Obamacare ruled Unconstitutional!!

[MRG]

If the ACA is repealed, it is replaced by nothing. The prior regulations would need to be introduced and approved once again, otherwise there is only current non-ACA healthcare regulations. There is no “back to before ACA”.

Prior to ACA states were obligated to sponsor “must insure” laws for business, but were free to interpret and implement locally. In Florida, this meant business had no obligation to insure, but if employers wanted to, insurance companies were obligated to extend coverage. Small businesses of 3 or fewer employees were categorized separately. Insurers were free to offer less comprehensive policies with some exclusions and priced like individual policies. The rates were basically uncontrolled, the multiple between lowest and highest for age groups was 10x. It was not robust, comprehensive coverage, and it was pricey. And it was definitely different around the country.

Well that's a pretty picture.

I'm guessing the systems that did all those things were properly mothballed and their source updated with the last 5 years of security changes.

Certainly the reimplementation of the laws, funding, sourcing providers will provide training opportunities for all involved.[emoji23]

 

[Chuckanut]

IMHO, we are depending far to much on the courts and individual judges to do the job of the legislative branch. It's time for Congress to step up and do its job of crafting good legislation, fixing bad legislation, and getting rid of out dated laws. To many decisions are left to judicial interpretation/opinions/biases which are often not as good as plain old political horse trading.

https://www.yahoo.com/news/9th-circuit-cautions-judges-setting-094458806.html

The U.S. Supreme Court, Wallace noted, has previously said that such injunctions can be detrimental to the development of the law because they can deprive appellate courts of multiple perspectives when coming to a novel legal issue. Wallace also wrote that nationwide injunctions can keep nonparties who fail to intervene in a first-moving action from participating in litigation that directly effects them.

 

[MichaelB]

Well that's a pretty picture.

I'm guessing the systems that did all those things were properly mothballed and their source updated with the last 5 years of security changes.

Certainly the reimplementation of the laws, funding, sourcing providers will provide training opportunities for all involved.[emoji23]

I’m not a lawyer, but my understanding is our regulatory system is not like a bright polyester shirt that can be stored away in a closet somewhere waiting for disco fashion to return. Once cast aside, it’s gone for good. This court ruling eliminates a series of regulations, and those areas would become unregulated if the ruling were upheld.

 

[aja8888]

Not necessarily. In many states childless adults are not entitled to be on Medicaid except in some very limited circumstances involving some disabilities. Simply being sick and broke is not sufficient to get on Medicaid. That was the entire point of the Medicaid expansion. People could die simply because they were poor and could not afford treatment particularly for illnesses such as cancer or other illnesses that require treatment beyond emergency treatment. So, yes, people did get turned away and they didn't get care in some states.

Yes, like in this state (Texas). We have a relative that needs a bone marrow biopsy (blood count going critically low every three months) and is unemployed over 50 plus divorced. She can't get the biopsy in the ER and can't get on Medicaid. We are about to step up and pay the freight ourselves to get this test done. And if she has cancer? Then what?

 

[Chuckanut]

Any politician, other than a few in very safe districts, who votes for going back to allowing the preexisting condition mess we had years ago had better not want to get re-elected. Just my 2¢

 

[explanade]

Any politician, other than a few in very safe districts, who votes for going back to allowing the preexisting condition mess we had years ago had better not want to get re-elected. Just my 2¢

I don't think any politician is saying that he or she is for eliminating preexisting conditions coverage.

They could say they're for it on the campaign trail but act exactly the opposite.

For instance, this case which was brought by 20 state AGs, one of those AGs got elected to the Senate from MO, all while claiming he is for protecting coverage for preexisting conditions, even though he was a party to this lawsuit which would invalidate the only law of the land that guarantees preexisting conditions coverage.

 

[Aerides]

***Mod Hat On***

We realize the ACA is of great importance to many ER members, and, despite the obvious political ramifications we very much want to keep this discussion open for everyone.

But let's please keep any specifics of politics out of further posts, to avoid going down any partisan paths that will lead to thread closure.

