SCOTUS's decision on The Health Care Law 6/28/12

[RTFirefly]

@Marley23

And all the public gets out of it is the health care.

What, no pony?

[lance_strongarm]

@RTFirefly

What, no pony?

Is Premarin close enough?

[John_Mace]

@Gangster_Octopus

What most folks know about the ACA you could fit in 72 Font Bold letters on the top of a gnat’s kneecap. I bet most folks have no idea that there is actually signifcant tax credits for both individual taxpayers and small businesses.

Can you explain that? NPR had a guy on this AM reporting that there are increases in taxes for employers, medical devices, and in some cases individuals. If I’m self-ensured, what tax credit do I get?

[GIGObuster]

One thing to notice is that even in extreme red places like Arizona taxes are not a bad word when they are targeted, even the governor approved a tax on sales for education.

One can say the Republican leaders did it because it was temporary, but many do want to make it a permanent one, currently the Republican leaders do know that it is popular enough to pass so they are now trying with shenanigans to prevent a proposition on that to appear in the November ballot.

[lance_strongarm]

@John_Mace

If I’m self-ensured, what tax credit do I get?

If you’re self-ensured, you don’t need an answer to any questions.

[John_Mace]

@lance_strongarm

If you’re self-ensured, you don’t need an answer to any questions.

What if I’m self assured?

[Jas09]

@John_Mace

Can you explain that? NPR had a guy on this AM reporting that there are increases in taxes for employers, medical devices, and in some cases individuals. If I’m self-ensured, what tax credit do I get?

Depends on your income. There are refundable tax credits to purchase insurance - I believe that ends at 200% of the poverty line. There are additional subsidies up to 400%, but it’s not immediately clear if that is a tax credit or some other form of cost sharing.

[Voyager]

@sciurophobic

There is no mandate to buy health insurance. There is just a tax on persons who can and refuse to buy health insurance so that those persons will have an incentive to buy it. But considering that there’s no criminal penalty for not paying it, the IRS can’t collect it unless you have a refund, and the penalty is far less than most people pay in health insurance it’s a weak incentive.

But the penalty should not be what people would pay in health insurance - it should be the average delta between what they would pay and the benefits they receive. Those who pay the penalty won’t be covered, so charging them the full price would be unfair.

[sciurophobic]

@Voyager

But the penalty should not be what people would pay in health insurance - it should be the average delta between what they would pay and the benefits they receive. Those who pay the penalty won’t be covered, so charging them the full price would be unfair.

But the penalty isn’t what people would pay in health insurance. The maximum penalty is 2.5% of taxable income. An individual policy costs much more.

[Gangster_Octopus]

@John_Mace

Can you explain that? NPR had a guy on this AM reporting that there are increases in taxes for employers, medical devices, and in some cases individuals. If I’m self-ensured, what tax credit do I get?

Washington Post: 11 Facts About the Affordable Care Act

2. Families making less than 133 percent of the poverty line — that’s about $29,000 for a family of four — will be covered through Medicaid. Between 133 percent and 400 percent of the poverty line — $88,000 for a family of four – families will get tax credits on a sliding scale to help pay for private insurance.

5. Small businesses that have fewer than 10 employees, average wages beneath $25,000, and that provide insurance for their workers will get a 50 percent tax credit on their contribution. The tax credit reaches up to small businesses with up to 50 employees and average wages of $50,000, though it gets smaller as the business get bigger and richer. The credit lasts for two years, though many think Congress will be pressured to extend it, which would raise the long-term cost of the legislation.

Secondary cite
IRS

[lance_strongarm]

@John_Mace

What if I’m self assured?

You certainly are.

[Finagle]

@WillFarnaby

The insurance companies controlled the content of the legislation. That is what matters. They will reap benefits at the expense of the public. With the *aid *of congress they succeeded in meeting their goals. It doesn’t matter if congress has the theoretical power to say no to insurance companies because they did not exercise it when the opportunity presented itself.

Will, in the course of a few posts, you went from “I’m willing to bet” to “The insurance companies controlled…”. You want to drag a few cites into the argument?

[twhitt]

@jtgain

SNIP. Is this true? If so, why wouldn’t a state now (say Wyoming, a red state against this law) refuse the Medicaid expansion and refuse to set up exchanges. If that happened, would Wyoming residents be exempt from the mandate, but still have protection against pre-existing conditions and price discrimination? If so, that’s a win-win. I’ll do my “Health Insurance Application Filled Out and In Pocket” trick with a check made for the first month’s premium. When I feel a heart attack coming on, I’ll have a friend mail it in. Once I come home from the hospital, I’ll cancel the insurance.

