The House comes up with an "answer" to the PPACA...

garamet · Mar 18, 2015

...i.e., a retread of something it cobbled together four years ago:

"New" House Budget Privatizes Medicare, Repeals ACA

Following a familiar script, House Republicans today introduced a budget bill for fiscal 2016 that would repeal the Affordable Care Act (ACA), partially privatize Medicare, turn Medicaid into a block-grant program for states, and produce a $13 billion budget surplus in 2024.

The script dates back to 2011, when the House Budget Committee, then chaired by Rep. Paul Ryan (R-WI), first proposed this package of measures. Even if the House and Senate, both controlled by the GOP, were to approve them, President Barack Obama would likely use his veto pen.

Under the plan released today by the House Budget Committee, Medicare would shift to a "premium support" model beginning in 2024 for new enrollees — in other words, Americans born in 1959 and thereafter. Seniors would choose between traditional Medicare or a private health plan, with the government paying a fixed premium subsidy to either. The subsidy may or may not cover the entire premium, depending on the plan. Subsidies would be higher for seniors with worsening medical conditions and lower for wealthier beneficiaries. Low-income individuals would receive financial help to cover out-of-pocket expenses.

Medicaid, a federal program administered on the state level and funded mostly with federal dollars, would take a decidedly state turn under the GOP proposal. Each state would receive a Medicaid block grant from the federal government that is less than what it would ordinarily receive, according to several analyses, along with more discretion in how to spend the money.

The budget proposal erases the ACA entirely from the books, "including all of the tax increases, regulations, subsidies, and mandates," according to a summary from the House Budget Committee. It purports to strengthen Medicare by ending "the over $700 billion Obamacare raid" on this program. The proposal does not offer any specific replacement for the ACA but instead calls for "starting over with a patient-centered approach to healthcare reform" that stresses freedom of choice and a smaller role for the federal government.

The legislation contains a clause that would permit the Senate to pass a repeal of the ACA with a simple majority in an expedited voting process called reconciliation. Among other things, it would prevent opponents — namely, Democrats — from filibustering an ACA repeal bill.

Congressional Democrats and Obama have sharply criticized these GOP healthcare policies since they first were aired. They have warned that a premium support system would "end Medicare as we know it" because the subsidies may not be enough for seniors to purchase traditional Medicare and its more generous benefits. And block-granting Medicaid, Democrats have said, would translate into fewer needy individuals receiving benefits.

At a meeting with Irish Prime Minister Enda Kenny at the White House today, Obama expressed disappointment with the current Republican plan. "Unfortunately, what we're seeing right now is a failure to invest in education, infrastructure, research, and national defense — all the things that we need to grow, need to create jobs, to stay at the forefront of innovation and to keep our country safe," Obama told reporters. He did not address the healthcare facets of the plan.

More information about the GOP budget proposal for 2016 is available on the website of the House Budget Committee.
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Diacanu · Mar 18, 2015

Lemme guess, tax cuts for the rich too.

garamet · Mar 18, 2015

Diacanu said: ↑

Lemme guess, tax cuts for the rich too.
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Yeah, that's probably in there somewhere...

Liet · Mar 18, 2015

Regarding this "budget:"
----------------
It assumes that current tax cuts will be allowed to expire as scheduled — which would amount to a $900 billion tax increase that nobody believes would be allowed to go into effect.

It proposes to repeal Obamacare but then counts revenues and savings from Obamacare as if the law remained in effect.

It claims to save $5.5 trillion over 10 years, but in the fine print — the budget plan’s instructions to committees — it only asks them to identify about $5 billion in savings over that time.
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This is a budget in the same sense that a rhinoceros is an iPhone.

garamet · Mar 18, 2015

^Of course. This thread is just a placeholder for all the other nonsense around King v Burwell, which I'll be posting between now and when the decision is handed down. "And there will be weeping and gnashing of teeth..."

Steal Your Face · Mar 18, 2015

garamet said: ↑

...i.e., a retread of something it cobbled together four years ago:

"New" House Budget Privatizes Medicare, Repeals ACA

Following a familiar script, House Republicans today introduced a budget bill for fiscal 2016 that would repeal the Affordable Care Act (ACA), partially privatize Medicare, turn Medicaid into a block-grant program for states, and produce a $13 billion budget surplus in 2024.

