So is this the last battle for Obamacare, aka ACA?

I was trying to find a way to abbreviate the ACA as CACA but couldn't figure out a word to start it out with at this moment.

The Supreme Court of course made their decision to overlook the verbiage in the monstrously large ACA. I don't believe it has been fully implemented yet. Since it is so good will all of the waivers finally be lifted so we all can bask in the greatness that it is?

The medicare subsidies from the feds for the increased participation will end after this year for all states who decided to implement their own exchange. I see that as a potential budget buster for many states. What do you think about all of this?

 

I would be very interested to hear the opinions of some of the legal experts on the board such as Mr. Deez regarding the majority opinion. It seemed that everyone agreed to what the law stated so I find it troubling if the majority opinion decided to interpret the intent of Congress rather than the letter of the law.

 

It is the last battle if a Republican does not win the presidency. Since that is not a high probability, I say yes. It will only be adjusted over the years to account for its major flaws and will require much higher taxes to pay for in the long run.

 

CACA, aka centralized affordable care act.

 

in law school, we are taught certain long-standing principles that guide interpretation of statutes. Amongst those principles (heavily paraphrased) are:

• The language of the statute is the starting-place for the analysis, and should not be disregarded lightly
• Provisions are not read in isolation, but rather in the context of the entire statute
• Language should not be interpreted in a way that will yield an absurd result
• The ultimate goal of interpreting a statute is to honor Congress's intentions

When reviewing a statute, courts first look at the "four corners" of the statute (the entire statute, not just the single phrase). If the meaning is found to be clear, based on the principles of interpretation, the court will apply that meaning. If the statute is found to be ambiguous, then the court will turn to secondary sources to determine Congressional intent.

If the single phrase at issue is viewed with blinders, in isolation from the rest of the statute, it seems to clearly say one thing. But when viewed under the applicable rules of interpretation, it seems clear that Congress intended something different. Justice Roberts's opinion does a good job of articulating the reasons for this.

When someone tries to interpret a statute in a way that will fundamentally undercut Congress's intent -- and especially when that is the goal -- the challenge should fail. That's just not the way statutes are read.

 

At minimum it should be allowed for insurance companies to compete across state lines. This should be changed no matter what happens in my opinion.

 

The Affordable Care Act is here to stay.....fighting it is now useless endeavor. But just like Medicare, Social Security, etc., things will be tweaked in years to come. But the days of the US not having health care for all is over.

 

The "selling across state lines" argument is a politically tested catch phrase that is , truly, mostly crap. There was never a national prohibition against selling health insurance "across state lines." Insurers are allowed as a matter of state law to sell policies only in states where they are licensed to do business. Most insurers obtain licenses in multiple states and have long sold policies "across state lines," but they write different policies meeting each subject state's requirements. States have different laws regulating benefits, consumer protections and financial and solvency requirements. States could have opted to set up compacts for health insurance, or done away with their state insurance commissions, but they did not. S
States could have deregulated, and permitted insurance to be sold "across state lines" in their states whenever they wanted to, but their legislators, who prattle on about "selling across state lines" never did so. They didn't because they believed that they have a duty to protect consumers from worthless products - for example, under-capitalized, under-reserved companies selling policies that they could not pay on, pocketing the profits, and then closing their doors. Regulation, reserve requirements, and minimum benefit requirements are the only thing that prevents unscrupulous business men from doing just that.

Are you proposing that the federal government take over this responsibility and dictate these matters to permit "selling across state lines?" A lot of liberals want that to change: It makes more sense, they say, for insurance to be regulated by the federal government. That way the product is standard across all the states.This would truly be a federal takeover.

Ezra Klein has written a lot about this, and I'm borrowing his points, heavily. He points out that Conservatives want the opposite: They want insurers to be able to cluster in one state, follow that state's regulations and sell the product to everyone in the country. In practice, that means we will have a single national insurance standard. But that standard will be decided by South Dakota. Or, if South Dakota doesn't give the insurers the freedom they want, it'll be decided by Wyoming. Or whoever.

