Federal Judge Strikes Down Part of Obamacare Law

[Gokul43201]

P&WA is a free-for-all for unsupported claims.

That's obvious.

Yay, you both agree! Let's call that a good resolution and move on.

 

[turbo]

No, you didn't in the post I responded to. You claimed that they would be "surprised" that insurance companies favored the mandate.

Self-described "conservatives" have absolutely no idea what is being done in DC. Tea-baggers, even less. The insurance companies needed to kill the public option at any cost, because it would have lowered costs for all of us - a fact that Olympia Snowe was not well-prepared enough to discuss in her AP interview.

Next, watch the fake "shock and darn" on the right when the health-care industries jump in with amicus briefs during the the appeals process.

I am pretty sick of the sniping and spinning on this thread, so unless you have something substantive to add, good-bye.

 

[Al68]

Next, watch the fake "shock and darn" on the right when the health-care industries jump in with amicus briefs during the the appeals process.

Still making no sense. Their http://www.ahip.org/" has advocated the mandate for years, and that's been public knowledge for years. Why would Conservatives be shocked that insurance companies will advocate the same thing they advocated all along, and that you advocate?

I am pretty sick of the sniping and spinning on this thread, so unless you have something substantive to add, good-bye.

LOL.

 

[WhoWee]

I pointed out that conservatives wanted to mandate minimum coverage years ago. The difference now is that "conservative" media and their mouthpieces are trying to paint Obama with that mandate, when it was their stalking horse Olympia Snowe that killed the public option in the draft coming out of the Finance Committee and made some kind of compulsion mandatory. Is everybody tone-deaf?

Please go back to the "conservative" health-care plans of the 1990s and 2000s and show us how the GOP would have lowered health-care costs and have never invoked mandated coverage. You can't.

P&WA is a free-for-all for unsupported claims. Perhaps we can get some more stringent standards here, though, it might be too much for Evo to deal with.

BTW: It was a common rally-cry among the GOP to call mandated coverage "personal responsibility" back then. How do you force a single mother with two children, who is working a part-time job at WalMart with no benefits to buy health-care when she needs food-assistance, fuel-assistance, and other public support to keep her little family alive (not just out of poverty).

Careful what you wish for my friend, the last time you went down this path, you lost the ability to use the term Neo-con.

 

[WhoWee]

Self-described "conservatives" have absolutely no idea what is being done in DC. Tea-baggers, even less.

Are you referring to Harry Reids behind the scene maneuvers to lock-in funding for healthcare reform in the lame duck session?

 

[mheslep]

[...]

Since you bring up Paul Ryan, I'm curious whether you find his proposal to auto-enroll the uninsured into private plans inside state-based health insurance exchanges so much less intrusive? Granted, there's no penalty for opting out but surely the government automatically placing you into a private insurance plan (based on behavioral economic research that shows inertia will tend to keep many people in the default plan setting, since many won't bother with the effort of un-enrolling) sets off a similar set of philosophical warning bells.

First, as you acknowledge and as http://www.roadmap.republicans.budget.house.gov/plan/#Healthsecurity" simply declares:

If individuals do not want health insurance, they will not be forced to have it.

Second, Ryan's exchanges are state based, not federal, so sign up would be at the state level which does not offend the US constitution if it was mandatory; it is the federal power grab that is topic of moment. Finally, Ryan suggests insurance enrollment would be done at, e.g., "places of employment, emergency rooms, the Division of Motor Vehicles", which implies the option is put in front of you at the time as an option; a blind auto enrollment could be done by simply processing the tax rolls or SSN lists.

So no, auto enrollment as described by Ryan doesn't bother me, though it warrants watching for abuse (unreasonable notice so people are defacto forced into purchasing insurance) by those trying to morph it into a back door mandatory enrollment.

