OBAMA/TRUMPCARE MEGATHREAD

[Soxbadger]

You're dong the exact same thing on the opposite end of the argument, yet because it's your view, it's right. Welcome to the world of opinion.

 

I hate when you argue like this. You're better/smarter than that.

 

No Im not. I dont believe any religion deserves special exceptions. Whether I agree with it or not. If the new rule is that anyone can not follow the laws based on religious exception, i would be fine with it.

 

But that isnt what we are doing here, we arent saying "Everyone has the right to opt out of govt regulations if it interferes with their beliefs."

 

If that was the ruling, id support it 100%. Because then I could refuse to pay taxes, follow laws, and do whatever I want in the name of "religion". Fair is fair, but this ruling isnt about fairness, its about promoting 1 religion at the expense of everyone else.

 

Maybe you dont believe it, but somewhere in your heart of hearts you must know that if a Muslim Company didnt want to pay taxes because the US was attacking Muslims, the Supreme Court wouldnt be okay with it.

[Chisoxfn]

My wife actually used them to treat one of those conditions. She got sick enough that she couldn't continue working due to the number of days she was missing, wound up both unemployed and losing her insurance, at which point she lost that treatment. The condition was described as "having her insides strangled". 4 years later I finally had good enough insurance to cover a family and we got her covered again and she wound up having surgery last year.

 

So yeah, there is a post here that is complete bulls*** but it isn't mine.

That doesn't mean that the %'s applied in that survey are right. That is a scenario but presumably not a common scenario.

[Chisoxfn]

You're crazy if you don't think women use it for those reasons just as well.

I think those are added side benefits but that is not the primary use of the drug.

[Chisoxfn]

If they cant afford it, they are 100% being stopped. Its entirely the same idea.

 

If this is allowable, a business run by Jehova's Witness should also be allowed not to pay for blood transfusions through insurance.

 

But like I said, as long as its your religion/position that is winning, you really seem to not care about the consequence.

Am I missing something. the employers are not required to provide the employees with insurance. So how about instead of all this stuff, they just tell everyone, fine, we will stop providing and just pay our required "employer shared responsibility payment" as part of Obamacare. Seems like hobbylobby is trying to actual ensure the employees get something, while also respective their right, to focus on certain things that they will not pay for because it goes against their fundemental beliefs which are protected under the constitution (as upheld by the supreme court).

[EvilMonkey]

No Im not. I dont believe any religion deserves special exceptions. Whether I agree with it or not. If the new rule is that anyone can not follow the laws based on religious exception, i would be fine with it.

 

But that isnt what we are doing here, we arent saying "Everyone has the right to opt out of govt regulations if it interferes with their beliefs."

 

If that was the ruling, id support it 100%. Because then I could refuse to pay taxes, follow laws, and do whatever I want in the name of "religion". Fair is fair, but this ruling isnt about fairness, its about promoting 1 religion at the expense of everyone else.

 

Maybe you dont believe it, but somewhere in your heart of hearts you must know that if a Muslim Company didnt want to pay taxes because the US was attacking Muslims, the Supreme Court wouldnt be okay with it.

it's not a 'new' rule, it is a legal interpretation that the RFRA applies in this case. The RFRA that was supported by many of the same Democratic idiots that are now complaining that it is a travesty, such as Reid, Boxer and so on. Democrats praised the RFRA back then. Now it is the devil!

[Balta1701]

it's not a 'new' rule, it is a legal interpretation that the RFRA applies in this case. The RFRA that was supported by many of the same Democratic idiots that are now complaining that it is a travesty, such as Reid, Boxer and so on. Democrats praised the RFRA back then. Now it is the devil!

Much like defense of marriage act, its name gives away how much bull it actually is.

[StrangeSox]

FWIW, RFRA was created in response to the SCOTUS ruling in Smith v Employment Division.

 

http://en.wikipedia.org/wiki/Employment_Division_v._Smith

[bmags]

Scalia's finest decision - green.

[farmteam]

Scalia's finest decision - green.

Not sure if anything is as bad as Lawrence.

[StrangeSox]

Not sure if anything is as bad as Lawrence.

 

His rant of a dissent in the Arizona SB1070 case that had more to do with talk radio talking points than anything the case was about is pretty noteworthy.

[cabiness42]

I don't think Muslims and Jews have an issue with paying for a meal plan that includes pork or shellfish as an option. Probably because they realize that it doesn't actually require them to personally consume those things, something that has alluded the Greens.

 

They have the right to have those restrictions, even though they choose not to.

[Jenksismyhero]

I'm shocked.