The script dates back to 2011, when the House Budget Committee, then chaired by Rep. Paul Ryan (R-WI), first proposed this package of measures. Even if the House and Senate, both controlled by the GOP, were to approve them, President Barack Obama would likely use his veto pen.

Under the plan released today by the House Budget Committee, Medicare would shift to a "premium support" model beginning in 2024 for new enrollees — in other words, Americans born in 1959 and thereafter. Seniors would choose between traditional Medicare or a private health plan, with the government paying a fixed premium subsidy to either. The subsidy may or may not cover the entire premium, depending on the plan. Subsidies would be higher for seniors with worsening medical conditions and lower for wealthier beneficiaries. Low-income individuals would receive financial help to cover out-of-pocket expenses.

Medicaid, a federal program administered on the state level and funded mostly with federal dollars, would take a decidedly state turn under the GOP proposal. Each state would receive a Medicaid block grant from the federal government that is less than what it would ordinarily receive, according to several analyses, along with more discretion in how to spend the money.

The budget proposal erases the ACA entirely from the books, "including all of the tax increases, regulations, subsidies, and mandates," according to a summary from the House Budget Committee. It purports to strengthen Medicare by ending "the over $700 billion Obamacare raid" on this program. The proposal does not offer any specific replacement for the ACA but instead calls for "starting over with a patient-centered approach to healthcare reform" that stresses freedom of choice and a smaller role for the federal government.

The legislation contains a clause that would permit the Senate to pass a repeal of the ACA with a simple majority in an expedited voting process called reconciliation. Among other things, it would prevent opponents — namely, Democrats — from filibustering an ACA repeal bill.

Congressional Democrats and Obama have sharply criticized these GOP healthcare policies since they first were aired. They have warned that a premium support system would "end Medicare as we know it" because the subsidies may not be enough for seniors to purchase traditional Medicare and its more generous benefits. And block-granting Medicaid, Democrats have said, would translate into fewer needy individuals receiving benefits.

At a meeting with Irish Prime Minister Enda Kenny at the White House today, Obama expressed disappointment with the current Republican plan. "Unfortunately, what we're seeing right now is a failure to invest in education, infrastructure, research, and national defense — all the things that we need to grow, need to create jobs, to stay at the forefront of innovation and to keep our country safe," Obama told reporters. He did not address the healthcare facets of the plan.

More information about the GOP budget proposal for 2016 is available on the website of the House Budget Committee.
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Sounds like a good start, but Medicare should be means tested and you should be allowed to opt out.

garamet · Mar 18, 2015

Federal Farmer said: ↑

Medicare should be means tested and you should be allowed to opt out.
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If it were means tested, the 1% would squeal like pigs, calling it the "Life Tax" to go with their "Death Tax."

garamet · Mar 30, 2015

As promised, an overview of the finer points of King v Burwell from various perspectives as the case progresses:

http://www.medscape.com/viewarticle/840564?src=wnl_edit_tpal&uac=127342PX

Supreme Court Hearing on ACA Subsidies Will Be 'Such' Drama
Robert Lowes

February 27, 2015
In the minds of many legal experts, no great constitutional issues will take center stage when the Supreme Court hears oral arguments on March 4 in a case challenging the validity of insurance premium subsidies in at least 34 states under the Affordable Care Act (ACA).

Instead, lawyers for both sides will parse the meaning of words in the law such as "such," marshalling dictionary definitions, context, and logic in an effort to sway the nine judges. It will be showtime for statutory construction, the nit-picking art of interpreting and applying legislation.

The eventual outcome of the case, which won't be known until this summer, will be anything but pedantic. At stake is health insurance coverage for millions of Americans, and perhaps the survival of the 5-year-old ACA, which narrowly escaped a Supreme Court smackdown in 2012.

Back then, the big issues were the individual mandate to obtain insurance coverage (upheld) and Medicaid expansion (made optional on a state-by-state basis). This time around, the high court will decide whether the Internal Revenue Service (IRS) correctly interpreted the ACA to make premium subsidies — in the form of tax credits — available to Americans enrolled in any health insurance marketplace, or exchange, in any state.

