# What is your ongoing opinion of the Affordable Care Act? (Title Edited) **URL:** \ **Category:** Politics & Elections\ **Created:** [January 17, 2013, 11:21pm UTC](https://boards.straightdope.com/t/what-is-your-ongoing-opinion-of-the-affordable-care-act-title-edited/647561 "2013-01-17T23:21:39Z")\ **Posts on this page:** 20\ **Page:** 130
**Author:** ![Iggy](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/iggy/32/3364_2.png) [@Iggy](https://boards.straightdope.com/u/Iggy)\ **Post date:** [July 7, 2014, 2:07pm UTC](https://boards.straightdope.com/t/what-is-your-ongoing-opinion-of-the-affordable-care-act-title-edited/647561/2582 "2014-07-07T14:07:16Z")
> [@ElvisL1ves](#): > > ACA is private insurance for which the covered pay premiums. Have you been paying no attention whatsoever? And for which the federal government has already paid millions in premium [subsides](http://obamacarefacts.com/obamacare-subsidies.php) and medicaid expansion. Have you been paying no attention whatsoever? ---
**Author:** ![ElvisL1ves](https://avatars.discourse-cdn.com/v4/letter/e/5daacb/32.png) [@ElvisL1ves](https://boards.straightdope.com/u/ElvisL1ves)\ **Post date:** [July 7, 2014, 2:13pm UTC](https://boards.straightdope.com/t/what-is-your-ongoing-opinion-of-the-affordable-care-act-title-edited/647561/2583 "2014-07-07T14:13:58Z")
Don’t be selective in your condemnation, **Iggy**. ACA is not a “handout” to what you and Terr imply are the “undeserving”, any more than tax subsidies to Big Oil are. The ideological debate has already been held, and your view lost, long ago, sometime around the New Deal if not earlier. We’re not going back - if you think we should, you need a more coherent and persuasive argument larger than _Obama delenda est_. ---
**Author:** ![Iggy](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/iggy/32/3364_2.png) [@Iggy](https://boards.straightdope.com/u/Iggy)\ **Post date:** [July 7, 2014, 2:20pm UTC](https://boards.straightdope.com/t/what-is-your-ongoing-opinion-of-the-affordable-care-act-title-edited/647561/2584 "2014-07-07T14:20:43Z")
> [@ElvisL1ves](#): > > And yet the DC District Court laughed it out of court, in the inimitable way judges have. Imagine that. The DC Court’s theory is tenable only if one accepts that in enacting the ACA, Congress intended to compel states to run their own Exchanges – and penalize them if they did not by such onerous penalties that the Supreme Court ruled that scheme as unconstitutional at yet those penalties were not compelling incentives to establish an exchange. The problem that the court confronts in pressing this argument is that it requires ignoring the statute itself and the precedential Supreme Court ruling on the matter. ---
**Author:** ![Iggy](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/iggy/32/3364_2.png) [@Iggy](https://boards.straightdope.com/u/Iggy)\ **Post date:** [July 7, 2014, 2:30pm UTC](https://boards.straightdope.com/t/what-is-your-ongoing-opinion-of-the-affordable-care-act-title-edited/647561/2585 "2014-07-07T14:30:24Z")
> [@ElvisL1ves](#): > > Don’t be selective in your condemnation, **Iggy**. ACA is not a “handout” to what you and Terr imply are the “undeserving”, any more than tax subsidies to Big Oil are. The ideological debate has already been held, and your view lost, long ago, sometime around the New Deal if not earlier. We’re not going back - if you think we should, you need a more coherent and persuasive argument larger than _Obama delenda est_. Don’t be obtuse. You are simply factually wrong that, "ACA is private insurance **for which the covered pay premiums.** Someone is paying those premiums. And by design, often that someone is not the person receiving the coverage. Routing the premium through the government via taxation is one way to accomplish that, similar to Social Security. Medicaid expansion has provided coverage to millions who are not paying the premiums. And before you presuppose to understand a thing about my views on tax subsidies for such matters you had probably best do a very thorough reading of my posting history about the need of providing such a government funded and government provided safety net. I consider such measures absolutely within the prerogative of government. ---
