Health Care Reform Act

[Just_A_Guy]

I wish someone could explain this act and it's implications to me in English...slowly! I've never been very good at understanding politics and government. I think there is a smooth spot in my brain where there should be wrinkles that would retain this info. I've been watching Fox and CNN off and on all day and the only thing I can gather is that a doctor's panel (on FOX) didn't think this was very good for the American people while our current POTUS (on CNN) thinks it's what's best for the American people. And something switched from it being a penalty to a tax? And Roberts is a hero or a villain depending on who you ask. And ...I'm lost! What does any of this have to do with Moi, my checkbook and my ability to get health care? We have good (more or less) insurance through my husband's work. Will that change?

Carlimac, one of the provisions of PPACA required everyone to buy health insurance unless they had health insurance through their work or were covered by Medicaid. The requirement (or "mandate") kicks in in early 2014.

The question for the court was whether the federal government can force you to purchase a product--in this case, health insurance. The president's lawyers argued that 1) the government has this power because the Constitution gives it power to regulate "interstate commerce", and 2) even if the government doesn't have this power, it's not really "forcing" you to buy a product--it's just using its constitutionally-granted power to tax in order to provide Americans with an incentive to purchase the product. The Supreme Court's majority, led by Chief Justice Roberts, rejected the first argument on the grounds that you can't regulate commerce that doesn't exist yet--the power to regulate commerce does not give you the right to create commerce from scratch. However, the Court went on to agree with the second argument. (The really fun part is that the four justices who agreed with Roberts on 1) disagreed with him on 2), and vice-versa; so it takes careful reading to pin down what "the court"'s position really is. It threw CNN for a loop--thry were briefly reporting today that the whole thing had been struck down.)

The conservatives are upset because 1) when the legislation was passed, its proponents were adamant that this was not a tax; and 2) the long-term implication is that the government can use its taxing power to "encourage" you to do whatever it wants you to do (a power which, in reality, it already uses--which is why you get tax deductions for marriage, children, mortgages, hybrid vehicles, etc). The fact that the deciding vote, Justice Roberts, has traditionally voted with the court's conservative bloc, adds insult to injury for many conservatives.

Unless your current health plan is very expensive, the new legislation shouldn't directly harm it. It may even get better in the short run--PPACA requires them to cover your adult children until they're 26, requires them to cover more types of procedures than they used to, prohibits them from raising your rates when you get sick . . . that kind of thing. However - and this is a broad generalization - PPACA essentially requires health insurers to provide more benefits without raising their rates. Ordinarily this would diminish the profits for the insurers - conceivably to the point of driving them out of business. (This is Economics 101 - price ceilings cause producers to stop producing, which inevitably leads to shortages.)

How do you prevent this? PPACA's authors included the "mandate" in order to kill two birds with one stone. First, by forcing everyone to buy coverage, you're basically getting a little money back from all those people who don't buy health insurance but still get medical treatment at emergency rooms and then walk away from their bills--via bankruptcy or otherwise. Second, by forcing everyone to buy coverage, you're also collecting money from people who have made a conscious decision not to buy health insurance because they are in good health and don't need it. You're increasing "the pool" - in other words, you're giving the health insurers more money that they can then use to offset the costs that the new legislation imposes on them.

Today's decision makes that "mandate" weaker. As I mentioned in an earlier post, it doesn't currently make financial sense for my family to purchase health insurance--it would cost me $4 or $5K/year, and the tax penalty is only $2K/year. I might still do it if there's a "mandate" threatening me with jail if I don't comply. But if the only down-side is the tax penalty, I'm more willing to just pay the penalty and self-insure. That decision doesn't help "the pool" at all, and so there's really no point to the "mandate" in its current form. (My $2K tax/penalty/fine goes to Uncle Sam, not the health insurers).

The trouble is that a number of folks think that even with the mandate, the insurers won't get enough revenue to remain profitable and will ultimately shut down. If that happens the way will be clear for something called a "single payer" government health care system. There are real concerns about the financial sustainability, quality of care, and incentive for research and development that would come from such a system.

