OBAMA/TRUMPCARE MEGATHREAD

[Texsox]

That's like saying health care is perfectly fine in the US because I work for Blue Cross Blue Shield, and we have a number of doctors/nurses on staff and a clinic in the basement of our offices.

 

That doesn't mean everyone else does.

 

Unfortunately, MOST people don't work for large employers, not the US, and not in Mexico.

 

And one doctor for an entire "large company and their families" doesn't sound all that amazing, to be perfectly honest.

 

I'm just suggesting the all cops are corrupt in Mexico may not be accurate.

 

We had 400 employees that classified as us a large employer. I think a lot of people work for companies of that size. One doctor 8 hours per day, 6 days per week. Plus a nurse the rest of the time. Anything they couldn't handle was paid for at the hospital.

 

For accurate comparison only. Use the facts as you wish.

[Y2HH]

I'm just suggesting the all cops are corrupt in Mexico may not be accurate.

 

We had 400 employees that classified as us a large employer. I think a lot of people work for companies of that size. One doctor 8 hours per day, 6 days per week. Plus a nurse the rest of the time. Anything they couldn't handle was paid for at the hospital.

 

For accurate comparison only. Use the facts as you wish.

 

Oh, no, I did not mean to insinuate that ALL cops in Mexico are corrupt, however, the Mexican police are pretty well known for corruption from the top down, complete with cartel involvement.

 

For a country that has a complete ban on guns, they seem to have just as many as we do.

 

And from everything I know, most people work for small companies (with less than ~25 people).

 

While I don't know the numbers for Mexico, here are the US numbers as of 2011:

 

In 2011, according to U.S. Census Bureau data, there were 5.68 million employer firms in the United States. Firms with fewer than 500 workers accounted for 99.7 percent of those businesses, and businesses with less than 20 workers made up 89.8 percent.

[StrangeSox]

here's the census data on firm size and number of employees:

 

http://www.census.gov/econ/smallbus.html

 

A slight majority (61M out of 120M) of all employees work for firms of 500 employees or more. Firms with 1-19 employees account for about 5.3M of all firms (out of 6M) but less than 18% of actual employees.

[Texsox]

Oh, no, I did not mean to insinuate that ALL cops in Mexico are corrupt, however, the Mexican police are pretty well known for corruption from the top down, complete with cartel involvement.

 

For a country that has a complete ban on guns, they seem to have just as many as we do.

 

And from everything I know, most people work for small companies (with less than ~25 people).

 

While I don't know the numbers for Mexico, here are the US numbers as of 2011:

 

In 2011, according to U.S. Census Bureau data, there were 5.68 million employer firms in the United States. Firms with fewer than 500 workers accounted for 99.7 percent of those businesses, and businesses with less than 20 workers made up 89.8 percent.

 

 

I'm wondering how they determine "employer firm". For example my wife and I edit books and have a business. We generate less than $5000 per year, teaching and coaching are our "real professions". Is our business included in employer firms? Owner/Operators are firms, so that could account as well. Interesting.

[StrangeSox]

Whether or not you actually have a payroll, I think. Not entirely sure, maybe hh knows.

[Y2HH]

here's the census data on firm size and number of employees:

 

http://www.census.gov/econ/smallbus.html

 

A slight majority (61M out of 120M) of all employees work for firms of 500 employees or more. Firms with 1-19 employees account for about 5.3M of all firms (out of 6M) but less than 18% of actual employees.

 

Ok, so only half the people are f***ed.

[cabiness42]

I'm wondering how they determine "employer firm". For example my wife and I edit books and have a business. We generate less than $5000 per year, teaching and coaching are our "real professions". Is our business included in employer firms? Owner/Operators are firms, so that could account as well. Interesting.

 

If your business pays employees salaries, then you are a business with employees. If you are just have a business and are pocketing the profits, then you are self-employed.

[farmteam]

If your business pays employees salaries, then you are a business with employees. If you are just have a business and are pocketing the profits, then you are self-employed.

What about a business with several independent contractors? Would that be included, or no? I can see how in some cases they perhaps should be included to be true to the spirit of the statistic, but there's also utility to having a bright-line rule of only considering businesses with actual employees.

[cabiness42]

What about a business with several independent contractors? Would that be included, or no? I can see how in some cases they perhaps should be included to be true to the spirit of the statistic, but there's also utility to having a bright-line rule of only considering businesses with actual employees.

 

I would have to look that up, which I don't have time to do right now, but off the top of my head I'm thinking that if there are no employees and only independent contractors, then it would not be considered a business with employees.

 

 

[Balta1701]

I would have to look that up, which I don't have time to do right now, but off the top of my head I'm thinking that if there are no employees and only independent contractors, then it would not be considered a business with employees.

This is correct:

[Texsox]

Interesting. Then one of the authors we have done work for would be considered an employer, he paid my wife as an employee. (There was a unique circumstance that helped us both out) This will also include anyone who employs full time housekeepers, nannies, etc.

[Y2HH]

Interesting. Then one of the authors we have done work for would be considered an employer, he paid my wife as an employee. (There was a unique circumstance that helped us both out) This will also include anyone who employs full time housekeepers, nannies, etc.

