Obamacare survives the SC. What next?

southsiderosie

So Obamacare survived the Supreme Court 6-3.

The key provision that 26 states opposing the law had challenged – known as the individual mandate – requires virtually all citizens to buy health insurance meeting minimum federal standards or to pay a fine if they refuse.

Many conservatives considered the mandate unconstitutional, arguing that if the federal government could compel people to buy health insurance, it could compel them to buy almost anything, with broccoli becoming the central example in court arguments.

It remained unclear whether the court officially upheld the mandate or chose a more technical path that effectively allowed it to stand.

The mandate’s advocates said it was necessary to ensure that not only sick people but also healthy individuals would sign up for coverage, keeping insurance premiums more affordable. The law offers subsidies to poorer and middle-class households, varying with their incomes. It also provides subsidies to some businesses for insuring their workers.

The law requires states to expand Medicaid coverage for poor and nearly poor households. In all, tens of millions of people are expected to gain insurance from the law, according to the Congressional Budget Office, as part of a march toward universal coverage, a goal that has eluded legislators and presidents – including Franklin Delano Roosevelt, Harry S. Truman, Lyndon B. Johnson, Richard M. Nixon and Bill Clinton – for generations.

I'd like this to be a thoughtful 'what next' thread, but to be honest, I am a bit emotional right now. I've been dealing with a close relative's health crisis for the last few weeks, and if the full implementation of this law means that other Americans won't have to face the miles of red tape and obfuscation from insurance companies and/or the specter of having to liquidate their businesses and assets in order to receive life-saving medical care, well, I think it is worth it, even if my taxes go up. I am not sure what the future holds, but the status quo is unbearable.

Brian?

I think thats it. Game over, affordable healthcare is on it's way for everyone. A great day for the USA.

Ludo

Vote to repeal it on July 11th. Do they have the numbers or is it a token protest vote just for the sake of it? I haven't been keeping track ship don't actually know these days.

snow scorpion

briankeating wrote: »

I think thats it. Game over, affordable healthcare is on it's way for everyone. A great day for the USA.

Care to put a number on "affordable"?

Remember: What's affordable to one household is not necessarily affordable to the people next door.

southsiderosie

snow scorpion wrote: »

Care to put a number on "affordable"?

Remember: What's affordable to one household is not necessarily affordable to the people next door.

The insurance mandate has provisions for government subsidies to low income people who can't afford insurance on their own.

In the next few years, I would expect things at a national level to look like how the 'Romneycare' reforms have panned out on Massachusetts. This 2012 article in Forbes magazine provides an interesting overview (note: I deliberately use Forbes because it is a pro-business magazine, not a left-wing think tank). Here is the gist of the plan:

There are basically three programs under state reform: the old MassHealth, which is Medicaid for low income families and individuals, and now there is Commonwealth Care and Commonwealth Choice.

Commonwealth Care is a subsidized program for adults who are not offered employer-sponsored insurance, make too much money for MassHealth, and earn up to 300% of the Federal Poverty Income line. In 2011, 300% of the poorhouse was $32,676 for an individual; $67,056 for a family of four. Some Commonwealth Care plans are free, based on income levels. The highest monthly premium is around $200.

Commonwealth Choice is the unsubsidized offering of private health plans, selected by competitive bidding, and available to individuals, families and certain employers in the state. There is also a special, lower priced plan for people between the ages of 18 and 26. Most of those people covered are in this private group here, where the state caps how much they can charge in monthly premiums. Still, health insurers are not going out of business due to premium caps.

When it comes to health insurance, Massachusetts is in a class by itself. For being one of the top three richest states in the country, it’s biggest health insurers are all non-profits. Blue Cross is non-profit, as are Tuft and Harvard Pilgrim Health plans. The other national for profit insurers, like Aetna and Cigna, for example, also have a presence in the state. It goes without saying that their market share is decisively lower than the state owned firms who have opted to make health insurance less of a privilege for the upper middle classes or those covered under big corporate plans.

However, these reforms haven't been cheap:

In 2008, two years after the reform act, health insurance premiums remained a problem. The cost of healthcare was a growing burden on individuals, businesses, and government. Then, the Massachusetts legislature enacted an array of measures related to health care costs and quality like the development of uniform coding and billing standards and prohibitions against hospitals seeking payment for preventable complications from medical errors, all of which helped add to costs.

By 2010, the state produced a series of reports on the underlying causes of high health care costs and the feasibility and possible impact of a range of solutions. A report by RAND for the Division of Health Care Finance and Policy assessed a wide range of cost containment strategies and their potential effect on the health care system in Massachusetts, and the state’s Health Care Quality and Cost Council issued a “Roadmap” report, with recommendations for “sustainable containment of health care costs.”