 

http://mashable.com/2014/07/30/obama-healt...om-Tw-main-link

 

WASHINGTON — A nonpartisan congressional investigation has concluded that management failures by the Obama administration set the stage for the computer woes that paralyzed President Barack Obama's health care program website last fall, officials told The Associated Press.

 

The findings are in a report to be released Thursday by the Government Accountability Office, which has spent months investigating the health law's chaotic rollout. GAO is the nonpartisan investigative agency of Congress.

 

Investigators found that the administration kept changing the contractors' marching orders for the HealthCare.gov website, creating widespread confusion and leading to tens of millions of dollars in additional costs.

 

Republican and Democratic congressional aides briefed on the report told the AP that it faults the Centers for Medicare and Medicaid Services — which is part of the Department of Health and Human Services — for ineffective oversight of contracts for the site's computerized sign-up system and its electronic back office. The Medicare agency, known as CMS, was designated to administer Obama's health care law.

 

The aides said they were briefed by GAO on a late draft of the report. They spoke only on condition of anonymity, saying they couldn't be quoted by name discussing the report ahead of its official release.

 

GAO concluded:

 

Contractors were not given a coherent plan, and instead they were kept jumping around from issue to issue.

 

The cost of the project grew by tens of millions of dollars as the contractors tried to accommodate administration requests.

 

CMS, the lead agency, failed to follow up on whether contractors were doing the work assigned to them, and to review that work for quality.

 

CMS sent conflicting signals, at one point notifying one contractor it was so dissatisfied that it would start withholding payments, and then quickly rescinded that decision.

 

The type of federal contract that the administration selected for HealthCare.gov was open-ended, which may have encouraged costly changes.

 

Two contractors took the lead on the computerized system.

 

Virginia-based CGI Federal built HealthCare.gov, the online gateway to subsidized private health insurance provided under the law. The site serves 36 states, while the remaining states built their own systems, with mixed results.

 

QSSI, based in Maryland, was responsible for an electronic back office that helps verify personal and financial information to determine if consumers are eligible for tax credits to help pay their premiums.

 

The front end of the system locked up the same day it was launched, Oct. 1, and it was down most of that initial month. The electronic back office had fewer problems.

 

Confronted with an embarrassing spectacle, the White House sent in management consultant Jeff Zients as a troubleshooter. One of his first decisions was to nudge CMS aside as project leader and give the agency a supporting role.

 

CMS administrator Marilyn Tavenner later personally apologized to Congress that, "the website has not worked as well as it should."

 

Zients' rescue operation got the site working by early December. Another major contractor, Accenture, was brought in to help fix things. Eventually, some 8 million people managed to sign up, far exceeding expectations.

 

Nonetheless, Health and Human Services Secretary Kathleen Sebelius stepped down amid complaints by White House officials that the president was blind-sided by the problems.

 

The original contractors testified to Congress that they did not have nearly enough time to test the system before it went live. Indeed, Tavenner took the unusual step of signing the operational security certificate for HealthCare.gov herself, after CMS security professionals balked. The site has since passed full security testing.

 

The GAO's findings amplified earlier conclusions in a report by Zients himself after the website was restored to working order.

 

In addition to hundreds of software bugs, insufficient infrastructure and subpar monitoring of problems, the White House troubleshooter said that "inadequate management oversight and coordination among technical teams prevented real-time decision making and efficient responses to address the issues with the site."

 

The House Energy and Commerce Committee will hold a hearing Thursday on GAO's investigation.

[Jake]

Remember how religious non-profits get an exemption from the ACA contraception mandate? Due to society's interest in providing contraception, the government instead subsidizes these services if needed by an employee of an exempted organization.

 

Until groups like Notre Dame sue the federal government saying they shouldn't have to sign the form that claims the exemption because that will ultimately lead to their employees getting contraception from someone else. Now the beef is that they get it at all. I suppose the next step will be freezing their paychecks because they could be used to purchase these services outright

 

http://www.msnbc.com/msnbc/the-next-hobby-lobby

[StrangeSox]

Pennsylvania’s GOP governor will expand Medicaid to 300,000 poor people

 

[greg775]

Pennsylvania’s GOP governor will expand Medicaid to 300,000 poor people

Meanwhile, Kansas' governor will probably announce he's making all poor people get up at 6 a.m. and do 100 pushups and sprints. Today this guy gave a cushy job to one of his cronies. The question is ... will Republican heavy Kansas actually vote out Brownback? Believe it or not, he still might win re-election. I wonder if Kansas now is officially the worst state in the Union.

[Y2HH]

Meanwhile, Kansas' governor will probably announce he's making all poor people get up at 6 a.m. and do 100 pushups and sprints. Today this guy gave a cushy job to one of his cronies. The question is ... will Republican heavy Kansas actually vote out Brownback? Believe it or not, he still might win re-election. I wonder if Kansas now is officially the worst state in the Union.