Yes, it’s true, within a certain income threshold. If you should be eligible for Medicaid by the reckoning of the Feds, they don’t give you a rebate (for the exchanges), and exempt you from the “penalty,” on the assumption that you will have Medicaid. If your state has failed to expand Medicaid up to the level the Feds anticipated, then you’re just poor, uninsured, and out of luck. I wouldn’t hope that this situation applies to you or to anyone, jtgain.

[DigitalC]

Am I the only liberal who was disappointed with the decision? The affordable care act was never enough, striking down the mandate ultimately would have put us closer to universal healthcare, by as much as decades. We are better off than we were but it is not enough and it will be a long time before a real fix is implemented now.

[Marley23]

@DigitalC

striking down the mandate ultimately would have put us closer to universal healthcare

In much the same way having your car stolen puts you closer to developing a spaceship.

[wolfman]

@sciurophobic

But considering that there’s no criminal penalty for not paying it, the IRS can’t collect it unless you have a refund,

My guess is that will be the first major change 3-5 years after full deployment.(assuming the Political winds don’t result in repeal). If it gets to the point where it is generally accepted that ACA is permanent, I can see bipartisan support for “misery loves company” and making sure everybody pays. I can just imagine “welfare queen” type stories about people who refuse to pay, aren’t subject to any enforcement penalties, but still keep ending up in the emergency room using “required to any patient” services, never paying their bills but still driving new cars etc. I think teeth are inevitable.

[Saint_Cad]

@Lobohan

You’re penalized for not having a home mortgage.

No you are not so just stop this meaningless argument. You are rewarded for having a mortgage which is not a punishment for those without.

If you pass a test, I give you a piece of candy, otherwise you don’t. Are you punished for failing the test? Hint: look at definition 3

If you fail a test I punch you in the face, if you pass then nothing happens. Is that a punishment if you fail? Is it a reward if you pass?

[suranyi]

@DigitalC

Am I the only liberal who was disappointed with the decision? The affordable care act was never enough, striking down the mandate ultimately would have put us closer to universal healthcare, by as much as decades. We are better off than we were but it is not enough and it will be a long time before a real fix is implemented now.

See, as a fellow liberal, I disagree here. Striking down the mandate would have killed universal healthcare for the rest of my lifetime. That’s what I think, at least.

[Iggy]

@RTFirefly

Can any of the board’s legal eagles explain to me why the Medicaid part of the decision wasn’t a blatant bit of poaching on Congress’ power to pass and repeal legislation?

As I understand it, Roberts basically said that it was OK for the law to say to the states, “you don’t get new Medicaid funds if you don’t participate in the Medicaid expansion,” but it wasn’t OK for Congress to say, “you lose [the Medicaid funds you’re already getting if you don’t participate in the Medicaid expansion.” Further, as best as I can tell, he’s saying that if Congress had initially constructed Medicaid in the form that it was after passage of the ACA, that would have been Constitutional. It was just the route taken to that otherwise Constitutional state that was the problem.

Brad DeLong points out that Congress could have circled around this by repealing Medicaid in one section of the ACA, then reinstating it with this change in the next section. (Repeal and replace, anyone? :)) Kevin Drum responds that this would be such an obvious bit of sophistry that it would get struck down too if a future Congress tried it.

But ISTM that that demonstrates the extent to which Roberts poached on Congress’ turf here. Of course Congress has the power to pass or repeal any legislation it wants to; and amending is inherently a combination of passing and repealing.

It’s almost as if Roberts is forcing a variant on stare decisis to Congress: if they’d passed this legislation as is, then everything would have been hunky-dory, but they’ve set a precedent by passing it in a different form, and they’ve got to honor that precedent.

Until shown otherwise, I have to regard this as nonsense. Roberts just invented this idea out of thin air, AFAICT.

IANAL but…

Really short version: The court ruled that the PPACA went too far by threatening to pull all of the federal funding for the existing Medicaid program. The states and the federal government have what is essentially a contract that forms an agreement that governs the Medicaid program.
For the longer version, check the spoiler.