Fixing that problem remains a long road. It was never a prerequisite to passing healthcare reform. Perhaps it should have been called health insurance reform. Regardless, the coverage has increased. The state is not going bankrupt. Nor are the companies paying the fair share assessment.

Health care expenditures in the state are still growing more rapidly than wages and income, according to the Blue Cross Foundation. The relative difference in premiums between Massachusetts and the U.S. has increased over time. By 2007, health care expenditures were estimated to account for 15.2% of GDP in Massachusetts compared to 13.7% for the nation as a whole. By 2018, if current trends continue, health care in Massachusetts is projected to cost $16,000 per person, $3,000 more than the projected national average. But that’s not because of healthcare reform....

Last year, the Commonwealth Care program was budgeted for $822 million. In 2010, it was $723 million with spending of $717 million. That’s just one program. Overall, healthcare coverage for residents takes up a big chunk of the state’s budget. Medicaid, or MassHealth, alone is nearly a third of the state’s budget before the Federal 50% reimbursement. Total public health coverage costs for the state is somewhere between 21% and 27% of the state’s budget, according to the Taxpayer Foundation. But that’s been a problem since the 1980s.

“Mitt Romney did not make the situation worse with this bill,” Widmer says.

When he signed the law in 2006, Romney wrote in a statement, “Today, we spend approximately $1 billion on the medical cost for the uninsured. It is fair to ask all residents to purchase health insurance or have the means to pay for their own care. This personal responsibility principle means that individuals should not expect society to pay for their medical costs if they forego affordable health insurance options.”

I think the last line is the crux of the issue, but also incomplete. People should take some responsibility for their health care expenses. But people who are responsible about it should not be denied future coverage, or driven to bankruptcy because they get ill.

Ultimately, the strategy in Massachusetts has been: 1) get everyone into the system, then b) once everyone is there, focus on driving costs down. The latter is easier when everyone has a stake in the outcome, hence the coverage mandate.

matthew8

What next is the democrats get their asses kicked in the senate and house, but it's a good result for Obama, especially considering his opponent. Senate democrats in key states this fall are scared of their own shadow, this is another problem.

One thing I take from this is that republicans can legitimately say Obama increased taxes, for once.

southsiderosie

Senate polling predicts a toss-up right now: http://www.realclearpolitics.com/epolls/2012/senate/2012_elections_senate_map.html

I think there are still a lot of people who don't understand how the health care legislation works, in part because the bill itself was such a monstrosity. If the president can do a better job of selling what is good about it, and how it can positively impact people - even those with insurance - then some of the furore around it may die down.

matthew8

southsiderosie wrote: »

Senate polling predicts a toss-up right now: http://www.realclearpolitics.com/epolls/2012/senate/2012_elections_senate_map.html

I think there are still a lot of people who don't understand how the health care legislation works, in part because the bill itself was such a monstrosity. If the president can do a better job of selling what is good about it, and how it can positively impact people - even those with insurance - then some of the furore around it may die down.

The polling says tossup, but convential wisdom says Indiana and ND won't be close come November. Maine is an independent-democratic pickup which makes it 54-46, but Nebraska and North Dakota are 2 seats I see going for republicans comfortably. I think MO and Montana will fall in line with the republicans when all's said and done. Then we have seats in Ohio, Virginia and Florida that are currently democratic. One win for republicans is needed there. Then we have Massachusetts, which is a possible democratic pickup but I'm very apprehensive about this. Scott Brown is a perfect MA fit and has done a good job, you don't see guys like him losing their seats.

southsiderosie

Ludo wrote: »

Vote to repeal it on July 11th. Do they have the numbers or is it a token protest vote just for the sake of it? I haven't been keeping track ship don't actually know these days.

The same thing will happen as when they voted to repeal the law in 2010: nothing. Republicans can't repeal it because it will get blocked in the Democrat-controlled Senate. If both the House and the Senate are controlled by the GOP in 2013, then things might get interesting, but at that point I think some of the benefits of the law would be tangible for voters.

Amerika

What’s next? My guess is the Republicans will take control of the Senate this November, in addition to holding the House... and President Romney threatens to repeal Obamacare after taking office. Then finally, since there will still be almost two years before the mandates fully go into effect, Romney gets both parties to scrap the framework of ObamaCare and instead work on a bipartisan overhaul of the health care industry as a whole, in order to bring about real reforms needed which the majority of Americans have been asking for. Such things as tort reform, fast track to getting drugs approved, stopping unnecessary additional testing to protect doctor liability, and more competitive insurance policies allowed across state lines... just to name a few.

poeticseraphim

I dont know enough as i should about the American healthcare system but...

