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Ron Pollack

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Affordable Care Act 'Ultimately Will Be Upheld in Its Entirety'

Posted: 06/ 9/11 02:22 PM ET

There's encouraging news out of Atlanta today for all Americans. The third hearing before the court of appeals left me feeling optimistic about the future of the Affordable Care Act.

But let's start from the beginning. There have been approximately two dozen suits filed against the Affordable Care Act's individual responsibility provision. All but two of the cases decided so far by federal district courts threw out those challenges, most on procedural grounds but several on the constitutional merits.

But Florida judge Roger Vinson, weighing in on a 26-state lawsuit against the new law, took his anti-health reform stance to the extreme. In February, he ruled that because he found the individual responsibility provision unconstitutional, the entire law should be thrown out with it.

Roger Vinson's ruling is simply conservative judicial activism run amok. Long-standing judicial principles make clear that courts should deal with constitutional challenges as narrowly as possible -- a principle Judge Vinson cited in his opinion and then did the exact opposite. Additionally, experts from both sides of the aisle have said his ruling goes too far.

Just a few days after Judge Vinson's extreme ruling, the Obama administration appealed his decision, which leads us to round two: Arguments at the 11th circuit court in Atlanta, Georgia. And this morning, three judges heard oral arguments to determine whether Judge Vinson's ruling can stand or whether it should be overturned.

The arguments put forward today by the federal government illustrate why the Affordable Care Act is both constitutional and good policy. As most courts have found, the individual responsibility provision challenged by the Attorneys General is easily within Congress's constitutional commerce clause powers.

All three judges remarked at some point that health care is a "unique" part of commerce. And they're right. Three aspects make it unlike any other part of the economy. First, everyone seeks health care -- even when they don't expect to (such as after an accident, heart attack, stroke, or other unexpected problem). Second, for those needing such care, it must be provided; hospitals and doctors can't turn someone down who is at risk of losing life or limb. Third, when an uninsured person receives such care but cannot pay for it, this results in a direct and substantial cost shift to others with insurance -- a premium add-on that averages over $1,000 for family coverage. This makes health care unique and -- unlike a requirement to purchase any other product -- makes it constitutionally appropriate for Congress to establish a personal responsibility provision.

It seems that the lawyer for the states even understands this fact. He conceded that Congress can require people to buy health insurance when they are at a hospital -- but he said that they could not force someone to buy insurance before then. According to that logic, it's just a timing thing.

The fact of the matter is the individual responsibility provision is good policy. It protects the overwhelming majority of Americans who have insurance. They will no longer have to pay higher premiums to cover the costs of caring for those who refuse to purchase insurance.

To throw out the entire law would do a great disservice to American families, who, for far too long, have been trapped in an unfair system. Thanks to the Affordable Care Act, children can no longer be denied access to insurance because they have a pre-existing condition. Seniors and people with disabilities can receive preventive care services free-of-charge. And insurance companies cannot arbitrarily jack up premiums just to increase their profit margin.

To suggest that Americans are better off without these new rights is ludicrous. Were the court to uphold the District Court's decision striking down the entire law, it could have devastating consequences for America's families.

After hearing today's arguments, however, I am feeling optimistic that this court will reject the Attorneys' General arguments in their entirety and leave the new law in place.

We've taken big strides forward with the Affordable Care Act, now is not the time to take a giant leap back.

 
 
 
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Bonafideparte
Top O' the morn' to ya'
05:35 AM on 06/12/2011
Great post and I concur.

The argument comes down to what consitutents care and then whom is to pay for it. The affordable care act is law and will stay that way. ( the plank is in leading to single payer ) Allready you have Vermont leading the way with a form of single payer and more states will follow . ( especially after their success ) I give it about 12- 15 years before it is across the land.

The only question now is whether the american voters will bring in enough true democrats next year to enact a strong public option speeding up the process to single payer.

I think they will.
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HUFFPOST SUPER USER
Elvin Frantz
11:55 AM on 06/15/2011
The process toward single-payer has already begun in the states. The Affordable Care Act gives a state the option to develop its own plan as long as it reaches more people and at less cost. Obama has explained this to the governors. The first state is Vermont and California is expected to follow soon. The Colorado Assembly is working on an idea which would be called The Colorado State Health Care Cooperative whereby every resident would be a member.
02:55 PM on 06/10/2011
Pay for ten years - get 6 years of benefits. Try to run a business with that model and see if you don't land in jail.........
02:50 PM on 06/10/2011
Let’s break the logic down. Judge Vinson ruled against the personal view of the author; therefore, the judge has a personal anti-health reform stance which led to an “extreme rulingâ€. Regardless of the judge’s personal feelings on the subject the author assumes that the judge ruled not because of the law but because of personal feelings. Basically this is a hit job on the judge’s character. I find it incredible that the author can read minds and know people’s intent as well as he does.

