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  Health Care Reform of 2009 and 2010
Parent Issue
Last ModifiedBrandon July 03, 2011 02:26pm
DescriptionThe Patient Protection and Affordable Care Act, along with the Health Care and Education Reconciliation Act of 2010, was the culmination of the Obama Administration's and the 111th Congress' nearly year-long push to enact sweeping health care reform in the United States, a cause championed by national leaders since Theodore Roosevelt.

The law's provisions are designed be phased in over several years, with the most significant structural changes to the health care system taking effect in 2014. All provisions of the law will be in effect by the end of 2018.

This is a place for discussion of issues surrounding the new law, including its implementation, effects, ongoing controversies, calls for total or partial legislative repeal and court challenges to the law.

Adorable Care Act  Discuss
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ObamaCare Survival Guide  Purchase Homegrown Democrat 

Date Category Headline Article Contributor
Apr 15, 2014 07:10pm Poll New! Americans increasingly prefer Democrats on healthcare  Article RP 
Apr 14, 2014 11:00am Report Obamacare Is Getting Cheaper; CBO says the law will cost taxpayers less than expected, and predicts only a slight increase in premiums next year.  Article Brandon 
Apr 13, 2014 08:30am News New! With new health law, insurers target diabetics   Article Brandon 
Apr 09, 2014 08:45am Perspective Obamacare: The health care law that won't die, but won't heal, either  Article Imperator 
Apr 09, 2014 08:20am News Latest ObamaCare surprise: Most won't be able to buy health insurance until end of year  Article kal 
Apr 08, 2014 07:00pm News Why Delaware’s Health-Care Premiums Have Increased by 100%  Article Scott³ 

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Previous Messages]
D:1RP ( 3311.3784 points)
Wed, March 28, 2012 10:27:08 PM UTC0:00
How would the 1986 EMTALA federal mandate that all hospitals that receive any money from the federal government (i.e. just about all of them) must treat anyone needing emergency healthcare regardless of their ability to pay be viewed in light of the "Coercion Doctrine"?

Or really, the government can't require individuals to have health insurance but can require that hospitals provide it for free to them?

D:479Brandon ( 1558.3782 points)
Wed, March 28, 2012 10:32:48 PM UTC0:00
I don't think there would be much of a case that that requirement is coercive, since patient treatment is directly related to that funding. Of course, that seems to be the case in this instance as well, which is why the Medicaid argument is the weakest of all of the challenges to the Act. It came as a big surprise to pretty much everyone that the Court even granted cert on it.

P:130karin1492 ( 609.4522 points)
Thu, March 29, 2012 12:43:55 AM UTC0:00
I do not want to give any president or congress, GOP or DEM, the power to tell me I MUST purchase a certain product or pay a fine.

You don't get a choice with health care anyway. At some point in your life, even if it's when you die, you will be a consumer of health care. That's the false equivocation in this whole mess. EVERYONE is a health care user. This law just says that you have to have insurance to cover that eventual cost.

R:7206Hikikomori Blitzkrieg! ( 290.2565 points)
Mon, April 2, 2012 11:51:19 AM UTC0:00
I suspect they'll toss out the individual mandate, but retain the rest of the statute. Which is sort of the best-of-both-worlds.

D:1RP ( 3311.3784 points)
Mon, April 2, 2012 10:35:28 PM UTC0:00
Well, except that premiums will skyrocket because it would be smart to only get insurance if you are non-healthy.

D:479Brandon ( 1558.3782 points)
Mon, April 2, 2012 10:48:07 PM UTC0:00
That is the significant point about the individual mandate that seems lost on many people. Yes, granted, no one likes being directed to do something they don't *think* they need, but unless that component remains in the law, guaranteed issue and community rating just cannot function effectively. If people can simply wait until they have cancer or some other illness to buy insurance, then that's what everyone will do. It means the only people in the risk pool will be sick people who need coverage presently, and that means insurers will be paying out to every one of their insureds at once. One of the central points of the mandate is to ensure that there are healthy individuals paying into the market to offset the additional costs insurers are going to have because they can no longer refuse coverage based on pre-existing conditions (that, and to prevent the cost-shifting that goes on when emergency rooms have to provide care to people without insurance).

