Tag: ACA

The Obamacare Trainwreck

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While freshman congressmen vote – yet again – to weaken or eliminate Obamacare, the news was actually quite good yesterday.

Good in a “it’s not Medicare-for-all, but it’s a vast improvement over the status quo” sort of way.

Yesterday, New York State revealed that rates for individual health insurance plans will plummet by over 50% next year, thanks to Obamacare. These are the “exchanges” you’ve been hearing about. If you can’t afford a plan, there will be a sliding scale of federal subsidies to help you pay for it. Why? Because it is far cheaper for the government to subsidize health insurance plans than to reimburse municipalities for unpaid bills resulting from uninsured people using the emergency room as a primary care facility. In the long run, prevention is cheaper than dealing with acute problems.

About 40 – 50 million Americans remain uninsured, and caring for their emergencies is something that we all subsidize. Our healthcare system is the most expensive in the world, and gets results that have plenty of room for improvement. For instance, Canada – with its socialized single-payer system – has lower maternal mortality than the US. Canada also spends a bit more than half on health care per capita than the US.

We’ll let Professor Krugman explain why this is going to work – and work spectacularly well.

To understand what’s happening in New York, you have to start with what almost everyone at least pretends to believe: Americans shouldn’t find it impossible to get health insurance because of pre-existing conditions that aren’t their fault. Two decades ago, New York tried to deal with this by imposing community rating: insurance is available to everyone, and the price doesn’t depend on your medical history.

The problem was that this created a death spiral: young, healthy people didn’t buy insurance, worsening the risk pool, driving up premiums, driving out more relatively healthy people, etc., until you were left with a rump of very ill people paying very high rates.

How do you deal with this? Well, ideally, Medicare for all. But since that wasn’t going to happen, you improve the risk pool by requiring everyone to buy insurance — the individual mandate. And since some people won’t be able to afford that, you also offer subsidies. Voila! ObamaRomneycare!

Where does the money for the subsidies come from? Partly by reducing corporate welfare: reducing overpayments for Medicare Advantage, reducing tax breaks for very generous insurance plans; partly with new taxes on the wealthy.

And while a few people will be hurt — young, healthy individuals too affluent to qualify for subsidies, wealthy taxpayers, etc. — a much larger number of people will be helped, some of them enormously.

Does this amount to “redistribution”? Well, yes — not as an end in itself, but yes, a lot of people will be made better off at the expense of an affluent few.

The reason why Obamacare will be popular? People who are happy will stay happy, while people who are uninsured will become happy with their new coverage.

Implementation won’t much affect the 78 percent of Americans currently covered through Medicaid, Medicare, or employer group health plans,” and among the remaining 22 percent, the predominant effect will be to get some subsidized health insurance.

Because the Obama administration decided to postpone the employer mandate for health insurance on businesses with over 50 full time (over 30 hrs/week) workers, congressional Republicans – who have a pathological, partisan, political vested interest in the failure of universal health insurance – voted yesterday to delay the implementation of the individual health insurance mandate, which is Obamacare’s quid for the insurers’ pro quo of guaranteed coverage for people with pre-existing conditions. That mandate is why rates are going down in New York next year.

Among the people voting to postpone affordable insurance for millions of Americans was Chris Collins (NY-27), who has taken it upon himself as a clout-free congressional freshman to demonize Obamacare at every step.

The failure of Obamacare is a particularly acute need for Collins because he believes that he defeated Kathy Hochul on that issue alone. If the people in the 27th district suddenly have access to cheap, subsidized, quality health insurance, and discover that Obamacare isn’t the Stalinist Kenyan train wreck Collins has sold, they may very well turn on him and demand to know what his problem is.

Collins constantly talks about all the people who write to him, explaining that they will lose their hours at work thanks to Obamcare’s employer mandate. So, if he’s so concerned about these people, why doesn’t he sponsor legislation to protect those workers from that sort of thing? Could you imagine? Chris Collins sponsoring a worker protection law? I know, it’s a ridiculous notion because Collins exists only to protect business owners and the very wealthy. The idea of individual people having the government meet a need that private industry can’t or won’t is anathema to Collins and his conservative cohorts.

So, you’ll see Collins and other congressional Republicans constantly refer to Obamacare as a “trainwreck”, a catchphrase likely forged by Frank Luntz in the fires of Mount Doom. When Obamacare is implemented, and people begin to benefit from it, the conservatives will be exposed for the lying frauds they are.

The best part about this is that Republicans are so short-sighted and beholden to political expediency that they don’t realize that their constant “trainwreck” language is lowering the public’s expectations of Obamacare. If they are made to think it’s a disaster, and it doesn’t become a disaster, they’ll all look like idiot chicken littles.

Medicare Part D and the Children’s Health Insurance Program … got through their rocky implementations in large part because benefits obtained with bureaucratic difficulty are better than no benefits at all. He’s right, and this is why conservatives are “magnanimously” offering to delay implementation of Obamacare. They realize that once people have guaranteed access to health coverage, they won’t want to give it up, even if there are implementation problems.