The author forgets to mention that Obamacare fails to stipulate that if any part of the law is found void then the remainder stays in effect (but that’s beside the point).

The author does have one thing right – we have taken great strides with Obamacare and going back is not an option – we do need real reform. The problem is that Obamacare and socialism are steps in the wrong direction. We need to move towards capitalism, free markets, and personal freedom (not to mention refusing to give up our constitutional right not to be forced to buy something in order to remain a citizen in good standing).
10:21 AM on 06/10/2011
Judge Vinson did not ignore judicial restraint. He noted that congress and the administration expressed concern regarding the law's unique constitutional underpinning. And, he noted that a common "savings provision," which states that any portion of a law that is unconstitutional shall not affect the remainder, was offered but rejected in the measure's final passage. On that basis, and considering the fact that the individual mandate is central to the law's ability to function, the Judge determined that it was Congress' intent to allow the law to stand or fall based on the constitutionality of the mandate. For all practical purposes the mandate is key. If the mandate is struck down but the remainder in tact, I will wait until I get sick to get a guarantee-issue policy.
09:58 AM on 06/10/2011
First, everyone has children, even when they don't expect it. Second, the children must then be delivered. Third, if the child can't be paid for, then there is a cost shifting to society. The Commerce Clause therefore gives Congress the authority to declare that anyone that can't afford their child must have an abortion.
01:48 PM on 06/10/2011
No, that would invade the established right to privacy. And even if it did, do you think any congress critter who voted for it would remain in office, or that the law would survive?

Don't be ridiculous.
HUFFPOST SUPER USER
dcflush
The nickname is about poker, not politics
03:53 PM on 06/10/2011
First, not everyone has children. Second, your nonsensical attempt at a comparison has already fallen apart.
08:40 AM on 06/10/2011
Claiming that policies will be cheaper because cost shifting
will end ignores the most relevant consequence. Taxpayers will
now subsidize the uninsured and those earning under $88000 for the mandated "cadillac" policies and pay the direct cost of buying bloated coverage. In addition, all premiums will rise to offset the costs of "free" preventative care, guaranteed issue, community rating, removal of annual and lifetime caps. One estimate of the current cost for the uninsured was $45 billion
(exponentially less than the burden Obamacare will put on the
49% of the country who still pay income taxes.) The middle
class will be sadly disappointed to discover increasing taxes on the top 2% will not cover the added costs of this demented legislation. Both their taxes and health insurance premiums will also "necessarily skyrocket". The fallback plan to control costs
is to cut payments to medical providers, which, if the laws of supply and demand still hold, will severely limit the availability of care. Expecting doctors to accept a 20% reduction in pay is insulting on its own, but even more so when government unions are thuggishly protesting having to pay anything for their health
insurance. Those wondering why so few jobs are being created should review the countless pages of regulations created by Obamacare, financial reform, Cass Sunstein and the EPA.
Businesses do NOT expand when they haven't a clue about
the rules or the cost of the rules. If only Obama had studied Friedman instead of Alinsky ....
08:59 AM on 06/10/2011
What 'countless pages'?

Are they 'countless', because there really aren't any?

Name a few, along with their adverse consequences.

If you can.

This whole "Businesses do NOT expand when they haven't a clue about
the rules or the cost of the rules" nonsense is a total load of cr@p.
11:33 AM on 06/10/2011
What is your solution to the puzzle of the three things Mr. Pollack described:
1) Everyone seeks health care
2) It can't be denied
3) Someone else has to pay for it when the recipient can't.

Can you solve this problem fairly in a different way? Or would you change the only one that can be changed, #2? Or as I suspect, are you just saying No like a spoiled child who can't get the world to be as he likes?
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ParrotPops
It's feeding time at the zoo...
01:23 AM on 06/10/2011
This article seems to have been to a different courtroom than the reporters who wrote the other accounts I've seen. Those reports focused on the Judges' concerns about the mandate, wondering 'if this is allowed, will there be any limit to the Federal Government's powers?' Single quotes, since I don't have a quot ebefore me, but this was the gist.
And it made me wonder. If the Federal Government is to be forbidden from requiring all citizens acquire a class of product (health insurance), is the converse true, too? If they take this tack, then is the Federal Government also forbidden from prohibiting the purchase of a product? Good bye drug laws, good bye product safety. You get the picture
kellygreen
"Ideology is the Science of Idiots" John Adams
08:18 AM on 06/10/2011
The individual mandate is simply a tax incentive.