 

[mheslep]

The precursor to the 1994 Consumer Choice Health Security Act was the nearly identical 1993 Republican counter-proposal to Clinton's Universal Healthcare plan. The 1993 bill also contained the individual mandate, the no denial for pre-existing conditions clause, as well as nearly every other major aspect of the Obama healthcare bill.

I disagree, not that I want to spend time defending Sen John Chafee (no conservative). Some of the differences are hugely important: malpractice reform, equalization of tax treatment especially as that would tend to do away with the employer provided disaster.

 

[Gokul43201]

I disagree, ...

With what specifically? That the characterization of the 1993 bill as having previously proposed "nearly every" major aspect of the 2009 bill is inaccurate? If so, how would you characterize the extent of similarity or dissimilarity of the two bills? Separately, as this was a sticking point earlier in the thread, do you deny that the individual mandate is not a new idea proposed by the Dems in office now?

... not that I want to spend time defending Sen John Chafee (no conservative).

Co-sponsors:

Sen Bennett, Robert F. [UT] - 11/22/1993
Sen Bond, Christopher S. [MO] - 11/22/1993
Sen Boren, David L. [OK] - 5/17/1994
Sen Cohen, William S. [ME] - 11/22/1993
Sen Danforth, John C. [MO] - 11/22/1993
Sen Dole, Robert J. [KS] - 11/22/1993
Sen Domenici, Pete V. [NM] - 11/22/1993
Sen Durenberger, Dave [MN] - 11/22/1993
Sen Faircloth, Lauch [NC] - 11/22/1993
Sen Gorton, Slade [WA] - 11/22/1993
Sen Grassley, Chuck [IA] - 11/22/1993
Sen Hatch, Orrin G. [UT] - 11/22/1993
Sen Hatfield, Mark O. [OR] - 11/22/1993
Sen Kassebaum, Nancy Landon [KS] - 11/22/1993
Sen Kerrey, J. Robert [NE] - 5/17/1994
Sen Lugar, Richard G. [IN] - 11/22/1993
Sen Simpson, Alan K. [WY] - 11/22/1993
Sen Specter, Arlen [PA] - 11/22/1993
Sen Stevens, Ted [AK] - 11/22/1993
Sen Warner, John [VA] - 11/22/1993

I think I recognize a conservative or two in that list.

 

[mheslep]

Co-sponsors:
...
I think I recognize a conservative or two in that list.

Most them decidedly not - Specter, Stevens, Kerrey, Bond, Bennet, ...

Yes I saw the cosponsors and scanned the bill. Cosponsors are also free to amend the thing later, the act of cosponsoring meaning one agrees with most of the bill. Heck, in another reality Sen mheslep might have co-sponored the thing in 1993 as an alternative to HillaryCare, with an open intent to slash the mandate out later, along with modifying the no pre-existing requirement into high risk pools.

 

[mheslep]

With what specifically? That the characterization of the 1993 bill as having previously proposed "nearly every" major aspect of the 2009 bill is inaccurate?

Yes, inaccurate. I don't see all the items in Kaiser's list as major, certainly not equal in importance.

If so, how would you characterize the extent of similarity or dissimilarity of the two bills?

Yes, and I listed some of them in my graphic, emphasizing their importance. Again: malpractice and the employer based system are the two largest cost problems with US health care in my view. The modern bill and the 1993 Chafee bill differ in that regard.

Separately, as this was a sticking point earlier in the thread, do you deny that the individual mandate is not a new idea proposed by the Dems in office now?

I didn't say it was. I said, and still say:

The support by the odd Republican like Richard "wage and price controls" Nixon does not make a federal insurance purchase mandate a "conservative cause".

 

[mheslep]

Legal objections to the mandate aside, here are the political and philosophical objections which I hold, well said by another.First, a common proponent argument, the first part of which in particular I find an anathema, especially from clever twenty somethings:

First, Obama aside, mandates matter because, sometimes, folks have to be protected from their worst instincts. That's why we force everyone to pay into fire departments through taxes. Otherwise, some folks would opt out under the theory that they don't do much cooking, and we don't want their houses to burn down

and in response:

But this is not true. We force everyone to pay into fire departments because fires have very bad negative externalities: if your house catches on fire, unless you live on a rural farm, there's a good chance that your neighbor's house will burn down too. Fire prevention is a genuine public good; most health care, with the exception of things meant to stop the spread of infectious disease, simply isn't.

