Supreme Court and the Individual Mandate

[Sloop]

We already have a government mandate for senior citizens called MEDICARE that's been in place for decades. So have you been denied any treatment yet?

Not yet ..... but ..... In order to help pay for ObamaCare, $500 BILLION (with a B) is going to be stripped away from Medicare. And this is happening to a program that is already on life-support, gasping for air.

[NateS]

How does the "pre-existing mandate" differ from the guy who wrecks his car and then walks into a State Farm Insurance office and demands coverage -- for the same price btw as the long time SF customer who has never filed a claim?

So by that logic, the person who is stricken with cancer is akin to "the guy who wrecks his car" - it's his or her own fault, so he should have to pay more for his insurance coverage?

Are you asserting that every sickness or illness is the result of some neglect or failure or negligence or recklessness on the part of the stricken patient?

Wow.

Nate

He didn't say that at all, did he Nate? Can you quote where he said the two are the same? Please let me know when you've done that.

Yes, he did. Here it is:

How does the "pre-existing mandate" differ from the guy who wrecks his car and then walks into a State Farm Insurance office and demands coverage -- for the same price btw as the long time SF customer who has never filed a claim?

The "pre-existing mandate" refers to the provision in the law which prohibits a health insurance company from refusing coverage or from charging more than they would charge a healthy person because of an illness or sickness which occurred before the application for insurance coverage.

"How does the "pre-existing mandate" differ …" means that he is equating the "pre-existing mandate" with "the guy who wrecks his car and then walks into a State Farm Insurance office and demands coverage -- for the same price btw as the long time SF customer who has never filed a claim?"

How can it be more clear than that?

Nate

[dragon672]

I forsee this bill/tax whatever you want to call as something that will probably sink the economy. According to the tax there are certain penalities that a business will be hit with if they don't purchase health care. These amount change based on the amount of employees. So if a business has 49 people do you think that will hire that 50th person and be hit with a penality? Nope. Businesses will stop hiring; I mean they've went this long working on reduced staff and are making it so why hire someone and have to pay more money.

My job has 24 workers and some of those are PT workers with no health coverage. My deductible is $2000; copays are $30, $50 but they do not count toward my deductible and neither do my medicine copays of $10, $30, $60. I except these to go up. A lot of my co-workers only make a little above $7.25 hr. I make less than $10. Of course there are others in similar situations all over the country. How does this tax help us? It doesn't; our costs will rise and we won't be able to keep our current plan because it will be cheaper for our employer to drop coverage and pay the penalty.

The penalty per person is 1% of your income if you make less than $20,000 a year and are healthy what's to stop someone from not even getting healthcare coverage? If you only take 1 or 2 meds and can get the $4 ones and your doctor office has a sliding scale you'd probably play less than $30 a visit. Better deal than what some have now.

[PST]

We already have a government mandate for senior citizens called MEDICARE that's been in place for decades. So have you been denied any treatment yet?

Not yet ..... but ..... In order to help pay for ObamaCare, $500 BILLION (with a B) is going to be stripped away from Medicare. And this is happening to a program that is already on life-support, gasping for air.

