operated federal government received nearly universally negative reactions media politicians website allows people apply insurance exchanges operated federal government crashed opening suffered problems month users found available plans ongoing problems website prompted development independently produced alternative contains consumer information committees chambers congress conducted hearings security concerns related discussed experts disagree extent vulnerable attacks march radio ads providing information affordable care act broadcast according indian country today media network house energy commerce committee reported april individuals families selected health plan federally facilitated marketplace paid month premium paid ages day committee ranking member henry issued statement saying reporting inaccurate irresponsible date accompanied memorandum detailing basis statement week later representatives health insurance companies told members congress percent people signed new health care law gone pay july government office released non partisan study concluded administration provide effective planning oversight practices developing website change insurance standards includes regulations set standards insurance specified law subsequently established secretary health human services new standards ban ability drop sick ban price discrimination basis pre existing conditions sex partial community rating allowing children remain parents insurance plan 26th birthday law authorization secretary health issued set defined essential health benefits new insurance plans include prohibited imposing annual lifetime coverage caps essential benefits cover patient services emergency services newborn care mental health substance use disorder services including health treatment drugs services devices laboratory services services chronic disease management services including oral vision care determining qualify essential benefit law requires scope standard benefits equal typical employer plan states discretion determining considered plan requirements law include services set secretary essential health benefits care childhood adult medical screenings covered insurance plan subject payments insurance specific examples services covered include visits diabetes screening testing counseling hiv screening counseling approved methods support supplies domestic violence screening counseling addition law established tiers coverage bronze plan silver plan gold plan platinum plan categories offer set essential health benefits categories specify division pocket costs bronze plans lowest monthly highest pocket costs vice versa platinum plans health care costs plans expected cover opposed pocket costs average bronze silver gold platinum required implement appeals process coverage determination claims new plans required spend premium dollars health costs claims instead administrative costs profits issued violated coverage provision law health insurance cover additional care screenings women specified regulations issued health resources services administration guidelines issued august included mandate food drug administration approved methods procedures patient education counseling women reproductive capacity mandate applies employers educational institutions religious organizations regulations included recommendations institute medicine concluded access medically necessary ensure women health initial regulations proved controversial certain religious groups notably especially roman catholic hierarchy hospitals charities educational institutions higher learning enterprises oppose grounds accommodate concerns access regulations adjusted allow religious organizations opt requirement include birth control coverage employee insurance plans instances offer coverage directly additional cost rule challenged corporations burden religious expression challenge reach supreme_court hobby lobby court ruled closely held corporations hobby lobby exempt rule religious freedom restoration act applies regulations govern activities closely held profit corporations follow case hobby lobby supreme_court issued injunction pending appeal evangelical college illinois affiliated nonprofit groups fill form offered religious effectively transfer cost employees college argued filling form trigger emergency coverage institution religious beliefs effects insurance studies insurance expect subsidies offered people pay prior reforms pay stable changing health circumstances transparent regulations insurance kaiser family foundation calculated half people currently buy insurance today eligible subsidies receiving subsidies times poverty line individuals family subsidies projected worth average household effectively projected price insurance thirds average individuals npr kaiser family foundation collaborated produce quick online people estimate based live income family size effect health insurance forecast individual market comprise market person increase half individuals receive subsidies decrease premium paid charged current law forecast small group market market impacted receiving subsidies large group market comprising market impacted high premium plans subject taxes charged factors taken account analysis included increased benefits particularly individual market healthy mandate administrative related health exchanges high premium insurance plans reducing benefits response tax september final projections average monthly premium scheduled offered exchanges came expectations reducing expected costs consumers government reducing overall cost subsidies larry health policy analyst kaiser family foundation noted individual market relatively small share said contrast don think significant cost increases employer market majority americans health insurance secretary health human services indicated cost increase individual market expected standard insurance allowed insurance exchanges higher quality generally available currently expensive government subsidies provided insurance affordable intended offset effect june study kaiser family foundation focused actual experience act affected individual market consumers buying insurance study found medical loss ratio provision act saved group consumers billion billion reducing costs bulk savings reduced individual insurance came premium paid consumers insurance companies failed meet requirements act associated_press reported result provisions closing coverage gap initial coverage limit catastrophic coverage threshold drug program individuals falling hole save percent savings came reportedly regard brand drugs secured companies change benefited million people middle class healthcare cost inflation presentation health costs federal budget stated rising health costs tremendous pressure federal budget decades judgment health legislation enacted earlier year substantially diminish pressure observed putting federal budget sustainable path certainly require significant reduction growth federal health spending relative current law including year health legislation concluded considerable agreement substantial share current spending health care contributes little people health providers health analysts making significant efforts health system efficient clear specific policies federal government adopt generate fundamental changes health system clear specific policies translate potential significant cost savings reality health policy analyst commented doesn produce estimates reform affect overall health care spending money society devote health care official determined long term trend spending inflation years lower long term trend matters affordable care act reduce cost care lot possible theory possible political universe fellow new republic editor claimed include estimate cost saving provisions intended reduce health inflation history consistently impact health legislation consultant helped develop massachusetts healthcare reform acknowledged guaranteed significantly bend curve rising healthcare costs real question far slowing cost growth great uncertainty uncertainty general control cost growth health care shortage good ideas ways shortage evidence approaches actually work consensus path best follow face uncertainty pursued path considering range different approaches controlling health care costs policies fully solve long run health care cost problem united_states doubtful provide step controlling costs understanding work broadly law created center innovation requires numerous pilot programs demonstrations affect healthcare costs cost reductions cost estimates business association commissioned report consulting company associates found legislation potentially reduce trend line employee respect insurance stated legislation potentially reduce rate future health care cost increases fully phased group cautioned dependent success cost saving government pilot programs wholly copied private market centers services reported costs capita continue rise rate increase