Supreme Court upholds ACA

[skcin]

Wow - over an hour has gone by & still no thread? Gone are the good old days of The Ledge when you could come here for breaking news.

Anyway, I'm sure there are differing opinions here. Discuss.

http://nbcpolitics.msnbc.msn.com/_ne...-care-law?lite

[jannieC]

As an Obama supporter, I am pleased about this decision. However, I honestly am not knowledgable enough on the ramifications to defend my opinions yet. I hate being dumb about some things.

[skcin]

Well, from what I understand (and maybe some of the legal professionals here can clarify) the Court basically decided that the government has the right to tax you if you decide NOT to buy health insurance. LIke, they're technically giving you a choice/option: a) get health insurance OR b) don't get insurance & pay an annual tax.

So you're not forced to get insurance - you won't go to jail or anything like that if you don't get it. In refusing to buy insurance, you're opting to pay the tax.


From MSN.com:

For individuals who choose to not comply with the individual insurance mandate, Congress deliberately chose to make the penalty fairly weak: only $95 for 2014; $325 for 2015; and $695 in 2016.

After 2016, that $695 amount is indexed to the consumer price index.

Congress specifically did not allow the use of liens and seizures of property as methods of enforcing the penalty.

Non-compliance with the mandate is also not subject to criminal or civil penalties under the Tax Code and interest does not accrue for failure to pay the penalty in a timely manner, according to the congressional Joint Committee on Taxation.

Now. I will admit that there is a tiny (TINY) piece of me (as a daughter of an immigrant from a formerly communist country) that says "whoa, wait a minute, should the government be telling people what they should do?" I see both sides of the argument, even the right-wing Republican's side. I get people's fears & concerns. But let's stick with reality - we are a democracy. Our president is NOT a communist.

I am also a health care worker. The main point of the ACA is to help people get access to affordable healthcare so they buy it & use it. And NOT just say "well, f*ck it, I don't feel like spending my money on insurance" then show up in an ER with no way to pay. Because that's how it is now, and those of us who DO opt to pay for insurance see costs & premiums & copays go up to offset the costs incurred by those other people. This should work in theory. Time will tell if it actually does!

[HejiraNYC]

Okay, I get the notion that the president''s health insurance mandate is supposed to enlargen the pool of healthy individuals in the insurance pool. And there will be a mandate to buy insurance or pay a penalty. But what isn't clear to me is what this will mean to the individuals who are not currently covered and are just initiating private coverage to comply with the mandate. Today, a barebones individual health insurance plan is around $5K/year (with a huge deductable). Under the mandate, do these insurance premiums decrease by law, or do private insurance companies get to charge whatever they like (as they do currently). Yes, the ultimate objective is to make healthcare more affordable for everyone, but so far I am not hearing about the concessions that insurance and healthcare companies are making to truly expand access to coverage. If people could not afford coverage before, how are they expected to afford it after it's mandated if everything else remains the same?

[skcin]

^ I am not totally clear on that either. I believe I had heard at one point that there would be discounted/affordable plans offered to those with income limitations; however, I can't recall if these would be through private companies or government-sponsored.

[KarmaContestant]

Originally Posted by HejiraNYC

Okay, I get the notion that the president''s health insurance mandate is supposed to enlargen the pool of healthy individuals in the insurance pool. And there will be a mandate to buy insurance or pay a penalty. But what isn't clear to me is what this will mean to the individuals who are not currently covered and are just initiating private coverage to comply with the mandate. Today, a barebones individual health insurance plan is around $5K/year (with a huge deductable). Under the mandate, do these insurance premiums decrease by law, or do private insurance companies get to charge whatever they like (as they do currently). Yes, the ultimate objective is to make healthcare more affordable for everyone, but so far I am not hearing about the concessions that insurance and healthcare companies are making to truly expand access to coverage. If people could not afford coverage before, how are they expected to afford it after it's mandated if everything else remains the same?

I'm no expert on the details, but the information is out there if you look. If you cannot afford insurance (which is determined by income - not lifestyle) then you can get a subsidy to help pay for it. It will not cover 100% of the cost. The example I read yesterday said that a family with an income of 60K could expect about 5K in assistance for insurance premiums, but the balance falls on their shoulders.

The poorest of poor, up to 1.3 times the Federal poverty level are able to enroll in Medicare. This alone will provide coverage to about 30 million of the 57 million uninsured.

There is no legal requiremnt to lower the cost of premiums, because we are a free-enterprise capitalist economy, and price controls are considered a no-no; so yes, the insurance companies will continue to determine the rate of premiums.

As far as this: "I am not hearing about the concessions that insurance and healthcare companies are making to truly expand access to coverage":.

