Supreme Court to hear arguments tomorrow on ACA Subsidy

[Texas Proud]

My perfectly healthy 23 old year son ventured onto the Healthcare.gov website to take a look around at health insurance. $239.00 a month with a $4000 deductible was the best he could do. Needless to say he elected to pay the penalty. Prior to the ACA he had a catastrophic plan that primarily covered major medical issues but he was also able to routinely see a doctor if he wished with affordable/manageable co-pays. $92.00 a month was his premium. If you are young and healthy the ACA shafts you because that is the only way they can afford to pay for the not young and healthy!

Mike

I thought that under a certain age you still could buy catastrophic plan under ACA.... am I wrong



Edit to add: Just checked.... a catastrophic plan for a 27 YO actually cost more than the lowest bronze plan where I live... cheapest plan was $155.... catastrophic was $170....

 

[Texas Proud]

update on arguments

3 huge surprises at Obamacare?s oral*arguments - Vox

Wow... interesting read...

I had read about the standing issue awhile back, but most people said that the SC would probably not look at it since all it would do it cause a delay.... eventually they would get a case like this and it would come up again...

The theory about forcing the states to set up an exchange is interesting...

I also think it is interesting that Alito thew out waiting until the end of the year.... he was probably a vote to stop subsidies and this can give some cover to another justice...

I bet there will be a split decision... IOW, the side that wins will have justices with different reasons for why they decide that way....

 

[2B]

Wow... interesting read...

I had read about the standing issue awhile back, but most people said that the SC would probably not look at it since all it would do it cause a delay.... eventually they would get a case like this and it would come up again...

The theory about forcing the states to set up an exchange is interesting...

I also think it is interesting that Alito thew out waiting until the end of the year.... he was probably a vote to stop subsidies and this can give some cover to another justice...

I bet there will be a split decision... IOW, the side that wins will have justices with different reasons for why they decide that way....

I was surprised that the government solictor general blew off the "standing" issue raised by Ginsberg. He knows that it will just come back again so he's going for a decision now before a potential Repub president could appoint a replacement justice. Of course, a Repub president could make the whole case a mute point with the current Congressional makeup.

We can count on it being a split decision. This is primarily a partisan political issue that SCOTUS is not immune to as much as we may wish it to simply interpret the "law." The law is frequently seen through politically colored glasses. This decision will not be the end no matter how it goes.

 

[explanade]

The thread topic is not about the merits of the ACA. That discussion has led to a multitude of health care threads being closed, and if it continues, is likely to happen once again.

It is about the Supreme Court case, which deals with the legality of providing subsidies to policies acquired on Federal health exchanges. All other provisions of the ACA have been implemented and are in force, such as essential health benefits, coverage for family members under age 26, and guaranteed coverage.

Why not stick to the thread topic? If the Supreme Courts decides against the subsidies, how will that affect us, and what options will we have?

But some are predicting that if subsidies are invalidated, millions of people would be affected directly and if they drop insurance because of the lack of subsidies,
the remaining insureds could see their premiums go up, the so-called "death spiral" that kills the whole system.

The plaintiffs were cultivated and the real forces behind this case, which include conservative think tanks looking for any way to challenge and invalidate the law, have the ultimate aim of killing the law entirely.

So it is a proxy battle for the law in its entirety.

 

[samclem]

The plaintiffs were cultivated and the real forces behind this case, which include conservative think tanks looking for any way to challenge and invalidate the law, have the ultimate aim of killing the law entirely.

So it is a proxy battle for the law in its entirety.

Can we please rein this in? The justices will rule on the information that is presented to them. There are PLENTY of vested interests on both sides (and some surprising "bedfellows") so let's just look at the case and its ramifications.

 

[explanade]

Well it's also another question about this case.

Are the justices going to consider this case only in "textualist" terms, literally the few words in a couple of sentences?

Or are they going to consider the context of this case, which is that it could unravel the whole law, leading to chaos in the ACA exchanges.

Alito apparently raised the idea of invalidating the subsidies but staying that decision through the end of this year, so that people who enrolled for this year would get coverage and subsidies to the end of the year but in 2016 and thereafter, there would be uncertainty about what form of ACA remains after the subsidies are gone for a huge portion of the ACA insured.