annual healthcare costs fallen capita cost increases averaged annually costs relative rising studies attempted explain reduction rate annual increase reasons include higher unemployment recession limited ability consumers purchase healthcare pocket payments constitute individual pays health costs insurance begins cover claims risen rising costs generally cause consumption healthcare services proportion workers employer sponsored health insurance requiring climbed quarters half structural changes healthcare system aim shift healthcare system paying quantity paying quality examples include incentives reduce hospital use electronic medical records care organizations bundled payments coordinate care quality quantity changes occurred healthcare providers acting anticipation future implementation reforms uncertainty exists extent factor responsible recent reduction health inflation overall trend including accompanying reduction long term deficit projections reduced healthcare costs studies found temporary effects recession account entirety structural changes likely share partial credit study estimated changes health system responsible quarter recent reduction inflation paul cost controls succeed reducing spent healthcare efforts insufficient long term burden placed demographic changes particularly growth population review barack_obama reported mean annual growth real spending negative mean year year similarly mean real growth private insurance spending year compared mean federal deficit estimates revenue impact deficit comprehensive estimate projected net deficit reduction billion period calculated law result billion total offset billion total receipts resulting billion net reduction deficit separately noted spending provisions begin revenue exceed spending subsequent years bill substantially reduce growth payment rates services impose tax insurance plans relatively high changes federal tax code programs ultimately extending trust fund years estimate prior supreme_court ruling enabled states opt expansion federal funding subsequently updated budget projection estimating impact ruling reduce cost estimate insurance coverage provisions billion reported june repeal increase deficit billion billion period total depending impact feedback effects words deficit repeal raise deficit reported repeal likely raise economic output mainly supply labor low income persons incentive work healthcare coverage provided major sources deficit reduction include higher taxes wealthy new annual fees health insurance providers similar fees healthcare industry manufacturers brand drugs certain medical devices limits tax medical expenses flexible spending accounts new tax insurance policies plans annual insurance excess individual family revenue mandate penalty payments federal sales tax indoor services spending reduction drug companies private advantage policies government office payment advisory commission found relative government reductions hospitals meet standards efficiency care generally provide cost estimates year budget projection period degree uncertainty involved projection decided case request estimated second decade deficit reduction predicted deficit reduction broad range half percent wide range changes occur commonly heard complaint cost estimates required exclude initial estimates effects likely fix legislation increase payments billion fix separate issue existed law cost different cost bush tax cuts opinions projections mixed opinion estimates health economist princeton wrote rigid artificial rules congressional budget office score proposed legislation unfortunately produce best forecasts likely fiscal impact legislation went budget office significantly conclusion bill actually help reduce future federal deficit doubt financing bill near irresponsible financing modernization act douglas director george bush administration later served chief economic policy adviser senator john_mccain presidential campaign alleged bill increase deficit billion argued loaded revenue loaded benefits new republic editors countered critical assessments law deficit impact arguing likely predictions deficit reduction noted easier example account cost definite levels subsidies specified numbers people account savings healthcare track record consistently costs savings health legislation innovations delivery medical care like greater use electronic medical records financial incentives coordination care doctors produce substantial savings slowing relentless climb medical expenses consider savings calculations innovations hadn tried large scale concert meant wasn hard data prove savings david walker general working peter foundation stated estimates likely accurate based assumption congress going going center budget policy priorities objected analysis congress good record implementing savings according study congress followed implementation vast majority provisions enacted past years produce savings employer mandate time working hours confused individual mandate employer mandate penalty incurred employers employees offer health insurance time workers provision included employers considering dropping current insurance plans insurance exchanges began operating alternative source insurance proponents reform law wanted address parts healthcare system believed working causing minimal disruption happy coverage recognized approximately americans insurance total population covered directly indirectly employer total population covered government mainly total population reported satisfied insurance situation significant minorities reported favorably medically related financial troubles dissatisfaction aspects insurance coverage especially poor sick intent employer mandate grandfather clause help ensure existing employer sponsored insurance plans people like stay place company fewer time employees face penalty concerned employer mandate creates incentive business employ people time instead time hypothetical phenomenon referred commentators sides political spectrum effect despite concerns massive spike time workers driven cost cutting efforts large employers number time jobs united_states fact declined number time jobs increased million period leading start date early time jobs turned time jobs public sector result efforts reduce state federal effort maintain increase corporate profits private sectors original fear individuals coined term effect similarly study found limited evidence increased time employment businesses state virginia clarified contracts time employees adding hour week cap reflect hour threshold time hours defined law labor market experts claim shifts clearly implementation pre existing long term trends working hours effects great recession time working hour patterns impact provision employers decision making partially offset factors offering healthcare helps attract retain employees increasing productivity reducing trade smaller time workforce larger time work force carries costs training administration business employers employees relatively small offer insurance changes employer plans provision expected small workers receive insurance employer plan able purchase insurance exchanges regardless rationale maintaining existing insurance arrangements happy policy analysts right left critical employer mandate provision policy merits argue incentives time hours change existing insurance plans real harmful raised marginal cost 50th worker businesses limit companies growth costs reporting administration businesses state enforcement worth trade maintenance current employer plans note employer mandate unlike individual mandate non essential law analysts suggested alternate pay play version employer mandate partially avoid problems instead business offer insurance percentage payroll employee hour cut offs furthermore healthcare policy analysts think better transition away employer based system systems market based insurance portable stable think bad idea try maintain existing employer insurance systems effects provision generated vocal opposition business interests unions granted july obama administration announced treasury department proposed regulations delay implementation employer mandate year survey national association business economics found percent surveyed said hasn influenced planning expectations percent said law wouldn prompt change hiring practices percent businesses surveyed said act harmful effect percent said beneficial february treasury department issued treasury decision final regulation delay employer mandate treasury decision proposed regulations changes existing individual insurance plans times debate surrounding obama stated like health care plan able health care plan law insurance plans effect law enacted significantly changed plans satisfy criteria cancelled comply law new requirements insurance standards furthermore law prohibit older plans reasons determination plan expensive maintain reasons fall millions americans individual policies