ACA Ruled Unconstitutional

[Twangbanger]

The individual mandate penalty was declared by SCOTUS to be a tax. That tax was the basis for the Constitutional ruling. Congress did away with the mandate. Without the mandate the tax doesnÂ’t exist.

Too simple? What am I missing?

I think you're missing that the existence of the "tax" was never really as pivotal to Obamacare as we were led to believe it was.

The prior Supreme Court decision was very limited in nature, concerning only the tax itself. Many of us were wrongly deluded by the media hype into believing that that decision was going to be the be-all, end-all of Obamacare: the Supreme Court rules against it, and it is done.

The only way a Supreme-Court strike-down in 2012 would have hurt Obamacare, is that it would have emboldened Republican efforts at repeal. They could have then said they were repealing an "unconstitutional law." That's why the media was so wound up about it.

But if you strip everything else away, ACA is just a Medicaid Expansion disguised as Health Care Reform. It added a small pile of rocks onto the already-existing mountain of free ***** the government gives to people. No such program (that I'm aware of) has ever been ruled unconstitutional, and I doubt that any ever will.

 

[Double T]

The only true way to fix healthcare, is to remove the 4 different bills you get from an ER trip. ER bill, lab bill, radiology, and then the ER physician's bill. Insurance seems to cover less and less of these as well.

 

[hoosierdoc]

My company pays 100% premium for our full time employees. We employ mainly medical professionals and three office staff. Our medical premiums are 2.5X higher than our malpractice premiums. They have gone up 53% since 2015. Malpractice has actually gone down.

 

[hoosierdoc]

The only true way to fix healthcare, is to remove the 4 different bills you get from an ER trip. ER bill, lab bill, radiology, and then the ER physician's bill. Insurance seems to cover less and less of these as well.

well, you need single payer for that. Go to a colts game, pay for parking, a ticket, and food. Three vendors.

it’s not the number of bills. It’s the inflated nature of them due to absurd payment schedules and massive bad debt.

hospitals/medical groups should be allowed to deduct unpaid bills as a business loss and carry that through on our personal taxes. That would help a lot. Let us deduct them at Medicare reimbursement rate. You know, $0.25 on the dollar

 

[Double T]

well, you need single payer for that. Go to a colts game, pay for parking, a ticket, and food. Three vendors.

it’s not the number of bills. It’s the inflated nature of them due to absurd payment schedules and massive bad debt.

hospitals/medical groups should be allowed to deduct unpaid bills as a business loss and carry that through on our personal taxes. That would help a lot. Let us deduct them at Medicare reimbursement rate. You know, $0.25 on the dollar

While I understand the ideology behind this, the hospital should dole out the payment to the vendors. If someone comes to the ED, they aren't really expecting 4 different bills. The ER visit mentioned was one example.

Surgery could be another, you have the radiology bill for any imaging done in the surgical suite, then you get an anesthesiologist bill, and labs, and pharmacy, etc.

Wouldn't it make sense for the patient to only receive the one bill for the general surgery? Sure, itemize the summary, but the bill should only come from the hospital no?

Saying a surgeon or an anesthetist has different billing, etc, is kind of silly. Don't they have to have privileges at a facility to work?

And I totally agree with you on the tax deductions for operating loss.

 

[Trigger Time]

This government is in shambles. I'm just pulling up a chair to watch the trainwreck. Nothing from judges or politicians is gonna fix this **** show at this point. Any good news just prolongs the inevitable from the Democrat traitors

 

[jamil]

Me. Right here.

Before the ACA I had a $5k deductible plus 20% to $5k, so to keep my premiums down I was on the hook for $6k total per year. I paid for my own private insurance. I work at a nonprofit and don't make a lot of money. So when ACA came in it was about (IIRC) a $3,750 deductible with a max out of pocket of $6,500. So I was on the hook for a whopping $500 more per year. HOWEVER, with the subsidy it saved me about $200 per month, so well worth it - for me.

The ACA helped (kindof) millions of people who are/were lower income. It broke even with some in the middle, and it screwed everyone else.

