The Moment of Truth

[ziggy29]

What is the answer? Maybe figure out the pre-existing problem first, take on one problem at a time.

The problem is that without an individual mandate or universal coverage, one can't easily deal with the problems of pre-existing conditions and underwriting without introducing massive adverse selection. In that sense, the "severability" question regarding the rest of the law is largely moot; if the Supremes strike down the individual mandate, allowing the elimination of underwriting and pre-existing condition exclusions is a disaster waiting to happen.

Options are so limited its not clear what most people could do. People with coverage look to make sure they keep it.

Translation -- I didn't really want to retire anyway....

 

[ERD50]

I am so very sorry for your confusion. This happens when one posts in a rush. Still, REW did get it and managed to correctly convey my intention.

I suspect what MichaelB is warning about is the fact this thread keeps drifting back fom "How will the Supremes rule on the ACA?" to "Let's debate the interpretation of the Constitution", which cannot be done in isolation of the current political divide. Since it appears difficult to do one without the other, and debating politics is off limits, I doubt this thread will last much longer.

OK, thanks for the confirmation then. I didn't want to take REWahoo's post at face value, since he also predicted a post #23 closure (just yankin' your chain REWahoo )

But I'll have to chew on that a while. I hardly see how debating health care is any less likely to go into partisan politics than discussing the SC ruling process. I guess I'm just not sure what this means. Oh well.


-ERD50

 

[ziggy29]

Again, I fail to see why this had to be done some quickly

It had so many back room deals because it was the only way to get 60 Senators on board. And it was done so quickly because the Senate lost its 60th vote before the bills could be reconciled in conference and the House had to swallow a badly flawed bill as "half a loaf" compared to not accepting it and probably not getting any significant reform for many, many years.

 

[FinanceDude]

OK, thanks for the confirmation then. I didn't want to take REWahoo's post at face value, since he also predicted a post #23 closure (just yankin' your chain REWahoo )

But I'll have to chew on that a while. I hardly see how debating health care is any less likely to go into partisan politics than discussing the SC ruling process. I guess I'm just not sure what this means. Oh well.
[ERD50

I think it was right for the SCOTUS to rule on this now. Virtually NO legislation is unwound once it takes effect and it entrenched in society.

The ruling, either way, WILL have an effect on folks looking to retire, as the biggest obstacle to ER is frequently health care up to age 65........

 

[MichaelB]

The problem is that without an individual mandate or universal coverage, one can't easily deal with the problems of pre-existing conditions and underwriting without introducing massive adverse selection. In that sense, the "severability" question regarding the rest of the law is largely moot; if the Supremes strike down the individual mandate, allowing the elimination of underwriting and pre-existing condition exclusions is a disaster waiting to happen.

A disaster, or perhaps the push and motivation needed for additional legislation to find another way to deal with the issue. There is an element of common interest which could bring all the constituencies to the table.

Translation -- I didn't really want to retire anyway....

Don't give up hope...

 

[ERD50]

Is anybody planning any concrete changes, or heard of strategies for this, based on this week's hearings? ...

Anyone else investigating options? Any value added in acting today?

I don't have any kids approaching that 'limbo' zone for another three years, and they will likely land a job with coverage (majoring in the health care field). So I'm not investigating any options right now.

If the bill is struck, I will be writing my Congresspersons to support reforms to replace this bill. We've talked about those before, no need to re-post.

-ERD50

 

[ziggy29]

A disaster, or perhaps the push and motivation needed for additional legislation to find another way to deal with the issue. There is an element of common interest which could bring all the constituencies to the table.

You have more faith in the sausage-making process than I do, then. Of course, if both sides realize that the ruling will lead the train off the cliff on 1/1/2014, they will be forced to find common ground to reroute it in 2013 regardless of what happens in November -- realizing that doing nothing is worse than accepting a solution that isn't ideologically pleasant to a large subset of them.

"Doing nothing" isn't always the worst course of action. But if the individual mandate is struck down while the rest of the bill is allowed to remain in force, "doing nothing" is economic suicide and if we thought health care inflation was bad before, "we ain't seen nothin' yet".