 

Odds are good that whatever state a person is from is the worst state of the union (unless they recently moved there, so everything is still amazing), because their experience of other states is based on short stints of travel for work or when they vacation to them ... and since we tend to see the very best of what they have to offer instead of daily life in those situations, it's easy to say that state is the greatest thing ever.

 

So, for example, IMO, IL is the worst state of the union, because we have unlimited amounts of corruption, a pension crisis that still hasn't been solved even to the smallest degree despite nonstop tax/fee increases and "discussions" about the pension crisis for over a decade ... and 90% of them will get re-elected, promising everything and delivering nothing, because we don't actually hold politicians accountable for anything.

 

...well, until they break the law so many times, or are so insanely stupid they end up in prison.

[StrangeSox]

After Surgery, Surprise $117,000 Medical Bill From Doctor He Didn’t Know

 

Piece in the NYT highlighting how more and more people are being hit with surprise medical bills that include huge charges from out-of-network physicians and surgeons who did little or nothing.

 

The United States has more neurosurgeons per capita than almost any other developed country, and they compete with orthopedists for spinal surgery. At the same time, Medicare and private insurers have reduced payments to surgeons. The average base salary for neurosurgeons decreased to $590,000 in 2014 from $630,000 in 2010, according to Merritt Hawkins, a physician staffing firm.

 

To counter that trend, some spinal surgeons have turned to consultants — including a Long Island company called Business Dynamics RCM and a subsidiary, the Business of Spine — that offer advice on how to increase revenue through “innovative” coding, claim generation and collection services.

 

Some strategies used by surgeons, including billing large amounts for a second surgeon in the room or declaring an operation an emergency, raise serious questions. The indications for immediate spinal surgery, such as loss of bladder function or rapidly progressive paralysis, are rare. But insurers are more likely to reimburse a hospital or surgeon with whom they do not have a contract if a case is labeled an emergency.

 

Surgeons from other specialties also team up: After Gunther Steinberg of Portola Valley, Calif., had a needle biopsy of an eye lesion in 2010, he discovered that his insurer had paid about $10,000 to the eye surgeon who performed the outpatient procedure and $10,700 to a second ophthalmologist in the room.

 

“The idea of having an assistant in the O.R. has become an opportunity to make up for surgical fees that have been slashed,” said Dr. Abeel A. Mangi, a professor of cardiac surgery at Yale, who said the practice had become commonplace. “There’s now a whole cadre of people out there who do not have meaningful appointments as attending surgeons, so they do assistant work.”

 

In Mr. Drier’s case, each surgeon billed for each step of the procedure. Dr. Tindel billed $74,000 for removing two disks and an additional $50,000 for placing the hardware that stabilized Mr. Drier’s spine. Dr. Mu billed $67,000 and $50,000 for those tasks.

 

 

[mr_genius]

After Surgery, Surprise $117,000 Medical Bill From Doctor He Didn’t Know

 

Piece in the NYT highlighting how more and more people are being hit with surprise medical bills that include huge charges from out-of-network physicians and surgeons who did little or nothing.

 

I read that story yesterday. Very messed up.

[Jake]

Appellate court just ruled that federal exchanges cannot issue subsidies. This is very bad. Without Congress amending the wording of the law, which seems ludicrously unlikely, this could effectively destroy the law. Let's hope that at least the Democratic states like Illinois will set up their own exchanges since nobody really anticipated the creation of the exchanges to be a big battleground in the first place.

[StrangeSox]

Appellate court just ruled that federal exchanges cannot issue subsidies. This is very bad. Without Congress amending the wording of the law, which seems ludicrously unlikely, this could effectively destroy the law. Let's hope that at least the Democratic states like Illinois will set up their own exchanges since nobody really anticipated the creation of the exchanges to be a big battleground in the first place.

 

The D.C. circuit court ruled the same way in a 3 judge panel a month or so ago in the Halbig case, but the full D.C. circuit elected to rehear en banc (full court) and is expected to reverse. I guess with the Oklahoma ruling, a circuit split is now inevitable and the SC will more or less have to take it up.

 

But so far, the federal courts have ruled overwhelmingly in favor of the subsidies being allowed on the federal exchanges. If Roberts wasn't willing to strike down the whole law then, I can't imagine he'd gut it now on what would be even more ridiculous grounds. One funny part about the people filing briefs on behalf of the plaintiff in Halbig is that they were arguing the exact opposite position (federal subisidies are available) in their NFIB v. Sebelius (the big 2012 ruling).

