OBAMA/TRUMPCARE MEGATHREAD

[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.

 

So on Friday the SC granted cert (meaning they will hear the case) in King v Burwell, another case along the same lines as Halbig. The ruling in King was in favor of statutory interpretation i.e. federal exchanges are eligible for subsidies.

 

What many people are fearing now is that if the SC accepts the "Moops invaded Spain" argument that's being put forth, millions of people in states that didn't establish their own exchanges will suddenly lose their subsidy eligibility and their access to affordable health care. They won't be able to afford plans without the subsidies, and they won't be eligible for Medicaid, especially in states that didn't take the expansion once the SC made it voluntary.

 

Now, only four justices need to agree to hear a case, and we don't know who voted for cert and why, but it's hard to imagine that the liberal four would be confident enough in another Roberts "split the baby" ruling to vote for cert, and the other four on the court were more than ready to toss the entire law last time.

Edited November 11, 2014 by StrangeSox

[greg775]

Our insurance at work went up another 20 percent today for next year. And we have a s***ty company, United.

Our country is f***ed, folks.

Healthcare is a big time joke.

[EvilMonkey]

Our insurance at work went up another 20 percent today for next year. And we have a s***ty company, United.

Our country is f***ed, folks.

Healthcare is a big time joke.

And yet nobody complains about the costs of the CARE, just the costs of the insurance. Oh, my insurance is too high! Well how about that $120 for a 5 minute office visit? Or the $32 for a plastic disposable razor if you have a hospital stay? $40 Tylenol? $12,500 for an anesthesiologist to work 45 minutes during your knee operation?

[NorthSideSox72]

And yet nobody complains about the costs of the CARE, just the costs of the insurance. Oh, my insurance is too high! Well how about that $120 for a 5 minute office visit? Or the $32 for a plastic disposable razor if you have a hospital stay? $40 Tylenol? $12,500 for an anesthesiologist to work 45 minutes during your knee operation?

Yeah, whether or not you like Obamacare in general, the fact is that it really focused almost entirely on the insurance end. Hospital and doctor markup games meanwhile are reaching Pentagon levels.

 

And even with the fixes to the insurance picture (some of which I'd contend were good, others not as much), they still missed one of the fundamental problems with the whole model - consumer price choice. When basically all medical care costs the same to the insurance holder regardless of where they go, it shouldn't be shocking that prices are what they are. Heck, even the part of the cost that does vary, no one actually knows what it will cost until after the fact. The entire cost and pricing structure is ludicrous as it stands right now.

 

[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.

 

[mr_genius]

And yet nobody complains about the costs of the CARE, just the costs of the insurance. Oh, my insurance is too high! Well how about that $120 for a 5 minute office visit? Or the $32 for a plastic disposable razor if you have a hospital stay? $40 Tylenol? $12,500 for an anesthesiologist to work 45 minutes during your knee operation?

 

Yep, exactly. I've been saying it for years but it seems like something most people are not able to comprehend. The knee operation will probably also have an "assistant surgeon" making $300,000 just to stand around and watch one operation.

[Y2HH]

Yeah, whether or not you like Obamacare in general, the fact is that it really focused almost entirely on the insurance end. Hospital and doctor markup games meanwhile are reaching Pentagon levels.

 

And even with the fixes to the insurance picture (some of which I'd contend were good, others not as much), they still missed one of the fundamental problems with the whole model - consumer price choice. When basically all medical care costs the same to the insurance holder regardless of where they go, it shouldn't be shocking that prices are what they are. Heck, even the part of the cost that does vary, no one actually knows what it will cost until after the fact. The entire cost and pricing structure is ludicrous as it stands right now.

 

I've maintained from the start that this would fail for these very reasons, not because it didn't have good intentions or even accomplish some good things, but because it looked to "fix" only one area of the industry, insurance. It was an easy villain to target, everyone hates insurance companies, but nobody looks at the people behind the curtain that actually send out the bills. In the end, the law did absolutely nothing to curtail the rising and arbitrary costs charged by hospitals/physicians. And so long as insurance companies can justify rate increases (and they can, because of how much doctors/hospitals charge), they too, will in turn continuously raise what they charge for their insurance packages.

[Balta1701]

I've maintained from the start that this would fail for these very reasons, not because it didn't have good intentions or even accomplish some good things, but because it looked to "fix" only one area of the industry, insurance. It was an easy villain to target, everyone hates insurance companies, but nobody looks at the people behind the curtain that actually send out the bills. In the end, the law did absolutely nothing to curtail the rising and arbitrary costs charged by hospitals/physicians. And so long as insurance companies can justify rate increases (and they can, because of how much doctors/hospitals charge), they too, will in turn continuously raise what they charge for their insurance packages.

Just to point out, it didn't do "nothing" about these problems. It did not go far enough, but it also did not go far enough to rein in the insurance industry. The PPACA required hospitals to actually begin publishing their rates for various procedures and how they come up with the numbers. Those began being published last fall, and made quite a few headlines. That data is only publicly available because of the PPACA.

 

Having anyone able to do anything about it is of course a much bigger issue, but we can say the same things about a lot in this industry.

[StrangeSox]

On the other hand, any time the topic of reduced doctors' compensation comes up, plenty of people scream that they'll all just leave the country or stop practicing medicine.

[Y2HH]

On the other hand, any time the topic of reduced doctors' compensation comes up, plenty of people scream that they'll all just leave the country or stop practicing medicine.

 

Well, that's laughable. Where are they going to go to make more money, even if they took a pay cut here? A competing single payer system? There is nowhere for them to go, and they won't just "stop practicing medicine", as it's likely their only method to make a living.