No denial for pre-existing conditions
No dropped coverage when you get sick
No price gouging based on health, age, smoker, etc...
Children can stay on parental insurance plans until age 26.

Granted, these aren't concessions, but legal requirements of the Affordable Health Care Act. One cannot expect a for-profit industry that makes billions in profits by price gouging and denying coverage to make concessions, but the idea is that the pool of funds will be greater when more peope are covered, and the cost of services could drop. How? If premiums are to decrease, Americans will really need to get serious about preventative care. Going to the doctor every six months for regular checkups and physicals. Getting off their fat asses and engaging in physical activites. Putting down the starchy carbs and eating fruit and vegetables. It's time to move away from treating (and extending) illnesses with expensive therapies and begin preventing illnesses with affordable lifestyle changes.

This can be argued, but I believe the prices of premiums will be determined by the free-market (as in, you and I). Be healthy and reduce the costs of care so that the costs of premiums can decrease as well. Or - continue to engage in unhealthy lifestyle choices and watch the fat-cats laugh their way to the bank as premiums continue to increase at the same rate as greed and laziness.

Personally, I support the Affordable Health Care Act, but prefer a socialized health care system where 100% of services (or close to 100%) are covered for 100% of the population, and all paid for with taxes. Denmark, Sweden, France - all are great models for what we should have here.

[KarmaContestant]

A friend of a friend posted this on Facebook and it has some very useful information.

The government could require you to participate in a number of programs and has done so for decades. The mandate was necessary.

Republicans were right when they supported the mandate back in the '90s under "Dole-Care," they were right when they supported it in the '00s as "Romney-care" (at the same time Obama was wrong when he opposed it), the president was convinced, correctly, that it was a necessary part of reform to eliminate free riders (who play a significant role in elevating costs). The only thing that changed was that the negotiations worked and the president was convinced that the Republicans were right. The unfortunate thing in 21st century politics is that as soon as the president agreed with something it became "bad" and had to be opposed at all costs as an attack on "freedom." That's why you have Romney in this bizarre situation where one of his most significant successes as governor cannot be spoken about because it is too similar to what has become one of the most hated things about Obama. It’s nonsense, pure partisanship and tribalism.

The need and legitimacy of the mandate are well established legal precedent, whether it was the insurance required for those in the merchant marine back in the 1790s, participation in social security, Medicare, unemployment contributions, etc., or state requirements for auto insurance.

So called "Obamacare" is a rather weak, incomplete, reform of healthcare which was desperately needed. We're the only modern industrialized country that doesn't have either full-fledged socialized medicine (Medicare for all), or at least a hybrid system. It's no surprise that we are also last amongst the modern industrialized countries in quality of health care, last in almost every health category, but, fortunately for us, we pay the highest percentage of our GDP for the worst care... YEAH!

I really don't care who comes up with the system, I care about what works. Our system doesn't work. 10% of the population receives 66% of the healthcare for a price that is nearly 1/5 of our entire GDP. That is a fatally broken system. Innovation and breakthroughs are moving to China because they're willing to directly intervene in their system. Europeans have far better qualities of life because they utilize hybrid/socialized systems. Singapore is #1 using a public option. The arguments that it can't work, doesn't work, etc., are patently false

[KarmaContestant]

AND - if you want to read something really hilarious.....

http://www.buzzfeed.com/daves4/peopl...e-of-obamacare

Riiiight... Conservative Americans are going to go to Canada to escape the "socialist" Obama healthcare bill?

CANADA.

Where they have socialized healthcare.

And gay marriage.

And essentially, legal weed.

[Macfanforever]

I don't like it and I don't buy it.Why the gov dictate and force americans to get health insurance .and get fined and go to jail if you don't comply.

We got forced to buy new TV's in 2009 due to the gov decided to cut the analog TV broadcasts to crappy digital TV.Which its useless and got to be on top of the transmitter to receive the station.Any they dished out those $40 coupons which probably added up to milions of dollars in which they could used it for more inportant things.

I see the gov should control what the doctors office and the hospitals charge for the treatments.

I hope there will be some changes in Washington in november .Also I think there should be term limits on all elected officals for office.

[nailatixela]

Thanks to those who have posted information here...like others I am still learning a lot about this. I knew republicans used to be all for this idea - their idea - I think it is ridiculous that they are against it now.

And Macfanforever - yes there will be a tax, but no, no one will go to jail for not purchasing insurance. And of course, we have some term limits on our elected officials...hence the changes you hope for in November.

[Macfanforever]

Originally Posted by KarmaContestant

AND - if you want to read something really hilarious.....

http://www.buzzfeed.com/daves4/peopl...e-of-obamacare

Riiiight... Conservative Americans are going to go to Canada to escape the "socialist" Obama healthcare bill?

