Federal Judge Strikes Down Part of Obamacare Law

[talk2glenn]

This is breaking, and completely unexpected (by me, that is).

The lower courts haven't tried to limit Congress' authority under Commerce since the New Deal, as far as I know. It is now within the realm of possibility that Congress may have finally overstepped its tolerable authority in the eyes of the court.

http://politicalticker.blogs.cnn.co...parts-of-health-care-reform-unconstitutional/

 

[drankin]

Major healthcare component ruled unconstitutional.

I guess I'll post it first.

Mandatory healthcare penalty ruled unconstitutional. The government cannot make you purchase healthcare or penalize you if you don't. No brainer to me.

http://www.foxnews.com/politics/201...les-favor-virginia-challenge-health-care-law/

 

[berkeman]

(I merged the two threads, since you have different links posted)

 

[lisab]

There will be an appeal, I'm sure.

 

[drankin]

(I merged the two threads, since you have different links posted)

Thank you.

 

[WhoWee]

There will be an appeal, I'm sure.

This will be in the courts for a long time - something like 28 state Attorneys General involved. I think the bigger battle in the next few months will be in Congress over funding of the Bill -a massive expansion of the IRS is currently on the table.

 

[Ivan Seeking]

At this point, two out of three Federal courts have upheld the mandate. One of them was also in Virginia.

 

[WhoWee]

At this point, two out of three Federal courts have upheld the mandate.

To clarify, are you saying that at this point, 1 Federal court has struck down this mandate?

 

[Ivan Seeking]

To clarify, are you saying that at this point, 1 Federal court has struck down this mandate?

Yes. Two thumbs up, one thumbs down.

 

[turbo]

It might be a good idea to review the ruling and the response(s) to such before relying on news accounts that have cherry-picked "news" that supports their biases.

http://big.assets.huffingtonpost.com/health-care-ruling.pdf

 

[turbo]

In the end, the judge severed the mandated minimum coverage provision from the health-care reform act and denied plaintiff's claim that inapplicability of the Commerce clause to individuals invalidates the entire act.

I feel that the mandated minimum requirement will be upheld. For instance, the permission to operate a motor vehicle is not a "right" - it is a privilege. Here in Maine, if you don't carry liability insurance on your vehicle, you cannot register it or (legally) operate it. Uninsured people who made the decision not to purchase insurance or who cancel it soon after obtaining an insurance card that allows them to register their vehicles are putting the general public at risk, as well as the insurance companies of innocent people that they injure through accident or negligence.

Redistribution of financial risk by the uninsured is not a small thing. My uncle was very badly injured by an uninsured driver several years ago and had to undergo extensive and expensive surgeries. He can hobble around now without crutches, but it is always in pain, and it affects his ability to conduct his business (HVAC). Since he is self-employed he had limited resources while he was under treatment. It takes years to get any kind of disability claim processed through SSDI, so by the time he managed to get any financial help from them, they owed him back-payments. When his doctor released him to go back to work with some restrictions, SSDI contacted him and told him that he must pay back the entire sum of the back-payments. Now he'll be tied up in appeals, paying lawyers and expert witnesses to avoid being victimized yet again.

 

[drankin]

In the end, the judge severed the mandated minimum coverage provision from the health-care reform act and denied plaintiff's claim that inapplicability of the Commerce clause to individual invalidates the entire act.

I feel that the mandated minimum requirement will be upheld. For instance, the permission to operate a motor vehicle is not a "right" - it is a privilege. Here in Maine, if you don't carry liability insurance on your vehicle, you cannot register it or (legally) operate it. Uninsured people who made the decision not to purchase insurance or who cancel it soon after obtaining an insurance card that allows them to register their vehicles are putting the general public at risk, as well as the insurance companies of innocent people that they injure through accident or negligence.