***/Mod Hat Off***

 

[pb4uski]

Yes, like in this state (Texas). We have a relative that needs a bone marrow biopsy (blood count going critically low every three months) and is unemployed over 50 plus divorced. She can't get the biopsy in the ER and can't get on Medicaid. We are about to step up and pay the freight ourselves to get this test done. And if she has cancer? Then what?

If she is unemployed and can't get on Medicaid, why can't she get heavily subsidized ACA health insurance?

 

[aja8888]

If she is unemployed and can't get on Medicaid, why can't she get heavily subsidized ACA health insurance?

You need a certain level of income to buy a policy on the ACA. She is unemployed and probably unemployable.

 

[Teacher Terry]

Aja, that’s a terrible situation. That’s the reason I think we need Medicare for all. I don’t think people need to literally die because our country doesn’t feel that HI for all isn’t a right.

 

[Texas Proud]

/snip/

It doesn't work that way at all. Severability law is complex. It is not a simple matter of simply looking at a statute and seeing if it has a severability clause and then severing the offending clause if it does and not severing it if it doesn't.

The reality is that Congress is 2017 eliminated the individual mandate penalty but didn't repeal the entire Act. Therefore there is an extremely powerful argument that Congress itself thought the mandate was severable from the rest of the statute.

The opinion overturning the entire statute is really radically sweeping. This has a host of consequences which have no relationship to the mandate. Calories on restaurant menus? Gone. Improvements to the donut hole for Medicare recipients? Gone. I guess it is possible that the Fifth Circuit and the Supreme Court would uphold this (on the ground anything is possible) but upholding this would certainly be a major substantive change in law that would have a great affect on many other statutes.

I would like to flesh this out a bit... are you an attorney? Cannot remember who was what when working...


Again, from what I remember.... they did not eliminate the individual mandate... this is why the judge ruled the way he did.... they changed the penalty amount to zero but the law still requires people to buy insurance... now, with no penalty this means nothing which is what I think was intended, but sometimes courts are strange in their rulings because of the language.... remember, some rulings have gone one way over another because or a comma...


I agree with you that it will probably not stand because Congress had the chance to repeal the whole law but did not... so we do know that the intent was to only take any teeth out of the mandate... and usually the Circuit courts are more reasonable than the District even though the Ninth and Fifth look at most things differently...

 

[Dtail]

You need a certain level of income to buy a policy on the ACA. She is unemployed and probably unemployable.

Any chance for a Roth conversion, or some sort of (gift) to her which would be taxable to her to generate the 16k? income needed?

 

[aja8888]

Any chance for a Roth conversion, or some sort of (gift) to her which would be taxable to her to generate the 16k? income needed?

We are working on getting her some help (financially). We are going to pay for the biopsy and doctor's reviews, etc and go from there. We also moved her in with her 75 year old father who is in bad shape physically but it's giving her a place to stay as he has a small house and SS/small pension. She applied for SSDI and got rejected twice. Apparently, it's pretty hard to get that unless you are on your deathbed or crippled.

This non-expansion of Medicaid here in Texas has left a lot of people out of the insurance market. These are the people you don't hear anything about. Their income (if any) is to low to qualify for the ACA and they can't afford an insurance plan for $1000+/month and $7K deductible. Heck, they can just about earn enough for essentials.

The only course of help to to go to an ER and get stabilized. She has done that twice and got transfusions to get her iron back up, but no Doc there will write an order for a bone marrow biopsy for charity.

 

[Dtail]

We are working on getting her some help (financially). We are going to pay for the biopsy and doctor's reviews, etc and go from there. We also moved her in with her 75 year old father who is in bad shape physically but it's giving her a place to stay as he has a small house and SS/small pension. She applied for SSDI and got rejected twice. Apparently, it's pretty hard to get that unless you are on your deathbed or crippled.

This non-expansion of Medicaid here in Texas has left a lot of people out of the insurance market. These are the people you don't hear anything about. Their income (if any) is to low to qualify for the ACA and they can't afford an insurance plan for $1000+/month and $7K deductible. Heck, they can just about earn enough for essentials.

The only course of help to to go to an ER and get stabilized. She has done that twice and got transfusions to get her iron back up, but no Doc there will write an order for a bone marrow biopsy for charity.