The problem has never been on the insurance side, at least not significantly. The problem is on the health industry side. The insurance pays the bills, but it doesn't create the massive waste and titanic bills. The best you could argue against insurance is that it adds a level of bureaucracy, but I don't believe that would account for more than maybe(?) 5% of the bill. So the a $24,000 for my broken hand in car accident the insurance added in maybe $1,000 - $1,500. All the rest came from massive waste generated by the health industry. Should fixing a broken hand bone cost money? Sure it should. But if we could sick a good CPA on the entire cost of my surgery and care I'll be it didn't come out to more than $10,000 for the surgeon, nurses, equipment etc etc etc.

I still blame the republicans for doing nothing before Obama came in. There were massive problems with growing healthcare costs. It was a problem. It still is. But before hand they could have taken conservative, free market corrections that could have changed direction and they did nothing. When Obama came in it was too late.

I still won't speak positively about the ACA. It is a horrible thing and now it is worse for America as all of the mechanisms to pay for it have been removed. The republicans in congress were again idiots for not letting the sour side of it reach the masses!!! Had people been forced to endure all the bad crap that was with it they would have had a fit and demanded change. The democrats didn't want it to bite them in the behind and the republicans were too stupid and short sighted to force them to keep the sour tasting side of it. So now all we have is a handout without pain. Idiots...

Regards,

Doug

EDIT - I didn't answer right. It DID help me, but I won't speak positively about it. You are correct. However, I have heard people that do.

Insurance is part of the problem. There’s little incentive for the supply side of health care to control costs. Look at the sectors if healthcare which haven’t seen skyrocketed increases in costs. Cosmetic surgery isn’t generally covered by insurance and their costs have been fairly flat. The medical costs for what insurance covers is in an upward spiral because there’s no reason not to.

 

[rob63]

This is purely an anecdote, but it is indicative of the role of having a 3rd party payer plays in the cost of medicine. My wife noticed on an insurance statement that they had covered a $4500 procedure that was performed on a date that she knew she was out of town at business meetings. She called the hospital and was told that it was a lab test performed on a tissue sample taken during a previous surgery. Here's the kicker, they told her not to worry, it would have only been a $250 charge if the insurance had not covered it at the $4500 rate!

 

[SheepDog4Life]

"A" for effort, but not sure the constitutionality argument makes sense here. The SC ruled it was A) a tax, and B) constitutional as such. It's not clear to me that setting the value of that tax to zero invalidates or in any way undermines that finding. In the previous go-round at the SC, the Court was asked to determine whether the levying of a particular tax was constitutional, and they ruled it was (thanks to a dick move by Justice Roberts). They did not find, at least to my knowledge, that any tax must in fact be levied. That's a question of fiscal responsibility, not constitutionality. Money is fungible. The writers of the ACA provided other sources of revenue for it (eg, subsidies). Setting one of those revenue streams equal to zero undermines the fiscal responsibility of the law, but it's not clear to me that it affects its constitutionality in any way.

Tax rates change all the time. Hell, in the case of Refundable Tax Credits, there are situations where the effective tax rate is actually a negative number. I don't see anyone ruling the Welfare State unconstitutional, on grounds that some of the taxes supporting it were set to negative values. It just changes the direction of flow of the money involved, not the fundamental "right" of the government to act as a payer of such benefits.

(I mean, really; if we could actually invalidate the constitutionality of entire government programs simply by retroactively setting their revenue sources equal to zero...what fun we could have! But in the absence of a Balanced Budget Amendment, I don't see how this can even remotely be argued to be rational).

Sorry to be the Denny here, but this is so obvious, I could almost write their opinion for them. Texas sometimes acts as sort of a "San Francisco 9th circuit" for kooky conservative opinions. I'm afraid this is just another one of them. It's just another deplorable example of the US Judiciary acting as a player in the "binary war of kooks," instead of making solid, rational arguments.

That's what I was thinking and scratching my head over this ruling. Leftist judges routinely abuse their power to create the policies they prefer. On the face of it, this looks like the start of judges on the right are beginning to respond in kind. Oh, lord!

