ACA ruled unconstitutional

[nightchief]

Interesting reasoning for ruling this way...

https://abcnews.go.com/Politics/federal-judge-rules-obamacare-unconstitutional-democrats-immediately-vow/story?id=59834094

[SteyrAUG]

Does that mean the US government is going to refund my penalty?

[Firefly]

Somehow, it will be ruled the Judge overstepped his bounds.

[SomeOtherGuy]

A judge in Hawaii has since ruled the Fifth Circuit to be unconstitutional.





















Just kidding, but no harder to believe than actual decisions coming from that direction.

As for the ruling - it seems legally sound to me, but that's no guarantee it will survive. Even if it does, what next? People have been hoping for this for years and I suspect most of the "right" will now be like the proverbial dog that caught the car.

Edit to add:

The US healthcare "system" has been a financial dumpster fire for patients under Obamacare (ACA), and it was a financial dumpster fire for patients pre-Obamacare. Ripping up ACA and going back to 2008 fixes nothing and makes life worse for some, better for others, with no net improvement and possibly even a net harm. ACA was driven by insurance companies first, and highly partisan Democrats second, and I don't think any intelligent person expected it to fix anything. What ACA did was pick winners - mostly insurance companies, but also low-income people with chronic medical conditions, and just by PURE UNFORESEEN COINCIDENCE those people are primarily "D" voters.

ACA also picked losers - anyone who actually pays for their own health insurance and doesn't get a massive subsidy, and to some extent hospitals and other providers. As a business owner who's been paying for 100% of my own health care costs since 2008, with no subsidies ever, the cost is outrageous. I will be paying $22,500 for heath insurance in 2019 to cover my family, using the lowest cost, ultra-high-deductible plan that still provides any useful coverage among providers in my area. Before ACA I paid $12,000 a year for vastly better coverage where I had only moderate co-pays, not a $6600 deductible.

The fundamental problems in the system are these, closely interrelated:
1) Costs are out of control.
2) There is a disconnect between payment for care, provision of care, and consumption of care, which makes all pricing inputs near useless.
3) There is no real competition for most products in the crucial sectors of pharmaceutical and medical devices.

Regardless of court rulings I don't see these problems getting fixed in the foreseeable future.

[SeriousStudent]

The ruling is only 55 pages. I'm going to pull it down and read it tomorrow.

[AndyLate]

A lot of folks smarter than I am tell the that the ACA was designed to fail in order to facilitate adoption of a single payer system.

Andy

[soulezoo]

Yeah. Single payer. Pffft.
Brought to you and ran by the same folks that run DMV...

[Leuthas]

A lot of folks smarter than I am tell the that the ACA was designed to fail in order to facilitate adoption of a single payer system.

Andy

Perhaps indirectly, but the fundamental idea is to push down a slope for total control of the entire industry - one of the three main goals outlined by Alinsky for creating a socialist state.

[AKDoug]

A judge in Hawaii has since ruled the Fifth Circuit to be unconstitutional.





















Just kidding, but no harder to believe than actual decisions coming from that direction.

As for the ruling - it seems legally sound to me, but that's no guarantee it will survive. Even if it does, what next? People have been hoping for this for years and I suspect most of the "right" will now be like the proverbial dog that caught the car.

Edit to add:

The US healthcare "system" has been a financial dumpster fire for patients under Obamacare (ACA), and it was a financial dumpster fire for patients pre-Obamacare. Ripping up ACA and going back to 2008 fixes nothing and makes life worse for some, better for others, with no net improvement and possibly even a net harm. ACA was driven by insurance companies first, and highly partisan Democrats second, and I don't think any intelligent person expected it to fix anything. What ACA did was pick winners - mostly insurance companies, but also low-income people with chronic medical conditions, and just by PURE UNFORESEEN COINCIDENCE those people are primarily "D" voters.

ACA also picked losers - anyone who actually pays for their own health insurance and doesn't get a massive subsidy, and to some extent hospitals and other providers. As a business owner who's been paying for 100% of my own health care costs since 2008, with no subsidies ever, the cost is outrageous. I will be paying $22,500 for heath insurance in 2019 to cover my family, using the lowest cost, ultra-high-deductible plan that still provides any useful coverage among providers in my area. Before ACA I paid $12,000 a year for vastly better coverage where I had only moderate co-pays, not a $6600 deductible.