 

[pb4uski]

I recognize in advance that this post may be controversial, and I apologize in advance.

I continue to believe that the current system will never be successful unless as a society we are willing to let those who fail to buy insurance because they want to spend their money on other things fend for themselves if they get sick and have an expensive illness. They would have to either go into debt or rely on charity or in the extreme, forgo treatment. If there were serious consequences for not having insurance, then fewer people would be uninsured and insurance would be more affordable since the cost of medical insurance would be spread over a wider base.

While I am in favor of income-sensitive subsidies of insurance since there are many poor who cold not afford to pay their share of the cost of providing coverage, they should still have to pay something. As an example, if the cost of insurance for a average middle class family is 10% of income, then perhaps the poor should be expected to pay 3-5% of income - but the point is it is not FREE - everyone is expected to contribute commensurate with their means. If someone is too cheap to participate that is fine - this is still a free country - but if they get sick they must live with that decision - it is a consequence of personal responsibility.

Children (to age 18) would get a pass (all would be covered) so they wouldn't have to pay the consequences of their parent's stupidity if the parent failed to buy health insurance.

If as a society we are unwilling to let people live with their poor decisions, then our system will never work IMHO, and the only alternative is government taking over the health care system and paying for it through taxes but that has its own problems.

I don't see much in between that would work.

While I hope this post doesn't close the thread, unless as a society we can have an open discussion of the issues (and this forum is a microcosm of society), we'll just continue with this same quagmire.

 

[ziggy29]

If there were serious consequences for not having insurance, then fewer people would be uninsured and insurance would be more affordable since the cost of medical insurance would be spread over a wider base.

This is one of the flaws of the law as passed -- it's also been a bit of a problem in Massachusetts in their law. The penalty for going uninsured isn't steep enough. I've said it many times, and I think it bears repeating -- the penalty for not having coverage should be at least equal to the lowest priced qualifying policy in order to eliminate *all* incentive to not play along.

If someone young and healthy is faced with paying a $1000 penalty or paying $4000 for the cheapest health insurance, they may opt out and pay the penalty, leaving the pool of insureds as older and sicker. Make the penalty $4000 and suddenly there's no incentive to do without.

There are plenty of flaws in the ACA; the change in the balance of power in the Senate forced a quick passage of an unfinished product. It doesn't do enough to control costs, the penalties for going uninsured are too weak, the phaseout of the subsidy occurs at an effective 15-16% tax rate in solidly middle class brackets and it doesn't reduce or eliminate the link between health insurance and employment. But my fear is: if this is all thrown out, how many more years will it be with the broken status quo before we can have another go at it? And will the status quo ever allow me to retire before I'm eligible for Medicare?

 

[samclem]

In that sense, the "severability" question regarding the rest of the law is largely moot; if the Supremes strike down the individual mandate, allowing the elimination of underwriting and pre-existing condition exclusions is a disaster waiting to happen.

I think that's why the severability question is critical and not moot. If the mandate is struck but everything else stands and goes into effect, the result will be insolvency for insurance companies, large losses for health care providers, turmoil regarding the actual provision of health care to the 80% of Americans who are satisfied with their healthcare today. The entire construct of the present legislation depends on the mandate. I think that much of the present law (exchanges, subsidies, expansion of Medicaid, etc) could be made to function without the mandate via other steps (especially the facilitation of non-governmental incentives to buy insurance), but that's not what we have now.
We still have a Congress, and (as a bonus) one that has been largely elected since the ACA was passed. Reports indicate the public's reaction to that law did a lot to shape the 2010 elections, so the legislators there now have a more recent and legitimate "mandate" from the electorate than the ones who crafted the ACA. I say let them get on with making a better law, if that's indeed a priority of the people who elected them.

 

[antmary]

OK, I'll jump in...I will simply share my personal experience with healthcare.

