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Old 11-08-2014, 09:31 AM   #21
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Meaningless lawsuit anyway. Even if the court rules that only states can give subsidies via their exchanges there are several simple workarounds.
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Old 11-08-2014, 09:56 AM   #22
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The workaround may be simple (or not), but when it comes to actually getting a state legislature to do anything that is another story. After all I think only 27(?) states have expanded Medicaid.
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Old 11-08-2014, 10:00 AM   #23
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The ACA will be tweaked going forward, but it is here to stay. Just like Medicare, Social Security, etc. There is no serious effort that will result in repeal or it being overturned and the pragmatic folks on both sides realize that, so we'll eventually get past the edge cases.
I don't think you realize how much people on the other side really loath the ACA.

Of course there is currently no "serious effort" to repeal the ACA right now. It would be vetoed. On the other hand, I wouldn't be surprised if the new congress sends the president a symbolic repeal bill that he then vetoes. Followed by some strategic "chipping away the the margins" legislation like repeal of the medical devices tax and maybe the penalty (or is it a tax?) if your insurance doesn't meet government standards.

If, always a big if, there is a republican president and congress after 2016, there is certainly a >50% that the ACA would be repealed (and replaced with something different).

Just reporting it as I see it...
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Old 11-08-2014, 10:26 AM   #24
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I don't think you realize how much people on the other side really loath the ACA.

Of course there is currently no "serious effort" to repeal the ACA right now. It would be vetoed. On the other hand, I wouldn't be surprised if the new congress sends the president a symbolic repeal bill that he then vetoes. Followed by some strategic "chipping away the the margins" legislation like repeal of the medical devices tax and maybe the penalty (or is it a tax?) if your insurance doesn't meet government standards.

If, always a big if, there is a republican president and congress after 2016, there is certainly a >50% that the ACA would be repealed (and replaced with something different).

Just reporting it as I see it...
Maybe they'll repeal the ACA and enact a new law like "Romney care" in MA which provided healthcare coverage to 97% of resident between 2006 and 2014.
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Old 11-08-2014, 11:10 AM   #25
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I don't think you realize how much people on the other side really loath the ACA.

Of course there is currently no "serious effort" to repeal the ACA right now. It would be vetoed. On the other hand, I wouldn't be surprised if the new congress sends the president a symbolic repeal bill that he then vetoes. ...
I do realize how much some people loathe ACA (and I loathe the backhanded way it was enacted) but it is about time that the congressional Republicans grow up and accept that you can't win them all and it is the law of the land. (and I am a life-long Republican who is disgusted with both parties right now).

The symbolic repeal that you describe would not surprise me but is as much waving a red flag at the President as executive order changes on immigration is waving a red flag at the Congress. While it might make some Congressmen feel better and allow them to say they voted for repeal in the 2016 election the only thing it will really accomplish is pissing off the other side. IMO they have lots of much better things to do than symbolic votes that they know the President will veto. I hope they come to their senses and get to work on important business the people need done.
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Old 11-08-2014, 11:18 AM   #26
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The cynic in me sees SCOTUS ruling that the subsidies should not be available to all Americans who qualify, but only to those who purchase insurance through state exchanges, and then have the individuals try to absorb the cost.
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Old 11-08-2014, 11:23 AM   #27
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Maybe they'll repeal the ACA and enact a new law like "Romney care" in MA which provided healthcare coverage to 97% of resident between 2006 and 2014.
Wouldn't surprise me. With almost the same elements good and bad of the ACA, but just called [new_pres]care and touted as a wonderful solution
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Old 11-08-2014, 11:30 AM   #28
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I am wondering if they would make people pay back the subsidies? Think if I was in a state with a Federal exchange and I was in ACA, I would set aside some cash for this just in case.
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Old 11-08-2014, 12:04 PM   #29
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I am wondering if they would make people pay back the subsidies? Think if I was in a state with a Federal exchange and I was in ACA, I would set aside some cash for this just in case.
Never hurts to be prepared for the unexpected, and no one 100% knows what SCOTUS will do.
If forced to predict, my bet would be that SCOTUS will uphold the current process and somehow find that the Fed exchange is a functional equivalent of state exchanges. IOW- Those states involved are using Fed Exchange as a functional subcontractor, so under ACA Fed Exchange = state exchange for purpose of subsidy processing. But then I thought SCOTUS would find ACA Medicaid expansion provisions legal (since it is joint state/Fed endeavor, Feds put up most of the $ anyway, and other Fed Medicaid reg's had been upheld), but strike down the individual mandate penalty as a coercion forcing citizens to purchase a private product (HI).... So I don't have the best track record on this
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Old 11-08-2014, 12:11 PM   #30
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There's already a repeal vote for ACA planned for January, once the new Congress is seated. The purpose of the vote is to allow new Congresspersons in the majority party to get on the record as having voted against the ACA, so 'not voting against the ACA' cannot be used as a campaign issue against then in the 2016 elections.

