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Miles J. Zaremski

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The Benefits of ACA and the Uncertainty That Its Mandate Is A Tax

Posted: 06/29/2012 6:16 pm

Mark June 28, 2012 -- the day that the Supreme Court upheld the Affordable Care Act (ACA) -- as the first day that health care starts to become a right, and not a privilege, for all Americans. Mark June 28, 2012 as the day that what Obama promised on the campaign trail against McCain in Nashville, Tennessee that health care was a right and not a privilege or responsibility has come true. Mark June 28, 2012 as the day when what FDR said in the 1940s about a Second Bill of Rights including the right to health has come to fruition.

To be sure, ACA will need improving, particularly so that upwards of 26 million more Americans will be able to access and afford health care over the additional 33 million citizens now to be helped through ACA among the following ways by being provided: (1) increased coverage for preventive services like mammograms and annual check-ups; (2) no limits on annual or lifetime limits on coverage; (3) coverage now for children with pre-exiting conditions; (4) coverage even though there exists a pre-existing condition; (5) Ob-Gyn services; (6) access to out-of-network emergency room services; (7) an appeals mechanism for health insurance plan decisions; (8) consumer assistance programs; (9) refunds from insurers unless they provide at least 80% of their revenues for reimbursement of medical care [the first such refunds are due this August]; (10) insurance even though an honest mistake was made in applying for it; (11) expanded prescription drug coverage [in the "doughnut hole"] within Medicare; (12) a reauthorization of the Indian Health Improvement Act; (13) coverage for children on their parents' policies up to the age of 26; health insurance exchanges effective 1-1-14 set up by states or in their absence by the federal government to allow those in the individual market more effective pricing of insurance through competition; (14) each state with the choice or option to participate in an expanded Medicaid program where $millions will be made available to the states; (15) a decrease in the number of patients without insurance who visit a hospital's emergency room each year [called "charity care"]; and (16) provides financial assistance and tax credits for individuals and small businesses who must struggle to pay for health insurance.

The above is quite a list to start ensuring health care as a right for our nation's citizens, particularly when those who oppose the President's health care law and the Supreme Court's ruling keep telling us the law does nothing we want. Kind of makes one wonder whether the opposition is now just sore losers with nothing but slop to throw against the wall, hoping that something will stick.

So, too, is the opposition now crying out that Obama's new law saddles Americans with $$$ in new taxes. Having read the opinion of the Court, do not believe any politician who criticized Chief Justice Roberts by saying this.

Here is a quick legal primer. The role of a court or a judge is to save where reasonable an enactment of a legislative body. Roberts and the majority of five did just that by first rejecting the commerce clause argument, saying in essence that being forced into the marketplace by, here, purchasing insurance, is not activity that can be regulated by Congress under commerce clause jurisprudence. But there was a second avenue and that was to see if the mandate within ACA could be saved through the taxing power of Congress, also found within the Constitution. While Roberts' opinion was quite nuanced, through it the law of the land became that regardless of whether a legislature calls money to pay the Federal Treasury for non compliance a penalty (as Congress attempted to do in ACA with the mandate), a fee, a fine, a surcharge or -- as Robert recognized it through ACA -- a shared responsibility payment, such an exaction can be analyzed through the Constitution's taxing authority. Names do not matter, for according to the majority of the Court, " '[M]agic words or labels' should not 'disable an otherwise constitutional levy.'" Some exactions to the Federal Treasury can be considered a tax; others called a tax may not be so under the Constitution.

Roberts also then opined that a levy for foregoing health insurance does not fall within any recognized category of direct tax upon citizens, or capitation (taxes paid by every person and apportioned among the several States). He added that it could be troubling to impose a tax for not doing something, though it is not new to encourage activity by providing tax incentives. Consider renting an apartment versus buying a home. With the former, one gets no tax deduction; with the latter property taxes are deductible. In the end, if the Congress has properly exercised its taxing power to encourage purchasing health insurance, then the mandate falls within Congress' taxing power to do so.

In order to uncover every stone to ensure ACA remained constitutional, the mandate was proper "because it can reasonably be read as a tax".

And if all of this were not confusing enough -- even for us lawyers -- an upfront part of the opinion concerned whether a federal law called the Anti-Injunction Act would bar the Court from even hearing the case. After all, if ACA's penalty for not buying insurance is a tax, it cannot be challenged until after it is paid, here that would be after April 15, 2015. But for purposes of this Anti-Injunction Act, Roberts wrote, "The Affordable Care Act does not require that the penalty for failing to comply with the individual mandate be treated as a tax for purpose of the Anti-Injunction Act. The Anti-Injunction Act therefore does not apply to this suit, and we may proceed to the merits."

Don't trust any politician that says Obama created the mandate as a tax; just pay attention atop this posting to what ACA provides all of us. We are all on our way to being ensured health care as a right; as Roberts concluded his opinion, "Under the Constitution, that judgment [the wisdom of the Affordable Care Act] is reserved to the people."

 

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HUFFPOST BLOGGER
Miles J. Zaremski
Attorney, essayist and commentator
01:33 PM on 07/01/2012
I'd like to ad a comment to my story without it being intended as a reply to any of the comments so far. On the Sunday talk shows today, Republicans keep stating that the mandate is a tax. Romney has gone on record as saying that as a result of the Supreme Court decision Obamacare will now tax middle Americans $500billion. Again, if facts do not fact one up, then throw slop against the wall; maybe something will stick. In fact, the mandate will affect about 1% of the population. In fact, the mandate is not a tax; call it a surcharge, a fine, a fee, a penalty or whatever you want---all it is is a payment to the US Treasury for not buying a health insurance policy. Query, what is the difference between this, and, let's say, getting a credit from the IRS if one purchases a health insurance policy? I would argue that both do one thing---motivate a citizen to undertake certain conduct for the betterment of the whole. If you buy the policy, you get a credit offsetting income taxes (like certain environmentally welcomed products like a gas efficient furnace). If one does not purchase a policy, (s)he pays $$ for the privilege of not doing so. Either way, the conduct to be achieve is to purchase the policy. In the end, call it what you want; the Supreme Court first did not call it a tax but later did in order to uphold ACA.
01:29 PM on 06/30/2012
There's no uncertainty. Obama argued in court that it's a tax, it was upheld as constitutional solely based up it being a tax.