I am 66, and dh is 63. I now receive Medicare, a Blue Cross plan, and Humana for drug coverage. Medicare is easy, and so is the supplemental Blue Cross plan - as far as paperwork goes. Humana is incredibly expensive and time-consuming - for what I get; I don't have many drug needs, and the pure hassle factor is a pain. I finally asked the robo-guy from the drugstore to stop reminding me that I need a script filled. In conclusion, I pay less for health care insurance than I did before Medicare, but I do pay.

My dh still has his Blue Cross plan, and it is going up to almost $1,000 per month. (ouch) Health insurance premiums are the costliest and scariest reality for our retirement security. Quite frankly, I have a very low regard for health insurance companies.

The point is, I prefer to deal with government-sponsored healthcare, such as the check-up I received when I turned 65. I don't like the energy coming from Blue Cross and other profit-motive health care entities. They seem to be much more concerned about their bottom-line than me as a patient.

If the supremes toss out the whole health care legislation, I think it will be very interesting come election time when push comes to shove.

 

[pb4uski]

I don't see insurer insolvencies. Rather than risk ruin by writing unprofitable policies, I think it is more likely that insurers will just increase premiums or stop writing health insurance if they cannot operate profitably. They will just take their capital and move on to more lucrative opportunities. That scenario creates pretty much the same problem though.

 

[harley]

You have more faith in the sausage-making process than I do, then. Of course, if both sides realize that the ruling will lead the train off the cliff on 1/1/2014, they will be forced to find common ground to reroute it in 2013 regardless of what happens in November -- realizing that doing nothing is worse than accepting a solution that isn't ideologically pleasant to a large subset of them.

"Doing nothing" isn't always the worst course of action. But if the individual mandate is struck down while the rest of the bill is allowed to remain in force, "doing nothing" is economic suicide and if we thought health care inflation was bad before, "we ain't seen nothin' yet".

I'm a little surprised at how poorly the administration legal team performed (IMO, based on reading transcripts and stories). It almost makes me wonder if they (administration) have realized how expensive and problematic this whole thing is going to be and sort of "took a dive", thinking to put the onus back on Congress to make a better sausage. I would have thought they could have mustered better arguments or at least forseen some of the questions and prepared better responses. Even though I don't tend to agree with them, I've seen much better arguments from various journalists and commentators over the past year or two than were made by the lawyers in the hearings. They just didn't seem to have their hearts in it.

 

[Hamlet]

What did the final version of the law allow for varying insurance rates based on age and other risk factors?

I remember that some initial versions allowed for some variance based on age. Did that get removed from the final bill?

 

[MichaelB]

Ziggy, I don't see how the entire act can be rejected. Some provisions are already implemented. None of us like the sausage making process, but it does move along best when enough different interests share a similar need. In this case, the similar need may be created if the mandate is struck down but the remaining provisions continue. That gives cover to some and motive to others, but effectively moves influential constituencies that voiced or practiced opposition to now focus on how to implement. No one benefits from mandate-free PPACA implementation. My guess is there will be resistance to specific proposals but the prevailing winds will lift one proposal above all others and just enough will embrace it saying "better this than nothing".

 

[easysurfer]

I think the difficulty is that by nature, insurance seems like a waste of money until you need it. When we are young and healthy, for many insurance just isn't a priority.

I know there are differences, but a comparison about the mandate brings back memories of working at megacorp with the annual United Way drive. Where I w*rked, and probably for many here, contributing a certain % of the monthy paycheck was on paper voluntary, yet if I chose not the participate, there sure was a lot of arm twisting done on me. But back to the comparison. I remember there was this co-w*rker, who at one point may have felt, he has given enough, first, no bonus, and now arm twisted to contribute to UW. But circumstances changed, he had a special needs child who, with the help of UW, couldn't have made it without.

I see both sides. On one, like many, I don't like being told what to do or how to spend my money. If I choose to use my money on unhealthy stuff instead of insurance, that's my choice. Yet on the otherhand, when insurance or other lifelines is there at a time of need, it sure is useful.