I understand and have empathy for your situation.
The medicaid expansion aspect is truly ridiculous. That aspect I know living in FLA, as my brother who does have some monies mostly in Roth accounts for his stock risk portion, so he can't generate enough MAGI. Thus I had to creatively (legally) have him covered through me as a dependent.

Exactly - how does someone earning 10k afford insurance for 12k?

 

[jim584672]

We are working on getting her some help (financially). We are going to pay for the biopsy and doctor's reviews, etc and go from there. We also moved her in with her 75 year old father who is in bad shape physically but it's giving her a place to stay as he has a small house and SS/small pension. She applied for SSDI and got rejected twice. Apparently, it's pretty hard to get that unless you are on your deathbed or crippled.

This non-expansion of Medicaid here in Texas has left a lot of people out of the insurance market. These are the people you don't hear anything about. Their income (if any) is to low to qualify for the ACA and they can't afford an insurance plan for $1000+/month and $7K deductible. Heck, they can just about earn enough for essentials.

The only course of help to to go to an ER and get stabilized. She has done that twice and got transfusions to get her iron back up, but no Doc there will write an order for a bone marrow biopsy for charity.

She should consider moving to a state that has expanded. Stem cell transplants can cost hundreds of thousands. Her life is on the line.

 

[Texas Proud]

She should consider moving to a state that has expanded. Stem cell transplants can cost hundreds of thousands. Her life is on the line.

+1 on this... I was going to type it but someone beat me...


I would seriously look at moving to a state that has expanded that she could afford to live... any relatives in a state that has expanded?


I think you would have to look to see how long it would take to get it though...

 

[pb4uski]

We are working on getting her some help (financially). We are going to pay for the biopsy and doctor's reviews, etc and go from there. We also moved her in with her 75 year old father who is in bad shape physically but it's giving her a place to stay as he has a small house and SS/small pension. She applied for SSDI and got rejected twice. Apparently, it's pretty hard to get that unless you are on your deathbed or crippled.

This non-expansion of Medicaid here in Texas has left a lot of people out of the insurance market. These are the people you don't hear anything about. Their income (if any) is to low to qualify for the ACA and they can't afford an insurance plan for $1000+/month and $7K deductible. Heck, they can just about earn enough for essentials.

The only course of help to to go to an ER and get stabilized. She has done that twice and got transfusions to get her iron back up, but no Doc there will write an order for a bone marrow biopsy for charity.

Desparate times call for desparate measures. Her 75 yo father has hired her to be his caretaker. He is paying her $12,500 a year... separately, she is gifting it all back to him. Of course, he has to pay FICA and other payroll taxes... but she then has enough income to buy a highly subsidized silver plan with CSRs.

 

[aja8888]

Desparate times call for desparate measures. Her 75 yo father has hired her to be his caretaker. He is paying her $12,500 a year... separately, she is gifting it all back to him. Of course, he has to pay FICA and other payroll taxes... but she then has enough income to buy a highly subsidized silver plan with CSRs.

We will look into this approach. Thanks.

Moving to another state is not that easy.

 

[Katsmeow]

No, but it does get one a free trip to the emergency room at no real cost to the recipient. (Blood from Stone theory)

Well, as mentioned, the ER will stabilize for acute stuff. They don't give chemotherapy in the ER. My daughter who has insurance but can't afford her deductible went to the ER when she broke her foot but it didn't the break set.

Yes, like in this state (Texas). We have a relative that needs a bone marrow biopsy (blood count going critically low every three months) and is unemployed over 50 plus divorced. She can't get the biopsy in the ER and can't get on Medicaid. We are about to step up and pay the freight ourselves to get this test done. And if she has cancer? Then what?

As you may recall, I am also in Texas. I have a relative who made under the poverty line last year. So, no subsidy. She does have an ACA policy at full freight but can't really get much benefit out of it unless there is a catastrophe because the deductible is so high. I tried to explain that she would need to earn more money to get a subsidy which is just crazy to have to explain to someone. Honestly, in that situation, I tend to think the best option for many is to simply move to a state that has expanded Medicaid. There is cost involved with that but at least there is health care...