One provision in the ACA stipulates that the subsidies go to qualified individuals enrolled in a federally approved health plan through an exchange "established by the state." However, when the IRS issued regulations in 2012 to implement the law, it decided that the ACA, read as a whole, intended to make subsidies also available to residents of states served by federally established exchanges.

As it turned out, 34 states, mostly "red" politically, declined to create exchanges. That left the Department of Health and Human Services (HHS) with the task of creating and operating "such exchange(s)" there, as the law required. They are served by the federal website healthcare.gov.

Sixteen other states, mostly "blue," as well as Washington, DC, created their own exchanges. Three of them — Nevada, New Mexico, and Oregon — fall in the category of "federally supported state-based" because they rely on healthcare.gov (bringing the total number of website users to 37 states). The remaining 13 states operate exchanges completely on their own — California, Colorado, Connecticut, Hawaii, Idaho, Kentucky, Maryland, Massachusetts, Minnesota, New York, Rhode Island, Vermont, and Washington — as does DC.

In the Supreme Court case against the Obama administration, the plaintiffs contend that the IRS ran roughshod over the explicit will of Congress to limit subsidies to individuals who bought insurance on an exchange "established by the state," the four embattled words of the Supreme Court case. This violated the constitution's separation of powers — only Congress has the power to tax and spend — and even the rule of law, according to a friend-of-the-court brief filed by the conservative Cato Institute.

The high-court debate over a handful of words points to a new era of strict statutory construction for the Supreme Court, said Robert Schapiro, dean of the Emory University School of Law, in Atlanta, Georgia, in an interview with Medscape Medical News. Before 1980 or so, said Schapiro, the subsidy case would have been a slam-dunk win for the government because the courts, like the IRS, would have considered the overarching purpose of the law — affordable healthcare for everyone.

"More recently, though, the court has been driven by (Associate Justice Antonin) Scalia and others to look more narrowly at the language of a statute, to focus on individual phrases," said Schapiro. "However, even that kind of textualism does requires looking not just at one phrase in isolation but looking at that phrase in the context in the overall statute."

Schapiro calls the challenger's case weak, but ACA supporters, such as Lawrence Gostin, a professor of global health law at Georgetown University, are nevertheless worried.

"I predict the Supreme Court will strike down the subsidies (in states with federally established exchanges)," Gostin told Medscape Medical News. "It's a very conservative court, and it's not shown a great deal of support for the ACA.

"I am very discouraged."

How the Case Arrived at the High Court's Doorstep

Conflicting decisions in lower courts on the IRS subsidy regulations set the stage for the Supreme Court battle.

A federal district court in Richmond, Virginia, ruled for the Obama administration in a subsidy suit brought by David King and three other residents of Virginia, which had defaulted to a federally established exchange. The King plaintiffs, whose case is funded and coordinated by a group called the Competitive Enterprise Institute, said they didn't want to buy comprehensive health insurance, but the availability of premium subsidies would force them to do so — or else pay a penalty — under the ACA's individual mandate.

Without the subsidies, they would be exempt from the mandate because they otherwise would have to spend more than 8% of their income on a health plan. With the subsidies bringing them under this income threshold, the mandate would apply. And in their view, the subsidies should not be in the equation because Virginia lacked an exchange "established by the state."

The district judge agreed with the government in King v. Burwell that the law in its entirety envisioned subsidies to Americans in all states, regardless of who established their exchanges. The King plaintiffs also lost at the appellate level, but for a different reason. The United States Court of Appeals for the Fourth Circuit found the law ambiguous when it came to Congress' intentions on subsidies.

But that was a boon for the government. When a law is ambiguous, the courts defer to the executive branch's interpretation as long as it is reasonable under a Supreme Court case called Chevron USA v. Natural Resources Defense Council (giving rise to the principle of "Chevron deference"). The appellate court did just that.

Another federal lawsuit that challenged subsidies in states like Virginia, however, triumphed at the appellate level, setting up the kind of judicial split that pulls in the Supreme Court to settle the matter. In Halbig v. Burwell, the United States Court of Appeals for the District of Columbia Circuit said that "the ACA unambiguously restricts the...subsidy to insurance purchased on 'exchanges established by the state.'... Within constitutional limits, Congress is supreme in matters of policy." The decision, reached by two members of a three-judge panel, was vacated when the entire appellate court agreed to rehear the case, later put on hold after the subsidy issue made the Supreme Court docket.

