Obamacare was just ruled unconstitutional in Texas

[buzzkill]

https://www.nbcnews.com/think/opinion/o ... ncna948621

A late Friday evening in mid-December — with the midterm elections safely in the rear-view mirror — is not when a public official releases something important that they want to receive a lot of public scrutiny. So it is almost certainly not a coincidence that Texas U.S. District Court Judge Reed O’Connor chose exactly such a moment to release his opinion in Texas v. U.S., holding that the Affordable Care Act was unconstitutional and should be struck down in its entirety.

[The Annoyed Man]

I ran across a brilliant and very complete explanation in a Twitter thread of the background issues, and how the court arrived at the decision, written by Josh Blackman, who is kind of an expert on the subject: https://twitter.com/JoshMBlackman/statu ... 7796428800

[Alf]

Does that mean Texans can't buy insurance on Healthcare.gov for 2019?

[The Annoyed Man]

Does that mean Texans can't buy insurance on Healthcare.gov for 2019?

No. What it means is that at some point in 2019, Obamacare will cease to exist. It has to work its way though the courts, but it has been ruled unconstitutional. Read the link I posted above. But we went ahead and enrolled my wife in a plan, because she does need insurance. We’ll reevaluate down the line when we know the final disposition of all of this.

[RicoTX]

Does that mean Texans can't buy insurance on Healthcare.gov for 2019?

No. What it means is that at some point in 2019, Obamacare will cease to exist. It has to work its way though the courts, but it has been ruled unconstitutional. Read the link I posted above. But we went ahead and enrolled my wife in a plan, because she does need insurance. We’ll reevaluate down the line when we know the final disposition of all of this.

If or when people lose coverage due to this, it will be the death of Republicans for the next election... it will just be one more reason for people to say it is the party of the rich.

[flechero]

It won't matter if only 1 person looses coverage- even if 10 million more can now afford it- the press will show the one person without it and demonize conservatives.

[crazy2medic]

Obamacare was a bad law but it allowed the Government to take over health care, Justice Roberts cast the deciding vote and ruled the individual mandate was a Tax and therefore Constitutional. Now that the individual mandate has been removed, the tax argument has been removed and the whole thing is UnConstitutional! This will be interesting to see how Roberts rules this time!
Heath Care is Not The Federal Government's Job!

[Maxwell]

I'll admit that I haven't read the entire explanation in TAM's link but I thought I heard that it was ruled unconstitutional BECAUSE the individual mandate was removed and that sounds backwards to me. I would have thought that the individual mandate, i.e. forcing people to have health insurance, would have been the unconstitutional part of it.

[warnmar10]

I'll admit that I haven't read the entire explanation in TAM's link but I thought I heard that it was ruled unconstitutional BECAUSE the individual mandate was removed and that sounds backwards to me. I would have thought that the individual mandate, i.e. forcing people to have health insurance, would have been the unconstitutional part of it.

You'll probably want to read the links from 2012 when the Supreme Court ruled forcing people to buy insurance is a tax.

[mojo84]

Unfortunately, ruling Obamacare unconstitutional will not reduce the cost of health insurance. Nothing will make a significant impact in reducing the cost health insurance until the cost of care is reduced drastically.

The costof care is the primary driver of insurance premiums. Less regulation, more transparency in healthcare pricing, fewer middlemen and more competition is what will lead to lower premiums.

Let's pray and push for real actual reform that will make a difference.

[The Annoyed Man]

I'll admit that I haven't read the entire explanation in TAM's link but I thought I heard that it was ruled unconstitutional BECAUSE the individual mandate was removed and that sounds backwards to me. I would have thought that the individual mandate, i.e. forcing people to have health insurance, would have been the unconstitutional part of it.

Here’s the logic, Max...

