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Joseph Gauthier
Byrne Robotics Member
Joined: 11 March 2009
Posts: 1414
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| Posted: 03 March 2015 at 1:13pm | IP Logged | 1
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For those not familiar with the lawsuit, the petitioners in this case have sued the federal government, claiming that the text of the law limits the availability of taxpayer funded insurance subsidies to consumers of plans purchased on state based exchanges, and does not provide the executive branch with the authority it exercised when subsidies were extended to consumers who purchased plans on the federal exchange. Arguments in this case are scheduled for tomorrow morning, with a ruling expected in late June.
For purposes of this discussion, I'm less interested in a re-litigation of the law itself than I am in a discussion of what happens going forward if the lawsuit is successful. For context, we do know that of the fifty states, only fourteen have created state based exchanges, potentially leaving consumers in thirty-six states without access to taxpayer funded subsidies- dependent upon the outcome of the case. While very few among the professional class of observers seem willing to predict the outcome of the case, there is near universal agreement that a favorable ruling for the plaintiffs could strike a fatal blow against the entirety of the law, setting in motion an inescapable death-spiral in which the law is, in effect, repealed by market forces. This outcome could be avoided, however, if the legislative branch exercises its lawmaking ability to extend eligibility for subsidies to the federal exchange. But if we assume, for purposes of this discussion, that the lawsuit succeeds, inaction by the Congress could potentially ensure a complete destruction of the law, so how likely is that?
One thing we can certainly count on, if the plaintiffs succeed, is intense political pressure directed at legislators from constituents on both sides of the aisle, lobbying their members of Congress to either keep the subsidies limited to state based exchanges, or to re-extend them to the federal exchange. One potential outcome is a grand compromise.
And that's what I'm most interested in with this discussion. If the lawsuit succeeds, would you be open to a compromise? Who do you feel would be in a stronger negotiating position? If you favor the law, what would you be willing to give up to ensure a return of subsidies to the federal exchange? If you're opposed to the law, what concessions would you demand in return for an extension of subsidies to the federal exchange?
For me, I could be made amiable to a reestablishment of federal subsidies in exchange for a repeal of all mandates associated with the law. I'm not sure if the funding of the law could be made viable without the mandates and the associated fines, but that's what it would take for me to even be open to a compromise. The details of the funding plan would determine my support. What about the rest of you? What do you think stays and what do you think goes? What would you like to see in a realistic compromise?
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Wilson Mui
Byrne Robotics Member
Joined: 27 June 2004
Location: United States
Posts: 4523
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| Posted: 03 March 2015 at 1:54pm | IP Logged | 2
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In order for universal healthcare to work, don't we need the mandate and penalties? If not, only sick people would sign up. Healthy people would just wait until they were really sick to get the coverage. That would bankrupt the system.
I would get rid of the rule that says the government is not allowed to negotiate drug prices. That makes no sense to me at all.
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Joseph Gauthier
Byrne Robotics Member
Joined: 11 March 2009
Posts: 1414
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| Posted: 03 March 2015 at 2:37pm | IP Logged | 3
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In order for universal healthcare to work, don't we need the mandate and penalties?
Not necessarily. The mandates and fines do provide a significant funding component in this particular writing of the law, but the law can be revised to provide alternative funding mechanisms. But you're right, if the mandates and fines are removed without concurrent revisions to address the resulting vacuum, the law would collapse in upon itself. But if we assume that the Supreme Court decides in favor of the plaintiffs in King v. Burwell, without revisions in the law, the law will still collapse in upon itself.
For me, and millions of other Americans I suspect, the mandates and the associated fines are non-negotiable. To us, they are the most toxic part of Obamacare, and represent the reason we are still passionately opposed to the law. In fact, I'm of the opinion that had Democrats passed a means tested Medicaid buy-in, rather than what they ended up with, they would have met the same resistance from from their constituents at the time (due to fiscal concerns), but opposition would have melted away among the voters as time passed. Today, more than half of the country still hates the law- passionately. And I believe it's the mandates that arouse those passions. It is in my case.
Finding an alternate funding mechanism would certainly be a tough slough, but inaction - in our scenario- ensures the death of the law, so I do see an incentive for Congressional Democrats to deal.
But here's another question, do you think the President would sign a compromise deal that alters the law, or would he dig in his heels, hoping that prevailing politics would play against Republicans?
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Brennan Voboril
Byrne Robotics Member
Joined: 15 January 2011
Posts: 1734
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| Posted: 03 March 2015 at 3:49pm | IP Logged | 4
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Add dental? Cap drug prices for seniors?
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Brad Wilders
Byrne Robotics Member
Joined: 15 December 2008
Posts: 173
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| Posted: 03 March 2015 at 4:16pm | IP Logged | 5
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The mandates and fines are anything but a "significant funding component" of the law. They exist solely as an incentive to get healthy people to buy insurance while they are still healthy and to avoid the situation where a healthy person refuses, but then seeks healthcare or health services as soon as they get sick. In the ideal world (according to the Congress who drafted the law), there would no fines because everyone would get the health insurance, the risk would be spread across healthy and non-healthy, and the costs of healthcare, relative to what they would be in the absent of the law, would go down. Re-writing the law to provide "alternate funding sources" would do nothing to ensure there are the necessary healthy people in the insurance pool to justify the restrictions imposed on the insurance companies (ie: being prohibited from rejecting someone on account of preexisting condition, lower costs by spreading the risk).
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Jason Czeskleba
Byrne Robotics Member
Joined: 30 April 2004
Posts: 4548
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| Posted: 03 March 2015 at 6:58pm | IP Logged | 6
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Without the individual mandate, insurance rates would skyrocket and the Affordable Care Act would inevitably collapse. It's not a compromise that anyone with an interest in maintaining this law would ever consider.
