So what happens when an uninsured person gets ill or injured? Do the hospital and doctor refuse to treat them? Or do they get treatment anyhow? And if they get treatment, who pays the costs? Plus those with insurance can get regular medical care, including addressing chronic conditions before they become an emergency room crisis.
As a point of clarification, under current law, there is no federal penalty. Obamacare originally had a penalty, but you could waive it if your income was low enough and also to provide more ways for low-income people to afford healthcare (obviously in several areas there were gaps that left some income brackets stuck in the middle).
As for the insulin, unfortunately Obamacare had little to nothing to combat the crony-capitalist health care system in the US, which would even be improved by simply making it more free-market in the sense that people would be more free to import drugs and the federal government could negotiate on drug prices.
In additional to what Dewey Finn said, pooling healthcare costs only works if net payers are buying into it. If I know I’m going to have high healthcare costs and you are likely not to and choose not to buy health insurance, I have no one to split the costs of my expensive health care with.
We haven’t reached this point yet, but IMO the lack of a penalty still runs the long-term risk of creating the “death spiral” where health people increasingly leave and costs go up, pricing out even more people.
I stand by what I said a year ago. The dissent had it right. According to the Supreme Court, this is not a criminal law but a tax. A tax that now says that if you do not purchase health insurance you owe the government $0.
Nobody can claim a moral injury because they want to “follow the law.” They can follow the law without penalty or guilt. They can make a free choice of whether to purchase health care. If they choose not to, they owe the government $0 and will face no persecution. That is simply not an injury nor are they a lawbreaker. They followed option two and paid nothing.
This is different than your earlier example about how you may not run a stop sign or you owe $0. If it is a criminal law or a traffic infraction, I could see the argument about a moral desire to follow all laws, even traffic laws. But this is not a criminal or traffic law, but a tax. If you pay the tax, you are following the law. And the tax is $0. What is the injury?
I find the standing argument without merit.
A law directing a person to take an action or refrain from an action while prescribing no penalty for violation of that law is only a suggestion, in my mundane humble opinion.
While that’s true, insulin prices have been on an exponential rise since the 1990s, so even if Obamacare had never been passed, he still would have gotten his insulin cheaper in 2009 than now.
JAMA Intern Med. 2015;175(10):1681-1687. doi:10.1001/jamainternmed.2015.4338
…might be behind a paywall for the reader, ask me if you want to read more…
Updates on movements on this case…
On Jan 21, 2020 the Supreme Court rejected a request for an expedited appeal of the 5th Circuit ruling. That ruling upheld the lower federal circuit court’s decision that the PPACA is unconstitutional following the amendment to the act setting the shared responsibility payment to $0. The appeals court then sent the case back to the federal circuit court judge for further consideration consistent with their ruling.
Now the 5th Circuit Court of Appeals has also rejected a petition for an en banc rehearing of of the appeal of the federal court judge’s initial decision.
That leaves the case back with the same federal court judge who made the initial ruling in the case. It makes it highly improbable that the matter will be settled prior to the elections in November.
Can I get something clarified here?
If a court – or a chain of courts up to and including SCOTUS – rules a law unconstitutional, does that law disappear from the law books? Or does it remain on the books, but unenforceable?
Suppose a future Congress – Maybe even a Democratic-ruled Congress in 2021? – simply passes a new law making the penalty non-zero again, that is, simply reversing what the Republicans did? And then a Democratic president signs that?
Will that alone suffice to bring the full ACA law back into full effect?
Or would Congress have to pass an entire new ACA law from scratch, completely de novo?
The law remains on the books but is unenforceable.
If, arguendo, this decision is upheld and the PPACA becomes unenforceable due to the $0 shared responsibility payment then a future Congress amending the PPACA to include even a $1 shared responsibility payment would seem to me to make the PPACA constitutional again.
The law remains on the books in a physical, literal sense only because the relevant legislature must be the one to take the step of repeal or amendment. However, a law declared unconstitutional does not “remain on the books” in the sense that it could be revived and enforced because a law declared unconstitutional is null and void and “an unconstitutional act…is in legal contemplation as inoperative as though it had never been passed.” (Norton v. Shelby County, 118 U.S. 425 at 434 (1886)
There is a big misconception that emergency care for the uninsured drives up the cost of insurance. This is not correct.
What happens when uninsured get ill or injured?
(a) They often do without care,
(b) They may pay out of their own pocket for care,
(c) they may get emergency stabilization at a hospital,
(d) having obtained “free” care, they may be pursued by bill collectors, forced to pay and/or forced into bankruptcy.
The hospitals that provide such emergency care are often non-profit institutions receiving charitable donations. There are also government programs to cover some of these costs.
According to Hidden Costs, Values Lost - NCBI Bookshelf , a report from 2003 (when there were many more uninsured than at present):
HTH.
I expect that if those who rely on emergency care for primary care instead are able to receive regular ongoing care from a primary care physician, overall costs will go down because chronic issues won’t rise to the level of an emergency before being treated.