received notices insurance plans terminated million danger seeing current plans cancelled november president obama stated sorry people losing plans finding situation based assurances got promised work help affected americans acts introduced congress allow people existing individual insurance plans president obama previous assurance consumers plans focal point critics political liability law proponents president obama knew statements incorrect time focus discussion controversy asset recovery provision nicknamed provision enacted congress response rising administrative costs states compelled try recover costs estates deceased program long term care placed individual home claims assets option states recover routine medical care expenses expansion affordable care act residents eligible state federal government february clarified guidelines triggering complaints consumers advocacy groups uncertainty hospitals start november hospitals rural areas closed according north_carolina rural health research program critics affordable care act stated new law caused hospitals close rural hospitals built funds hill burton act increase access medical care rural areas hospitals opened forms medical facilities small number opened facilities operate emergency rooms urgent care centers january quarter emergency room doctors seen major surge patients nearly half seen significant increase number patients seven doctors lack resources deal large increases number patients biggest factor increased number patients insufficient number primary care providers handle larger number patients public opinion public opinion polls indicate united_states public generally supports healthcare reform public views increasingly negative reaction specific plans discussed legislative debate polling statistics general population general negative opinion law years favor approximately october whites approve law compared african americans according research center usa_today survey conducted september usa_today found opinions strongly divided age person law inception solid majority seniors opposing bill solid majority younger years old favor specific elements popular political spectrum notable exception mandate purchase insurance describing public opinion law said surveys consistently found americans overall negative view affordable care act consistently shown large americans favor individual elements law example poll june indicated americans supported law party affiliation democrats republicans favored law overall individual provisions law received varying levels support favored banning insurance companies denying coverage people pre existing conditions favored allowing children stay parents insurance age supported requiring companies employees provide insurance employees supported individual mandate insurance pay penalty party affiliation republicans democrats favored mandate polls showed additional provisions receiving majority support include creation insurance exchanges small businesses consumers people advantage large group benefits providing subsidies individuals families health insurance affordable specific ideas enacted showed majority support included drugs canada lower government controlled prices limiting awards reducing age qualify public health insurance option reasons opposition cnn poll respondents said thought increase money personally spend health care said bill gives government involvement health care said thought families better legislation polls found people concerned law cost projected control cost health care affecting families opposition law americans believe reform far poll indicated opposed bill republican opponents reject overall believed far independent opponents divided relatively smaller group democratic opponents reject overall wanted measure democrats believed grow popular time like implementation benefits law effect close information gap contents bill june majority public indicated desire congress implement law repeal following supreme_court individual mandate national federation independent business poll released july showed americans want critics president obama health care law drop efforts block national issues health reform opinion study showed respondents unfavorable view favorable view individuals polling averages showed public approval poll averages february march associated_press poll released march showed americans support wall_street_journal nbc poll released april indicated respondents affordable care act working way end option poll showed repeal leave improve wanted leave improve june cbs news new_york_times poll showed americans approved health care law time major poll indicated number americans approved bigger ones small margin political term term originally coined opponents affordable care act term law term print march healthcare scott penned health industry journal writing soon care obama care care edwards care totally revamped care 1990s according research atlantic magazine expression early generally writers describing candidate proposal expanding coverage word political campaign des iowa said state worked healthcare time half million people insurance said people raising taxes having government healthcare let tell don democrats democrats medicine government managed care known want common term refer law supporters opponents contrast use patient protection affordable care act affordable care act limited formal official use use term positive sense suggested democrat john president obama endorsed nickname saying problem people saying obama cares care number search engine department health human services purchased google advertisements triggered term direct people official site march obama reelection campaign embraced term urging obama supporters post twitter messages begin like debut phrase capitol hill according analysis sunlight foundation july june term nearly times congressional speeches october associated_press npr began cutting use term stuart npr managing editor said term politically charged term accepted vernacular common death panels august sarah claimed proposed legislation create death panels decide sick elderly americans worthy medical care allegation named lie year outrageous term american dialect society described rumors gross cruel research center reported americans familiar claim believed true contemporaneous polls finding similar results poll august found americans believed death panels claim death panel separate issues initially related proposed provisions found early drafts claim law seniors denied care age government advise end lives instead receiving care eventually independent payment advisory board established passage instead authority determine recommend additional cost saving changes program adoption additional cost effective treatments similar cost recovering measures statutory levels set administration program exceeded given year cycle scheduled fact board prohibited recommending changes reduce payments certain providers prohibited recommending changes benefits eligibility taxes changes result related issue concerns advance care planning consultation section house reform proposal physicians providing voluntary recipients end life health planning covered private plans enabling patients specify request kind care wish receive old age described site provision allow patients prepare day seriously ill unable medical decisions engaging doctors discuss range end life care options available cost covered including accept refuse extreme life saving measures selection care programs appointment relatives act patient behalf etc provision included final draft bill enacted law members congress exempt requires members congress obtain health insurance exchange program approved law instead insurance offered federal employees federal employees health benefits program federal government continue maintain contributions new health insurance plans federal employees benefits illegal immigrants provide benefits illegal immigrants poll found believed explicitly denies insurance subsidies unauthorized illegal aliens opposition resistance opposition efforts repeal legislation drawn support range sources includes labor unions prominent conservative advocacy groups congressional state republicans certain small business organizations tea party movement groups believe law lead disruption existing health plans increased costs new insurance standards increase deficit idea universal healthcare viewing insurance similar people entitled unions expressed concerns negative impact members health care benefits included called highly union health care plans said drive costs union sponsored plans international brotherhood united food commercial workers international union unite leaders sent letter harry nancy arguing hard earned health benefits destroy foundation hour work week backbone american middle class january terry sullivan president laborers international union north_america taylor president unite sent letter harry nancy