Obamacare is the law of the land


I’m sure they’ll try, and I’m sure some people will believe it. But those people were not going to vote for Democrats regardless.

On the other hand, there are lots of people who voted for Obama in 2012 and Trump in 2016. They thought Trump was the person most likely to help them, and they are unlikely to believe that Obama is to blame for losing affordable health care, which after all he first provided. If they turn against Trump, he’s toast.


There are few things Trump could do that would hit the pocket book directly of some of the “disenchanted” who voted for him, and one of those things is health care premiums. It will be pretty damn hard in 2019 to blame skyrocketing insurance costs, or the fact that you have no insurance, on Obama by then. Trump will own it.


Sen. Chuck Schumer states the obvious:

In this, politically, he’s in much worse shape than we are. The American people, even a large number of Republicans, are on our side in terms improving the system, not destroying it. So I don’t think he has much leverage to threaten or bully.


“Except for the part where we allow him by fiat to do whatever he wants and don’t stop him.”


If you’re talking about the cost sharing subsidies, they couldn’t stop him. In fact, there is a good chance that a federal judge would have ended them even without Trump’s intervention. Trump’s hands would have been clean and Democrats would have been in a much tougher spot.

Instead, Trump takes the blame. I suspect that Democrats are secretly breathing a sigh of relief.


What was the reasoning behind the subsidies being illegal? And wouldn’t that have been brought up already in the case where the Supreme Court looked at the ACA? The only provision they had an objection with was States being forced to expand Medicaid, and they left that up to the States, which created this big gap in the red states. But they didn’t have an objection with the subsidies to help lower premiums did they?


National Federation of Independent Business v. Sebelius was decided in 2012. This was the SCOTUS decision that upheld the individual mandate.

In 2014, the Obama administration did not get a Congressional appropriation for cost sharing reductions (CSR), but decided it had the authority to pay them anyway. That’s what the current court case is about. The Obama administration lost the case in 2016 and immediately appealed. The judge allowed the administration to keep making payments until the appeals were exhausted.


A really simple one. Congress never appropriated the money to fund them.
Article 1, Section 9, Clause 7

“No Money shall be drawn from the Treasury, but in Consequence of Appropriations made by Law;”

House Republican in sued to prevent the spending of the money that hadn’t been appropriate.

The case was heard by Judge Collyer and she was quite explicit in her opinion.

Article I of the United States Constitution established the Congress, which comprises a House of Representatives and a Senate. U.S. Const. art. I, § 1. Only these two bodies, acting together, can pass laws — including the laws necessary to spend public money. In this respect, Article I is very clear: “No Money shall be drawn from the Treasury, but in Consequence of Appropriations made by Law…” U.S. Const. art. I, § 9, cl. 7.

The crux of the case had nothing to do with appropriations clause but rather did the House Members have standing to sue, and she ruled they did. That decision was being appealed. So in order for the subsidies to be paid the Federal Government would have to win on appeal.

It is quite common for a new administration for to drop cases on appeal by the previous administration. Barrack Obama did it for several Bush-era policies, such as waterboarding being torture or not.

Trump does a boatload of shit that is unconstitutional or borderline unconstitutional, in this case he is actually upholding the constitution.


Sorry that I’m so dense on this topic. I hope you gentlemen don’t mind educating me.

So the ACA never appropriated money for the subsidies? Does that mean the subsidies were never part of the bill that passed? Or the bill that passed didn’t appropriate the money yet, and that had to be done as a second step that was never done?


I’m not 100% positive (the budget rules are arcane to put it mildly) but I believe the subsidies didn’t survive the next years budget, which IRC was the one that was actually negotiated by Paual Ryan and Sen. Patti Murray.


Ah ok. So it went something like this then:

  1. ACA passes under democratic house, senate, presidency.
  2. 2010 Republicans voted into House, try to repeal ACA, but not successful
  3. Budget showdown sometime, and one compromise at some point was to defund the subsidies part of the ACA?


Yup, that’s my understanding.


I’m sure the electorate will totally understand the procedural bullshit that leaves them dying in a gutter and accept it.
They love that shit.

It wont be long before people just put all the politicians against the wall and start over.