It isn't like state level mandates (like for purchasing auto insurance) where the government can fine you, jail you, or seize your property.

It simply states that if you do not purchase (or otherwise have provided for you) health insurance, then you will be taxed a certain amount to offset the costs that guarenteeing you access to health care entails.

So this notion that this is some radical expansion of Federal authority is ridiculous...and if its underlying principle is struck down...you are right.

Not only do broad areas of the governments ability to regulate commerce become open to challenge....so to does the government's ability to protect people from discrimination...as well as the basis for most of the tax incentives in our tax code.
09:01 AM on 06/10/2011
If the Federal Government can't coerce the public to buy insurance, then what justifies its ability to take young men and send them off to be killed?

I don't see anywhere in the Constitution justification for a draft, yet we institute one from time to time, and the machinery to do so is still in place.
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ParrotPops
It's feeding time at the zoo...
12:05 PM on 06/10/2011
Article 1, section 8
"The Congress shall have Power To lay and collect Taxes, Duties, Imposts and Excises, to pay the Debts and provide for the common Defence and general Welfare of the United States; but all Duties, Imposts and Excises shall be uniform throughout the United States;"

"To raise and support Armies, but no Appropriation of Money to that Use shall be for a longer Term than two Years;

To provide and maintain a Navy;

To make Rules for the Government and Regulation of the land and naval Forces;

To provide for calling forth the Militia to execute the Laws of the Union, suppress Insurrections and repel Invasions;

To provide for organizing, arming, and disciplining, the Militia, and for governing such Part of them as may be employed in the Service of the United States, reserving to the States respectively, the Appointment of the Officers, and the Authority of training the Militia according to the discipline prescribed by Congress;"

It doesn't specifically mention 'draft' and doesn't need to.
You really didn't look too hard, did you?
12:40 AM on 06/10/2011
This legislation is a steaming pile of garbage vomited out of the Democratic controlled houses and signed by the Change Candidate who promised a Public Option, and then killed it behind closed doors.

There is nothing "affordable" about it. The mandate to be forced by law to purchase garbage policies peddled by predatory corporations is obscene. There is NOTHING motivating the costs downward because there is no competition.

You get what you deserve America!
01:03 AM on 06/10/2011
Where do you get the idea that that there is "no competition"?

The insurance companies will still exist, and are going to be falling over themselves trying to capture a fair share of the many millions of new consumers flooding the market.

And do you really think that there won't be any savings achieved through economies of scale, not to mention a public that is much healthier, seeking medical help earlier and getting it - due to insurance policies that will be required to spend 85% of premiums on... health care?
kellygreen
"Ideology is the Science of Idiots" John Adams
08:25 AM on 06/10/2011
Well said.

The problem is that you are up against an emotional argument.

Unfortunately many progressives are simply more interested in waging war against corporations than they are in actually providing health care to people who currently priced out of the market.

So it is more important to them that insurance companies are denied profit, than it is that sick people actually get the health care that they need.
09:05 AM on 06/10/2011
There is not a lot of competition now. In each state, only two or three insurance companies own almost all of the market. And the public interest is diametrically opposed to their interest. 'Cartel', rather than 'competition' pertains.

I don't expect any savings from this law. If there is, it will arise from (a) more people paying in and (b) care for the bottom half won't have to be conducted through the Emergency Room.

Having said that, the law, as it is today, is better than nothing, and is certainly a start.

That's a lot more than we have had in the last 45(!) years.
01:15 AM on 06/10/2011
"promised a Public Option, and then killed it behind closed doors."

Actually, if you checked you facts, you would know that it was the Republicans who pushed for the elimination of the public option.
10:23 PM on 06/09/2011
What if I don't want to exercise my new "right" of single payer, government sponsored Obamacare.
Guess what, I got my ass out of bec about 14 years ago and went to work. Then I got a job w health benifits and moved on w my life. I understand people need help from time to time but I do not appreciate the federal government shoving these programs down our throat
01:00 AM on 06/10/2011
If you read the Affordable Care Act, you would first, know that it is NOT a single payer system. Second, there is no government option. Your insurance continues to come from your current insurance companies. They are just more limited as to how much they can charge you for your premiums and they can't refuse you for pre-existing illnesses or if you become sick. Third, if you have a job with benefits, you're already paying for it or rather your employer is paying the bulk and you're paying a small share. And don't be so naive as to think that is people don't have health insurance, it's because they're lazy or not working. Many of us work 6 - 7 day a week and don't receive benefits from our job but rather have to pay 100% of the premium.
kellygreen
"Ideology is the Science of Idiots" John Adams
08:35 AM on 06/10/2011
How about you actually READ the law...and UNDERSTAND what it is that you are opposing before you go spouting off against it.