Yes, really. And yes, the insider opinion of the voting public really does assume this level of intellectual capacity on the part of the voters.

The majority party is well aware that the repeal bill won't get past the President, and may not even come up for a vote in the Senate, depending on how the Senate sets it's rules for the new session. It is just there to get new House members on the record regarding ACA.
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Old 11-08-2014, 12:19 PM   #31
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I think most of you are too hopeful and trusting. Congress can turf the ACA and the Court is already in or nearly in the tank. [MOD EDIT]
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Old 11-08-2014, 01:28 PM   #32
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I don't think you realize how much people on the other side really loath the ACA..............
And I think you underestimate how much furor would be associated with taking away the right to buy health insurance regardless of pre-existing conditions. That strikes right at the heart of middle class Americans who know that it really could be them that is bankrupted by a serious illness followed by a job loss and subsequent loss of insurance.
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Old 11-08-2014, 01:48 PM   #33
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And I think you underestimate how much furor would be associated with taking away the right to buy health insurance regardless of pre-existing conditions. That strikes right at the heart of middle class Americans who know that it really could be them that is bankrupted by a serious illness followed by a job loss and subsequent loss of insurance.
The side that is trying to repeal the ACA really doesn't care if a middle-class American goes bankrupt due to a pre-existing condition.

Unfortunately their real agenda is to eliminate the ACA and it will probably happen sooner than later.
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Old 11-08-2014, 01:51 PM   #34
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I don't think you realize how much people on the other side really loath the ACA.

Of course there is currently no "serious effort" to repeal the ACA right now. It would be vetoed. On the other hand, I wouldn't be surprised if the new congress sends the president a symbolic repeal bill that he then vetoes. Followed by some strategic "chipping away the the margins" legislation like repeal of the medical devices tax and maybe the penalty (or is it a tax?) if your insurance doesn't meet government standards.

If, always a big if, there is a republican president and congress after 2016, there is certainly a >50% that the ACA would be repealed (and replaced with something different).

Just reporting it as I see it...
I got out my copy of the 2002 book, "Fixing Elections," by Steven Hill. He wrote about something which happened in 1999 when Clinton was in his last 2 years as president and still had a Republican congress (pages 251-252). Before the summer break, the Republicans passed a big tax cut bill that Clinton vetoed, claiming it was too big, tilted too much toward the wealthy, etc. Clinton expected to work out a smaller, more balanced "split the difference" type of deal when the summer was over. Instead, the Republicans returned to their home states and districts and said to their constituents, "If you want a tax cut, then elect a Republican president in 2000 who will sign, not veto, our tax cut bill." They had no plans at all to negotiate a deal like the one Clinton anticipated. Clinton got outmaneuvered, a rarity for him.

I see the same thing playing out with a bill to repeal the ACA, especially when there are many Republicans (including Boehner and McConnell) who were around back in 1999. They will pass an ACA-repeal bill in 2015 and Obama will expectedly veto it. Then, they will go back to their home states and districts and say to their constituents, "If you want to get rid of the ACA, then elect a Republican president in 2016 who will sign our bill to repeal the ACA."