The Roberts judgement notes:

“[t]he current Medicaid program offers federal funding to States to assist pregnant women, children, needy families, the blind, the elderly, and the disabled in obtaining medical care.” And much later he goes on to write, “In order to receive that funding, States must comply with federal criteria governing matters such as who receives care and what services are provided at what cost. By 1982 every State had chosen to participate in Medicaid.”

Analysis
The states know what they are signing up for by joining the Medicaid program. They do not have to do it. It sounds a bit like a contract, and that is, in fact, how the courts have looked at it.

Again, reading further down the decision:

"[O]ur cases have recognized limits on Congress’s power under the Spending Clause to secure state compliance with federal objectives. “We have repeatedly characterized . . . Spending Clause legislation as ‘much in the nature of a contract.’” The legitimacy of Congress’s exercise of the spending power “thus rests on whether the State voluntarily and knowingly accepts the terms of the ‘contract.’”

emphasis mine

Fundamentally, Roberts ruled that the Affordable Care Act expands Medicaid so much that it is not merely a change to an existing contract but an entirely new contract. Both parties must come to an agreement on the terms of the new contract.
It is true that Congress has used financial pressure before to get states to enact regulations. The 55mph speed limit came about under threat of the federal government pulling federal highway funding. South Dakota brought the highway funding matter before the Supreme Court.

In the case South Dakota v. Dole the court noted that “the federal funds at stake constituted less than half of one percent of South Dakota’s budget at the time.” The court allowed that level of coercion, calling it “relatively mild encouragement.”

But according the the Roberts judgement in the PPACA case:

the financial “inducement” Congress has chosen is much more than “relatively mild encouragement”—it is a gun to the head. <snip>

A State that opts out of the Affordable Care Act’s expansion in health care coverage thus stands to lose not merely “a relatively small percentage” of its existing Medicaid funding, but all [sic] of it. [cite deleted] Medicaid spending accounts for over 20 percent of the average State’s total budget, with federal funds covering 50 to 83percent of those costs.

A person cannot, as much as some people might like, hold a gun to a banker’s head to force him to renegotiate your current mortgage. Anything he does is coerced, not voluntary. Similarly the court ruled the federal government cannot force cannot force the states to revise the existing Medicaid “contract” under threat of undue force.

Finally the Roberts opinion wraps up on the topic stating:

It is easy to see how the *Dole *Court could conclude that the threatened loss of less than half of one percent of South Dakota’s budget left that State with a “prerogative” to reject Congress’s desired policy, “not merely in theory but in fact.” [cite deleted] The threatened loss of over 10 percent of a State’s overall budget, in contrast, is economic dragooning that leaves the States with no real option but to acquiesce in the Medicaid expansion.

Medicaid already has a provision that allows for amendment of the program, but…

Indeed, the manner in which the expansion is structured indicates that while Congress may have styled the expansion a mere alteration of existing Medicaid, it recognized it was enlisting the States in a new health care program.
<snip>
Congress mandated that newly eligible persons receive a level of coverage that is less comprehensive than the traditional Medicaid benefit package. [cite snipped]

As we have explained, “[t]hough Congress’ power to legislate under the spending power is broad, it does not include surprising participating States with postacceptance or ‘retroactive’ conditions.” [cite deleted] A State could hardly anticipate that Congress’s reservation of the right to “alter” or “amend” the Medicaid program included the power to transform it so dramatically.

So Roberts, along with Scalia, Kennedy, Thomas, and Alito ruled that Congress went too far. That the Medicaid expansion under PPACA was more than a change, it was a new program. It has different funding rules, different eligibility requirements, and different levels of benefit for those insured under the Medicaid expansion under PPACA as opposed to those in the old Medicaid.

Congress wrote into the PPACA law that if the portion that included the Medicaid expansion was ruled unconstitutional then the remainder of the act was to remain unaffected as it relates to other persons.

[Left_Hand_of_Dorkness]

@Saint_Cad

No you are not so just stop this meaningless argument. You are rewarded for having a mortgage which is not a punishment for those without.

If you pass a test, I give you a piece of candy, otherwise you don’t. Are you punished for failing the test? Hint: look at definition 3

If you fail a test I punch you in the face, if you pass then nothing happens. Is that a punishment if you fail? Is it a reward if you pass?

It’s exactly the same! There’s an option A, where you do what I want and good things happen, and an option B, where you don’t do what I want and bad things happen. Whether you call A “reward” or B “punishment” is immaterial: you’re the one making the argument that’s literally meaningless, since there’s no meaningful difference between calling A “reward” and calling B “punishment.”