Post by guest on Jun 27, 2012 22:50:21 GMT 2
(TL;DR version available at the bottom of this post)
Background
As many of you know, Democrats in Congress passed a law in 2010 that significantly altered the US Health Care system. The formal legislation was titled “The Patient Protection and Affordable Care Act,” but it has become widely known as “Obamacare.” Obamacare includes a number of changes to the way existing healthcare operates, including requirements to provide insurance to anyone who wants it (called Guaranteed Issue); an inability to charge drastically different prices to people based upon their gender or age (called Community Rating); and a significant expansion of Medicaid, the Federal and State-run health insurance program for poor people (different from Medicare). Obamacare also requires people to have health insurance, and gives them financial assistance to buy it while also including money-penalties if you don’t buy it.
Upon passage, Obamacare was immediately derided as an unconstitutional encroachment upon personal liberties by the Republican party. A number of individuals, organizations, and State Attorney Generals filed suit. In March, the case was argued before the US Supreme Court. Tomorrow morning, the Supreme Court is expected to issue one of the most significant – and likely most controversial – rulings of the decade.[/i]
So – what is the Obamacare debate all about? In this post, I will discuss Obamacare and the Supreme Court with the help of my alternate personality, Conservative Superguest (ps. He’s wrong about the Supreme Court decision in the Arizona case. The court upheld the basic principle of the Supremacy Clause – affirming literally centuries of constitutional law that establishes enumerated rights for States, but that does not allow states to supercede federal law. SO *cruiser* YOU SUPERGUEST).
As someone who worked on the policies before it was passed, and who actually read the entire text of the bill, I am eminently qualified to discuss this legislation. In fact, I have spoken about Obamacare at conferences, to state legislatures, and to a variety of industries.
Conservative Superguest doesn’t know as much as me, but that never stops him from commenting on anything.
So here we go.
There are technically multiple components to the Supreme Court Ruling – so it’s not necessarily just “Is Obamacare legal?” So we’ll break down our discussion by each section. Starting with:
The individual mandate:
This is the big one. Obamacare says that you have to carry some kind of health insurance (Medicaid, Medicare, Job-issued insurance, or privately purchased). If you don’t, you pay a penalty - the larger of $695/year or 2.5% of your total income. Opponents argue that it’s an unconstitutional encroachment on liberty by forcing them to buy something. Proponents argue that it’s regulating interstate commerce, which is specifically allowed under the Commerce Clause of the Constitution.
Myther(s) this impacts: Pogue, HeadHunter, Honkey. These poor bastards have no health care, and that’s sad. Also impacts Shinco, but that’s just because he doesn’t want to do anything Obama says – so he stopped buying health insurance the second Obamacare passed.
My take: the Commerce Clause has been used to regulate things like a farmer growing products for their own use (see: www.law.cornell.edu/supct/html/historics/USSC_CR_0317_0111_ZS.html ) or a person growing medical marijuana (see: www.law.cornell.edu/supct/html/03-1454.ZS.html/ ). So, it seems like an extreme stretch to say that people’s refusal to carry health insurance is not economic activity. Remember, we already have universal coverage in this country – you just have to get sick or injured enough to use ER services – and they have to treat you (see: EMTALA www.cms.gov/Regulations-and-Guidance/Legislation/EMTALA/index.html?redirect=/emtala/ ). So, by not buying insurance, people are explicitly increasing ER utilization and driving up everyone’s cost.
Conservative Superguest’s take: The democraps are trying to say that Commerce Clause can regulate INactivity, when it was only ever supposed to regulate economic activity. If you say that the commerce clause can make someone buy insurance, what’s to stop them from forcing people to eat broccoli every day? If they eat more broccoli, they’ll be healthier and need less healthcare – so that has an economic impact.
Best guess at what happens: The Supreme Court upholds the individual mandate. The vote is 6-3.