The fundamental problems in the system are these, closely interrelated:
1) Costs are out of control.
2) There is a disconnect between payment for care, provision of care, and consumption of care, which makes all pricing inputs near useless.
3) There is no real competition for most products in the crucial sectors of pharmaceutical and medical devices.

Regardless of court rulings I don't see these problems getting fixed in the foreseeable future.

I could have written this same post as a business owner as well. What's worse is that several of my employees that were not full time had emergency health care plans that cost them about $400 a month. The minute the ACA was enacted those plans disappeared and those same people were forced into plans that cost more than twice as much.

I will say that even though I am paying nearly what you are for coverage and the same deductible, insurance saved my financial ass over the last couple years. I have a daughter that has hereditary angioedema and her medication pushes $80K a month, that's right..nearly a million $$ per year. I had a heart ablation last year to fix a PSVT problem and that was over $100K.

I truly hope this spurs along the ability to quote coverage across state lines and form group plans across state lines (and otherwise loosen requirements on group plans)

[FromMyColdDeadHand]

A lot of folks smarter than I am tell the that the ACA was designed to fail in order to facilitate adoption of a single payer system.

Andy

Ding, ding, ding. Frankly, with places like CA, you already have the gov as a huge payer already. IIRC, it is close to 50% of healthcare dollars spent there are medicare, medicaid, govt employer health plans.

The real issue that I understand from Medicare for all, is that Medicaid doesn't pay it's fair share and the it is subsidized by private money to make the system work. If every patient paid in Medicaid money, the books won't 'balance' and you'd have to make cuts somewhere. Now I know I used Medicare and Medicaid interchangeably there. But I think that is the right way to think about it since it is the right age group and we haven't paid into it all our lives.

The interesting thing about single payer, is that to get it to work at all, you have to have everyone paying much higher tax rates, even if it is some kind of transfer from employee benefit that they don't see directly, to a direct tax. You'd have to raise taxes to do it- and the middle class won't get off with a token payment. We are talking about like doubling tax rates- and then a decline in services.

What we need is s two tier system to our single tier now. Everyone gets the same care. We need to get the medicaid type people out of high-cost/high-service to lower-cost/appropriate service.


ETA: I agree that insurers were winners in the ACA shuffle, but some got hurt. I know one here in CO that is in a death spiral. They offered plans that people would take, get services, pay for a couple of months and then drop out and stop paying. That along with selling plans at low prices and not being able to make up the margin on volume.

[The_War_Wagon]

Where the hell was this judge 7 years ago?!?!

[Sam]

The ruling is encouraging but it still doesn't help the sky rocketing cost of health insurance.

Somebody fix that crap, make insurance more affordable for us hard working, wage earners.

[RetroRevolver77]

deleted

[Sam]

Now people are paying a mortgage payment with healthcare and it's the reason they aren't able to save properly for retirement. I always thought the ACA was designed specifically to destroy the middle class and it seems to be working.

x100000

[Averageman]

I'd be SOL if my wife's company didn't have very good coverage. My old company covered everything but then prices went way up. Now people are paying a mortgage payment with healthcare and it's the reason they aren't able to save properly for retirement. I always thought the ACA was designed specifically to destroy the middle class and it seems to be working.

I worked with a guy who's daughter (age 4) had a preexisting condition, their family insurance costs ate a bit more than two weeks of his salary every month. His Wife worked, they couldn't afford day care so grandma watched the kids after school. It was a accounting and logistical nightmare for this young family.
So, do we need a .gov program to help them? Do we need some sort of accountability for insurance companies? The ACA didn't exactly do what it has promised to do, as a matter of fact, it's actually made things worse.
I don't have an answer for this other than, we're being gouged out of existence and something has to give.

[AndyLate]

I could have written this same post as a business owner as well. What's worse is that several of my employees that were not full time had emergency health care plans that cost them about $400 a month. The minute the ACA was enacted those plans disappeared and those same people were forced into plans that cost more than twice as much.

I will say that even though I am paying nearly what you are for coverage and the same deductible, insurance saved my financial ass over the last couple years. I have a daughter that has hereditary angioedema and her medication pushes $80K a month, that's right..nearly a million $$ per year. I had a heart ablation last year to fix a PSVT problem and that was over $100K.

I truly hope this spurs along the ability to quote coverage across state lines and form group plans across state lines (and otherwise loosen requirements on group plans)

There is no doubt in my mind that your daughter is worth every penny.