He points out that this is exactly what happened in the credit card industry, which is regulated in accordance with conservative wishes. "In 1980, Bill Janklow, the governor of South Dakota, made a deal with Citibank: If Citibank would move its credit card business to South Dakota, the governor would literally let Citibank write South Dakota's credit card regulations." http://www.pbs.org/wgbh/pages/frontline/shows/credit/more/rise.html

"Citibank wrote an absurdly pro-credit card law, the legislature passed it, and soon all the credit card companies were heading to South Dakota, and 28% interest rates. And that's exactly what would happen with health-care insurance. The industry would put its money into buying the legislature of a small, conservative, economically depressed state. The deal would be simple: Let us write the regulations and we'll bring thousands of jobs and lots of tax dollars to you. Someone will take it. The result will be an uncommonly tiny legislature in an uncommonly small state that answers to an uncommonly conservative electorate that will decide what insurance will look like for the rest of the nation. In fact, they could deregulate insurance entirely, and an "across state lines" law would mean that Texas, for instance, could not prohibit these unregulated insurance companies from marketing insurance in Texas."

Insurance cannot operate without heavy, reasonable government regulation. Without reasonable regulation, insurers would cherry pick who they wish to insure, and destroy the very risk spreading mechanism that is the basis of an insurance system. The "across state lines" argument is a political ploy designed to appeal to shallow, laissez faire thinking. It is superficially appealing, I admit.. If it were a real political/economic solution, however, the states would have done it long ago. "Consumer choice" is illusory in a field as complex as insurance. That is why even the most conservative state legislatures knew better than to leave insurance to the market.

Damn, I intended to address Burwell, and got side tracked by Zork's "across state lines" argument. Later then.

 

towersniper,

Thanks for the writing. I respect the Supreme Court even if I don't always agree. The way this subject is turning is not what I thought it would be. The Boehners aren't doing anything except being coopted by the POTUS in my limited mind. Or maybe they have run the numbers to let the thing stand and then run against it in '16?



If you own a car and the state mandates you buy insurance that is one thing since you have a choice not to drive. But it seems different than the way this is going, especially with the subsidy system blowing up rates by overcharging the people who have means to pay for everyone else(who get the subsidies).

If it is such a great program then there should be fewer loopholes or exemptions for companies like McDonalds or whomever else is getting the exemptions while the individuals with means take it in the shorts .

It seems downright un-American. But maybe America is changing? Doesn't seem like positive change for me but I try and use family funds to pay for family needs or go without.

We'll see how it turns out as time goes on.

Still, I think it is: CACA, aka centralized affordable care act.

 

Most all "loopholes" were demands by the Republicans when the initial law was written. If the Republicans run against The Affordable Care Act and/or against Gay Marriage, it will be another loss for the Republican Party. National health care, as well as gay marriage, is here to stay......forever.
Some changes will be made in the Affordable Care Act, as changes were made in Medicare and Social Security, but it's never going away.
Unlike choosing not to drive a car, you can't choose when/if you'll become ill. Nor can you just choose insurance of any type "after the fact."
Like it or not, philosophically, the Affordable Care Act is never going away.

 

Literally now you can with CACA.

 

For the last time, ACA is insurance premium redistribution, not healthcare.

 

I still don't have health insurance, and specifically because I cannot afford it. Do I not count in the notion of "health care for all", which was more correctly defined as premium redistribution in the post above?

 

That is an outstanding discussion. I figured that the GOP would write national standards and then preempt the state laws and rules governing insurance. However, it would be easier to get a pro-insurance model by following what you've described. The carriers could simply move to a state whose politicians and judges have the insurance industry's balls firmly entrenched in their mouths and then impose that nationally. Hey, how about Texas?

 

ACA, or CACA depending on your opinion, greatly benefits two factions, the insurance lobby and the hospitals, no one else in the medical industry. Since they are the most powerful $ wise, those who say it is never going away are correct.
Those who do not gain from this act are the physicians, technicians, and nurses ( some would argue to include the patient but that is a completely separate discussion). The strongest, defined in the good ole US of A as those with most $ to flaunt, define policy and always win. ACA is no exception.

 

I'm not sure why you choose to say that the patients are a "separate discussion". There isn't any debate that the underinsured benefited from this. Whether we the tax payers are getting good value or not is certainly debatable but some of the patients most in need certainly made out like bandits.

