Author Topic: Supreme Court challenge to the ACA  (Read 38029 times)

forummm

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Re: Supreme Court challenge to the ACA
« Reply #100 on: June 25, 2015, 07:12:36 PM »
It's a good step. We'll see what 2017 brings post-election.

Cherry Lane

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Re: Supreme Court challenge to the ACA
« Reply #101 on: June 25, 2015, 07:59:15 PM »
So...the decision is in. Is anyone going to sleep a little easier tonight?  FIRE sooner*?

I'd been waiting on this news to help with expense planning, but I came across another wrinkle recently.  As one eligible for Tricare Retired Reserve (at a cost of ~$5k/year), it seems I may be ineligible for ACA subsidies.  Anyone know for sure/can point me to a reference?

* OK, maybe not that, since this is the post-FIRE group...
I believe this is true about Tricare. I use the VA (service-connected disability) and because of that can not get ACA subsidies. It's either one or the other, not both.

Oh, I'm not looking for both.  I want to be able to use subsidized ACA instead of Tricare, because it will be less expensive.

Exflyboy

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Re: Supreme Court challenge to the ACA
« Reply #102 on: June 25, 2015, 09:21:40 PM »
Personally I'm thrilled!

Monkey Uncle

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Re: Supreme Court challenge to the ACA
« Reply #103 on: June 26, 2015, 04:02:30 AM »
So...the decision is in. Is anyone going to sleep a little easier tonight?  FIRE sooner*?

I'd been waiting on this news to help with expense planning, but I came across another wrinkle recently.  As one eligible for Tricare Retired Reserve (at a cost of ~$5k/year), it seems I may be ineligible for ACA subsidies.  Anyone know for sure/can point me to a reference?

* OK, maybe not that, since this is the post-FIRE group...

It's definitely a big relief for me.  The status of the ACA is the biggest remaining hurdle to my projected 1/1/19 FIRE.  But as Forummm says, we still need to get past whatever happens after the next presidential election.  Personally, I think it will get increasingly difficult from this point on to eliminate or gut the ACA.  I saw a poll out the other day that suggests public opinion is starting to turn in favor of the law as it becomes clearer that it really is reducing the ranks of the uninsured and is starting to at least slow the growth in costs.  Upholding the subsidies essentially turns the ACA into back-door single-payer.  I think once people get a taste of that, they will wonder how they ever lived without the ACA.

forummm

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Re: Supreme Court challenge to the ACA
« Reply #104 on: June 26, 2015, 07:17:51 AM »
So...the decision is in. Is anyone going to sleep a little easier tonight?  FIRE sooner*?

I'd been waiting on this news to help with expense planning, but I came across another wrinkle recently.  As one eligible for Tricare Retired Reserve (at a cost of ~$5k/year), it seems I may be ineligible for ACA subsidies.  Anyone know for sure/can point me to a reference?

* OK, maybe not that, since this is the post-FIRE group...

It's definitely a big relief for me.  The status of the ACA is the biggest remaining hurdle to my projected 1/1/19 FIRE.  But as Forummm says, we still need to get past whatever happens after the next presidential election.  Personally, I think it will get increasingly difficult from this point on to eliminate or gut the ACA.  I saw a poll out the other day that suggests public opinion is starting to turn in favor of the law as it becomes clearer that it really is reducing the ranks of the uninsured and is starting to at least slow the growth in costs.  Upholding the subsidies essentially turns the ACA into back-door single-payer.  I think once people get a taste of that, they will wonder how they ever lived without the ACA.

Yeah, this is what the Republicans are terrified of. Once people understand that we aren't killing grandmas and the economy didn't collapse and blood isn't running in the streets--but now their aunt has affordable health insurance after getting laid off--they are going to be pretty upset about that going away.

If they ever do get to "repeal and replace" it, the replacement will be pretty similar to the ACA.

MoneyCat

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Re: Supreme Court challenge to the ACA
« Reply #105 on: June 26, 2015, 09:31:26 AM »
I'm really pleased that the ACA subsidies were upheld, because that's a major pillar of my FIRE plans for the future.  The ACA isn't perfect, but it will do for now until we have a Republican party in Congress that's more inclined to discussion and compromise.

CaveDweller

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Re: Supreme Court challenge to the ACA
« Reply #106 on: June 27, 2015, 08:25:32 AM »
As a healthcare provider, the SCOTUS ruling is a big relief for me too. More people with insurance means fewer bills go unpaid, more job security and predictability of revenue for providers.