• The individual mandate was judged by both congress and the courts to be inextricably entwined with the tax. You can’t have this particular tax without the individual mandate, and you can’t have the individual mandate without the tax. That was the position of Congress, the Obama administration, and SCOTUS.
• The reasoning is that the tax was necessary to paying for the individual mandate. An act of Congress is empty if there exists no funding to make it happen. (For example, we have legislation from 10 or 12 years ago mandating a wall be built along our border with Mexico....and it still isn’t built, because democrats wouldn’t fund it, even though they voted for it.) It is unconstitutional for the federal gov’t to mandate the purchase of a commercial product, if the gov’t won’t fund that purchase. This is why the tax was inextricably tied to the mandate, and the mandate could not stand without the tax.
• It was ALSO the position of Congress, the Obama administration, and SCOTUS that Congress had the authority to enact the ACA as written. By extension, Congress also has the authority to amend, repeal, or override the law in its entirety - as Congress has done a thousand times since 1776 with other laws.
• So, Congress repealed the tax associated with the ACA. Actually, it set the amount of the tax to $0, which effectively gutted the tax, and defunded the individual mandate
• Since the individual mandate and the tax were considered inextricable, if one or the other was repealed or modified in such a way as to render it moot, the other half would also become moot.
• Based on both the legislative and judicial precedents concerning the ACA, if Congress repealed the tax, the individual mandate would become unconstitutional.
• So, Congress repealed/neutered the tax.
• The state of Texas, as the plaintiff in the case, went to court to have the court declare the individual mandate unconstitutional, since it had been severed from the tax.
• Upon reviewing all the evidence, including the documentation of legislative intent at the time the ACA was written and passed, as well as the arguments and opinions in subsequent litigations and decisions, the court concluded that the individual mandate was indeed inextricably tied to the tax, and if the tax were struck down by Congress - which absolutely had the authority to do so - then the mandate on its own was indeed, unconstitutional.
• IF, for instance, Congress had repealed the mandate but not the tax, then the tax would become unconstitutional, and subsequent litigation would have fixed that.
• What RicoTX wrote above, about the GOP being perceived as “the party of the rich” would have most certainly been the case if Congress had stuck down the individual mandate instead of the tax. But by relieving the “little guy” from having to pay a tax to fund everyone else’s healthcare, in fact, the opposite will be the case. That tax actually hurt me personally in a very tangible way. I’m damned glad it is gone ... and I’m a “little guy”.
• The fact is, the GOP dominated congress gave average Americans a tax break, and it is the COURT that made a decision about the individual mandate, in a case in which the plaintiff is The People of the state of Texas ... not the GOP.

Unfortunately, ruling Obamacare unconstitutional will not reduce the cost of health insurance. Nothing will make a significant impact in reducing the cost health insurance until the cost of care is reduced drastically.

The costof care is the primary driver of insurance premiums. Less regulation, more transparency in healthcare pricing, fewer middlemen and more competition is what will lead to lower premiums.

Let's pray and push for real actual reform that will make a difference.

Mojo84, who if I recall correctly is in the insurance business, is at least partially right ... the cost of healthcare has been a major driver of the cost of insurance, and the remedies he proposes will help to drive the cost down. But, the willingness of insurance to pay the high costs is at least partially to blame too. And then there is the cost of litigation. A LARGE part of the costs included in provision of care is the cost of malpractice insurance. And a large part of that particular insurance cost is because we are a litigious society, FULL of people who don’t want to accept the consequences of their own lifestyle choices, or who want to sue somebody if they have a bad outcome.

The fact is, when gov’t mandates any kind of insurance, insurance companies raise their prices, NOT just because they now have to included bad risks in their customer base, but because they CAN. I’ll never forget with California first a mandate for motor vehicle insurance. The argument from both supporters and politicians was that, by expanding the pool of coverage, the cost of motor vehicle insurance to the individual would go down. Instead, guess what happened? The cost of MV insurance shot upwards. Why? A lot of reasons. But primarily, they could not charge enough money from people who previously could not get insurance to cover the increased liability those people added to the pool of insured. So, they raised EVERYbody’s price, including for those who had perfectly good driving records, with no accidents or tickets. Why? Because they could. The law mandated everyone have insurance, so they could charge whatever they wanted. The reason the mandated vehicle insurance wasn’t unconstitutional is that there was no mandated tax penalty associated with it. Sure, you couldn’t register your vehicle, but you didn’t have to PAY a penalty tax for not having done so.


And the result? There are STILL people driving around California without insurance - despite laws which say they can’t renew their CDL or registrations without proof of insurance. It’s a lot like gun laws which forbid known gang members to have guns. Does it stop them? No. Neither did mandated vehicle insurance. And by the way, neither did mandated health insurance. There were still people who didn’t enroll in a plan, but they just had to pay a penalty tax for not doing so. When the required penalty tax was done way with, it effectively invalidated the individual mandate.

[mojo84]

Yes, I have been selling insurance for over 20 years.

Medical malpractice claims have been capped in Texas. Medical malpractice premiums are not increasing like many docs and providers would like the general public to believe they are.

The reason carriers are willing to pay the higher costs for care is because they can charge increased premiums based upon how much they pay out. Their profit and operating expenses have been capped at 20% of total premium revenue. Therefore, the more they pay out the more they can charge the more profit they make.

A lot of the cost provider expenses come from having to have so many admin people to deal with the bureaucracy and red tape.

[Maxwell]

Thank you TAM.

[talltex]

Yes, I have been selling insurance for over 20 years.

Medical malpractice claims have been capped in Texas. Medical malpractice premiums are not increasing like many docs and providers would like the general public to believe they are.