 

[ziggy29]

Ziggy, I don't see how the entire act can be rejected. Some provisions are already implemented. None of us like the sausage making process, but it does move along best when enough different interests share a similar need. In this case, the similar need may be created if the mandate is struck down but the remaining provisions continue. That gives cover to some and motive to others, but effectively moves influential constituencies that voiced or practiced opposition to now focus on how to implement. No one benefits from mandate-free PPACA implementation. My guess is there will be resistance to specific proposals but the prevailing winds will lift one proposal above all others and just enough will embrace it saying "better this than nothing".

Maybe, but there's too much intractability. Both sides, I think, would know darn well that no underwriting + no individual mandate = economic disaster. I don't know anyone, on any side of this debate, who thinks the combination of no underwriting and no mandate is economically feasible.

But I think one group will want to create a different mechanism for ensuring universal coverage, and the other will just want to repeal everything that isn't yet in force. And in this case, 1/1/2014 would pretty much be a "drop dead date" -- whichever way it went, it would be calamitous to implement all of the PPACA except for the mandate. Kicking the can won't be an option because I suspect the impact on the health insurance industry would be almost immediate and severe.

 

[Texas Proud]

I recognize in advance that this post may be controversial, and I apologize in advance.

I continue to believe that the current system will never be successful unless as a society we are willing to let those who fail to buy insurance because they want to spend their money on other things fend for themselves if they get sick and have an expensive illness. They would have to either go into debt or rely on charity or in the extreme, forgo treatment. If there were serious consequences for not having insurance, then fewer people would be uninsured and insurance would be more affordable since the cost of medical insurance would be spread over a wider base.

While I am in favor of income-sensitive subsidies of insurance since there are many poor who cold not afford to pay their share of the cost of providing coverage, they should still have to pay something. As an example, if the cost of insurance for a average middle class family is 10% of income, then perhaps the poor should be expected to pay 3-5% of income - but the point is it is not FREE - everyone is expected to contribute commensurate with their means. If someone is too cheap to participate that is fine - this is still a free country - but if they get sick they must live with that decision - it is a consequence of personal responsibility.

Children (to age 18) would get a pass (all would be covered) so they wouldn't have to pay the consequences of their parent's stupidity if the parent failed to buy health insurance.

If as a society we are unwilling to let people live with their poor decisions, then our system will never work IMHO, and the only alternative is government taking over the health care system and paying for it through taxes but that has its own problems.

I don't see much in between that would work.

While I hope this post doesn't close the thread, unless as a society we can have an open discussion of the issues (and this forum is a microcosm of society), we'll just continue with this same quagmire.

But there are enough people in society that say we need to help the 'needy'... and someone who is about to die because they failed to pay insurance will look very needy...

I am not going to try and move the thread, but just want to make a comment that the original idea of the law was to reduce cost, not make sure everybody was insured... since IMO the drift occurred at the beginning it is hard to fix... and I actually do like some of what is in the law...

As to the mandate and the uninsured... I do not see it fixing the problem that you present.... in my state it is a requirement for all drivers to have insurance.... but I pay a good amount of my premium for uninsured/under insured drivers.... there is a separate number.... so I know how much it costs me for the people who do not have enough insurance....

This mandate will not fix the problem of cost shifting... it might reduce it a bit, but it looks to me like a larger cost shift with the amount that the gvmt will be spending to pay insurance for some....

 

[Texas Proud]

Ziggy, I don't see how the entire act can be rejected. Some provisions are already implemented. None of us like the sausage making process, but it does move along best when enough different interests share a similar need. In this case, the similar need may be created if the mandate is struck down but the remaining provisions continue. That gives cover to some and motive to others, but effectively moves influential constituencies that voiced or practiced opposition to now focus on how to implement. No one benefits from mandate-free PPACA implementation. My guess is there will be resistance to specific proposals but the prevailing winds will lift one proposal above all others and just enough will embrace it saying "better this than nothing".

I think that some of the things that have already been implemented will probably stay.... IOW, the 'free' screening, having kids on till 26, etc. they seem to be popular with most...