Of course it's much less important that ACA is beneficial to people like me and much more important that it benefits the country as a whole. Not only does the law provide more avenues and greater ease of obtaining insurance, but it also means (at least in theory) somewhat lower costs for those who already had insurance because hospitals will have less need to artificially inflate prices to accommodate for so much charity care/the unpaid bills of the people who don't have insurance. Though I'm the first to admit that such lower prices are painfully slow to materialize...

...Upholding the subsidies essentially turns the ACA into back-door single-payer.

I have to disagree with this sentiment though, as I think single-payer systems are generally far superior to the one we currently have. It's great that millions more people are now covered, but there's still HUGE variability in cost-sharing among different policies and maddening examples where people live in an area where no in-network providers are accepting new patients (what good is insurance then?). Or where the local hospital may be in-network, but the group of ED docs are not, and so after an emergency visit people get a surprise bill for thousands. Then there's the family affordability glitch that unfairly excludes a lot of low-income working parents from subsidies. Also the windfall to pharmaceutical companies and device-makers whereby CMS is prohibited from negotiating lower prices (even while CMS literally dictates prices to hospitals and providers for procedures and care). None of these issues are typical in Canada, Britain, or other single-payer countries.

ACA is a major step in the right direction, but make no mistake that there are still glaring flaws that need to be fixed. It's a shame it has become such a polarizing political issue, because it'll take the good faith efforts and cooperation of a lot of people to improve the system further. (Ok, putting my soapbox back into storage for now)

forummm

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Re: Supreme Court challenge to the ACA
« Reply #107 on: June 27, 2015, 08:35:15 AM »
Yeah, the ACA was a move away from a single payer. It would have been far easier, far cheaper, and far more popular to just have provided "Medicare for all", with people below 65 paying a premium based on age and income. But that idea didn't line the pockets of the private health insurers, and would eventually kill them off, so it didn't see the light of day.

Monkey Uncle

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Re: Supreme Court challenge to the ACA
« Reply #108 on: June 28, 2015, 04:25:37 AM »
O.K., I over-reached a bit in the way I worded my comparison of ACA to single-payer.  Obviously, in its current state, it is nowhere near the single-payer systems that most developed countries have.  But I think it will trend in that direction over time as working people start to realize that a heavily subsidized exchange policy competes quite favorably (cost-wise) with their expensive employer-provided plan.  As more people start using subsidized plans, the taxpayer picks up more and more of the total cost of health care.  The government becomes the 800 lb gorilla in the health care market, which gives it a lot of negotiating power (whether it will choose to use that power is another matter).  The cap on administrative cost and the mandate to provide real coverage for everyone limits the extent to which insurance companies can make money by abusing their policy holders, so they have an incentive to negotiate with providers for lower prices (they've already been doing this for many years - check out your next explanation of benefits statement to see the difference between what the provider says the service should cost vs. what the insurance company will actually pay for it).

Yes, it's still a sucky system, and I'm still pissed at Obama for taking real single-payer off the table at the beginning of the negotiations.  I think we'll get there eventually, but it's likely to be a long, painful road.  We'll need some new regulations that force providers to accept exchange policies.  Unfortunately it's politically infeasible to just euthanize the insurance companies and for-profit hospitals and move on.

forummm

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Re: Supreme Court challenge to the ACA
« Reply #109 on: June 28, 2015, 05:46:50 AM »
O.K., I over-reached a bit in the way I worded my comparison of ACA to single-payer.  Obviously, in its current state, it is nowhere near the single-payer systems that most developed countries have.  But I think it will trend in that direction over time as working people start to realize that a heavily subsidized exchange policy competes quite favorably (cost-wise) with their expensive employer-provided plan.  As more people start using subsidized plans, the taxpayer picks up more and more of the total cost of health care.  The government becomes the 800 lb gorilla in the health care market, which gives it a lot of negotiating power (whether it will choose to use that power is another matter).  The cap on administrative cost and the mandate to provide real coverage for everyone limits the extent to which insurance companies can make money by abusing their policy holders, so they have an incentive to negotiate with providers for lower prices (they've already been doing this for many years - check out your next explanation of benefits statement to see the difference between what the provider says the service should cost vs. what the insurance company will actually pay for it).

Yes, it's still a sucky system, and I'm still pissed at Obama for taking real single-payer off the table at the beginning of the negotiations.  I think we'll get there eventually, but it's likely to be a long, painful road.  We'll need some new regulations that force providers to accept exchange policies.  Unfortunately it's politically infeasible to just euthanize the insurance companies and for-profit hospitals and move on.

That's very different from single payer. Yes, private insurer overhead is limited. But none of the tax credits or anything gives the government any leverage or bargaining power at all. Those are still retained by the insurers--and they have limited ability to use that leverage. In our current dynamic if there's only one hospital in an area, or one hospital that buyers want included, the hospital can charge whatever they want and the insurer has no choice but to pay it. And hospitals are buying up physician practice networks to further increase their leverage. It's a really stupid system, and not at all a competitive free market. It would be much more efficient to just have one payer.