1. "Obamacare" is not a single-payor system. A single-payor system is truly SOCIALIZED health insurance system, where only the government is permitted to provide health insurance and pay for healthcare.

2. What "Obamacare" is IN REALITY....is a system with an individual mandate, and subsidized premiums. IOW, insurance companies are denied the rigth to refuse to sell health-insurance to the sick...and in return, all adults are required to have some form of health insurance. For those who do not have it provided as a work benefit...and cannot afford an individual policy...the government pays for part of their premiums....

...or taxes them an additional amount to help offset the cost of providing them coverage.

3. No one is shoving anything "down your throat". Because here's the reality. YOU ARE ALREADY PAYING FOR OTHER PEOPLE'S HEALTH CARE. Your taxes are going to pay for Medicare and Medicaid. About $1200 per year of the insurance premiums that your employer is paying for on YOUR behalf...goes to offset the costs of providing "emergency care" to the uninsured.
10:15 AM on 06/10/2011
So, its a good thing for gov't to subsidize premiums for purchase of private insurance? Then you support Rep. Ryan's plan to save Medicare? BTW, since you have read the ACA what do you think of the section calling for a commission to make a cost-benefit analysis of treatments to make "recommendations" regarding reimbursment and the Health Secretary's recommendation last year that the cost of mamograms for women under 40 do not justify the few thousand cases for which such screening allows early treatment (i.e. survival)?
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HUFFPOST SUPER USER
Grace Note
Is it just me?
08:26 PM on 06/09/2011
I hope the author is right. As flawed as the law is, it is better then what we had and a foundation to build on. IF employers opt out of insuring their employees then everyone will be forced to the health exchanges, the best plans will be selected and the majority in every state will be under the same plans, Then some tinkering can get done and it might result in Universal care like the Canadians have, where each province is responsible for their own health care plans.
08:01 PM on 06/09/2011
Interpreting individual citizens of the United States of America to be, for being alive and having potential to be attacked by germs or to meet accidents, engaged in commerce, as if breathing and eating are commercial activities, engaged in as mercantile trade and business, so they can stretch the Constitution's Commerce Clause to be a kind of over-arching net, in which all citizens may be trapped to drag them to be forced to be customers for a giant, and giantly profitable, nation-owning insurance industry, is wonderously astonishingly twisted legal thinking. It is duplicitous legalesian sophistry on a scale found in history only in medieval Roman Church Scholastical Canon Law Sophistries. The stuff that justificated the excesses of the Inquisition.

I am so impressed now that I am considering switching now from my previous opposition to looking forward to the mis-nomered "Affordable Healthcare Act" becoming law

Do you realize that about at the time it comes into legal effect approximately 60% of Americans will be in unable to afford adequate shelter and food for themselves, let alone afford to even WISH they could obey the new law.

Thus, in a single stupid swoop, the new "Vacuum in Every Wallet" law will turn over half of America into criminals. All subject to penalty liens in addition to backcharges, surcharges, etc. at least in the eyes of the present seditiously installed Government of the United States...
kellygreen
"Ideology is the Science of Idiots" John Adams
08:36 AM on 06/10/2011
Yawn.
09:10 AM on 06/10/2011
It already is in effect.
07:41 PM on 06/09/2011
All I can say is that we need more Judges like Judge Vinson! Finally, a judge says what we all already know... This law is unconstitutional, period!If we can be forced to by insurance today, what will it be tomorrow? Maybe guns, maybe a certain home, maybe a certain car, maybe a certain clothing item...The list is never ending. Besides, whoever thinks that just because you have health insurance, there are no bills to be paid is ignorant! I have very good insurance (That I've worked my tai;l off for) and it does not cover 100% of anything! I still must pay out of pocket. Get jobs, take responsibility for yourself, and stop expecting something be handing to you for nothing. You freebie today, costs someone else tomorrow!
01:12 AM on 06/10/2011
I suggest you actually read the Affordable Health Care Act then you would actually know what you were talking about. According to you, people shouldn't be required to pay for their health care. In that case, as a health professional, I should be able to deny you care if you can't pay.
01:37 AM on 06/10/2011
I would suggest that you go back and read my post. I never said people shouldn't pay for insurance. I said that having insurance does not mean that 100% of your medical bill is covered, hence, there is still out of pocket fees, and that people need to take responsibility for themselves and stop expecting others to it for them. I do know what I'm talking about... I agree... If someone can't pay, they should be denied care! I was saying that I pay my bills, everyone else should try paying theirs and stop expecting freebies by taking from a hardworking American and giving to those who refuse to work.
09:14 AM on 06/10/2011
However you dice it and slice it, it amounts to a tax. The government is allowed to tax people.