 

Ruling that federal exchanges can't offer subsidies would destroy large parts of the law in a majority of states and leave millions of people back in the position of not being able to afford health insurance, but at least it wouldn't gut the Medicaid expansion (more than Roberts already did) or the state exchanges.

 

[StrangeSox]

Apparently the 10th circuit is 7 democrat-appointed judges and 5 republican appointed ones, so this could end up being just like the D.C. circuit and reversed en banc.

 

The problem for the plaintiffs is that under the Chevron doctrine, courts are deferential to agency interpretations of ambiguous statutes. When you read one line out of thousands within the bill, you can make the argument that the plaintiffs are that the statute excludes federally run exchanges and does so intentionally. Looking only at that one line and nothing else within the bill or any of the legislative history (nobody seemed to think this was a clever and deliberate way to force states to set up exchanges until this 'glitch' was discovered by people looking to destroy the ACA using any means necessary), it may even be the most plausible interpretation. When you read that line in the context of the rest of the bill, that argument is harder to make, and the intention of including federal subsidies becomes more likely.

 

But really, which one is "more likely" doesn't matter. The courts don't decide that; as long as the IRS's "federal subsidies are ok" interpretation is a plausible reading of the statute, it's fine. Even if it's not the most likely interpretation, courts will still defer to the agency.

[farmteam]

Apparently the 10th circuit is 7 democrat-appointed judges and 5 republican appointed ones, so this could end up being just like the D.C. circuit and reversed en banc.

 

The problem for the plaintiffs is that under the Chevron doctrine, courts are deferential to agency interpretations of ambiguous statutes.[ When you read one line out of thousands within the bill, you can make the argument that the plaintiffs are that the statute excludes federally run exchanges and does so intentionally. Looking only at that one line and nothing else within the bill or any of the legislative history (nobody seemed to think this was a clever and deliberate way to force states to set up exchanges until this 'glitch' was discovered by people looking to destroy the ACA using any means necessary), it may even be the most plausible interpretation. When you read that line in the context of the rest of the bill, that argument is harder to make, and the intention of including federal subsidies becomes more likely.

 

But really, which one is "more likely" doesn't matter. The courts don't decide that; as long as the IRS's "federal subsidies are ok" interpretation is a plausible reading of the statute, it's fine. Even if it's not the most likely interpretation, courts will still defer to the agency.

But, like you said, that only applies when the statutory text is ambiguous. The judge in Oklahoma thought it unambiguous.

 

Also, this wasn't an appellate ruling, it was the Eastern District of Oklahoma. I think the only appellate courts to rule on it so far are DC (striking down the IRS rule) and the 4th (upholding the IRS rule).

[StrangeSox]

The opinion cites blog posts. That struck me as funny.

 

But yeah this was district not appellate level, so it'll definitely get reviewed there and then possibly en banc before hitting the sc. It might be settled due to the other two cases before it even gets to that point.

[farmteam]

The opinion cites blog posts. That struck me as funny.

That's actually becoming increasingly common. It especially happens on hot topics like this, i.e. issues that blogs are talking about. There's often lots of good insight from a place like Volokh. Those are some pre-eminent scholars writing quality stuff, just in short bursts.

[StrangeSox]

So why is our infant mortality so bad?

 

Reporting differences (the favorite explanation of those defending the US healthcare system from the infant mortality metric attack) explained up to 40% of the disadvantage in US infant mortality. But that would only get us closer. It would still leave us way worse. Worse conditions at birth accounted for 30% of the remaining difference compared to Austria, but 75% of the remaining difference compared to Finland.

 

More concerning, though, is that our neonatal mortality (or the mortality in the first month of life) wasn’t so different than the other countries. What accounted for the real disadvantage was postneonatal mortality, or mortality from one month to one year of age. That difference was almost entirely due to excess inequality in the US.

 

In other words, most of the infant mortality difference between the US and other countries was due to really high postneonatal mortality in less advantaged groups. If differences were due to neonatal mortality, then you would want to try and reduce preterm births. That’s often what we’ve been trying to do. But this study shows us that this isn’t where the lesion is. It’s in the postneonatal period. (This point is consistent with Austin’s latest post about NICUs on the JAMA Forum.) It’s possible that the inpatient care is excellent right after birth, but once babies go home, their access to care is different along socio-economic lines. To fix that, you likely need to improve the health care system, or inequality in the US.

 

So there are two main takeaways from this paper. The first is that although reporting differences can account for some of our worse infant mortality statistics, most of the differences we see are not due to that explanation. The second is that most of the rest of the disadvantage is due to differences in postneonatal mortality, that likely require fixes to the healthcare system. Whether the ACA does so remains to be seen.