CaveDweller

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Re: Supreme Court challenge to the ACA
« Reply #110 on: June 28, 2015, 11:14:09 AM »
Yes, it's still a sucky system, and I'm still pissed at Obama for taking real single-payer off the table at the beginning of the negotiations.  I think we'll get there eventually, but it's likely to be a long, painful road.

Amen brother, I really hope you're right about that!

And forummm, you make an EXTREMELY salient point that as long as private insurers act as the mandatory middle man, that 800 lb gorilla is effectively shackled, ball-gagged, and hog-tied in not being able to negotiate prices (or in the case of CMS being prohibited from negotiating with pharmaceuticals, Congress has shackled itself).

I SAY LET LOOSE THE GORILLA!!!!!!!

Exflyboy

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Re: Supreme Court challenge to the ACA
« Reply #111 on: June 28, 2015, 04:18:40 PM »
As a British Ex Pat who's Father has to go see the Cardiologist every couple of months I can say the single payer system works very well indeed.. Of course its not perfect, but its also half the cost as what we pay in the USl.

Obama could not get a single payer systems to stick in the USA.. way too many powerful (monied) interests to prevent that.

BUT... anything that keeps HC on the table and causes discussion (and pain for all) might eventually move the needle to the next "new deal".

My God, maybe we might wake up and realize Medicare is THE most cost efficient way we actually buy medical care in the US...Maybe we'll realize that not everything has to be a business... MAYBE one day we will vote based on data rather than ideology!

Then again.. Maybe one day pigs will actually fly as well.

Pooperman

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Re: Supreme Court challenge to the ACA
« Reply #112 on: June 29, 2015, 05:13:15 AM »
Then again.. Maybe one day pigs will actually fly as well.

We got a black president, gay marriage is legal, pot will be, and you think we won't? Shit happens that you don't expect. It might not be this year, but it will happen eventually.

dragoncar

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Re: Supreme Court challenge to the ACA
« Reply #113 on: June 29, 2015, 12:56:07 PM »
Then again.. Maybe one day pigs will actually fly as well.

We got a black president, gay marriage is legal, pot will be, and you think we won't? Shit happens that you don't expect. It might not be this year, but it will happen eventually.

So true. The way science is advancing, it's inevitable that pigs will eventually fly.

sol

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Re: Supreme Court challenge to the ACA
« Reply #114 on: June 29, 2015, 02:41:30 PM »
Then again.. Maybe one day pigs will actually fly as well.

We got a black president, gay marriage is legal, pot will be, and you think we won't?

Well shit, when you say it like that it's no wonder ISIS hates us so much.

Pooperman

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Re: Supreme Court challenge to the ACA
« Reply #115 on: June 29, 2015, 03:49:19 PM »
Then again.. Maybe one day pigs will actually fly as well.

We got a black president, gay marriage is legal, pot will be, and you think we won't?

Well shit, when you say it like that it's no wonder ISIS hates us so much.

They be hatin our slightly less crappy healthcare system.

Arktinkerer

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Re: Supreme Court challenge to the ACA
« Reply #116 on: July 01, 2015, 10:47:16 AM »
About to pull the plug and the ACA makes me a lot more comfortable about my healthcare options right now.  But a very quick scan of the comments and it seems like people are to focused on whether they like/dislike ACA and not the process that got us here.

The ACA was done via a backdoor mechanism so the D's could shove it thru congress.  The pretzel the Supremes made of logic to try and keep it going in the first challenge opened it to another challenge that is still pending.  Even those that bent over backwards to approve it this time acknowledged that it was passed in a bizarre manner and was poor legislation.  It is very clear that few legislators read the thing (how could they given the length and the time frame they had) but that may be business as usual and now more people know it.

I guess my main point is which ever way you lean on the legislation itself, it is now very clear, in my opinion, that the Supreme Court is very broken.  The law is not interpreted as written.  Congress is broken-- since they don't really write or even read the laws, the Supreme Court can't really look at original intent.  The Supreme Court no longer holds the moral high ground--when you helped craft the legislation, you should not be in a position to rule on its legality.


forummm

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Re: Supreme Court challenge to the ACA
« Reply #117 on: July 01, 2015, 11:21:33 AM »
About to pull the plug and the ACA makes me a lot more comfortable about my healthcare options right now.  But a very quick scan of the comments and it seems like people are to focused on whether they like/dislike ACA and not the process that got us here.