So, coming back to your question: We have good (more or less) insurance through my husband's work. Will that change? The answer is "No--unless your HMO shuts down."

Edited June 29, 2012 by Just_A_Guy

[Guest]

I wish someone could explain this act and it's implications to me in English...slowly! I've never been very good at understanding politics and government. I think there is a smooth spot in my brain where there should be wrinkles that would retain this info. I've been watching Fox and CNN off and on all day and the only thing I can gather is that a doctor's panel (on FOX) didn't think this was very good for the American people while our current POTUS (on CNN) thinks it's what's best for the American people. And something switched from it being a penalty to a tax? And Roberts is a hero or a villain depending on who you ask. And ...I'm lost! What does any of this have to do with Moi, my checkbook and my ability to get health care? We have good (more or less) insurance through my husband's work. Will that change?

Okay, very slowly, in my English-as-a-Foreign-Language English to cover just the main point of the bill:

1.) Health insurance is a mandate. That is - everybody is REQUIRED to carry a certain basic coverage health insurance. If you are employed, your employer is required to cover your health insurance. If they refuse, they pay a fine. If you are not employed by anybody, you get to buy your own health insurance. If you refuse to buy one, you get to pay a fine. If you are not employed by someone and you can't afford insurance, the government will give you money to get one. The government gets to decide if you can afford one or not. The fine for non-covered businesses or individuals is going to be added to your Federal Tax obligation.

2.) Health insurers have to accept all applicants for basic coverage regardless of pre-existing conditions or any other reason. Also, people with pre-existing conditions or special needs cannot be charged a higher premium than everybody else.

3.) Seniors and disabled people continue to be covered through medicare/medicaid. Everyone else gets to be covered by private insurance.

Okay, now, the lawsuit by the States is in regards to the Constitutionality of the Federal Government mandating private commerce. That is - the federal government is forcing the people to buy something. In this case, health insurance that is heavily regulated.

Now, the Supreme Court ruled that the mandate to buy health insurance is covered in the commerce clause (Constitution Article 1 Section 8) and the 16th constitutional amendment that gives the Federal Government the right to levy tax without having to give the States a portion and without need for census results.

So, basically, the Supreme Court reduced Obamacare to an increase in taxes for individuals and businesses that the Federal Government is going to use to give everybody health insurance coverage in a round-about way... basically paying the tax either to the federal government as a fine who will then purchase the insurance for you or paying the tax directly to a private health insurance.

Okay, this is a super simplistic way of explaining the thing. It is much more complicated than this, of course, but this is what matters for now.

Now, the wierd thing about this is... this opens the door to a Federal Mandate on anything. For example - if the Federal Government decides that you have to buy an American-made electric car or pay a fine through increased federal tax obligation because we have to reduce pollution and save the auto industry at the same time... well, according to the Supreme Court, they can.

Edited June 29, 2012 by anatess

[Just_A_Guy]

Okay, very slowly, in my English-as-a-Foreign-Language English to cover just the main point of the bill:

Now, the Supreme Court ruled that the mandate to buy health insurance is covered in the commerce clause (Constitution Article 1 Section 8) and the 16th constitutional amendment that gives the Federal Government the right to levy tax without having to give the States a portion and without need for census results.

With all due respect, Anatess: with regard to the Commerce Clause, SCOTUS held just the opposite: The commerce clause does not justify the "mandate"; Congress' taxing power does.

Incidentally, that means that in light of SCOTUS' opinion health insurance isn't a "mandate" anymore than marriage, child-rearing, or having a mortgage is a "mandate"--it's just something that, if you do, will get you preferential tax treatment.

