ACA (a.k.a. Obamacare) Upheld

[nehalem256]

Thats because neither party wants to address the root problem, the actual cost of healthcare. We the Dems would like to address that, sorta, but the GOP doesnt give two shits.

We need to focus on healthcare costs, not healthcare insurance costs.

Healthcare costs started skyrocketing in the 1980s when non-profit hospitals switched to for profit. The switch to for-profit healthcare is what has caused runaway costs.

So why did the Democrats decide to focus on health insurance instead of the cost of health care?

 

[chucky2]

Yep. But the reality is we're already paying for people without insurance who show up at the hospital ER with the sniffles and are required by law to be cared for. This just makes a way for the hospitals to get paid. Hospital stocks jumped way up today after the ruling.
http://finance.yahoo.com/news/sector-snap-hospitals-surge-health-143622915.html

I'm on an outage call so I'm not able to really dedicate 100% attention to this..so forgive me if I ask a dumb question:

The point of the mandate was to make sure everyone got insurance I thought. People in the middle class and up either already have it, or, can already afford it. It's the other 45% or whatever that were whining they needed a health mandate.

Ok, so this ACA is passed, it mandates Everyone get insurance or they pay a fine. Now it's looking like the fine amount is so low, those that aren't subsidized will just pay the fine.

Those that are subsidized aren't paying sh1t in anyways, they're already a net drain.

I'm sorry....what exactly does this mandate accomplish in the grand scheme of things???

 

[bfdd]

Whhhaaaaaaa???????????

a tax plan funded by other tax dollars! TOTALLY SUSTAINABLE! lols

 

[CPA]

so, what's done is done and unless their is a leadership change in November, this tax will be coming on soon.

However, what I'm very interested in is the GDP impact of this change. As we all know, the libs hammered on about how healthcare costs are 16% of GDP and it was the insurance companies fault. So, if the federal government is now going to be more actively policing costs through Obamacare (and don't let anyone fool you, costs will be driven by this plan) then I'd like to see what percentage of GDP healthcare represents in 2016. If it's higher, and I suspect it will be, will anyone complain?

 

[Wreckem]

That might work, except for when people lose their jobs. What happens when you lose your job, are really actively trying to get a job for 14 months, and finally get one?

Obviously once you have your new job you could be expected to get some kind of health insurance, but, while you don't have one, how are you going to pay for it and thus maintain coverage?

That depends on how much unemployment you are drawing.

 

[IndyColtsFan]

If it's higher, and I suspect it will be, will anyone complain?

If they do, they'll blame the Republicans.

 

[munkus]

I don't think you'll get any Rightist on board for that.

Maybe not. I'm a conservative in many areas, but I believe that health care should be run by private, non-profit organizations. Crazy, I know...

 

[blankslate]

We need a tax that if you dont vote republican you get taxed. Based on this ruling perfectly legal.


Oh wait, democrates might now take that idea and actually run with it, and their sheep here will defend it.

That is an extremely thoughtless post... because no one will advocate people having to reveal who they vote for.

 

[Wreckem]

So why did the Democrats decide to focus on health insurance instead of the cost of health care?

Because they could barely get this passed. They stood no chance passing what needs to be passed to lower actual healthcare costs.

 

[munkus]

I'm on an outage call so I'm not able to really dedicate 100% attention to this..so forgive me if I ask a dumb question:

The point of the mandate was to make sure everyone got insurance I thought. People in the middle class and up either already have it, or, can already afford it. It's the other 45% or whatever that were whining they needed a health mandate.

Ok, so this ACA is passed, it mandates Everyone get insurance or they pay a fine. Now it's looking like the fine amount is so low, those that aren't subsidized will just pay the fine.

Those that are subsidized aren't paying sh1t in anyways, they're already a net drain.

I'm sorry....what exactly does this mandate accomplish in the grand scheme of things???

It's a stepping stone towards single-payer, as far as I can tell.

 

[chucky2]

If this is news to you, you have no business even talking about this law because you have no clue what's in it.

I guess I'm stunned is all. This whole time I thought this bill penalized the insurance companies but at least mandated that people (not the Fed) go get insurance or be fined.

