Obamacare ruled Unconstitutional!!

[pb4uski]

I think it is hard to assert that the shared responsibiity payment is essential to the ACA as the minority asserted in NFIB when we know since it has been made toothless that many people are still buying health insurance and the individual health insurance market is as robust and healthy as ever. Premiums are stabilizing, and in some state actually decreasing, and insurers are making modest profits.

IMO very few people bought health isurance because of the individual mandate.. let's face it, the penalties, particularly in the early years of ACA, were trivial and many people were still buying individual health insurance.

People buy health insurance because they want and need it, the mandate/tax is a trivial issue in most cases.

 

[pb4uski]

SCOTUS did actually rule that the mandate was unconstitutional. From the federal court's opinion at https://oag.ca.gov/system/files/att...ting-plaintiffs-partial-summary-judgment.pdf:

In NFIB, the Supreme Court held the Individual Mandate was unconstitutional under the Interstate Commerce Clause but could fairly be read as an exercise of Congress’s Tax Power because it triggered a tax.​

Yes, I see that now... wasn't aware of that.

 

[pb4uski]

If I pay 0% LTCG tax, I would say that I pay no tax. If the penalty for murder was zero days in jail, most folks would say there is no penalty for murder.

Good point that the law could be changed to make the rate very low to fix the problem; however, in my opinion, making the law unconstitutional was one of the motivations for passing the repeal of the ACA penalty in the first place. It was an easy way to kill the law by having the courts do the dirty work.

And I would say that you pay CG tax but based on the rates established in statute the tax is zero.

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.

 

[easysurfer]

Too many moving parts.

As usual, really need to wait and see what happens .

 

[jimandthom]

I agree on the second part... I would like to see all health insurance individual so when one has a job change it doesn't disrupt their health insurance... the entire country (or at least, each state) would be one humongous group that insurers could vie for.

If its purchased by the individual there then the possible issue of pre-existing conditions arises.

Had a very good friend ran into this problem in 2002(?) thereabouts as he had a stroke while on Cobra after the company closed. Once Cobra was done he was SOL. State high risk pool was full and a bit too many assets even after stroke related costs and living expenses, to be immediately eligible for Medicaid.

I'm sure my rendition is a bit off on timing etc, as it was 15 yrs ago. He did get another job(retail) which provided medical until he was laid off again in 2015. May 2016 he had another stroke at age 57 and will never be able to work again.


He is now broke, sick and

 

[Closet_Gamer]

Yeabut insurers are making profits providing plans for Obamacare. https://www.politico.com/story/2017/12/07/obamacare-profits-health-care-285258

For sure that's true today, but there are future outcomes (potentially accelerated by the end of the mandate) where govt transfers necessary to keep the whole thing afloat fall apart due to economics or politics. Things could unravel in a very disorderly fashion (similar to the financial crisis).

I'm not saying this will happen. I'm saying its possible and the thrashing political environment is unhelpful to sound FIRE planning

 

[Texas Proud]

Now I'll nit-pick #2. I hate the term "swing vote". In a 5-4 decision, each of the 5 votes count, and they have equal weight. So what you are saying is that Kavenaugh replaced Kennedy, and Kennedy voted against ACA, so if Kavenaugh votes against ACA, no change and it is upheld anyhow, right? Semantics I guess, but I just hate the term "swing vote" - they are all votes!

-ERD50

I have not seen if anybody has commented on this....


BUT, since a good number of the 5-4 decisions had a consistent 4 justices on one side of the vote and 4 others on the other side and it was just one justice that made the difference then that vote is the 'swing vote'...



The thing is that 5 go 4 is not the majority of cases...

(since 2000)....The 5-to-4 decisions, by comparison, occurred in 19 percent of cases.
​

https://www.washingtonpost.com/news...-common/?noredirect=on&utm_term=.c0470fbd9663

 

[pb4uski]

For sure that's true today, but there are future outcomes (potentially accelerated by the end of the mandate) where govt transfers necessary to keep the whole thing afloat fall apart due to economics or politics. Things could unravel in a very disorderly fashion (similar to the financial crisis).

I'm not saying this will happen. I'm saying its possible and the thrashing political environment is unhelpful to sound FIRE planning

Very unlikely... we never saw anything close to that since ACA started... those insurers who couldn't make a go of it just abandoned the market and generally, other market participants stepped into the void.

Aliens could land their spaceship on the parking lot next door since anything is possible, but it isn't an outcome that I would worry about.

 

[explanade]

I agree on the second part... I would like to see all health insurance individual so when one has a job change it doesn't disrupt their health insurance... the entire country (or at least, each state) would be one humongous group that insurers could vie for.

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?

 

[Luck_Club]

High risk pools do not work. They fill up way too fast and are typically underfunded. The only real answer is to remove insurance companies from the mix and have a standardized HC system, whatever that shakes out to be. Unfortunately the insurance companies hold too much influence over the powers that be. Medicare for all is really the only solution, all be it not the perfect one.

The high risk pools could work if KISS is followed:
High risk _diabetes due to weight and controllable factors = high premium paid by individual
High risk -diabetes type 1 subsidized by government

Personal responsibility needs to play a role in our insurance premiums.

 

[joeea]

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]

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/some-highest-medical-malpractice-settlements-recent-history

 

[pb4uski]

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]

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]

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]

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]

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]

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]

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]

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/some-highest-medical-malpractice-settlements-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.