The ACA was done via a backdoor mechanism so the D's could shove it thru congress.  The pretzel the Supremes made of logic to try and keep it going in the first challenge opened it to another challenge that is still pending.  Even those that bent over backwards to approve it this time acknowledged that it was passed in a bizarre manner and was poor legislation.  It is very clear that few legislators read the thing (how could they given the length and the time frame they had) but that may be business as usual and now more people know it.

I guess my main point is which ever way you lean on the legislation itself, it is now very clear, in my opinion, that the Supreme Court is very broken.  The law is not interpreted as written.  Congress is broken-- since they don't really write or even read the laws, the Supreme Court can't really look at original intent.  The Supreme Court no longer holds the moral high ground--when you helped craft the legislation, you should not be in a position to rule on its legality.

I differ slightly. The first part of the ACA was passed through normal Congressional activity (not reconciliation). But when Kennedy died, they still had to pass the fixes they intended to pass all along. But the Republicans were still filibustering it. So they could only pass the budget items through the normal reconciliation process. And some things never got fixed as a result. And in any bill of any complexity, there are going to be typos--like these 4 words were. That's just reality. Normally the typos would be 1) ignored and not sued over because they were obviously typos, 2) fixed by some unanimous consent motion or 3) a court would say "yeah these are clearly typos". The absurd partisan atmosphere around this bill made the first 2 go atypically. So the 3rd one had to be invoked--at a great waste of everyone's time.

I don't think the SCOTUS decisions on any of the ACA cases were "bending over backwards" or "pretzel logic". You may not like them (I don't like some aspects of them). But they were all reasonable. And not that atypical for court cases. There's all kinds of weird stuff and unintended consequences with legislation. Lots of typos or things they didn't consider. It happens all the time. Maybe you're just not familiar with it. Only a few high profile cases out of the hundreds of thousands of lawsuits filed each year become news.

SCOTUS didn't help craft the legislation. That's not a reasonable point of view. They just decided between conflicting interpretations of the law. Like courts do as their job every day.

UnleashHell

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Re: Supreme Court challenge to the ACA
« Reply #118 on: July 01, 2015, 01:01:03 PM »
Then again.. Maybe one day pigs will actually fly as well.

We got a black president, gay marriage is legal, pot will be, and you think we won't?

Well shit, when you say it like that it's no wonder ISIS hates us so much.
I think its the flying pigs they'll be having more of an issue with...

Arktinkerer

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Re: Supreme Court challenge to the ACA
« Reply #119 on: July 01, 2015, 08:51:09 PM »

I differ slightly. The first part of the ACA was passed through normal Congressional activity (not reconciliation). But when Kennedy died, they still had to pass the fixes they intended to pass all along. But the Republicans were still filibustering it. So they could only pass the budget items through the normal reconciliation process. And some things never got fixed as a result. And in any bill of any complexity, there are going to be typos--like these 4 words were. That's just reality. Normally the typos would be 1) ignored and not sued over because they were obviously typos, 2) fixed by some unanimous consent motion or 3) a court would say "yeah these are clearly typos". The absurd partisan atmosphere around this bill made the first 2 go atypically. So the 3rd one had to be invoked--at a great waste of everyone's time.

I don't think the SCOTUS decisions on any of the ACA cases were "bending over backwards" or "pretzel logic". You may not like them (I don't like some aspects of them). But they were all reasonable. And not that atypical for court cases. There's all kinds of weird stuff and unintended consequences with legislation. Lots of typos or things they didn't consider. It happens all the time. Maybe you're just not familiar with it. Only a few high profile cases  out of the hundreds of thousands of lawsuits filed each year become news.

SCOTUS didn't help craft the legislation. That's not a reasonable point of view. They just decided between conflicting interpretations of the law. Like courts do as their job every day.

It was not passed in the normal manner--even the Democrats acknowledge that.  A failed bill was stripped of everything but the title and the entire text was added as an amendment.  Declaring what was specifically described as a fee as a tax was the only way one Justice could say it was permissible.  That is the basis for the next challenge given that the original bill started in the Senate and not the House as is constitutionally required for a tax.  That appeal is now working its way up the chain.  That the SC will accept that case is unlikely and that they would acknowledge that violation  if the case was heard is even less unlikely given at least one very powerful individual would have to admit he was wrong.  Most judges aren't built that way.  The Constitution as a whole means very very little anymore.  Laws are not worth the words they use or the ink to print them.

waltworks

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Re: Supreme Court challenge to the ACA
« Reply #120 on: July 01, 2015, 10:26:01 PM »
Thing is, if you really want to go down the rabbit hole of appealing every tiny technicality and typo to SCOTUS, you really basically have admitted you have no useful ideas.

