Patient Protection and Affordable Care Act

[javero]

Posted: 9/26/13 at 5:13pm

Hi All,

I'm starting this thread in hopes that we might have a civil discussion about the merits and shortcomings of this groundbreaking US law. I don't claim to be an expert on all the finer points of the language therein or implementation outside of my state of MD.

If I recall correctly a few of you are licensed attorneys who should be able to shed some light on a particular issue which completely confounds me. That is, the constitutionality of the US gov't imposing a penalty on an otherwise uninsured adult who opts out of the program for whatever reason, aka "individual mandate". If memory serves the only major area in which candidate Obama differed from candidate Hillary Clinton was with respect to the individual mandate; he was opposed to the imposition at the time while she felt it appropriate. I'm aware of the SCOTUS' 5-4 ruling in support of the individual mandate but don't understood the distinction between it and Medicaid expansion at the state level.

Overall, I'm pleased that the marketplace enrollment starts on Oct 1 as I know many folks without coverage currently. What I'm humbly requesting though is that you share your thoughts on whether or not the law has room for improvement (or implementation in your state) and if the White House's projections for funding it were legitimate.

Correction: I wrote Medicaire earlier in error.

Updated On: 9/26/13 at 05:13 PM

[Liza's Headband]

Posted: 9/26/13 at 5:28pm

"I'm starting this thread in hopes that we might have a civil discussion about the merits and shortcomings of this groundbreaking US law."

We'll see how long that lasts.

To answer your question, I feel there is PLENTY of room for improvement. This policy does not solve many of the problems our broken healthcare system is facing. It's a baby step in the right direction but it sure does fall terribly short. I'm sure Dented and Henrik will have something more enlightening to add. I'm for single payer healthcare. Hope we get there soon.

In the meantime, my Husband and I will fortunately not be impacted either way by the ACA but I will certainly hear about it ad nauseam at various family functions; many on his side are doctors who vehemently oppose it.

[themysteriousgrowl]

Posted: 9/26/13 at 5:42pm

Ugh nm

Updated On: 9/26/13 at 05:42 PM

Posted: 9/26/13 at 6:10pm

Hilary did indeed favor what some call "Single payer" or "medicare for all" plan where all citizens would pay into a government program and receive Medicare-like coverage. She supported this plan in 1992 when the Clinton Healthcare reform was debated and during her run for President in 2008.

In an attempt to bring Republican into the fold, an alternative plan that was proposed by a Republican think-tank (and others) to require health insurance of all citizens and to open "Health care marketplaces" where insurers can compete to offer coverage with government grants to assist those with lower incomes was offered instead.

Despite this compromise, Republicans now uniformly oppose this idea (Mitt Romney, I'm looking at you).

Updated On: 9/26/13 at 06:10 PM

Posted: 9/26/13 at 6:19pm

One thing I would think Conservatives would like about this new law is this:

Currently, if you are in need of medical attention and you go to a hospital THEY MUST treat you regardless of your insurance or ability to pay. Needless to say, hospitals end up eating a huge portion of these costs. The ACA will hugely curtail this. Hospitals will still be treating some patients that cannot pay, but a far far greater proportion of patients will have insurance.

[javero]

Posted: 9/26/13 at 6:58pm

"Hospitals will still be treating some patients that cannot pay, but a far far greater proportion of patients will have insurance."

Joe, I think that's a positive but a few physicians I know are complaining about what they describe as paltry ACA payments. One explained to me just a few minutes ago that none of them were interested in taking on more Medicaid patients and many see ACA enrollees as another breed of second tier patients. After that revelation I let him know that he'd never be treating me or any of my loved ones with that attitude.

VA got a glimpse of the new rates earlier today. This and the impending shutdown at 11:59 PM Mon have been the talk of the town today.
Virginia gets glimpse of insurance rates

[Jungle Red]

Posted: 9/26/13 at 7:06pm

I don't recall where exactly I read this, but I have read that the penalty for not having insurance goes into a pool that pays for those that are uninsured.

If you've got the time, read what Trader Joe's says about Obamacare.

CoveredCA.com has all the info for California residents.
Read about it here.

Posted: 9/26/13 at 7:12pm

I have never heard that they penalties go into some sort of fun for the uninsured. I sort of think they are SOL

[artscallion]

Posted: 9/26/13 at 7:17pm

"...the constitutionality of the US gov't imposing a penalty on an otherwise uninsured adult who opts out of the program for whatever reason..."

My state, and many others have had mandatory car insurance laws for years. You must have a certain level of car insurance in these states. And you have to carry proof of it. If you opt out for whatever reason, or even if you fail to have proof on you when you're stopped, you pay a fine and your license can be revoked. So, while I'm not really knowledgeable on the constitutionality of this type of thing, there is certainly precedent set.