**Author:** ![RTFirefly](https://avatars.discourse-cdn.com/v4/letter/r/c77e96/32.png) [@RTFirefly](https://boards.straightdope.com/u/RTFirefly)\ **Post date:** [July 7, 2014, 3:52pm UTC](https://boards.straightdope.com/t/what-is-your-ongoing-opinion-of-the-affordable-care-act-title-edited/647561/2586 "2014-07-07T15:52:06Z")
> [@Terr](#): > > You forgot [the children](http://i49.photobucket.com/albums/f259/bigbadterr/lovejoy.jpg). Wow, such a devastating rebuttal. > [@](#): > > What I hate is seeing millions more Americans being deliberately hooked on government handouts. And what does this mean? Does having affordable health care create incentives to be lazy or irresponsible? Or is it just some vacuous line of bullshit? Door #2, of course. SATSQ. ---
**Author:** ![RTFirefly](https://avatars.discourse-cdn.com/v4/letter/r/c77e96/32.png) [@RTFirefly](https://boards.straightdope.com/u/RTFirefly)\ **Post date:** [July 7, 2014, 3:59pm UTC](https://boards.straightdope.com/t/what-is-your-ongoing-opinion-of-the-affordable-care-act-title-edited/647561/2587 "2014-07-07T15:59:21Z")
> [@adaher](#): > > In that case, why does anyone need to work? We can all take handouts and nothing bad will come of it. You might notice that the ‘handouts’ listed by \*\*iiandyiii \*\*don’t exactly incentivize people to not work, do they? Free highways didn’t turn people into layabouts; people took advantage of them to build and sell more stuff. 30-year mortgages, a government creation, didn’t turn people into layabouts; it enabled the vast majority of Americans to become homeowners. Free public schools didn’t turn people into layabouts; it meant that people could go to work while someone else educated their children. Free public libraries didn’t turn people into layabouts (though they caused some of us to spend more time with our heads in a book than would otherwise have been the case); they enabled people to learn and read more widely on their own. Why free health care would be any different, I don’t know. Please explain this thing to me. ---
**Author:** ![ElvisL1ves](https://avatars.discourse-cdn.com/v4/letter/e/5daacb/32.png) [@ElvisL1ves](https://boards.straightdope.com/u/ElvisL1ves)\ **Post date:** [July 7, 2014, 4:12pm UTC](https://boards.straightdope.com/t/what-is-your-ongoing-opinion-of-the-affordable-care-act-title-edited/647561/2588 "2014-07-07T16:12:37Z")
Why, **RTF**? Because Obama. That’s all, literally. > [@Iggy](#): > > The DC Court’s theory is tenable only if one accepts that in enacting the ACA, Congress intended to compel states to run their own Exchanges Exactly the opposite is true. They explained it quite well themselves, as you would know if you actually read any of it… And, given that, I find I must decline your polite invitation to familiarize myself further with your entire posting history, since it must be only more of the same. ---
**Author:** ![Iggy](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/iggy/32/3364_2.png) [@Iggy](https://boards.straightdope.com/u/Iggy)\ **Post date:** [July 7, 2014, 5:02pm UTC](https://boards.straightdope.com/t/what-is-your-ongoing-opinion-of-the-affordable-care-act-title-edited/647561/2589 "2014-07-07T17:02:56Z")
I actually read it all. The DC court argues there is no indication in the law that Congress intended to compel or incentivize states to provide marketplaces. > [@DC Court's ruling](#): > > Plaintiffs’ theory is tenable only if one accepts that in enacting the ACA, Congress intended to compel states to run their own Exchanges – or at least to provide such compelling incentives that they would not decline to do so. The problem that plaintiffs confront in pressing this argument is that there is simply no evidence in the statute itself or in the legislative history of any intent by Congress to ensure that states established their own Exchanges. But there are exactly such incentives in the law. Congress provided [grants and subsidies for states to set up exchanges.](https://www.cfda.gov/index?s=program&mode=form&tab=core&id=0a53c1074dd153e213bf711416246e41) States not implementing their own exchanges don’t get the money. Per Sections 1311 and 1323 of Patient Protection and Affordable Care Act, Public Law 111-148 It’s right there. Really. Black letter in the law. > [@PPACA](#): > > SEC. 1311. AFFORDABLE CHOICES OF HEALTH BENEFIT PLANS. > (a) ASSISTANCE TO STATES TO ESTABLISH AMERICAN HEALTH BENEFIT EXCHANGES ---