Severability:
Severability asks whether you can cut a piece out of the law without ruining the whole thing. The question basically asks whether the individual mandate is so crucial to the Law that nothing else can work without it. Ie: if we remove the mandate, do we have to overturn the whole law – or can we just remove the mandate (and penalty) and have everything else work. This question is crucial because there’s a lot of concern that people just won’t buy health insurance until they get in an accident or get sick, and then they’ll stick the companies with all of the bills (since other parts of the law say that you can’t deny care just because someone’s sick). That could make the whole thing unworkable for insurance plans, and make them go out of business. This only matters if the Individual Mandate is determined to be unconstitutional.
Myther(s) this impacts: Everyone. There were enough changes in the bill for it to have a huge impact on the whole health system – so if the whole thing goes down, we’ll all feel it. And before you foreigners jump in and claim that it’s just an American problem – remember that a lot of health care research, innovation, and purchasing flows through the US marketplace. So it will impact your economies, care systems, and health treatment as well. (Fuckers)
My take: it should be severable. Personally, I think we need single payer – so anything to make the companies go broke faster is a good thing. But even beyond that, legally, courts and judges are supposed to do everything they can to avoid striking down full pieces of legislation (presumed severability. See: papers.ssrn.com/sol3/papers.cfm?abstract_id=1752570 ).
Conservative Superguest’s take: The whole law should be struck down. It was pushed through a partisan legislature and is a total piece of crap. The whole law sucks.
Best guess at what happens: it doesn’t matter because the mandate is upheld. If the mandate is struck down, then I think there will be presumed severability.
Anti-Injunction Act:
One law in the US is that you can’t sue the government about a tax until you’ve actually had to pay the tax. This is called the Tax Anti-Injunction Act (see: www.law.cornell.edu/uscode/text/26/7421 ). So the argument here is that the “penalty” for not paying the mandate is, in fact, a tax. Thus, since it doesn’t start until 2014, the whole lawsuit is invalid. Come back in 2 years and try again.
Myther this impacts: Karma. He'll probably kill himself if they allow more taxes. Boy, Karma sure hates taxes.
My take: It’s definitely an interesting argument, but neither side of the argument agreed with it. Obama and the people suing him both said that it shouldn’t apply. But – the Supreme Court still asked an independent lawyer to argue in favor of delaying judgement based on the anti-injunction principle.
Conservative Superguest’s take: *cruiser* Obama, *cruiser* liberals, and *cruiser* you.
Best guess: they issue a ruling tomorrow, and ignore the tax arguments.
Medicaid Expansion:
The law also requires every state to significantly expand Medicaid (health care for the poor). Currently, Medicaid covers between 50-60 million people across the country, with 57% of the costs paid by the Federal government and 43% paid by states. Obamacare would add another 15-20 million people to the program – all of them poor – and the Federal government would pay 90% of the cost of those new people. States argue that this is forcing them to expand with money they don’t have – this is well beyond the scope of Federal powers. Obama argues that Medicaid is an optional program, so states can stop providing the program completely, if they don’t want to expand.
Myther(s) this impacts: Ducky, since he’s really *cruisering* poor. Asmodian too, probably.
My take: When the Federal government gives money to states, they’re allowed to attach strings. One of the reasons every state has 21 as the legal drinking age is because the Federal gov’t stopped giving highway money to states that had it lower. But, highway money was optional so if the state wanted to keep the drinking age below 21, they could just refuse the funds. States sued, but they lost at the Supreme Court (See: caselaw.lp.findlaw.com/scripts/getcase.pl?court=us&vol=483&invol=203 ). Since Medicaid is optional, states can walk away.
Conservative Superguest’s take: This is more examples of the Federal government’s encroachment on States’ rights! It’s Arizona all over again! Why do we even have states if the Feds are going to keep pushing them around like this? It’s totally unconstitutional.
Best guess at what will happen: the court will uphold Medicaid expansion with either 6-3 or 7-2 vote.
Well…that’s all for now. But don’t forget, even outside of these Supreme Court questions, there’s a lot in obamacare! Things like:
-Requirement for insurance companies to provide mental health treatment: this will totally help Kirk with his ongoing problems! And therefore, it affects ALL of us!