I hope I will be forgiven for plagiarizing one of my old posts here, but no there is sense reinventing the wheel. It is not true that the PPACA is taking $500 billion out of Medicare and using it to fund the broader Medicaid eligibility the act provides for. That was a frequent talking point in the Republican presidential primary debates, but it wasn't accurate. The PPACA does try to control the increase in Medicare spending over the next ten years. The $500 billion figure comes from a reduction in the total budget planned for Medicare over ten years compared to what it was predicted Medicare would cost if we did nothing. I don't know anyone, anywhere who is against trying to control rising Medicare costs. The normal complaint is that the PPACA doesn't do enough. "Stealing from Medicare" is just something opponents trot out misleadingly when they want to demonize the act. Under the PPACA, the cost of Medicare will "only" go from $499 billion per year in 2009 to $929 billion per year in 2020. If the act can save an average of $50 billion a year, that would be great. There is an excellent, dispassionate explanation of how the PPACA aims to accomplish this at http://www.kaiseredu.org/Tutorials-and- ... icare.aspx. A large part comes from controlling the increase in the rate of provider payments. Part of the savings is from curtailing what are called disproportionate share hospital (DSH) payments. These are payments to hospitals that treat a disproportionate number of uninsured patients. That doesn't sound like it should be Medicare, but it is, because a large part of DSH comes out of the Medicare budget. Those payments will be greatly reduced starting in 2014, which makes sense, because the number of uninsured patients should decline. Finally, much of the savings comes from reducing the subsidy to Medicare Advantage members. This is a program that replaces traditional Medicare by instead paying an insurance premium to a private carrier. That's all well and good, except we are now paying much more for the Medicare Advantage members than for other beneficiaries. If private insurance is more efficient, good, but why should we pay extra. The PPACA cuts back on the subsidy. My main point, though, is that the PPACA isn't taking money out of one program and putting it in another. It is simply trying to control the rate of increase in Medicare costs, which everyone agrees is necessary. It was mere political demagoguery to then claim that this effort to reduce the rate of cost increases was really stealing from Peter to pay Paul.

[Sloop]

He didn't say that at all, did he Nate? Can you quote where he said the two are the same? Please let me know when you've done that.

Yes, he did. Here it is:

How does the "pre-existing mandate" differ from the guy who wrecks his car and then walks into a State Farm Insurance office and demands coverage -- for the same price btw as the long time SF customer who has never filed a claim?

The "pre-existing mandate" refers to the provision in the law which prohibits a health insurance company from refusing coverage or from charging more than they would charge a healthy person because of an illness or sickness which occurred before the application for insurance coverage.

"How does the "pre-existing mandate" differ …" means that he is equating the "pre-existing mandate" with "the guy who wrecks his car and then walks into a State Farm Insurance office and demands coverage -- for the same price btw as the long time SF customer who has never filed a claim?"

How can it be more clear than that?

Nate

Well as much as the two can be compared -- here goes:

Healthy person pays health insurance premiums for years, and collects no benefits. He suddenly gets sick and collects benefits.
A car owner pays car insurance premiums for years, and collects no benefits. He suddenly wrecks his car (whether it is his fault or not, in the case of another uninsured vehicle) and collects benefits.

Please understand -- in no way am I am saying that a wrecked car holds the same emotional weight as a sick body. But we are talking about a business venture. Entering into a deal with an insurance company is just that.

So let's focus on the two different insurance entities. Both are private enterprises. Both are in the business of selling insurance. Both have stockholders to please. I think in the case of health insurance companies, the horse has been let out of the barn. This is signifcant damage to Federalism. With today's ruling, you now have the taxing authority circumventing Federalism.

[Sloop]

PST

What you say all sounds good, but even in just a couple of years, the long-term cost of ObamaCare has more than doubled. Ten years from now, we'll look back on this "doubling" as nothing more than pie in the sky -- the costs will be orders of magnitude higher than what is projected now. It is simply runaway insanity.

[dragon672]

And also its going to be headaches for patients. My mother has oxygen that she sleeps with at night. Her DME; which is different than mine; has been pretty good to her. She got a call that the government is going back and checking all the DME's records and every patient has to go back to their doctor and been seen again to get approved again for their medical equipment. My mother has Medicare and a very fixed income and now she has to go 20 miles to her doctor to get a stupid piece of paper signed and pay for another office visit if she wants to be able to keep her oxygen.

This is what I foresee for all of us. The DME's and doctor's offices will be swamped with stupid paperwork and patients that may not really need to be see on that particular day.

[porete]

Two Words: Romney 2012!!