**Author:** ![RTFirefly](https://avatars.discourse-cdn.com/v4/letter/r/c77e96/32.png) [@RTFirefly](https://boards.straightdope.com/u/RTFirefly)\ **Post date:** [July 7, 2014, 5:29pm UTC](https://boards.straightdope.com/t/what-is-your-ongoing-opinion-of-the-affordable-care-act-title-edited/647561/2590 "2014-07-07T17:29:27Z")
> [@Iggy](#): > > I actually read it all. The DC court argues there is no indication in the law that Congress intended to compel or incentivize states to provide marketplaces. > > But there are exactly such incentives in the law. Congress provided [grants and subsidies for states to set up exchanges.](https://www.cfda.gov/index?s=program&mode=form&tab=core&id=0a53c1074dd153e213bf711416246e41) States not implementing their own exchanges don’t get the money. Per Sections 1311 and 1323 of Patient Protection and Affordable Care Act, Public Law 111-148 > > It’s right there. Really. Black letter in the law. So what does the law say about how much each state gets, over and above the cost to the state of setting up an exchange? ---
**Author:** ![ElvisL1ves](https://avatars.discourse-cdn.com/v4/letter/e/5daacb/32.png) [@ElvisL1ves](https://boards.straightdope.com/u/ElvisL1ves)\ **Post date:** [July 7, 2014, 5:48pm UTC](https://boards.straightdope.com/t/what-is-your-ongoing-opinion-of-the-affordable-care-act-title-edited/647561/2591 "2014-07-07T17:48:07Z")
So file an amicus brief with the SC explaining how the DC court got it all backward, then. I’m sure they’d love to be straightened out. :shrug: ---
**Author:** ![Iggy](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/iggy/32/3364_2.png) [@Iggy](https://boards.straightdope.com/u/Iggy)\ **Post date:** [July 7, 2014, 5:52pm UTC](https://boards.straightdope.com/t/what-is-your-ongoing-opinion-of-the-affordable-care-act-title-edited/647561/2592 "2014-07-07T17:52:19Z")
My point is this… The DC Circuit Court argues from the position that there are no incentives to the States in the PPACA and as such the court should not presume that Congress intended to create an incentive by limiting premium subsidies to policies sold on exchanges set up by a state and exclude subsidies on policies sold through a federal exchange. It would be a very powerful argument if it were true. It’s not. There are in fact subsidies to the states built into the PPACA. In fact one such incentive was deemed to have violated state sovereignty by the SCOTUS. That is in fact how the Medicaid expansion was ruled unconstitutional. The DC Circuit Court could have argued instead that certain subsidies/incentives were explicit. After all, why didn’t Congress make explicit this particular one that the plaintiffs claim? It is a more accurate argument. Perhaps slightly weaker, but still sufficient to uphold the same decision. But it is more in line with the plaintiff’s argument because it opens up the Circuit Court to needing to explain the converse… since the law does include instances that refer separately to the sections authoring states to establish exchanges and the section authorizing the federal government to establish exchanges on behalf of the states, then why did Congress leave out the second reference in this one critical place? Maybe they meant to do so. As an incentive. ---
**Author:** ![Iggy](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/iggy/32/3364_2.png) [@Iggy](https://boards.straightdope.com/u/Iggy)\ **Post date:** [July 7, 2014, 5:56pm UTC](https://boards.straightdope.com/t/what-is-your-ongoing-opinion-of-the-affordable-care-act-title-edited/647561/2593 "2014-07-07T17:56:57Z")
> [@ElvisL1ves](#): > > So file an amicus brief with the SC explaining how the DC court got it all backward, then. I’m sure they’d love to be straightened out. :shrug: I think we agree that this is destined for the Supreme Court regardless of how the DC Court of Appeals rules. Probably another year - or maybe even two - until a final ruling on the matter. I assume the administration would appeal if they lose. I’d be shocked if they didn’t. A loss would pose a major problem for the PPACA. Equally I assume that the Halbig side would also appeal if they lose. If there is any chance that this could go before the SCOTUS before the 2016 election then I think it is guaranteed they would seek cert. ---
