Yeah, I had to laugh at Scalia’s assertion that Congress was very selective about how it used the language in question. This was one of the most slap-dash and sloppily drafted pieces of legislation I’ve seen (and I see a lot of legislation). A lot of the ACA reads like it wasn’t even proofread.
Pretty much. Law isn’t computer code.
I suppose there are still people who believe women aren’t entitled to any rights because the constitution says “all men are created equal.”
We have to pass it so we can spell-check it!
That’s our declaration of independence, not our constitution.
From your link:
You mean like they didn’t want to state that it was a tax on people who had insurance plans, or they didn’t want the CBO to score it as taxes, or they didn’t come out and say that the limited attention and economic understanding of the American voter was critical to passing the law? Because the optics are terrible.
How many “administrative” changes did they make after the law was passed? It could be that they realized that Obamacare wasn’t going to be as popular as they thought, that it wouldn’t be the cudgel which they thought it was, and then needed the federal subsidies to make their plan work.
Gruber has every reason to lie about what he said now; he certainly didn’t then.
You mean like they didn’t want to state that it was a tax on people who had insurance plans, or they didn’t want the CBO to score it as taxes, or they didn’t come out and say that the limited attention and economic understanding of the American voter was critical to passing the law? Because the optics are terrible.
a lot of which was screamed and bitched and moaned about. probably millions of lawyers and legislators and reporters and experts were looking at this bill. none of them seemed to think federal exchanges were going to lose subsidies. given how much coverage death panels got, you’d think “revoking tax credits” and “insurance markets held hostage” would have been given some airtime as well. again, when the lawsuit came out, there was a collective confused, “what?” at every level involved: congress, staffers, governors, state legislatures, bureaucrats. no one thought subsidies were going away.
Gruber has every reason to lie about what he said now; he certainly didn’t then.
so we are setting a baseline that “then” (in jan 2012) gruber had no reason to hide his threats. in his book published dec 2011, he lists the cadillac tax, small business requirements, the mandate, and the x% income or $300 lost in penalties (and increasing in later years) but he does not list anything about denying tax credits to federal exchanges. the core tenet of the reform was the mandate, offset with tax credits, and exchanges like in the romneycare model to expand the number insured, not reduce it.
the debate and law design happened 2008 and onwards. it was law by the “then” of 2012. his stat models always had federal subsidies in there. there are none showing gop states markets collapsing due to the federal run exchanges being there and not getting subsidies.
not only does gruber need to be made a liar, but multiple congressmen, staffers, reporters, and republicans who hate obamacare have to be liars as well.
you need to make a new timeline to support your theory.
It could be that they realized that Obamacare wasn’t going to be as popular as they thought, that it wouldn’t be the cudgel which they thought it was, and then needed the federal subsidies to make their plan work.
no it couldn’t. the staffers drafting the law always assumed the federal subsidies were there. always. there’s no reputable legislative source saying it was understood that federal exchanges would not receive tax credits. do you have any governors or civil servants or people drafting the law saying otherwise?
“It was always intended that the federal fallback exchange would do everything that the statute told the states to do, which includes delivering the subsidies,” says Chris Condeluci, who worked as tax and benefits counsel for the Senate Finance Committee Republicans during the Affordable Care Act debate.
“The evidence of Congressional intent here is overwhelming,” John McDonough, who worked on the Health, Education, Labor and Pension committee during the health reform debate, wrote in an email. “There is not a scintilla of evidence that the Democratic lawmakers who designed the law intended to deny subsidies to any state, regardless of exchange status.”
“The clear intent of the tax credits is to make insurance more affordable, especially when you’re mandating its purchase,” says Topher Spiro, who worked as deputy staff director for health policy for the U.S. Senate Committee on Health, Education, Labor, and Pensions. “It’s crazy to think of a mandate without subsidies. It just doesn’t make any sense.”
take a look at the provisions listed below:
http://thinkprogress.org/justice/2014/07/22/3459165/halbig/
-An amendment to the Affordable Care Act requires the federally-run exchanges to report various information that they would only be able to report if they were providing subsidies, such as whether taxpayers received an “advance payment of such credit”; information needed to determine individuals’ “eligibility for, and the amount of, such credit”; and “[i]nformation necessary to determine whether a taxpayer has received excess advance payments.” Congress would not have imposed this reporting requirements if they thought that the federal exchanges would not offer subsidies.