[Jungle Red]

Posted: 9/26/13 at 7:25pm

I can't find the site I first read, but here's what another site is saying. The Shared Responsibility Provision is also known as the Penalty Tax.
Here.

[Gothampc]

Posted: 9/26/13 at 7:54pm

"So, while I'm not really knowledgeable on the constitutionality of this type of thing, there is certainly precedent set."

This is not precedent. Your state doesn't require you to buy insurance if you don't own a car. You have a choice. If you don't want to spend money on insurance, you ride the bus or hitchhike.

Unfortunately, this health plan forces you to spend money on insurance and that's where it's not constitutional. You shouldn't be forced to purchase things you don't want.

[siny]

Posted: 9/26/13 at 7:58pm

If ACA is unconstitutional, then so is the requirement that hospitals treat everyone regardless of their ability to pay, which amounts to government forcing businesses to provide free service. Is there anyone out there who is fighting to repeal THAT law ? It's that law that makes individual mandate necessary.

Updated On: 9/26/13 at 07:58 PM

[Jungle Red]

Posted: 9/26/13 at 8:18pm

If the ACA was unconstitutional, then the Supreme Court would've decided it so. Alas, they did not.

[Liza's Headband]

Posted: 9/26/13 at 8:59pm

By: Michael Katz, M.D.

My plea in this post is a variation on the theme I've already established for this topic: maybe we are on our own. Maybe the founders did not anticipate drug-eluting coronary stents, chronic ambulatory peritoneal dialysis, or the costs, co-pays, and deductibles that come along with them. Maybe we need to use our own common sense, rather than keep telling one another why long-dead people meant to say what our particular team wishes they meant to say.

I suppose even common sense might take us in opposing directions, but here's where mine takes me. Healthcare is not a 'commodity' like any other.

The crux of the Constitutional debate seems to be whether or not the federal government can compel us to buy any commodity. What my common sense tells me is that in the case of healthcare, it is not the government, but the slings and arrows of outrageous fortune that compel the 'purchase.'

If you can't afford a car, you can get by without one. If you can't afford nice clothes, you can manage with Good Will. If you don't ski, there is certainly no reason to buy skis, or lift tickets.

But if you are hit by a bus, or fall off your roof, or drive a shovel into an underground electric cable, or have a heart attack, or get struck by lightning, or develop diabetic ketoacidosis ... you will get treated. The only option is for passers-by to leave you lying, writhing, seizing, or bleeding -- because you have not expressly, in advance, chosen to 'purchase' health care. Chances are, if you were conscious while seizing or hemorrhaging, you might want the opportunity to reconsider.

But there is no opportunity to reconsider priorities, commodities, or purchases during a calamity. During a calamity, the default judgment of passers-by, the default action of a society of fundamentally decent, compassionate people is ... to shoot treatments at you first, and ask questions about your insurance status and credit score afterward. Would anyone really want this to work differently? Can you envision the world where you are left on the sand to bleed after a shark attack until we verify your financial assets?


More Here

[winston89]

Posted: 9/26/13 at 9:32pm

Goth

You're a fool. There's a big difference between healthcare and care insurance. If you don't want to pay car insurance or can't afford it, then there are other options of getting around from place to place. However, with health insurance, you can't really decide to not get sick at one point or another. You're right, you shouldn't be forced to buy things that you don't want. But can you honestly sit there and tell me that it's bad for the government to force folks to spend a little money to go towards something that they need to not die? After all, with your argument you may as well say that having car insurance is going against the constitution as well, isn't it just forcing you to buy something you don't want too? I feel that the tax to cover everyone for health care makes sense because part of the government's job is to take care of its citizens.

Posted: 9/26/13 at 10:30pm

Like it or not the constitutionality of this law has been decided. There are only 9 opinions that count and they've spoken.

[javero]

Posted: 9/27/13 at 12:00pm

"Like it or not the constitutionality of this law has been decided. There are only 9 opinions that count and they've spoken."

Yep, and I can live with the outcome and probably much better now that it's the law of the land.

What I don't understood fully though is how it's going to be funded. I'm going to have to read the text again and surf over to the website. I haven't come across anything claiming that the penalties will be put into a kitty to cover the uninsured children or whatnot.

Lord knows I don't even want to consider the fate of the children of undocumented workers when the children are citizens. I've never quite understood how undocumented workers file income tax returns to begin with. If I understand the law correctly, even if a parent is a undocumented worker if that parent has a child(ren) who is a lawful citizen the parent faces a penalty (or tax liability) if he or she doesn't enroll the child(ren) on a suitable exchange. In short, there are many parents who aren't eligible to participate in ACA but have children who qualify for coverage.

Updated On: 9/27/13 at 12:00 PM

[Jungle Red]

Posted: 9/27/13 at 12:17pm

Of course Goth will never come back to this, but I'm going to waste my two minutes asking him this anyway.