I would *love* to see the ACA repealed and replaced with something better. I even have lots of (just suck it up and let anyone who wants to sign up for Medicare?) ideas for what that could be.

But the folks filing the lawsuits, AFAIK, have nothing. Now, if the ACA mandated euthanasia for everyone over the age of 60 to save money, or something, then obviously any and all means to repeal it would be fine. It's hard for me to see how it's *worse* than the old status quo, though, and arguably it's somewhat better. Regardless it's not forcing everyone to wear a swastika and sing the internationale every morning over lukewarm soylent green.

Which means... I should be dizzy from all the great ideas the repeal-this-mediocre/convoluted-centrist-legislation folks have in mind. Because if you just throw the damn thing out, and don't do anything to replace it, then a whole lot of folks are in for a very hard time. So it's on the repeal side to have a DAMN GOOD replacement ready and waiting. Maybe that exists, but if it does they sure don't talk about it much.


sol

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Re: Supreme Court challenge to the ACA
« Reply #121 on: July 01, 2015, 10:43:47 PM »
So it's on the repeal side to have a DAMN GOOD replacement ready and waiting. Maybe that exists, but if it does they sure don't talk about it much.

The problem with all of the alternatives suggested thus far is that while they still hate the mandate that forces everyone to buy insurance, they love the part about preexisting conditions being covered.  So all of their proposals keep the universal coverage without the universal mandate, which everyone recognizes is a pathway to the death spiral. 

Rates would rise as healthy people declined to enroll.  The whole point of the ACA was to do both simultaneously, increasing insurance company revenues while expanding their coverage to more people, and you can't do the second without the first. At least not if you want the insurance companies to stay in business, or let them drive up rates to unaffordable levels.  That system would be even worse than what we had before.

dragoncar

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Re: Supreme Court challenge to the ACA
« Reply #122 on: July 01, 2015, 11:56:05 PM »
Thing is, if you really want to go down the rabbit hole of appealing every tiny technicality and typo to SCOTUS, you really basically have admitted you have no useful ideas.

Who is appealing this anyways?  Oh, https://en.wikipedia.org/wiki/Competitive_Enterprise_Institute  What a waste of money

Arktinkerer

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Re: Supreme Court challenge to the ACA
« Reply #123 on: July 02, 2015, 06:35:33 AM »
The last three comments have proved my point.  While you may like the ACA, or prefer it to its alternatives, or decry the lack of alternatives, the system has broken down.  We don't discuss and work within the legal framework anymore.  The system is broken from bottom to top.  The SC doesn't just interpret law.  The congress and president give lip service, if that, to the constitution, the public wants what they want by any means needed.

We have the means to change even the legal framework if that is what we want to do.  The Constitution is a good framework but its not sacred.  Still, we refuse to change it or say "It's too hard to change." So we are becoming a lawless society.  The law means whatever they say it means at this moment in time.

forummm

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Re: Supreme Court challenge to the ACA
« Reply #124 on: July 02, 2015, 07:53:13 AM »
The last three comments have proved my point.  While you may like the ACA, or prefer it to its alternatives, or decry the lack of alternatives, the system has broken down.  We don't discuss and work within the legal framework anymore.  The system is broken from bottom to top.  The SC doesn't just interpret law.  The congress and president give lip service, if that, to the constitution, the public wants what they want by any means needed.

We have the means to change even the legal framework if that is what we want to do.  The Constitution is a good framework but its not sacred.  Still, we refuse to change it or say "It's too hard to change." So we are becoming a lawless society.  The law means whatever they say it means at this moment in time.

Regarding the bolded, I don't agree. If you want to pick a real example where we are ignoring the law, you would have a good case with warrantless mass surveillance, civil forfeiture, stop and frisk, etc. But the ACA is not that example. You disagreeing with what a law says does not mean that people aren't following it.

waltworks

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Re: Supreme Court challenge to the ACA
« Reply #125 on: July 02, 2015, 07:57:33 AM »
Ok, what's your constitutional amendment suggestion that will help with providing health care?


Arktinkerer

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Re: Supreme Court challenge to the ACA
« Reply #126 on: July 02, 2015, 05:15:01 PM »
Ok, what's your constitutional amendment suggestion that will help with providing health care?

This will probably decay into a pure political squabble.  If any moderator thinks we should just kill this line of thought or move it to another forum please say so.  Not sure what the limits are around here.

