Court case on if protections for preexisting conditions are unconstitutional: Sept 10, 2018

[yllus]

From Andy Slavitt...

Here is what the Trump side will be arguing to eliminate in the Oral arguments 60 days before the election:

 

[K1052]

I believe that healthcare has consistently polled as the most potent issue for Democrats in the midterms and there is a simple sales pitch (Medicare for All).

So timing on this probably not so good for the GOP.

 

[vi edit]

If there's any tangible middleground for Democrats to extend a branch to Trump's base it's health care. They just need to figure out a way to message it bluntly without being condescending. That's a tight rope to walk.

 

[dainthomas]

If there's any tangible middleground for Democrats to extend a branch to Trump's base it's health care. They just need to figure out a way to message it bluntly without being condescending. That's a tight rope to walk.

76% of people support keeping protections for pre-existing conditions. You'd think just stating the president wants to get rid of those protections would be a potent weapon.

 

[hal2kilo]

76% of people support keeping protections for pre-existing conditions. You'd think just stating the president wants to get rid of those protections would be a potent weapon.

Way to logical of an argument for tribal deplorables.

 

[fskimospy]

This is one of the all-time dumbest lawsuits so it's not surprising which side Trump is on. The fundamental argument is that because the individual mandate was repealed the entire law is invalid due to the doctrine of 'inseverability'. Inseverability generally refers to court rulings where if one integral part of the law that can't be done without with is found unconstitutional then the whole law is done away with.

There's only one problem with saying that the individual mandate can't be severed - that being that Congress and the president literally severed it late last year. Oops! To be clear, this lawsuit was so dumb that even the National Review and the American Enterprise Institute found it too stupid to back.

 

[glenn1]

It should be unconstitutional since there is no insurable interest for an event which has already occurred. If you want the government to subsidize the additional healthcare costs of those with pre-existing conditions that's a perfectly fine policy to advocate for, but doing so by artificially inflating the prices for an "insurance" product for everyone else is a really stupid way of doing it. Hell the entire ridiculous system we have of paying for healthcare in this country is really stupid starting with the decision 70ish years ago to give tax subsidies to employer provided "health insurance" but all the ACA and similar efforts since are making things even worse. We need to scrap the entire nonsense and start over again from scratch. "Medicare for all" is better than what we have (although that's hardly a compliment), but if we were serious we'd do the following:

1. scrap the employer health insurance tax subsidy, replace with a voucher to purchase a catastrophic health insurance policy (i.e. actual health insurance, not the BS we call "insurance" now).
2. greatly expand Health Savings Accounts and use that for routine/expected care and acute events under the limits for the catastrophic policy.
3. taxpayer paid clinics for the poor providing primary care for those where 2 is not practical.

 

[fleshconsumed]

1. scrap the employer health insurance tax subsidy, replace with a voucher to purchase a catastrophic health insurance policy (i.e. actual health insurance, not the BS we call "insurance" now).
2. greatly expand Health Savings Accounts and use that for routine/expected care and acute events under the limits for the catastrophic policy.
3. taxpayer paid clinics for the poor providing primary care for those where 2 is not practical.

So what happens if
1. Someone loses the health lottery and needs lifetime of medications running $1000 per month?
2. Someone really loses the health lottery and gets stuck with cancer and requires lifetime checkups, follow ups, and continued care if it comes back?

How does catastrophic insurance and HSA fill this gap?

 

[fskimospy]

It should be unconstitutional since there is no insurable interest for an event which has already occurred. If you want the government to subsidize the additional healthcare costs of those with pre-existing conditions that's a perfectly fine policy to advocate for, but doing so by artificially inflating the prices for an "insurance" product for everyone else is a really stupid way of doing it.

I'm unaware of the legal precedent where things become unconstitutional because you think they are bad ideas. All of this is certainly within Congress' powers as has been verified by god-knows-how-many courts at this point.