CANADA.

Where they have socialized healthcare.

And gay marriage.

And essentially, legal weed.

Yes it looks like everybody will be moving to canada according to the comment section.

[LB Freakazoid]

And this tax penalty is different from paying into Social Security and Medicare - how?
People got their panties in a bunch when those items were automatically taken from their paychecks in the beginning... Same thing now...
Why isn't anyone upset at the amount of utility tax (power), communication tax (cell phone, internet, land line, etc), cable or satellite tax, etc. that's paid every month?
That averages out to approx. $1800 a year...

[skcin]

Originally Posted by KarmaContestant

I'm no expert on the details, but the information is out there if you look. If you cannot afford insurance (which is determined by income - not lifestyle) then you can get a subsidy to help pay for it. It will not cover 100% of the cost. The example I read yesterday said that a family with an income of 60K could expect about 5K in assistance for insurance premiums, but the balance falls on their shoulders.

The poorest of poor, up to 1.3 times the Federal poverty level are able to enroll in Medicare. This alone will provide coverage to about 30 million of the 57 million uninsured.

There is no legal requiremnt to lower the cost of premiums, because we are a free-enterprise capitalist economy, and price controls are considered a no-no; so yes, the insurance companies will continue to determine the rate of premiums.

As far as this: "I am not hearing about the concessions that insurance and healthcare companies are making to truly expand access to coverage":.

No denial for pre-existing conditions
No dropped coverage when you get sick
No price gouging based on health, age, smoker, etc...
Children can stay on parental insurance plans until age 26.

Granted, these aren't concessions, but legal requirements of the Affordable Health Care Act. One cannot expect a for-profit industry that makes billions in profits by price gouging and denying coverage to make concessions, but the idea is that the pool of funds will be greater when more peope are covered, and the cost of services could drop. How? If premiums are to decrease, Americans will really need to get serious about preventative care. Going to the doctor every six months for regular checkups and physicals. Getting off their fat asses and engaging in physical activites. Putting down the starchy carbs and eating fruit and vegetables. It's time to move away from treating (and extending) illnesses with expensive therapies and begin preventing illnesses with affordable lifestyle changes.

This can be argued, but I believe the prices of premiums will be determined by the free-market (as in, you and I). Be healthy and reduce the costs of care so that the costs of premiums can decrease as well. Or - continue to engage in unhealthy lifestyle choices and watch the fat-cats laugh their way to the bank as premiums continue to increase at the same rate as greed and laziness.

Personally, I support the Affordable Health Care Act, but prefer a socialized health care system where 100% of services (or close to 100%) are covered for 100% of the population, and all paid for with taxes. Denmark, Sweden, France - all are great models for what we should have here.

Well yes, but people don't want the government telling them what to do. Remember when they tried to put a small tax on soft drinks?

Originally Posted by KarmaContestant

AND - if you want to read something really hilarious.....

http://www.buzzfeed.com/daves4/peopl...e-of-obamacare

Riiiight... Conservative Americans are going to go to Canada to escape the "socialist" Obama healthcare bill?

CANADA.

Where they have socialized healthcare.

And gay marriage.

And essentially, legal weed.

That? Is hilarious.

Originally Posted by Macfanforever

I don't like it and I don't buy it.Why the gov dictate and force americans to get health insurance .and get fined and go to jail if you don't comply.

We got forced to buy new TV's in 2009 due to the gov decided to cut the analog TV broadcasts to crappy digital TV.Which its useless and got to be on top of the transmitter to receive the station.Any they dished out those $40 coupons which probably added up to milions of dollars in which they could used it for more inportant things.

I see the gov should control what the doctors office and the hospitals charge for the treatments.

I hope there will be some changes in Washington in november .Also I think there should be term limits on all elected officals for office.

1) You're not being forced. You have an option. You may not like the option, but it's there.
2) I didn't buy a new TV. I got a free converter box with one of those coupons.
3) The doctor's offices & hospitals have to charge more to cover care for the MORONS WHO REFUSE TO BUY HEALTH INSURANCE.

JMO, of course.

[louielouie2000]

Originally Posted by skcin

Wow - over an hour has gone by & still no thread? Gone are the good old days of The Ledge when you could come here for breaking news.

This was my initial reaction, too. I almost started a thread, but decided against it. I guess I'm just burnt out on discussing political issues. Everyone's just so permanently polarized... civil debating is just nonexistent these days.

