As MoJo's own Suzy Khimm writes today, the more than a dozen states set to fight President Obama's health care bill in court may not succeed, but there's still plenty they can do to undermine how reform is implemented. Like how states establish insurance exchanges, as the new law requires, which require plenty of supervision and appointees at the state level. Now another state, Oregon, has now joined the states' legal health care battle—but it's on the side fighting for the bill.

Oregon's attorney general, John Kroger, announced yesterday that he's readying a massive defense alongside the state's governor to defend the constitutionality of Obama's health bill. (Both men are Democrats.) "The health care reform cases present some of the most important constitutional issues facing this generation," Kroger said in a statement.

Oregon's defense of health care reform faces stiff opposition from a spate of attorneys general nationwide. The AGs already vowing to fight Obamacare, as opponents call it, hail from Florida, Alabama, Michigan, South Carolina, Nebraska, Pennsylvania, Colorado, Texas, Utah, Louisiana, Indiana, Idaho, South Dakota, and Washington. (All of these states are party to the same suit, filed by Florida AG Bill McCollum.) The Virginia AG has also announced that he'll sue the Obama administration over the health bill as well. One particular piece of the health bill that has these state AGs up in arms is a mandate that all Americans buy medical insurance or pay a fine; the states say this demand violates the constitution's commerce clause, which gives the feds the power to regulate interstate commerce. These states counter by saying insurance contracts aren't commerce, and thus fall under state's regulatory power. Their opposition also stems from states' broader fiscal woes, with budgets already deep in the red and likely to suffer more when required to implement Obama's health care plan.

With Oregon now joining the fray, the fight over Obama's health reform is shaping up to be a bruiser. And don't be surprised to see more states chime in the coming days and weeks.

It couldn't have been easy for Admiral Robert Willard, the commander of the U.S. Pacific Command, to maintain a straight face during his completely bizarre grilling by Rep. Hank Johnson (D-Ga.) last week. Willard was testifying before the House Armed Services Committee at a hearing concerning his command's FY 2011 budget. Part of the hearing centered on plans to shift thousands of US troops from Okinawa to Guam. This move is likely to put a serious strain on the tiny island—but not the kind that Johnson is worried about. Take it away, Hank:

My fear is that the whole island will become so overly populated that it will tip over and capsize.

To which Willard, who appears to be stifling a grin, says:

We don’t anticipate that. The Guam population, I think, currently about 175,000, and again, with 8,000 marines and their families, it’s an addition of about 25,000 more into the population.

Earlier, in another cringe-worthy moment, Johnson goes into exhaustive detail about the island's dimensions, eventually posing this question to the admiral: "I don't know how many square miles it is, do you happen to know?"

Willard: "I don't have that figure with me, sir, but I could certainly supply it to you if you'd like."

Since Willard definitely has more important things to do than Google the square mileage of Guam, I'll save him the trouble: approximately 212.

Jon Stewart needs to send Johnson a thank you note. You can't make this stuff up.

UPDATE: Johnson, via his spokesman, responds:

“I wasn’t suggesting that the island of Guam would literally tip over,” said Johnson. “I was using a metaphor to say that with the addition of 8,000 Marines and their dependents – an additional 80,000 people during peak construction to the port on the tiny island with a population of 180,000 – could be a tipping point which would adversely affect the island’s fragile ecosystem and over burden its already overstressed infrastructure.

“Having traveled to Guam last year, I saw firsthand how this beautiful – but vulnerable island – is already overburdened, and I was simply voicing my concerns that the addition of that many people could tip the delicate balance and do harm to Guam.”

The 14 states suing the Obama administration to stop the enactment of health care reform aren't likely to get very far. But though they probably won't succeed in overturning the legislation, they could seriously undermine it. The Affordable Care Act, as the reform bill is known, will create health insurance exchanges, which each state will be responsible for setting up. And reform-resistant state governments will have much opportunity for foot-dragging and spotty regulatory enforcement. 

Under the law, the federal government will establish national regulations for the exchanges—which will enable individuals and small businesses to purchase more affordable coverage in a regulated market—but the states will have the job of creating and overseeing them. As the New Republic's Jonathan Cohn explains:

It requires appointing people to run the exchanges and figuring out how Americans will use them, but it also means preparing to regulate insurers more closely than anybody regulates them now. The law creates minimum standards for what insurance covers and requires insurers to spend most of their money on actual patient care, to name only two obvious changes.The states will have primary responsibility for enforcing these standards.

Once they're established, the state exchanges will need enough people enrolled and enough competition to bring prices down. "In essence, the bill spurs 50 different health reforms," says Anthony Wright, executive director of advocacy group Health Access California. That fact has become clear in the days following the passage of the bill. Some states are trying to roll back reform, while others "are already at work implementing—and improving" it, he explains. For instance, on the same day Obama signed the bill into law, the California state legislature passed legislation to implement one of its immediate provisions to ban "recessions"—that is, the insurance industry practice of retroactively denying coverage to people after they become ill. States will also be responsible for overseeing an unprecedented expansion of Medicaid coverage—a major reform that many state governments have already protested, because they'll be shouldering part of the cost.

