Federal Judge Strikes Down Part of Obamacare Law

[mheslep]

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.

On a conference call this afternoon, Brian Gottstein, communications director for Virginia attorney general Ken Cuccinelli, said one to two years is the best guess: About one year if the Supreme Court agrees to take the case directly from the district court, two if the case is heard first by the Fourth Circuit (and minus a few months if it goes straight to en banc consideration by all the judges on the Fourth Circuit, bypassing a three-judge panel).

http://www.nationalreview.com/corner/255199/whats-next-virginia-case-daniel-foster

Cuccinelli immediately just sent a letter to the US AG requesting the case go directly to the US Supreme Court. If Holder agrees, we should have a decision in year.

 

[WhoWee]

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.

Nonsense is correct - the insurance industry is rated by AM Best and others.

Here's more information about health care strategies and the Government.
http://www.hhs.gov/recovery/programs/cer/cerannualrpt.pdf

"V. STRATEGIC FRAMEWORK FOR CER
There are countless opportunities for action and investment in CER. Many Federal, state, and private institutions are already involved in CER and have made choices about which of these activities and investments to pursue. After completing the draft definition and criteria for prioritization of potential CER investments, the Council recognized the need to develop a strategic framework for CER activity and investments to categorize current activity, identify gaps, and inform decisions on high-priority recommendations.
This framework represents a comprehensive, coordinated approach to CER priorities. It is intended to support immediate decisions for investment in CER priorities and to provide a comprehensive foundation for longer-term strategic decisions on CER priorities and the related infrastructure. At the framework’s core is responsiveness to expressed needs for comparative effectiveness research to inform health care decision-making by patients, clinicians, and others in the clinical and public health communities. The framework will be supported by detailed inventories of Federal CER activities and research/data infrastructure, and a priority-setting approach. This organizing framework fosters consideration of the balance of activities and priority themes, focuses on the most pressing needs expressed by patients and clinicians, and allows for identifying and addressing gaps in the current landscape of CER.
CER activities and investments made by the government or other institutions can be grouped into four major Core Categories:
•
Research includes activities or investments in primary research or meta-analysis. Organizations involved in this group of activities may be funding research, conducting research themselves, or helping to establish a common set of research priorities to create momentum around the most critical research topics.
•
Human and Scientific Capital includes activities or investments that enhance the United States’ capacity for CER by expanding and strengthening relevant research skills or by advancing CER approaches and methodologies. Organizations involved in this group of activities may be directly involved in training and workforce development, developing new CER methods, validating results of CER, or driving consensus on valid approaches to CER.
•
CER Data Infrastructure includes activities or investments that develop, build, or maintain data infrastructure, systems, or tools. These investments could include the creation of new research data sets and repositories, aggregation of existing data sources, development of new tools to query and analyze existing data sets, or creation of standards for new data collection.
25
•
Dissemination and Translation of CER includes activities or investments that disseminate CER findings and put them into practice. Activities and investments range from dissemination and distribution of CER information to improving processes and outcomes in health care and public health delivery systems through CER translation and adoption.
Table 1 Example Activities in Each Major Category
Activity
Examples
Research
Comparing outcomes of treatments or care delivery for a specific condition
Human & Scientific Capital
Training new researchers to conduct CER or developing CER methodology and standards
CER Data Infrastructure
Developing a distributed practice-based data network, linked administrative or EHR databases, or patient registries
Dissemination and Translation of CER
Building tools and methods to disseminate findings and translate CER into practice to improve health outcomes for patients
Furthermore, investments or activities focused on a specific priority theme can cut across these categories. The potential themes include:
•
Conditions. Organizing investments and activities around a condition or disease state is common in research and reflects the organization of medical practice. Focusing on a single disease state across all four major categories of activity (e.g., funding primary CER in oncology, developing new methodologies for CER in palliative care settings, expanding the Surveillance, Epidemiology, and End Result database (SEER), and partnering with an academic cancer center to pilot CER implementation strategies) could result in significantly improved patient-centered outcomes in that disease area.
•
Patient populations. While clinical research is relevant to the patient population it is designed to address, it often provides little information relevant to patient groups not typically enrolled in clinical studies. In private-sector-funded trials, this often includes the elderly, racial and ethnic minorities, children, and persons with disabilities. The NIH, however, already requires that all publicly funded trials include appropriate numbers of women and racial and ethnic minorities. Cross-cutting activities and investments that facilitate studies responsive to the needs of these populations can ensure that all Americans benefit from CER.
•
Type of intervention. Several potential areas of focus emerge from studying interventions by type. In defining CER, the Council specifically included the following types of interventions: medications, medical and assistive devices, procedures, behavioral change, diagnostic testing, and delivery system strategies. Each of these has unique opportunities for coordinated investment in data infrastructure, research, building
26
research capacity, and translation. In addition, one could focus on interventions at a stage of the disease (i.e., prevention, diagnosis, treatment, and management).
Together, these activities and themes make up the CER strategic framework (Figure 1).
Agencies or organizations that are engaged in CER will often make investments in one group of activities or across multiple groups within a cross-cutting theme. The pattern of activity and investment for a single organization highlights its strategy. For example, a medical information database company may concentrate its CER activities in data infrastructure, whereas the National Cancer Institute is involved in multiple types of activities with a focus on cancer. When patterns of activity for the most critical agencies and organizations involved in CER are viewed in aggregate, the CER framework reveals gaps in CER activities and investments. These gaps are potential areas of opportunity and impact for the Secretary’s ARRA funds. As such, the framework is useful for determining what investments are appropriate for ARRA funds and for future Federal investments in CER, as well as for codifying the ongoing activities of Federal agencies involved in comparative effectiveness research."