<3 to all,
Superguest
TL-DR Version:[/u]
Background
As many of you know, Democrats in Congress passed a law in 2010 that significantly altered the US Health Care system. The formal legislation was titled “The Patient Protection and Affordable Care Act,” but it has become widely known as “Obamacare.” Obamacare includes a number of changes to the way existing healthcare operates, including requirements to provide insurance to anyone who wants it (called Guaranteed Issue); an inability to charge drastically different prices to people based upon their gender or age (called Community Rating); and a significant expansion of Medicaid, the Federal and State-run health insurance program for poor people (different from Medicare). Obamacare also requires people to have health insurance, and gives them financial assistance to buy it while also including money-penalties if you don’t buy it.
Upon passage, Obamacare was immediately derided as an unconstitutional encroachment upon personal liberties by the Republican party. A number of individuals, organizations, and State Attorney Generals filed suit. In March, the case was argued before the US Supreme Court. Tomorrow morning, the Supreme Court is expected to issue one of the most significant – and likely most controversial – rulings of the decade.[/i]
So – what is the Obamacare debate all about? In this post, I will discuss Obamacare and the Supreme Court with the help of my alternate personality, Conservative Superguest (ps. He’s wrong about the Supreme Court decision in the Arizona case. The court upheld the basic principle of the Supremacy Clause – affirming literally centuries of constitutional law that establishes enumerated rights for States, but that does not allow states to supercede federal law. SO *cruiser* YOU SUPERGUEST).
As someone who worked on the policies before it was passed, and who actually read the entire text of the bill, I am eminently qualified to discuss this legislation. In fact, I have spoken about Obamacare at conferences, to state legislatures, and to a variety of industries.
Conservative Superguest doesn’t know as much as me, but that never stops him from commenting on anything.
So here we go.
There are technically multiple components to the Supreme Court Ruling – so it’s not necessarily just “Is Obamacare legal?” So we’ll break down our discussion by each section. Starting with:
The individual mandate:
This is the big one. Obamacare says that you have to carry some kind of health insurance (Medicaid, Medicare, Job-issued insurance, or privately purchased). If you don’t, you pay a penalty - the larger of $695/year or 2.5% of your total income. Opponents argue that it’s an unconstitutional encroachment on liberty by forcing them to buy something. Proponents argue that it’s regulating interstate commerce, which is specifically allowed under the Commerce Clause of the Constitution.
Myther(s) this impacts: Pogue, HeadHunter, Honkey. These poor bastards have no health care, and that’s sad. Also impacts Shinco, but that’s just because he doesn’t want to do anything Obama says – so he stopped buying health insurance the second Obamacare passed.
My take: the Commerce Clause has been used to regulate things like a farmer growing products for their own use (see: www.law.cornell.edu/supct/html/historics/USSC_CR_0317_0111_ZS.html ) or a person growing medical marijuana (see: www.law.cornell.edu/supct/html/03-1454.ZS.html/ ). So, it seems like an extreme stretch to say that people’s refusal to carry health insurance is not economic activity. Remember, we already have universal coverage in this country – you just have to get sick or injured enough to use ER services – and they have to treat you (see: EMTALA www.cms.gov/Regulations-and-Guidance/Legislation/EMTALA/index.html?redirect=/emtala/ ). So, by not buying insurance, people are explicitly increasing ER utilization and driving up everyone’s cost.
Conservative Superguest’s take: The democraps are trying to say that Commerce Clause can regulate INactivity, when it was only ever supposed to regulate economic activity. If you say that the commerce clause can make someone buy insurance, what’s to stop them from forcing people to eat broccoli every day? If they eat more broccoli, they’ll be healthier and need less healthcare – so that has an economic impact.
Best guess at what happens: The Supreme Court upholds the individual mandate. The vote is 6-3.