The political landscape is already dire for those who still hope to repeal Obamacare, and they’re actually making their position worse by talking constantly about what a nightmare implementation is going to be. This fall, as the exchanges come on line, tens of millions of people are going to find they can get health coverage they never could before. They are likely to be quite happy about that, especially if they’ve been hearing for months in advance that it will be a mess.

So, when Obamacare is implemented and people are happy about it, I hope the voters take Collins’ scare tactics and throw them back in his face.

As an aside, I have asked Collins and his people numerous times in various media whether he holds health insurance through the federal government for himself and his family. I will conclude from the deafening silence that he does, and that excellent, federally subsidized health insurance is something to which he and his family are entitled – but you and I are not.

Not only that, but he will work tirelessly to prevent you and me from being guaranteed quality health insurance. Who goes into public service to screw the public?

 

Obamacare: The Mandate And the Taxing Power

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Oftentimes, the federal government finds itself wanting to promote a certain behavior as part of a national program, but without the direct power to do so. By way of example, in the 1980s, the Reagan Administration decided that it wanted the drinking age to be raised from 18 to 21 nationwide. But the drinking age isn’t a federal, but a state statute. In order to persuade states to raise the drinking age, the federal government passed an incentive plan. If a state failed to raise its drinking age to 21, it would find itself with a diminution in federal highway funding. 

“The power to tax involves the power to destroy”, wrote Chief Justice John Marshall in 1819. With respect to the Affordable Care Act, or “Obamacare”, the power to tax also involves the power to build something. Under the law, beginning in 2014, Congress will require most Americans to obtain health insurance, or – if you don’t, you pay a fine to the government. The mandate was, ironically, a precondition set by the insurance industry, without which they would not be able to economically justify offering insurance to people with pre-existing conditions at no penalty.

The key part of Chief Justice Roberts’ opinion yesterday reviewed the constitutional justification for that mandate to purchase health insurance.  Congress’ powers are specifically limited and enumerated in Article 1 of the Constitution. 

Roberts turned first to the Commerce Clause (Article 1, Section 8), whereby Congress has the power to “regulate Commerce with foreign Nations, and among the several States, and with the Indian Tribes.”  Roberts rejected the argument that the government could regulate the absence of commerce; you cannot regulate that which does not exist.  His analysis seems somewhat limited, however. After all, there is not a personal alive who isn’t engaged in the health care market now, or inevitably. Even if you’re not seeking medical care, you’re paying for others’. 

Right now, you and I (and everybody) are taxed to help pay for uninsured people’s emergency room visits. ERs can’t turn people away, and oftentimes the poor and uninsured use them for primary care.  Those hospitals seek reimbursement for the cost of providing those services through two Federal Programs, Disproportionate Share Hospital (DSH) and Upper Payment Limit (UPL)–that require a 50% local share match. So…instead of forcing the cost of health care provision onto the people who don’t have insurance, you (a taxpayer, or a person with insurance) are paying for them to get health care with both your federal and county tax dollars. 

Secondly, Roberts turned briefly to the “Necessary and Proper” Clause, also in Article 1, Section 8, it reads, “The Congress shall have Power – To make all Laws which shall be necessary and proper for carrying into Execution the foregoing Powers, and all other Powers vested by this Constitution in the Government of the United States, or in any Department or Officer thereof.”  Roberts declined to go along with this, reasoning that…

Each of our prior cases upholding laws under that Clause involved exercises of authority derivative of, and in service to, a granted power. For example, we have upheld provisions permitting continued confinement of those already in federal custody when they could not be safely released…[t]he individual mandate, by contrast, vests Congress with the extraordinary ability to create the necessary predicate to the exercise of an enumerated power.

And so, the last resort – the “in the alternative” argument – was most persuasive to the 5 members of the Court who voted to maintain the ACA mandate. The very first Congressional power enumerated at Article 1, section 8 involves the power to tax and spend. Roberts wrote that Congress’ mandate isn’t the issue – it’s the “penalty” imposed on people who refuse to purchase insurance. While the dissent argued that the government is semantically blocked from calling the “penalty” a “tax”, Roberts argued that the word “penalty” assumes some sort of fine for illegality. Yet the refusal to purchase insurance isn’t illegal – it isn’t a crime. It is merely a choice, and a person’s choice to opt to pay a tax instead of buying insurance is one that government can regulate under its taxing power. 

…the Government asks us to read the mandate not as ordering individuals to buy insurance, but rather as imposing a tax on those who do not buy that product…

…None of this is to say that the payment is not intended to affect individual conduct. Although the payment will raise considerable revenue, it is plainly designed to expand health insurance coverage. But taxes that seek to influence conduct are nothing new. Some of our earliest federal taxes sought to deter the purchase of imported manufactured goods in order to foster the growth of domestic industry

Because Roberts invoked the taxing power, dumber pundits and lazy politicians have pivoted to calling it all – the whole law – a “huge tax”.  Perhaps they should read the law, and then read the Court’s opinion. It’s not a “huge tax”. It’s a mandate that you have health insurance. Chances are, you already have it – it’s not like you’re being forced to buy super-more health insurance on top of what you may already have. And if you don’t have it, you’ll have much easier and cheaper access to health insurance. And if you choose not to have any at all, then you’ll be assessed a fine, a tax, whatever you want to call it. 