Redistribution of financial risk by the uninsured is not a small thing. My uncle was very badly injured by an uninsured driver several years ago and had to undergo extensive and expensive surgeries. He can hobble around now without crutches, but it is always in pain, and it affects his ability to conduct his business (HVAC). Since he is self-employed he had limited resources while he was under treatment. It takes years to get any kind of disability claim processed through SSDI, so by the time he managed to get any financial help from them, they owed him back-payments. When his doctor released him to go back to work with some restrictions, SSDI contacted him and told him that he must pay back the entire sum of the back-payments. Now he'll be tied up appeals, paying lawyers and expert witnesses to avoid being victimized yet again.

I don't think this can be compared to auto insurance. I can opt out of car insurance, I just won't be able to drive. The government can't require us to insure our bodies. That's a bit much.

 

[WhoWee]

In the end, the judge severed the mandated minimum coverage provision from the health-care reform act and denied plaintiff's claim that inapplicability of the Commerce clause to individual invalidates the entire act.

I feel that the mandated minimum requirement will be upheld. For instance, the permission to operate a motor vehicle is not a "right" - it is a privilege. Here in Maine, if you don't carry liability insurance on your vehicle, you cannot register it or (legally) operate it. Uninsured people who made the decision not to purchase insurance or who cancel it soon after obtaining an insurance card that allows them to register their vehicles are putting the general public at risk, as well as the insurance companies of innocent people that they injure through accident or negligence.

Redistribution of financial risk by the uninsured is not a small thing. My uncle was very badly injured by an uninsured driver several years ago and had to undergo extensive and expensive surgeries. He can hobble around now without crutches, but it is always in pain, and it affects his ability to conduct his business (HVAC). Since he is self-employed he had limited resources while he was under treatment. It takes years to get any kind of disability claim processed through SSDI, so by the time he managed to get any financial help from them, they owed him back-payments. When his doctor released him to go back to work with some restrictions, SSDI contacted him and told him that he must pay back the entire sum of the back-payments. Now he'll be tied up appeals, paying lawyers and expert witnesses to avoid being victimized yet again.

Does the law require that you purchase a car? Does the law require that you have a driver's license? Does the law require that you learn to drive? Does the law require that you drive a car?

The answer is no - the law basically says if you choose to have a vehicle and operate it - then you must have insurance to protect other people from your actions.

 

[turbo]

We'll see what happens. The VA AG argued that Congress could not apply the commerce clause to individuals, but what have the hospitals to say about that? Their situation does not appear to have been considered in this narrow ruling. Requiring hospitals to provide emergency care to uninsured individuals certainly impacts their ability to conduct commerce, and that costs billions every year, according to the Secretary's response. Still she focused on the very narrow question of the motivation of Congress to impost a mandate. The health care industry has some pretty big shoes to drop, IMO, and will likely be filing amicus briefs of behalf of the Secretary as the case moves up the appeals chain.

 

[FlexGunship]

I don't think this can be compared to auto insurance. I can opt out of car insurance, I just won't be able to drive. The government can't require us to insure our bodies. That's a bit much.

Unless you choose to opt out of living.

I think this is the most important distinction to be made. This is the first time the U.S. federal government has tried to force its populous to purchase a product or service under penalty of law. It will often reward someone with a tax break, but never penalize someone with a fee.

Simply being alive is enough to require that you buy something.

 

[CAC1001]

Redistribution of financial risk by the uninsured is not a small thing. My uncle was very badly injured by an uninsured driver several years ago and had to undergo extensive and expensive surgeries. He can hobble around now without crutches, but it is always in pain, and it affects his ability to conduct his business (HVAC). Since he is self-employed he had limited resources while he was under treatment. It takes years to get any kind of disability claim processed through SSDI, so by the time he managed to get any financial help from them, they owed him back-payments. When his doctor released him to go back to work with some restrictions, SSDI contacted him and told him that he must pay back the entire sum of the back-payments. Now he'll be tied up in appeals, paying lawyers and expert witnesses to avoid being victimized yet again.

I understand your arguments turbo-1, but just because one can make an argument that everyone should buy health insurance doesn't mean the government has the actual power to force people to.