One can make a modestly compelling moral hazard argument for a mandate--people will be tempted to free ride on the rest of us, knowing that we won't deny them health care in extremis, so the only thing to do is make them pay up front. But I'm persistently disturbed by the notion that most of our fellow citizens are intellectual children who need to be forced to do what is good for them even at massive cost to their liberty, and ours.

http://www.theatlantic.com/business/archive/2008/03/protect-them-from-themselves/2906/

 

[turbo]

A little history - The GOP previously wanted to mandate health insurance coverage. It was not an idea favored by the Dems.

During the writing of the present bill, Baucus and the Dems on the Finance Committee rejected such a mandate and incorporated a public option as a way to achieve savings and cut premiums. The problem was that their draft was supported by NO Republicans. Olympia Snowe agreed to lend her vote to get the draft out of committee, but ONLY if the public option was dropped. The insurance companies hated that idea and she got it rejected, so we ended up with a mandate instead. Baucus didn't want to bring the bill out of committee that way, but it was the only way he could get anything out of committee.

When an AP reporter asked Snowe if she rejected the public option because she thought it would cost too much (as Lieberman had claimed), she said no, she was blocking it because it would be too cost-effective and would drive private insurers out of the market.

Now that the mandate has been ruled unconstitutional by a single Federal judge, we have right-wing pundits claiming that the Democrats were responsible for championing the mandate at the behest of the insurance companies. That is 180 degrees wrong. It's what they had to settle for to get a single GOP senator to support the draft bill. When I pointed out that the insurance companies and hospitals would likely file amicus briefs in support of the mandate during the appeals process, right-wing apologists said that of course they would because the Democrats were in the pocket of the insurance companies (paraphrasing). This is absolutely wrong, as it was a single GOP senator that killed the public option for the benefit of the insurance companies.

This dishonest revisionism is happening all over the country in right-wing circles, prompting wake-up articles like this one in the Miami Herald.

http://www.miamiherald.com/2010/03/23/1544321/individual-health-insurance-mandate.html

If people believe the right-wing spin, the GOP will have a big stick to beat the Dems with come 2012. The mandate should never have been included in the bill, and it wasn't by any means the choice of the Dems. By forcing reconciliation, the GOP managed to lock the Dems into a bill crippled with a mandate instead of a public option. People ought to be told this, though the media is loathe to deal with lengthy, if uncomplicated, history lessons to set partisan stories straight.

 

[WhoWee]

A little history - The GOP previously wanted to mandate health insurance coverage. It was not an idea favored by the Dems.

During the writing of the present bill, Baucus and the Dems on the Finance Committee rejected such a mandate and incorporated a public option as a way to achieve savings and cut premiums. The problem was that their draft was supported by NO Republicans. Olympia Snowe agreed to lend her vote to get the draft out of committee, but ONLY if the public option was dropped. The insurance companies hated that idea and she got it rejected, so we ended up with a mandate instead. Baucus didn't want to bring the bill out of committee that way, but it was the only way he could get anything out of committee.

When an AP reporter asked Snowe if she rejected the public option because she thought it would cost too much (as Lieberman had claimed), she said no, she was blocking it because it would be too cost-effective and would drive private insurers out of the market.

Now that the mandate has been ruled unconstitutional by a single Federal judge, we have right-wing pundits claiming that the Democrats were responsible for championing the mandate at the behest of the insurance companies. That is 180 degrees wrong. It's what they had to settle for to get a single GOP senator to support the draft bill. When I pointed out that the insurance companies and hospitals would likely file amicus briefs in support of the mandate during the appeals process, right-wing apologists said that of course they would because the Democrats were in the pocket of the insurance companies (paraphrasing). This is absolutely wrong, as it was a single GOP senator that killed the public option for the benefit of the insurance companies.