If she is unemployed and can't get on Medicaid, why can't she get heavily subsidized ACA health insurance?

Not in states that didn't expand Medicaid if your income is below the poverty line.

I would like to flesh this out a bit... are you an attorney? Cannot remember who was what when working...

Yes, I am a retired attorney. There is of course no certain prediction of what a court will ultimately do. So no one really knows for sure. But, from looking at the district court's opinion it is just hard to see how it gets upheld particularly when it would upend so much law on other issues.

 

[sengsational]

Key to my decision to RE was the ACA; I quit and signed up the first year. I predicted a flood of wage slaves that were locked into work in order to keep coverage would be flooding out with me (not sure if the data backs that up). If the ACA as we know it goes away (which I doubt will happen quickly, if at all), I'll shop different states and move if the differences are large enough.

 

[ShokWaveRider]

Yes, like in this state (Texas). We have a relative that needs a bone marrow biopsy (blood count going critically low every three months) and is unemployed over 50 plus divorced. She can't get the biopsy in the ER and can't get on Medicaid. We are about to step up and pay the freight ourselves to get this test done. And if she has cancer? Then what?

We are working on getting her some help (financially). We are going to pay for the biopsy and doctor's reviews, etc and go from there. We also moved her in with her 75 year old father who is in bad shape physically but it's giving her a place to stay as he has a small house and SS/small pension. She applied for SSDI and got rejected twice. Apparently, it's pretty hard to get that unless you are on your deathbed or crippled.

This non-expansion of Medicaid here in Texas has left a lot of people out of the insurance market. These are the people you don't hear anything about. Their income (if any) is to low to qualify for the ACA and they can't afford an insurance plan for $1000+/month and $7K deductible. Heck, they can just about earn enough for essentials.

The only course of help to to go to an ER and get stabilized. She has done that twice and got transfusions to get her iron back up, but no Doc there will write an order for a bone marrow biopsy for charity.

This is so sad we have let ourselves come to this as a country. No one deserves this lack of HC.

This is the REAL problem with the ACA, NOT the fact that some folk who earn too much cannot get a subsidy. But those who do not earn enough, but are not quite poor enough CANNOT get HC at all. The assumption was made that all states would expand Medicaid, I could have told you they would not, and even taken a very good guess at which states wouldn't. You know what they say about assumptions. "Makes an Ass out of You an Me".

 

[scrabbler1]

This is so sad we have let ourselves come to this as a country. No one deserves this lack of HC.

This is the REAL problem with the ACA, NOT the fact that some folk who earn too much cannot get a subsidy. But those who do not earn enough, but are not quite poor enough CANNOT get HC at all. The assumption was made that all states would expand Medicaid, I could have told you they would not, and even taken a very good guess at which states wouldn't. You know what they say about assumptions. "Makes an Ass out of You an Me".

Remember when the AA was passed, the Medicaid Expansion featured included both a carrot and a stick. The carrot part, federal support, remains in place. The stick part, withholding of all federal Medicaid support, including for existing enrollees, was struck down by SCOTUS in 2012. This decision made it easier for states to opt out of Medicaid Expansion, along with creating this income bubble where many people are trapped.

 

[fh2000]

Our options (and I always keep this to myself, except on this forum):

ACA, while it is still available
Cobra (expensive)
Retiree health plan (expensive)
All else fails, move back to home country (near free universal health care)

 

[gstillson]

Desparate times call for desparate measures. Her 75 yo father has hired her to be his caretaker. He is paying her $12,500 a year... separately, she is gifting it all back to him. Of course, he has to pay FICA and other payroll taxes... but she then has enough income to buy a highly subsidized silver plan with CSRs.

Another thing to try is to set her up a brokerage account with $1000 or so and then estimate that her 2019 income will be $12,500 from trading in that account. This will qualify her for a bronze policy with probably no cost. If she doesn't make $12,500 from her account she won't have to pay back the premium because of her low income.

 

[jim584672]

I would be careful not to estimate income that is not reasonable, they may consider that fraudulent.