The reason carriers are willing to pay the higher costs for care is because they can charge increased premiums based upon how much they pay out. Their profit and operating expenses have been capped at 20% of total premium revenue. Therefore, the more they pay out the more they can charge the more profit they make.

A lot of the cost provider expenses come from having to have so many admin people to deal with the bureaucracy and red tape.

YES ! The bottom line is it is aways about profits for the insurance companies. Another factor is the rapidly increasing mergers of major Hospital groups that are gaining control of the regional markets and charging higher prices because they are then able to. In central Texas, Scott & White was the largest network and also the only one with their own health insurance company (Scott & White Health Plan). They provided outstanding medical services at a very reasonable rate. As a small group employer, I had been held hostage by my group provider (Pacific Mutual) for 6 years because I had two employees who had suffered heart attacks. They raised my rates every year dramatically and knew I wasn't going to go elsewhere because those two employess would be unable to get insurance anywhere else under the "pre-existing" condition exclusion that was in effect. In 1999, a rep from S&W stopped by and told me he had a great deal for me as a small group (less than 45 employees) employer. SWHP would give small groups the same coverage as large group employers. One price for all, regardless of family size, sex or age, and no pre-existing condition exclusion. It WAS a fantastic deal for small employers and I jumped on it and we had GREAT healthcare at a good price for 17 years. In 2016, S&W merged with Baylor Medical into "Baylor Scott and White". I had sold my business in 2005, but continued with S&W as they allowed me to retain my status as a small group since I was still a corporation although only my family was on the plan. After the merger with Baylor ( who had no private health insurance plan) Baylor referred and recommended all their patients and business customers sign up with SWHP. I was still able to keep my coverage that year, but had to buy it off the exchange the first year the ACA went into effect as they no longer offered the small group program after Baylor took over. In 2017, they pulled off the exchange saying it wasn't profitable for them. I drove 75 miles to Temple, to the SWHP headquarters, to talk to them and see what kind of plan I could purchase as an individual. I was told at the main desk that they weren't really offering much in individual plans and I told them my situation, that I had been with them for 17 years and didn't want to lose my doctors or the excellent care we had received there over the years. I asked how many other self employed businesses that had been with them a long time had lost their coverage too? They said I would have to talk to someone on the "third floor" to obtain that information and I asked who I needed to see and the lady looked stunned and sair "well they dont talk to anyone-they run the company". I waited 3 hours for a woman to come down to the lobby to speak to me. She walked over to me and asked "Who are you? Some kind of investigative reporter?" I said "no, I'm someone who has had insurance with S&W for 17 years and I'd just like to find out what kind of coverage I can purchase, since you have pulled off the exchange this year." She said "We are not really focusing on the individual market at this time, but concentrating on our corporate and Large Group clients." I said "Well surely you have to be offering individual plans for the thousands of other self employed customers that have been with you for years?" she said "Yes, we have one individual plan available", and handed me a summary sheet. I quickly scanned the highlights and asked if she was serious--you can't even call this insurance--it was a $14,300 deductible per person, with no prescription coverage period, and it allowed ONE Primary care Physician visit per year at no charge and nothing else until the full deductible had been met. The premium for that was going to be $1473.00 per month. At the same time this occurred, bull&W went on a building spree putting up new multi billion dollar facilities located near high end real estate subdivisons north and south of DFW and north of Austin. They added 6 new stand alone Clinics in Waco and built satellite specialty clinics all around the original main hospital in Temple, and started buying up private medical practices. One of my customers who was part of a well established medical group with their own treatment facility in Waco, sold out to them and when I asked him about it, he said they were doing it all over the cities where they had hospitals and in the suburb areas around them. I asked him why they sold out and he said they offered us a ton of money for our practice, and now we are employed by them and have alot off extra benefits along with the money. He said that by buying our real estate as well as our practice, our building is now considered part of the bull&W Hospital in Waco and every patient that comes in now has a "facility fee" of $179.00 tacked onto the bill. The only option we had to get decent coverage was a gold plan with BCBS-TX and we lost all our specialists for two years. About 4 months ago, bull&W started making some of their specialists available to us again. I doubt it was because they wanted to help us out, but that it was simply another revenue source and they have so many more physicians that have been added to their staff by the buyouts that they want more patients. And 2 months ago they announce that bull&W would be merging with Herman Hospital system out of Houston also. They are creating a giant Healthcare monoply. They are not building billions of dollars in new facilities because they are losing money. As MOJO stated above the insurance companies are will to pay the higher provider costs because they can then justify higher premiums. bull&W / Herman is going for the whole enchilada--they will charge their own insurance company higher prices and thus justify higher premiums to them--both get richer!