This dishonest revisionism is happening all over the country in right-wing circles, prompting wake-up articles like this one in the Miami Herald.

http://www.miamiherald.com/2010/03/23/1544321/individual-health-insurance-mandate.html

If people believe the right-wing spin, the GOP will have a big stick to beat the Dems with come 2012. The mandate should never have been included in the bill, and it wasn't by any means the choice of the Dems. By forcing reconciliation, the GOP managed to lock the Dems into a bill crippled with a mandate instead of a public option. People ought to be told this, though the media is loathe to deal with lengthy, if uncomplicated, history lessons to set partisan stories straight.

Turbo, it's not clear that this is your OPINION.

Please clarify by placing an opinion label on your post or providing links (please) - lot's and lot's of links.

 

[mheslep]

A little history -

Not in that post. Nice, entertaining short story maybe. The public option died in a Senate Committee vote on Sept 29, 2009 with the Dems holding a 60 seat filabuster proof majority in the Senate, and the committee vote included some D. no's. It never had a serious chance again, despite some December hand waiving by Reid. Sen Brown took office in Feb 2010
http://www.nytimes.com/2009/09/30/health/policy/30health.html?_r=1

 

[turbo]

Turbo, it's not clear that this is your OPINION.

Please clarify by placing an opinion label on your post or providing links (please) - lot's and lot's of links.

We have been all through this ad-nauseum. The construction of the bill in the Finance Committee, Snowe's role in removing the public option, and the ruling that the mandate was unconstitutional. And you were in the various threads all along. Why don't you take it upon yourself to tell me what you think is opinion and not fact, and I'll gladly provide you with lots and lots of links. And don't say "the whole thing", because you know better than that.

 

[Gokul43201]

Most them decidedly not - Specter, Stevens, Kerrey, Bond, Bennet, ...

That's five out of twenty. Here's five conservatives from the list: Dole, Domenici, Grassley, Simpson, Hatch. I've left out Lugar and Warner, since I consider them moderates. Most of the rest, I don't know - I suspect few of them are still in office today.

Yes I saw the cosponsors and scanned the bill. Cosponsors are also free to amend the thing later, the act of cosponsoring meaning one agrees with most of the bill. Heck, in another reality Sen mheslep might have co-sponored the thing in 1993 as an alternative to HillaryCare, with an open intent to slash the mandate out later, along with modifying the no pre-existing requirement into high risk pools.

Point taken. However, given 20 co-sponsors - and 24 co-sponsors in the 1994 version of the bill - I think it's a stretch to imagine they all wanted to do that.

Yes, inaccurate. I don't see all the items in Kaiser's list as major, certainly not equal in importance.

I didn't say they were, nor does my statement require them to be. However, I would say that the individual mandate and the pre-existing condition clause were major aspects of the debate in the present healthcare kerfuffle. Also quite important, in that it generated a lot of emotional opposition to the bill, was the issue about end-of-life counseling (aka "death panels", "pulling the plug on grandma", etc.), which is an idea copied from the 2003 Prescription Drug Bill (citation upon request).

Yes, and I listed some of them in my graphic, emphasizing their importance.

Not sure I understand how this answers the question it is written in response to. Moving on ...

Again: malpractice and the employer based system are the two largest cost problems with US health care in my view.

I imagine this ought to be a matter of reasonably verifiable fact (given the amount of discussion and analysis this issue has garnered over the last decade or so), rather than opinion. I've only ever heard of some debate regarding the cost savings from tort reform, and the biggest number I've seen is the roughly $5B/yr estimate from the CBO - a drop in the bucket compared to the $2T/yr total healthcare cost. I think I recall an article in the Times that estimated a negative number, but I won't even bother to dig that up, for obvious reasons.