stating implemented fair marketplace competition health care industry legal challenges opponents patient protection affordable care act turned federal courts challenge legislation national federation independent business decided june supreme_court ruled vote individual mandate constitutional congress taxation powers law upheld congress regulatory power commerce clause court determined states forced participate expansion effectively allowing states opt provision written withheld funding states declining participate expansion supreme_court ruled withdrawal funding individual states right opt expansion losing funding federal government provisions continue effect effect scheduled subject states determination expansion march roman_catholic_church supportive objectives voiced concern united_states conference catholic bishops aspects mandate covering artificial narrow definition religious organization violations amendment right free exercise religion conscience numerous lawsuits pending addressing concerns june supreme_court ruled federal subsidies health insurance states set insurance exchanges state expansion following supreme_court ruling states controlled republicans opted reject expanded coverage provided act half national population lives states january states district_of_columbia adopted expansion states remained states declined expand choose opt time intended cover individuals families effective definitions income federal poverty level expanding eligibility chip enrollment process low income individuals families federal poverty level receive federal subsidies sliding scale choose purchase insurance exchange example individuals poverty level premium cost income supreme_court ruling created potential coverage gap states chose reject expansion maintain pre existing eligibility set states significantly poverty line individuals furthermore states available childless adults income level subsidies insurance plans purchased exchanges available poverty line created coverage gap states state threshold eligibility threshold example kansas able bodied adults children income poverty line eligible poverty level family ineligible federal subsidies buy insurance children able bodied adults eligible kansas studies impact state decisions reject expansion july million americans fall coverage gap commonwealth fund report found states expanded million currently americans gain insurance states expand federal government pays expansion opposing states argue responsibility funding expansion states budgets studies suggest rejecting expansion cost states expanding increased spending emergency care partially paid coverage opting states federal funding benefit states economies agreed expansion expansion associated increased tax revenue job growth significant reductions expansion states population study found states expanding million americans remain lead deaths states agreed expand non cooperation officials texas florida alabama wyoming arizona oklahoma missouri decided oppose elements discretion example missouri declined expand establish health insurance marketplace engaged active program non cooperation having enacted statute forbidding state local official render aid specifically required federal law functioning affordable care act republican politicians tried discourage efforts advertise benefits law conservative political groups launched campaigns discourage enrollment repeal efforts subject unsuccessful repeal efforts republicans house steve king introduced bills house repeal day signed senator jim senate republicans gained control house_of_representatives votes held bill titled job killing health care law act house passed vote republicans democrats voted repeal house democrats proposed amendment repeal effect majority senators representatives opted federal employees health benefits program republicans voted measure senate bill offered amendment unrelated bill voted president obama stated vetoed bill passed chambers congress following supreme_court ruling constitutional republicans held vote repeal law july house_of_representatives voted republicans democrats favor repeal marked 33rd partial repeal attempt president obama reelection democrats expanding majority senate following elections republicans conceded repeal certainly occur february house_of_representatives added repeal vote record members moving action senate republican senator texas introduced legislation repeal vote september federal government strong partisan disagreement congress prevented adjustments act provisions change proposed repeal tax medical devices received support congressional republicans argued improvements law grounds weaken arguments repeal republicans attempted implementation october house republicans supported senators paul mike lee refused fund federal government accompanied delay implementation president pushed employer mandate year critics claim legal right republican held house_of_representatives passed versions bill funding elements government submitting versions repeal delay version delaying enforcement individual mandate bills unable muster votes democrat held senate democratic leadership stating senate pass clean funding bill restrictions congress failed pass continuing funding resolution midnight october government ensued conservative groups heritage action provided lobbying support government senate republicans threatened block appointments relevant agencies independent payment advisory board centers services economic consequences passage majority citizens company sponsored insurance plan rich nation case companies began offering insurance policies world war attract talent reduced supply workers practice later cemented tax policies encouraged benefits health care ones cash offering insurance lieu cash compensation corporations responsible employee health rising insurance costs coupled rising salaries benefits salaries aging workers found salaries benefits cut large company policies norm tax laws benefits cheaper cash employees losing corporate policies find insurance insurance system introduced employers stopped company sponsored insurance plan eliminated largest compensation benefits shifted costs employees include insurance rising compared according kaiser family foundation workers paying reaching twice according study firms saw offering insurance years found evidence companies reducing hours workers avoid requirements employees working hours week house republican leadership forth argument favor repeal job killing law period contended lead loss jobs figure report congressional budget office noted figure included report referred saying republican statement badly congressional budget office said law fact saying effect employment probably small rated republican statement false citing projections summarized primary employment effect alleviate job lock people working desperately need employer sponsored health insurance longer concluded reform significant employment impact reduction labor force primarily people holding jobs insurance finally retire health insurance outside jobs impact repeal federal budget projections congressional budget office analyzed proposals repeal law analysis law estimated entire law spending provisions increase net federal deficit billion revised accounting following july house repeal vote taking account impact supreme_court ruling consistent previous estimate repeal cause net increase federal budget billion period

Patient Protection and Affordable Care Act


united_states code congressional administrative news united_states code congressional administrative news west group publication collects selected congressional administrative materials publication single resource published 1st session congress published session congress published monthly pamphlets contain cumulative subject index cumulative table laws enacted addition selected documents pamphlets reissued bound volumes session congress concludes documents publishes text new federal laws selected committee reports house senate signing statements presidential executive orders reorganization plans president messages federal regulations proposed constitutional amendments federal court rules sentencing guidelines arranged chronological order published bound volumes legislative history documents placed separate volumes apart rest materials published prior congress legislative history materials contained house senate report congress legislative history materials included house senate report committee report presidential signing statements considered readily accessible source materials like committee reports originals result recommended citation source addition original document

United States Code Congressional and Administrative News