I do have a question.... didn't a tax already start I know that they delayed some of the bill so they could collect taxes for a few years and not have expense, so the 10 year cost was low.... if the law is thrown out, can the people get their money back Or, am I wrong in that no tax money has been collected...

 

[ziggy29]

I do have a question.... didn't a tax already start I know that they delayed some of the bill so they could collect taxes for a few years and not have expense, so the 10 year cost was low.... if the law is thrown out, can the people get their money back Or, am I wrong in that no tax money has been collected...

I think this was largely to pay for the proposed subsidy for lower and moderate income households starting in 2014. If the individual mandate is "severable" from the rest of the law and is thrown out, presumably this subsidy could remain in effect, but with no individual mandate we'd have a bad adverse selection problem which would likely make the subsidies grossly inadequate unless addressed in next year's legislative session.

 

[ERD50]

Ziggy, I don't see how the entire act can be rejected. Some provisions are already implemented. ....

I'm fascinated by the 'mechanics' of this. There must be some precedent?

If a law is struck down, does it just poof- go up in smoke that very moment? It seems there must be some provision for 'winding it down'? Do they set a date in the future, so plans can be made? In this case, one specific would be someone under 26 on their parents policy. If the law was struck at 1:00PM on June 27th, would that mean a person could go from full coverage to none as that moment? Does not seem workable, but it's also not a reason to hold to a law determined to be un-constitutional (I need an abbreviation for that, too much typing and I seldom spell it right on the first try - UNC?).

How does that work?

-ERD50

 

[FinanceDude]

It had so many back room deals because it was the only way to get 60 Senators on board.

Well, it took a lot of work, an Alaskan Senator getting railroaded, Arlan Spector jumping parties, Al Franken winning a voting recall, etc.

You do realize there was little to no compromise in this bill, right? There was no option to consider for Congress other than the individual mandate, which no Republicans wanted on constitutionality concerns, which brings us to now.

I know that common knowledge is that the party of majority in Congress gets to call the shots, particularly in the Senate. However, the lack of compromise on landmark legislation like this was quite troubling........

End of June could be quite interesting..........

 

[ziggy29]

You do realize there was little to no compromise in this bill, right? There was no option to consider for Congress other than the individual mandate, which no Republicans wanted on constitutionality concerns, which brings us to now.

Without bogging down into the party politics of it or who was to blame for what happened (let's please not go there), there were other proposals besides mandating that everyone buy insurance from private companies -- remember the talk about the "public option"?

And I'm pretty sure that the "public option" would not be under the same Constitutional challenge, as the challenge relates to the federal government forcing us to buy products from *private* entities. There is legal precedent for a federal "public option" in health insurance -- Medicare. So the irony is that some in Congress wanted the individual mandate but no public option, and as it turns out maybe the "public option" will turn out to be the only individual mandate that could have passed Constitutional muster.

Having said all that, what's done is done and the sausage is already made. Now it's up to the "inspectors" to ensure that the sausage is fit for human consumption.

 

[pb4uski]

If the health care law is deemed unconstitutional and set aside, hopefully it will be a lesson to lawmakers of what happens when they railroad legislation through without due process.

Aw, shucks ... what am I thinking

Time for a beer....

 

[Texas Proud]

I'm fascinated by the 'mechanics' of this. There must be some precedent?

If a law is struck down, does it just poof- go up in smoke that very moment? It seems there must be some provision for 'winding it down'? Do they set a date in the future, so plans can be made? In this case, one specific would be someone under 26 on their parents policy. If the law was struck at 1:00PM on June 27th, would that mean a person could go from full coverage to none as that moment? Does not seem workable, but it's also not a reason to hold to a law determined to be un-constitutional (I need an abbreviation for that, too much typing and I seldom spell it right on the first try - UNC?).

How does that work?

-ERD50

The insurance companies already have policies for the year with the language... so the contract would (or should) be honored until the next year's contract comes up... they then can take it out if they wish...

To me, that is the likely outcome of most of the things implemented... they will either stay in place because it would be seen as a bad move on the insurance company or the buying company.... as for individual policies, I would think there would be an option, with higher costs of course....