...for the "Strategic Framework" chart - see page 27.

 

[turbo]

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 are familiar with insurance companies and they way they handle claims, you know that they set up moving targets so they can deny and delay claims on technicalities, especially in regard to more extensive procedures. We had the finest ophthalmic coding staff in the region, and they were trained and retrained periodically, especially when we knew coding requirements by the various carriers were coming down the line.

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?

Nothing in that Act addresses how insurance companies routinely deny and delay claims. The sad and all-too-routine holdups in payments practiced by the insurance companies are friction in health-care, and those holdups cost us a lot of money. They cost the doctors interest, loss of lines of credit, and loss of profit. Also, every dollar denied in legitimate claims has to be made up from other patients. Your health care costs 'way more than it ought to because of the coercive tactics of the insurance companies.

A good friend of mine is an ophthalmic pediatrician, and he went out on his own and started his own practice. Much of his practice is Medicaid patients. His practice is doing well financially, because the public programs don't change coding requirements constantly, so his reimbursements are consistent, unlike doctors who have do deal with patients whose insurance companies play games and withhold payments. His staffing levels are light, and his office manager is not stressed. She is my cousin, and she left the big practice to start up his practice and manage his office. Bill isn't the only doctor around to have publicly (as in letter-to-the-editor public) supported a robust public option. My primary care physician does as well, as does my wife's primary care doc.

This information is apocryphal, so you'll probably reject it out of hand unless you are friends with some doctors who have small private practices. If so, you'll know that it's true, and that many small practices have had to opt out of participating in private insurance plans that are the worst offenders.

 

[WhoWee]

If you are familiar with insurance companies and they way they handle claims, you know that they set up moving targets so they can deny and delay claims on technicalities, especially in regard to more extensive procedures. We had the finest ophthalmic coding staff in the region, and they were trained and retrained periodically, especially when we knew coding requirements by the various carriers were coming down the line.

Nothing in that Act addresses how insurance companies routinely deny and delay claims. The sad and all-too-routine holdups in payments practiced by the insurance companies are friction in health-care, and those holdups cost us a lot of money. They cost the doctors interest, loss of lines of credit, and loss of profit. Also, every dollar denied in legitimate claims has to be made up from other patients. Your health care costs 'way more than it ought to because of the coercive tactics of the insurance companies.