If you would like to advocate for different health policy that's fine but show us how it leads to superior outcomes, don't invent magical constitutional provisions the old way violates.

Hell the entire ridiculous system we have of paying for healthcare in this country is really stupid starting with the decision 70ish years ago to give tax subsidies to employer provided "health insurance" but all the ACA and similar efforts since are making things even worse. We need to scrap the entire nonsense and start over again from scratch. "Medicare for all" is better than what we have (although that's hardly a compliment), but if we were serious we'd do the following:

1. scrap the employer health insurance tax subsidy, replace with a voucher to purchase a catastrophic health insurance policy (i.e. actual health insurance, not the BS we call "insurance" now).
2. greatly expand Health Savings Accounts and use that for routine/expected care and acute events under the limits for the catastrophic policy.
3. taxpayer paid clinics for the poor providing primary care for those where 2 is not practical.

1) This offers no protections for people with pre-existing conditions so that's a non-starter.
2) Having special 'poor person clinics' is a great way to end up with a horrific system that doesn't work. Also a bad idea.

All you're basically advocating here is a return to the old system but with even fewer protections for pre-existing conditions. Americans overwhelmingly want a system with MORE protections for that so anything you think of will have to include that. It's done the world over so it shouldn't be too hard to do here. The first step is to get past the fact that it doesn't matter what we call it. If you want to call it 'health maintenance plan' instead of insurance that's fine as the name is irrelevant.

 

[Fanatical Meat]

Anyone tired of winning yet?

 

[Fanatical Meat]

So what happens if
1. Someone loses the health lottery and needs lifetime of medications running $1000 per month?
2. Someone really loses the health lottery and gets stuck with cancer and requires lifetime checkups, follow ups, and continued care if it comes back?

How does catastrophic insurance and HSA fill this gap?

It doesn’t

 

[glenn1]

It doesn’t

Yeah that's kind of the point. We don't have the policy holders for homeowners insurance pay for the housing costs of the homeless because it's outside the scope of insurance, in this case protecting the value and utility of your home against unexpected events like a lightning strike or fallen tree. Health insurance shouldn't pay for the long term care costs of someone with a pre-existing medical condition for the same reason we don't mandate homeowners insurance holders to pay for a homeless shelter downtown. You're advocating for an entirely different type of benefit which the government would provide. Which is fine for you to do, but really dumb to conflate with what benefits a health insurance system should provide.

I'm unaware of the legal precedent where things become unconstitutional because you think they are bad ideas. All of this is certainly within Congress' powers as has been verified by god-knows-how-many courts at this point.

If ACA isn't a tax (which is the grounds the ACA was upheld on by SCOTUS) and no revenue is being generated by the ACA anymore so it's not a tax by definition, hen the mandate to provide coverage for preconditions would represent a 'taking" under 5A since it's an abridgement of contract rights. A mandate to pay for insurance benefits you can't by definition receive (such as for pre-existing conditions if you don't have one) directly breaks the principle of adequate consideration.

 

[ElFenix]

It should be unconstitutional since there is no insurable interest for an event which has already occurred. If you want the government to subsidize the additional healthcare costs of those with pre-existing conditions that's a perfectly fine policy to advocate for, but doing so by artificially inflating the prices for an "insurance" product for everyone else is a really stupid way of doing it. Hell the entire ridiculous system we have of paying for healthcare in this country is really stupid starting with the decision 70ish years ago to give tax subsidies to employer provided "health insurance" but all the ACA and similar efforts since are making things even worse. We need to scrap the entire nonsense and start over again from scratch. "Medicare for all" is better than what we have (although that's hardly a compliment), but if we were serious we'd do the following:

1. scrap the employer health insurance tax subsidy, replace with a voucher to purchase a catastrophic health insurance policy (i.e. actual health insurance, not the BS we call "insurance" now).
2. greatly expand Health Savings Accounts and use that for routine/expected care and acute events under the limits for the catastrophic policy.
3. taxpayer paid clinics for the poor providing primary care for those where 2 is not practical.

your beef is that this thing that isn't insurance is being called insurance.