 

[BugI02]

Perhaps what is unconstitutional is congress telling insurance companies what products they may sell and whom to make them available to. Can you say restraint of trade? Since they wouldn't allow competition across state lines, difficult to see how the interstate commerce clause can be bent to fit. Seeing some problems with those pesky 4th, 5th, 9th and 10th amendments also

 

[GodFearinGunTotin]

I saw an article yesterday whose headline said now that Obamacare has been ruled unconstitutional Trump wants a new bill to replace it. I should have read it then because the way the FB algorithm works, you can never find a post again when you go to look for it.

 

[BugI02]

The internet has a very short attention span. Does your browser support a reading list? I've learned to archive things I might want to read when encountered until I have time to really make that call

 

[mmpsteve]

This is purely an anecdote, but it is indicative of the role of having a 3rd party payer plays in the cost of medicine. My wife noticed on an insurance statement that they had covered a $4500 procedure that was performed on a date that she knew she was out of town at business meetings. She called the hospital and was told that it was a lab test performed on a tissue sample taken during a previous surgery. Here's the kicker, they told her not to worry, it would have only been a $250 charge if the insurance had not covered it at the $4500 rate!

Abuse and fraud is rampant in the whole system. My elderly Grandma received bogus bills (that WERE paid by medicare). When my Mom questioned the doctor's office, she was told not to worry, 'it's been paid; didn't cost you anything. Just a computer glitch, we'll fix it'. Not until she threatened to pursue it, did they amend their bill and make it right. But how many people would even pay attention, if it's not costing them anything?
And who knows if the doctor's office actually reimbursed Medicaid; I doubt it, as it might draw attention and scrutiny to their practice.
.

 

[PaulF]

I saw an article yesterday whose headline said now that Obamacare has been ruled unconstitutional Trump wants a new bill to replace it. I should have read it then because the way the FB algorithm works, you can never find a post again when you go to look for it.

Repeal? Okay.

Replace? That bit makes me uneasy.

I think the best solution to the national healthcare crisis is to leave government intervention, where (and if) appropriate, to the states. I just don't see where a one-size-fits-all approach is ever going to work. Washington DC is too far away from the problem to be an effective solution, especially since (like many problems) it manifests itself differently from place to place depending on the local circumstances.

I've made this argument here before, but it has never gotten much traction...

...I think the states should be tasked with deciding what level of government intervention is appropriate, how to apply it, and how to pay for it.

Just for the sake of illustration, imagine New York wanted to create an entirely public system, single payer, services provided on State property...all that. If that's what their taxpayers want they should be free to implement such a system...at their own expense. On the other hand maybe Iowa decides to have an entirely hands-off approach...no government intervention at all. The market alone decides what services are available, their cost, what recourse is available to the patient...all that. They should be free to do so. The rest of the states would each address the issue as they see fit, and from that experience we should be able to form a better idea of what works best (in broad terms) based on a set of defined conditions.

Maybe my idea is crap, but it leaves room at least for somebody to take an evidence-based approach to the problem. To me, everything that comes out of Washington seems more agenda-based, which I don't think is a sincere way to address social or economic problems on a macro-scale.

 

[Dean C.]

Repeal? Okay.

Replace? That bit makes me uneasy.

I think the best solution to the national healthcare crisis is to leave government intervention, where (and if) appropriate, to the states. I just don't see where a one-size-fits-all approach is ever going to work. Washington DC is too far away from the problem to be an effective solution, especially since (like many problems) it manifests itself differently from place to place depending on the local circumstances.

I've made this argument here before, but it has never gotten much traction...

...I think the states should be tasked with deciding what level of government intervention is appropriate, how to apply it, and how to pay for it.

Just for the sake of illustration, imagine New York wanted to create an entirely public system, single payer, services provided on State property...all that. If that's what their taxpayers want they should be free to implement such a system...at their own expense. On the other hand maybe Iowa decides to have an entirely hands-off approach...no government intervention at all. The market alone decides what services are available, their cost, what recourse is available to the patient...all that. They should be free to do so. The rest of the states would each address the issue as they see fit, and from that experience we should be able to form a better idea of what works best (in broad terms) based on a set of defined conditions.

Maybe my idea is crap, but it leaves room at least for somebody to take an evidence-based approach to the problem. To me, everything that comes out of Washington seems more agenda-based, which I don't think is a sincere way to address social or economic problems on a macro-scale.

