Obamacare Survives SCOTUS

[Velo Vol]

I haven’t read the opinion yet but if the states don’t have standing and individuals aren’t subjected to a tax, does anybody have standing to challenge the law under this theory?

I just listened to the Advisory Opinions on this and they really go after the rationale on standing.

It does seem the court opted to rule on narrow technical grounds, twice, and let the other two branches duke out the ACA.

 

[AshG]

we are crawling with urgent care facilities in Birmingham - in my 10 minute drive to work I go by at least 2.

EDIT - just did a Google search and there are 17 within 10 miles of my house.

That's sincerely good to know, thanks.

Now the billion dollar question is how to get people to use them instead of the ER.

 

[Velo Vol]

I know I'm an outlier who has experienced something that less than 0.1% of the population has gone through, but the removal of lifetime maximums in the ACA has saved my ability to provide what I can for my family. I'm still paying a significant amount per year because of my ongoing medical issues ($130 a month on prescriptions, just for me, in-office surgery every week on my leftover leg), but at least I have the ability to continue being insured.

The system is absolutely broken and needs to be amended, but you can understand why I fear much of the "scrap it and start over" talk that tends to accompany this line of discussion.

???

 

[AshG]

???

The vasopressors the doctors used to get blood back to my internal organs when I was in septic shock destroyed the vascular system in my left leg and caused me to lose 50% of the skin and 20% of the muscle from the knee down. I have to go in for weekly manual (and sometimes mechanical) debridement, repacking, and wrapping. Any time I get an infection, it blows out most of the progress. Doxy has been it's own food group for a few years now.

I'm approaching the end, though; the remaining hole is down to the size of my thumb and finally starting to close.

 

[volinbham]

The vasopressors the doctors used to get blood back to my internal organs when I was in septic shock destroyed the vascular system in my left leg and caused me to lose 50% of the skin and 20% of the muscle from the knee down. I have to go in for weekly manual (and sometimes mechanical) debridement, repacking, and wrapping. Any time I get an infection, it blows out most of the progress. Doxy has been it's own food group for a few years now.

I'm approaching the end, though; the remaining hole is down to the size of my thumb and finally starting to close.

good news

 

[volinbham]

That's sincerely good to know, thanks.

Now the billion dollar question is how to get people to use them instead of the ER.

I think that happens here simply because they are more convenient. OTOH, if the need is infrequent people tend to forget that place is right down the street and instead head for the big place they remember downtown.

As a tangent, IIRC the Medicaid expansion portion of ACA actually led to more utilization of the ER as primary care as they found that type usage was more common among Medicaid users than the uninsured. Yet another unintended consequence of massive, government rewrite of complex systems

 

[Velo Vol]

The vasopressors the doctors used to get blood back to my internal organs when I was in septic shock destroyed the vascular system in my left leg and caused me to lose 50% of the skin and 20% of the muscle from the knee down. I have to go in for weekly manual (and sometimes mechanical) debridement, repacking, and wrapping. Any time I get an infection, it blows out most of the progress. Doxy has been it's own food group for a few years now.

I'm approaching the end, though; the remaining hole is down to the size of my thumb and finally starting to close.

Yikes. Hope it finally heals.

 

[RockyTop85]

I just listened to the Advisory Opinions on this and they really go after the rationale on standing.

It does seem the court opted to rule on narrow technical grounds, twice, and let the other two branches duke out the ACA.

Yeah, I should have read the opinion before listening. It was a little hard to follow their technical points about standing without having read any of it. Still haven’t had time with the big Juneteenth celebration weekend.

Divided Argument is another scotus podcast that’s good but often less entertaining than AA. I guess I just really like David French and Sarah Isgur grew on me.

Plus Sarah responded to and read from the one and only email I’ve ever sent to a podcast and agreed with parts of it so they’ll always have a special place in the rotted out log that is RT85’s heart.

 

[Velo Vol]

Yeah, I should have read the opinion before listening. It was a little hard to follow their technical points about standing without having read any of it. Still haven’t had time with the big Juneteenth celebration weekend.

Divided Argument is another scotus podcast that’s good but often less entertaining than AA. I guess I just really like David French and Sarah Isgur grew on me.

Plus Sarah responded to and read from the one and only email I’ve ever sent to a podcast and agreed with parts of it so they’ll always have a special place in the rotted out log that is RT85’s heart.

Reading the opinions would really help, but for the pathetically lazy among us, just listening to a podcast is better than nothing.

If you listen to the second half of the one above, Sarah I gives an interesting theory on what happened behind the scenes in Fulton v. City of Philadelphia.

I've not heard Divided Argument. I'll look it up.

