Obamacare ruled Unconstitutional!!

[joeea]

Quote:

Originally Posted by Jerry1 Signed in 2010 and we still are arguing about it. So disgusting. I’m so grateful that I have insurance through and employer and retiree healthcare, but as a citizen, this is enough to make me puke. We have been so let down by our representatives on this issue. Fix it. It’s past time.

Apparently, setting the mandate penalty to $0 triggered the decision in this court.

There are several very simple solutions. We'll see what actually happens.

[Luck_Club]

Quote:

Originally Posted by Mr._Graybeard IMO, tort reform is a red herring in the health care equation, a talking point for some politicians that has little real bearing on expenses. In my state, there already is a $750,000 cap on non-economic damages related to medical malpractice. It hasn't contained the cost of healthcare.

Yes but $100 million dollar plus awards still happen all the time.

This link shows a quick 1/2 a billion in added cost to the nations health insurance. MERE PEANUTS IN THE GRAND COST STRUCTURE, since it is easily offset by those states that already cap damages.

https://www.natlawreview.com/article...recent-history

[pb4uski]

Quote:

Originally Posted by explanade For whatever reason they don't do that. They cherry pick counties like the auto insurers red line certain counties. One reason may be that the number of providers in a given metro area varies a lot from another metro area. For instance, ACA premiums in Northern CA are higher than those in Southern CA because Southern CA has a much more competitive market for health care so presumably insurer reimbursements are lower and they can price premiums lower. How would an insurer treat say a small rural town struggling to attract new doctors the same as a big metropolis where there are dozens of hospitals and medical groups as well as hundreds or thousands of individual practitioners?

Where I live, pricing is the same state-wide.... in other states, it may be county since there are different rates for counties... I'm not aware where rates are developed for anything smaller than a county but it might exist.

[Dtail]

The rates in FLA can vary widely by county.

[explanade]

It might be done by MSA, that is the metro area vs. metro areas.

You hear about insurers bailing out of certain areas or entire states so it seems really dependent on locality.

Of course you also have some states which refused to take the Medicaid expansion or are in other ways hostile to the ACA so premiums in those states might be higher than they otherwise would be.

Thing is, the US is the size of a continent compared to many nations so it's harder to have a single market for many things. Obviously housing varies a lot depending on location, as well as wages and other COL items.

Now does Medicare reimbursement vary by market? Probably not. I guess it's big enough to pretty much force some uniform or standardized rates.

Prescription drug prices do not vary within the US but obviously neighboring countries pay a lot less.

So maybe it's possible to have standardized health care prices, but of course they're not transparent to begin with -- what one hospital or lab charges for an MRI could be a lot different from what another hospital charges for the MRI in a different market.

[pb4uski]

So the hypothetical question of the small rural town isn't really relevant because the smallest pricing cohort would be the county or MSA depending on how the state is geographcally divided for health insurance pricing.

[explanade]

Quote:

Originally Posted by pb4uski So the hypothetical question of the small rural town isn't really relevant because the smallest pricing cohort would be the county or MSA depending on how the state is geographcally divided for health insurance pricing.

Maybe.

Maybe if a rural county is in the same MSA as the closest big city, which could be a 100 miles away, they do it that way.

I guess some people do have to drive far to get to a bigger hospital.

[Luck_Club]

Quote:

Originally Posted by explanade It might be done by MSA, that is the metro area vs. metro areas. You hear about insurers bailing out of certain areas or entire states so it seems really dependent on locality. Of course you also have some states which refused to take the Medicaid expansion or are in other ways hostile to the ACA so premiums in those states might be higher than they otherwise would be. Thing is, the US is the size of a continent compared to many nations so it's harder to have a single market for many things. Obviously housing varies a lot depending on location, as well as wages and other COL items. Now does Medicare reimbursement vary by market? Probably not. I guess it's big enough to pretty much force some uniform or standardized rates. Prescription drug prices do not vary within the US but obviously neighboring countries pay a lot less. So maybe it's possible to have standardized health care prices, but of course they're not transparent to begin with -- what one hospital or lab charges for an MRI could be a lot different from what another hospital charges for the MRI in a different market.

