Suppose HCR gets overturned in the Supreme Court? Then what?

[Leaper]

For whatever parts of the law are not examined/struck down? For HCR efforts in general? Politically on both sides? (Obviously, Obama's opponents will crow that he's a defeated, ineffectual, wrong-headed President, while his supporters will say that irrational hatred of him merely got its way this time, but how about actual predictions for general reactions, especially since a decision might come around election time?)

[Leaper]

Oh, and also feel free to address other laws in general, insofar as you think they'd be affected.

[Balthisar]

"Then what?" as far as next steps for helping the uninsured, or next steps as far as trying to ensure Obama gets re-elected?

[McReady]

Best-case scenario (from my POV): HCR is overturned, the House and Senate are forced to address practical alternatives like a single-payer public option, we end up with actual public health care, and it turns out the Republicans were playing checkers and Obama was playing three-dimensional chess.

(Well, I can dream.)

[Really Not All That Bright]

Then we go back to the old system, and in 16 years we'll all have HSAs and high deductible health plans. Except the uninsured, who will still be fucked.

[Acid Lamp]

The collapse of the HC industry in a few years. It is unsustainable and way out of line already. More and more people will begin canceling insurance or defaulting on the bills. More and more uninsured will turn up in the ER for their kid's sniffles and will overload the system. Eventually "emergency" legislation will be passed allowing for, or mandating certain low cost everyday treatment centers. It will roll on slowly and reform will eventually happen when the right no longer can make money off it.

[Jas09]

Acid is probably closest regarding the health-care system. Although I would add that more and more companies will start dropping employee plans and putting folks in the individual market as the costs make it impossible for them to remain competitive.

Politically, it might be neutral. The GOP can rally the base around a big win for them (although it's not clear how they will deal with the pissed of parents of 26-year-olds or the elderly that have to send back their $250 checks). And the Democrats have their big issue back, and will ride it hard. It's not like the public prefers GOP ideas on health-care reform.

[Really Not All That Bright]

Well, they might, if there were any.

[Jas09]

Originally Posted by Really Not All That Bright

Well, they might, if there were any.

I know you're joking, but that is obviously what the GOP has to do. Cannibalize the popular parts of the plan and build some sort of policy that has enough cost savings to get a reasonable CBO score. Oh, and get 60 votes in the Senate to pass it, and a president that will sign it.

The problem, as far as I can tell, is that the only GOP plans seem to get their major savings from privatizing Medicare, and for some reason I just don't see that happening for them politically.

In fact, I'm wondering if the GOP really wants SCOTUS to strike down this bill before the 2012 elections. Creating and backing a plan is a lot harder than opposing one with unpopular portions.

As for Obama, if the SCOTUS strikes it down, he just rails on about "judicial activism" and promotes a new plan, similar to the first, but with alternatives to the individual mandate (something like yearly enrollment windows and decreased subsidies the longer you go without insurance). And then bring out story after story about small business, elderly, and kids that are now uninsured thanks to big bad John Roberts (and John Boehner).

[Really Not All That Bright]

They probably won't need 60 votes in the Senate. I don't see the Democrats using the filibuster the same way the GOP has in recent times, even if they end up in the minority.

[Jas09]

Originally Posted by Really Not All That Bright

They probably won't need 60 votes in the Senate. I don't see the Democrats using the filibuster the same way the GOP has in recent times, even if they end up in the minority.

On the health-care portion of, for example, Paul Ryan's road map? Or any other plan that "fixes" health care by reducing consumer protections and privatizing Medicare?

They sure as hell will, and they sure as hell better.

[magellan01]

What would happen is what needs to happen: they'd all start over. Some simple things can be stopped immediately, like recission. Once a company accepts you they shouldn't be able to drop you if you get sick and start racking up bills. Those with pre-existing conditions need to be covered in a reasonable way. And we need to address the uninsured. One thing that should be done the day it's repealed is to allow health insurance to be sold over state lines. We should learn how much that would help pricing. If all fails, I'd leave all options on the table, even a single-payer system. But this mandate thing has got to go. I am loathe to grant the powers that be another mechanism by which to extract money from our pockets.

[Jas09]

Originally Posted by magellan01

If all fails, I'd leave all options on the table, even a single-payer system. But this mandate thing has got to go.

I sincerely don't understand these two sentences (unless the first one is not sincerely meant). How could a single-payer system (funded, one would presume, by a new universal tax) be less intrusive than a mandate to buy from a wide-range of private policies?

[Really Not All That Bright]

Originally Posted by magellan01

One thing that should be done the day it's repealed is to allow health insurance to be sold over state lines.

Like Congressional Republicans, you only advocate this because you have no idea what it means in practice. I'll explain.

Look, insurers are regulated at the state level. That means State X can demand that health insurance plans offered in State X include benefits A and B. If State Y only requires insurers to offer benefit A, its insurance plans might be cheaper. So people in State X who aren't interested in benefit A can buy State Y plans and save money, right?