With respect to your question, I think the problem is much deeper and older than that.  The first question is does the Constitution allow the federal government to require or even regulate healthcare?  The question of the limits on the federal government go way back.  The 10th amendment says powers not delegated to the feds belong to the states.  The use of the "general welfare" clause has been stretched so far that there are serious legal scholars claiming the 10th amendment should be treated as a truism by which they really mean ignored.  Either the general welfare clause needs to go or the 10th needs to go.  Since the 10th was the latest modification I would say it takes priority but that's not the way things seem to be going...

forummm

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Re: Supreme Court challenge to the ACA
« Reply #127 on: July 02, 2015, 05:30:13 PM »
Ok, what's your constitutional amendment suggestion that will help with providing health care?
The first question is does the Constitution allow the federal government to require or even regulate healthcare? 

This is not a question. SCOTUS has already decided that the federal government can levy a tax on people who do not have health insurance. And similarly with regulation of the industry.

Arktinkerer

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Re: Supreme Court challenge to the ACA
« Reply #128 on: July 02, 2015, 07:24:08 PM »
Ok, what's your constitutional amendment suggestion that will help with providing health care?
The first question is does the Constitution allow the federal government to require or even regulate healthcare? 

This is not a question. SCOTUS has already decided that the federal government can levy a tax on people who do not have health insurance. And similarly with regulation of the industry.

So the tenth amendment was repealed when?  Name three areas of our lives that the tenth amendment prohibits the feds from interfering with and reserves to the states.  I can't think of one where the federal government would be barred on just the 10th amendment.

sol

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Re: Supreme Court challenge to the ACA
« Reply #129 on: July 02, 2015, 07:37:40 PM »
Name three areas of our lives that the tenth amendment prohibits the feds from interfering with and reserves to the states.  I can't think of one

1.  Driver's licenses
2.  Concealed carry permits
3.  Health care exchanges, unless the state declines to do so in which case the federal government steps in.

That took about nine seconds.  I bet you and I could both think of a few more without trying too hard.

Cathy

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Re: Supreme Court challenge to the ACA
« Reply #130 on: July 02, 2015, 07:51:46 PM »
Arktinkerer is apparently making the arguable philosophical point that the rulings of the Supreme Court only reflect the opinion of the Supreme Court, as opposed to being "the law" in some Štheral sense. Earlier in this very thread I implicitly took the opposite position in this debate when I suggested that articles disagreeing with the rulings of the Court did not change the actual state of "the law".

However, some scholars -- including some justices -- would agree with Arktinkerer's position. Thomas J often specially concurs or dissents to allege that the precedents of the Court are wrong and should be ignored. For example, in Preston v. Ferrer (2008), 552 US 346, the question before the Court was whether the Federal Arbitration Act superseded state law that specified the forum for arbitration. Previous decisions of the Court had already ruled that the Act applied to proceedings in state court. Rather than grapple with the question before the Court, Thomas J dissented on the basis on that the Act categorically does not apply in state court proceedings, contrary to the law as determined by the Court.

You might say there is a difference between Thomas J penning a dissent in an actual court case, compared to Arktinkerer posting to this forum, but legally there really isn't. Preston was decided on an 8-1 vote and the dissent of Thomas J has the same legal effect as Arktinkerer's posts here (i.e. none at all).

Regarding the 10th amendment to the US Constitution, it only restates the principle that was codified in the text of the main body of the Constitution; it is not the source of any legal rule itself. The Supreme Court has repeatedly stated that the 10th amendment "added nothing to the [US Constitution] as originally ratified and has no limited and special operation": United States v. Sprague (1931), 282 US 716, 733. The correct question is whether a federal statute is within the powers of Congress; asking instead whether it "violates the 10th amendment" is an unnecessarily indirect way of phrasing the question and implies (incorrectly) that the 10th amendment contains rights of its own, which it does not. The 11th amendment is often similarly misunderstood, but that's a discussion for another post.

As for the federalism concerns relative to healthcare, there are ways to handle healthcare in a federation other than the approach adopted by the legislation commonly referred to as the "Affordable Care Act". Here's an example of a different approach:

The Canada Health Act, RSC 1985, c C-6, provides that each province will receive a "cash contribution" if the healthcare system in the province satisfies certain minimum requirements. If a province wants to receive the cash contribution, it can then use whatever approach it wants to bring its healthcare system up to the standards dictated in the federal Act. The Act does not require provinces to do anything (unless they want to receive the cash contribution). The Act also does not impose any requirements on individuals whatsoever.

The actual health care regulation is not a matter of federal law in Canada. For example, Alberta's health care system is authorised by the Alberta Health Care Insurance Act, RSA 2000, c A-20, an Act of the Legislature of Alberta. This approach is actually remarkably decentralised compared to the US approach. The Canada Health Act is only 7 printed pages long and sets out the requirements for the cash contribution in a very broad and open-ended set of terms. The details of health care regulation are instead found in provincial statutes.