A good friend of mine is an ophthalmic pediatrician, and he went out on his own and started his own practice. Much of his practice is Medicaid patients. His practice is doing well financially, because the public programs don't change coding requirements constantly, so his reimbursements are consistent, unlike doctors who have do deal with patients whose insurance companies play games and withhold payments. His staffing levels are light, and his office manager is not stressed. She is my cousin, and she left the big practice to start up his practice and manage his office. Bill isn't the only doctor around to have publicly (as in letter-to-the-editor public) supported a robust public option. My primary care physician does as well, as does my wife's primary care doc.

This information is apocryphal, so you'll probably reject it out of hand unless you are friends with some doctors who have small private practices. If so, you'll know that it's true, and that many small practices have had to opt out of participating in private insurance plans that are the worst offenders.

AM Best insurance rating...
http://www.ambest.com/ratings/methodology.asp

http://www.nejm.org/doi/full/10.1056/NEJMp0900665

"Beginning in 2011, Medicare and Medicaid will provide financial incentives over multiple years of up to $40,000 to $65,000 per eligible physician and up to $11 million per hospital for “meaningful” use of health information technology, such as the electronic exchange of data and reporting of clinical quality measures. Starting in 2015, physicians and hospitals that do not use certified products in a meaningful way will be penalized. The Congressional Budget Office projects that the incentives will boost the proportions of physicians and hospitals adopting comprehensive electronic health records by 2019 to 90% and 70%, respectively, from the 65% and 45% that would be expected to do so anyway.4

"

 

[mheslep]

A good friend of mine is an ophthalmic pediatrician, and he went out on his own and started his own practice. Much of his practice is Medicaid patients. His practice is doing well financially, ...

Medicaid, a single payer system, is unsustainable. Medicare, a single payer system, is unsustainable with current http://www.ncpa.org/pub/ba662" . Dirigo health in Maine was a state run health system, also unsustainable and now failed.

 

[turbo]

By the way, one of the worst offenders for denial of claims and recission of coverage is Wellpoint/Anthem. That's the insurer for my wife's employer. Thanks to them, I had to spend hours on the phone with her doctor's office, the lab at the hospital, and the insurance company to avoid paying hundreds of dollars in valid claims for diagnostic testing. I finally got on the phone with a supervisor at Anthem, and told her that her company was wrongfully denying a claim and explained what I knew about coding and denials. She told me to have the lab re-submit. No recoding, no nothing. They paid for the tests.

 

[turbo]

Medicaid, a single payer system, is unsustainable. Medicare, a single payer system, is unsustainable. Dirigo health in Maine was a state run health system, also unsustainable and now failed.

Can you provide proof that they are unsustainable?

 

[WhoWee]

By the way, one of the worst offenders for denial of claims and recission of coverage is Wellpoint/Anthem. That's the insurer for my wife's employer. Thanks to them, I had to spend hours on the phone with her doctor's office, the lab at the hospital, and the insurance company to avoid paying hundreds of dollars in valid claims for diagnostic testing. I finally got on the phone with a supervisor at Anthem, and told her that her company was wrongfully denying a claim and explained what I knew about coding and denials. She told me to have the lab re-submit. No recoding, no nothing. They paid for the tests.

http://www.tradingmarkets.com/news/press-release/wlp_a-m-best-affirms-ratings-of-wellpoint-inc-and-its-subsidiaries-941580.html

"A.M. Best Co. has affirmed the financial strength ratings (FSR) and issuer credit ratings (ICR) of various insurance subsidiaries of WellPoint, Inc. (WellPoint) (Indianapolis, IN) [NYSE: WLP].
Additionally, A.M. Best has upgraded the FSRs to A (Excellent) from A- (Excellent) and the ICRs to "a+" from "a-" of Blue Cross Blue Shield of Wisconsin and Compcare Health Services Insurance Corporation (both of Milwaukee, WI). A.M. Best also has upgraded the ICRs to "a+" from "a" and affirmed the FSR of A (Excellent) of Anthem Insurance Companies, Inc (Indianapolis, IN), Anthem Health Plans of Maine, Inc., HMO Maine, Anthem Health Plans of New Hampshire, Inc. and Matthew Thornton Health Plan.
"

 

[turbo]

http://www.tradingmarkets.com/news/press-release/wlp_a-m-best-affirms-ratings-of-wellpoint-inc-and-its-subsidiaries-941580.html