united_states approximately pounds shark fins united_states approximately pounds shark fins decision united_states court appeals ninth circuit concerning civil admiralty law judge stephen wrote judge panel ordered shark fins returned owners reversing decision southern district california government appeal case case began coast guard crew working navy ship stopped searched king diamond hong_kong based vessel international waters coast guatemala board ship found shark fins equivalent tons tonnes corresponding shark coast guard investigation found documentary evidence arranged meet fishing vessels locations buy quantities fins activities believed violate shark prohibition act fins seized ship escorted san_diego nearest american port federal agencies filed charges owner operator captain sought fins jurisdiction resulting unusual case title judge barry granted order boat owners appealed ninth circuit reversed years later held seizure illegal reasons activities meet definition fishing vessel stevens fishery conservation management act fins seized high seas president barack_obama signed shark conservation act law closed background china late 20th century economic reforms produced middle class increased demand traditional luxury items like shark fins chinese traditional medicine healing effects fins soup considered costing bowl chinese demand fins led fishing crews sharks start fishing sharks directly shark populations began declining predators near marine food chain umbrella species playing important role maintaining ocean ecosystems adverse environmental consequences marine fisheries campaigns began nations prohibit greatly territorial international waters work international agreements practice president bill_clinton signed shark prohibition act law shortly leaving office amended stevens fishery conservation management act primary statute regulating fisheries exclusive economic zone nautical miles offshore prohibit territorial waters vessels possession fins vessel international waters landing fins port corresponding amounting times weight fins national marine fisheries service charged implementing regulations enforce act congressional debate non voting delegate house_of_representatives american expressed concerns lack language barring vessels engaging fins purchasing taken vessels high seas stop introduced amendment bill banning possession fins fishing vessels defined stevens act landing vessel congress assumed language sufficient accomplish intended purpose underlying dispute august navy destroyer uss international waters southeast acapulco mexico observed king diamond foot vessel owned inc shipping company hong_kong home port crew asked questions radio learned having sailed honolulu time ago way honolulu guatemala coast guard detachment aboard confirmed properly flying flag coast guard suspicious ship low water suggesting carrying heavy cargo cranes equipment legitimate fishing vessel expected instead large shipping containers radio asked joint task force west consortium federal law enforcement agencies permission investigate drug known use route receiving permission coast guard boarded decaying flesh quickly led large quantity shark fins deck shipping container filling ton hold odor strong coast found breathe mouth burned nose corresponding found task force told boarding party indicated likely violation consider ship crime scene fins days later coast guard cutter chase took escorting san_diego way investigation continued coast guard reported man crew cooperative investigation largely sitting watching television lounge claimed sharks believed wrong ship records revealed met fishing vessels primarily korean fishing boats locations high seas near fiji solomon islands bought fins total earlier voyage summer ship million shark fins obtained way korean language records broker board indicated ongoing operation giving names ships involved unit board broken ship left honolulu fins deck attempt dry reduce odor san_diego fins weighed took crew seven hours fins tied foot weighing roughly pounds trucks secured cold storage facility evidence pending outcome legal proceedings tons tonnes total twice anticipated making largest seizure shark fins estimated fins represented total sharks taken litigation early national oceanic atmospheric administration fisheries office law enforcement finished investigation charged marine products ltd hong_kong fins bought tan captain counts violating assessed fines highest civil penalty levied violation act believed government exceeded statutory authority fins argued judge barry federal district judge southern district california granted injunction prohibiting selling fins company agency agreed return putting bond possession shark fins remained cold storage pending outcome case fins equal fine initiated civil action bond fins district court government went seeking summary judgement case turned fishing vessel early issued ruling holding directly engaged fishing engaging activities supporting fishing subject grant moved deferred stevens act definition fishing vessel according statute fishing vessel engaged fishing aiding assisting vessels sea performance activity relating fishing including limited preparation supply storage transportation processing rejected argument engaged fishing fishing vessel previous ownership equipped equipment held federal permit shortly bought ship longer valid argument based paper fact fishing vessel definition depends configuration outfitted time seizure wrote record declined decide question grounds consider turned support aspect simply issue case narrows vessel equipped type normally aiding assisting vessels sea performance activity relating fishing question agreed going ship ship buy store transport fins crew directly aided assisted foreign vessels fishing activity statute qualified interpretation government assertion mere purchase fins constituted activity support fishing pointing fishing vessel ship aboard purchased single fin personal use case crew acted effectively shark fin market foreign fishing vessels sea act aided assisted foreign fishing vessels longer store transport land shark fins order sell market saved time money fishing vessels taken fins cited document records communication korean broker explicitly saying rendezvous save time cost proof suggests buying fish fishermen sea activity related fishing wrote selling fish sea saves storage transportation landing expenses necessary bring fish market increasing voyage going ship ship purchasing total pounds shark fins wholesale market aided assisted activity related fishing plain meaning statute fishing vessel found reinforcement regulations implementing prohibition landing shark fins corresponding extends vessel including cargo shipping vessel obtained fins vessel sea read sea transfer shark fins effectively receiving vessel fishing vessel receiving vessel acting support fishing claimed language applied vessels landing shark fins possessing time responded use indicated broader reach bill legislative history showed congress intended broad reach senator opposing bill worried bar american ships shark fin trade entirely congressional budget office found bill enacted mandate effect report house_of_representatives legislative history confirms applies possession pounds shark fins wrote lastly argued fishing vessel statute sections implementing regulations rendered vague making impossible easily determine statute applied argued failure government provide adequate notice law enforced vessels violation right process found supreme_court decision estates relevant analysis court reversed seventh circuit upheld local ordinance imposing restrictions sale drug like observed ordinance enforced civil penalties primarily economic regulation aimed business activity businesses reasonably expected study prepare accordingly provisions merit strict scrutiny lesser standard strongly rejected argument fishing vessel definition broad face wrote broad fact ordinary person reasonable intelligence think activities probably included blanket fishing vessel definition exempt indicates picking fish parts sea aids fishing renders vessel express definition fishing vessel stevens found publication regulations federal register constituted notice reasonable person shark fin business aware application activities appeals court appealed working process foremost agreement market value fins appeals court ruled favor district court granted middle case went ninth circuit court appeals judges stephen fisher richard nominated court presidents jimmy carter bill_clinton george bush respectively hear case oral arguments announced decision months later march unanimously reversed ruled fishing vessel fins seized case wrote find plain meaning statute provide notice owners activities render fishing vessel read text statute closely ship store transport fins governing words aid assist cited dictionary definitions words generally ing act benefit explained length purchase item constitute aid assistance seller case purchase store transport shark fins benefit foreign fishing vessels instead purchased fins commercial purposes foreign fishing vessels interest shark fins selling result subsequent post purchase