I agree 100% each state is different, and this was very well put together ! If only our politicians weren't so self serving and just assume the rest of the country operates like their home state (the representatives of California and New York are especially guilty of this)

 

[hoosierdoc]

FR

While I understand the ideology behind this, the hospital should dole out the payment to the vendors. If someone comes to the ED, they aren't really expecting 4 different bills. The ER visit mentioned was one example.

Surgery could be another, you have the radiology bill for any imaging done in the surgical suite, then you get an anesthesiologist bill, and labs, and pharmacy, etc.

Wouldn't it make sense for the patient to only receive the one bill for the general surgery? Sure, itemize the summary, but the bill should only come from the hospital no?

Saying a surgeon or an anesthetist has different billing, etc, is kind of silly. Don't they have to have privileges at a facility to work?

And I totally agree with you on the tax deductions for operating loss.

Many physicians do not want to work for a hospital. They are inefficient at billing, they are giant corporations who often do not care about providers.
My group used to let hospital do our billing. And then on the audit we found out that the hospital employed billing agents would simply dump charts in the garbage can at the end of their shift because they wanted to go home.

The docs who have joined hospital employment is usually do to insurance/Medicare mandates for billing requirements that make private practice impossible.

Working for yourself > working for someone else

Now, it would be nice if all doctors at a particular hospital had to be in network for the insurance company that the overall hospital is.
But then again that completely annihilates your negotiating ability with insurance company for payment. Our practice negotiates independently with each insurance company that we contract with. The reimbursement rates are determined by contract. If anthem knew we only staff at one hospital, and the bylaws required us to be in network with anthem, we would have zero negotiating ability and they could pay us even less than they do now.

 

[Libertarian01]

Insurance is part of the problem. There’s little incentive for the supply side of health care to control costs. Look at the sectors if healthcare which haven’t seen skyrocketed increases in costs. Cosmetic surgery isn’t generally covered by insurance and their costs have been fairly flat. The medical costs for what insurance covers is in an upward spiral because there’s no reason not to.

While I agree that insurance is part of the problem, it is also the best way for people to pay for health care. So the problem it does cause is very minor cost wise.

That it exists is the problem. It gives a guaranteed money flow to the health care industry that has no incentive itself to streamline. Which is why I always argue that free market reforms being shoved down its throat would be the best solution to the problem.

Also yes on the second part. Look at eyeballs and boobs. Corrective eye surgery has gone up in quality and down in price. Same for boob jobs. Up in quality, down in price. (Up in size too...)

Regards,

Doug

 

[HoughMade]

It's weird.

It's like people people think that there was wholesale slaughter in the streets before the ACA.

There was a problem- some companies and some states had significant gaps in preexisting condition coverage, however, there were state-level programs that dealt with this many (if not most) places. Certainly, even if it was deemed appropriate for the feds to address this, preexisting conditions were a mere pretext in order to upend the entire healthcare insurance industry.

The uninsured? They got the care they needed. No one is kicked out of a hospital for not having insurance when life-saving care is on the line. It's a lie. It does not happen. Do they get the best of preventative care and elective care? Nope. Being poor sucks, but people were not dying outside the doors of hospitals having been thrown out.

They could have fixed the issue of preexisting conditions and the truly uninsured and left everyone else alone.

I laugh when I hear about people paying less now for health insurance than they did before the ACA. I am POSITIVE these instances are true. I would expect, maybe, a Christmas card or a simply "thank you". Nothing.

People like me, who get no subsidy, saw our premiums rise significantly with the coverage we really care about being reduced. We used to have health insurance policies that, for instance, did not include maternity coverage. We used to be able to make that choice. That coverage is extremely expensive, but under the ACA, there is no choice. We have to have that coverage and we have to pay for it. This is just an example. There are several mandated coverages that we used to be able to opt out of.

So- what has been the effect. The year before the ACA, we paid about $700-$750/month. It's been over $1,200 for a few years now. There's no sleight-of-hand hiding the real cost by passing it on to the employer- I am my employer. BTW- if you don't mind your employer having to pay more, keep in mind that if you are a hard worker, that's just money your employer has to pay for everyone from the best to the worst employees, so there is less money for paying the best employees more.