Still, it's hard for me to justify in my mind selling medication like it's made from crushed diamonds with a platinum binder.

Part of the cost is malpractice/liability, some is research and testing, some is advertising, and some is the utterly bizarre way that drug companies move their product (salesmen and women).

I don't know what the answer is, but I am thankful I am retired military and have Tricare, warts and all.

[THCDDM4]

There is no doubt in my mind that your daughter is worth every penny.

Still, it's hard for me to justify in my mind selling medication like it's made from crushed diamonds with a platinum binder.

Part of the cost is malpractice/liability, some is research and testing, some is advertising, and some is the utterly bizarre way that drug companies move their product (salesmen and women).

I don't know what the answer is, but I am thankful I am retired and have Tricare, warts and all.

A large portion of the exorbitant cost for prescription medication here, is the us subsidizing other countries lower costs for the same medications.

We are the deep pockets/market that makes the board of directors of big pharma multi $100 million nuts and the rest of the world gets cheap meds that we susbidize.

Add in all the illegals and downtrodden going to urgent care for the sniffles/some codeine cough syrup and a back ache/hydrocodone and the picture is clear.

[SomeOtherGuy]

Now people are paying a mortgage payment with healthcare and it's the reason they aren't able to save properly for retirement. I always thought the ACA was designed specifically to destroy the middle class and it seems to be working.

I have never had a mortgage payment as high as my current monthly health insurance bill, and I've lived in some nice houses financed with typical 20% down mortgages.

ACA was a "D" dream come true. Everyone needs to realize that the Dems are a corporate party with an absurd pretense of being a working person / lower class / social welfare party. They do enough BS to get the idiot vote and then they hand a selected group of wealthy people anything they want on a silver platter. ACA is just another, very large and painful, example of this practice. ACA benefits drug companies and the larger, greedier health insurance companies. Destroying the middle class is not a primary goal, but I'm sure it is a perfectly OK side effect. A lot of those people are now voting "D" anyway, and all the rest are hateful deplorables who deserve worse than they get, from the D's perspective.

To a great extent this is just rearranging deck chairs. Nothing will improve until costs are brought under control, and the far reaches of the system are like a cancer of the economy at this point.

[Tx_Aggie]

I have never had a mortgage payment as high as my current monthly health insurance bill, and I've lived in some nice houses financed with typical 20% down mortgages.

ACA was a "D" dream come true. Everyone needs to realize that the Dems are a corporate party with an absurd pretense of being a working person / lower class / social welfare party. They do enough BS to get the idiot vote and then they hand a selected group of wealthy people anything they want on a silver platter. ACA is just another, very large and painful, example of this practice. ACA benefits drug companies and the larger, greedier health insurance companies.

Destroying the middle class is not a primary goal, but I'm sure it is a perfectly OK side effect. A lot of those people are now voting "D" anyway, and all the rest are hateful deplorables who deserve worse than they get, from the D's perspective.

To a great extent this is just rearranging deck chairs. Nothing will improve until costs are brought under control, and the far reaches of the system are like a cancer of the economy at this point.

Absolutely right. I couldn't have said it any better myself, and the above cannot be stressed enough.

[AKDoug]

There is no doubt in my mind that your daughter is worth every penny.

Still, it's hard for me to justify in my mind selling medication like it's made from crushed diamonds with a platinum binder.

Part of the cost is malpractice/liability, some is research and testing, some is advertising, and some is the utterly bizarre way that drug companies move their product (salesmen and women).

I don't know what the answer is, but I am thankful I am retired and have Tricare, warts and all.

She's worth every dime. The maker of the medication she takes has bought back the rights to make the medication in Canada and Mexico, thereby controlling the production and price. The level of service one gets as a user of this drug is incredible, and somebody ends up paying for it. My daughter has a nurse that is on call 24/7 to assist her with any problem she has (it's self IV administered), the nurse flew from California to Alaska just for my daughter, and they host "seminars" for all the patients so they can get together and share their experiences. The last "seminar" was in one of the most expensive restaurants in Alaska.(which she refused to attend) The whole thing is a freeking sham and we're embarrassed that we have to be part of it. The pharmaceutical company that makes this stuff is taking a free ride on the backs of taxpayers and insurance payers. We'd drop it in a heartbeat if it wasn't the only thing that works for her. We honestly don't know what we will do if she get's denied insurance in the future.