A federal district court in Muskogee, Oklahoma, also read "established by the states" literally and ruled against the Obama administration. The government's appeal of that decision is on ice until the Supreme Court decides King v. Burwell.

The Jonathan Gruber Factor

The Supreme Court on March 4 is likely to hear attorneys for the government and the plaintiffs spar over the ACA provision that, in the event of state inaction on an exchange, requires the HHS to establish "such exchange." The government maintains that "such exchange" represents a legal surrogate for an exchange "established by the state." The plaintiffs counter that although exchanges may function the same way regardless of their creator, "such" still does not touch on who created them. Besides, exchanges created by US territories such as Guam are "such" exchanges, yet their enrollees aren't eligible for premium subsidies. So where's the equivalence?

Mere semantics? "Believe it or not, it matters when you talk about lawyering," said Ilya Shapiro, a constitutional-law expert at the Cato Institute.

At the same time, both sides in the case will look at the context of contested phrases. The individual mandate is meaningless without the subsidies, the Obama administration will contend. The government can't require Americans to buy insurance when it's unaffordable. Furthermore, the lack of subsidies would exempt millions of Americans from the mandate in states with HHS-established exchanges, draining the individual-insurance risk pools there of healthy young adults, even as insurers continue to accept all applicants, sick or not, as required by law. The result would be a "death spiral" of higher premiums and declining enrollment. To think that Congress engineered such exchanges to fail is unreasonable and absurd, according to the government.

Not so absurd, counter the challengers. The King plaintiffs claim that Congress made subsidies contingent on state-established exchanges to pressure states to get with the program. Lawmakers took the same approach with Medicaid expansion, they assert, threatening to withhold all federal contributions to state Medicaid programs if they refused to loosen their eligibility requirements (the Supreme Court in 2012 cancelled that threat in the name of states' rights). And back in 2009, conditional subsidies were on the menu of healthcare reforms that lawmakers could choose from.

The government denies that Congress hid such a "poison pill" in the ACA, and a number of constitutional experts agree, pointing to a dearth of evidence about what lawmakers were thinking about behind closed doors. A "sheer, cynical fabrication," said Simon Lazarus, senior counsel at the Constitutional Accountability Center, in an email interview with Medscape Medical News.

For its part, the plaintiffs hope to get a lot of mileage from some evidence that has embarrassed the Obama administration. Jonathan Gruber, an economics professor at the Massachusetts Institute of Technology, advised the White House as a paid consultant on crafting the ACA in the likeness of RomneyCare in Massachusetts, which he helped design.

Gruber went on to write a comic book explaining healthcare reform ("...I've got a little experience in this area," his character quipped on page 7). On January 10, 2012, he was captured on video explaining to an audience that "if your governor doesn't set up an exchange, you're losing hundreds of millions of dollars in tax credits to be delivered to your citizens." Eight days later he repeated this point in another talk. "I hope that's a blatant enough political reality that states will get their act together and realize there are billions of dollars at stake here in setting up these exchanges," Gruber said, apparently confirming the position of the King plaintiffs.

Confronted with the videos, Gruber initially said he misspoke and that Congress had made a clerical mistake in drafting the law (a point made by others). He later said that he was addressing the possibility that the federal government may fail to set up exchanges in lieu of the states. Gruber declined to grant an interview to Medscape Medical News.

Like some other legal scholars, Lazarus said that Gruber's "after-the-fact, off-the-cuff remarks" should not factor in the court's decision because they were not part of the actual legislative history of the ACA. "There is a massive amount of other evidence that this is not what Congress intended," added Emory's Robert Schapiro.

There remains the question of how much the high court will consider any outside evidence that illuminates "established by the state," whether it is a staff-written memo or a lawmaker's speech about who would receive subsidies (every American who qualified on the basis of income, according to Democrats and Republicans alike at the law's debut). The notion of interpreting a tricky legal text in light of its legislative history is repugnant to the influential Associate Justice Scalia, who once remarked, "It is the law that governs, not the intent of the lawgiver."

Questions the Judges Might Pose

By the time a Supreme Court case makes it to oral arguments, litigants will have already spelled out their positions in written briefs. The focus of the oral arguments, rather, is on the questions that the nine justices will ask the attorneys and how well they defend their positions.

