Affordable Care Act provision upheld by SCOTUS

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Affordable Care Act provision upheld by SCOTUS

Post by Martin Blank » Thu Jun 25, 2015 5:48 pm

Today, the Supreme Court upheld in a 6-3 decision the tax refunds for the Affordable Care Act (aka Obamacare). The three voting against it were predictable: Thomas, Scalia, and Alito dissented. However, Chief Justice Roberts went with the majority and wrote the decision.

The ruling wasn't about constitutionality, but about legal interpretation. It came down to a plain-text meaning of one specific line in the entire body of the ACA or a context-based meaning when considering the intent of Congress when the ACA was passed. Tax credits for a portion of privately-purchased health insurance (as opposed to employer-provided insurance) are available to those who make between 100% and 400% of the poverty line wages. The tax credits are available for plans purchased through "an Exchange established by the State."

There were initially significant encouragements for individual states to establish their own exchanges, but for those that chose not to, a federal exchange would be available. While under a strict reading, tax credits would be available as described above, denying tax credits to those who get theirs from the federal exchange would be unfair, especially as another section describes the tax credits as being available to any "applicable taxpayer" which is defined as someone who makes between 100% and 400% of the poverty line.

With these conflicting definitions, the Court sided with the White House and let stand the tax credits no matter which exchange was used to purchase the coverage. Had the requirement been overturned, some 6 million people in affected states (those in which the plaintiffs resided when they purchased their insurance) and possibly several million more in other states could have lost their insurance, or at least paid significantly more for it.

On a note relevant to another thread here, Republicans could have paid dearly for a decision for the plaintiffs. With millions of people losing their health insurance, including some Republicans who have come to accept and even welcome the coverage, it could have turned even more voters against the Republicans in 2016. They might have gotten lucky in not having to do something to ensure the coverage remained (a small wording change would have sufficed, but probably would have been bogged down in politics), and yet get to complain about the "activist" courts rewriting law even as they know the ACA isn't going anywhere unless opponents get 60 seats in the Senate, something which is unlikely to happen soon.
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Re: Affordable Care Act provision upheld by SCOTUS

Post by JermCool » Thu Jun 25, 2015 6:11 pm

The law of unintended consequences. We're currently on the Nevada Exchange (much to my dismay and disgust, but it's cheaper than the IRS penalties), thanks to it being cheaper than my employer's plan (which was affordable until it was deemed a 'Cadillac Plan'). No doubt if the system had fallen apart, it wouldn't have stopped the IRS penalties for not being insured.

If interpretation of wording vs actual wording isn't enough to kill this behemoth, I don't think anything will, short of a congressional super-majority and a friendly President who have a working replacement. Obamacare is stuck for life, IMO.
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Re: Affordable Care Act provision upheld by SCOTUS

Post by Deacon » Thu Jun 25, 2015 7:14 pm

The court finds against words having meaning.

I guess the new refrain will be "we have to pass it to find out how terribly written it is" from now on.
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Re: Affordable Care Act provision upheld by SCOTUS

Post by NorthernComfort » Thu Jun 25, 2015 7:53 pm

The health insurance companies ought to fire whoever wrote that passage so sloppily.
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Re: Affordable Care Act provision upheld by SCOTUS

Post by Deacon » Thu Jun 25, 2015 8:58 pm

Haha well played.
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Re: Affordable Care Act provision upheld by SCOTUS

Post by Deacon » Thu Jun 25, 2015 9:54 pm

So Rare.us clearly disagrees with SCOTUS and backs Scalia's dissenting opinion. To me the interesting bit is this:
Recall Jonathan Gruber, the MIT economist and architect of Obamacare, who became a household name when it was revealed that he mocked the “stupidity of the American voter” for believing Obamacare wouldn’t ban their insurance plans or increase costs. He also stated in January 2012: “I think what’s important to remember politically about this, is if you’re a state and you don’t set up an Exchange, that means your citizens don’t get their tax credits.”
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Re: Affordable Care Act provision upheld by SCOTUS