[PST]

PST, you make a decent argument in favor of Obamacare, but you don't address the damage that ObamaCare is doing to the business world -- to companies that are too scared to hire any more employees for fear of the unknown. There are trillions of dollars that right now are simply sitting on the sidelines waiting for some sanity from Washington before this money will be put in play. I would put to you that a large part of the blame for this stagnation of our economy is because of this uncertainty.

Speaking as an employer, I don't think decisions to hire have the slightest thing to do with uncertainty about ObamaCare. It has nothing to do planning at my firm, that's for sure. Businesses will hire more employees when demand for their products and services are higher and they can make a profit by mobilizing more workers. New employees will not be hired until they are needed to meet demand, pure and simple. There was a huge reduction in demand beginning in 2008. To oversimplify, when house prices crashed, we all felt poorer, and we stopped spending so much money. This became self-perpetuating as lower spending begat more lost jobs which begat even lower spending (rinse and repeat). I agree that trillions of dollars are sitting on the sidelines, that is why interest rates are so remarkably low, but we need an increase in aggregate demand if we want jobs to expand more rapidly. The stimulus program helped, but it was less than it should have been, although probably as much as political reality allowed. and it was offset by states shedding employees at a rapid pace. Of course, Paul Krugman is like a god to me, so I would believe these things. In any event, businesses are good at handling risk, and investors act in the face of uncertainty all the time, but no one hires if there isn't enough for new workers to do.

As I understand today's ruling with re to Medicade, there will be millions of Americans who were supposed to qualify for the "expanded Medicade", i.e., they make too much in earnings to be put under the standard Medicade, but now the states will NOT be obligated to provide Medicade to this group. This was the group that also was used to a large degree in originally selling the program. So now (or beginning in 2014), these folks will be obligated to purchase their own healthcare, with no government assistance, or suffer a penalty on their tax returns from the IRS. Such a deal.

The Medicaid program is administered by the states and has a hodge-podge of eligibility requirements. The states administer the program, with quite different rules, and the federal government pays much of the cost. Participation is voluntary, but no state says no. One important part of the PPACA was to set a uniform eligibility requirement of 133 percent of the federal poverty level (FPL). That's about $31,000 for a family of four. This change would increase the cost of Medicaid, and the federal government would bear 100 percent of the increased cost at first, although the percentage would eventually decline to 90 percent. Participation in the new, expanded program is likewise voluntary, but of course the states don't get the money unless they play by the new rules. All the Supreme Court said today was that the federal government can't take away its financing of old Medicare from a state that refuses to go along with the expansion. Seven justices agreed with this, including liberals Breyer and Kagan. Personally, I think that when the dust settles, no state will actually pass on this. The deal is too good to say no to. Moreover, the participation or non-participation of states in the expansion of Medicare does not affect the federal government's subsidy of the purchase of insurance on the new insurance exchanges. This subsidy kicks in to prevent anyone from being forced to spend more than 2 percent of their income on health insurance if they are at 133 percent of FPL or below. I actually don't think the mandate applies at 133 percent or below, but I can't remember, and I'm getting too tired of the subject to look it up. I may retire from the fray.

[NateS]

Well as much as the two can be compared -- here goes:

Healthy person pays health insurance premiums for years, and collects no benefits. He suddenly gets sick and collects benefits.
A car owner pays car insurance premiums for years, and collects no benefits. He suddenly wrecks his car (whether it is his fault or not, in the case of another uninsured vehicle) and collects benefits.

Sloop, you're describing the insurance business as if it's a savings plan, or a reward for frugality. It's not. And it has nothing to do with how long the insured person pays the insurance company.

How about this, adapting from your statement:

Healthy person pays health insurance premiums for 10 days, and collects no benefits. He suddenly gets sick and collects benefits.
A car owner pays car insurance premiums for 10 days, and collects no benefits. He suddenly wrecks his car (whether it is his fault or not, in the case of another uninsured vehicle) and collects benefits.