That's why the Constitution includes the amendment process. There have been multiple times in this nation's history where the Constitution was found to be wrong or in need of some additions or in need of a change or upgrade, which is why we can amend it.

The Constitution exists to limit the powers of the Federal government. It says the Federal government can only do this, this, and that, with some broad interpretations here and there, not that the Federal government can do whatever it wants with a few minor exceptions.

Just because one sees a law or policy as reasonable doesn't mean it is constitutional. The inverse also is true: just because something was constitutional didn't mean it was reasonable (or morally right).

 

[WhoWee]

We'll see what happens. The VA AG argued that Congress could not apply the commerce clause to individuals, but what have the hospitals to say about that? Their situation does not appear to have been considered in this narrow ruling. Requiring hospitals to provide emergency care to uninsured individuals certainly impacts their ability to conduct commerce, and that costs billions every year, according to the Secretary's response. Still she focused on the very narrow question of the motivation of Congress to impost a mandate. The health care industry has some pretty big shoes to drop, IMO, and will likely be filing amicus briefs on behalf of behalf of the Secretary as the case moves up the appeals chain.

Let's not forget that hospitals are licensed and highly regulated. Additionally, their fee structure is basically dictated by Medicare reimbursement schedules (already).

 

[drankin]

Also, if i end up in ER and don't have insurance, I end up paying the ER bill anyway. If I can pay for insurance then I must be able to make payments. If people that go to ER can't pay for it, then it's likely they can't pay for insurance either. IMO.

 

[turbo]

Let's review in part how those fee structures came about, and the current lack of transparency regarding the rates that are negotiated with private insurers.

http://economix.blogs.nytimes.com/2010/11/26/how-medicare-sets-hospital-prices-a-primer/

 

[lisab]

Also, if i end up in ER and don't have insurance, I end up paying the ER bill anyway. If I can pay for insurance then I must be able to make payments. If people that go to ER can't pay for it, then it's likely they can't pay for insurance either. IMO.

Wow, you must have not seen a hospital bill lately! In my experience, (hospital bills) >> (insurance premiums)

 

[drankin]

Let's review in part how those fee structures came about, and the current lack of transparency regarding the rates that are negotiated with private insurers.

http://economix.blogs.nytimes.com/2010/11/26/how-medicare-sets-hospital-prices-a-primer/

I read some this article. I'm at work so I can't read it all just yet. I have never seen a price list at a hospital. Maybe this is something that should be available by law to the public?

 

[drankin]

Wow, you must have not seen a hospital bill lately! In my experience, (hospital bills) >> (insurance premiums)

Not sure what you mean. I have a wife, so I see my share of hospital bills. :)

 

[WhoWee]

I read some this article. I'm at work so I can't read it all just yet. I have never seen a price list at a hospital. Maybe this is something that should be available by law to the public?

The information is available to the public. Start here and Google Medicare Fee Schedules and Medicare Reimbursements for a lot more.

http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/medicare/the-medicare-physician-payment-schedule.shtml

 

[drankin]

The information is available to the public. Start here and Google Medicare Fee Schedules and Medicare Reimbursements for a lot more.

http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/medicare/the-medicare-physician-payment-schedule.shtml

I guess I mean a literal list of pricing for the general public that is not on medicare. It may be a state by state deal. A quick google search got a price list of a hospital in Ohio: http://www.stlukeshospital.com/pg_about/patient.price.list.pdf

I'll look at comparing it with medicare tonight.

 

[WhoWee]

I guess I mean a literal list of pricing for the general public that is not on medicare. It may be a state by state deal. A quick google search got a price list of a hospital in Ohio: http://www.stlukeshospital.com/pg_about/patient.price.list.pdf

I'll look at comparing it with medicare tonight.

To cut through the rhetoric, insurance companies negotiate "network discounts" with providers (volume buying power) and the Medicare reimbursement schedule is the running track for all pricing. The Government is already VERY involved in health care.