I just asked this in the other thread.

Seriously any service needs decades of investment and it needs to be consistant from administration to administration. Is it that contraversial in America ? There seems to be such a polarity that no consistancy is reached in order to invest enough time in any fund or service. It needs time to invest and save in it.

What about the German system ?? Universal healthcare that is standardised but with different public funding choices?

Or even have Universal health care directly tax funded like in the UK and Ireland??

Would it be so controversial? ....

I think at least children should have universal healthcare.

I apologise for not knowing as much as i should.

But suh polarity and difference in policy between administrations just because of party politics is going to be costly and does not allowfor planinng and saving into a fund over time to save cost in the long term.

InTheTrees

poeticseraphim wrote: »

What about the German system ??

Or the French.

But you never hear the US compared with other countries by the US media unless its favorably.

And that applies to most aspects of life not just health care.

Brian?

Amerika wrote: »

What’s next? My guess is the Republicans will take control of the Senate this November, in addition to holding the House... and President Romney threatens to repeal Obamacare after taking office.

None of that is going to happen, keep wishing. Even if there is a president Romney it takes 60 seats in the senate to repeal the law. The Republicans won't have 60 seats after this election cycle.

Brian?

southsiderosie wrote: »

The same thing will happen as when they voted to repeal the law in 2010: nothing. Republicans can't repeal it because it will get blocked in the Democrat-controlled Senate. If both the House and the Senate are controlled by the GOP in 2013, then things might get interesting, but at that point I think some of the benefits of the law would be tangible for voters.

As I said in the other post, they need 60 seats to repeal.

matthew8

briankeating wrote: »

I think thats it. Game over, affordable healthcare is on it's way for everyone. A great day for the USA.

This isn't about affordable healthcare. It's about sticky situations involving uninsured people and who pays the bill.

Brian?

matthew8 wrote: »

briankeating wrote: »

I think thats it. Game over, affordable healthcare is on it's way for everyone. A great day for the USA.

This isn't about affordable healthcare. It's about sticky situations involving uninsured people and who pays the bill.

That's an extremely cynical way to look at it. It's called the "Affordable Healthcare Act". It's a step in the right direction.

matthew8

briankeating wrote: »

That's an extremely cynical way to look at it. It's called the "Affordable Healthcare Act". It's a step in the right direction.

Of course they gave it a nice name. They do that with all the acts. It probably is a step in the direction of more gov. Involvement in healthcare, but if an act like this was so tough to get through, it's hard to see them going further for a long time.

Brian?

matthew8 wrote: »

briankeating wrote: »

That's an extremely cynical way to look at it. It's called the "Affordable Healthcare Act". It's a step in the right direction.

Of course they gave it a nice name. They do that with all the acts. It probably is a step in the direction of more gov. Involvement in healthcare, but if an act like this was so tough to get through, it's hard to see them going further for a long time.

The healthcare system needed more government involvement because it's a mess.

It was tough to get through, but it's here and not going anywhere.

Overheal

Amerika wrote: »

What’s next? My guess is the Republicans will take control of the Senate this November, in addition to holding the House... and President Romney threatens to repeal Obamacare after taking office. Then finally, since there will still be almost two years before the mandates fully go into effect, Romney gets both parties to scrap the framework of ObamaCare and instead work on a bipartisan overhaul of the health care industry as a whole, in order to bring about real reforms needed which the majority of Americans have been asking for. Such things as tort reform, fast track to getting drugs approved, stopping unnecessary additional testing to protect doctor liability, and more competitive insurance policies allowed across state lines... just to name a few.

Thats naive, to be fair. This president promised the same bipartisan rhetoric, tried to gain bitartisan support for the overhaul, and the other side was not interested in it.

This raises 2 questions: why would the republicans then suddenly be willing to be bipartisan just because of who was in the oval office, and secondly whats to say whatever the republicans think will be the best way to overhaul healthcare, will be something that the democrats lend bipartisan support to? This is the same situation we just had, with flipped roles!!

I do have a general question though, poised at anyone: how, unlike student loans say, is this not going to increase the 'market cost' of medical expenses? College tuition is inflated because it can be. Colleges and Universities know they can charge exorbitant fees because kids will just get the government to help them pay for it (oh, and thats being reformed too now: no more 6 month grace period on new loans). If doctors know the expenses will always be backed by a government entity what stops them from billing uncle sam $500 every time you visit your GP for a cough?