The lead attorney for the Obama administration is Solicitor General Robert Verrilli, Jr, reprising his role from the 2012 Supreme Court case. Both Ilya Shapiro and Robert Schapiro expect the justices to test Verrilli with this question: "If Congress intended subsidies to Americans enrolling in any exchange, including federally established ones, why didn't it say so in clear language?"

If Verrilli were to concede that the wording of the law amounted to a typo, the government's case would weaken because "it's not the court's job to correct errors of Congress," noted Schapiro.

Facing off against Verrilli is Michael Carvin, his Supreme Court nemesis from 2012. Ilya Shapiro said that the justices may challenge Carvin on the distinction that he draws between state- fashioned exchanges and those of HHS parentage. "Is there really a difference in who set them up?" Carvin also will be pressed to prove that Congress knowingly would have put HHS exchanges at grave risk by withholding subsidies from their enrollees, said Robert Schapiro. "Could Congress have intended this result?"

Supreme Court watchers are tempted to analyze the justices' questions in hopes of deciphering how they're leaning in the case. However, don't get carried away with this diagnostic exercise, cautions Robert Doherty, senior vice president of governmental affairs and public policy at the American College of Physicians (ACP). Justices who appear hostile toward one position during the oral arguments often end up supporting it. "The questions are not always indicative of the outcome," Doherty told Medscape Medical News.

Will the Court Consider the Fallout of a King Victory?

In its written brief in King v. Burwell, the Obama administration stated that the plaintiffs "seek to upend the (ACA) and extinguish the coverage of millions of Americans."

"This is no abstract case about principles of statutory construction," the administration said. "Petitioners' position, if accepted, means many more people will get sick, go bankrupt, or die."

Recent research bears out the administration's fears. A study from the Urban Institute predicts that if the Supreme Court rules in favor of the King plaintiffs, 9.3 million individuals would lose subsidies in the 34 states that declined to set up exchanges, and 8.2 million would become uninsured (some say subsidies in the remaining three states served by healthcare.gov also may be at risk).

The Rand Corporation, a nonprofit research organization focused on public policy, also put the number of potential uninsured in the 34 states at about 8 million. In addition, insurance premiums would climb as adverse selection kicks in, leading to a cycle of enrollment declines and further premium hikes that would devastate the individual insurance markets in those states, according to Rand.

These prophecies of healthcare apocalypse loom large in friend-of-the-court briefs filed by a broad swathe of the healthcare industry in favor of the Obama administration. Supporters include America's Health Insurance Plans, the American Hospital Association, the American Nurses Association, and medical societies such as the American Academy of Pediatrics, the American Academy of Family Physicians, and the ACP.

"It's a life-and-death situation," said the ACP's Robert Doherty. "There’s plenty of evidence that having health insurance is associated with better outcomes, and lack of health insurance is associated with preventable mortality and morbidity."

It's anybody's guess how much the justices will heed the possibly dire fallout from a King victory described by the Obama administration and others. "Should those appeals matter when everyone knows there are winners and losers with every decision?" asked the Cato Institute's Ilya Schapiro.

"Outcomes aren't strictly relevant, legally,” said Lawrence Gostin, at Georgetown University. "But justices are humans beings. They're aware of the effects of their rulings."

The justices also know that if they do invalidate premium subsidies in states with federally established exchanges, other branches of government have ways to undo the damage, at least in theory. Congress could amend the ACA to make subsidies available in every state. But Congress is controlled by Republicans who have vowed to repeal the ACA. The GOP conceivably might agree to save the subsidies, though, if it can wring concessions from Democrats, such as the elimination of the employer mandate or the medical device tax.

Another remedy is for states with federally established exchanges to take them over so their residents can keep their subsidies. But that assumes a willingness to do so on the part of Republican governors and Republican-dominated legislatures that heretofore have tried to roadblock the ACA. "There may be political pressure to move in the direction of state-operated exchanges," said Gostin, "but governors have been prepared to stab their own citizens in the heart before, by refusing to expand Medicaid."

Gostin expects the Supreme Court's conservative majority to read "established by the state" literally and invalidate subsidies in states with federally established exchanges. Other legal scholars aren't so sure what will happen.