"A.M. Best Co. has affirmed the financial strength ratings (FSR) and issuer credit ratings (ICR) of various insurance subsidiaries of WellPoint, Inc. (WellPoint) (Indianapolis, IN) [NYSE: WLP].
Additionally, A.M. Best has upgraded the FSRs to A (Excellent) from A- (Excellent) and the ICRs to "a+" from "a-" of Blue Cross Blue Shield of Wisconsin and Compcare Health Services Insurance Corporation (both of Milwaukee, WI). A.M. Best also has upgraded the ICRs to "a+" from "a" and affirmed the FSR of A (Excellent) of Anthem Insurance Companies, Inc (Indianapolis, IN), Anthem Health Plans of Maine, Inc., HMO Maine, Anthem Health Plans of New Hampshire, Inc. and Matthew Thornton Health Plan.
"

Financial strength rating? That's deflecting the relevant issue entirely. Wellpoint has been under attack in recent years (most well-publicized in California) for making recissions while raising rates at ~15X the rate of inflation. I don't care how rich they are - just how they get that rich. It's like you're advocating for Halliburton and KBR based on their bottom-line.

 

[WhoWee]

Can you provide proof that they are unsustainable?

Are you serious? I think President Obama said it best...

http://politifact.com/truth-o-meter...says-medicare-and-medicaid-are-largest-defic/

""I think it's a very legitimate question," Obama began. "I guess that the first point I'd make is, if we don't do anything, costs are going to go out of control. Nobody disputes this. Medicare and Medicaid are the single biggest drivers of the federal deficit and the federal debt by a huge margin."
If we don't do something soon to rein in health care costs, Obama said, Medicare and Medicaid "will consume all of the federal budget."

We decided to check his statement that "Medicare and Medicaid are the single biggest drivers of the federal deficit and the federal debt by a huge margin."

We consulted a number of experts, both left-leaning and right-leaning, and they agreed that over the long term, Medicare and Medicaid, along with Social Security — the programs popularly known as "entitlements" — will indeed overwhelm the federal budget and are the main drivers of the deficit. (Of the three programs, Medicare is the largest by a significant margin.)

But there's also some explaining to do about Obama's statement.

When he talks about Medicare and Medicaid driving the deficit, he's not talking about 2009. The 2009 deficit will be powered primarily by the economic downturn, both spending on stimulus and bailouts, and lost tax revenues from the lack of economic activity. The Bush tax cuts, the wars in Iraq and Afghanistan, and the recent Medicare prescription drug benefit have also created gaps between spending and revenues in recent years.

But Obama's singling out of Medicare and Medicaid is true over a much longer window of time, say, over the next 50 to 75 years. "

Again, if you want to have a serious discussion - let's have it.

 

[WhoWee]

Financial strength rating? That's deflecting the relevant issue entirely. Wellpoint has been under attack in recent years (most well-publicized in California) for making recissions while raising rates at ~15X the rate of inflation. I don't care how rich they are - just how they get that rich. It's like you're advocating for Halliburton and KBR based on their bottom-line.

Please review the AM Best link I posted above - they explain their rating methodology - payment of claims is a factor in the rating.

 

[mheslep]

Can you provide proof that they are unsustainable?

Medicare liabilities are were $89 trillion as of 2009.
http://www.ncpa.org/pub/ba662
Dirigo was started in ~2003 with the promise of a one time start-up funding of $53 million, and there after it would cover all 100,000 + of Maine's uninsured. It never insured more than 10-15,000, and quickly went broke forcing the the legislature to ask for a tax increase, which was http://www.seacoastonline.com/articles/20081104-NEWS-81105003" . Now entry into the program is capped, as Maine has a balanced budget requirement.
http://business.mainetoday.com/news/060820bragdon.shtml
http://online.wsj.com/article/SB10001424052970204619004574322401816501182.html

 

[mheslep]

Are you serious? I think President Obama said it best...

http://politifact.com/truth-o-meter...says-medicare-and-medicaid-are-largest-defic/

Thanks, I should have guessed he made such a comment.

 

[wasteofo2]

It was always a dumb idea to force people to buy private health insurance.