Manic Moran

There was a quote about naming legislation in Yes, Minister: Get rid of the difficult bit in the title. Most people never go beyond that bit.

I do have a general question though, poised at anyone: how, unlike student loans say, is this not going to increase the 'market cost' of medical expenses? College tuition is inflated because it can be. Colleges and Universities know they can charge exorbitant fees because kids will just get the government to help them pay for it (oh, and thats being reformed too now: no more 6 month grace period on new loans). If doctors know the expenses will always be backed by a government entity what stops them from billing uncle sam $500 every time you visit your GP for a cough?

It's a fair question and is my primary issue with the legislation as well. I haven't seen anything which addresses the overall cost of healthcare in the US, it only seems to juggle the method of paying for it. If the legislation truly made healthcare affordable, there would be little need to mandate people get it or else, and little need for vouchers, subsidies, and whatnot.

Amerika

Overheal wrote: »

Thats naive, to be fair. This president promised the same bipartisan rhetoric, tried to gain bitartisan support for the overhaul, and the other side was not interested in it.

No it's not. Why couldn’t Obama get bipartisan support? Perhaps because the American people, on little more than a hope and a prayer, elected one of the most divisive US Senators into one of the most divisive US Presidents of all time. Surprise surprise!

I believe Romney can bring the parties together better based on his executive experience as governor of Massachusetts. He instituted a number of spending cuts and also tax increases that eliminated a $1.5 billion state deficit. Do you think the Republicans have been fond of RomneyCare? And he enjoyed somewhat high approval numbers in a heavily Democratic state until the rumors of his run for POTUS started.

UDP

Amerika wrote: »

No it's not. Why couldn’t Obama get bipartisan support? Perhaps because the American people, on little more than a hope and a prayer, elected one of the most divisive US Senators into one of the most divisive US Presidents of all time. Surprise surprise!

I believe Romney can bring the parties together better based on his executive experience as governor of Massachusetts. He instituted a number of spending cuts and also tax increases that eliminated a $1.5 billion state deficit. Do you think the Republicans have been fond of RomneyCare? And he enjoyed somewhat high approval numbers in a heavily Democratic state until the rumors of his run for POTUS started.

So basically people should vote for him in the hope that he flip flops on what he says (as always). I don't think he is the right wing nut he is forced to come across as but with the amount of pressure that will be on him from the republican party it will be hard to see him being able to be reasonable.

CamperMan

snow scorpion wrote: »

Care to put a number on "affordable"?

Remember: What's affordable to one household is not necessarily affordable to the people next door.

take Germany, a self employed person has to pay a whacking €340 per month for his health insurance.

southsiderosie

Amerika wrote: »

No it's not. Why couldn’t Obama get bipartisan support? Perhaps because the American people, on little more than a hope and a prayer, elected one of the most divisive US Senators into one of the most divisive US Presidents of all time. Surprise surprise!

Divisive senator? LOL. Obama wasn't even in the Senate long enough to be a polarizing figure - he has carefully sidestepped controversy his entire political career. You have to be relentlessly partisan to not acknowledge how amorphous Obama's political leanings have been - to the point that many people in his own party don't know where he stands on many issues.

Barack Obama is divisive, but this increasingly seems to have less to do with him, and more to do with an increasingly wild-eyed electorate.

Amerika wrote: »

I believe Romney can bring the parties together better based on his executive experience as governor of Massachusetts. He instituted a number of spending cuts and also tax increases that eliminated a $1.5 billion state deficit. Do you think the Republicans have been fond of RomneyCare? And he enjoyed somewhat high approval numbers in a heavily Democratic state until the rumors of his run for POTUS started.

Sorry, but I have lived in Massachusetts on and off since 2002, and there is NO comparison between the Massachusetts legislature and the US Congress. Romney was able to 'bring parties together' because he didn't have to work with a legislature that said NO to everything he proposed. Despite the fact that he was working with a Democrat-controlled legislature, Romney worked very hard to create a bill that provided universal coverage but took the concerns of business into account as well, and he was able to get the bill passed (it had unanimous support in the state senate). It will be a cold day in hell before Tea Party-era Republicans are willing to give a Democratic president (much less Barack Obama) that level of bipartisan support.

In addition, as the Forbes article I link above pointed out: 1) once the bill was passed, it had COMPLETE bi-partisan support and 2) while the bill has been reformed several times, neither party has suggested that it be scrapped altogether.

