The U.S. Supreme Court has accepted review of the Affordable Care Act -- what opponents call "Obamacare" -- America's new health care reform law. It's no surprise the Court accepted review. The lower courts split on its constitutionality, and the Supreme Court must weigh in to resolve the split. Before opponents start cheering -- or proponents start fearing -- that the Act will be entirely stricken, a close analysis of the issues the Supreme Court actually accepted for review is warranted.
The Supreme Court declined certain constitutional attacks, and accepted review of only four issues. The key issue concerns the "individual mandate" as to which the Court allotted twice the usual amount of time for oral argument. The Court will reach this issue only if the Anti-Injunction Act does not bar review. The Anti-Injunction Act is a jurisdictional law that precludes judicial review of taxes, or fees similar to a tax, before they are collected. Any penalty fees generated from the "individual mandate" would not be collected before 2014 tax returns are filed, so if the Anti-injunction Act applies, judicial review of the Act would be postponed until 2015.
The Court will also review the Act's expansion of Medicaid to 133 percent of the federal poverty level. Numerous states attack this expansion as "coercive" since they are primary overseers of Medicaid with federal financial support. It is noteworthy that no lower court to date has agreed with the States' attack on this issue. Finally, the Court will review whether the Act is "severable." If it is "inseverable," then it must be stricken in its entirety if any portion of it falls. The Court allowed 1.5 times the usual argument length for this issue. Altogether, 5.5 hours have been set aside to hear the issues involving the health reform Act.
Tellingly, the Court rejected any challenge to what has been coined the "employer mandate" that requires large employers to obtain minimum health coverage for employees or pay a tax penalty. Specifically, the Court refused the States' challenge to this mandate requiring them to provide minimum health coverage for State employees. That the Court refused to hear any attack on the employer mandate foreshadows the Act's "individual mandate" could survive challenge as well, but even if not, that only a small portion of the Act is really at risk.
The health reform Act has ten separate parts, called "Titles," and the vast majority of its provisions within those Titles, are not subject to any legal challenge. Only two provisions out of these ten Titles are before the Court. In light of the Court's narrow review, it seems safe to say that some form of health care reform is "here to stay." Those waiting for a ruling telling them whether the law is really here or not before taking steps to get ready for what it requires may want to reconsider.
The Supreme Court selected for review only Title I's "individual mandate" and Title II's Medicaid expansion. No other provision will be heard, and that means eight Titles are not at risk unless the entire Act is found "inseverable." Even though the Court agreed to consider "severability," the Court's refusal to entertain the employer mandate suggests the Court already views the Act as severable. Only four Justices are needed to accept review of any issue, but not even four were interested in the employer mandate. That means fewer than four have any concern at all with the constitutionality of the employer mandate and the Court is perfectly willing to review the Act on an issue-by-issue basis, suggesting further that it may be poised to view the Act as severable.
Courts are reluctant to interpret statutes as "inseverable," especially when their scope is as comprehensive as this one. The Act's ten Titles address numerous subjects and topics. Title I expands private health insurance coverage abolishing discriminatory exclusions like preexisting conditions, but also establishes insurance "exchanges," among other provisions. Only a portion of Title I concerns the "individual mandate." The Obama administration takes the position nothing in Title I except its expanded health coverage is so tied to the "individual mandate" that the entire Act must be stricken; indeed, the balance of the entire Act stands easily without the mandate. Likewise, Title II deals with much more than Medicaid expansion; Title II improves, simplifies and coordinates both Medicaid and the Children's Health Insurance Program (CHIP), and importantly, enhances the quality of health services provided in these programs. Striking the entire Act based on an alleged "coercive" expansion in Medicaid would frustrate other unrelated improvements to such programs.