The ACA’s “shared responsibility payment”  is a tax only on people who choose not to hold insurance. Anyone who says otherwise is ignorant, mistaken, and/or lying. 

With the mandate in place, no longer will the person without health care get away with not paying hospital bills, and no longer will taxpayers be “mandated” to subsidize those choices. Instead, the person making the choice to avoid insuring himself will be assessed a tax in the eventuality that he becomes ill and can’t afford to pay his bill. Do you want the person without health care to be taxed, or do you want to continue to be taxed because they don’t have health care?

In the olden days, “personal responsibility” was a conservative talking point.  Now, we’re essentially codifying it through Obamacare – you’re responsible to get coverage, or for the consequences if you don’t. Now? 

The remaining portions of the decision dealt with (a) the Court’s analysis of whether the issue was ripe for decision (it is); (b) whether striking the mandate meant invalidating the whole law (they didn’t have to reach it); and (c) a provision dealing with the expansion of Medicaid, holding that States can reject federal funding and therefore not comply with the new rules. 

The misinformation and disinformation being spread over the last 24 hours has been simply mind-blowing. For instance, here’s a fundraising email that Republican congressional candidate Chris Collins (who, incidentally, never, ever has to worry about not being able to afford anything, ever, including health care) sent yesterday: 

Dear friend,

The Supreme Court has confirmed what we already knew – ObamaCare is nothing more than a massive tax increase that will hurt hardworking families and continue to act as a wet blanket on economic growth and job creation.

Today, I’m asking for your donation of $27 dollars to protect the residents of the 27th Congressional District from this massive tax hike and help end ObamaCare.

I need your help to stop Kathy Hochul and Barack Obama from raising taxes on thousands of Western New York and Finger Lakes families. 

$27. 

$27 is how we can protect our families in the 27th Congressional District from massive tax increases.

When I go to Congress, my first order of business will be to lead the fight to repeal ObamaCare and replace it with common sense solutions that protect seniors and don’t crush small businesses and cost us jobs.

$27 can get us there.

Whether it’s $27, or $5, $10, $50 or $100 – anything you can do to help us stop Barack Obama and Kathy Hochul from raising taxes and cutting Medicare by $500 billion is so important.  Will you consider donating today?

There’s so much at stake, and I need your help.

Sincerely,

CHRIS COLLINS

Congressional Candidate, NY-27

No, it’s not one side or another that won or lost – everybody won. Everybody will benefit from the implementation of Obamacare. It isn’t at all a huge tax increase, and the only reason Medicare funding goes down is because the ACA picks up the slack. Obamacare isn’t a “huge tax increase”, indeed it will help families by reducing the most common type of bankruptcy – ones brought about through medical expenses. Is this law a boon to insurers? Yes. That’s why many progressives didn’t like it much, and that’s why the law is something of a Frankenstein’s monster. But Obamacare, like its progenitor, Romneycare, is a fundamentally conservative idea. Because it’s been adopted by a Democratic President whom the Republicans are determined to ruin, it is now characterized as something it’s not. 

And make no mistake – the Republican drive to ruin Obama is so concentrated and driven, that it doesn’t matter what collateral damage there is to average Americans, or the economy. 

It’s not surprising to see a politician lie, but when mere puffery, (“I’m the best”), turns into brazen lying, (“I poop rainbows and spit unicorns”), you have to wonder what the politician thinks of the people who are going to vote for him. I heard some of our right-wing omniphobe media personalities liken the United States under the ACA to North Korea. There was heavy emphasis on “Hussein” yesterday, because “Hussein” is a foreign, Muslim name, and because somehow that correlates with socialism. Or something. I wish I was a professional psychologist so I could better analyze what was taking place.  Even Mitt Romney noted that the Court didn’t hold that Obamacare was a “good policy”. That’s jaw-droppingly dumb – Palin dumb. 

Requiring Americans to buy private health insurance from private corporations is socialist? Spreading the risk across most Americans so that health insurers can’t refuse to insure people with pre-existing conditions is like living in a Stalinist dictatorship with no market, no freedom, no food, no money, closed borders, and extensive gulags? How dumb. Almost as dumb as the many people who took to Twitter to decry the loss of America’s freedom and announce that they’d move to Canada, which has true single-payer socialized medicine. 

Set aside the crazies and the liars – Americans won today. The ACA – Obamacare – isn’t a perfect solution. No solution is perfect, after all. But it will make our health insurance in this country more affordable, with better coverage, and no longer will you live at the mercy of health insurance companies, fearing arbitrary rate hikes, lifetime payout maximums, or being barred from buying insurance due to a pre-existing condition if you change your job. This is good for people. 

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