Yesterday in New York, the international donors' conference on Haiti's recovery hopefully helped raise billions of dollars to fund the earthquake-ravaged Caribbean country's redevelopment—on Haiti's own terms. According to reports in the Huffington Post and New York Times, a few main things must be accomplished for Haiti to rebuild itself: Funds must be transferred from NGOs in the country to the Haitian government (regardless of the government's corrupt past), the country must be decentralized, and it must use its own methods and, if possible, resources to regain economic strength. The Congressional Black Caucus recently hosted a conference to review the progress of recovery efforts in Haiti, and panelists continuously repeated these sentiments.

"A democracy cannot be run by NGOs," Rep. Yvette Clark (D-N.Y.) said, after noting that she represented the second-largest Haitian population in the US. She visited Haiti a few weeks ago and assessed the situation there:

What I witnessed on the ground in Haiti was a government made impotent by an overemphasis on the financial contributions to an NGO network, an NGO network that is not accountable to anyone other than themselves or perhaps their boards...many of the NGOs are not even registered with the Haitian government, and so the tracking and transparency that comes from the support mechanisms that they are providing are not made clear. The accountability around the financial support they’ve received is not as clear either, unless they're registered with the US in which case we can track them…

Clark maintained that help from NGOs is not in itself a mechanism to a civil society. "I am advocating for direct financial assistance to the Haitian government. If you make the Haitian government impotent and in the view of its own people unable to provide for them, then democracy is dead."

Clark asked President Obama to pass an executive order to establish a Haitian Enterprise Development Fund modeled after the private equity and venture capital funds financed by US foreign aid. "We need to make sure that the work that we do in Haiti is one that is inspired and is taken ownership of by Haitians in Haiti, so that the development of the civil society is authentically Haitian," she said.

The growing divide between regular Haitians and the NGO workers sent to assist them was also highlighted in a story broadcasted on Al Jazeera English, which is worth watching in full:



At the CBC forum, Rajiv Shah, a USAID administrator, echoed Clark's concerns. "We absolutely must prioritize a mechanism for managing resources and managing donor engagement that allows for real alignment with the government of Haiti's strategy," he said. "We should all be patient in how we spend those resources...Instead of rushing to do major reconstruction contracts with outside parties, we should take more time, be more deliberate, plan more carefully, and indentify local partners that can implement projects and programs. And use the influx of resources to build their critical capacities that will be necessary for Haiti to have a more vibrant future."

Speaking of that future, Raymond Joseph, Haitian ambassador to the US, announced that "the new Haiti will have to go green." After the earthquake hit the country, Joseph said, traffic lights were still working because they're powered by solar panels. Joseph acknowledged the "astounding solidarity" the world has shown in helping post-quake Haiti, but he cautioned against a do-anything strategy that lacked forethought and national scale.

"It took an earthquake to bring the whole world around Haiti," he said. "One thing that has happened in this earthquake is that it has given us a new idea of how to remake Haiti. Not as the Republic of Port-au-Prince, but as the Republic of Haiti."

Follow Titania Kumeh on Twitter.


US Army Soldiers hand out hundreds of pink backpacks filled with school supplies and toys to students at a girl's school in Iraq, on March 25, 2010. Photo via the US Army photo by Sgt. Bryce Dubee.

The Center for Constitutional Rights has filed a lawsuit in the U.S. District Court in D.C. on behalf of five prisoners held in solitary confinement in the “Communications Management Units” (CMUs) of two federal prisons. The “experimental” units were supposedly designed to hold high-risk inmates, including terrorists, whose crimes warrant heightened monitoring of their external and internal communications. But the reality, the CCR asserts, is that many prisoners end up in the CMUs ”for their constitutionally protected religious beliefs, unpopular political views, or in retaliation for challenging poor treatment or other rights violations in the federal prison system.”

The two CMUs, at the federal prisons in Marion and Terre Haute, now hold about 70 men. They were secretly created by the federal Bureau of Prisons during the Bush Administration, in 2006 and 2007, and have remained intact since the Obama Administration came to power. 

Inmates in the CMUs are subject to isolation which in some respects exceeds even that of federal supermax prisoners. According to the CCR:

Prisoners in the CMU, alone out of all general population prisoners within the federal system, are categorically banned from any physical contact with visiting friends and family, including babies, infants, and minor children. To further their social isolation, the BOP has placed severe restrictions on their access to phone calls and work and educational opportunities.

What’s more, unlike most supermax prisoners, those assigned to the CMUs are not even accused of any disciplinary violations that might warrant their segregation–for example, attacks on guards or other inmates, or other violations of prison rules. And they receive not even a pretense of due process before being placed--and held permanently--in these extreme conditions. As CCR explains:

All five men confined in the CMU have been classified as low or medium security, but were designated to the CMU despite their relatively, and in two cases perfectly, clean disciplinary history. Not a single one has received discipline for any communications-related infraction within the last decade, nor any significant disciplinary offense.

Like all CMU prisoners, the men received no procedural protections related to their designation, and were not allowed to examine or refute the allegations that led to their transfer. They are also being held indefinitely at the CMU without any meaningful review process. They expect to serve their entire sentences in these isolated and punitive units.

Predictably, the lack of procedural protections has allowed for an unchecked pattern of discriminatory and retaliatory designations to the CMU. Rather than being related to a legitimate penological purpose or based on substantiated information, our clients’ designations were instead based on their religious and/or perceived political beliefs, or in retaliation for other protected First Amendment activity.