Enidigm
4004
Controlling costs absolutely would require reducing doctor’s salaries as well as, probably, creating subsized housing for nurses and doctors, allocating better resources in education, streamlining and creating a national health care database, importing generic drugs if drug companies refuse to take prices in-line with international markets.
But all that requires a strong government will to do so - and the GOP not only will refuse to do anything but actively wants to take away government participation in the medical field as it is.
There’s almost certainly a huge influx of wasteful / inefficient government spending through Medicare and Medicaid, and this does distort the medical market. OTOH if you just “best case”, as the GOP might put it, took away Medicare and Medicaid and replaced it with nothing, you’d see a massive shrinkage of the medical field as it is today as the industry took an enormous haircut and had nothing to replace it by. Effectively you’d have corporate insurance or rich individual insurance, and everyone else would be SOL because everyone else wouldn’t be able to afford health care and the heath care industry would no longer service the everyone else market anyway so there wouldn’t even be providers available.
Which the GOP would probably be ok with, because it sucks to be poor but what can you do? Especially when they don’t really think the kind of people that are poor are their sorts of people anyway.
A SCOTUS decision today casts a spotlight on one of the many ways the GOP tried to torpedo the ACA.
The ACA as drafted sought to encourage insurers to join the markets by providing a Risk Corridor, set of rules that both limited insurer profits (to keep premiums down) and limited insurer losses (to keep them in the marketplace). If an insurer made more than X, they had to pay it to the government. If they lost more than Y, the government made up the difference. This mechanism was meant to be in place during the first three years of the market places — through 2016 — as a way of easing the program in while controlling the increase in health care premiums.
Republicans in the Senate, however, simply refused to appropriate money to make the payments, and added a rider to the appropriations bill prohibiting funds from being used to make those payments. Effectively they killed the Risk Corridor provision without ever actually repealing it, in the hopes that it would help kill ACA health care marketplaces.
The Court rules today that Congress can’t repudiate debt obligations by declining to allocate money for them. If Congress meant to repeal the obligations in the Risk Corridor provision, they needed to do that explicitly. The government owes the payments contemplated by the provision and must pay them. The decision is 8-1, 5 in the majority, Thomas in and Gorsuch joining in part, only Alito dissenting.
Hmmm, this seems like it would have pretty massive implications (even beyond the ACA, which is obviously very important). I remember covering situations where it was effectively said the US couldn’t participate in some long term funding plan because Congress couldn’t bind spending of future Congresses (in some more restrictive sense than that any government can repeal previous laws). One obvious implication is that the debt ceiling laws are unconstitutional (apart their prima facie unconstitutionality as calling into question the validity of the public debt of the United States).
No, I don’t think the Court is saying you can’t repeal a past law which contemplates spending. I think the Court is saying you have to do it explicitly, not by implication. If Congress had passed a law repealing the Risk Corridors provision, the government would not owe the money. Instead they simply refused to allocate the money.
Menzo
4008
This would be weird considering things like Social Security and Medicare.
Sure, I understand that.But that’s true of any government. The situations I’m thinking of, the US was considered different somehow because of its appropriations process, such that even if they passed a law saying they would commit to fund x programme so many years into the future, it wouldn’t be binding even if not repealed, such that the programme in question couldn’t get a AAA rating.
Ironically enough, the main one I’m thinking about was to do with vaccinations.
Well indeed. The argument never made much sense to me. But it seemed to be taken very seriously.
I think it is binding if not repealed. The ‘Congress can’t bind a future Congress’ is an acknowledgement that a future Congress can repeal.
And yet other countries participating in the scheme didn’t have this issue, even though they can repeal laws.
magnet
4013
This isn’t really about a future obligation. There is a law currently on the books saying “The government owes $X to any company that met certain criteria”.
That law still exists, so if a company met the criteria then the government owes it money. If the company isn’t paid, then, it can sue the government like anyone else who owes it money. And if the company wins, the government has to pay regardless of whether it bothered to appropriate money.
SCOTUS:
Section 1342 imposed a legal duty of the United States that could mature into a legal liability through the insurers’ participation in the exchanges. … That §1342 contains no language limiting the obligation to the availability of appropriations
Yes, that’s a clear explanation, thanks!
If you are talking about multi-country treaties to fund certain programmes, the US is definitely goofy.
The US can enter into treaties to do certain things, and generally must abide by them under US laws that holds treaties (if appropriately ratified by congress) as binding legal documents. But Congress can simply pass laws in the future which alter or repeal the treaty provisions, and then suddenly the treaty isn’t enforceable on the US under US law. That makes long term funding treaties with the US tricky as we are never more than one election away from a congress that suddenly has very different spending priorities and is answerable to domestic voters and not foreign governments.
And that’s that.
Truly the thread title does not lie.
Indeed, the Republican bloodbath of 2018 now seems to have been just as much related to Obamacare repeal as it was anger at the occupant of the White House.
Opinion is here:
Tl;dr: the plaintiffs lack standing because they can’t be harmed by an unenforceable individual mandate, and without the harm there is no controversy to be adjudicated.
magnet
4018
For those keeping track, it was a 7-2 decision with Alito and Gorsuch dissenting. That’s right, Thomas was in the same majority as Sotomayor (though unlike Roberts, Barrett, and Kavanaugh, he wrote a separate concurrence).
That pretty much has to be the death knell for striking down the ACA.
Menzo
4020
Really great news, but I wouldn’t assume that Republicans are done with this just yet. I wouldn’t be shocked to see them take another run at repeal next time they have the Presidency and Senate.
I’ll never say never, but this is such a losing issue for them, and I think more and more Republicans are fully understanding that as time goes by.
Scuzz
4023
Especially since the GOP idea of an option to ACA is no option at all.