"I do believe that the four more liberal justices (Elena Kagan, Stephen Breyer, Ruth Bader Ginsburg, and Sonia Sotomayor) will vote with the government," said Robert Schapiro. "With the other five, I don't have a prediction."

As with the 2012 decision that saved the ACA, a victory for the Obama administration in King v. Burwell will require a swing vote coming from one of the five conservative justices. If someone does swing, who will it be?

That judge may be keeping a poker face at next week's oral arguments.

Medscape Medical News © 2015 WebMD, LLC

Send comments and news tips to news@medscape.net.

Cite this article: Supreme Court Hearing on ACA Subsidies Will Be 'Such' Drama. Medscape. Feb 27, 2015.
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Steal Your Face · Mar 30, 2015

Maybe neither side has a clear answer and we just need a do-over.

http://tenthamendmentcenter.com/201...e-latest-obamacare-mess-at-the-supreme-court/

garamet · Mar 30, 2015

Federal Farmer said: ↑

Maybe neither side has a clear answer and we just need a do-over.

http://tenthamendmentcenter.com/201...e-latest-obamacare-mess-at-the-supreme-court/
Click to expand...

And this is the part where you're once again asked what to do about the:

Nearly 11.7 million signed up for Obamacare health insurance

And you flap your arms and fly away...again.

Meanwhile, for those of us who are concerned about the U.S.'s economic stability:

CBO cuts estimates for Obamacare costs, long-term U.S. deficits

Steal Your Face · Mar 30, 2015

garamet said: ↑

Federal Farmer said: ↑

Maybe neither side has a clear answer and we just need a do-over. http://tenthamendmentcenter.com/201...e-latest-obamacare-mess-at-the-supreme-court/
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And this is the part where you're once again asked what to do about the: Nearly 11.7 million signed up for Obamacare health insurance And you flap your arms and fly away...again. Meanwhile, for those of us who are concerned about the U.S.'s economic stability: CBO cuts estimates for Obamacare costs, long-term U.S. deficits
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I guess Congress doesn't exist and can't act?

Dinner · Mar 30, 2015

Congress's inability to act is well known. Or at least if Republicans are in charge it has no ability to act. That is just a sad fact.

I don't much like Dems that much either but they at least say the right things even though it is clearly they have no intentions of doing any of those things. In the last political test I took I matched the green party 90% but only 70% with dems.

garamet · Mar 30, 2015

Federal Farmer said: ↑

garamet said: ↑

Federal Farmer said: ↑

Maybe neither side has a clear answer and we just need a do-over. http://tenthamendmentcenter.com/201...e-latest-obamacare-mess-at-the-supreme-court/
Click to expand...

And this is the part where you're once again asked what to do about the: Nearly 11.7 million signed up for Obamacare health insurance And you flap your arms and fly away...again. Meanwhile, for those of us who are concerned about the U.S.'s economic stability: CBO cuts estimates for Obamacare costs, long-term U.S. deficits
Click to expand...

I guess Congress doesn't exist and can't act?
Click to expand...

So you've got nothing...again.

Steal Your Face · Mar 30, 2015

Dinner said: ↑

Congress's inability to act is well known. Or at least if Republicans are in charge it has no ability to act. That is just a sad fact.

I don't much like Dems that much either but they at least say the right things even though it is clearly they have no intentions of doing any of those things. In the last political test I took I matched the green party 90% but only 70% with dems.
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So it's all good as long as they pay lip service, got it.

garamet said: ↑

Federal Farmer said: ↑

garamet said: ↑

Federal Farmer said: ↑

Maybe neither side has a clear answer and we just need a do-over. http://tenthamendmentcenter.com/201...e-latest-obamacare-mess-at-the-supreme-court/
Click to expand...

And this is the part where you're once again asked what to do about the: Nearly 11.7 million signed up for Obamacare health insurance And you flap your arms and fly away...again. Meanwhile, for those of us who are concerned about the U.S.'s economic stability: CBO cuts estimates for Obamacare costs, long-term U.S. deficits
Click to expand...

I guess Congress doesn't exist and can't act?
Click to expand...