storage transport shark fins benefit foreign vessels product aids assists seller storing goods acquired warehouse transporting location intends mere act purchasing constitute act aiding assisting seller necessary criminal statutes intended punish buyers sellers illegal substances specify group selling bought illicit product district court theory simple act purchasing buyer simply incorrect noted purchase specifically included support activity statute reasons rejected finding specifically purchase fins locations high seas aided fishing vessels purchased fins times acting interests beneficial necessary vessels business operations choice change nature actions respect observed purchased fins stored transported commercial purposes standpoint benefit seller incidental letter broker specifically stating sea purchases save time expense convincing establish failure inability arrangements respect foreign vessels constituted aiding assisting actually went surely purchasing shark fins dock cost remain surely sellers benefited selling particular location benefited making sale place purchase making purchase desires business reasons result district court assumption seller benefit location particular sales appears reasonable irrelevant court recognized congress intent eventually eliminate shark passing broad purpose act provides help government regard issue appeal wrote turned finally regulations pointed applied language broadly context suggests opposite instead case vessel shark fins bound american port case instead covered regulations possession bound foreign port provisions specific fishing vessels agency includes language section regulation reasonable agency acted intentionally language wrote parallel supreme_court precedent congressional intent taken concluded regulations reasonably read provide notice vessels engage sea transfers fins prohibited landing shark fins port provide notice vessels prohibited possessing fins purpose making delivery foreign port noted language stating intent interfere international trade circumstances reasonable person fair notice activities render fishing vessel statute result hold district court application possession prohibition fishing vessel violated process shark conservation act month decision delegate guam introduced shark conservation act house close created decision eliminated fins ratio entirely replaced language forbidding vessel fishing vessel carrying shark fins naturally attached corresponding law adopted hawaii later report bill nick committee chair said congress believed language stevens sufficient prevent new legislation primary purpose stated explicitly close decision opened bill referred natural resources committee referred fisheries wildlife oceans chaired hearings held week later clarke researcher imperial college london studies shark fin trade observed operations common likely continue competition hong_kong industry traditional center grew intense ban effective response decision suggested shipments fins allowed separated landing report directly criticize court don young alaska committee ranking member section additional views end report called ninth circuit decision mistaken action clearly violation act court ruled wrote court clearly wrong decision glad court decision case june met mark bill amendment language prohibiting vessel transport fins passed voice vote week later committee adding amendment requiring fins attached sent bill house july passed voice vote referred senate sponsored john massachusetts read twice referred committee commerce science transportation action taken congress bill died reintroduced amended beginning congress gained bypassed committee stage passed voice vote march reintroduced senate month later eventually gained senate oceans atmosphere fisheries coast guard held hearings bill june senate report jay west_virginia reiterated bill clarify statute popularly understood scope application prior case commentary group shark attack survivors visited senators offices lobby bill july passed near end year signed law president barack_obama january

United States v. Approximately 64,695 Pounds of Shark Fins


adoptive couple baby girl adoptive couple baby girl decision supreme_court united_states held sections indian child welfare act apply native american indian biological fathers indian child court held procedures required end parental rights apply child lived father additionally requirement extra efforts preserve indian family apply preferred placement child indian family required party formally sought adopt child couple south_carolina matthew sought adopt child father brown enrolled member nation mother predominantly hispanic brown contested adoption grounds properly notified accordance won trial court appeal south_carolina supreme_court december father given custody child case received extensive coverage national media spurred calls congress review amendments law october adoptive couple petitioned supreme_court united_states review case january court granted heard case april june supreme_court issued decision holding non father rights sent case south_carolina courts hearings issue july south_carolina trial court finalized adoption child adoptive couple prohibited august oklahoma supreme_court stay lifted september child turned adoptive parents month background indian child welfare act prior adoption indian children forcibly removed homes placed native american boarding schools non indian foster adoptive homes studies conducted indicated percent tribal children removed homes consequently tribal culture testimony house committee interior affairs showed states capita rate indian children foster care nearly times higher rate non indians cases bureau indian affairs paid states remove tribal children place non indian families religious groups congress determined indian children continued removed indian homes rate tribal survival threatened stated tribal stability important best interests child factors judgment differences culture best interest non indian child necessarily best interest indian child especially influence extended families tribal relationships indian child welfare act enacted protect indian tribes children applies indian children defined unmarried person age eighteen member indian tribe eligible membership indian tribe biological child member indian tribe additionally case voluntary adoption indian child courts follow specific guidelines indian birth parents parental rights terminated provides relinquish parental rights indian parent writing judge parent understood actions understands spoken english translator available executed prior days child birth indian parent withdraw consent adoption time prior final order years final order consent obtained fraud termination occurs supported evidence reasonable doubt consent withdrawn procedures followed indian child immediately returned indian parent tribal rights covered act tribal courts exclusive jurisdiction cases arising indian reservations concurrent jurisdiction case removed state court tribal court request tribe indian child parents object case tribe right intervene proceeding act protect tribal rights child case history brown member nation brown served united_states_army fort oklahoma non indian single mother brown engaged married december informed brown pregnant january learning pregnant brown began press ahead marry refused provide financial support married broke engagement text message cut communications brown june sent brown text message asking pay child support relinquish parental rights brown responded text message relinquished rights child support order place time furthermore laws vary state state generally impossible parent male female surrender parental rights court hearing determines best interest child father terminate parental rights contract informal means text message months prior baby birth began work adoption attorney place child matthew duncan james island south_carolina oklahoma law requires indian tribe informed indian child adopted attorney brown provided incorrect date birth result tribe notified proposed adoption receiving permission oklahoma authorities based identification child hispanic native american took child south_carolina months birth child days deployment iraq brown served notice proposed adoption brown signed document believing rights brown realized signed immediately tried retrieve document failed contacted judge advocate general fort assistance seven days notified proposed adoption brown obtained stay adoption proceedings civil relief act deployed army unit iraq trial court adoption case heard charleston county family court september brown contested adoption nation intervened party right case court denied petition adopt child ordered child returned brown biological father south_carolina law father parental rights terminated provide pre birth support involved child shortly birth court noted state law november court issued ruling holding applied unconstitutional