Would either of those alternative examples bother you? They shouldn't. Insurance is not intended to be a savings plan, or a reward for frugality. It's a transaction intended to spread the risk of loss among a large number of persons, by exchanging a certain smaller cost in exchange for relief from the uncertainty of a potential calamitous cost. It is a pooling of funds, with some compensation to be retained by the entity undertaking the risk.

Here is how Wikipedia defines it:

Insurance is defined as the equitable transfer of the risk of a loss, from one entity to another, in exchange for payment.

http://en.wikipedia.org/wiki/Insurance

The health insurance industry has turned itself from a legitimate risk-taking business into a parasite, cherry-picking only those healthiest persons least likely to become ill, leaving all the rest to be paid for by the taxpayers, which is what happens now. How does that plan suit you, as a taxpayer? Why shouldn't that be corrected?

Respectfully, Nate

[drog]

My health insurance premiums have gone up $150 per month since the passage of this law (and yes, the law was used as the excuse). This after losing a large portion of my income due to the economy and having to move to a much more expensive area. I have never had a problem with coverage for pre-existing conditions and believe that most people could find a way to get insurance if they really wanted it. The people this law is going to hurt the most are the young who are less likely to be financially stable and the uninsured who are uninsured because they can not afford insurance in the first place.

[Sloop]

The health insurance industry has turned itself from a legitimate risk-taking business into a parasite, cherry-picking only those healthiest persons least likely to become ill, leaving all the rest to be paid for by the taxpayers, which is what happens now. How does that plan suit you, as a taxpayer? Why shouldn't that be corrected?

Respectfully, Nate

Using your definition, I would argue that there has been no evolution as you suggest -- health insurance companies ALWAYS operated the way they did until ObamaCare.

If you are so sold on health reform, did you support tort reform? Or how about knocking down the barriers of intra-state policies? Democrats were not interested in such things. Every single avenue to LOWER health care costs should have been included in the legislation. But, this really was not about real health reform as much as it was about establishing political power.

[Bons]

My health insurance premiums have gone up $150 per month since the passage of this law (and yes, the law was used as the excuse). This after losing a large portion of my income due to the economy and having to move to a much more expensive area. I have never had a problem with coverage for pre-existing conditions and believe that most people could find a way to get insurance if they really wanted it. The people this law is going to hurt the most are the young who are less likely to be financially stable and the uninsured who are uninsured because they can not afford insurance in the first place.

My 25 year old daughter was unable to get healthcare at any price until she finally (3 years after graduation) got a job in a public school district, starting in August. Her asthma, polycystic ovarian syndrome, hypothyroid, sleep apnea and a few other issues meant no one would take her. Thank God for Obamacare because during the year after her graduation and before the new laws kicked in we paid over $5000 for her prescription medications. She went a year without bloodtests for the thyroid and pso. Last year she needed surgery, which she could never have afforded, and without which she'd have been in a wheelchair for life.

Her fiancee's crashing our car and thus giving us an insurance settlement that went straight to paying our next quarter of health insurance was a real blessing. Under Obamacare the fact that she has had insurance should force the school district's insurance to pay for her pre-existing conditions.

[Sloop]

Today's ruling ensures that several million former Obama supporters will now turn against him because their "taxes" will increase some $2-3000 a year. Who are these people? I'll explain. These are young folks, who currently are gainfully employed but opt NOT to purchase their company's subsidized health care insurance because:
A. They are young, healthy, and invincible, and
B. They'd rather spend the money on the new BMW.

Now, they either have to purchase this policy that they don't want, or pay the penalty -- both costing several thousand dollars. I know these people exist, because I used to be one of them. They are legion.

I fully understand there are young people who are ill -- I don't need a lecture on that as my daughter is a four year cancer survivor. But most young people are as I described above. They truly see no need for health insurance and would much rather use the money for paying off student loans, etc.

[BlackSpinner]

Ah the American educational system strikes out again

http://www.buzzfeed.com/daves4/people-m ... -obamacare