So you've got nothing...again.
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No, you got nothing. You keep asking me for answers and solutions and I give them to you. Just because you don't like the solutions, doesn't mean I didn't provide them.

garamet · Mar 30, 2015

Federal Farmer said: ↑

You keep asking me for answers and solutions and I give them to you.
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"Congress should repeal it" is the only "solution" you've offered. When asked what you'd recommend, you reply with "I'm not in Congress." I.e., your "solution" is . Again.

Meanwhile:

King v. Burwell oral argument

Ebeneezer Goode · Mar 30, 2015

Here's a thought, the US government's various aspects should actually sit down and decide what they actually want from a health service. They may want to start with a trip to Singapore.

Obamacare looks to be slightly less messy version of what was before, but if you're arguing on the best kind of dog shit to eat, you probably want to consider not eating dog shit.

steve2^4 · Mar 30, 2015

Unfortunately the majority of people in this country don't realize they've been fed dog shit and think it's pâté.

Dinner · Mar 30, 2015

I believe most supporters have spent years saying it is an improvement but that universal single payer would be preferable.

How have you missed that for the last half decade.

tafkats · Mar 30, 2015

Indeed.

The state of health insurance in this country still isn't perfect. But it's a damn sight better than it used to be.

And Obama's main legacy will probably be that he was the first president to actually make -- and pass -- an honest attempt to address the problem.

Steal Your Face · Mar 30, 2015

tafkats said: ↑

Indeed.

The state of health insurance in this country still isn't perfect. But it's a damn sight better than it used to be.

And Obama's main legacy will probably be that he was the first president to actually make -- and pass -- an honest dishonest and deceptive attempt to address the problem.
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FTFY.

tafkats · Mar 30, 2015

Have you come up with your own proposal yet, aside from "let the free market take care of it and everything will be fine" with a side order of making it harder for people to sue when they're injured?

Rimjob Bob · Mar 31, 2015

I wonder if the GOP Congress would be crazy enough to pass this legislation if a Republican were in the White House and it would actually become law.

Ancalagon · Mar 31, 2015

My premiums decreased about 5% this year and my insurance company cut me a check for $153. Will I have to give that back if Obamacare is repealed?

garamet · Mar 31, 2015

http://obamacarefacts.com/repeal-obamacare/

The Effects of Repealing ObamaCare or Defunding ObamaCare
If the Affordable Care Act was repealed or defunded, especially now that it’s “the law of the land”, the effects would be massive to say the least. For starters since so much of the health care reform law is already implemented, many aspects would not just go away overnight.

Some of the parts that would go away, such as protections for the 1 in 2 Americans with preexisting conditions, would do little to curb federal, state, or personal health care spending.

In fact, the estimated cost of repealing the law is $6.2 Trillion (over the next 75 years). This is because the bulk of the law actually curbs healthcare spending and takes in revenue, while only a small part contributes to spending.
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garamet · Mar 31, 2015

http://www.medscape.com/viewarticle/842300?src=wnl_edit_tpal&uac=127342PX

ACA at 5 Years: 25 Numbers to Know
Robert Lowes

March 30, 2015
When President Barack Obama signed the Affordable Care Act (ACA) on March 23, 2010, he said the landmark measure would enshrine "the core principle that everybody should have some basic security when it comes to their healthcare."

Five years later, the ACA could use a little security itself. Congressional Republicans continue to call for its repeal, just as they did as the ink was drying on the law's presidential signature in 2010. The House has voted 54 times to void, defund, delay, or otherwise amend the ACA, according to the Washington Post. And the Supreme Court is deliberating on a legal challenge to the law's premium subsidies in 34 states that could undo its attempt to extend health insurance coverage to more Americans.

Nevertheless, the act, popularly known as Obamacare, has made it to a fifth birthday with something to show for itself. Medscape Medical News has created a paint-by-numbers portrait of the law, with its beauty spots and warts.

The stats come from federal agencies and think-tanks such as the Kaiser Family Foundation, the Robert Wood Johnson Foundation, and the Urban Institute. Because different institutions use different time frames and methodologies to arrive at estimates of the law's effect, some figures here may vary somewhat from those published elsewhere.

37.2 million: Number of Americans who were uninsured in the first 9 months of 2014, a decrease of 23% from 2010, when the ACA was passed.

11.7 million: Number of Americans who have signed up or reenrolled for coverage on ACA insurance exchanges for 2015.

46%: Increase in the number of Americans signing up for coverage in an ACA exchange plan from 2014 to 2015.