 

I think those are all still considered contractors.

[StrangeSox]

Decision of the Fourth Circuit is affirmed in King v. Burwell. 6-3. Roberts with the opinion.

 

Holding is that subsidies are available on all exchanges. Six are the Chief, Kennedy, Ginsburg, Breyer, Sotomayor, and Kagan.

Edited June 25, 2015 by StrangeSox

[Balta1701]

Oh thank goodness. Thank you thank you thank you thank you thank you.

[StrangeSox]

Really makes you wonder why the case was granted cert in the first place since 1) they upheld the lower court ruling and 2) there wasn't even a split among the lower courts (once the DC Circuit announced they were going to rehear the case before them). Did Kennedy vote with Scalia, Alito and Thomas to grant cert hoping to grab Roberts but was ultimately convinced the case was really a sham?

 

opinion available here

 

From the majority opinion: "Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them."

 

(source is SCOTUSblog)

 

The court didn't even rely on ambiguity and "Chevron" agency interpretation, they flat-out ruled that the availability of subsidies is unambiguous and that the argument to the contrary requires ignoring the entire rest of the statute.

 

this part of the decision neatly explains why this legal argument couldn't find traction in any of the lower courts in the first place:

 

(b) When read in context, the phrase “an Exchange established by

the State under [42 U. S. C. §18031]” is properly viewed as ambiguous.

The phrase may be limited in its reach to State Exchanges. But

it could also refer to all Exchanges—both State and Federal—for

purposes of the tax credits. If a State chooses not to follow the directive

in Section 18031 to establish an Exchange, the Act tells the

Secretary of Health and Human Services to establish “such Exchange.”

§18041. And by using the words “such Exchange,” the Act

indicates that State and Federal Exchanges should be the same. But

State and Federal Exchanges would differ in a fundamental way if

tax credits were available only on State Exchanges—one type of Exchange

would help make insurance more affordable by providing billions

of dollars to the States’ citizens; the other type of Exchange

would not. Several other provisions in the Act—e.g., Section

18031(i)(3)(B)’s requirement that all Exchanges create outreach programs

to “distribute fair and impartial information concerning . . .

the availability of premium tax credits under section 36B”—would

make little sense if tax credits were not available on Federal Exchanges

 

a key feature of Roberts not even really getting to Chevron ambiguity: it's not even about agency interpretation, so a hypothetical future Republican administration couldn't direct the IRS to 're-interpret' the statute so as to remove subsidies from Federal exchanges. Short of changing the law in Congress, subsidies are here to stay.

Edited June 25, 2015 by StrangeSox

[Soxfest]

I wish Obama would quit lying how everyone is saving money because of Obamacare he said it again today. I do not know anyone who's deductible that is not thousands of dollars more. Higher premiums and less coverage is all Obamacare has done to the working class. Only people happy about this is the Medicaid crowd.

Edited June 25, 2015 by Soxfest

[StrangeSox]

I do not know anyone who's deductible that is not thousands of dollars more.

:raises hand:

 

:points to numerous studies and surveys directly contradicting that claim:

 

:also points to millions of people who can afford any insurance at all thanks to the subsidies:

Edited June 25, 2015 by StrangeSox

[cabiness42]

:raises hand:

 

:points to numerous studies and surveys directly contradicting that claim:

 

Any Federal employee saw virtually no change in their coverage due to Obamacare (unless they voluntarily changed plans).

[Brian]

:raises hand:

 

:points to numerous studies and surveys directly contradicting that claim:

 

Ditto. Mine is the same as the last 3 years.

[Jenksismyhero]

Scalia's dissent is a great read.

[Chisoxfn]

I wish Obama would quit lying how everyone is saving money because of Obamacare he said it again today. I do not know anyone who's deductible that is not thousands of dollars more. Higher premiums and less coverage is all Obamacare has done to the working class. Only people happy about this is the Medicaid crowd.

I will be the first person to tell anyone about how my costs have gone up across the board (not just higher premiums but less coverage along with those higher premiums). And before Balta answers, in my exact situation it has nothing with my employer covering less. They cover the same % split and haven't changed that during this window.

 

However, the real comparison would be on how the costs were increasing pre Obama Care vs. Post Obamacare and you have to look at it from multiple perspectives...not just premium costs but total out of pocket costs (as those would be reflective of potential lower benefits that you are receiving). I am sure the data is out there but as a stat / analytic guy (I live in that world pretty much all day), the data I've typically seen around just has a lot of holes in the assumptions, etc, that I question the overall validity.

 

By the way, despite being a republican, I do think their were certain things about Obamacare that were absolutely fantastic and necessary. Healthcare is something everyone should have the right to have and people shouldn't not be able to get healthcare because of past health issues (many of which were completely and utterly out of their control).

[StrangeSox]

Scalia's dissent is a great read.

I agree but I'm sure for completely different reasons.

[Balta1701]

However, the real comparison would be on how the costs were increasing pre Obama Care vs. Post Obamacare and you have to look at it from multiple perspectives...not just premium costs but total out of pocket costs (as those would be reflective of potential lower benefits that you are receiving). I am sure the data is out there but as a stat / analytic guy (I live in that world pretty much all day), the data I've typically seen around just has a lot of holes in the assumptions, etc, that I question the overall validity.