 

[mheslep]

That's five out of twenty. Here's five conservatives from the list: Dole, Domenici, Grassley, Simpson, Hatch. I've left out Lugar and Warner, since I consider them moderates. Most of the rest, I don't know - I suspect few of them are still in office today.
Point taken. However, given 20 co-sponsors - and 24 co-sponsors in the 1994 version of the bill - I think it's a stretch to imagine they all wanted to do that.

I don't. I expect, from what I know of co-sponsors, that they all very likely had some disagreement with the bill.

I didn't say they were, nor does my statement require them to be. However, I would say that the individual mandate and the pre-existing condition clause were major aspects of the debate in the present healthcare kerfuffle. Also quite important, in that it generated a lot of emotional opposition to the bill, was the issue about end-of-life counseling (aka "death panels", "pulling the plug on grandma", etc.), which is an idea copied from the 2003 Prescription Drug Bill.
Not sure I understand how this answers the question it is written in response to. Moving on ...

Two discuss a comparison of the two bills, we need some agreement with what constitutes "major". Yes the mandate was one major issue of agreement. In no way do the two agree in "nearly all" major points, by my definition of what's important.

I imagine this ought to be a matter of reasonably verifiable fact (given the amount of discussion and analysis this issue has garnered over the last decade or so), rather than opinion.

No its quite difficult, because most of the cost is locked up in defensive medicine practice, loss of physicians to disgust with fees, all subjective. The actual payouts are trivial in comparison.

 

[WhoWee]

We have been all through this ad-nauseum. The construction of the bill in the Finance Committee, Snowe's role in removing the public option, and the ruling that the mandate was unconstitutional. And you were in the various threads all along. Why don't you take it upon yourself to tell me what you think is opinion and not fact, and I'll gladly provide you with lots and lots of links. And don't say "the whole thing", because you know better than that.

I bolded your first sentence because I'm not sure you've supported ANY of your posts on the subject - repeating unsupported posts, regardless of how many times, does not make it accurate or factual. With that said, let's take at look at how you opened the post - followed by how you closed it.


"A little history - The GOP previously wanted to mandate health insurance coverage. It was not an idea favored by the Dems."" support for this specifically - and THIS PARTICULAR MANDATE please - not some other language.

""During the writing of the present bill, Baucus and the Dems on the Finance Committee rejected such a mandate and incorporated a public option as a way to achieve savings and cut premiums. The problem was that their draft was supported by NO Republicans."How do we verify any of this including the cost saving guarantees of a public option?

"The mandate should never have been included in the bill, and it wasn't by any means the choice of the Dems. By forcing reconciliation, the GOP managed to lock the Dems into a bill crippled with a mandate instead of a public option." This sounds like opinion to me.


It looks to me that you've presented an idea that Republicans used a mandate to prevent Democrats from pushing through the "public option" - that is Government single payer health care - is this correct?

 

[turbo]

I bolded your first sentence because I'm not sure you've supported ANY of your posts on the subject - repeating unsupported posts, regardless of how many times, does not make it accurate or factual. With that said, let's take at look at how you opened the post - followed by how you closed it.


"A little history - The GOP previously wanted to mandate health insurance coverage. It was not an idea favored by the Dems."" support for this specifically - and THIS PARTICULAR MANDATE please - not some other language.

This has been demonstrated and supported by links to previous GOP health-care plans in this very thread. The GOP didn't call it a mandate, but "personal responsibility".

"During the writing of the present bill, Baucus and the Dems on the Finance Committee rejected such a mandate and incorporated a public option as a way to achieve savings and cut premiums. The problem was that their draft was supported by NO Republicans."

How do we verify any of this including the cost saving guarantees of a public option?

We cannot verify any guarantee of cost-savings, of course, but that was Snowe's stated reason for opposing the public option.

"The mandate should never have been included in the bill, and it wasn't by any means the choice of the Dems. By forcing reconciliation, the GOP managed to lock the Dems into a bill crippled with a mandate instead of a public option." This sounds like opinion to me.