Given the Supreme Court will review only two issues out of ten Titles, it seems highly unlikely the Court will strike the entire Act as "inseverable." More likely, if any constitutional infirmity is found at all, the Court will follow the administration's lead and excise only those portions directly tied to what is unconstitutional. To date, the lone circuit court of appeals to strike down the "individual mandate" expressly rejected any attempt to strike the entire Act, and for good reason. Titles III and IV have nothing to do with the "individual mandate" or Medicaid expansion, but were intended to enhance the quality and efficiency of America's health care delivery system, to prevent disease and promote public health. Titles V and VI provide incentives and other support to America's health care workforce, and require greater integrity and transparency in public health programs. Titles VII and VIII improve access to innovative medical therapies and to long term care. Titles IX and X contain revenue provisions and other amendments to strengthen the Act. Nothing in these other provisions or Titles need be stricken just because the "individual mandate" or Medicaid expansion could fall. A court exercising judicial restraint will find it difficult to interpret the Act's intent behind these divergent provisions to require they all be stricken based solely on infirmity with the "individual mandate" or Medicaid expansion.
For this reason, employers and health care providers would be well advised not to put on "hold" any plans for coming into compliance with other provisions of the health care reform law. Hesitation may mean missed opportunities. The Act employs free-market tools to accomplish many of its reforms. Indeed, the Hon. Laurence Silberman, a conservative Judge appointed by Pres. Ronald Reagan, observed in his recent D.C. Circuit Court of Appeals' decision upholding the Act: "The theory of the individual mandate... is that private entities will do better than government in providing certain social insurance... Privatized social services combined with mandatory-purchase requirements... partially privatize the social safety net... and move, at least to some degree, away from the tax-and-government-benefit model that is common now." This Judge expressly recognized one of the market-oriented concepts found in the Act. There are numerous others that affect businesses and health care providers. Waiting to see if the Supreme Court strikes the entire Act could sacrifice strategic positioning in an evolving marketplace as business competitors and other care providers start movement to comply with the Act.
While the Supreme Court will soon decide whether the "individual mandate" and Medicaid expansion are constitutional, the Court's decision will not likely reverse the many reforms scheduled to occur over the next two years. Large employers should start considering how best to provide employees with affordable minimum health coverage which they must have in place by 2014 or pay tax penalties. Small businesses may want to start considering how health insurance shopping in the soon-to-be-established "insurance exchanges" affects their employee benefit plans. Medical providers such as hospitals and physicians must start considering the strategic impact that change from a "fee-for-service" to a "fee-for-value" payment system means for their organization and collaborations with other health care providers. Regardless how the Supreme Court rules on the two provisions of the Affordable Care Act now before it, prudence dictates that businesses and providers start considering health care reform as "here"!
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Okay Now that you have read it - you say, so, the insurance companies start to fail and beg to be bailed out, right a game we have seen over and over - BUT then you consider that the Dodd/frank (A seemingly unreleated legislation has to say about bail outs.)
The Failure of the Insuace companies, paired with dodd frank create a healthcare crisis and the only selution is the public sector taking charge of health care... Not a public option but universal health care the real thing....
An key aspect of "Obamacare" - that some on the right espouse as the answer to ever rising prices for health insurance - is an across-state-lines health insurance option. This option must be implemented through states entering into multi-state insurance regulatory compacts, but "Obamacare's" imprimatur is already on them.
Another key reform is the consumer-owned, non-profit insurance "co-ops" option. Market competition between "co-ops" (assuming they're well run) should, in classic economic theory, hold a lid on pricing by "for profit" insurers, and the medical loss ratio will only have to do so, by law, as a backstop.
yet we have spent what, a few trillion dollars killing Iraqi civilians to avenge 9/11 (never mind it had nothing to do with Iraq), but we need to starve affordable healthcare options and make sure that the Blackwaters and Halliburtons of the privatized, for-profit insurance industry get their mercenary money?
hmmm.
The charges for preventive tests are so high you would not pay much more for treating the disease.
I needed some medicine refilled. I had been to see the doctor 6 months before, but they wouldn't refill it until I came in. They charge a lot of money for asking you if your medicines are the same. I think that little office visit cost Medicare $250. The doctor did not physically touch me.
This country pay twice as much for health care as any other country but don't have the best healing, etc.
My wife and I pay over $15,000 a year just to insure the two of us.