History will repeat itself. Welcome to the beginning of the 2016 presidential campaign.
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Old 11-08-2014, 01:54 PM   #35
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It is just there to get new House members on the record regarding ACA.
That seems an above-board way to do things. Much more transparent and better for public confidence in "the process" than bottling up a bill in Committee so that members aren't forced/allowed to go on the record.

Regarding the lawsuits: I think too much is being made of them and the threat they pose to the ACA. If it is found that Federal exchanges don't qualify for the subsidy, then there will tremendous public pressure in those states to "deem" them to be state exchanges and slap the various logos of the state on the web sites. The federal government will sell the infrastructure for running things to the states for a dollar and it will be a done deal. I don't think, at this point, that the opposition to ACA in any state has the ability to resist the force of voters who have had their "free" subsidies for a year and now want to keep them. In this respect, the drafters of this law were 100% correct in their estimation of the political dynamics. Businesses and individuals in those states will be subject the mandates once the state governments accept the exchanges.

The only way I see around this, for ACA opponents, is if the electorate in these states sees the cost/benefit of the forced health insurance purchases to >still< be a bad deal even after the subsidies. The opposition might be able to pick off enough votes by offering a non-compulsory statewide alternative to the federal ACA, but this would have all the known problems with adverse selection, etc that have plagued other similar attempts to provide noncompulsory community-rated health insurance.

And if the SCOTUS rejects the lawsuits, then things continue much as they have been. In that case, maybe states with exchanges will eventually pass the responsibility back to the federal government--it's just an expensive administrative burden, and there's so little latitude in how states run them that they might as well just pass it back to DC rather than serve as admin clerks for Washington.

"We must keep the ACA" and "we must repeal the ACA" are both overly simplistic bumper-sticker slogans useful for fundraising and "rallying the base", but not much else. The fact that ACA was voted in (kinda) does not make it immune to modification or outright repeal. Whatever its merits, a law that was publicly unpopular from day 1 and which would not even have won approval in the legislature by the time it was signed into law is not a prime candidate to reamain unchanged. There's no permanent, immutable "law of the land" in the US, thank goodness. We need something better than what existed before and better than this thing we have now. Politicians should get busy on that. As we've seen, it ain't easy.
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Old 11-08-2014, 01:55 PM   #36
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The side that is trying to repeal the ACA really doesn't care if a middle-class American goes bankrupt due to a pre-existing condition.

Unfortunately their real agenda is to eliminate the ACA and it will probably happen sooner than later.
But since folks have experienced the sweet taste of getting insurance without the threat of pre-existing conditions, is there a way to turn back the clock?
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Old 11-08-2014, 04:18 PM   #37
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But since folks have experienced the sweet taste of getting insurance without the threat of pre-existing conditions, is there a way to turn back the clock?
Hopefully the clock won't get turned back on the ACA. Because if that happens I see noway another healthcare act could ever go through with all the disagreements on both sides and particularly without tea party conflict.

People complain that the ACA got passed the way it did but its not like both sides would have ever worked together side by side to pass something.

The fact that we even have a ACA in place right now is pretty amazing.

It will be interesting to see how this whole repeal the ACA thing plays out.
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Old 11-08-2014, 04:39 PM   #38
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But since folks have experienced the sweet taste of getting insurance without the threat of pre-existing conditions, is there a way to turn back the clock?
I don't think so. While states like Kentucky hate Obamacare, they love Kynect, which is the state run ACA exchange. And coincidentally McConnell is from Kentucky.
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Old 11-08-2014, 05:09 PM   #39
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I am wondering if they would make people pay back the subsidies? Think if I was in a state with a Federal exchange and I was in ACA, I would set aside some cash for this just in case.
Most of the people who are getting large subsidies are getting them because they need them. They don't have money to set aside "just in case". If you have the money to set aside then you probably shouldn't be getting the subsidy to begin with.
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Old 11-08-2014, 05:20 PM   #40
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