The Supreme Court decision on ObamaCare

[RecycleMichael]

http://www.theatlantic.com/business/archive/2012/06/the-health-care-decision-explained-in-1-paragraph-on-scotusblog/259097/
The Health Care Decision, Explained in 1 Paragraph on SCOTUSblog
By Derek Thompson

Jun 28 2012, 10:37 AM ET33


In Plain English: The Affordable Care Act, including its individual mandate that virtually all Americans buy health insurance, is constitutional. There were not five votes to uphold it on the ground that Congress could use its power to regulate commerce between the states to require everyone to buy health insurance. However, five Justices agreed that the penalty that someone must pay if he refuses to buy insurance is a kind of tax that Congress can impose using its taxing power. That is all that matters. Because the mandate survives, the Court did not need to decide what other parts of the statute were constitutional, except for a provision that required states to comply with new eligibility requirements for Medicaid or risk losing their funding. On that question, the Court held that the provision is constitutional as long as states would only lose new funds if they didn't comply with the new requirements, rather than all of their funding.

[Hoss]

http://www.politico.com/blogs/on-congress/2012/06/rand-paul-obamacare-is-still-unconstitutional-127574.html

Last time I checked, opthamologist <> Supreme Court Justice.

[Townsend]

Why Women Stand To Gain the Most From the Health Care Decision

http://www.slate.com/blogs/xx_factor/2012/06/28/supreme_court_and_health_care_why_the_decision_is_good_news_for_women_.html

The Supreme Court's decision is in. With the Affordable Care Act mostly intact, tens of millions of uninsured Americans will gain coverage. Senior citizens will get billions of dollars of prescription drug benefits. Everyone with insurance will get preventive services at no cost. Roughly 60,000 people now covered by the new Pre-existing Condition Insurance Plan will still have that coverage, even though they are actually sick and thus might actually use it. We all still have the guarantee that our policies won't be canceled when we get sick. And our adult children can stay on our health plans until they're 26.

The bullet we just collectively dodged would have caused pain throughout the country, with women taking the hardest hit. That's because women stand to gain the most from the health law. We are already getting improved benefits under the Affordable Care Act—things like mammograms, pap smears, and immunizations for our kids, which insurers have been required to cover without a co-pay since last year. And in just over a month, on Aug. 1, women will have the same unfettered access to diabetes screenings (men too, but women are more negatively impacted by the disease), annual well-woman visits, HPV testing, domestic violence screenings, breast-feeding support, and, after much wrangling, contraception.

Even more is on the horizon, of course. Though the decision left new room for states to wiggle out of expanding their Medicaid programs in 2014, millions of uninsured women will still likely gain coverage this way, when states are made to include everyone with incomes below 133 percent of the federal poverty level. Also, by then, insurers will be forbidden from charging women more, an abhorrent practice known (though apparently not widely known) as gender rating.

Women have been getting a harsh deal on health care for years. We pay more than men on average for our policies. It's been de rigueur—and perfectly legal—to deny us coverage in the private insurance market because we have had breast cancer or a c-section or been sexually assaulted. (Men are denied coverage because of pre-existing conditions, too, of course, but women, being more likely to have chronic diseases, are more likely to face this problem.) Even pregnancy has been grounds for insurance companies to refuse policies on the grounds that it's a pre-existing condition. 

All this made women more likely to be uninsured—as one in five women under 65 were in 2010. And even when we did have coverage, we often weren't able to get our insurers to pay for birth control and other basic prevention (even while they were doling out Viagra, no questions asked).

Many mothers stayed in full-time jobs they didn't otherwise want because they provided them, and their kids, with health care. Shameful bogus "maternity insurers" sprung up to exploit the very real desperation of pregnant women who couldn't find care in the individual market. And because many health plans lacked abortion coverage, some women even resorted to do-it-yourself abortions.

And then came the Affordable Care Act. Years after other rich nations figured out how to provide all their citizens with decent health care, we were finally heading there ourselves. Had the court decided to reverse that progress, women might have remained stoic. Given our years spent taking the greed and unfairness of the insurance industry on the chin (and uterus), you might think we'd just soldier on with our benefits returned to their former pathetic level.