It's a tax.
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HUFFPOST BLOGGER
Miles J. Zaremski
Attorney, essayist and commentator
10:51 PM on 06/30/2012
If there is no uncertainty there why did the Supreme Court say in the first art of its opinion that is was NOT a tax?
10:45 AM on 06/30/2012
If it's a tax, why not take the sting out by legislating a tax credit (as opposed to deduction) for all health insurance (and no-insurance fee) payments.
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HUFFPOST BLOGGER
Miles J. Zaremski
Attorney, essayist and commentator
10:58 PM on 06/30/2012
The purpose of whatever you want to call it that gets paid into the treasury if a taxpayer does not purchase instance is to motivate folks to do something (buy insurance to fulfill their individual responsibility), just like, e.g., purchasing a home vs. continuing to rent. Whether getting a tax credit, a deduction, an exemption , or...having to pay a fee or whatever, they all serve the same purpose---to motivate folks to act or do in a certain way.
05:37 AM on 07/01/2012
Dear person who *insists* on using my email address to sign up to multiple things - I don't know who you are, but I'm assuming you really aren't terribly bright. Simply using an email address doesn't allow you to take it over. I have held this account for more than five years, and I would appreciate it if you would stop signing up to HuffPo, Skype and any other things that take your fancy.
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HUFFPOST BLOGGER
Miles J. Zaremski
Attorney, essayist and commentator
06:46 PM on 07/02/2012
Please explain what the heck you are talking about? Vc
04:20 AM on 06/30/2012
THey should have called it a tax from the beginning....The FREELOADERS TAX. It's a tax on those who can afford to purchase health insurance, but choose not to. Thereby raising the costs for all the rest of us when they do need to get health care. And if it had been called the Freeloader's Tax, it would have been very hard for the Republicans to argue against it.
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HUFFPOST BLOGGER
Miles J. Zaremski
Attorney, essayist and commentator
09:13 AM on 06/30/2012
Nice metaphor. In the end, though, money to the treasury decided by Congress can always be called one thing and then the judicial branch can legally determine it in another way. But, to be sure, if a piece of legislation included the word "tax", it surely would never have passed in the first instance. Again, the Supreme Court said the mandate was not a tax for one purpose and then said it could be for another purpose. Masterfully written by Roberts.
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HUFFPOST PUNDIT
Steelsil
Warren/Grayson 2016! Yes We Can!
12:59 AM on 06/30/2012
A government that can mandate lifejackets, seatbelts, and helmets can obviously require health insurance on the same basis - that your safety requires it.  The rebuttal that those are for voluntary activities misses the point - you don't get to choose whether or not to have a body, and hospitals are mandated to treat you whether you have insurance or not.
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HUFFPOST BLOGGER
Miles J. Zaremski
Attorney, essayist and commentator
09:14 AM on 06/30/2012
Excellent points!
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HUFFPOST SUPER USER
David Engage America
11:50 PM on 06/29/2012
Tammy Frisbee of the Hoover Institute told Engage America that the decision to uphold the ACA will cost taxpayers "hundreds of billions of dollars through the ACA's creation of a huge entitlement program of insurance subsidies, a massive expansion of Medicaid, and other new taxes on income, savings, and investment" http://eng.am/Ljob3J
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HUFFPOST PUNDIT
Steelsil
Warren/Grayson 2016! Yes We Can!
01:01 AM on 06/30/2012
I doubt her figures, but it still wouldn't be a patch on what the Bank$ters cost us - and they can do it again, thanks to Republican obstructionism.
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HUFFPOST BLOGGER
Miles J. Zaremski
Attorney, essayist and commentator
09:18 AM on 06/30/2012
Nice observation.
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HUFFPOST SUPER USER
David Engage America
04:43 PM on 07/02/2012
While you may doubt her figures, the CBO, the most respected non-partisan Washington agency, does not. http://1.usa.gov/NIwSYs

I care about the facts and If you look at the CBO's numbers the ACA will cost taxpayers hundreds of billions of dollars per year just like Tammy said.
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HUFFPOST BLOGGER
Miles J. Zaremski
Attorney, essayist and commentator
09:17 AM on 06/30/2012
And if this is what the Hoover Institute say, then I have a bridge to sell someone in Brooklyn costing a buck. Come on, stop believe all the fear mongering by the sore losers who lost out with how the Supreme Court ruled.
12:32 AM on 07/02/2012
http://www.cbo.gov/sites/default/files/cbofiles/ftpdocs/107xx/doc10731/reid_mandate_penalty_11-20.pdf
Looking at the 2 Billion that the CBO says will be collected in "penalties" it sure seems like they're relying on the tax to fund this disaster. In 2016, they expect to be receiving 46% of their penalty revenue from those of us who are just above the Federal Poverty Level through 300 % FPL!
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HUFFPOST SUPER USER
David Engage America
04:37 PM on 07/02/2012
Could you please tell me what part of my comment isn't factual?

Unless the ACA is going to be implemented for the low cost of free (which it isn't) it will cost taxpayers hundreds of billions of dollars to implement as well as create new taxes on income and investment to pay for it. http://bit.ly/QXaI4Z