 

[Ajay]

Affordable health coverage for all is a moral good and, for advanced nations, is a moral obligation (because we can afford to treat ppl with the dignity and respect that their humanity demands). Denying this via various constructs, at this point in civilization, is to deny our own shared humanity.

 

[senseamp]

I almost want Republicans to live (or die if they lose coverage for lifesaving care) with this. Almost.

 

[Ajay]

From Andy Slavitt...

Here is what the Trump side will be arguing to eliminate in the Oral arguments 60 days before the election:​

Thank you for posting this. Very timely and useful information.

 

[glenn1]

your beef is that this thing that isn't insurance is being called insurance.

You should care also. If your way were to be upheld, then what’s stopping Trump and the GOP Congress from passing a law mandating you to buy insurance that covers future Trump bankruptcies? Or mandating that your car insurance include coverage for your yacht (which you don’t even own) to subsidize the cost of yacht insurance for Bill Gates?

A general principle of evaluating whether an idea or law is a good one is to attempt to use the law to reach its worst possible conclusion. If you don’t like the conclusion that it’s a bad law even if you like the way it could be used to reach a good conclusion.

 

[sactoking]

You continue to argue this on philosophical grounds, trying to assert certain things about health insurance without a fundamental understanding of the basic nature of insurance in general, health insurance specifically, and how they combine with policy decisions to promote the greater welfare of the population.

 

[Ajay]

You should care also. If your way were to be upheld, then what’s stopping Trump and the GOP Congress from passing a law mandating you to buy insurance that covers future Trump bankruptcies? Or mandating that your car insurance include coverage for your yacht (which you don’t even own) to subsidize the cost of yacht insurance for Bill Gates?

There aren't guarantees in a democracy if the electorate makes bad choices.

A general principle of evaluating whether an idea or law is a good one is to attempt to use the law to reach its worst possible conclusion. If you don’t like the conclusion that it’s a bad law even if you like the way it could be used to reach a good conclusion.

That's a fear driven methodology. We need to elect better people, not run in a panic because democracy can be abused.

 

[ElFenix]

You should care also. If your way were to be upheld, then what’s stopping Trump and the GOP Congress from passing a law mandating you to buy insurance that covers future Trump bankruptcies? Or mandating that your car insurance include coverage for your yacht (which you don’t even own) to subsidize the cost of yacht insurance for Bill Gates?

A general principle of evaluating whether an idea or law is a good one is to attempt to use the law to reach its worst possible conclusion. If you don’t like the conclusion that it’s a bad law even if you like the way it could be used to reach a good conclusion.

what's stopping them from passing a tax law that says anyone who makes over $200,000 in unearned income a year pay no taxes whatsoever and in fact gets a big rebate? not a goddamn thing. that doesn't stop us from passing tax laws.


your argument is that because republicans can pass dumb laws if we take things to absurd extremes, then democrats shouldn't pass laws.

 

[Sunburn74]

1. scrap the employer health insurance tax subsidy, replace with a voucher to purchase a catastrophic health insurance policy (i.e. actual health insurance, not the BS we call "insurance" now).
2. greatly expand Health Savings Accounts and use that for routine/expected care and acute events under the limits for the catastrophic policy.
3. taxpayer paid clinics for the poor providing primary care for those where 2 is not practical.

Comical. Absolutely comical. Shows basically zero knowledge of how healthcare is structured or works in this country.

So if you need an elective $100,000 bilateral knee replacements for degenerative issues should I take a shotgun and intentionally blow out my knees so it falls under a catastrophic plan or should I spend my life's saving to get it through a health savings account?

 

[glenn1]

Comical. Absolutely comical. Shows basically zero knowledge of how healthcare is structured or works in this country.

So if you need an elective $100,000 bilateral knee replacements for degenerative issues should I take a shotgun and intentionally blow out my knees so it falls under a catastrophic plan or should I spend my life's saving to get it through a health savings account?