The purpose of a fine is to deter people from doing (or not doing) the activity related to the fine. If what Wreckam posts is true, the fine is a joke. The large majority of people who have two brain cells to rub together are still not going to buy the insurance and just pay the fine - unless there is some real incentive (or disincentive) in doing that.

What is even the purpose of this law if a.) the Fed is going to keep paying for the low income peoples HC (and they're already subsidized for tons of other sh1t at that point also) and b.) people will just pay a nominal fine rather than shell out for HC insurance?

You sound like your well versed in this, and obviously I'm not, so maybe you can rationally explain that to me. So far I see a lot of nothing as far as people who don't have HI now paying into the system to keep it solvent while it handles Everyone.

Chuck

 

[chucky2]

It's a stepping stone towards single-payer, as far as I can tell.

That's what I wanted, but we have this. Now 'This' isn't even what I thought it would be....wtf....

 

[chucky2]

That depends on how much unemployment you are drawing.

What 'that' are you referring to?

 

[jstern01]

Maybe not. I'm a conservative in many areas, but I believe that health care should be run by private, non-profit organizations. Crazy, I know...

But non of the private organizations are non-profit.

 

[ichy]

chucky2: There is a glaring grammatical error in your sig.

 

[Phokus]

We need to focus on healthcare costs, not healthcare insurance costs.

Part of Obamacare requires that doctors are paid based on the quality of care for their patients rather than the number of treatments they use on their patients. There was an article on this as this was a new type of practice that a couple private hospitals had used to great success and Obamacare is modelling off of: they lowered surgeon pay but gave bonuses based on metrics... there were fewer mistakes, fewer procedures, better patient outcomes, and costs went down (and the surgeons made more money).

Conservatives: THE HORROR!

A bunch of other stuff from reddit:

Okay, explained like you're a five year-old (well, okay, maybe a bit older), without too much oversimplification, and (hopefully) without sounding too biased:
What people call "Obamacare" is actually the Patient Protection and Affordable Care Act. However, people were calling it "Obamacare" before everyone even hammered out what it would be. It's a term mostly used by people who don't like the PPACA, and it's become popularized in part because PPACA is a really long and awkward name, even when you turn it into an acronym like that.
Anyway, the PPACA made a bunch of new rules regarding health care, with the purpose of making health care more affordable for everyone. Opponents of the PPACA, on the other hand, feel that the rules it makes take away too many freedoms and force people (both individuals and businesses) to do things they shouldn't have to.
So what does it do? Well, here is everything, in the order of when it goes into effect (because some of it happens later than other parts of it):
Already in effect:
It allows the Food and Drug Administration to approve more generic drugs (making for more competition in the market to drive down prices)
It increases the rebates on drugs people get through Medicare (so drugs cost less)
It establishes a non-profit group, that the government doesn't directly control, [1] PCORI, to study different kinds of treatments to see what works better and is the best use of money. ( [2] Citation: Page 665, sec. 1181 )
It makes chain restaurants like McDonalds display how many calories are in all of their foods, so people can have an easier time making choices to eat healthy. ( [3] Citation: Page 499, sec. 4205 )
It makes a "high-risk pool" for people with pre-existing conditions. Basically, this is a way to slowly ease into getting rid of "pre-existing conditions" altogether. For now, people who already have health issues that would be considered "pre-existing conditions" can still get insurance, but at different rates than people without them.
It renews some old policies, and calls for the appointment of various positions.
It creates a new 10% tax on indoor tanning booths. ( [4] Citation: Page 923, sec. 5000B )
It says that health insurance companies can no longer tell customers that they won't get any more coverage because they have hit a "lifetime limit". Basically, if someone has paid for health insurance, that company can't tell that person that he's used that insurance too much throughout his life so they won't cover him any more. They can't do this for lifetime spending, and they're limited in how much they can do this for yearly spending. ( [5] Citation: Page 14, sec. 2711 )
Kids can continue to be covered by their parents' health insurance until they're 26.
No more "pre-existing conditions" for kids under the age of 19.
Insurers have less ability to change the amount customers have to pay for their plans.
People in a "Medicare Gap" get a rebate to make up for the extra money they would otherwise have to spend.
Insurers can't just drop customers once they get sick. ( [6] Citation: Page 14, sec. 2712 )
Insurers have to tell customers what they're spending money on. (Instead of just "administrative fee", they have to be more specific).
Insurers need to have an appeals process for when they turn down a claim, so customers have some manner of recourse other than a lawsuit when they're turned down.
New ways to stop fraud are created.
Medicare extends to smaller hospitals.
Medicare patients with chronic illnesses must be monitored more thoroughly.
Reduces the costs for some companies that handle benefits for the elderly.
A new website is made to give people insurance and health information. (I think this is it: [7] http://www.healthcare.gov/ ).
A credit program is made that will make it easier for business to invest in new ways to treat illness.
A limit is placed on just how much of a percentage of the money an insurer makes can be profit, to make sure they're not price-gouging customers.
A limit is placed on what type of insurance accounts can be used to pay for over-the-counter drugs without a prescription. Basically, your insurer isn't paying for the Aspirin you bought for that hangover.
Employers need to list the benefits they provided to employees on their tax forms.
8/1/2012
Any health plans sold after this date must provide preventative care (mammograms, colonoscopies, etc.) without requiring any sort of co-pay or charge.
1/1/2013
If you make over $200,000 a year, your taxes go up a tiny bit (0.9%). Edit: To address those who take issue with the word "tiny", a change of 0.9% is relatively tiny. Any look at how taxes have fluctuated over the years will reveal that a change of less than one percent is miniscule, especially when we're talking about people in the top 5% of earners.
1/1/2014
This is when a lot of the really big changes happen.
No more "pre-existing conditions". At all. People will be charged the same regardless of their medical history.
If you can afford insurance but do not get it, you will be charged a fee. This is the "mandate" that people are talking about. Basically, it's a trade-off for the "pre-existing conditions" bit, saying that since insurers now have to cover you regardless of what you have, you can't just wait to buy insurance until you get sick. Otherwise no one would buy insurance until they needed it. You can opt not to get insurance, but you'll have to pay the fee instead, unless of course you're not buying insurance because you just can't afford it.
Insurers now can't do annual spending caps. Their customers can get as much health care in a given year as they need. ( [8] Citation: Page 14, sec. 2711 )
Make it so more poor people can get Medicaid by making the low-income cut-off higher.
Small businesses get some tax credits for two years.
Businesses with over 50 employees must offer health insurance to full-time employees, or pay a penalty.
Limits how high of an annual deductible insurers can charge customers.
Cut some Medicare spending
Place a $2500 limit on tax-free spending on FSAs (accounts for medical spending). Basically, people using these accounts now have to pay taxes on any money over $2500 they put into them.
Establish health insurance exchanges and rebates for the lower and middle-class, basically making it so they have an easier time getting affordable medical coverage.
Congress and Congressional staff will only be offered the same insurance offered to people in the insurance exchanges, rather than Federal Insurance. Basically, we won't be footing their health care bills any more than any other American citizen.
A new tax on pharmaceutical companies.
A new tax on the purchase of medical devices.
A new tax on insurance companies based on their market share. Basically, the more of the market they control, the more they'll get taxed.
The amount you can deduct from your taxes for medical expenses increases.
1/1/2015
Doctors' pay will be determined by the quality of their care, not how many people they treat. Edit: a_real_MD addresses questions regarding this one in far more detail and with far more expertise than I can offer in [9] this post. If you're looking for a more in-depth explanation of this one (as many of you are), I highly recommend you give his post a read.
1/1/2017
If any state can come up with their own plan, one which gives citizens the same level of care at the same price as the PPACA, they can ask the Secretary of Health and Human Resources for permission to do their plan instead of the PPACA. So if they can get the same results without, say, the mandate, they can be allowed to do so. Vermont, for example, has expressed a desire to just go straight to single-payer (in simple terms, everyone is covered, and medical expenses are paid by taxpayers).
2018
All health care plans must now cover preventative care (not just the new ones).
A new tax on "Cadillac" health care plans (more expensive plans for rich people who want fancier coverage).
2020
The elimination of the "Medicare gap"
.
Aaaaand that's it right there.
The biggest thing opponents of the bill have against it is the mandate. They claim that it forces people to buy insurance, and forcing people to buy something is unconstitutional. Personally, I take the opposite view, as it's not telling people to buy a specific thing, just to have a specific type of thing, just like a part of the money we pay in taxes pays for the police and firemen who protect us, this would have us paying to ensure doctors can treat us for illness and injury.
Plus, as previously mentioned, it's necessary if you're doing away with "pre-existing conditions" because otherwise no one would get insurance until they needed to use it, which defeats the purpose of insurance.
Whew! Hope that answers the question!