**Author:** ![Iggy](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/iggy/32/3364_2.png) [@Iggy](https://boards.straightdope.com/u/Iggy)\ **Post date:** [July 7, 2014, 6:10pm UTC](https://boards.straightdope.com/t/what-is-your-ongoing-opinion-of-the-affordable-care-act-title-edited/647561/2594 "2014-07-07T18:10:20Z")
On further reading, it seems the initial appeal would likely go to the full DC Appeals Court. It’s most recent hearing was by a three judge panel of that court. After the full appeals court has its say, then onward to SCOTUS which could decide to take it on or refuse to grant cert. There are similar cases proceeding in other districts. If the Appeals courts come to conflicting rulings then it is more likely that SCOTUS would take up the matter. ---
**Author:** ![RTFirefly](https://avatars.discourse-cdn.com/v4/letter/r/c77e96/32.png) [@RTFirefly](https://boards.straightdope.com/u/RTFirefly)\ **Post date:** [July 7, 2014, 6:12pm UTC](https://boards.straightdope.com/t/what-is-your-ongoing-opinion-of-the-affordable-care-act-title-edited/647561/2595 "2014-07-07T18:12:59Z")
> [@Iggy](#): > > My point is this… > > The DC Circuit Court argues from the position that there are no incentives to the States in the PPACA and as such the court should not presume that Congress intended to create an incentive by limiting premium subsidies to policies sold on exchanges set up by a state and exclude subsidies on policies sold through a federal exchange. It would be a very powerful argument if it were true. It’s not. Do go on… > [@](#): > > There are in fact subsidies to the states built into the PPACA. In fact one such incentive was deemed to have violated state sovereignty by the SCOTUS. That is in fact how the Medicaid expansion was ruled unconstitutional. well, yeah, there was a clear incentive in the ACA _to expand Medicaid._ If a state didn’t do so, it stood to lose a chunk of money it was already getting, and would otherwise continue to get. But here, the ‘incentive’ is, if the states set up their own exchanges, they’ll be reimbursed for their costs. _They’ll break even._ That’s not what any reasonable person would call an _incentive_. ---
**Author:** ![ElvisL1ves](https://avatars.discourse-cdn.com/v4/letter/e/5daacb/32.png) [@ElvisL1ves](https://boards.straightdope.com/u/ElvisL1ves)\ **Post date:** [July 7, 2014, 6:35pm UTC](https://boards.straightdope.com/t/what-is-your-ongoing-opinion-of-the-affordable-care-act-title-edited/647561/2596 "2014-07-07T18:35:13Z")
The Court does not “argue” a position. It \*rules \*it. And the \*ruling \*amounts to “The Halbig argument is so full of shit it’s leaking out its ears.” But you can certainly dream. ---
**Author:** ![Iggy](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/iggy/32/3364_2.png) [@Iggy](https://boards.straightdope.com/u/Iggy)\ **Post date:** [July 7, 2014, 6:55pm UTC](https://boards.straightdope.com/t/what-is-your-ongoing-opinion-of-the-affordable-care-act-title-edited/647561/2597 "2014-07-07T18:55:20Z")
The Medicaid expansion certainly had no plan to do anything more than break even. As envisioned in the PPACA, it came with a big stick for non-compliance. And we regard that as an incentive. Halbig simply argues that Congress was again using a big stick approach to encourage states to set up an exchange. No plan to break even required. The monies provided to states to set up exchanges per Sec1311 are referred to as “grants”, “awards” or “amounts awarded” subject to limitations that the monies be spent to set up an exchange or in the planning process to do so. Carrot, no stick. But arguably an incentive. See… set up an exchange and the feds can cover your costs in doing so! ---