[mr_genius]

Well, that's laughable. Where are they going to go to make more money, even if they took a pay cut here? A competing single payer system? There is nowhere for them to go, and they won't just "stop practicing medicine", as it's likely their only method to make a living.

 

^^^

[StrangeSox]

Well, that's laughable. Where are they going to go to make more money, even if they took a pay cut here? A competing single payer system? There is nowhere for them to go, and they won't just "stop practicing medicine", as it's likely their only method to make a living.

Hey I didn't say "don't socialize our medical care with OBUMMERCARE! the doctors will all leave for CANADA! or GO GALT!" made any damn sense.

[Iwritecode]

I wonder if someone can explain how the tax penalty works.

 

We have insurance through my wife’s employer. Our oldest daughter just turned 18 in August and just started her first PT job about a month ago.

 

She was included on our insurance plan but we have been fighting with idiots at the insurance company because they kept insisting they needed more information to prove that we are US citizens. Apparently birth certificates, driver’s licenses and school ids weren’t good enough somehow.

 

Somewhere in the midst of all this, they kicked our daughter off. We found later it was somehow related to the fact that my wife was still going by her maiden name when she had her (we were 18 at the time). This made zero sense because we had our second daughter before we were married as well.

 

We’ll be able to get her back on before the year ends and she only works about 12 hours a week so I doubt her yearly income will even be enough to make the penalty enforceable but I’m not 100% sure on that.

 

 

Also FWIW, we found out that our insurance costs will actually go down next year. It’ll be around $60/month.

Edited November 14, 2014 by Iwritecode

[StrangeSox]

There's no way she'd be hit by the mandate penalty making that little money. If she wasn't covered by your plan until age 26, she'd probably be eligible for Medicaid now anyway.

[bmags]

It also had the bundled payments to help with this. They actually threw a ton of small changes at the hope that any stuck. Probably a good idea because they had no idea what was the reason behind the explosing for 30 years and did not have political capital for single payer.

[bmags]

I wonder if someone can explain how the tax penalty works.

 

We have insurance through my wife’s employer. Our oldest daughter just turned 18 in August and just started her first PT job about a month ago.

 

She was included on our insurance plan but we have been fighting with idiots at the insurance company because they kept insisting they needed more information to prove that we are US citizens. Apparently birth certificates, driver’s licenses and school ids weren’t good enough somehow.

 

Somewhere in the midst of all this, they kicked our daughter off. We found later it was somehow related to the fact that my wife was still going by her maiden name when she had her (we were 18 at the time). This made zero sense because we had our second daughter before we were married as well.

 

We’ll be able to get her back on before the year ends and she only works about 12 hours a week so I doubt her yearly income will even be enough to make the penalty enforceable but I’m not 100% sure on that.

 

 

Also FWIW, we found out that our insurance costs will actually go down next year. It’ll be around $60/month.

 

That's an interesting question. If you had no insurance for 2014 but are insured at tax time 2015, do you pay a penalty? I would guess no but I'm not sure.

[bmags]

Well, that's laughable. Where are they going to go to make more money, even if they took a pay cut here? A competing single payer system? There is nowhere for them to go, and they won't just "stop practicing medicine", as it's likely their only method to make a living.

 

I agree with what you say, but with comments like these I'm just wondering how much of the 2009-10 health care fight you remember. Cutting doctor pay would have been impossible.

 

Nationalized insurance is a way easier sell than nationalized health care.

[StrangeSox]

That's an interesting question. If you had no insurance for 2014 but are insured at tax time 2015, do you pay a penalty? I would guess no but I'm not sure.

The fee is for the year you're filing the taxes for, so picking up coverage in 2015 wouldn't help you meet your requirements for 2014, plus you need to be insured for at least 9 months out of the year.

[bmags]

The fee is for the year you're filing the taxes for, so picking up coverage in 2015 wouldn't help you meet your requirements for 2014, plus you need to be insured for at least 9 months out of the year.

 

Interesting.

[cabiness42]

I know I probably say this every year about this time, but there is a very simple way to do this:

 

I just got my listing of Federal employee plans/premiums for 2015. There are nationwide FFS plans ranging from $375/month for an individual up to $1650/month for a family, plus there are dozens of regional HMO plans.

 

There is no reason that these plans couldn't be offered to everybody. Much easier solution than the convoluted law we ended up with.

[Balta1701]

I know I probably say this every year about this time, but there is a very simple way to do this:

 

I just got my listing of Federal employee plans/premiums for 2015. There are nationwide FFS plans ranging from $375/month for an individual up to $1650/month for a family, plus there are dozens of regional HMO plans.

 

There is no reason that these plans couldn't be offered to everybody. Much easier solution than the convoluted law we ended up with.

We know.

[bmags]

I know I probably say this every year about this time, but there is a very simple way to do this:

 

I just got my listing of Federal employee plans/premiums for 2015. There are nationwide FFS plans ranging from $375/month for an individual up to $1650/month for a family, plus there are dozens of regional HMO plans.

 

There is no reason that these plans couldn't be offered to everybody. Much easier solution than the convoluted law we ended up with.

 

Talk to Nelson/Landrieu

[Balta1701]

Talk to Nelson/Landrieu

My personal favorite will always be Lieberman.

 

Trying to find a way to sabotage it close to the time there was a final, passable bill, in December of ~2009 (I think) he did a press conference where he outlined a plan to replace everything that was being talked about with a proposal to drop the Medicare age to 55.

 

As soon as all the Democrats said "Absolutely OMFG YES" he decided that was a terrible idea and never spoke of it again.

[cabiness42]

Talk to Nelson/Landrieu

 

What were their problems with it?

[Balta1701]

What were their problems with it?

If you want to read it as cynically as possible, that any sort of publicly-available plan would be too good and private insurers couldn't compete with it.

 

"This is why we can't have nice things."