Severability:
Severability asks whether you can cut a piece out of the law without ruining the whole thing. The question basically asks whether the individual mandate is so crucial to the Law that nothing else can work without it. Ie: if we remove the mandate, do we have to overturn the whole law – or can we just remove the mandate (and penalty) and have everything else work. This question is crucial because there’s a lot of concern that people just won’t buy health insurance until they get in an accident or get sick, and then they’ll stick the companies with all of the bills (since other parts of the law say that you can’t deny care just because someone’s sick). That could make the whole thing unworkable for insurance plans, and make them go out of business. This only matters if the Individual Mandate is determined to be unconstitutional.
Myther(s) this impacts: Everyone. There were enough changes in the bill for it to have a huge impact on the whole health system – so if the whole thing goes down, we’ll all feel it. And before you foreigners jump in and claim that it’s just an American problem – remember that a lot of health care research, innovation, and purchasing flows through the US marketplace. So it will impact your economies, care systems, and health treatment as well. (Fuckers)
My take: it should be severable. Personally, I think we need single payer – so anything to make the companies go broke faster is a good thing. But even beyond that, legally, courts and judges are supposed to do everything they can to avoid striking down full pieces of legislation (presumed severability. See: papers.ssrn.com/sol3/papers.cfm?abstract_id=1752570 ).
Conservative Superguest’s take: The whole law should be struck down. It was pushed through a partisan legislature and is a total piece of crap. The whole law sucks.
Best guess at what happens: it doesn’t matter because the mandate is upheld. If the mandate is struck down, then I think there will be presumed severability.
Anti-Injunction Act:
One law in the US is that you can’t sue the government about a tax until you’ve actually had to pay the tax. This is called the Tax Anti-Injunction Act (see: www.law.cornell.edu/uscode/text/26/7421 ). So the argument here is that the “penalty” for not paying the mandate is, in fact, a tax. Thus, since it doesn’t start until 2014, the whole lawsuit is invalid. Come back in 2 years and try again.
Myther this impacts: Karma. He'll probably kill himself if they allow more taxes. Boy, Karma sure hates taxes.
My take: It’s definitely an interesting argument, but neither side of the argument agreed with it. Obama and the people suing him both said that it shouldn’t apply. But – the Supreme Court still asked an independent lawyer to argue in favor of delaying judgement based on the anti-injunction principle.
Conservative Superguest’s take: *cruiser* Obama, *cruiser* liberals, and *cruiser* you.
Best guess: they issue a ruling tomorrow, and ignore the tax arguments.
Medicaid Expansion:
The law also requires every state to significantly expand Medicaid (health care for the poor). Currently, Medicaid covers between 50-60 million people across the country, with 57% of the costs paid by the Federal government and 43% paid by states. Obamacare would add another 15-20 million people to the program – all of them poor – and the Federal government would pay 90% of the cost of those new people. States argue that this is forcing them to expand with money they don’t have – this is well beyond the scope of Federal powers. Obama argues that Medicaid is an optional program, so states can stop providing the program completely, if they don’t want to expand.
Myther(s) this impacts: Ducky, since he’s really *cruisering* poor. Asmodian too, probably.
My take: When the Federal government gives money to states, they’re allowed to attach strings. One of the reasons every state has 21 as the legal drinking age is because the Federal gov’t stopped giving highway money to states that had it lower. But, highway money was optional so if the state wanted to keep the drinking age below 21, they could just refuse the funds. States sued, but they lost at the Supreme Court (See: caselaw.lp.findlaw.com/scripts/getcase.pl?court=us&vol=483&invol=203 ). Since Medicaid is optional, states can walk away.
Conservative Superguest’s take: This is more examples of the Federal government’s encroachment on States’ rights! It’s Arizona all over again! Why do we even have states if the Feds are going to keep pushing them around like this? It’s totally unconstitutional.
Best guess at what will happen: the court will uphold Medicaid expansion with either 6-3 or 7-2 vote.
Well…that’s all for now. But don’t forget, even outside of these Supreme Court questions, there’s a lot in obamacare! Things like:
-Requirement for insurance companies to provide mental health treatment: this will totally help Kirk with his ongoing problems! And therefore, it affects ALL of us!
<3 to all,
Superguest
TL-DR Version:[/u]