Simply make it illegal for healthcare companies to turn down people or charge them for prexisting conditions. That would be a great way to make US healthcare seriously streamline its costs. There certainly is some money to be squeezed out of the most expensive healthcare in the world, after all.

 

[mheslep]

It was always a dumb idea to force people to buy private health insurance.

Simply make it illegal for healthcare companies to turn down people or charge them for prexisting conditions.

Or just make it a government program.

Why not just make everything a government program?

 

[CRGreathouse]

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.

I think we fundamentally agree, but I wanted to point out that the states are restricted by more than just the bill of rights. For example, they are bound by the commerce clause and by the 19th Amendment.

 

[CRGreathouse]

Simply make it illegal for healthcare companies to turn down people or charge them for prexisting conditions.

Yeah! And while we're at it, let's make it illegal for used car dealerships to turn down offers below Blue Book value just because of preexisting damage. (MfL, anyone?)

 

[talk2glenn]

I think we fundamentally agree, but I wanted to point out that the states are restricted by more than just the bill of rights. For example, they are bound by the commerce clause and by the 19th Amendment.

You're right, its more complicated than I implied, but we are in general agreement.

The point is that the states have general authority, subject to express prohibitions (all powers not granted to the federal government being reserved to the states and to the people). The feds have limited, granted authority. Congress has to show that its actions were permitted by the constitution; the states have to show only that its actions weren't prohibited.

 

[mugaliens]

Yeah! And while we're at it, let's make it illegal for used car dealerships to turn down offers below Blue Book value just because of preexisting damage. (MfL, anyone?)

Exactly. By the way, I have my eye on a VLJ (very light jet) but I think $3.2 Million is too much, so I'll just take it for $32,000, instead.

 

[Mech_Engineer]

It was always a dumb idea to force people to buy private health insurance.

You're right, we should just hold them responsible for their actions. If you don't have health insurance, and you get in a car wreck and need $100,000 in medical care to save your life, it's your job to pay for it.

Simply make it illegal for healthcare companies to turn down people or charge them for prexisting conditions.

Wait a minute- it should be illegal to force people to buy health insurance, but we should force health insurance companies to let high-risk candidates in, regardless of how much it raises the cost for everyone else? What if someone refuses to buy health insurance until they get cancer or HIV, and then want in? We should have to pay for that?

That would be a great way to make US healthcare seriously streamline its costs.

If by "streamline" you mean "completely screw up," you're right!

There certainly is some money to be squeezed out of the most expensive healthcare in the world, after all.

Where? Last I checked, hospitals are going out of business left and right due to the emergency room being overrun by people with no money and no insurance using the ER as their primary care physicians, and it costs someone with proper health insurance $500 to get a band-aid in the ER because there were 25 people like him who skipped on their bills.

 

[CRGreathouse]

Wait a minute- it should be illegal to force people to buy health insurance, but we should force health insurance companies to let high-risk candidates in, regardless of how much it raises the cost for everyone else? What if someone refuses to buy health insurance until they get cancer or HIV, and then want in? We should have to pay for that?

Sigh...

You said this so much better than I did.

 

[jbunniii]

While the personal mandate makes sense economically, it did seem like the federal government may be overstepping its bounds. (Not that it doesn't routinely do so on countless other matters! We all have to pay for Medicare, whether or not we ever enroll in the system.)

I say it makes economic sense because the insurers have a valid argument that if they are required to insure anyone regardless of health, then many people will buy insurance only if they become ill.

But there are ways around that which do not require everyone to buy insurance. How about:

1) insurers must offer coverage to anyone who applies, and are not permitted to drop coverage except for serious fraud or nonpayment of premiums;

2) no one is required to have health insurance

however

3) insurers are entitled to charge more (for some period of time) for those who have not maintained continuous coverage starting at some date after the legislation takes effect

This is more or less how auto insurance works, and it would still have been a massive improvement over what we had before, where insurers could and did cherry-pick only the healthiest applicants, and drop them the moment they started costing money.

There will still be some people who buy insurance only when they become ill, and this will drive up costs for everyone, but at least those people who game the system in this way will be forced to pay more from their own pockets.