[SteyrAUG]

I have never had a mortgage payment as high as my current monthly health insurance bill, and I've lived in some nice houses financed with typical 20% down mortgages.

ACA was a "D" dream come true. Everyone needs to realize that the Dems are a corporate party with an absurd pretense of being a working person / lower class / social welfare party. They do enough BS to get the idiot vote and then they hand a selected group of wealthy people anything they want on a silver platter. ACA is just another, very large and painful, example of this practice. ACA benefits drug companies and the larger, greedier health insurance companies. Destroying the middle class is not a primary goal, but I'm sure it is a perfectly OK side effect. A lot of those people are now voting "D" anyway, and all the rest are hateful deplorables who deserve worse than they get, from the D's perspective.

To a great extent this is just rearranging deck chairs. Nothing will improve until costs are brought under control, and the far reaches of the system are like a cancer of the economy at this point.

No joke.

[Doc Safari]

The ruling is encouraging but it still doesn't help the sky rocketing cost of health insurance.

Somebody fix that crap, make insurance more affordable for us hard working, wage earners.

Supposedly the lack of action on this by the Republican Congress is one reason the Dems took back the House this past election. Healthcare is in the background right now compared to other issues like immigration, but I do believe there is a growing dissatisfaction in the American public that the ACA is still around but falling apart and no one is doing a damn thing to look out for the American people. I'm worried this is like one of those cartoons where the snowball rolling down the mountain just gets bigger and bigger sucking up everything in its path and by the time of the 2020 election it will be the only issue. The bad thing is the Dems own this issue due to the inaction of the Repubs if nothing else, so we may be in for an electoral meltdown in 2020.

[Hmac]

The ruling is encouraging but it still doesn't help the sky rocketing cost of health insurance.

Somebody fix that crap, make insurance more affordable for us hard working, wage earners.

You mean have the government subsidize your health insurance costs? Or take over your health insurance completely?

[Firefly]

Why can’t we just....you know...let the Insurance Companies compete interstate?

Have a free market and no penalty for not participating and allow for financing?

Anything but State run or State involved.

[Doc Safari]

Why can’t we just....you know...let the Insurance Companies compete interstate?

Have a free market and no penalty for not participating and allow for financing?

Anything but State run or State involved.

If the Donald were smart, he'd offer this deal: Cover pre-existing conditions and you can compete nationwide. No more restricting the insurance companies to competing within a state or small section of the country. That would be a simple but workable solution and I think the insurance companies would jump on it.

[Firefly]

If the Donald were smart, he'd offer this deal: Cover pre-existing conditions and you can compete nationwide. No more restricting the insurance companies to competing within a state or small section of the country. That would be a simple but workable solution and I think the insurance companies would jump on it.

That would make too much sense, be too convenient, and would be independent from government phuckduggery so it wouldn’t ever happen.

Your future is more and more African Witch Doctors and Quacks and dying young, most likely on the shitter.

This is the fate I have resigned myself to. But... I drink a health smoothie once a week and try to keep up on my cardio. I also leave it in God’s hands. All we can do in this bastion of personal liberty

[26 Inf]

Why can’t we just....you know...let the Insurance Companies compete interstate?

Have a free market and no penalty for not participating and allow for financing?

Anything but State run or State involved.

Think about that deeply for a moment. Why would the insurance companies want more competition? The mega companies would love that, they come in and based on initial economies of scale, decimate the smaller ones and then shazam! we have a near monopoly of larger insurance companies dictating the market, what many complain about now.

If you look at healthcare. Today what you see is more and more hospitals merging, hospitals directly employing more doctors. On the doctor side of things you see fewer and fewer doctors in small, one or two person practices, instead you see groups of doctors forming clinics, and those clinic buying up other clinics.

My doctor, who I really like, explains to me that such arrangements provide improved care and efficiency, and I agree that is true. What he glosses over is that as clinics and hospitals gain more market share, near-monopolies can and will drive up market prices.

Some regulation by 'the state' is needed to temper the profit motive and protect consumers.

[ramairthree]

What we really need is someone preaching common sense health care reform.
And also to beat people up about hard choices.

Do we really need millionaire salary insurance executives? There is a lot of money going from people into insurance companies, and a lot less of it coming out to pay for actual healthcare.