 

[Todd33]

One step closer to the US becoming a first world country. Baby steps...

 

[fskimospy]

I guess I'm stunned is all. This whole time I thought this bill penalized the insurance companies but at least mandated that people (not the Fed) go get insurance or be fined.

The purpose of a fine is to deter people from doing (or not doing) the activity related to the fine. If what Wreckam posts is true, the fine is a joke. The large majority of people who have two brain cells to rub together are still not going to buy the insurance and just pay the fine - unless there is some real incentive (or disincentive) in doing that.

What is even the purpose of this law if a.) the Fed is going to keep paying for the low income peoples HC (and they're already subsidized for tons of other sh1t at that point also) and b.) people will just pay a nominal fine rather than shell out for HC insurance?

You sound like your well versed in this, and obviously I'm not, so maybe you can rationally explain that to me. So far I see a lot of nothing as far as people who don't have HI now paying into the system to keep it solvent while it handles Everyone.

Chuck

The fine is sort of bullshit, I agree actually. It's not entirely so however.

Health insurance for young, healthy people tends not to be that expensive, however. For those people the cost of the fine and the annual cost of health insurance are actually much closer to one another and so people in such cases could be compelled to purchase it on their own. (and I have no doubt that if the fine proves insufficient it will be given greater teeth)

 

[Pulsar]

Because they could barely get this passed. They stood no chance passing what needs to be passed to lower actual healthcare costs.

Exactly. The dems, to their credit, recognized what needed to happen to make this bill 'right'. They also understood it would never pass in that form because of the lobbiests for the insurance companies.

Unfortunately, the few shining gems in this law are vastly outshown by the giant pile of poop that forms the rest of the law.

I'm not sure why anyone is surprised. This was too big a landmine for the Supremes to do anything other than pass it. Had they killed it, it would have thrown the entire health insurance industry into a tailspin.

It would be.... entertaining.... to see who those supreme court justices have been in contact with over the past 2 months. Phone records, etc. If anyone doubts that insurance lobbiests haven't been chewing their ears off and fattening their.... wallets.... you're incredibly naive.

The constitution IS just a piece of paper. This just proves it. Again.

 

[JEDI]

ok.. WTF?!

conservative Chief Justice Roberts joins the Left to make this a 5-4 over the Right Wingers on the Supreme Court?!

And Romney says he'll overturn Obamacare?! Wasnt he the Gov that instituted mandatory Heathcare when he was Gov of Mass???

WTFMadworld?!?

 

[jstern01]

I guess I'm stunned is all. This whole time I thought this bill penalized the insurance companies but at least mandated that people (not the Fed) go get insurance or be fined.

The purpose of a fine is to deter people from doing (or not doing) the activity related to the fine. If what Wreckam posts is true, the fine is a joke. The large majority of people who have two brain cells to rub together are still not going to buy the insurance and just pay the fine - unless there is some real incentive (or disincentive) in doing that.

What is even the purpose of this law if a.) the Fed is going to keep paying for the low income peoples HC (and they're already subsidized for tons of other sh1t at that point also) and b.) people will just pay a nominal fine rather than shell out for HC insurance?

You sound like your well versed in this, and obviously I'm not, so maybe you can rationally explain that to me. So far I see a lot of nothing as far as people who don't have HI now paying into the system to keep it solvent while it handles Everyone.

Chuck

The argument for the mandate, was it would make healthy people get insurance and thus spread the risk amoung a large pool of policy holders, thus keeping the costs down. That was the theory.

But our stupid congress watered down the penalty for non compliance to the point that if the cost of getting insurance exceeds the tax penalty, many will opt for the tax penalty, that because of the way its written in the ACA law, IRS can not collect, because it explicitly says not too (see my earlier post about the penalty and enforcement clauses).

In the end, nobody is 100% happy, except the morons in DC that can go back to their districts and states and claim victory for their side, regardless of what there side is.

 

[Wreckem]

I guess I'm stunned is all. This whole time I thought this bill penalized the insurance companies but at least mandated that people (not the Fed) go get insurance or be fined.