existing indian family exception case brown consent termination parental rights adoption child failed clear convincing evidence brown parental rights terminated december turned child brown accordance trial court order appealed supreme_court south_carolina state supreme_court chief justice jean delivered opinion court july members court split justices joining majority opinion justice john joined justice opinion decided issues removed child oklahoma second state law brown status parent met burden proof terminate parental rights brown noted correct removal child oklahoma create unsafe environment child incorrect legal issue oklahoma properly notified indian child nation alerted child interests member tribe protected noted point case properly court proceeded address second issue argued takes mere biology provisions south_carolina law father reside mother month period preceding birth child contribute pregnancy related expenses order rights court determined state law trial court properly determined grants indian fathers greater rights state law turned issue trial court refusal terminate brown parental rights brown agreed consent adoption court noted set clear procedural guidelines comply requirements failed clear convincing evidence brown parental rights terminated prior terminating indian parent rights indian child party seeking terminate parental rights shall satisfy court active efforts provide services programs designed prevent breakup indian family efforts proved unsuccessful court noted efforts comply requirement federal law actively sought prevent father obtaining custody child months old court addressed best interests child said quoting mississippi band indians indian child best interests stake inquiry child best interests account status indian placement best interests indian child based fundamental assumption indian child best interest relationship tribe protected stated best interest child father preserved tribal affiliation finally addressed placement requirements requires placement preference given order member child family member child tribe indian family court stated intended comply statute claim breaking bond formed child grounds ignore statute court affirmed decision charleston county family court returning indian child father reiterated state law termination parental rights indian parents dissent justice john joined justice argued state standards best interest child concluded trial court judge findings fact noted brown income approximately paid assist pre birth expenses indicated intend addition stated record reflected informed adoption agency adoption attorney child heritage tribe correct identifying information father child birth present matt cut cord evaluated noting south_carolina law allow father brown position contest adoption brown acknowledged dna test proved biological father brown met definition indian parent apply case brown acknowledged child indian federal law apply stated applied congress intend replace state law regard child best interests concluded brown abandoned child allowed contest adoption noted provided child loving stable home finally ruled termination brown parental rights best interest child reversed decision trial court supreme_court arguments south_carolina supreme_court declined case filed petition united_states supreme_court writ seven entities filed supreme_court support hearing case included general paul behalf guardian behalf birth mother american academy adoption attorneys national council adoption california state association counties center adoption policy submitted january court granted agreed hear case second time case involving granted review supreme_court april court decided allow participate oral argument divided time allowed oral argument follows minutes minutes guardian minutes birth father minutes solicitor general brown represented charles director yale law school supreme_court clinic supreme_court washington office international law firm mayer brown nation represented carter phillips austin represented lisa mark headed supreme_court practice international law firm arnold porter registered native american attorney founder indian child welfare law center issues presented court non parent indian child welfare act block adoption voluntarily initiated non indian parent state law defines parent include biological father complied state law rules attain legal status parent parties filed merit brown nation respondents different filed arguing merits case favor reversal remainder including united_states department justice supported respondents generally opinion court justice samuel delivered opinion court noted provisions relevant case noted undisputed south_carolina law brown able object adoption stated heightened standard required apply parent question custody child focusing phrase continued custody statute continued require efforts parent custody brown physical legal custody efforts required finally prevent non indian couple adopting preferred individuals entities formally sought adopt child opinions justice thomas justice thomas issued opinion thomas stated canon constitutional avoidance required outcome reached majority thomas contended constitutional authority congress enact application adoption unconstitutional result majority avoids issue thomas concurred majority justice justice stephen issued short opinion stated address treat fathers court decision broad noted placement order required changed tribe tribe resolution grant father place placement opinions justice justice issued short opinion stated opinion phrase continued custody refer custody future words biological father custody child past future apply noted biological parents legal rights reason law policy rights justice justice majority opinion stated continued custody read refer generally continuation parent child relationship parent child stated non father child relationship family purposes efforts needed prevent breakup stated majority turned law upside reach result indicated narrow interpretation statute majority destroyed unified federal standard established congress favor system state control finally stated majority ignored primary purpose interpretation noted prevent grandparents filing petition adopt child noted opinion mandated return child subsequent developments media coverage prior supreme_court decision coverage mainstream media extensive charleston post ran series articles case news picked media outlets included local television stations distant television stations cable news network cnn fox news channel national magazines news new_york_times additionally featured television episode aired october immediately sparked controversy indian newspapers internet news sources calling boycott alleged sided attack native americans alleged mainstream media incorrect false information portrayed good light brown bad light terry cross national indian child welfare association commented despite negative press needed protect indian children having tribal rights taken noted failure comply caused controversy case author senator jim initially stated totally different intended time weeks later said main intent law ensure tribes opportunity sign adoption tribal children post opinion supreme_court decision media outlets stated won case correctly noted gain custody receive order adoption noted decision return child case return south_carolina state courts additional hearings social media case received great deal coverage social media friend duncan publicist previously contracted work duncan employer services therapy south_carolina started save campaign aimed gathering support couple efforts charleston family court south_carolina supreme_court decisions runs marketing firm trio solutions inc trio mount pleasant south_carolina responsible making case known according source responses native american community pointed irony campaign editorial cartoon depicting campaign save indian child indians addition movement supporting brown stand ground said baby case strong example problems adoption industry pushed adoption reform stand ground started facebook protests rallies states legal developments filed suit south_carolina district court july asking declared unconstitutional july legally adopted child concurrently south_carolina court adoption native american rights fund filed civil rights lawsuit district court behalf child alleging rights violated south_carolina court addition south_carolina court order enforced oklahoma agreement oklahoma court brown stated fight order oklahoma aid nation prior south_carolina adoption finalized nation district court granted temporary brown wife parents brown military training state time judge south_carolina ordered brown immediately turn child representatives nation said impossible brown performing military duties august oklahoma supreme_court stayed order district court child immediately transferred custody brown court ordered visits girl oklahoma brown family celebrated girl fourth birthday party september court ordered hearing took place september september failed produce resolution oklahoma supreme_court lifted stay district court order september clearing way custody child returned girl turned adoptive parents evening september september charleston county family court began contempt proceedings brown nation face south_carolina adoption decree finalized july parties face financial sanctions include living legal expenses period brown nation allegedly contempt court october brown announced dropping appeals daughter chance normal life november matt filed lawsuit county oklahoma demanding million court costs custody battle lawsuit biological father brown nation nation issued forceful response saying responsible paying fees costs eleventh amendment sovereign immunity suits express consent clear tribe displeasure public media appearances interviews fundraising schemes time parties statutory gag order south_carolina