-The Affordable Care Act also provides that the only people who are qualified to purchase insurance at all on a federally-run exchange are people who “reside in the State that established the Exchange.” Thus, if federally-run exchanges are not deemed to be “established by the State,” that means that no one at all is allowed to purchase health insurance on the federally-run exchanges, and there would be no purpose whatsoever to their existence. As the trial court explained in this very case, this interpretation makes no sense, because “courts presume that Congress has used its scarce legislative time to enact statutes that have some legal consequence.”
they were totally expecting subsidies.
either it was a typo, or there was a giant doomsday threat against the gop states that no one noticed for almost half a decade and wound up never being used or remembered by anyone. i know democrats are shitty at making threats but they can do better than “established by the state.”
again, was there any reasonable piece by a reputable law expert(aside from a couple certain gop appointed judges) that said the plaintiff’s had any kind of case given the evidence? i mean, i put actual money on the line and bought some healthcare sector stock the day before because of the preponderance of evidence. (the bucket i bought only went up 3% :/ )
If you want an example of what an intended threat looks like, read the Medicaid expansion language. There is an entire section that details the timeline for compliance, method of officially notifying states that will lose funding, an appeals board, a process to restore government funding if/when states comply, and other minutia that will be familiar to anyone who has dealt with the federal government.
The notion that “by the state” is the entirety of a threat is ridiculous.
Blue Cross Blue Shield of Texas is dropping individual PPO plans. I had this myself until about October of last year.
Update: This spills over from the presidential discussion.
The ACA really gutted the ability for insurers to manage risks. When you disallow Pre-Ex and implement community rating, insurers can’t control costs and the result has been an insurance death spiral. There’s no reason to buy insurance until you’re sick, which means you don’t have an insurance market but a group of people who simply pay costs. New York experimented with CR/pre-ex and destroyed their individual markets (MArk Hall, 2000 Evaluation of NY Reform Law). That created a death spiral for the individual market. Hence the need for other tools like the individual mandate/small open enrollment window.
Insurers are really ticked that the HHS wanted to maximize enrollment at the cost of sticking it to insurers. The Administration thought they could have taxpayers make insurers whole through the risk corridor scheme. But that ended when that was made to be budget neutral. So right now you have a lot of insurers who are losing their shirts over sick people who buy insurance to pay their medical bills and then stop paying premiums when they don’t need health care bills paid. That’s not insurance and is a huge problem for the ACA and one reason my carriers are furious. (http://www.nytimes.com/2016/01/10/us/politics/insurers-say-costs-are-climbing-as-more-enroll-past-health-act-deadline.html?_r=0) THe Administration realizes this a problem and is promising to crackdown and narrow the window (http://www.modernhealthcare.com/article/20160112/NEWS/160119970)
There’s a newer problem cropping up in that insurance plans that are trying to hold costs and be effective are being hammered by the risk adjustment program. (https://www.washingtonpost.com/national/health-science/critics-say-aca-risk-strategies-are-having-reverse-robinhood-effect/2016/01/13/e41cf574-b48f-11e5-a842-0feb51d1d124_story.html?tid=ss_tw) I talked to a board member of my carrier and this is a problem for them. They got blindsided by this ACA transfer of funds and are being penalized for managing risk well.
My view is that HIPAA helped alleviate pre-x in the group market and could have been tightened. The individual market was a complete mess. But instead of wiping about the ability to of insurers to price/manage risk, it would have been better to improve portability and expand HIPAA to individual market.
I think the ACA is in big trouble since insurers are getting creamed and will exit the exchanges. I remain highly skeptical of a) it’s repeal b) good alternative c) any of the cost control measures having any bite. The ACA was always weak on cost control and the fact that both parties have teamed in favor of the Cadillac tax is not a good sign.
It’s a pipedream, but I wish the insurance companies crashing and burning would be the impetus for us to have real healthcare reform.
Thanks for posting those links, Wahoo. The special enrollment periods are much more pervasive than I realized. Are they in place partly to make the program look more successful via larger sign-up numbers? I was also completely unaware of the “Risk Adjustment Program,” and that sounds like a fundamentally stupid idea.
Here is my question: Is there a mechanism to fix this stuff? Even as a staunch supporter of the ACA, it’s clear that the law has significant problems. Congress appears to be fundamentally incapable of addressing anything resembling complex policy challenges. That’s depressing.
Agreed. I think it’s still many years off, but the shift to single-payer seems almost inevitable.