 

[mheslep]

Exactly. By the way, I have my eye on a VLJ (very light jet) but I think $3.2 Million is too much, so I'll just take it for $32,000, instead.

Damn greedy jet makers. Single payer for jets is what we need.

 

[Gokul43201]

This is probably an extremely silly question (and it comes without reading the ruling of the Fed Court, so it's also a lazy question): how is forcing someone to buy health insurance any more unconstitutional than forcing them to (for instance) purchase social security through a tax?

 

[Al68]

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

I think the important point is that this will be decided by the Supreme Court. Considering recent rulings, it seems unimaginable that SCOTUS would rule that the power to regulate commerce among the states equals a power to force citizens to buy a product.

Of course, it's just as obvious that, despite their pretenses to the contrary, not a single U.S. judge in the country honestly interprets the commerce clause that way.

 

[Al68]

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

If your experience was representative, there would be no insurance industry. Insurance companies are in business to make money, not lose it. Their margins may only be 2-4%, but that's profit, not loss, which means (insurance premiums) > (hospital bills) + (everything else covered by insurance).

 

[mheslep]

.)
I say it makes economic sense because the insurers have a valid argument that if they are required to insure anyone regardless of health, then many people will buy insurance only if they become ill.

Yes that's a point that should be watched. Several Republic politicians have made noises that, after getting the rid of the purchase mandate either through the courts or through legislative repeal, they kind of like all the requirements on insurers. Well that's economic nonsense as well.

But there are ways around that which do not require everyone to buy insurance. How about:

1) insurers must offer coverage to anyone who applies, and are not permitted to drop coverage except for serious fraud or nonpayment of premiums;

2) no one is required to have health insurance

however

3) insurers are entitled to charge more (for some period of time) for those who have not maintained continuous coverage starting at some date after the legislation takes effect

This is more or less how auto insurance works,

Eh, no, auto insurers are not required to cover anyone that applies nor keep them. They routinely drop people for one too many fender benders or tickets. Most states have a high risk liability insurance pool that they run, in conjunction with, if I recall, one or more designated carriers, so that everyone can get the minimal liability insurance required to be on the road. That, is a good model in my opinion health care - high risk pools for the chronically ill wherein the term 'insurance' doesn't make any economic sense.

 

[Al68]

Simply make it illegal for healthcare companies to turn down people or charge them for prexisting conditions.

Some of us want and need medical insurance, not a comprehensive health care plan that covers things we have no desire to pay for. Covering pre-existing conditions is by definition not insurance.

Making private "insurance only" policies illegal is just as bad as trying to force people to buy comprehensive health care plans.

I have a novel idea: stay out of peoples' private business. If politicians really thought they could offer a better deal for health insurance, they would have no need or reason to pass any law to do it.

 

[talk2glenn]

This is probably an extremely silly question (and it comes without reading the ruling of the Fed Court, so it's also a lazy question): how is forcing someone to buy health insurance any more unconstitutional than forcing them to (for instance) purchase social security through a tax?

Social Security is treated as a tax and separate expenditure (benefit) under the law, and was upheld by the Supreme Court under the general welfare and tax clauses of the Constitution. It does not consider Congressional power under the commerce clause.

The insurance mandate is, under the statute, a penalty for not not complying with statutory requirements to obtain private health insurance, and it is justified under commerce.

Roosevelt also had Congress change the language of the Social Security statute to make it more like a "tax" and "benefit" than an "insurance". Congress could have written the "penalty" up as a "tax", but that would have brought its own challenges (SS was unsuccesfully challenged on the basis that it was a tax on some people to provide benefits for the other, and therefore didn't satisfy "general welfare" or "equal protection" - same could have happened here). They could also have simply nationalized health care outright (the public "option", as a tax-and-benefit program), which would be apparently legal, but that was a political non-starter.

 

[russ_watters]

This is probably an extremely silly question (and it comes without reading the ruling of the Fed Court, so it's also a lazy question): how is forcing someone to buy health insurance any more unconstitutional than forcing them to (for instance) purchase social security through a tax?

SS is a government program, paid for by a tax. Health insurance is private and paid for by private fees.