The purpose of a fine is to deter people from doing (or not doing) the activity related to the fine. If what Wreckam posts is true, the fine is a joke. The large majority of people who have two brain cells to rub together are still not going to buy the insurance and just pay the fine - unless there is some real incentive (or disincentive) in doing that.

What is even the purpose of this law if a.) the Fed is going to keep paying for the low income peoples HC (and they're already subsidized for tons of other sh1t at that point also) and b.) people will just pay a nominal fine rather than shell out for HC insurance?

You sound like your well versed in this, and obviously I'm not, so maybe you can rationally explain that to me. So far I see a lot of nothing as far as people who don't have HI now paying into the system to keep it solvent while it handles Everyone.

Chuck

They obviously don't believe that half the people in the US are stupid.

But sadly they are. If, the healthcare insurance exchanges lower the cost of insurance. Why piss away $1250 a year($50k in income) when you can spend a little more and get insurance. Instead of blowing $1250 on a fine and then in the future having medical problems and getting socked with 10s or 100s of thousands in bills.

Unfortunately, like I said people are stupid and would likely pay the fine and the if something happens be stuck with huge amount of debt and probably eventually bankruptcy. Some may call that smart and gaming the system, but life ain't so rosey in that situation.

 

[Fern]

This ruling seems a real 'head scratcher' to me. And I should think progressives would feel the same way.

Putting aside the merits, or lack thereof, of the policy/Obamacare, several things seem quite strange:

1. Many progressives argued the mandate should be seen as legal under the CC or General Welfare etc, pointing to SS and Medicare programs. But this court rejected that.

2. They finally found a limit to the Commerce Clause? This may have interesting ramifications.

3. A tax on not owning something? As a tax professional I cannot think of any precedent for this. I hope this is discussed in the opinion somewhere.

(Those suggesting it's a tax similar to paying extra because you don't have a mortgage are wrong. If you have a mortgage, yes, you can claim a deduction. But we have that with HI already. HI is a (medical) deduction just like mortgage interest is. So mort interest= HI deduction. Mort int != new penalty.)

4. Roberts says this new tax (penalty) is not a direct tax. At first glance is appears to have every element of a direct tax. But then again, this is the first time we've ever had a tax on not having something. (I've never even seen such a tax any foreign country I've worked it.) If it's not a direct tax, what the hell kind of tax is it?

It's a long opinion, so it's going to take a while to get some good professional analysis.

We may be seeing some extraordinary extra-Constitutional expansion to govt power. Initially the federal government was given very limited taxing power. Indirect taxes were allowed. (One easy way to think of indirect taxes is that they are those someone else pays for you. You do not pay them directly. E.g., federal gas taxes. While the seller may collect them from you, you do not pay. They do. They are responsible for paying them. If they fail to collect them from you, you cannot be forced to pay them.)

Direct taxes must be apportioned. This stems from the days of the Articles of Confederation. The federal govt had even less taxing power back then. Instead the federal govt, when needing to raise revenue/taxes, would make the request directly to states themselves for the money. It was up to each state to raise this, and they were free to do so in whatever way they chose. However, each state could only be asked to give money in proportion to it's population. I.e., if NY had 10 times the population of MA, it would be asked to give 10 times the money. This was so small states were not unduly burdened.

The Constitution STILL requires that direct taxes be apportioned. (Income taxes are a form of direct taxes, that's why we needed a Constitutional amendment to allow it without the requirement for apportionment.)

It seems this court has found a whole new way to tax us, a new taxing power for the federal govt.

Fern

 

[highland145]

I believe it does cover FSA, HSA, and their ilk, all.



Ummm... you don't know what you're talking about. People with a high-deductible plan and a FSA/HSA do cover themselves. The problem is that FSA/HSA contributions are tax-deductible (so long as they are used for qualified medical expenses) and now that deductibility threshold is lower. More and more people are having to use high-deductible plans, and now it just became more expensive to do so. This is, in effect, another tax increase under the ACA...

Mother F-er.

 

[nehalem256]

Maybe not. I'm a conservative in many areas, but I believe that health care should be run by private, non-profit organizations. Crazy, I know...

Why not treat hospitals the same way you treat electric companies?