HHS has a lot of authority to change the special enrollments. They are starting to tighten up now that they see th problem. I think it is more likely it waits till net President. This Admin leans towards maximizing enrollment to ensure its longevity. There is a lot of “après moi, le deluge”. I purchase Hi for my firm and both my carrier and broker are warning me about 2017 in terms of premium shocks. My curent provider is a coop that started under the Aca. Hey don’t have a great track record of viability. Their books also took a hit because they had a much much higher payout under the risk adjustment program.
R’s need a solution. Jeb has a plan and maybe Rubio. But the health care system pre Aca had real holes.
I am doubtful US goes single payer because of power of elderly, docs and some patient groups.
I hope you’re right, but if you think the Right is making a stink about the ACA, I think it’ll be positively apoplectic about the prospect of single-payer. Hell, they haven’t tried to stop gutting Social Security by “reforming” it, even after all these decades.
I certainly hope so. Even though I’ve (thankfully) had good health, last year saw an unexpected hospital stay for 3-4 days back in April. It wasn’t intensive care, I just needed to have an IV with saline pumped through me for a few days (rhabdomyolysis, if anyone’s curious). Even being employed with solid insurance, that still sucked up a huge portion of my disposable income from May onwards. I’ve been paying $400/mo towards it since May and still have a month to go, which for me is a lot of money. That meant no vacations, no computer upgrades, no replacement for my TV, no new mattress. I pretty much lived to pay my regular bills and for my expensive hospital vacation in the spring.
And that was with insurance, which covered 80% of it. That other 80% is still going to get paid for by someone, whether it’s through insurance premiums or the hospital writing something off. In any case, the system is just unsustainable. The amount of profiteering at every level is just absurd… the stories I hear from my friend who works for company that produces components used in back surgeries are just gross on every level, from the pricing to the deals they make with surgeons to use their product.
The amount of greed involved is just to cause the system to collapse eventually. I’m not looking forward to the clusterfuck that is going to be the result of that, but I feel like it needs to happen before we can finally move to a better system. Our government (and to be fair, the people they represent) seem to be incapable of addressing this problem.
I hope I don’t sound too much like a raving loon, it’s just been a sore point for me for a long time and having to pay these (relatively modest) medical bills throughout 2015 kind of exacerbates it. It doesn’t help that my family fits the “Git your gummint hands out of my medicare!” stereotype to a T. I don’t know how many times I’ve been lectured about how lucky we are that we don’t have the devil’s healthcare like Canada has, which is insanely frustrating since I’m the only one in my family that’s lived in Canada for any period of time (I lived in Ottawa and Thunder Bay for a few years in the late 90’s and yes, saw the healthcare system first hand)! Argh.
Yeah, the healthcare system in the US seems like it’s going to proverbially collapse under its own weight (a similar argument might be made for the wealth disparity, but I sadly think that has less traction). Government regulations are shaping the ways that health insurance providers and even health care providers can be successful, and limiting their profit potentials. Theoretically, that will in turn - over a long period of time - shift the investment to other markets and subsequently create an under-served clientele (patients and doctors). At that point, with the private sector unable to properly meet the need, the argument for government taking control becomes almost a foregone conclusion. All of the above is just silly theory and is far from optimal if it happens, but I can see something sort of like that coming to pass within the next couple of decades.
My wife is Canadian with all of her family still up there. In November her mom was told she needed to have a colonoscopy by their family doctor. The earliest she could get it scheduled was February 8th. A 3 month wait for a diagnostic procedure that her doctor felt was necessary. The wait is so long because there just aren’t enough place in Ontario that conduct colonoscopies. Without market forces allowing expansion of an under-serviced demand, you end up with these kinds of things.
Don’t get me wrong, overall Colleen’s side of the family is very happy with the Canadian health-care system. In the U.S., they would be considered the “working poor”, but have never had major medical payments, even after major things like back surgery and a double knee-replacement. On the flip side, my mom had a single knee operated on and has been paying $250 towards the bill for over 18 months now with no end in site.
Neither system is good. They both have their positives and their negatives. The negatives here, in my opinion, are driven by a health-for-profit system that is spinning out of control. Hospitals in Omaha look like 16th century churches. Soaring archways, sculptures, expensive artwork on the walls. When you step in to one you think “holy crap, this place must be a cash cow”. But that for-profit-ness is also what drives places to invest in the best new medical equipment, to pour money in to research for the next great treatment, to keep the patients alive and kicking so they can keep paying bills. (on a side note: medical bills are the #1 cause of bankruptcies in the United States. That is freaking insane.)
I’d rather not have the innovation if I’ll never be able to afford it in my lifetime.
Get costs under control first.