2.3 million: Number of young adults who gained coverage from 2010 through September 2013 by staying on their parents' health insurance plan up to age 26 years.

28: Number of states, along with Washington, DC, that expanded their Medicaid eligibility requirements under the ACA.

11.2 million: Number of additional Americans enrolled in Medicaid and the Children's Health Insurance Program in January 2015 compared with in the fall of 2013, 86% of them in states that expanded their Medicaid programs.

30,700: Jobs that Alabama would have gained each year through 2020 if it had expanded its Medicaid program.

900,000: Number of Americans whose individual or employer-sponsored health policies were cancelled for 2015 because they did not comply with the ACA.

$7.4 billion: Drop in uncompensated care for hospitals nationwide in 2014 resulting from ACA exchange coverage and Medicaid expansion.

46%: Percentage of Americans who said they approved of the ACA in the first Kaiser Family Foundation tracking polling in April 2010.

50%: Highest ever approval rating for the law in the Kaiser Family Foundation poll, posted in June 2010.

33%: Lowest ever approval rating for the law, posted in November 2013 during the glitchy rollout of healthcare.gov.

41%: Approval rating for the law in March 2015.

87%: Percentage of 2015 enrollees in ACA exchange plans in the 37 states using healthcare.gov who receive a premium subsidy in the form of a tax credit.

$3960: Average premium subsidy (annual) in 2015.

1 in 2: Number of American households eligible for a premium subsidy in 2014 who will have to pay some money back to the government in 2015 because of income changes.

$794: Estimated average payment these households will owe the government in 2015.

$15 billion: Amount saved so far by 9 million Medicare beneficiaries receiving prescription drugs as a result of the law's shrinkage of the infamous Part D "doughnut hole."

18: ACA tax increases, new taxes, fees, and penalties the Heritage Foundation counted in a government analysis of the ACA.

15: Number of seats on the law's Independent Payment Advisory Board, created to curb Medicare spending and loathed by organized medicine.

0: Number of people appointed to the Independent Payment Advisory Board so far.

26%/12%: Percentages of Republicans and Democrats, respectively, who said in March 2015 that an ACA government panel helps make decisions about patients' end-of-life care. As in a "death panel."

$10: Threshold for "transfers of values" to physicians — think of a $10 bag of bagels from a pharmaceutical representative — that drug and device makers must report to the government, as required by the ACA's Sunshine Act.

0.3%: Percentage point increase in new-patient visits as a proportion of all visits for primary care physicians from 2013 (22.6%) to 2014 (22.9%), when insurance coverage expanded under the ACA.

3: Number of lawsuits about the ACA that have made it to the Supreme Court: National Federation of Independent Business v Sebelius (individual mandate and Medicaid expansion), Burwell v Hobby Lobby (contraception coverage mandate), and King v Burwell (premium subsidies). The last case is pending.

Medscape Medical News © 2015 WebMD, LLC

Send comments and news tips to news@medscape.net.

Cite this article: ACA at 5 Years: 25 Numbers to Know. Medscape. Mar 30, 2015.
Click to expand...

steve2^4 · Mar 31, 2015

I suspect the insurance industry really really likes ACA. Really. If they wanted to repeal obamacare, I think we'd know it. They've been quiet, haven't they?

Dinner · Mar 31, 2015

Those are incredible numbers, Garamet. Truly, every single thing the Republicans have said about the ACA has been proven to be completely wrong. They have done nothing but lie and make false predictions.

garamet · Mar 31, 2015

steve2^4 said: ↑

I suspect the insurance industry really really likes ACA. Really. If they wanted to repeal obamacare, I think we'd know it. They've been quiet, haven't they?
Click to expand...

Part of the reason the law as it stands is so clunky is because of early meddling by insurance lobbyists. Nevertheless, it's succeeding in spite of itself. Future spinoffs should be interesting...

Ebeneezer Goode · Apr 1, 2015

Dinner said: ↑

How have you missed that for the last half decade.
Click to expand...

I haven't, I'm just pointing out that Slightly Less Fucking Stupid is still a subset of Fucking Stupid.

AlfredCref · Apr 1, 2015

I dont ever see those shows ending. CSI has been around since I can remember. Surely thats late teens if anything?

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