Who gives a damn, if all you really care about is transferring the cost to wealthier healthier people then why care how we do it? If you need a $100k knee replacement just hold hostage a hospital full of nurses and doctors and force them to provide care to you for free. Makes just as much sense as making me pay for insurance coverage for something that I don’t even have an insurable interest in to cover your knee work.

 

[zzyzxroad]

It should be unconstitutional since there is no insurable interest for an event which has already occurred. If you want the government to subsidize the additional healthcare costs of those with pre-existing conditions that's a perfectly fine policy to advocate for, but doing so by artificially inflating the prices for an "insurance" product for everyone else is a really stupid way of doing it. Hell the entire ridiculous system we have of paying for healthcare in this country is really stupid starting with the decision 70ish years ago to give tax subsidies to employer provided "health insurance" but all the ACA and similar efforts since are making things even worse. We need to scrap the entire nonsense and start over again from scratch. "Medicare for all" is better than what we have (although that's hardly a compliment), but if we were serious we'd do the following:

1. scrap the employer health insurance tax subsidy, replace with a voucher to purchase a catastrophic health insurance policy (i.e. actual health insurance, not the BS we call "insurance" now).
2. greatly expand Health Savings Accounts and use that for routine/expected care and acute events under the limits for the catastrophic policy.
3. taxpayer paid clinics for the poor providing primary care for those where 2 is not practical.

Does any of this address the actual issue which is our healthcare and medicine costs are out of control? Isn't preventative care for the masses better overall in reducing both deaths and healthcare cost? Health Savings Accounts are a joke and your plan is going to leave less middle class without employer sponsored plans.

 

[s0me0nesmind1]

It should be unconstitutional since there is no insurable interest for an event which has already occurred. If you want the government to subsidize the additional healthcare costs of those with pre-existing conditions that's a perfectly fine policy to advocate for, but doing so by artificially inflating the prices for an "insurance" product for everyone else is a really stupid way of doing it. Hell the entire ridiculous system we have of paying for healthcare in this country is really stupid starting with the decision 70ish years ago to give tax subsidies to employer provided "health insurance" but all the ACA and similar efforts since are making things even worse. We need to scrap the entire nonsense and start over again from scratch. "Medicare for all" is better than what we have (although that's hardly a compliment), but if we were serious we'd do the following:

1. scrap the employer health insurance tax subsidy, replace with a voucher to purchase a catastrophic health insurance policy (i.e. actual health insurance, not the BS we call "insurance" now).
2. greatly expand Health Savings Accounts and use that for routine/expected care and acute events under the limits for the catastrophic policy.
3. taxpayer paid clinics for the poor providing primary care for those where 2 is not practical.

I have to agree in that you need to stop with the illogical fallacy that this is still called "insurance". It's not. It's subsidizing, plain and simple. Quit the BS phrasing of it.

Though to that - I have to ask you - what would you suggest for pre-existing conditions? For some context - I have epilepsy and require expensive medication on a monthly basis (mostly paid with my employer since I refuse to not work). Nothing that complicated though - is your answer that medicare for all?

 

[glenn1]

Does any of this address the actual issue which is our healthcare and medicine costs are out of control? Isn't preventative care for the masses better overall in reducing both deaths and healthcare cost? Health Savings Accounts are a joke and your plan is going to leave less middle class without employer sponsored plans.

They are out of control because were not willing to do what it takes to make the costs go down. The consumers of the good aren’t directly paying for the cost so they care very little about keeping the prices down. There are entire cottage industries full of making money off of every step of the process like trial attorneys, insurance companies, and politicians. We are unwilling to maintain the distinction between acute care and long-term care which this thread is showing magnificently. Basically everyone is trying to get something for free or reduced cost and trying to pass those cost down to some one further down the line thinking it won’t be them who bears those cost. And there’s a whole segnent of people effectively who are looking for government to be the charity they refuse to be themselves.