It sounds to me like Arktinkerer is basically saying that he prefers the Canadian system of health care regulation to the US one.
« Last Edit: July 02, 2015, 11:51:15 PM by Cathy »

waltworks

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Re: Supreme Court challenge to the ACA
« Reply #131 on: July 02, 2015, 08:22:32 PM »
The general welfare clause has been widely understood to give the federal gov't a lot of power for a long time. Hard to argue that health care isn't "general welfare" (not to mention plenty of interstate commerce happening there, but I digress).

I guess you could amend things a bunch and basically recreate the articles of confederation, but there's a reason that didn't work out. The constitution was a direct reaction to the federal government NOT having enough power and the states having too much - resulting in a large-scale collective action problem that made the whole thing unworkable.

But let's get back to brass tacks. Say your state has unlimited authority to regulate health care as it sees fit (ala Canada). No federal interference. What do you propose *actually doing*? I don't want political philosophy here, I want "my baby is healthy because I was able to afford/got the vaccinations and health checks she needed, so now she can grow up and contribute to society."

-W
« Last Edit: July 02, 2015, 08:47:52 PM by waltworks »

Arktinkerer

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Re: Supreme Court challenge to the ACA
« Reply #132 on: July 03, 2015, 06:00:35 AM »
Name three areas of our lives that the tenth amendment prohibits the feds from interfering with and reserves to the states.  I can't think of one

1.  Driver's licenses
2.  Concealed carry permits
3.  Health care exchanges, unless the state declines to do so in which case the federal government steps in.

That took about nine seconds.  I bet you and I could both think of a few more without trying too hard.

Federal government does regulate drivers licenses and defines much of how the health exchanges must work.  While concealed carry permits for citizens are not regulated yet, there are federal laws concerning concealed carry for law enforcement.  But you have entirely skipped the point.  If tomorrow, there were federal laws regulating all three of these in every detail, do you think they could be effectively challenged in court as violations of the 10th amendment?


Arktinkerer

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Re: Supreme Court challenge to the ACA
« Reply #133 on: July 03, 2015, 06:19:50 AM »
A more general reply to the two previous comments--

There does seem to be a lot of belief that the supreme court is somehow unerring and all powerful in that once they say something it is totally settled and should/can never be changed.  They are wrong.  They do change.  Much more needs to be changed. 

One more small example that is very anti-mustachian and drives home the overreach and recasting of laws.  Growing hay on my property to feed my own cattle is subject to federal regulation.  This went to the SC who ruled it could be regulated under interstate commerce.  Why?  Because if I grow hay, I won't buy it, and I might have bought it from another state.

For Waltwork's more direct question--I would immediately remove the link between employment and health insurance.  It will take years for the full impact of this to roll thru the system but I believe this is what caused much of our problems in the first place.  People don't know what they pay because almost no one pays directly--providers usually can't even tell you the costs if you ask them.  If they don't know, and don't pay directly, most people are not cost sensitive to the issue.  Second, remove federal regulation and funding on residents (doctors in training).  The federal government tried to limit the growth of medical costs by limiting the number of doctors.  Not the smartest move.

These will take a while to work but should drastically reduce medical costs over time.

Arktinkerer

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Re: Supreme Court challenge to the ACA
« Reply #134 on: July 03, 2015, 06:46:50 AM »
Just got one more quick comment before I go to work for Megacorp (a little over one month to go before I pull the plug and go on Obamacare!).  I appreciate Cathy's post.  I would love to discuss that in more detail but I fear I am already drifting from the intent of this thread and, again, I have to go to work!

waltworks

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Re: Supreme Court challenge to the ACA
« Reply #135 on: July 03, 2015, 07:17:01 AM »
Yeah, employment should have nothing to do with health care (other than providing salary which you can use to pay for it, if you want). How would you go about doing that? Make it illegal? Or just remove the tax deductibility of benefits for employers?

We're going on ACA in about a month too, cheers!

-W

forummm

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Re: Supreme Court challenge to the ACA
« Reply #136 on: July 03, 2015, 08:24:59 AM »
Yeah, employment should have nothing to do with health care (other than providing salary which you can use to pay for it, if you want). How would you go about doing that? Make it illegal? Or just remove the tax deductibility of benefits for employers?

We're going on ACA in about a month too, cheers!

-W

Remove the tax deductibility and the (new via ACA) fee for large employers not providing insurance to employees. It would go away quickly.

Telecaster

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Re: Supreme Court challenge to the ACA
« Reply #137 on: July 03, 2015, 12:41:36 PM »
The last three comments have proved my point.  While you may like the ACA, or prefer it to its alternatives, or decry the lack of alternatives, the system has broken down.  We don't discuss and work within the legal framework anymore.  The system is broken from bottom to top.  The SC doesn't just interpret law.  The congress and president give lip service, if that, to the constitution, the public wants what they want by any means needed.

