Federal Judge Strikes Down Part of Obamacare Law

CRGreathouse

Yeah! And while we're at it, let's make it illegal for used car dealerships to turn down offers below Blue Book value just because of preexisting damage. (MfL, anyone?)

talk2glenn

You're right, its more complicated than I implied, but we are in general agreement.

The point is that the states have general authority, subject to express prohibitions (all powers not granted to the federal government being reserved to the states and to the people). The feds have limited, granted authority. Congress has to show that its actions were permitted by the constitution; the states have to show only that its actions werent prohibited.

mugaliens

Exactly. By the way, I have my eye on a VLJ (very light jet) but I think $3.2 Million is too much, so I'll just take it for $32,000, instead.

Mech_Engineer

You're right, we should just hold them responsible for their actions. If you don't have health insurance, and you get in a car wreck and need $100,000 in medical care to save your life, it's your job to pay for it.

Wait a minute- it should be illegal to force people to buy health insurance, but we should force health insurance companies to let high-risk candidates in, regardless of how much it raises the cost for everyone else? What if someone refuses to buy health insurance until they get cancer or HIV, and then want in? We should have to pay for that?

If by "streamline" you mean "completely screw up," you're right!

Where? Last I checked, hospitals are going out of business left and right due to the emergency room being overrun by people with no money and no insurance using the ER as their primary care physicians, and it costs someone with proper health insurance $500 to get a band-aid in the ER because there were 25 people like him who skipped on their bills.

CRGreathouse

Sigh...

You said this so much better than I did.

jbunniii

While the personal mandate makes sense economically, it did seem like the federal government may be overstepping its bounds. (Not that it doesn't routinely do so on countless other matters! We all have to pay for Medicare, whether or not we ever enroll in the system.)

I say it makes economic sense because the insurers have a valid argument that if they are required to insure anyone regardless of health, then many people will buy insurance only if they become ill.

But there are ways around that which do not require everyone to buy insurance. How about:

1) insurers must offer coverage to anyone who applies, and are not permitted to drop coverage except for serious fraud or nonpayment of premiums;

2) no one is required to have health insurance

however

3) insurers are entitled to charge more (for some period of time) for those who have not maintained continuous coverage starting at some date after the legislation takes effect

This is more or less how auto insurance works, and it would still have been a massive improvement over what we had before, where insurers could and did cherry-pick only the healthiest applicants, and drop them the moment they started costing money.

There will still be some people who buy insurance only when they become ill, and this will drive up costs for everyone, but at least those people who game the system in this way will be forced to pay more from their own pockets.

mheslep

Damn greedy jet makers. Single payer for jets is what we need.

Gokul43201

This is probably an extremely silly question (and it comes without reading the ruling of the Fed Court, so it's also a lazy question): how is forcing someone to buy health insurance any more unconstitutional than forcing them to (for instance) purchase social security through a tax?

Al68

I think the important point is that this will be decided by the Supreme Court. Considering recent rulings, it seems unimaginable that SCOTUS would rule that the power to regulate commerce among the states equals a power to force citizens to buy a product.

Of course, it's just as obvious that, despite their pretenses to the contrary, not a single U.S. judge in the country honestly interprets the commerce clause that way.

Al68

If your experience was representative, there would be no insurance industry. Insurance companies are in business to make money, not lose it. Their margins may only be 2-4%, but that's profit, not loss, which means (insurance premiums) > (hospital bills) + (everything else covered by insurance).

mheslep

Yes that's a point that should be watched. Several Republic politicians have made noises that, after getting the rid of the purchase mandate either through the courts or through legislative repeal, they kind of like all the requirements on insurers. Well that's economic nonsense as well.

Eh, no, auto insurers are not required to cover anyone that applies nor keep them. They routinely drop people for one too many fender benders or tickets. Most states have a high risk liability insurance pool that they run, in conjunction with, if I recall, one or more designated carriers, so that everyone can get the minimal liability insurance required to be on the road. That, is a good model in my opinion health care - high risk pools for the chronically ill wherein the term 'insurance' doesn't make any economic sense.