So, will this stand up? Good question. Severability is extremely complex. I have not studied this particular case. the general idea is that when you have a comprehensive Act (set of laws) if one part of it is found unconstitutional, the rest of the laws remain in effect. However, if the one part found unconstitutional is an integral part to the set of laws and cannot be "severed" from them, then the entire Act is unconstitutional.

That analysis, as I said, is quite complex.

What NO court can do is simply say: "well, I'm putting the fine back in." Nope. Can't do it. No way.

Congress passed an amendment to the ACA and the President signed it. Congress passing and the President signing is what got us the ACA. It holds no special status where the Congress and President can't amend it.

All a court can do in this procedural posture is determine that the individual mandate (without the fine) is either not unconstitutional (though it would seem to be unenforceable) or if unconstitutional, severable from the rest of the ACA.

 

[Tactically Fat]

You know... If the gov't didn't waste billions upon billions upon billions of dollars, all of this would be relatively easy to solve.

 

[SheepDog4Life]

It's weird.

It's like people people think that there was wholesale slaughter in the streets before the ACA.

There was a problem- some companies and some states had significant gaps in preexisting condition coverage, however, there were state-level programs that dealt with this many (if not most) places. Certainly, even if it was deemed appropriate for the feds to address this, preexisting conditions were a mere pretext in order to upend the entire healthcare insurance industry.

The uninsured? They got the care they needed. No one is kicked out of a hospital for not having insurance when life-saving care is on the line. It's a lie. It does not happen. Do they get the best of preventative care and elective care? Nope. Being poor sucks, but people were not dying outside the doors of hospitals having been thrown out.

They could have fixed the issue of preexisting conditions and the truly uninsured and left everyone else alone.

I laugh when I hear about people paying less now for health insurance than they did before the ACA. I am POSITIVE these instances are true. I would expect, maybe, a Christmas card or a simply "thank you". Nothing.

People like me, who get no subsidy, saw our premiums rise significantly with the coverage we really care about being reduced. We used to have health insurance policies that, for instance, did not include maternity coverage. We used to be able to make that choice. That coverage is extremely expensive, but under the ACA, there is no choice. We have to have that coverage and we have to pay for it. This is just an example. There are several mandated coverages that we used to be able to opt out of.

So- what has been the effect. The year before the ACA, we paid about $700-$750/month. It's been over $1,200 for a few years now. There's no sleight-of-hand hiding the real cost by passing it on to the employer- I am my employer. BTW- if you don't mind your employer having to pay more, keep in mind that if you are a hard worker, that's just money your employer has to pay for everyone from the best to the worst employees, so there is less money for paying the best employees more.

So, will this stand up? Good question. Severability is extremely complex. I have not studied this particular case. the general idea is that when you have a comprehensive Act (set of laws) if one part of it is found unconstitutional, the rest of the laws remain in effect. However, if the one part found unconstitutional is an integral part to the set of laws and cannot be "severed" from them, then the entire Act is unconstitutional.

That analysis, as I said, is quite complex.

What NO court can do is simply say: "well, I'm putting the fine back in." Nope. Can't do it. No way.

Congress passed an amendment to the ACA and the President signed it. Congress passing and the President signing is what got us the ACA. It holds no special status where the Congress and President can't amend it.

All a court can do in this procedural posture is determine that the individual mandate (without the fine) is either not unconstitutional (though it would seem to be unenforceable) or if unconstitutional, severable from the rest of the ACA.

HM, you allude to it, if someone receives the full subsidy, then it is possible, and it does happen. I know someone whom this applies. Makes less than $20/hour and pays less than $100 per month for coverage. Has either gold or silver, I cannot remember, but not bronze.

That said, for the last two years, there has been only ONE option (i.e. no choices) on the exchange in this region. Most (all?) of the big players are out of the exchanges because it is a huge loss.

IMO, this is to what the creators of ACA wanted, so that the ACA-endgame would force the creation of single-payer, socialized medicine, a la Europe and Canada and is the biggest reason I've been opposed to it from the start.