 

[samclem]

Alito apparently raised the idea of invalidating the subsidies but staying that decision through the end of this year, so that people who enrolled for this year would get coverage and subsidies to the end of the year but in 2016 and thereafter, there would be uncertainty about what form of ACA remains after the subsidies are gone for a huge portion of the ACA insured.

Great! If the concern is really about assuring people can get health insurance, then people should be happy that a way might be found to do that (and to ease the transition) if a major part of the law is upheld (well, "overturned" in some people's view).

 

[jim584672]

Decision will not bother me, I live in NY (state exchange).

 

[mpeirce]

Catastrophic plans, even for those under 30, are not much cheaper than Bronze plans

Not in my experience.

For an Ohio family of 3 (53/62/20) we currently pay $480/month for a non-ACA catastrophic/HSA plan. The cheapest bronze exchange plan I could find was $1200/month.

And this horrible, non-compliant, just shy of illegal plan pays for preventative care such as annual physicals, breast exams, flu shots, and colonoscopy (all items we've used this year).

 

[modhatter]

According to a recent study by the Rand Study in conjunction with Kaiser, eliminating the subsidy would leave only the sickest people clinging on to policies, with a loss of the healthy middle and lower income folks, and have a very significant effect on the cost of insurance across the board for everyone.
The only way to avoid that is to re-instate underwriting and have insurance companies be able to impose pre-existing conditions again. Google the study.

 

[samclem]

The only way to avoid that is to re-instate underwriting and have insurance companies be able to impose pre-existing conditions again. Google the study.

No, a false dilemma. There are many of ways to skin this cat. Medicare has no subsidies and no underwriting. And what is at issue in this case is the linkage of subsidies to "state establishment of exchanges" and that also affects the requirement to buy insurance (because without the subsidies, the premiums are unaffordable and therefore the person isn't fined for not buying insurance). It would be easy to break that chain in several ways.
If the Court rules for Burwell, the affected states will have the option of establishing their own exchanges (with lots of Fed help) or doing something else. Maybe the "something else" will be terrifically good. There may be legislation to facilitate this alternative, and we'd see some smart alternatives emerge.
Many of the offered alternatives on the table have subsidies (to the patient to the insurer, or as directly provided services)--it's got to be that way in one form or another. And all address prior conditions--either through lack of underwriting (guaranteed issue) or risk pools.

 

[EastWest Gal]

Don't fool yourself into believing that because you don't receive a subsidy that it won't impact what you pay for insurance.. it will because many lower income healthy (typically young) people will not subscribe. Their participation is helping to pay for colder, sicker subscribers. Insurance rates will increase, including what employers are providing.

Hospital systems will loose (sp) money forcing them to increase their rates across state lines.

I didn't see them lowering their rates the past couple of years when they should have. Heck, does anyone actually know what hospital rates are anyway?

Hospital administrators are greedy, just like most folks. Especially the for-profit systems. They don't ever lower their rates unless forced through legislation and regulation.

The billing system was a complete mess before ACA, but I don't think the ACA actually made it worse.


Sent from my iPhone using Early Retirement Forum

 

[rodi]

I will be following this issue on Scotusblog. They have a good track record of covering the legal issues before the supreme court, the hearings, as well as the decisions when they come out.
SCOTUSblog

 

[sheehs1]

update on arguments

3 huge surprises at Obamacare?s oral*arguments - Vox

I found this interesting as well.
So..if the Court sides with Burwell this Justice feels the net affect is the Supreme Court would be responsible for enforcing something that is unconstitutional or has unconstitutional consequences....which is "coercion" on the states to set up exchanges - something they specifically said last time could not be done.

Regarding the "standing" issue, I had previously read that it was only required that one of the plaintiffs has standing. And I gather that one does.

Interesting concept that if they rule for Burwell they can stay it until the end of the year.

Going to be tricky. Interesting but tricky.

p.s. Rodi: Thanks for that link to the Scotusblog

 

[harley]

I don't have anything to say about the topic, but just wanted a chance to post in it before it closed. I'm always missing the chance on these political threads.

 

[2B]

According to a recent study by the Rand Study in conjunction with Kaiser, eliminating the subsidy would leave only the sickest people clinging on to policies, with a loss of the healthy middle and lower income folks, and have a very significant effect on the cost of insurance across the board for everyone.
The only way to avoid that is to re-instate underwriting and have insurance companies be able to impose pre-existing conditions again. Google the study.