Expand Medicare to cover EVERYONE.
Vermont is going for single-payer.
California will have a ballot proposition next year to allow the state insurance commissioner sign off or not sign off on premium increases and to create a public health insurance option for our state's coming health insurance exchange.
http://www.consumerwatchdog.org/story/health-care-measure-seeks-public-option-rollbacks
The organization Consumer Watchdog is the same one that successfully spearheaded Proposition 103 in 1988 that has saved California consumers a fortune in auto insurance.
Since it is a given that Democrats will crush Republicans again in California next year, this is where my 2012 electoral energy is going.
“The increase is partly attributed to a tax credit created by the nation's new healthcare law. Some insurers are aggressively marketing the break, which can offset up to 35% of a company's costs.”
http://articles.latimes.com/2010/dec/27/business/la-fi-health-coverage-20101227
More Small Businesses Offering Health Care To Employees Thanks To Obamacare
http://blogs.forbes.com/rickungar/2011/01/06/more-small-businesses-offering-health-care-to-employees-thanks-to-obamacare/
More employees getting healthcare coverage?
Man, that's just awful. (To conservatives)
Do the next 10 years just magically get better withiout any structural changes? Somehow I doubt it.
Second issue. These "policies" simply do not provide coverage or offer health security. It's extortion by marauding corporate entities.
Every attempt is being made to keep this disgraceful American gravy train limping along....the whole world has this figured out!
The first shot across the bow was the statement that mammograms are not needed until age 50 for women. It was roundly shouted down. That is the foreshadow of what everyone else in the world calls medical rationing.
Go get a mammogram if you want one. Difference here is that with the present arrangement your are screwed if the results are not in your favor.
People die and go bankrupt in this country because the fall ill. It's screwed up.
That is because in its current form, it is quite limited to begin with.There are two exemptions to it already in the health care reform law that are very broad; for those whose payment for the lowest cost health exchange plan exceeds 8% of their income, and for those with incomes below the tax filing threshold. When these two criteria are applied to actual health insurance premium costs using Congressional Budget Office data, the results are amazing;
-About 50% of the uninsured wouldn't even be subject to the mandate and penalty.
-For about 45% of the uninsured in lower incomes who are subject to the penalty (singles between $9350 and $24,000, and family of four between $18,700 and $55,000), the penalty shouldn’t be of much concern because the subsidies to them when they sign up for an insurance plan are very generous and it is hard to see why they would pass that up.
-For the remaining 5%; singles with incomes above $64,000 and a family of four above $176,000 the mandate and penalty may be bothersome; but they have the financial means to pay it if they so choose. So the effect on their decisions whether to buy insurance is minimal as well.
The conclusion is that the mandate will actually affect very few people and expressed concern over its loss is being way overblown.
They just hate anything that lacks exaggeration and fantasy.
Elimination of the individual mandate would not devastate the health reform law. The Court of Appeals opinion now on review before the Supreme Court, made this very point. Even though the opinion struck down the individual mandate, it refused to strike the entire law on the basis that Congress would have enacted it anyway, even without the mandate.
In June 2010, CBO projected there would be 16 million more people not covered in 2019 if the mandate were eliminated. But, there would still be 23 million more people covered because of the Act even without the mandate. CBO further projected a negative impact on private insurance rates because fewer people would maintain coverage without the mandate: rates were estimated to rise as much as 15-20% more than if the mandate remained in place.
Interestingly, however, striking the mandate, according to the CBO, would have a positive impact on the public fisc due to the fact that fewer people would be enrolled in Medicaid and CHIP. The CBO projected the total upside to the federal deficit through 2019 would be $202 billion without the mandate.
So, if the Supreme Court struck down the individual mandate, a mixed policy impact would result: fewer covered individuals (up to 16 million less); higher premiums in the private insurance market (as much as 15-20% greater); but, tremendous savings to the federal deficit (up to $202 billion).
No, they will just tax or fine you.
If you think the government can't garnish your wages or income ask the IRS.
Jail isn't an option -so much for your hyperbole.
You can't get away from them even in death!