I think it does vary by service area. Which would make sense right, HCOL Doc won't work for LCOL wages.

[MRG]

Quote:

Originally Posted by explanade Maybe. Maybe if a rural county is in the same MSA as the closest big city, which could be a 100 miles away, they do it that way. I guess some people do have to drive far to get to a bigger hospital.

Some people drive a long distance to get to a hospital, specialists.

I see a urologist every 3 months, his "office" is 50 miles away. My appointment is always on a Friday, he drives 100 miles from another state, one Friday a month. My coverage is no good in his state, I can't drive 70 miles to see him at his his regular office, in network.

Of course there's equipment and space that this one day a month office has that's wasted 29 days a month, surely it only costs a fraction as much as the stuff that's used daily.

There's a lot of artificial boundaries, perhaps it's good if they go away.

[Elbata]

Sorry, haven't read all the comments, but will most likely skip intermediate appeals and go straight to the Supreme Court.

[gindie]

Quote:

Originally Posted by pb4uski The law can only be killed if the individual mandate is viewed as essential, and I think there is a lot of evidence to say that the individual mandate is not essential.

From page 2 of the decision:

"Finally, Congress stated many times unequivocally—through enacted text signed by the President—that the Individual Mandate is “essential” to the ACA. And this essentiality, the ACA’s text makes clear, means the mandate must work “together with the other provisions” for the Act to function as intended. All nine Justices to review the ACA acknowledged this text and Congress’s manifest intent to establish the Individual Mandate as the ACA’s “essential” provision. The current and previous Administrations have recognized that, too. Because rewriting the ACA without its “essential” feature is beyond the power of an Article III court, the Court thus adheres to Congress’s textually expressed intent and binding Supreme Court precedent to find the Individual Mandate is inseverable from the ACA’s remaining provisions."

[copyright1997reloaded]

I'm surprised we are on page 4 of this thread w/o "That's all folks".

Shocked really.

[MichaelB]

Quote:

Originally Posted by explanade It might be done by MSA, that is the metro area vs. metro areas. You hear about insurers bailing out of certain areas or entire states so it seems really dependent on locality. Of course you also have some states which refused to take the Medicaid expansion or are in other ways hostile to the ACA so premiums in those states might be higher than they otherwise would be. Thing is, the US is the size of a continent compared to many nations so it's harder to have a single market for many things. Obviously housing varies a lot depending on location, as well as wages and other COL items. Now does Medicare reimbursement vary by market? Probably not. I guess it's big enough to pretty much force some uniform or standardized rates. Prescription drug prices do not vary within the US but obviously neighboring countries pay a lot less. So maybe it's possible to have standardized health care prices, but of course they're not transparent to begin with -- what one hospital or lab charges for an MRI could be a lot different from what another hospital charges for the MRI in a different market.

Insurers did not leave any marketplace in the US. They did stop offering individual policies, and that got a lot of attention, but in all those areas they continued to offer group and Medicare, and Managed Medicaid.

[pb4uski]

Quote:

Originally Posted by gindie From page 2 of the decision: "Finally, Congress stated many times unequivocally—through enacted text signed by the President—that the Individual Mandate is “essential” to the ACA. And this essentiality, the ACA’s text makes clear, means the mandate must work “together with the other provisions” for the Act to function as intended. All nine Justices to review the ACA acknowledged this text and Congress’s manifest intent to establish the Individual Mandate as the ACA’s “essential” provision. The current and previous Administrations have recognized that, too. Because rewriting the ACA without its “essential” feature is beyond the power of an Article III court, the Court thus adheres to Congress’s textually expressed intent and binding Supreme Court precedent to find the Individual Mandate is inseverable from the ACA’s remaining provisions."

And politicians would never overstate a point to sell a bill, would they?