[ADoyle90815]

Here's the actual opinion:

http://www.supremecourt.gov/opinions/11pdf/11-393c3a2.pdf

[carlimac]

So...I have a sister with multiple health issues but who refuses to go to a doctor because she doesn't have health insurance. She claims she can't afford insurance or health care. I don't know for sure but I think she and her husband make too much money to be eligible for govt. assistance, but in her opinion, not enough money to buy insurance. He is self employed. She is unemployed. They had their house flooded by a hurricane last August and have had to gut 3/4 of it right down to the framing and are probably 75% dependent on volunteers to rebuild. I believe they got about $35,000 from the govt to rebuild which is a drop in the bucket when you consider having to re-do a whole kitchen, walls, flooring, appliances, furnace and yard. And her husband's business flooded, too. They had no home owners insurance (which I thought was illegal but whatever...) They've been living in a FEMA trailer since last fall. So they really are poor (I think?? She doesn't give us many specifics).

Given this scenario, is the new "Affordable Health Care Act" a boon for her or not?

Edit: and thanks for the explanations!

Edited June 29, 2012 by carlimac

[Just_A_Guy]

So...I have a sister with multiple health issues but who refuses to go to a doctor because she doesn't have health insurance. She claims she can't afford insurance or health care. I don't know for sure but I think she and her husband make too much money to be eligible for govt. assistance, but in her opinion, not enough money to buy insurance. He is self employed. She is unemployed. They had their house flooded by a hurricane last August and have had to gut 3/4 of it right down to the framing and are probably 75% dependent on volunteers to rebuild. I believe they got about $35,000 from the govt to rebuild which is a drop in the bucket when you consider having to re-do a whole kitchen, walls, flooring, appliances, furnace and yard. And her husband's business flooded, too. They had no home owners insurance (which I thought was illegal but whatever...) They've been living in a FEMA trailer since last fall. So they really are poor (I think?? She doesn't give us many specifics).

Given this scenario, is the new "Affordable Health Care Act" a boon for her or not?

Depending on her income, after 2014 she'll be eligible for a partial subsidization of her health care premiums such that her bottom-line costs don't exceed a certain percentage of her income. Also, if she already qualifies for Medicaid she'll still qualify. In fact, some states will be extending their Medicaid coverage under the new plan. (Even if her state doesn't opt in, based on your statements it sounds like there's a good chance her family already qualifies for Medicaid and she just doesn't know it.)

At least in the short term, yeah, it'll probably be an improvement over her current situation. The key questions, for those of us who oppose the legislation, are a) whether the whole ball of wax is financially sustainable (and what happens to the government's dependents if/when the whole house of cards comes crashing down), b) whether the system can provide a decent standard of care for the poor (without significantly compromising the excellent care for those who can afford it--in other words, are we going to impose a system where I can't have a pacemaker even if I could otherwise afford one?), c) to what degree we're infringing on the personal liberty of those who, for whatever reason, do not wish to participate in the system, and d) whether the benefits of any such system really outweigh the cronyism and bureaucratic bumbling that are sure to follow a greater governmental role in the allocation of health care.

[bytor2112]

In twenty years people are going to be wondering what all the hullabaloo was all about.

M.

Yes...in 20 years many will have forgotten how much their freedom has eroded.

[bytor2112]

Anyone besides me concerned about the capital gain tax sky rocketing?

[Guest]

Anyone besides me concerned about the capital gain tax sky rocketing?

Of course. But, you know how it is here on lds.net... if you say anything about anything affecting high income earners you're not going to get much mileage.

[MorningStar]

What I wonder is how many people will have insurance they can actually afford to use? With my husband's last job, we were suddenly put on a plan with a $3,000 deductible. It didn't cover any prescriptions or any visits at all until you paid $3,000, unless it was for a well child visit. Luckily, we had our daughter two days before we were switched to that plan or else we would have had a huge bill. It was combined with a health savings account, but there was nothing in that account yet to offset the cost. My husband's co-worker had surgery less than a month later and got a huge bill. Oh yes, if it's over $3,000, you have to pay that amount and then a percentage of the rest. We paid $700 a month for that awful plan.

There won't be any victory in everyone having health coverage if they can't afford the co-pays and deductibles. If they can't afford the premium and the government says they can, well it will be cheaper to just pay the "tax" and then they still won't have insurance.