The easiest way to look at this is "Total U.S. Healthcare spending" because that is a readily-tracked value and it reflects both contributions. The results as of last year continue to say "health care costs growing at a much slower rate than they were prior to passage of the PPACA.

The United States spent $2.9 trillion on health care in 2013, or about $9,255 per person, according to a new detailed accounting of the nation's health care dollars. The 2013 totals represent just 3.6 percent growth in national health spending from 2012 — the lowest annual growth rate since 1960, according to a federal report published in the policy journal Health Affairs.

 

It also marks the fifth straight year of low health spending growth, and it shows a slowdown from the 4.1 percent growth rate in 2012. And for the fifth straight year, health care spending as a share of the economy held steady at 17.4 percent.

Supporting link. Forbes has a writer who has argued there are additional costs in the system here but those costs in the numbers given actually have not gone up at all over the time period he writes, which would lower that growth rate even more.

 

Basically, whatever portions you count...year over year cost growth is at the lowest level in decades.

[Jenksismyhero]

I agree but I'm sure for completely different reasons.

 

You can still appreciate it for what it is, even if you don't agree with the result.

 

I love the last two paragraphs:

 

Today’s opinion changes the usual rules of statutory

interpretation for the sake of the Affordable Care Act.

That, alas, is not a novelty. In National Federation of

Independent Business v. Sebelius, 567 U. S. ___, this Court

revised major components of the statute in order to save

them from unconstitutionality. The Act that Congress

passed provides that every individual “shall” maintain

insurance or else pay a “penalty.” 26 U. S. C. §5000A.

This Court, however, saw that the Commerce Clause does

not authorize a federal mandate to buy health insurance.

So it rewrote the mandate-cum-penalty as a tax. 567

U. S., at ___–___ (principal opinion) (slip op., at 15–45).

The Act that Congress passed also requires every State to

 

Cite as: 576 U. S. ____ (2015) 21

SCALIA, J., dissenting

accept an expansion of its Medicaid program, or else risk

losing all Medicaid funding. 42 U. S. C. §1396c. This

Court, however, saw that the Spending Clause does not

authorize this coercive condition. So it rewrote the law to

withhold only the incremental funds associated with the

Medicaid expansion. 567 U. S., at ___–___ (principal

opinion) (slip op., at 45–58). Having transformed two

major parts of the law, the Court today has turned its

attention to a third. The Act that Congress passed makes

tax credits available only on an “Exchange established by

the State.” This Court, however, concludes that this limitation

would prevent the rest of the Act from working as

well as hoped. So it rewrites the law to make tax credits

available everywhere. We should start calling this law

SCOTUScare.

 

Perhaps the Patient Protection and Affordable Care Act

will attain the enduring status of the Social Security Act

or the Taft-Hartley Act; perhaps not. But this Court’s two

decisions on the Act will surely be remembered through

the years. The somersaults of statutory interpretation

they have performed (“penalty” means tax, “further [Medicaid]

payments to the State” means only incremental

Medicaid payments to the State, “established by the State”

means not established by the State) will be cited by litigants

endlessly, to the confusion of honest jurisprudence.

And the cases will publish forever the discouraging truth

that the Supreme Court of the United States favors some

laws over others, and is prepared to do whatever it takes

to uphold and assist its favorites.

 

Pretty much.

 

I love how he also called an argument "applesauce." So great.

Edited June 25, 2015 by Jenksismybitch

[StrangeSox]

You can still appreciate it for what it is, even if you don't agree with the result.

 

I love the last two paragraphs:

 

 

 

Pretty much.

 

I love how he also called an argument "applesauce." So great.

 

On a first read, it's overwrought hack-work. I appreciate the sweet, sweet tears and his hypocrisy.

 

He assumes his own conclusion over and over, relies on appeals to "common sense" instead of how the bill was actually drafted and passed through congress (why it says "...by the state" in some areas and not in others), and his closing statement could very easily be turned against him by changing "favors" to "disfavors" and "uphold and assist" to "undermine and destroy."

 

for example:

 

Words no longer have meaning if an Exchange that is

not established by a State is “established by the State.” It

is hard to come up with a clearer way to limit tax credits

to state Exchanges than to use the words “established by

the State.”

 

Words no longer have meaning!!!

 

And no clearer way? Well, you could not bury that phrase in a formula for calculating federal tax credits and not make it clear anywhere else within the bill. You could not have the federal government establish "such exchange" if the states don't do it themselves. You could explicitly say "FEDERAL EXCHANGES ARE NOT ELIGIBLE FOR SUBSIDIES" or "ONLY STATE EXCHANGES ARE ELIGIBLE FOR SUBSIDIES." There are trivially easy ways to limit tax credits to state Exchanges.

 

He doesn't ever really get around the addressing the arguments laid out in multiple briefs filed with the court that Roberts seems to rely heavily on (or at least they're very similar to his opinion).

Edited June 25, 2015 by StrangeSox