 

[jbunniii]

Some of us want and need medical insurance, not a comprehensive health care plan that covers things we have no desire to pay for. Covering pre-existing conditions is by definition not insurance.

What should be done about people with conditions that preclude them from being insured? If they can't afford care that will manage their condition (e.g. diabetes, high blood pressure, whatever), then it is likely they will end up in a very expensive emergency room situation at some point, effectively on the taxpayers' dime.

There are two ways to reduce this cost: either all laws forbidding emergency rooms from turning away patients should be repealed, and let these people die on the street, or provide them with some sort of coverage that they (1) are entitled to buy and (2) isn't priced so high that they are unable to buy it.

You can do this one of two ways: either by requiring the private sector to cover these people (with government subsidies if necessary); or offer a public option. The latter was dead in the water before it even got started. As a result, we got the rather mediocre Obama plan which no one seems to like very much and which may even be unconstitutional.

Or we kick the can down the road for another 20 years (and say "too bad" to those who need coverage and can't get it), just like we did when Hillarycare failed.

 

[WhoWee]

Sigh...

You said this so much better than I did.

If you want to buy a homeowners policy would you expect the company to take a look at the house - maybe see if you have a gas leak and a few sparking wires - or a roof? Would it be unreasonable for them to charge higher rates if your house was a fire hazard?

I have a specific example of what is going on in the health insurance market presently. Medicare has something called a Guarantee Issue period for Medigap (supplements).

A situation developed recently where a 65 year old woman was losing her Medicare Advantage plan - it was being discontinued. She had several very expensive Part B drugs -cost approx $130,000 per year and used a nebulizer.

Under the 2011 Medicare Advantage plans available, she would be responsible for 20% of the cost of the Part B prescriptions - roughly $26,000. Because her plan did not renew, she had a Guarantee Issue and took a Medigap plan at a cost of about $85 per month that covered 100% of (her share of) the Part B prescription cost.

By contract, the insurance company will collect roughly $1,000 per year in premiums and pay out $26,000 in Part B prescription costs - plus the (20% balance) of all of her Dr. visits, MRI's, CT scans, ambulance rides, plus the Part A co-insurance (hospital) amounts. She will pay nothing else for any of these items as long as she pays her premium.

The insurance company can not drop her, but will have the right to increase the premiums for everyone in her risk pool - but can't single her out.

In this scenario, who is the bad guy? Is it her, the insurance carrier, Medicare, the drug manufacturer, the FDA, the doctor, the insurance carrier that left the area, or is everyone or nobody to blame?

Health care reform was too complicated an issue to be handled in the manner Congress and the President handled it - I hope the Court restores sanity to the lawmaking process.

 

[jbunniii]

If you want to buy a homeowners policy would you expect the company to take a look at the house - maybe see if you have a gas leak and a few sparking wires - or a roof? Would it be unreasonable for them to charge higher rates if your house was a fire hazard?

This is not a very good analogy, as you can move to another house if yours is uninsurable (and you probably knew it was uninsurable when you CHOSE to move there), but you cannot move to another body, and the one you are stuck with may have maladies that you could not have prevented even if you lived a model lifestyle, e.g. inherited conditions.

One could argue that such conditions should be tested for prior to birth, and if found, offer an abortion, but I think many opponents of Obamacare wouldn't like that very much, either!

 

[WhoWee]

This is not a very good analogy, as you can move to another house if yours is uninsurable (and you probably knew it was uninsurable when you CHOSE to move there), but you cannot move to another body, and the one you are stuck with may have maladies that you could not have prevented even if you lived a model lifestyle, e.g. inherited conditions.

One could argue that such conditions should be tested for prior to birth, and if found, offer an abortion, but I think many opponents of Obamacare wouldn't like that very much, either!

Insurance is a business that protects you against all or part of your risk - nothing else.

If you owned a restaurant and the Government dictated how much you could charge customers along with the type and size of portions (regardless of your cost) would it be fair?

 

[Gokul43201]

SS is a government program, paid for by a tax. Health insurance is private and paid for by private fees.

Thanks for the response. So, any problem with constitutionality might be resolved if healthcare were nationalized? If the USSC does rule this unconstitutional, I wonder if Dems will push for such a "fix".