 

I agree, but would qualify it to say some hospitals benefit, especially for-profit facilities. Rural county hospitals are having a very hard time surviving and many have closed.

 

Exactly why I said separate discussion Seattle. There is admitted positive for patients ie no denial, newly insured, etc. but it comes with caveats. There will be more cost, either the higher deductibles or higher monthly premiums, all in my option a different discussion from my assertion of whom is the benefactor at large for the law itself.
Theo you are correct, but the demise of the small community hospital began before the ACA. It only exacerbated the situation brought on by CMS way before ACA. The rural hospital exists only to support those big enough and smart enough to conscript them into a feeder role. But while contend the hospital stands to gain by ACA I do not mean to pretend it is inclusive. Competition for the $ rewards will eliminate the timid. Example is Memorial in Houston, they have stretched themselves to positions everywhere. They read the tea leaves early, very early and are positioning themselves into a dominate posture.

 

Now I totally agree.

 

Wait a second,(not to just Nebraskans) more to come:

Who pays what and how it all ends up affecting the budgets is still to be determined. It gets beyond the nice, cushy, theory of the ideal vs the realities of life. Why don't we provide the CACA for the world instead of just people living in the USA?(we were told in the beginning that undocumented people living in the USA weren't going to be eligible)

http://www.cnbc.com/id/102791870


Then there is this matter about the pools of people who are and, more key, who aren't participating in CACA:

We are just beginning to see what the true costs are and what they will be is far from certain. But, but, Iraq Trillions, Kerry/Obama vacations and world travel, we can afford it if we can afford that.

 

Perhaps Texas will come to its senses and accept the Medicaid plans set forth with the Affordable Care Act to help cover almost all costs of health insurance for those who cannot afford health care even with the new federal government incentives. Sadly, the state of Texas has made a conscious decision to refuse the Medicaid plan which would insure, quite literally, millions more Texans.

Hopefully, now that the Supreme Court has ruled in favor of the Affordable Care Act, once again, state leaders, who have refused to accept the fact that national health care is here to stay, will start accepting the federal government's Medicaid plan for each individual state. That way, you would have insurance paid for by the federal government. I hope, for your sake, that will help you become covered with health insurance. It would, literally, be cost-free to you. Sooner rather than later, the states who've refused help will have to move in that direction.

 

I would not qualify for medicaid. The government in its (highly questionable) wisdom says our household income is too high for me to qualify. And indeed, it is. Nevertheless, with three kids and the costs of running said household, if I was to take on several hundred more dollars per month in expenses to pay for a policy for myself (the rest of the family is covered), our budget would tip to the red.

I have chosen to go without insurance because I am very healthy, and I will not piss away the modest amount of savings we are able to set aside to purchase a worthless health insurance policy for myself. Am I rolling the dice? You bet your *** I am. And it is my life, and my right to do so, no matter what the federal government and those idiots in the majority on the supreme court have to say about it.

 

So if Texas accepts, how do they pay future bills when the government stops funding it?

 

56?

I did not know this, "Most all "loopholes" were demands by the Republicans when the initial law was written."

which loopholes were demanded by Pubs as law was written? Who among the Pubs demanded loopholes be written into law?

 

We've had this discussion before. I think your stance works in a society that is willing to say "you made your own bed now lie in it" and walk away from people that made the choice not to get health insurance when disaster strikes. Of course, we already know that our society doesn't accept that. So, you've made your choice knowing that should you need medical help there are government funded solutions to help you. Right now, the healthy you may say "I'll refuse help" but in a life/death situation do you think your wife and children will accept that choice? You may try to pay all your savings to help your situation but what happens when/if you face financial ruin? Will you then put your hand out? Our emergency rooms are full of people that don't have insurance.

 

glad to hear you have a solution and your problems are solved. I know what you mean about "those idiots in the majority" (5 Republicans) on the Supreme Court.

 

That's ********. I'm not a GOP apologist by any means, but the Democrats wrote the law by themselves and passed it entirely with Democratic votes. They own the law good and bad 100 percent. The loopholes and compromises that were made happened because of insurance and business-friendly Democrats. The liberal Democrats didn't have the votes all by themselves. That's why the public option was dropped as well.

 

CACA happens, unless you are in a union and get a waiver.

 

Or a member of Congress