[bytor2112]

Of course. But, you know how it is here on lds.net... if you say anything about anything affecting high income earners you're not going to get much mileage.

Of course....capital gains affect a HUGE percentage of the population.

[applepansy]

We are uninsured and we cannot afford insurance. We're barely making ends meet now. Losing $20,000 a year really did a number on us. We almost had everything paid off except our mortgage and now the principle on the mortgage has increase and our loan extended back to 30 years because we had no choice but to refinance or loose everything. I'm can no longer work because ofI can't sue them because there are laws pushed through by lobbyists for the Insurance companies which did away with punitive damages if you sue your insurance company, even if they were wrong and their decisions cost live of limb.

So... where is the money going to come from to pay the new tax/fine/penalty? We don't qualify for Medicaid, hubby makes too much money to qualify but not enough to even put more than $20-$50 in savings a month.

My objections to all this new "law" is that it will make the lower middle class the new poor and it infringes on my rights. I shouldn't have to participate in this and nobody else should have to either.

I remember when insurers started covering health care. They came into my work and sold us on $3 prescriptions and free well child care. They sold us on low premiums and low out of pocket expenses. They would cover it all. I only paid $250 out of 15,000 when my last baby was born. Who wouldn't take advantage of that? Then slowly over the last 30 or so years its changed a little bit at a time. They cover less and less and it costs more and more. But they got done what they set out to do. Everyone thinks you have to have health insurance. the myth is that its a necessity. The scam has become law. and to me that's criminal.

I've worked in the health care industry. My sisters, my mother, and many members of my family. My dad sold whole term life insurance when I was a kid. When insurance started covering health care he wondered out loud how long it would take before the bottom fell out. The only health insurance that should ever have been available is major medical. Well checks are something you budget for. Being healthy is an educational issue.

The American People were sold a bill of goods with nothing behind it and now this is the way our government is going to SAVE the Insurance Industry. To me this is just another bailout, regardless of what they call it.

.

Edit: I'm sure I'm not the only one who will be severely and adversely affected by this.

Edited June 30, 2012 by applepansy

[HoosierGuy]

I remember when insurers started covering health care. They came into my work and sold us on $3 prescriptions and free well child care. They sold us on low premiums and low out of pocket expenses. They would cover it all. I only paid $250 out of 15,000 when my last baby was born. Who wouldn't take advantage of that? Then slowly over the last 30 or so years its changed a little bit at a time. They cover less and less and it costs more and more. But they got done what they set out to do. Everyone thinks you have to have health insurance. the myth is that its a necessity. The scam has become law. and to me that's criminal.

Hmm. So what changed thirty or so years ago? I know and I'm sure your dad or grand dad know too because they supported that change (most likely).

The healthcare industry is corrupt. Pure corruption and the American public allow them to get away with it.

[applepansy]

Hmm. So what changed thirty or so years ago? I know and I'm sure your dad or grand dad know too because they supported that change (most likely).

The healthcare industry is corrupt. Pure corruption and the American public allow them to get away with it.

No, my dad did not support health insurance. My parents bought life a whole life insurance policy (you can't even get those anymore). Medical expenses were a budget item. They saved money for medical.

My grandfather wasn't insured. But after he died my aunts and uncles bought insurance for my Grandmother. That didn't work out well. When she came to live with me I added up what they had paid out and compared it to the premiums. If my aunts/uncles had saved the premium they could have paid for grandma's pacemaker completely. But they didn't and ended up paying more for her medical expenses that was necessary. Yet even after I showed them in black and white they felt I was wrong to cancel the insurance.

The solution: people take responsibility. You insure for major medical only and you budget well care, routine care and elective surgeries.

[Just_A_Guy]

Unfortunately, not only does PPACA try to steer people into health insurance plans (via "tax incentives"-ex-"mandates"), but it actively discourages people from the kind of budgeting for ordinary expenses that Applepansy mentions. It cuts the tax deduction for out-of-pocket outlays, limits the amount you can put in a tax-free health savings account, reduces the kinds of treatment you can purchase with an HSA, and imposes stiff financial penalties if you inadvertently use the HSA for an unapproved health care service.