Requiring insurance companies to foot the bill for millions more people via guaranteed issue, without a commensurate increase in the number of healthy people paying into that system is not workable. It's like maintaining Medicare benefits for everyone but no longer taxing people to pay for it. Clearly that can't work.

D:7CA Pol Junkie ( 2702.2412 points)
Mon, April 2, 2012 11:14:36 PM UTC0:00
Tossing just the mandate would bring about a high stakes game of chicken in Congress. Doing nothing would screw over insurance companies and everyone in the individual market. I don't know if that would be enough to bring Republicans to the table to do something about it though.

D:6086Jason ( 7718.4429 points)
Tue, April 3, 2012 01:33:26 AM UTC0:00
The idea that insurance companies will lower premiums out of the kindness of their own hearts is patently absurd. Consumers will have no recourse as long as they're mandated to buy insurance from a non-competitive marketplace.

D:479Brandon ( 1558.3782 points)
Tue, April 3, 2012 01:37:54 AM UTC0:00
Who said anything about them lowering premiums out of the kindness of their heart? The addition of healthy individuals into the pool is simply to offset the added expenses they'll have of covering additional sick people at the same rates as everyone else. Seriously, how do you expect insurance companies to feasibly cover those costs if everyone can simple wait until they contract an illness to buy insurance? Do you not agree that doing that is going to cause severe adverse selection problems in the insurance market?

D:411Picimpalious ( 1229.6810 points)
Tue, April 3, 2012 01:41:07 AM UTC0:00
Who said anything about them lowering premiums

No one. That's part of the problem.

D:479Brandon ( 1558.3782 points)
Tue, April 3, 2012 01:45:18 AM UTC0:00
Cost containment is one of the law's biggest weakenesses, that much is true. The exchanges should help with that somewhat, but there's no doubt that goal was one of the bigger misses here. Still, the particular reforms I noted are dependent on the mandate to work adequately. You really can't separate them. Even the government concedes that the pre-existing condition bad isn't severable from the mandate.

D:479Brandon ( 1558.3782 points)
Tue, April 3, 2012 01:45:44 AM UTC0:00

D:1RP ( 3311.3784 points)
Tue, April 3, 2012 02:00:03 AM UTC0:00
Jason: The idea that insurance companies will lower premiums out of the kindness of their own hearts is patently absurd. Consumers will have no recourse as long as they're mandated to buy insurance from a non-competitive marketplace.

The law requires that insurance companies spend at least 85% of the premiums on medical costs. If less healthy people get insurance, costs can and will go up. If healthy people get insurance, costs will go down and the 85% requirement will require premiums to go down as well.

D:1656The Sunset Provision ( 1384.6633 points)
Sat, June 9, 2012 08:57:31 PM UTC0:00
If the SCOTUS strikes down the individual mandate in the ACA, wouldn't this also, at least in theory, strike down the individual mandate on the state level in Massachusetts?

D:479Brandon ( 1558.3782 points)
Sat, June 9, 2012 09:17:26 PM UTC0:00
No. The predicate of the challenge to the mandate (which is accurate as far as it goes) is that the federal government is one of limited and enumerated powers, while the states have far-reaching general police powers. Under that rubric, just because Congress doesn't have the power to do something doesn't mean that individual state legislatures don't. Everyone involved in the litigation agrees that the states have the power to enact such a mandate.

D:1656The Sunset Provision ( 1384.6633 points)
Sat, June 9, 2012 09:35:26 PM UTC0:00
Thanks for answering my question. I am a supporter of both the individual mandate on the federal level and the ACA, however, if it is struck down, another question that arises for me is (from a legal standpoint) why can the federal government mandate I buy into federal programs like Social Security, Medicare, etc., but I cannot be mandated to buy insurance?