If you want to call this opinion, fine. Go for it. The GOP made it clear that they would filibuster any up-or-down vote in the Senate, so the only way that the health care bill could be enacted was if the Senate version was reconciled with the House version which contained a public option (which had to be removed, of course). What was left was essentially a combined version which was crippled by the mandate, which was the only way that Snowe would allow the Senate bill out of the committee.

It looks to me that you've presented an idea that Republicans used a mandate to prevent Democrats from pushing through the "public option" - that is Government single payer health care - is this correct?

The GOP has been proposing mandated coverage for over a decade. That would add more customers to the insurers' pool, and the insurance companies were all for it. A public option would have undercut the insurance companies. Health care reform without expanded coverage would not have saved us money (IMO) because we would still have a huge pool of uninsured people driving up the costs of health-care by tying up ERs, thus a mandate of some sort (which the GOP and the insurance companies want) was necessary to get the expanded coverage in lieu of a public option.

The GOP used their filibuster powers to prevent the Senate from voting on a bill that might have included the public option (House version), so that reconciliation was the only option. That doomed the public option. I don't think that was an unintended consequence, do you?

 

[WhoWee]

This has been demonstrated and supported by links to previous GOP health-care plans in this very thread. The GOP didn't call it a mandate, but "personal responsibility".

We cannot verify any guarantee of cost-savings, of course, but that was Snowe's stated reason for opposing the public option.

If you want to call this opinion, fine. Go for it. The GOP made it clear that they would filibuster any up-or-down vote in the Senate, so the only way that the health care bill could be enacted was if the Senate version was reconciled with the House version which contained a public option (which had to be removed, of course). What was left was essentially a combined version which was crippled by the mandate, which was the only way that Snowe would allow the Senate bill out of the committee.

The GOP has been proposing mandated coverage for over a decade. That would add more customers to the insurers' pool, and the insurance companies were all for it. A public option would have undercut the insurance companies. Health care reform without expanded coverage would not have saved us money (IMO) because we would still have a huge pool of uninsured people driving up the costs of health-care by tying up ERs, thus a mandate of some sort (which the GOP and the insurance companies want) was necessary to get the expanded coverage in lieu of a public option.

The GOP used their filibuster powers to prevent the Senate from voting on a bill that might have included the public option (House version), so that reconciliation was the only option. That doomed the public option. I don't think that was an unintended consequence, do you?

I think the basic formula of CRAP(in) = CRAP(out) is true for any legislation in excess of about 100 pages.

As for the "mandate", it seems we agree the particulars vary. The "personal responsibility" Republicans speak of is not the specific "mandate" found in the Bill - is it?

As for saving money with ANY plan that expands coverage - just not realistic.

 

[Al68]

Now that the mandate has been ruled unconstitutional by a single Federal judge, we have right-wing pundits claiming that the Democrats were responsible for championing the mandate at the behest of the insurance companies. That is 180 degrees wrong. It's what they had to settle for to get a single GOP senator to support the draft bill. When I pointed out that the insurance companies and hospitals would likely file amicus briefs in support of the mandate during the appeals process, right-wing apologists said that of course they would because the Democrats were in the pocket of the insurance companies (paraphrasing).

Your "paraphrasing" is fraudulent, assuming you were referring to me as a "right-wing apologist", but nobody else said any such thing, either. I never suggested that Democrats were "in the pocket of the insurance companies". I said that insurance companies advocated the mandate passed by Democrats, and being fought for now in the courts by Obama. I never made any assertion about the motives of Democrats.

Attacking the motives of those who disagree is not an argument, it's a logically fallacious act of desperation and a de facto acknowledgment of an inability to make a legitimate logical argument.

And you continue to dodge my the actual point of my response to your claim. Which was "why would conservatives be surprised" at what you "pointed out", but has been obvious and well known to everyone for years?