Well, no. The vast majority of the differences in the cost of insurance between states are caused by the relative costs of treatment. It's cheaper to insure somebody in Wyoming than New York largely because doctors, hospitals, equipment and so on are cheaper. If Wyoming health insurers start selling insurance in New York, either the cost of insurance in Wyoming will go up commensurate with the decrease in the cost of insurance in New York, or the cost of Wyoming plans to New Yorkers will be largely the same as the cost of New York plans.

There's a much bigger problem, if you're a Republican. If Federal legislation is passed allowing insurance plans to be sold in multiple states, that means the Federal government has to assume the task of regulating them. Effectively, the Feds would be passing legislation preempting existing state laws. Is that actually what you want? An actual Federal government takeover of healthcare (as opposed to the imaginary one Sarah Palin bitches about)? Bear in mind that many state coverage mandates were passed directly by state voters.

It also means that residents of one state who get screwed over by their insurers would be forced to appeal to the insurance regulators in another state for redress. Do you really think the Wyoming insurance commissioner is going to give a fuck about enforcing your rights?

Oh, and besides all that, it wouldn't actually have any effect on the number of people covered, since although it would increase the number of people purchasing individual plans, it would cause some employers to drop employee coverage.

[Leaper]

Originally Posted by Balthisar

"Then what?" as far as next steps for helping the uninsured, or next steps as far as trying to ensure Obama gets re-elected?

Considering I mentioned both, my answer would be "either, or both."

[Smitty]

Originally Posted by Really Not All That Bright

Like Congressional Republicans, you only advocate this because you have no idea what it means in practice. I'll explain.

Look, insurers are regulated at the state level.

Like Congressional Democrats you only oppose it because you have no idea how businesses work.

You really think a company is incapable of offering different policies based on state regulations? Each state has its own tax law, too. You think H&R Block can only do taxes in one state? This in no way requires the federal regulation you seem to think it does.

[gonzomax]

McCain ran partly on fixing health care ,which is nit sustainable. The Repubs admitted it was broken. They just don't want Obama getting the credit.

[jasg]

Originally Posted by Smitty

Like Congressional Democrats you only oppose it because you have no idea how businesses work.

You really think a company is incapable of offering different policies based on state regulations? Each state has its own tax law, too. You think H&R Block can only do taxes in one state? This in no way requires the federal regulation you seem to think it does.

Multi-State insurance is certainly possible, just look at auto insurance. However I think with health insurance, it rapidly becomes more complex. Medical costs vary greatly on a regional basis but car repairs are pretty standardized. Also, insurers negotiate directly with hospitals and physicians. I'm not sure that would scale to allow every insurer to negotiate directly with those groups in many states.

Sales across state lines could also mean some sort of federal regulation where it is currently state regulation - and/or it could mean loss of consumer protections.

This article has a good primer on the issues, it is a quick read.

[magellan01]

Originally Posted by gonzomax

McCain ran partly on fixing health care ,which is nit sustainable. The Repubs admitted it was broken. They just don't want Obama getting the credit.

So, it's not possible that they want it fixed, but fixed in a different way?

[Really Not All That Bright]

Originally Posted by Smitty

Like Congressional Democrats you only oppose it because you have no idea how businesses work.

You really think a company is incapable of offering different policies based on state regulations? Each state has its own tax law, too. You think H&R Block can only do taxes in one state? This in no way requires the federal regulation you seem to think it does.

That would be the system we have now, smart guy.

[Jas09]

Originally Posted by Smitty

You really think a company is incapable of offering different policies based on state regulations?

This is currently allowed. In fact, most large health insurance companies do exactly that.

The GOP proposal, as I understand it, is to allow me, living in Missouri, to buy a policy from a company that is only licensed in, say, Arkansas. Said policy would only meet the regulatory guidelines of Arkansas, not Missouri.

Any reduction in costs this would generate would come from either (a) insurance companies flocking to the least-regulated states and offering these minimal policies nation-wide, (b) increased competition driving down premiums nation-wide, or (c) better risk-pooling by allowing insurers to have access to a broader market rather than just the state or handful of states their licensed in. Obviously different experts have different opinions on which of these would predominate and how large the savings (if any) might be.

Finally, the PPACA included something similar to this, allowing states to enter compacts that allow for insurance policies across their borders. Additionally, multi-state insurers will be allowed in underserved markets as long as they meet federal minimum coverage guidelines.

[L. G. Butts, Ph.D.]

Originally Posted by magellan01

So, it's not possible that they want it fixed, but fixed in a different way?

What way would that be?

As far as I can tell the only health care reform promoted by Republicans in the last couple of decades was the one that was passed in 2009 and signed by President Obama. First it was promoted by Newt Gingrich in response to "Hilarycare", then a lot of it's properties were touted by some conservative think tanks during the Bush administration, then John McCain supported mandates during the 2008 campaign, and Romney supported something very similar to it in Massachusetts. So now that it has been signed into law by our Demcratic president, what are the Republicans wanting to replace it with?