Do we really need millionaire malpractice attorneys? We at least need loser pays to stop frivolous suits, and some more serious tort reform on top of that.

Do we really need the greater than 2000% increase in hospital administration since the 1970s? Again, that is a ton of money being siphoned off. What would a new car cost if every dealership had a window sticker manager, key inventory committee, car wash procedure review board, mandatory electronic sales record compliance of the sheets you and the salesman write on, buyer parking review panel, and window cleaner approval board? And none of those people knew how to sell, fix, maintain, or evaluate cars?

And how would that dealership be doing if by law, no matter what people did to their cars, they could bring it back and have it fixed for life? And never paid a dime. And abused it.

Do we really need to spend millions of dollars on the last month or year or two of life on people with metastatic cancer? These are the expectants on the battlefield of life. Socialized care is only workable if we don’t. Our current system is failing because we do.

Neither system works when we take a thirty something year old who high blood pressure, drug, and alcohols his kidneys to death and end up on dialysis, so we put him on Medicare, SSDI, and dialysis. He keeps doing the same and skipping dialysis. Then he has a stroke. Then he gets cardiac stents or bypass surgery. Or we put prisoners on life sentences on dialysis. Or we try to save 22 week crack baby premature deliveries. Or we cover 150k for a couples fertility treatments. Or we cover all the meds, diseases, and surgery of someone that weighs 500 pounds.

Modern medicine has real costs. Even if we get rid of the bloat, those are significant. The guy working at jiffy lube changing oil will likely never make enough in his life to pay for his wife that got in a serious accident with a lot of injuries and the baby she prematurely delivered. Who is on the hook and obligated to pay for it?

To get costs further down, we need to take a hard look at a lot of issues regarding self inflicted medical issues. And end of life issues with terminal diseases. And even justnelder care. About ten million old people need some help with the basics just to get through the day. Another one to two million need significant nursing home care, some to the point of just laying there and needing to be hand fed, bathed, and diapers changed. The human race is only designed for parents to provide that level of care to a baby, not a full sized adult. Plus the kids of the 89 year old in that condition are likely not in new parent condition. And the grandkids that are are taking care of their own babies.

The system as it exists is failing.

Government/socialized medicine will typically increase the unnecessary expenditures in a bloated bureaucracy.
Pure capitalism will typically increase the costs to increase profits for as many people as possible who are not actually the care providers without any true interest in the patients.

Nobody wants to make the hard decisions and let people die instead of spending massive fortunes on them. Whether it be from natural causes, bad luck, self inflicted issues, etc.

Some problems you can throw money at. If you want to land on the moon you can throw a lot of money at a lot of smart people. If you want idiots to stop doing drugs, weighing five hundred pounds, skipping dialysis, and riding motorcycles at 100mph when drunk, throwing money at them tends to result in more drugs, more weight, faster motorcycles, and more alcohol.

[SomeOtherGuy]

If the Donald were smart, he'd offer this deal: Cover pre-existing conditions and you can compete nationwide.

Blanket coverage for pre-existing conditions is NOT insurance, it's robbing Peter to pay Paul. Not saying that insurers weren't shady and sometimes downright dishonest about pre-existing conditions, but the opposite we have now is no good either.

Imagine if you could buy auto collision coverage retroactively. You get in an accident, you buy some "insurance" for $80/month, they pay $10k to fix your near-totaled car, and you stop paying a month later. Our current system basically allows this for health issues.

I can hear the crying now, but reality is that most issues of "pre-existing conditions" are an issue of OUTRAGEOUS pricing for drugs and services, and if the pricing was fixed it would be fair to expect people to pay their own way for such conditions.

Nothing will be fixed until the fundamental pricing issue is fixed, and I don't see that happening until the system totally collapses. Whatever people may think, that could be decades away still.

[Hmac]

I not only buy health insurance just like you all do, I have to rely on them to pay me for the work that do. You guys all seem to have a clear idea of how to fix the health insurance problem and health care costs. I fight with those ****ers every day and I don't know the answer. It's not even close to being as simple as you think, but I do know that eliminating the state-by-state restriction is a great place to start.

[Firefly]

Meh, don’t worry about it

[nate89]

Does that mean the US government is going to refund my penalty?

Seriously. For someone like me going to school as well as working in 2017-2018, paying taxes still plus getting a penalty for something I chose not to buy really sucks.