We have the means to change even the legal framework if that is what we want to do.  The Constitution is a good framework but its not sacred.  Still, we refuse to change it or say "It's too hard to change." So we are becoming a lawless society.  The law means whatever they say it means at this moment in time.

I think you are way over stating your case.  Congress clearly meant for there to be functioning insurance exchanges in each state.   There was one phrase that might have suggested something different, but maybe not.   The court looked at it and concluded that Congress meant for there to be functioning insurance exchanges in each state.  Courts make these types of rulings all the time when portions of laws or different laws conflict with each other.   Been that way since day one.

And by the way, your objections as to how laws are made and interpreted by the courts are not indications of a lawless society.   They are indications you don't like the way laws are made and interpreted by the courts.   You might have some good points in there, but they get drowned  in the over-the-top hyperbole.   We're not a lawless nation.  C'mon.   




Arktinkerer

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Re: Supreme Court challenge to the ACA
« Reply #138 on: July 04, 2015, 10:50:39 AM »
I think you are way over stating your case.  Congress clearly meant for there to be functioning insurance exchanges in each state.   There was one phrase that might have suggested something different, but maybe not.   The court looked at it and concluded that Congress meant for there to be functioning insurance exchanges in each state.  Courts make these types of rulings all the time when portions of laws or different laws conflict with each other.   Been that way since day one.

And by the way, your objections as to how laws are made and interpreted by the courts are not indications of a lawless society.   They are indications you don't like the way laws are made and interpreted by the courts.   You might have some good points in there, but they get drowned  in the over-the-top hyperbole.   We're not a lawless nation.  C'mon.

Do you really think congress read this before they signed it? Remeber "We have to pass the bill so that you can find out what is in it"? A primary architect (Gruber) of the legislation stated publicly that the clause was intentional to make it financially imperative for states to set up their own exchanges:  "If you're a state and you don’t set up an Exchange, that means your citizens don’t get their tax credits. … I hope that’s a blatant enough political reality that states will get their act together and realize there are billions of dollars at stake here in setting up these Exchanges, and that they’ll do it.” That was in 2012.  Story is different now.  Like the penalty is really a tax even if it says its a penalty in the law and was never discussed as a tax.  It means whatever they want it to mean at this moment in time.

Are we lawless like Somalia?  Not yet.  But we are not following our laws anymore.  Is marijuana illegal?  Colorado says yes, feds say no but they will not enforce the law.  In the country illegally?  We will give you food shelter and medical care. We are still a mostly moral and ethical country but more and more people are breaking laws because they just don't mean much anymore.   The consequences of getting caught matter so we measure what happens if we get caught but we won't do the work to change the laws thru the legislative process.  The top 1% political and economic elite are worst of all.  Laws are for the little people and the laws mean whatever the leaders choose to say they mean at this moment in time. 

Maybe its always been this way and we are now really getting a good blow by blow account of how the country has always been run.  Certainly not the way were indoctrinated, I mean taught, in school.
« Last Edit: July 04, 2015, 10:52:27 AM by Arktinkerer »

Arktinkerer

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Re: Supreme Court challenge to the ACA
« Reply #139 on: July 04, 2015, 10:58:55 AM »
Yeah, employment should have nothing to do with health care (other than providing salary which you can use to pay for it, if you want). How would you go about doing that? Make it illegal? Or just remove the tax deductibility of benefits for employers?

We're going on ACA in about a month too, cheers!

-W

Any service provided by a business should be taxable as income.  If we want insurance to be deductible it should be at the individual level.  Being an employee should be as close to being a self employed contractor as possible.  Anything more just muddies the waters and makes it a much bigger jump for people to break away from corporations and start their own enterprises.  The employment taxes and laws are also so complex it makes it harder for the small ventures to grow.  Make it simpler all around and I think private enterprise would grow enough to more than make up for all the newly unemployed accountants and tax preparers!

DavidAnnArbor

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Re: Supreme Court challenge to the ACA
« Reply #140 on: July 05, 2015, 10:03:33 AM »

we are not following our laws anymore.  more and more people are breaking laws because they just don't mean much anymore.   Maybe its always been this way and we are now really getting a good blow by blow account of how the country has always been run.

The underground railroad, churches sheltering illegal aliens who were fleeing poverty, gay people openly dancing together in mafia run bars in the 1950's, civil disobediance against Jim Crow segregation laws are examples of not following unjust laws that were made by repressive politicians who pandered to whatever it took to get elected.