Post by NorthernComfort » Thu Jun 25, 2015 10:34 pm

It's damning. Here's the full quote from Gruber in January 2012:
I think what’s important to remember politically about this, is if you’re a state and you don’t set up an Exchange, that means your citizens don’t get their tax credits. But your citizens still pay the taxes that support this bill. So you’re essentially saying to your citizens, you’re going to pay all the taxes to help all the other states in the country. I hope that’s a blatant enough political reality that states will get their act together and realize there are billions of dollars at stake here in setting up these Exchanges, and that they’ll do it. But you know, once again, the politics can get ugly around this.
Ugly, indeed. Later on in the very same speech, he says:
The third threat, and the one that’s least well-known, is state implementation. This legislation puts enormous power in the hands of states to implement health care reform. Once again, another myth about health care reform: this is not a federal takeover. There’s a huge role for states to actually run these Exchanges, and decide how people get health insurance in the states. But states have to take up that challenge. It’s a challenge. It’s a lot of work. And states need to be willing to take up that challenge, and really fairly implement this law. So that’s really the third threat, is that states won’t do that. So really you have these three threats to the system, and so how they get resolved will determine, you know, where health care reform ultimately goes.
Obamacare is fundamentally flawed, and reflects our current culture of incompetence. They wanted a "federal takeover", everybody knew it was one, it was truly the Congressional intent all along... they just forgot to write it into law. Whoops! Good thing the whole thing was so sloppily written. All in all, we'd have a really terrible mess on our hands if they court found otherwise.

The hilarious thing is that if they had just removed "established by the State" it would all be fine- who actually read the whole thing before voting? Anybody beyond Gruber and an army of lobbyists? I doubt it. But it's a moot point now.
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Re: Affordable Care Act provision upheld by SCOTUS

Post by The Cid » Fri Jun 26, 2015 1:36 pm

The Affordable Care Act breaks my heart.

You want to know why healthcare in America costs so much? You should be pointing the finger squarely at three groups:
-Lawyers, who make becoming a general practice physician (or worse, a pediatrician) a living Hell from constant ambulance-chasing malpractice suits. These people are allowed to advertise their horrible legal practices on television. Occasionally they get elected to government positions.
-Insurance companies, whose ghoulish practices minimize actual procedures while maximizing their own profits. These are giant, mega-powerful corporations.
-Hospital administrators, who put a whole new shine on the word "markup" that would make everyone from Apple to the videogame industry in Australia look generous.

Hey, guess who wrote pretty much the entire ACA. Lawyers, insurance companies, and hospital administrators. They now have the vast majority of control over the practice of medicine in the United States.

Instead we blame pharmaceutical companies. People complain about their business practices, their pricing models, and just about everything they do. Hey, did you know that if you needed a drug and can't afford it, you can pretty much always call the company that makes the drug and find they have a program to help you get your medicine without going broke? Because they absolutely do and I know that for a fact. Meanwhile, if you can't afford your premiums I dare you to call your insurer and complain. And I doubt these ambulance chasers are piling on pro bono cases.

And we make it difficult to be a doctor. GPs? Dying breed, and why would you want to be one when an entire industry of lawyers exists to ruin your life with no remorse or repercussion? Pediatricians? Same thing. But we have millions of specialists who will bill you a ridiculous amount of money for the most basic of procedures. We have networks of doctors across healthcare systems set up to make money, not progress.

Any politician that acts as though the ACA was supposed to help anyone but lawyers, insurance companies, and hospital administrators is not only lying to you, he or she's borderline embezzling money.
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Re: Affordable Care Act provision upheld by SCOTUS

Post by Martin Blank » Fri Jun 26, 2015 5:54 pm

Deacon wrote:The court finds against words having meaning.
The same complaint was made by Second Amendment opponents following Heller regarding the plain-text meaning of militia.

Abbe Gluck has an interesting write-up about how this may be a sign of the decline of textualism (based solely on a reading of the statute at hand) and a return of intentionalism that looks at what the legislative body was trying to achieve. The decision itself looks at what the Congress was trying to avoid, among other things the so-called death spirals of people not getting insurance until they needed it, thus raising costs for insurance companies and leading to spiraling rates which meant fewer people got insurance unless they needed it. The Court took an interpretation that let stand that goal.

And as I mentioned, may have saved the GOP a lot of votes. People who have family members die because they couldn't afford treatment would be a big play in the campaign, and it's not at all certain that Republicans could have gotten the specific section edited rapidly.
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