Perhaps, but the more likely occurrence is this doesn’t get changed and people don’t die and Trump voters will uses this as another example of the media lies.

IMO, when Democratic official mouth “Obamacare isn’t perfect, Republican should help fix it.” These insurance companies subsidies and the even worse risk-corridor subsidy is exactly the type of awful shit that Obamacare does that need to be eliminated.

Trump’s actions eliminated $7 billion per year that effects the copayments of 7 million folks in the individual market with income level of <250% of the FPL. Now if this $7 billion was being distributed by the government to poor individuals to help them with their medical cost, then I could see a backlash. But that not how it is going to work. A family of 3 making $30K, who is eligible for Silver Plus plan this enrollment period is going to pay exactly the same for health care in 2018, regardless of how or if this subsidy gets paid. It may or may not affect the premium of the 2019 plans but being able to isolate to this particular program being eliminated is almost impossible. The money Trump stop paying is going to insurance companies not poor people.

Looking at the big picture $7 billion in the context of 3.3 trillion we spend on Healthcare is less <.25%, the dire prediction of collapsing market on what is rounding error is just dumb.

Back when Obamacare was first being debated, my argument on why single payer wasn’t the answer was that overall insurance company profits aren’t all that large. Back in 2009 health insurance net profit were in the 3-4%, which is below average for US corporation. Thanks to Obamacare health insurance company revenues have increased dramatically and net profit margins have increased to 6-7% (slightly above average) and their stock prices have tripled vs doubled for the S&P since ACA started. Today eliminating insurance companies would probably reduce annual healthcare expenditure from $300-$600 compared to only 100-300 back in 2009.

If we take a look at the United Healthcare, the largest insurance company, 2009 profits were $3.8 billion this year they will top $9 billion. So the growth in profit of a single health insurance company is roughly the same as the $7 billion that everyone is claiming will destroy the market and leave people dying in the gutter.

Despite all the protesting by the insurance companies on how they can’t make money on the exchanges. The reality is they’ve done very well under Obamacare, and seem to be behaving like oligopolies on the exchanges

Now, I’m an unabashed capitalist and generally supportive of big business, and I think profits are great. But, even I don’t really think the American taxpayer should giving money to insurance companies to improve their profit margins. But I do get some pleasure watching liberal demanding we give more money for big insurance companies.


Forget it - post deleted.


If we want a health care system in which insurance companies are responsible for medical payments instead of the government - and apparently we do - then we should expect revenues to increase whenever more people are insured. Likewise gross profits should increase. That was kind of the point.

Stock prices are a poor indicator of anything relevant to a patient. They reflect sentiments like financial uncertainty and confidence in future operations, both of which naturally improved after the ACA was passed. So what?

As for profit margins, in 2016:

United Healthcare reported $7b in net income on $184b in revenue, a margin of <4%. This is not excessive.

Anthem, the second largest insurer, reported $2.5b in net income on $85b in revenue, a margin of <3%.

Aetna, the third largest insurer, reported $2.3b in net income on $63b in revenue, still <4%.

Humana, the fourth largest insurer, reported $600m in net income on $54b in revenue. That’s barely 1%.

Cigna, the fifth largest insurer, reported $1.9b in net income on $40b in revenue. That’s <5%.

No, they aren’t. Because unlike an oligopoly, health insurance revenues are basically capped by law. If less than 80% of premiums are used for medical expenses, then they are required to partly refund the premiums. This is unlike pretty much any other industry.

Not true. With the CSR in place, the insurance company lowers out of pocket costs for low income families.

They aren’t being used to improve profit margins. They are used to lower out of pocket costs. Which means more people insured and lower premiums in general.

As expected, the loss of CSR is being shifted directly to the consumer. 2018 premiums are projected to increase by 20% to offset ending of CSR. Federal premium subsidies will also increase, and the government will end up paying more than it saves.


This was the first big effect of the ACA passage that we felt personally in our lives. The insurance my wife had through her job suddenly refunded a large part of the premium she had paid that year. This is before the insurance marketplace was setup because that part of the law hadn’t gone into effect yet, but the part about refunding premiums had gone into effect.




Damn @triggercut
I was just running over here to ask if you had seen the new subsidies news…and yes, yes you did :)