 

[talk2glenn]

I feel that the mandated minimum requirement will be upheld. For instance, the permission to operate a motor vehicle is not a "right" - it is a privilege. Here in Maine, if you don't carry liability insurance on your vehicle, you cannot register it or

You've missed two points here:

1) You are licensed to drive by your state, not the federal government. The federal government has limited, enumerated powers. The states do not; they are restricted only by the bill of rights.

2) The insurance mandate is a form of involuntary market participation. This is unprecedented. Maine requires all drivers carry insurance, not all state residents. This is a huge distinction - the basis of the law in America (in almost every case) is action, reaction. Very rarely does the law punish you for inaction.

Two thumbs up, one thumbs down.

It was always anticipated (by me at least, and I imagine most people observing these law suits) that the initial rulings would all be negative. The lower courts are bound by precedent, and frankly, legal precedent gives the Congress wide berth under Commerce. The Supreme Court has only ruled against Congress under Commerce twice since the New Deal, that I'm aware of, in US v Lopez and US v Morrison, both of which are pretty famous cases (one was gun-free school zones and the other a violence against women act).

But I was wrong; a lower court did rule against the Government in the Lopez case, but not in the Morrison case. Nonetheless, it is extremely unusual for the lower courts to step on the toes of Congress. Slightly less usual in the case of the higher courts since the mid-90's, but even where they've ruled against congress, it's been on activities that were clearly not commercial in nature (local criminal conduct in both cases).

 

[WhoWee]

You've missed two points here:

1) You are licensed to drive by your state, not the federal government. The federal government has limited, enumerated powers. The states do not; they are restricted only by the bill of rights.

2) The insurance mandate is a form of involuntary market participation. This is unprecedented. Maine requires all drivers carry insurance, not all state residents. This is a huge distinction - the basis of the law in America (in almost every case) is action, reaction. Very rarely does the law punish you for inaction.



It was always anticipated (by me at least, and I imagine most people observing these law suits) that the initial rulings would all be negative. The lower courts are bound by precedent, and frankly, legal precedent gives the Congress wide berth under Commerce. The Supreme Court has only ruled against Congress under Commerce twice since the New Deal, that I'm aware of, in US v Lopez and US v Morrison, both of which are pretty famous cases (one was gun-free school zones and the other a violence against women act).

But I was wrong; a lower court did rule against the Government in the Lopez case, but not in the Morrison case. Nonetheless, it is extremely unusual for the lower courts to step on the toes of Congress. Slightly less usual in the case of the higher courts since the mid-90's, but even where they've ruled against congress, it's been on activities that were clearly not commercial in nature (local criminal conduct in both cases).

Does anyone think the President now wishes he didn't scold the Court during his address to Congress - the balance of power might just save us in the end - IMO.

 

[turbo]

I guess I mean a literal list of pricing for the general public that is not on medicare. It may be a state by state deal. A quick google search got a price list of a hospital in Ohio: http://www.stlukeshospital.com/pg_about/patient.price.list.pdf

I'll look at comparing it with medicare tonight.

I spent about 5 years as IT manager for a large medical practice. Believe me, the public has absolutely no knowledge of what "payments" and fee schedules are negotiated with medical practices or hospitals. In the case of our practice (ophthalmology, with specialists in plastic surgery, retinal surgery, and vision -corrective surgery) insurance companies often "negotiated" expensive procedures by withholding valid reimbursement claims for a month, 2 months, 3 months... If your receivables get too aged, your bank slashes your line of credit, so you can kiss that new surgical laser goodbye. The insurance companies would reject claim after claim, saying that our staff hadn't coded procedures properly. The last thing the insurance companies would allow is transparency regarding the actual claims rates they pay and how they "negotiate" those rates. It's like making sausage.

 

[drankin]

To cut through the rhetoric, insurance companies negotiate "network discounts" with providers (volume buying power) and the Medicare reimbursement schedule is the running track for all pricing. The Government is already VERY involved in health care.