moral rights united_kingdom law moral rights united_kingdom law parts copyright law protect personal interests author work economic interests protected elements copyright found copyright designs patents act moral rights right identified author work known right right object treatment work known right integrity right identified author work right privacy right exists entire copyright term requires individuals commercially broadcast sell perform exhibit literary dramatic musical artistic works identify author work apply things works subject crown copyright right integrity protects authors having works altered fashion constitute distortion original work way author reputation honour cases vary right integrity interpreted judges saying distortion taken wider clause reputation honour avoid decisions interpreting clause distinct types violation right object false protects individuals identified authors works contributed unlike moral rights exists individual lifetime years death term copyright united_kingdom law moral rights criticised failing correctly implement convention protection literary artistic works narrow types creative works covers definition copyright law history sought protect financial interests authors personality rights evolving french moral moral rights protect personality reputation work author convention protection literary artistic works providing protection moral rights member states legal systems actual rights provided vary nation nation french law treats moral rights supreme perpetual german law gives moral economic rights british legal system traditionally manifested certain claims authors deserve special protection law copyright designs patents act little protection passage act academics debate far rights rights authors rely old common law rights remain force act alternate forms relief claim dedicated moral rights dubious seen unlikely succeed similarly author rely contractual rights bbc allowed block modifications work virtue contractual clause prohibiting bbc making structural changes script originally forms relief injured authors section copyright act created act distinct moral rights recognised right identified author right right object treatment right integrity right object false right privacy private films photographs moral rights personal rights attached author economic rights attached work transferred assigned waived right identified right identified known right applies creators original literary dramatic musical artistic works films right identified granted director writer specific types work protected right particularly report current events periodicals newspapers exceptions included result lobbying publishing industry fear need author current events report interfere delivery undermine image news objective neutral section right identified apply authors computer programs computer generated works works protected crown copyright works covered moral right need assert instrument assigning copyright instrument written author director asserting document designed assign copyright claims notice instrument applies directly informed assertion right identified asserted applies duration copyright works created august right author director legal right author properly identified circumstances work attributed exceptions defences apply regards lack proper identification identification acceptable author appear copy work prominent fashion section act appropriate author appear copy appear fashion brings identity attention person acquiring copy work work building visible people entering approaching author pseudonym form identification asserting right form identification adopted specific circumstances lead requirement circumstances right identified author literary dramatic work right identified work broadcast performed public sold commercially director film right named videos commercially sold film broadcast television formats songwriters treated slightly differently author song right named commercial publications requirement identify song broadcast performed public work artistic artist right identified work commercially published exhibited public visual image broadcast artwork recorded artist identified resulting film shown public work sculpture work artistic building author named copies graphic work representing photograph shown public right object treatment right object treatment right integrity considered important innovations act applying authors literary dramatic musical artistic works directors films right treatment work circumstances author protected treatment word treatment refers addition alteration adaptation work words interference work internal structure deliberately translations literary works arrangements musical works involving change key register proven modifications amounted treatment treatment section act provides treatment constitutes distortion work damages honour reputation author act gives guidance constitutes distortion courts cases adopted idea concepts considered clause prohibiting damage author honour reputation records warner music ltd alternative simply looking distortion individual concepts result confusion highly nature words judges supported interpretation treated individual concepts treatments author reputation considered light treatment constitute distortion trustees natural history museum treatment occurred circumstances author right protected right object treatment exist simply protect damage author reputation literary dramatic musical works author protected treatment treatment published commercially performed public communicated public protected film sound recording including treatment publicly issued work artistic author sue treatment commercially published publicly exhibited publicly shows film sound recording treatment films author protected treatment shown communicated public copies issued public exceptions normal infringement fair dealing apply right object treatment exceptions works created employees company course work company employees alter work question author rights giving way light business reality exception apply employee identified work time alteration point exception allows alteration work order avoid committing criminal offence publications act right object false right object false oldest statutory moral rights originating albeit limited form fine arts copyright act found section act right object false allows individuals avoid named works author applies literary dramatic musical artistic works films applies acts false august lasts years death person falsely attributed authorship individual issues copies work public exhibits public broadcasts false work attributed wrong person depends according clark associated newspapers single meaning work conveys reasonable reader need prove false caused harm actual author right interpreted cover situations diverse newspaper parody clark diaries interview replica painting contained signature original author right closely linked passing non statutory causes action supplement claim right object false david writing international journal law information technology goes far right object false merely passing writ large note strong overlap rights false treatment right privacy moral right privacy english law right privacy operates limited circumstances individual photograph film commissioned private use original hold monopoly broadcasting showing publicly issuing copies public right lasts length copyright commissioner work holds right individually person commissioned work choose license criticism united_kingdom law relating moral rights repeatedly criticised primarily failing entirely comply convention point right object treatment uses far narrower definition treatment convention merely requires author able object action limitation notes attitude moral rights expression given rights act testament article convention requires exercise authors moral rights shall subject right requires author assert ownership writing available authors default addition exclusion things computer programs step international