Goth: Were you home schooled? Did you complain way back when the Government made it the law to send your children to school? I know you're old enough to remember back in 1910. Parents either choose to send their children to public school or they choose private school, or they choose homeschooling. Either way, children had to go to school. The Government says so, and there are penalties for not.

I don't see any difference between universal education and universal healthcare. Don't go to school? Pay a fine. Parents who don't send their kids get fined.

Again, Goth won't answer, but I'm open to hearing opinions from others.

(Edited: I don't know why I used "chose" instead of "choose".) Updated On: 9/27/13 at 12:17 PM

[javero]

Posted: 9/27/13 at 12:22pm

"I don't see any difference between universal education and universal healthcare."

I think that's a brilliant analogy and don't know why I didn't pick up on that before.

[suestorm]

Posted: 9/27/13 at 12:48pm

your comparison to sending kids to school by law is clever but there is one big obvious diff.... children are children.

just like you must feed them, you must clothe them, you must educate them. because... wait for it... they are children! they cant fend for themselves. Adults can. Big Brother shouldnt make you or force you to do anything that affects no one but yourself

[Jungle Red]

Posted: 9/27/13 at 12:55pm

Your argument doesn't work either, SueStorm. "Big Brother" decided a hundred years ago that children between the ages of 5-18 had to attend school of some kind. Religious parents, and paranoid ones too, are exempt* and can homeschool as long as they follow some sort of government approved curriculum. If the adults do not choose to educate their kids, then there are consequences and repercussions.

"Big Brother shouldnt make you or force you to do anything that affects no one but yourself."

Except it does... if you break the law, you're required to go to court. If you're summoned for jury duty, you're required to go. If you want to travel abroad, you must have a passport. If you want to drive, you must have a license, registration, insurance, etc. If you want to practice medicine, you must have a medical degree and a license. Hell, if you want to cut hair, sell anything, open a day care, you must have a license. The Government says so, and you must follow.

Same with the ACA.

Updated On: 9/27/13 at 12:55 PM

[Liza's Headband]

Posted: 9/27/13 at 1:03pm

Javero. This is from the American Public Health Association:

"7. How much is the ACA expected to cost, and how is it funded?

The Affordable Care Act includes a number of coverage and other provisions that will require more government spending, but these costs are offset by other ACA provisions that will either bring new revenue into the government, or decrease current spending. In total, the ACA is expected to reduce budget deficits by $210 billion over 2012-2021, according to the Congressional Budget Office’s estimates in February 2011. This includes $1,390 billion in gross costs related to the ACA’s insurance coverage provisions, offset by $349 billion in coverage-related revenues and savings (including minimum coverage provision penalty payments), and $1,252 billion in other revenues and savings.

The Supreme Court decision may impact the cost and coverage impacts of the ACA. As of July 2012, the CBO estimates that the ACA’s coverage provisions will cost $1,168 billion over 2012-22. This is $84 billion lower than CBO estimated in March 2012, and the lower cost is due to the Supreme Court’s June 2012 decision that limited the federal government’s ability to enforce the Medicaid expansion. CBO estimates that due to the Court’s decision, there will be less government spending on Medicaid, and even though there will be more government spending on exchange subsidies for people who would otherwise be eligible for Medicaid, there will be an overall decrease in spending. It’s important to remember that this decrease in spending is because more people will lack coverage; and these numbers don’t account for the costs of uncompensated care.

Although in its July 2012 numbers, the CBO did not update its projection of the ACA’s overall reduction of the budget deficit, it did update a previous estimate of the potential cost of repealing the ACA. CBO now estimates that repealing the ACA would increase federal budget deficits by $109 billion over the 2013–2022 period. Repealing the coverage provisions would save $1,171 billion over that period, but repealing the rest of the act would increase direct spending and reduce revenues by a total of $1,280 billion."

[javero]

Posted: 9/27/13 at 1:03pm

"your comparison to sending kids to school by law is clever but there is one big obvious diff.... children are children."

sue, I agree but a woman your age is not a child but by your own admission you still live off your dad's largess with respect to health care. So the question begs, if you couldn't avail yourself of your parent's insurance and your college or university didn't offer coverage to students how would you personally go about obtaining health insurance? Now that you've reached the age of majority and you're not incapacitated your parents are under no obligation to provide you with housing, further education, insurance, etc.

[suestorm]

Posted: 9/27/13 at 1:37pm

Javero, i believe the law was always that kids of children were eligible under their parents plan till they were 21 or 25 so i would be covered. but I know what youre saying, and that is a valid question. once i reached 21 or 25 i guess i would have to find a job and get my coverage that way. It would be difficult no doubt.

Updated On: 9/27/13 at 01:37 PM

[Gothampc]

Posted: 9/27/13 at 1:59pm

winston89 and junglered, what part of the original poster's opening statement didn't you understand?

"I'm starting this thread in hopes that we might have a civil discussion..."