 

[NorthDallas40]

Yeah, I should have read the opinion before listening. It was a little hard to follow their technical points about standing without having read any of it. Still haven’t had time with the big Juneteenth celebration weekend.

Divided Argument is another scotus podcast that’s good but often less entertaining than AA. I guess I just really like David French and Sarah Isgur grew on me.

Plus Sarah responded to and read from the one and only email I’ve ever sent to a podcast and agreed with parts of it so they’ll always have a special place in the rotted out log that is RT85’s heart.

As you commented a few days ago if the states don’t have standing then who the hell does FFS?!

 

[RockyTop85]

As you commented a few days ago if the states don’t have standing then who the hell does FFS?!

Some of these respondents were individuals, so the insurance companies might have standing but not on the theory of the tax/penalty. Still haven’t read the case but the logic of it seems to be that by zeroing out the penalty, congress stopped the penalty from harming anyone so nobody has standing.

 

[NorthDallas40]

Some of these respondents were individuals, so the insurance companies might have standing but not on the theory of the tax/penalty. Still haven’t read the case but the logic of it seems to be that by zeroing out the penalty, congress stopped the penalty from harming anyone so nobody has standing.

I don’t understand how that makes sense. Wouldn’t that imply that the legislation is so perfect that no party could be harmed by its administration? How does that even make sense.

That isn’t at you. I’m taking your assessment at face value you’re more versed here than me. Just if you’re right …

 

[RockyTop85]

I don’t understand how that makes sense. Wouldn’t that imply that the legislation is so perfect that no party could be harmed by its administration? How does that even make sense.

That isn’t at you. I’m taking your assessment at face value you’re more versed here than me. Just if you’re right …

Not really. Remember, this suit was only over the mandate and they tried to loop on the rest of the law. The court basically said that a mandate without a penalty doesn’t harm anyone.

Someone being harmed by the actions of the defendant is one of the necessary jurisdictional components under Article 3 of the Constitution.

The individual plaintiffs say that having to buy insurance is an injury. The court says this cannot be traced to the actions of the defendants* because there is no means of enforcement.

He basically explains that courts don’t have the authority to simply declare statutes unconstitutional, courts have the power to ameliorate or prevent injuries by ordering the repayment of damages or enjoining officials from carrying out their duties. He says there’s no traceable damages and no official conduct to enjoin because no official is attempting to apply this penalty.

He then examines the claim and says that the individuals grievances aren’t subject to any kind of relief that the court is empowered to give.

The state claims are a little closer, but all of the evidence that was submitted at the lower courts to establish standing had to do with injuries that were a result of the intervening actions of third parties (people choosing to use state funded healthcare programs) and the only evidence linking those actions to the defendant* pertained to the period where there was an enforceable penalty.

* - Defendant here refers to the United States. The Trump DOJ sided with the plaintiffs and other states intervened, which is why the case is styled with the names of two states.

 

[RockyTop85]

@Velo Vol

Read it.

I can see what she was saying about the court having to peek at the merits. I don’t think I agree with that, necessarily, but I do think I agree with Alito’s argument that state standing ought to be really broad. That sort of goes back to fundamental antebellum civics.

 

[LouderVol]

What's your solution?

Healthcare premiums were rising at unsustainable levels prior to the ACA. For profit healthcare and pharma simply sent bills to insurance companies, the insurance companies don't care what sht costs because they pass it along to the paying consumer along with their cut. Meanwhile, millions of American's are priced out of the game all together, so they show up to the ER like it's a walk-in family practice clinic, all the while tax payers subsidize the cost of that care because ER's are net losers for every hospital system in the country. But that's really not a big deal to them because they just send uncle sam a bill for the tax payers to eat.

If we, American's want to thump our chests about being 'da bestest' wouldn't you agree that middle class families shouldn't have to choose between putting food on the table or paying BCBS in case tragedy strikes? And if the decision is to put food on the table and little Johnny gets cancer, the family is now thrust into bankruptcy.

Perhaps ACA isn't the answer, but at some point it's naysayers are going to have to put up an alternative or sit down.

So the solution to insurance being too expensive was to mandate that everyone has insurance? That's the type of brilliance only the government can come up with. Not only did they increase demand, but they cut supply. Including many plans which were not ACA compliant, aka cheap.

And it was such a great idea it had to be written in secret, with as little outside input as possible.

 

[LouderVol]

But the "leave it alone" solution doesn't fix the un debatable issue of the rising costs of health insurance being levied by a "for profit" system. MILLIONS of American's were and are still having to make the choice between coverage and food.

What it boils down to is are American's willing to pay more to make sure everyone gets cradle to grave healthcare, no questions asked?