Is "right-wing apologist" a political slur? It's certainly insulting and derogatory, not to mention completely fraudulent.

This dishonest revisionism is happening all over the country in right-wing circles...

LOL.

 

[mheslep]

Processing tax forms is an acceptable auto-enrollment mechanism under his bill ("Such mechanisms shall include automatic enrollment through various venues, which may include emergency rooms, the submission of State tax forms, places of employment in the State, and State departments of motor vehicles.").

I said blind auto enrollment, which I don't favor, could be done by tax rolls, that which is already on the books, requiring no input from the citizen. All of Ryan's examples, tax forms, going to the DMV, etc, coincide with some active acknowledgment from the citizen. Whatever form of signing up is chosen, as long as it holds with his declaration:

If individuals do not want health insurance, they will not be forced to have it.

I'm fine with it, as that is surely not what we have with the ACA.

 

[mheslep]

...Second, Ryan's exchanges are state based, not federal, so sign up would be at the state level which does not offend the US constitution if it was mandatory;

The ACA's exchanges are state-based.

The ACA has a central, singular, federal exchange, called the "Health Insurance Exchange" ( Sec 301). Also, the ACA says it will allow "State-based Health Insurance Exchanges" (Sec 308), largely at the discretion of "The Commissioner", that must behave similarly to the federal exchange. Furthermore "The Commissioner" may terminate the state's operation of the exchange and take it over (308.c.2). By contrast, Ryan's plan proposes no federal health exchange, only state exchanges. More importantly, as Ryan http://www.hillsdale.edu/news/imprimis/archive/issue.asp?year=2010&month=02" the real difference lies in who pays for the creature:

...allow me to clear up a misperception about insurance exchanges: it makes absolutely no difference whether we have 50 state exchanges rather than a federal exchange, as long as the federal government is where the subsidies for consumers will be located. In other words, despite what some seem to believe, both the House and the Senate versions of health care reform set up a system in which, if you are eligible and you want a break on your insurance premium, it is the federal government that will provide it while telling you what kind of insurance you have to buy [under ACA]. In this sense, the idea of state exchanges instead of a federal exchange is a distinction without a difference.

http://docs.house.gov/rules/health/111_ahcaa.pdf

 

[WhoWee]

The ACA has a central, singular, federal exchange, called the "Health Insurance Exchange" ( Sec 301). Also, the ACA says it will allow "State-based Health Insurance Exchanges", largely at the discretion of "The Commissioner", (Sec 308) that must behave nearly identically to the federal exchange. Furthermore "The Commissioner" may terminate the state's operation of the exchange and take it over (308.c.2). By contrast, Ryan's plan proposes no federal health exchange. More importantly, as Ryan http://www.hillsdale.edu/news/imprimis/archive/issue.asp?year=2010&month=02" the real difference lies in who pays for the creature:

They have learned NOTHING from the fiasco known as Medicare (or Medicaid).

The exchange is the one true chance they have of reforming health insurance under this legislation.

IMO - to perhaps over-simplify - all they need to do is design 3 or 4 standard policy options that can be sold/purchased anywhere in the country - with premiums adjusted to location - the carriers will save hundreds of millions (legal, administrative, marketing, and a host of compliance associated costs) and the savings will be passed through the system.

 

[WhoWee]

Let me clarify - I want to start over < repeal the whole mess > that aside, there is a way to make the exchange idea work to sell policies across state lines and create competition.

 

[Al68]

Careful what you wish for my friend, the last time you went down this path, you lost the ability to use the term Neo-con.

You just used it! Are you exempt from forum rules? :!)

Seriously, I made an unanswered request to clarify whether the prohibition on "Marxist" is only on using it to refer to a person, or a more general prohibition on using the word at all. (If the latter, I just violated the rules, too.)

The same should go for "neo-con". Is there a general prohibition on using the words at all, or just a prohibition on using them to refer to a person, or as an insult or political slur?