Regarding the Supreme Court ruling... I have to say it greatly surprised me. Especially that John Roberts was the one who broke the tie. In the end, I feel it was the right decision for the country. And while the healthcare overhaul (as it stands) is pretty weak, it's a step in the right direction. I have no doubt in time that Americans fear of the program will evaporate, and they will come to regard it more highly.

[HejiraNYC]

Originally Posted by KarmaContestant

There is no legal requiremnt to lower the cost of premiums, because we are a free-enterprise capitalist economy, and price controls are considered a no-no; so yes, the insurance companies will continue to determine the rate of premiums.

This is where this program falls apart. If insurance companies are making a windfall of new revenue due to all of the new younger/healthier people who are now paying insurance premiums, they should be required to somehow reduce insurance costs for consumers across the board. Current insurance premiums are based on the calculated risk of disease based on demographics. When the demographics are changed so drastically, insurance companies must adjust the premiums accordingly, and more than likely the adjustment should be downward.

As far as this: "I am not hearing about the concessions that insurance and healthcare companies are making to truly expand access to coverage":.

No denial for pre-existing conditions
No dropped coverage when you get sick
No price gouging based on health, age, smoker, etc...
Children can stay on parental insurance plans until age 26.

Granted, these aren't concessions, but legal requirements of the Affordable Health Care Act. One cannot expect a for-profit industry that makes billions in profits by price gouging and denying coverage to make concessions, but the idea is that the pool of funds will be greater when more peope are covered, and the cost of services could drop. How? If premiums are to decrease, Americans will really need to get serious about preventative care. Going to the doctor every six months for regular checkups and physicals. Getting off their fat asses and engaging in physical activites. Putting down the starchy carbs and eating fruit and vegetables. It's time to move away from treating (and extending) illnesses with expensive therapies and begin preventing illnesses with affordable lifestyle changes.

I am not understanding your logic. For one thing, why do you assume that the cost of services will drop? If anything, expanded coverage = expanded healthcare utilization. But what does that mean regarding major medical endpoints? The system could be flooded with people looking to get the latest and greatest diagnostic/screening tests and who are enabled by all-too-willing physicians and laboratories who receive generous fees for these services. Recent evidence already suggests that some mammograms are unnecessary. Early PSA screening has also been found to be unnecessary, if not downright detrimental to health outcomes. It seems not improbable that people will demand these tests... just because they can.

I also don't understand your premise that people will suddenly become more willing to engage in lifestyle modification to prevent major medical illness due to Obamacare. Yes, people need to stress the importance of prevention; however, it would seem that people would be less willing to take care of their health when the safety of healthcare coverage to save them in their time of need. I have known quite a number of people whose philosophy about life is basically "there's a pill for that." Why eat salads and oatmeal when there are pills (almost free under insurance) that will reduce blood pressure, reduce LDL cholesterol and prevent fat absorption? Pass the steak! Although the current insurance system is not perfect, at least there were financial consequences for smoking, being overweight, etc. Without any element of personal responsibility under Obamacare, it seems that there will be less incentive for people to eat well, exercise and stay away from tobacco.

This can be argued, but I believe the prices of premiums will be determined by the free-market (as in, you and I). Be healthy and reduce the costs of care so that the costs of premiums can decrease as well. Or - continue to engage in unhealthy lifestyle choices and watch the fat-cats laugh their way to the bank as premiums continue to increase at the same rate as greed and laziness.

Just like the current American energy cartel, and it truly is a cartel in every sense of the word, insurance is similarly a cartel. Insurance companies will band together to prevent any significant reduction in premiums- that's the American way. Of course any Republican will tell you that the free market will establish the most rational market... but we all see how well those "free market" principles fared after the great recession. No, it should not be socialized or subject to price controls per se... but they definitely need to be regulated closely. As we have seen already, big business and big money can never be trusted to regulate themselves.

Personally, I support the Affordable Health Care Act, but prefer a socialized health care system where 100% of services (or close to 100%) are covered for 100% of the population, and all paid for with taxes. Denmark, Sweden, France - all are great models for what we should have here.

I am a bit conflicted regarding a single-payer system, such as you are describing. Yes, these are systems that seem to be working fairly well in many other western countries. But the problem with a single payer, making medical and formulary decisions for everyone, is that it has the potential to stifle innovation. Where are most drugs developed/researched? Where are the greatest advancements in medicine discovered? Who is essentially subsidizing (indirectly) the healthcare of people around the world? Yes- the United States. And it's only possible thanks to the absence of price controls, tax breaks and a free market. No, drug companies are not saints... but it is a vital segment of the economy that actually improves quality (and quantity) of life for the public at large. Sadly the U.S. consumer ultimately ends up subsidizing the patient in France who enjoys 10 Euro top tier prescription drugs.