The quality of healthcare argument that seems to get trotted out is also a loser. Given the vast sums that our country pumps into healthcare, our outcomes are on average with or lagging behind most of our 1st world peers.

The before ACA times still included a bunch of government regs. When you rewind to when costs were manageable you will see very little government intervention.

So no we dont actually know that the leave it alone option doesnt work. Our government wont let it happen. All ACA did was let the government get into the action even more.

 

[LouderVol]

That's sincerely good to know, thanks.

Now the billion dollar question is how to get people to use them instead of the ER.

Let ERs reject people, with directions to the local quick care or other facility if it's not an emergency.

 

[Septic]

So the solution to insurance being too expensive was to mandate that everyone has insurance? That's the type of brilliance only the government can come up with. Not only did they increase demand, but they cut supply. Including many plans which were not ACA compliant, aka cheap. And it was such a great idea it had to be written in secret, with as little outside input as possible.

You say this with an accusatory tone as if I support it. I've never held that the ACA was a winning solution only that the alternative (which was doing nothing at all), is also a terrible option and not a "solution" at all.

 

[Septic]

The before ACA times still included a bunch of government regs. When you rewind to when costs were manageable you will see very little government intervention.

So no we dont actually know that the leave it alone option doesnt work. Our government wont let it happen. All ACA did was let the government get into the action even more.

I've already demonstrated that it's a revisionist history that costs were in check prior to the ACA, they weren't.

A for profit health and pharma system was never and will never be self limiting without regulation. It was ripe for abuse as it often proved.

 

[utvolpj]

You say this with an accusatory tone as if I support it. I've never held that the ACA was a winning solution only that the alternative (which was doing nothing at all), is also a terrible option and not a "solution" at all.

But why is that the only alternative? How about opening up markets that have been denied because of govt intervention? These rules, including the ACA, were all written by insurance companies and passed by paid for reps.

 

[Septic]

Let ERs reject people, with directions to the local quick care or other facility if it's not an emergency.

What difference would it make? The local "urgent care" clinics would still need to pass the buck to the .gov for repayment or they'd go out of business as well. Ultimately, someone has to pay for it and it will not be the for profit health systems taking the bath.

 

[LouderVol]

You say this with an accusatory tone as if I support it. I've never held that the ACA was a winning solution only that the alternative (which was doing nothing at all), is also a terrible option and not a "solution" at all.

When the possible solutions are worse than the current situation it's not unreasonable to let things lie.

It's the same argument used against capitalism all the time. Well we didnt really give capitalism a chance by interfering, and things failed. So clearly its capitalism's fault, and not our own.

The way healthcare has provided and used by the general public has changed completely with government interference. And the capitalist core isnt allowed to make the adaptations it needs to because its "not fair".

Unless people are willing to accept about a 50% increase in taxes to get their "free" health care, the european model that gets championed is just blowing smoke.

You could do a lot more to fix the issue by fixing the people who use the broke system. The reason europe doesnt have the same health issues we have isnt because their system is better. It's because they have healthier people. Healthier people is less demand on the system, and less demand on cutting edge life changing procedures/medicines, which means lesser costs. Transplanting their system here wont work. We have eaten ourselves out of that possibility.

 

[Velo Vol]

@Velo Vol

Read it.

I can see what she was saying about the court having to peek at the merits. I don’t think I agree with that, necessarily, but I do think I agree with Alito’s argument that state standing ought to be really broad. That sort of goes back to fundamental antebellum civics.

I'll have to look at it. I haven't thought much about state standing versus the federal government.

So the solution to insurance being too expensive was to mandate that everyone has insurance? That's the type of brilliance only the government can come up with. Not only did they increase demand, but they cut supply. Including many plans which were not ACA compliant, aka cheap.

The regulation changes are a separate matter, but yes, adding 20-somethings into the insured basket lowers the average cost in the pool.

 

[LouderVol]

I've already demonstrated that it's a revisionist history that costs were in check prior to the ACA, they weren't.

A for profit health and pharma system was never and will never be self limiting without regulation. It was ripe for abuse as it often proved.

Way to move goalposts. I didnt say costs were in check before ACA. I even pointed out there were existing government interference before ACA. So all you are demonstrating is my point. We havent tried the leave it alone strategy in a long long time.

 

[Septic]

But why is that the only alternative? How about opening up markets that have been denied because of govt intervention? These rules, including the ACA, were all written by insurance companies and passed by paid for reps.

Who said it is? I didn't - I've already stated I don't have a solution. I'm all for a free market, open state solution. Me pointing out the fact that the system prior to the ACA sucked, doesn't mean I support the post ACA system.