It's in the interest of the insurance companies to keep those details on the DL. It would be nice to know what a the retail prices are compared to what deal my insurance company gets. And compare it again with what medicare mandates.

 

[drankin]

I spent about 5 years as IT manager for a large medical practice. Believe me, the public has absolutely no knowledge of what "payments" and fee schedules are negotiated with medical practices or hospitals. In the case of our practice (ophthalmology, with specialists in plastic surgery, retinal surgery, and vision -corrective surgery) insurance companies often "negotiated" expensive procedures by withholding valid reimbursement claims for a month, 2 months, 3 months... If your receivables get too aged, your bank slashes your line of credit, so you can kiss that new surgical laser goodbye. They would reject claim after claim, saying that our staff hadn't coded procedures properly. The last thing the insurance companies would allow is transparency regarding the actual claims rates they pay and how they "negotiate" those rates. It's like making sausage.

I agree.

 

[WhoWee]

I spent about 5 years as IT manager for a large medical practice. Believe me, the public has absolutely no knowledge of what "payments" and fee schedules are negotiated with medical practices or hospitals. In the case of our practice (ophthalmology, with specialists in plastic surgery, retinal surgery, and vision -corrective surgery) insurance companies often "negotiated" expensive procedures by withholding valid reimbursement claims for a month, 2 months, 3 months... If your receivables get too aged, your bank slashes your line of credit, so you can kiss that new surgical laser goodbye. The insurance companies would reject claim after claim, saying that our staff hadn't coded procedures properly. The last thing the insurance companies would allow is transparency regarding the actual claims rates they pay and how they "negotiate" those rates. It's like making sausage.

Do you honestly believe that "health care reform legislation" streamlines the billing process? Also, why did your staff keep making the same type of coding errors - was the process confusing - do you think Medicare guidelines (and I know the coding is different) had anything to do with the system?

If you want to have a serious discussion about IT and billing - let's do so.

Is anyone familiar with the health IT component of of the American Recovery & Reimbursement Act? The Stimulus Bill appropriates $19 Billionto encourage healthcare organizations to adopt and effectively utilize Electronic Health Records. The second part of the Act calls for $17 Billion in incentives payments to physicians and hospitals.

We might want to start a separate thread to discuss this important topic?

 

[WhoWee]

The Stimulus Bill allocated quite a bit to health care - here's an additional "$8.2 billion in extramural funding"

http://www.grants.nih.gov/recovery/

http://www.nih.gov/about/director/02252009statement_arra.htm

 

[WhoWee]

Here's more
http://www.hhs.gov/recovery/reports/index.html#grant

 

[mheslep]

To clarify, are you saying that at this point, 1 Federal court has struck down this mandate?

Yes. Two thumbs up, one thumbs down.

The Richmond, Va court opted to not (yet) issue an injunction order against the mandate part of the law either, even though the judge found the mandate unconstitutional.

 

[talk2glenn]

It's in the interest of the insurance companies to keep those details on the DL. It would be nice to know what a the retail prices are compared to what deal my insurance company gets. And compare it again with what medicare mandates.

Good luck; negotiated rates are proprietary. Anecdotally (as in, in my experience going to the doctor), it seems to be a discount of between 20% and 40%, depending on the service. The more routine services appear to have a greater discount. Maybe somebody else is getting a better deal :P

In the case of our practice (ophthalmology, with specialists in plastic surgery, retinal surgery, and vision -corrective surgery) insurance companies often "negotiated" expensive procedures by withholding valid reimbursement claims for a month, 2 months, 3 months...

This is nonsense. If an insurance company withheld payment on valid claims, it would be in tremendous trouble with local regulators and civilly liable to your practice. If it did so to influence negotiated rate discussions, it would run afoul of federal anti-trust legislation, and face even more civil liability.

Please provide a source for any kind of systemic conduct of this kind in the insurance industry. Your practices failure to code claims properly in some cases doesn't imply a conspiracy, and the absence of any facts in your post make the claim impossible to test.