Some insurance is better than NO insurance.

Tens of millions of Americans WHO HAVE JOBS don't have health insurance.

There are a gazillion 'freebies', as you call them, occurring all the time! In Emergency Rooms all across the country. YOU and I are paying for that. And, believe me, it ain't 'free'.
07:18 PM on 06/09/2011
There is no where in the Constitution that healthcare is a federal responsibility. It is under the Tenth Amendment and is a responsibility of states or individuals.
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Brian Gilmer
Respect the bunny.
07:53 PM on 06/09/2011
Nowhere in the constitution does it say anything about political parties but there they are. The 10th Amendment basically says the same thing as the rest of the US Constitution. It is the reminder amendment.
kellygreen
"Ideology is the Science of Idiots" John Adams
08:44 AM on 06/10/2011
Anything that involves interstate commerce, the Congress has the authority to regulate. See Article I, Section 8, Clause 3 of the Constitution.

If you want the Federal government to have a more restricted role than that, then I suggest you amend the Constitution.

Otherwise, you are putting forward a baseless argument.
06:59 PM on 06/09/2011
There are some erroneous statements in this post. First, nothing in this law prevents insurance companies from jacking up rates. Even when full "reform" is implemented, nothing stops them from doing so and please don't try to tell me the regulations that state they'll have to justify the increase will actually be enforced by the regulators. We only have to look at the Financial Crisis and its aftermath to see the fallacy in that. Second, Judge Vinson ruling that the entire bill must be thrown out if the individual mandate is unconstitutional is not conservative judicial activism as much as it is wholesale political negligence on the part of Obama and Company. Since Congress intentionally left out severability language and the administration keeps insisting the individual mandate is crucial to make the other parts work, they have actually made the case for total repeal. You cannot simultaneously claim that the abominable mandate is critical but that the other parts shouldn't be repealed. The point is, the mandate is unconstitutional. The government has no right to insist upon commerce only to regulate commerce voluntarily initiated. Otherwise it is coercion. The fact that this administration chose to sell out real reform (Public Option, drug price negotiation, end to antitrust exemption) in favor of this corporatist schlock and then chose to exclude severability language in order to strong arm the court leaving the good parts of the bill vulnerable, should make people angrier than attempts to abolish the mandate.
09:18 AM on 06/10/2011
Yeh, but in the meantime, some states, e.g., Vermont are likely to experiment with different variations, such as a public option, and if that works well, other states will be pressured to follow (at least in theory).

I say that "at least in theory" part, because, if that is true, we would already be mimicing one of the methods of healthcare/insurance delivery in use in Europe, ALL of which are cheaper and ALL of which provide better outcomes in aggregate.

I guess that goes to show you that you can lead a horse to water, but you can't keep him from being his own rear end.
banana republican
Provoking Progressives with unwelcome perspectives
06:40 PM on 06/09/2011
It boggles the mind that, in the midst of a deep recession caused by a government sponsored social engineering debacle called 'affordable housing' (sub-prime mortgage lending), so many are willing to fall blithely in line behind another preposterous promise if it's given a sweet name like 'affordable healthcare'. We're reaching the tipping point where it can be said that 'You can fool most of the people MOST of the time.
09:19 AM on 06/10/2011
CDO's are a government-sponsored social engineering debacle?

Really?
03:15 PM on 06/10/2011
Except the "sub-prime lending" was being done by private investment banks (Wells fargo and Citibank being two of the top offenders). The subprime mortgage crisis arose from 'bundling' subprime and regular mortgages which they were traditionally isolated from, and sold in a separate market from prime loans. These 'bundles' of mixed (prime and subprime) mortgages were the basis Asset-backed securities so the 'probable' rate of return looked superb (since subprime lenders pay higher premiums, and the loans were anyway secured against saleable real-estate, and so, theoretically 'could not fail'). Then the borrowers suddenlt hit the high payemtns segment of their ARM loan and started defaulting at alarming rates, making the asset packages tank.

http://www.huduser.org/portal/datasets/manu/subprime_2006_distributed.xls