But I don't think so. While this decision is a victory for the Obama administration, it should also come as a relief to the very Republicans who mounted the challenge—and surely would have been the objects of wrath had they stripped these basic, humane gains from the millions of women and other Americans who are already benefiting from them.

[guido911]

While I disagree with the concept of Obamacare (and since I am insured and have health care already built in the family), I cannot argue too terribly right now with the "tax" rationale of the mandate. I personally do not know how it will look if the IRS begins chasing around lower or middle class "tax cheats" who do not want insurance and refuse (or cannot afford) to pay the tax. My thought is that it is not the "rich" or even the "middle" who have an issue with paying for or having health care, only the government intrusion part bothers them.

[Conan71]

Also, by then, insurers will be forbidden from charging women more, an abhorrent practice known (though apparently not widely known) as gender rating.

Women have been getting a harsh deal on health care for years. We pay more than men on average for our policies. It's been de rigueur—and perfectly legal—to deny us coverage in the private insurance market because we have had breast cancer or a c-section or been sexually assaulted. (Men are denied coverage because of pre-existing conditions, too, of course, but women, being more likely to have chronic diseases, are more likely to face this problem.) Even pregnancy has been grounds for insurance companies to refuse policies on the grounds that it's a pre-existing condition. 

Uh, this is the way all insurance works.  The largest risks and highest exposures for loss always have a higher premium!

It's going to be a few years before we can truly see either the benefit or complete folly the ACA is on medical costs.  Honestly, I don't see how costs come down when you bring 10+ more million people into the care pool.

[Townsend]

Uh, this is the way all insurance works.  The largest risks and highest exposures for loss always have a higher premium!

It's going to be a few years before we can truly see either the benefit or complete folly the ACA is on medical costs.  Honestly, I don't see how costs come down when you bring 10+ more million people into the care pool.

They'll have insurance now?

[carltonplace]

While I disagree with the concept of Obamacare (and since I am insured and have health care already built in the family), I cannot argue too terribly right now with the "tax" rationale of the mandate. I personally do not know how it will look if the IRS begins chasing around lower or middle class "tax cheats" who do not want insurance and refuse (or cannot afford) to pay the tax. My thought is that it is not the "rich" or even the "middle" who have an issue with paying for or having health care, only the government intrusion part bothers them.

Why don't they want health insurance? Will they have a private health savings account? If so they are in the system! Or do they just want to go to the Hospital and pay per use, or not pay at all? In that case you and I have traditionally paid for them with higher insurance premiums.

[carltonplace]

Uh, this is the way all insurance works.  The largest risks and highest exposures for loss always have a higher premium!

It's going to be a few years before we can truly see either the benefit or complete folly the ACA is on medical costs.  Honestly, I don't see how costs come down when you bring 10+ more million people into the care pool.

hopefully 80% or better of these additional people are healthy so they are just paying and only using their new insurance for preventive medicine.

[Townsend]

Why don't they want health insurance? Will they have a private health savings account? If so they are in the system! Or do they just want to go to the Hospital and pay per use, or not pay at all? In that case you and I have traditionally paid for them with higher insurance premiums.

And hospital costs.  CT scan at St John's was $1,000 more my cost than a private stand alone in South Tulsa.  Per the admin I spoke with, "to cover the costs the hospital has to absorb from helping the uninsured."

[Teatownclown]

Uh, this is the way all insurance works.  The largest risks and highest exposures for loss always have a higher premium!

That is not how insurance works. Depending the amount of risk the insured wishes to self insure for, the premium can be lowered substantially despite the risk and exposure. I know you know this so why did you say "always?"  

[Teatownclown]

And hospital costs.  CT scan at St John's was $1,000 more my cost than a private stand alone in South Tulsa.  Per the admin I spoke with, "to cover the costs the hospital has to absorb from helping the uninsured."

You can negotiate with them by saying "I'm not paying that amount....I will pay you what they charge in South Tulsa and no more." ( we refer to this as Christianing them down on price )

[Conan71]

That is not how insurance works. Depending the amount of risk the insured wishes to self insure for, the premium can be lowered substantially despite the risk and exposure. I know you know this so why did you say "always?"  