IMHO, this foreshadows what some in Congress hope to do with 401(k)s and IRA's - throw everyone into a national system (in that case, Social Security), and create a legal code where the assets of those who continued to plan ahead for themselves eventually revert back to the feds.

[HoosierGuy]

No, my dad did not support health insurance. My parents bought life a whole life insurance policy (you can't even get those anymore). Medical expenses were a budget item. They saved money for medical.

I was talking about a certain "Revolution" in the U.S. that took place back in 1981 to the late 80s that your parents may have or may not have supported. That "Revolution" changed things for the worse even though some people think the person behind it is some kind of demi-god.

[Just_A_Guy]

Correlation is not causation, Hoosierguy. If you amend Applepansy's statement about "last 30 years or so" to "last 40 years or so", you know what happened right about 1965? That's right: the introduction of Medicare and Medicaid.

If Reagan (and every other president in the last 3-4 decades) had anything to do with this, it was that they failed to recognize that the HMOs and health care providers have in many ways been essentially colluding to limit competition and keep prices high; and failed to deploy their Attorneys General to take appropriate action under existing anti-trust law. Rather, some recent presidents have falsely represented the status quo as a free market, gleefully proclaimed its failure, and attempted to use that "failure" in order to justify various schemes that boil down to the co-option of nearly 20% of the nation's GDP.

If anything, your acknowledgement that things were just hunky-dory until the 1980s merely confirms that a true free market unfettered by monopolistic/cartel-ish behavior can (and, until a few decades ago, did) provide quality health care at reasonable prices, without the need for the single-payer system that statist little hearts so dearly desire.

Edited July 1, 2012 by Just_A_Guy

[annewandering]

Just curious. What is the opposite of 'statist'? I keep seeing that word and it just really makes me pause and wonder if it goes along with "nananana pants on fire"?

[Dravin]

Just curious. What is the opposite of 'statist'?

Well if Wikipedia is to be believed, the opposite would be anarchist. Linky: Statism - Wikipedia, the free encyclopedia

[Misshalfway]

My FB is lighting up with people comments for and against this new ruling. People on both sides are very, very passionate about this.

My husband and I were reading something about all the commentary on FB and Twitter regarding this.

It's hilarious because tons of people are posting..... "I'm moving to Canada!"

[Guest]

Just curious. What is the opposite of 'statist'? I keep seeing that word and it just really makes me pause and wonder if it goes along with "nananana pants on fire"?

Well if Wikipedia is to be believed, the opposite would be anarchist. Linky: Statism - Wikipedia, the free encyclopedia

True and not true... There are different levels of statism. Statist basically means we as individuals choose to let the State (government) to manage aspects of society. So, you can have complete statism (e.g. communist government) or partial statism (e.g. State only controls specific aspects like welfare for the poor, firefighting, policing, etc).

Anarchism is rejecting a State (government) to run any aspect of society. Anarchism does not have "levels". So it is only opposite to complete statism and not partial statism.

What JAG means when he uses the word statist is the increase in the level of statism that we allow in our country. The level ranges from zero statism (anarchism) to full statism (communism). We want to remain in the partial statism area closer to the bottom of middle level than to the top of middle level.

Make sense?

Edited July 1, 2012 by anatess

[annewandering]

In that case I would think that fascism would be the opposite not communism. In fact I would say communism was way closer to anarchism that fascism is.

[Just_A_Guy]

IMHO they're both (at least, as historically practiced) forms of statism because they both resulted in absolutist governments with virtually unlimited powers that quickly degenerated into tyranny.

[annewandering]

ahh and there we go. Tyrnanny is the true evil form of government. :)

[MarginOfError]

My husband and I were reading something about all the commentary on FB and Twitter regarding this.

It's hilarious because tons of people are posting..... "I'm moving to Canada!"

As well they should. At least then they'd get decent healthcare!