The facts are different. The penalty was very minor in the early years to make it less objectionable, but even when the penalty was minimal millions of people still bought health insurance... including those with no subsidy (including me!)... because they needed and wanted to have health insurance coverage to protect them from the financial calamity of an unexpected illness. And now in 2018, the penalty exists but is not being inforced by the administration yet millions of people are still buying health insurance even though there is effectively no penalty. The same will continue in 2019 once the penalty becomes $0.

[Mr._Graybeard]

Quote:

Originally Posted by Luck_Club Yes but $100 million dollar plus awards still happen all the time. This link shows a quick 1/2 a billion in added cost to the nations health insurance. MERE PEANUTS IN THE GRAND COST STRUCTURE, since it is easily offset by those states that already cap damages. https://www.natlawreview.com/article...recent-history

As you yourself say, mere peanuts in the overall cost structure.

You're outraged -- well, there's a case here in Wisconsin where a woman lost both arms and both legs because of medical negligence and was limited to $750,000 in non-economic damages under state law. I'm outraged by that.

[mickeyd]

If ACA is eventually ruled illegal, I'll be looking for a big tax reduction. I am paying for the coverage of others, and I do not see any benefit to me and mine. Sounds selfish, but it is the truth in my case.

[aaronc879]

Quote:

Originally Posted by Mr._Graybeard As you yourself say, mere peanuts in the overall cost structure. You're outraged -- well, there's a case here in Wisconsin where a woman lost both arms and both legs because of medical negligence and was limited to $750,000 in non-economic damages under state law. I'm outraged by that.

If I understand correctly she was awarded the $750,000 maximum which is in addition to the costs of her health care. She doesn't pay for her health care related to the malpractice from that $750,000.

More on that case here: https://www.jsonline.com/story/news/...cap/736673002/

[HGTVfan]

Quote:

Originally Posted by copyright1997reloaded I'm surprised we are on page 4 of this thread w/o "That's all folks". Shocked really.

If this thread is closed, there is a good discussion over at Bogelheads.

[travelover]

Quote:

Originally Posted by pb4uski And politicians would never overstate a point to sell a bill, would they? The facts are different. The penalty was very minor in the early years to make it less objectionable, but even when the penalty was minimal millions of people still bought health insurance... including those with no subsidy (including me!)... because they needed and wanted to have health insurance coverage to protect them from the financial calamity of an unexpected illness. And now in 2018, the penalty exists but is not being inforced by the administration yet millions of people are still buying health insurance even though there is effectively no penalty. The same will continue in 2019 once the penalty becomes $0.

It may end up to be true that the ACA can withstand people not taking out insurance until they need it, but it still is profoundly unfair and sure to generate resentment once the implications are publicized.

[Jerry1]

Quote:

Originally Posted by Mr._Graybeard IMO, tort reform is a red herring in the health care equation, a talking point for some politicians that has little real bearing on expenses. In my state, there already is a $750,000 cap on non-economic damages related to medical malpractice. It hasn't contained the cost of healthcare.

Quote:

Originally Posted by Luck_Club Yes but $100 million dollar plus awards still happen all the time. This link shows a quick 1/2 a billion in added cost to the nations health insurance. MERE PEANUTS IN THE GRAND COST STRUCTURE, since it is easily offset by those states that already cap damages. https://www.natlawreview.com/article...recent-history

The real benefit of tort reform is not the reduction in large settlements. The cost is the extra care that is performed for defensive reasons. If you come into an ER with a bump on your head, you’re gonna get a CT scan. I can’t imagine all the extra testing that gets performed on pregnant women just in case. How many times have you heard a doctor say, I think you have X but let’s just do a couple tests. Defensive medicine. The cost is way more than the big settlements.

I remember arguing with my doctor about a test for strep throat. Given that she had already said she was giving me an antibiotic given the look of my throat, I asked, how would my treatment change if I did have strep. It wouldn’t. So why do it. I didn’t.