They have the penalty to consider unless it is continuously deferred.

 

[Brat]

...

So..if the Court sides with Burwell this Justice feels the net affect is the Supreme Court would be responsible for enforcing something that is unconstitutional or has unconstitutional consequences....which is "coercion" on the states to set up exchanges - something they specifically said last time could not be done.

.....

That argument caught me by surprise. The "coercion" issue together with the fact that this specific 'requirement' is not in the legislative history or discussed by representatives in the Senate or House of Representatives (in fact the reverse was claimed by some) leads me to conclude that Burwell will not upheld.

 

[2B]

The billing system was a complete mess before ACA, but I don't think the ACA actually made it worse.

I was going to say "talk to your doctor" but you are one. There is a major code revamp to go into effect later this year driven by the ACA. Doctors that run their own practices are complaining about the costs involved and the lack of knowledgeable people to implement the change. It is another force driving doctors into consolidating their practices into a physicians' owned entity or going to work for Big Med.

 

[ERhoosier]

My WAG after reading about today's oral arguments is 6-3 to uphold, with Kennedy joining the 2012 5-4 majority. But predicting SCOTUS has always been a crap-shoot

 

[longranger]

Given the political history of this court I have no idea how they will rule. It would be particularly upsetting if this major case was decided by an issue tangential to ACA itself. On the other hand given the general dysfunction in our healthcare system and the pre-emminent role of insurance companies in that system part of me would like to see things start over from scratch. Sorry for the last sentence .

 

[Texas Proud]

My WAG after reading about today's oral arguments is 6-3 to uphold, with Kennedy joining the 2012 5-4 majority. But predicting SCOTUS has always been a crap-shoot

You might be right.... but as I said earlier I bet that the 6 you predict will not all agree on the majority opinion.... maybe a 4-2-3 decision....

 

[M Paquette]

A ruling in the case is months away. Nothing to get excited about in the near term.

One of the most intriguing points about this case, and apparently one the plaintiffs have not really thought through, is the case law that would be established by the plaintiffs having the Court concur with their point. It would be a Pyrrhic victory such as rarely seen in the existence of this country.

Plaintiffs position is that the Affordable Care Act intended for income tax linked subsidies to be available only to persons who purchase health insurance through state run exchanges, and the subsidies should not be available to those purchasing insurance through the federally run exchange.

Specifically, accepting plaintiffs position means that the Federal government is permitted to set differing effective levels of the Federal income tax in different states, as an incentive or penalty regarding compliance with Federal programs. That's quite a precedent to be putting into case law. It's very different from existing programs such as Federal highway funds, where the cash flows to the states if they implement certain basic requirements.

This could really impact the decision making process for folks trying to pick the optimal state(s) to retire in. "Hmmm... Which state is least likely to rock the boat regarding Federal policies for the next 30 years or so?" Good luck guessing THAT!

Executive summary: Be careful what you wish for. You just might get it.

 

[rbmrtn]

The plaintiffs argument is weak, attempting to take a specific sentence out if context. They refer to "established by the state" but the leave out it is "established by the state under 1311". Section 1311 covers the "state" exchange, but following is section 1312 which covers the Fed exchange which is established if the state fails to do so. Specifically 1312(c)

the Secretary shall (directly or through agreement with a notfor-profit
entity) establish and operate such Exchange within
the State and the Secretary shall take such actions as are necessary
to implement such other requirements.

The term "such exchange" means the state exchange. Another way to think about it is there are two ways for a state to create an exchange as required by the law. They can use their own resources or default to a federally facilitated one. Whatever choice the state makes, they have created an exchange for their state.

 

[Philliefan33]

Last week's "Slate's Amicus" podcast discusses this case. Both sides get a chance to speak and I found it a nice introduction to the issue.

(I am a SCOTUS neophyte and not an attorney, so the Amicus podcast is just my speed)

 

[imoldernu]

Interesting to see how the market interprets SCOTUS remarks. See the reaction to Justice Kennedy's comments:
Health Care stocks rise following Justice Kennedy's comments in ACA case - NASDAQ.com

Makes for thoughtful analysis as to what financial interests are involved and what public interests are served.