As far as compromises go, I am skeptical there is any significant change that could be made to this law that would not render it unworkable. It is a Rube-Goldberg-esque contraption of a law that can't really be tweaked without breaking it completely.
At any rate, discussion of compromise negotiation will never extend beyond the hypothetical. There is too large a contingent of Republicans who will settle for no less than total dismantling of the law, and would not be willing to negotiate in any way. No compromise legislation will cross Obama's desk.
If both Roberts and Kennedy rule in favor of King v Burwell, the ACA is quite simply coming to an end.
Edited by Jason Czeskleba on 03 March 2015 at 6:59pm
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Peter Hicks
Byrne Robotics Member
Joined: 30 April 2004
Location: Canada
Posts: 1886
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| Posted: 03 March 2015 at 8:03pm | IP Logged | 7
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As a Canadian, I have no dog in this fight. I am curious as to why the majority of Americans strongly dislike Obamacare, when the mandate only affects less than 20 percent of the population (since most Americans have healthcare paid for by their employers, Medicare, or Medicare). And Obamacare confers significant benefits for everybody, such as no more lifetime deductible limits, no more denial of coverage for pre existing conditions, keeping your children on your family policy until age 26, etc. Is it just the association with Obama that is really the issue? I would think that if Republicans got their wish and Obamacare was repealed, there would be public pressure to establish replacement legislation to maintain the same benefits that Obamacare created.
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David Miller
Byrne Robotics Member
Joined: 16 April 2004
Posts: 3004
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| Posted: 03 March 2015 at 8:20pm | IP Logged | 8
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The problem is, if the Supreme Court crippled Obamacare, there's no fix.
There will be no compromise bill for Obama to sign. Republicans have been promising an alternative to Obamacare for six years, and have produced jack and shit in the way of specifics. (It's ironic, since Obamacare was created by Republicans as an alternative to Hillarycare in the Nineties.)
Basically, the country can look forward to following the years of disarray in setting up Obamacare with years of chaos dismantling it, not to mention the capital wasted in the effort, while health care prices return to rising at their pre-2010 rates plus interest and people like me can go back to spending 50% of our income on medical care, just the way Jesus intended.
But hey, the Republican Party can blame Obama for the consequences of their bullshit lawsuit while they congratulate themselves to their calcified base for keeping the government out of Medicare.
This is why I don't want them going anywhere near Social Security.
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Jason Czeskleba
Byrne Robotics Member
Joined: 30 April 2004
Posts: 4548
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| Posted: 03 March 2015 at 9:03pm | IP Logged | 9
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Peter Hicks wrote:
| I am curious as to why the majority of Americans strongly dislike Obamacare |
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I am of the opinion that a lot of people who dislike Obamacare do so either because they do not understand it, or simply because it is associated with Obama.
I myself dislike it because it is a complicated jumble of a law designed to appeal to insurance companies, keeping healthcare management in the private sector rather than the more efficient and cheaper system of simply having the government provide insurance and paying for it with taxes. That said, I would not like to see the law dismantled because it would result in millions losing their insurance, and likely the rise of healthcare costs. Flawed as it is, it is preferable to leaving things as they were beforehand.
There are also those who object to the law on the grounds that the government shouldn't be forcing someone to buy a product from private businesses. A fair complaint, but a situation that was created by the insistence on crafting pro-insurance industry legislation and not considering a public option.
QUOTE:
| I would think that if Republicans got their wish and Obamacare was repealed, there would be public pressure to establish replacement legislation to maintain the same benefits that Obamacare created. |
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If the two undecided members of the SCOTUS do rule against Obamacare, it will be interesting to see how this all plays out. The popular parts of the law can't be maintained without the unpopular, at least not without increasing costs to the point of unfeasability. I suspect there will be significant political blowback if the Republicans get their wish and the law collapses. Causing millions to lose their insurance is not going to be popular... and not all those millions are Democrats, despite what Mitt Romney might think.
Edited by Jason Czeskleba on 03 March 2015 at 9:07pm
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Stephen Robinson
Byrne Robotics Member
Joined: 16 April 2004
Location: United States
Posts: 5835
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| Posted: 03 March 2015 at 9:36pm | IP Logged | 10
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The individual mandate seems like something that
conservatives would support. Requiring citizens to
purchase health insurance is not like requiring them to
buy broccoli because unlike the latter, the former is
something that every citizen will eventually require. And
it's not (nor should it be) policy to turn away people at
the emergency room. And when (as it happens) uninsured
people wind up with a serious illness, their going
bankrupt doesn't help anyone.
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Steven Myers
Byrne Robotics Member
Joined: 10 June 2004
Location: United States
Posts: 5624
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| Posted: 03 March 2015 at 9:46pm | IP Logged | 11
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I think we need Obamacare until we finally pass a system that removes for-profit companies from heath care. We need single payer.
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Neil Lindholm
Byrne Robotics Member
Joined: 12 January 2005
Location: China
Posts: 4940
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| Posted: 03 March 2015 at 9:47pm | IP Logged | 12
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It seems that the northern European methods of public and private health care is the way to go. Everyone has access to the public system but you can get insurance and such to participate in the private system. My brother waited 6 months for a basic hernia operation in Canada, which forbids private health care. Just before the operation, he could barely get out of bed due to the pain but still had to wait. Here in China, I discovered the hernia on a Wednesday and was in for surgery the next Monday. I have private insurance since by law, foreigners working in China must have private, western level of quality health insurance.
Why couldn't the US simply expand Medicare to everyone and then allow the private market as well? I wish Canada would join the rest of the western world and allow private health care.
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