D:479Brandon ( 1558.3782 points)
Sat, June 9, 2012 11:19:59 PM UTC0:00
The federal government enacted both Social Security and Medicare as federal programs pursuant to its powers under the General Welfare Clause of the Constitution (also called the Taxing and Spending Clauses). This clause is also being used as a backup argument by the government in support of the mandate, although thus far only one federal judge (in a dissenting opinion at the 4th Circuit) has bought that argument. Congress pretty clearly used language in the ACA indicating it was invoking the Commerce Clause to justify the provision. However, some have expressed the view that the courts shouldn't get overly formalistic about which power is being used, since both sides in the litigation have conceded that Congress has the clear constitutional power to establish single-payer health care pursuant to the General Welfare Clause, and so if it has that broad and far-reaching power, it seems a bit ridiculous to suggest it can't enact a more modest system of compulsory private insurance under the Commerce Clause instead. Justice Kennedy even asked a few questions at oral argument that indicated he might be sympathetic to this line of reasoning.

The challengers, however, would argue that while it would be perfectly constitutional for Congress to invoke its taxing and spending powers to create a system of truly nationalized health care (e.g. single-payer "Medicare for All"), it is NOT constitutional for Congress to require people to transact business and obtain products from private companies. The counter to that, of course, is that an insurance policy isn't a stand-alone commodity in the sense that no one obtains insurance as an end product in itself, but rather it's simply acquired as a financing mechanism for the ultimate end-product, i.e. health care services, and, therefore, the proper way to view the mandate isn't as a requirement that people buy a product, but as a requirement regarding the particular manner in which people finance the health care they are currently or will in the future obtain.

D:479Brandon ( 1558.3782 points)
Sat, June 9, 2012 11:29:45 PM UTC0:00
I should also add that the challengers would argue that the federal requirement for you to contribute to Social Security and Medicare are contingent upon you entering the workforce of your own volition, whereas the individual mandate is more pervasive than that in a sense, since it places a requirement on you irrespective of anything you've voluntarily done.

D:479Brandon ( 1558.3782 points)
Sat, June 9, 2012 11:42:37 PM UTC0:00
Also, FWIW, this story reports that the Supreme Court may hand down its decisions in this case as early as Monday:


D:1656The Sunset Provision ( 1384.6633 points)
Sun, June 10, 2012 06:51:15 PM UTC0:00
Kennedy is going to have secured himself a highly polarized legacy--however he may vote.

D:479Brandon ( 1558.3782 points)
Mon, June 11, 2012 06:17:52 PM UTC0:00
The Court has handed down all of its decisions and opinions for the day, none of them ACA-related. The next day for decisions to be handed down is Thursday.

D:479Brandon ( 1558.3782 points)
Mon, June 25, 2012 08:01:12 PM UTC0:00
There is some pretty strong speculation now that since Kennedy authored the majority opinion in Arizona v. U.S., by inference, it is a near-certainty that Chief Justice Roberts is the author of the majority opinion in HHS v. Florida.

If that is so, it will almost definitely be either a 6-3 opinion upholding the mandate, or a 5-4 opinion striking it down. A 5-4 decision upholding it can pretty much be ruled out.

R:549kal ( -57.2262 points)
Mon, June 25, 2012 11:29:07 PM UTC0:00
A 5-4 decision upholding it can pretty much be ruled out.

R:1153J.R. ( 744.6801 points)
Mon, June 25, 2012 11:43:55 PM UTC0:00
Ha. If we knew the author were going to be Kennedy, that would tell us nothing. If we knew the author were one of the other 7 associate justices, that would tell us everything. The author being the Chief Justice gives everybody just enough information to try to dissect.

D:479Brandon ( 1558.3782 points)
Mon, June 25, 2012 11:52:09 PM UTC0:00
Kal, I don't understand why you quoted that? Did I type something unintentionally stupid and/or funny and I'm just missing it?