**Author:** ![Iggy](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/iggy/32/3364_2.png) [@Iggy](https://boards.straightdope.com/u/Iggy)\ **Post date:** [July 7, 2014, 6:59pm UTC](https://boards.straightdope.com/t/what-is-your-ongoing-opinion-of-the-affordable-care-act-title-edited/647561/2598 "2014-07-07T18:59:55Z")
> [@ElvisL1ves](#): > > The Court does not “argue” a position. It \*rules \*it. And the \*ruling \*amounts to “The Halbig argument is so full of shit it’s leaking out its ears.” > > But you can certainly dream. Quite right. The more proper way to phrase it that I should have used is: The DC Circuit Court could have [del]argued[/del] reasoned instead that certain… Doesn’t really address the argument though. The PPACA does contain incentives to the States. ---
**Author:** ![RTFirefly](https://avatars.discourse-cdn.com/v4/letter/r/c77e96/32.png) [@RTFirefly](https://boards.straightdope.com/u/RTFirefly)\ **Post date:** [July 9, 2014, 1:31am UTC](https://boards.straightdope.com/t/what-is-your-ongoing-opinion-of-the-affordable-care-act-title-edited/647561/2599 "2014-07-09T01:31:57Z")
> [@Iggy](#): > > The Medicaid expansion certainly had no plan to do anything more than break even. As envisioned in the PPACA, it came with a big stick for non-compliance. And we regard that as an incentive. We agree on this. > [@](#): > > Halbig simply argues that Congress was again using a big stick approach to encourage states to set up an exchange. No plan to break even required. > > The monies provided to states to set up exchanges per Sec1311 are referred to as “grants”, “awards” or “amounts awarded” subject to limitations that the monies be spent to set up an exchange or in the planning process to do so. Carrot, no stick. But arguably an incentive. See… set up an exchange and the feds can cover your costs in doing so! So you keep arguing that a break-even offer is an incentive. I don’t think I need to say any more. ---
**Author:** ![iiandyiiii](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/iiandyiiii/32/7924_2.png) [@iiandyiiii](https://boards.straightdope.com/u/iiandyiiii)\ **Post date:** [July 10, 2014, 3:59pm UTC](https://boards.straightdope.com/t/what-is-your-ongoing-opinion-of-the-affordable-care-act-title-edited/647561/2600 "2014-07-10T15:59:44Z")
Right-wing attempts to ‘report’ on Obamacare’s supposed failure, [when taken together](http://nymag.com/daily/intelligencer/2014/07/libertarian-accidentally-shows-obamacare-success.html), are accidentally demonstrating just how successful it has been so far. I like this quote the best: “The message of every individual dispatch is a confident prediction of the hated enemy’s demise, yet the terms described in each, taken together, tell the story of retreat. _The enemy’s invasion fleet has been destroyed; its huge losses on the field of battle have left it on the brink of surrender; the enemy soldiers will be slaughtered by our brave civilian defenders as they attempt to enter the capital; the resistance will triumph_!” ---
**Author:** ![ElvisL1ves](https://avatars.discourse-cdn.com/v4/letter/e/5daacb/32.png) [@ElvisL1ves](https://boards.straightdope.com/u/ElvisL1ves)\ **Post date:** [July 10, 2014, 4:59pm UTC](https://boards.straightdope.com/t/what-is-your-ongoing-opinion-of-the-affordable-care-act-title-edited/647561/2601 "2014-07-10T16:59:38Z")
The first paragraph of that link should have been your lede: > [@](#): > > The Commonwealth Fund has a new survey showing that the proportion of adults lacking health insurance has fallen by a quarter, from 20 percent of the population to 15 percent. (Most respondents, including 74 percent of newly insured _Republicans_, report liking their plan.) Also, this week, the Congressional Budget Office again revised down its cost estimates for Medicare, which now spends $50 billion a year less than it was projected to before Obamacare passed. Also, the New England Journal of Medicine recently estimated that 20 million Americans gained insurance under the new law. [Previous page](https://boards.straightdope.com/t/what-is-your-ongoing-opinion-of-the-affordable-care-act-title-edited/647561.md?page=129) [Next page](https://boards.straightdope.com/t/what-is-your-ongoing-opinion-of-the-affordable-care-act-title-edited/647561.md?page=131)