Finally, let's not forget that Massachusetts voters have long supported universal health care coverage, which was a pet issue for Senator Kennedy. The Massachusetts electorate - and in particular, Massachusetts Republicans - are not representative of the general electorate.

Amerika

southsiderosie wrote: »

Divisive senator? LOL. Obama wasn't even in the Senate long enough to be a polarizing figure - he has carefully sidestepped controversy his entire political career. You have to be relentlessly partisan to not acknowledge how amorphous Obama's political leanings have been - to the point that many people in his own party don't know where he stands on many issues.

I’ll give you that one in a way. I was basing my opinion in retrospect. I’ve seen him as US Senator complain and lambaste Republican use of Executive Orders, Executive Privilege, the Wars, Gitmo, etc; all of which as President he now embraces. I guess all that was just rhetoric on his part to get ahead politically.

Sorry, but I have lived in Massachusetts on and off since 2002, and there is NO comparison between the Massachusetts legislature and the US Congress. Romney was able to 'bring parties together' because he didn't have to work with a legislature that said NO to everything he proposed. Despite the fact that he was working with a Democrat-controlled legislature, Romney worked very hard to create a bill that provided universal coverage but took the concerns of business into account as well, and he was able to get the bill passed (it had unanimous support in the state senate). It will be a cold day in hell before Tea Party-era Republicans are willing to give a Democratic president (much less Barack Obama) that level of bipartisan support.

In addition, as the Forbes article I link above pointed out: 1) once the bill was passed, it had COMPLETE bi-partisan support and 2) while the bill has been reformed several times, neither party has suggested that it be scrapped altogether.

Finally, let's not forget that Massachusetts voters have long supported universal health care coverage, which was a pet issue for Senator Kennedy. The Massachusetts electorate - and in particular, Massachusetts Republicans - are not representative of the general electorate.

So essentially no matter what happens in November... we’re screwed?

One thing of interest to note is the SCOTUS decision on ObamaCare ruled the individual mandate a "tax." Therefore if Republicans hold their majority in the House, and they gain enough seats in the Senate to get a simple majority, they could repeal that provision using a "budget reconciliation," which requires only a majority vote, and eliminates the use of a filibuster by the Democrats.

InTheTrees

CamperMan wrote: »

take Germany, a self employed person has to pay a whacking €340 per month for his health insurance.

You'd pay at least double for that in the US. For inferior coverage too.

matthew8

InTheTrees wrote: »

You'd pay at least double for that in the US. For inferior coverage too.

It's not inferior (well, I can't speak for Germany, but really most US hospitals have all you could ask for). 400$ per month was the rate I saw advertised on TV in America a few years back. Let's be safe and call it 450$, which translates to 360 euro, and the cost of living is higher in America anyway in general.

20Cent

Seems like things will backfire on the republicans calling it Obamacare in order to attack the plan. Millions of people now able to access health care and the doom predictions that did not happen (doctors leaving the country etc). It makes life more difficult for Romney as well.

Amerika

20Cent wrote: »

It makes life more difficult for Romney as well.

That is debatable. Since the court’s ruling, and as of this morning, Romney’s campaign has raised $4.6 million from 47,000 donations. Also it is my understanding that the SCOTUS ruling leaves in place 21 tax increases costing nearly $700 billion. Of those taxes, 12 would affect families earning less than $250,000 per year. And the last number I remember is 57% of Americans favor repeal of Obamacare. If the Republicans can educate the American public on what this ruling is actually going to cost them personally, it might just get them to believe the only way to repeal this bad legislation is to defeat Obama in November.

20Cent

Amerika wrote: »

That is debatable. Since the court’s ruling, and as of this morning, Romney’s campaign has raised $4.6 million from 47,000 donations. Also it is my understanding that the SCOTUS ruling leaves in place 21 tax increases costing nearly $700 billion. Of those taxes, 12 would affect families earning less than $250,000 per year. And the last number I remember is 57% of Americans favor repeal of Obamacare. If the Republicans can educate the American public on what this ruling is actually going to cost them personally, it might just get them to believe the only way to repeal this bad legislation is to defeat Obama in November.

What I meant was how is Romney going to attack Obama on Obamacare when he brought in essentially the same legislation in Massachusetts.

Amerika

20Cent wrote: »

What I meant was how is Romney going to attack Obama on Obamacare when he brought in essentially the same legislation in Massachusetts.

Fair enough. And Romeny will always find this a problem with Conservatives and the Tea Party. But the Federal government doing something versus a State doing something is quite differnent. If I don't like something done in MA, I could always move to NH. If something is done at the Federal level, I don't have much recourse other than to leave the country.