 

[mheslep]

...that's not the ACA. The "ACA" refers to what was formerly H.R. 3590, the Patient Protection and Affordable Care Act, and is now a public law, P.L. 111-148 (and P.L. 111-151). This is what during the long legislative process would've been known as "the Senate bill."

What you're referring to is the bill passed by (only) the House in November 2009, the Affordable Health Care for America Act. ...

My mistake, you are correct of course. I lost track of the final law amidst the original House bill X, Senate Committee Y markup, Senate Committee Z, Reconciallation ZZ, etc, with several thousand pages each.

... But yes, ACA's exchanges are state-based.

The actual ACA contains clause after clause on what the state exchanges may or may not do and how they may do it. It is clear that the staff hired to answer the state exchange phones will be 'state - based', beyond that I cite Rep Ryan again:

...allow me to clear up a misperception about insurance exchanges: it makes absolutely no difference whether we have 50 state exchanges rather than a federal exchange, as long as the federal government is where the subsidies for consumers will be located. In other words, despite what some seem to believe, both the House and the Senate versions of health care reform set up a system in which, if you are eligible and you want a break on your insurance premium, it is the federal government that will provide it while telling you what kind of insurance you have to buy [under ACA]. In this sense, the idea of state exchanges instead of a federal exchange is a distinction without a difference.

http://www.hillsdale.edu/news/imprimis/archive/issue.asp?year=2010&month=02

 

[mheslep]

...
Er, what? Ryan's own bill extends a refundable federal tax credit into the individual insurance market (i.e. his state exchanges) for "qualified health insurance" to be defined by HHS through the administrative rulemaking process. Aside from that, I can't tell if he's being disingenuous in minimizing the differences between state-based exchanges subject to federal guidelines and a single national exchange or if he just doesn't know.

Ryan's tax credit to individuals has nothing to do with his state exchanges (which are voluntary in any case). The tax credit is only "qualified" to go for what's reasonably known as health care insurance, similar to the way the IRS now qualifies the health care insurance tax exclusion for employers. There is no tinkering of minutia by bureaucrats to determine exactly what kind of defined benefit plan qualifies for the tax break.

...The term `qualified health insurance' means any insurance constituting medical care which (as determined under regulations prescribed by the Secretary)--
`(A) has a reasonable annual and lifetime benefit maximum, and
`(B) provides coverage for inpatient and outpatient care, emergency benefits, and physician care.

http://thomas.loc.gov/cgi-bin/query/F?c111:1:./temp/~c111gAF77i:e35401:

BTW, could you explain the differences under PPACA "between state-based exchanges subject to federal guidelines and a single national exchange" [from the original House bill], of which you believe Ryan either disingenuously minimizes or is simply ignorant? That is, aside from who answers the phone and sets up the web site. The distinctive differences are lost on me.

 

[WhoWee]

Typically, anything that increases bureaucracy will increase cost - would you agree?

The greatest current obstacle to a free market (competitive pricing) is state controlled regulation - every state currently has it's own rules. An insurance carrier that wants to insure people in 50 states needs (at a minimum) 50 duplicate compliance departments.

Now, the Federal Government is heaping regulations on top of this pile and mandating an expansion of coverage.

How (other than cut backs in service) can this possibly save money?

Sometimes the answer is to UNRAVEL the tangle and start over - this is one of those opportunities. If the intention is reform - then we need to simplify, untangle, streamline, and taper the whole regulatory process - not complicate it to the point that an agent and a recordskeeper need a law degrees.

 

[WhoWee]

The "base rules" were already well established before the recent legislation. Medicare sets the reimbursement schedules. HHS and HIPPA/MIPPA control all information. The state and federal agencies control provider services, training, product, techniques, reporting, and general administration. The state departments of insurance control the carriers and their products, operations, marketing and administration.

I look at the insurance code in the same way a contractor looks at building codes. If you build to the highest code - every building will be compliant.

Simplification could mean raising the standard - while reducing the administrative costs.