I'm not comparing how much someone cares to self-insure on the cost difference between two separate risks, simply the level of risk.

Given the same deductible from one policy to another, if the risk of exposure is greater to the insurer, the premium will be higher at given deductible levels whether the deductible is $500 or $1500 for the person, building, or ?? which represents a higher risk to the insurer.

[Teatownclown]

I'm not comparing how much someone cares to self-insure on the cost difference between two separate risks, simply the level of risk.

Given the same deductible from one policy to another, if the risk of exposure is greater to the insurer, the premium will be higher at given deductible levels whether the deductible is $500 or $1500 for the person, building, or ?? which represents a higher risk to the insurer.

So, you take self insuring and premium balancing out of the discussion to get to an identical deductible? I see why I have to argue with you so often.....

[Townsend]

What the Obamacare Ruling Means for Consumers

http://www.usnews.com/news/articles/2012/06/28/what-the-obamacare-ruling-means-for-consumers

The Supreme Court's ruling on the Affordable Care Act—also known as Obamacare—is being hailed as a victory for President Barack Obama and healthcare reform, but what does it mean for consumers' pocketbooks?

Here's a breakdown of how the Affordable Care Act affects you:

The uninsured. For the millions of uninsured Americans, the Supreme Court's ruling to uphold the individual mandate—the part of the Affordable Care Act that requires most Americans to have health insurance—means they'll have to get health insurance by 2014, or pay a penalty of $95 a year or 1 percent of their income, whichever is greater.

Insurance companies will be required to sell policies to everyone regardless of current or past health issues. As a result, over the next two decades, tens of millions more Americans will get health coverage under the new systems.


"The law certainly facilitates greater access to health insurance for millions of consumers," says David Balto, a Washington, D.C.-based attorney.

Americans looking for health insurance will also be able to better shop around for coverage the fits their needs using "health insurance exchanges" that function a lot like online travel agencies such as Expedia.

That is if the law survives past the November election. According to some experts, the Supreme Court's decision will give Republicans and other opponents fresh fodder to campaign on in the months leading up to the election.

The insured. For the other 256 million Americans who already have health insurance through their employers or another source, the impact isn't as dramatic. Parents will still get to keep kids on their insurance plans up to age 26 and many insurers will continue to offer preventative services, such as immunizations, without a co-pay.

While most insurance companies instituted the major provisions of the health care law, there could be changes coming down the pipeline as insurers tweak plans to comply with new regulations, such as covering preventative services without a co-pay. The new regulations almost certainly mean rising premiums, which have already edged up according to experts. That doesn't even take into consideration the overall rising costs of healthcare, which insurers pass on to customers.

"Insurance companies are still free to add to the premium for the additional benefits that they're required to offer," says Caryl Carpenter, professor of health care management at Widener University. "People with insurance can also expect an increase not because of the Affordable Care Act, but just because health care costs are still going up."


Seniors on the other hand could see a little break in their premiums as the Affordable Care Act puts some restrictions on how much insurers can vary costs by age.

Those eligible for Medicare. Seniors who fell in the "doughnut hole"—the gap in Medicare's prescription drug coverage—will continue to get discounts on their medications.

Those eligible for Medicaid. According to the Court's ruling, expansion of state Medicaid programs is no longer mandatory. So while a greater number of less fortunate Americans would have had access to care under the ACA's Medicaid expansion, that probably won't happen now. Given how fragile many state budgets are, states have not been eager to expand Medicaid because it takes necessary spending away from other things, Carpenter says.

"It's no longer mandatory that [states] expand [Medicaid], and if a voluntary option continues to exist, it may not be exercised," she says. "The consumer who would've gotten coverage [under Medicaid] probably lost out in this decision."

[guido911]

Why don't they want health insurance? Will they have a private health savings account? If so they are in the system! Or do they just want to go to the Hospital and pay per use, or not pay at all? In that case you and I have traditionally paid for them with higher insurance premiums.

Some people, especially the young, consider themselves "healthy" and figure the cost of insurance is unnecessary. Kinda of a gamble. Then there is EMTALA. Also, there are wealthy people who don't need it or pay out of pocket.

In a way I want to see how this plays out. Stop the litigation, interference, and give this a chance.