Al68

Some of us want and need medical insurance, not a comprehensive health care plan that covers things we have no desire to pay for. Covering pre-existing conditions is by definition not insurance.

Making private "insurance only" policies illegal is just as bad as trying to force people to buy comprehensive health care plans.

I have a novel idea: stay out of peoples' private business. If politicians really thought they could offer a better deal for health insurance, they would have no need or reason to pass any law to do it.

talk2glenn

Social Security is treated as a tax and separate expenditure (benefit) under the law, and was upheld by the Supreme Court under the general welfare and tax clauses of the Constitution. It does not consider Congressional power under the commerce clause.

The insurance mandate is, under the statute, a penalty for not not complying with statutory requirements to obtain private health insurance, and it is justified under commerce.

Roosevelt also had Congress change the language of the Social Security statute to make it more like a "tax" and "benefit" than an "insurance". Congress could have written the "penalty" up as a "tax", but that would have brought its own challenges (SS was unsuccesfully challenged on the basis that it was a tax on some people to provide benefits for the other, and therefore didn't satisfy "general welfare" or "equal protection" - same could have happened here). They could also have simply nationalized health care outright (the public "option", as a tax-and-benefit program), which would be apparently legal, but that was a political non-starter.

russ_watters

SS is a government program, paid for by a tax. Health insurance is private and paid for by private fees.

jbunniii

What should be done about people with conditions that preclude them from being insured? If they can't afford care that will manage their condition (e.g. diabetes, high blood pressure, whatever), then it is likely they will end up in a very expensive emergency room situation at some point, effectively on the taxpayers' dime.

There are two ways to reduce this cost: either all laws forbidding emergency rooms from turning away patients should be repealed, and let these people die on the street, or provide them with some sort of coverage that they (1) are entitled to buy and (2) isn't priced so high that they are unable to buy it.

You can do this one of two ways: either by requiring the private sector to cover these people (with government subsidies if necessary); or offer a public option. The latter was dead in the water before it even got started. As a result, we got the rather mediocre Obama plan which no one seems to like very much and which may even be unconstitutional.

Or we kick the can down the road for another 20 years (and say "too bad" to those who need coverage and can't get it), just like we did when Hillarycare failed.

WhoWee

If you want to buy a homeowners policy would you expect the company to take a look at the house - maybe see if you have a gas leak and a few sparking wires - or a roof? Would it be unreasonable for them to charge higher rates if your house was a fire hazard?

I have a specific example of what is going on in the health insurance market presently. Medicare has something called a Guarantee Issue period for Medigap (supplements).

A situation developed recently where a 65 year old woman was losing her Medicare Advantage plan - it was being discontinued. She had several very expensive Part B drugs -cost approx $130,000 per year and used a nebulizer.

Under the 2011 Medicare Advantage plans available, she would be responsible for 20% of the cost of the Part B prescriptions - roughly $26,000. Because her plan did not renew, she had a Guarantee Issue and took a Medigap plan at a cost of about $85 per month that covered 100% of (her share of) the Part B prescription cost.

By contract, the insurance company will collect roughly $1,000 per year in premiums and pay out $26,000 in Part B prescription costs - plus the (20% balance) of all of her Dr. visits, MRI's, CT scans, ambulance rides, plus the Part A co-insurance (hospital) amounts. She will pay nothing else for any of these items as long as she pays her premium.

The insurance company can not drop her, but will have the right to increase the premiums for everyone in her risk pool - but can't single her out.

In this scenario, who is the bad guy? Is it her, the insurance carrier, Medicare, the drug manufacturer, the FDA, the doctor, the insurance carrier that left the area, or is everyone or nobody to blame?

Health care reform was too complicated an issue to be handled in the manner Congress and the President handled it - I hope the Court restores sanity to the lawmaking process.

jbunniii

This is not a very good analogy, as you can move to another house if yours is uninsurable (and you probably knew it was uninsurable when you CHOSE to move there), but you cannot move to another body, and the one you are stuck with may have maladies that you could not have prevented even if you lived a model lifestyle, e.g. inherited conditions.

One could argue that such conditions should be tested for prior to birth, and if found, offer an abortion, but I think many opponents of Obamacare wouldn't like that very much, either!