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Supreme Court: Affordable Care Act Is Constitutional
This morning the U.S. Supreme Court ruled 5-4 that the Affordable Care Act is constitutional. The health insurance mandate, also known as "Obamacare" was found to be "permissible under Congress's taxing authority." The full ruling (PDF) is now available, and the court's opinion begins on page 7. Amy Howe from SCOTUSblog summarized the ruling thus:
"The Affordable Care Act, including its individual mandate that virtually all Americans buy health insurance, is constitutional. There were not five votes to uphold it on the ground that Congress could use its power to regulate commerce between the states to require everyone to buy health insurance. However, five Justices agreed that the penalty that someone must pay if he refuses to buy insurance is a kind of tax that Congress can impose using its taxing power. That is all that matters. Because the mandate survives, the Court did not need to decide what other parts of the statute were constitutional, except for a provision that required states to comply with new eligibility requirements for Medicaid or risk losing their funding. On that question, the Court held that the provision is constitutional as long as states would only lose new funds if they didn't comply with the new requirements, rather than all of their funding."
Further coverage is available from CNN, the NY Times, and Fox.
If you don't do what the government wants, you will find a new "tax" will appear to make you do it.
What ever happened to the public option? You know, cutting the profit motive out of funding health care, so that people do not have to fight with their insurance companies or with hospitals just to get the treatment they need?
Palm trees and 8
Medical insurance is not only incredibly frustrating to deal with, but a huge unnecessary expense in the system.
Quite surprising to see Roberts cross the aisle on this decision. For all of its flaws (and there are many), the Affordable Care Act is a step in the right direction. Health care is one of the major issues of our time, and it's not realistic to suppose that a single piece of legislation can resolve it.
I'm already taxed for not having a mortgage, not producing "clean" coal, not having children, and numerous other things that we as a culture have decided should be incentivized. The former two items in your list would be a clear violation of the first amendment, which this case did not rest on, whereas the third would be constitutional(but also kind of silly).
You were already doing that before, partly through your taxes, partly through effectively paying higher amounts to hospitals, in order to compensate hospitals for the all the ER visits they get from people without insurance (and thus likely never pay). You potentially could have ended up in the situation you were worried about if the Supreme Court struck down the individual mandate, but kept the rest of the law.
Nonsense.
There are all sorts of contingent taxes.
Probably so--the individual mandate was a Republican idea to begin with.
I admire the Democrats for helping to tackle health care reform. There are some really good things in there--preventing insurance companies from rescinding coverage, allowing parents to insure kids up to 26, etc. But as a Democrat, I have mixed feelings about today's decision. I do not like the individual mandate, as like you, I feel that Congress shouldn't have the power to make you buy something from a private company.
I was actually hoping that the law would stand as-is, except for the individual mandate, which I was hoping would be overturned. At that point, insurance companies would be screwed--they'd still be forced to cover those that they traditionally worked so hard to drop off the rolls, but without money coming in from those who are statistically healthier and less likely to pay for insurance. At that point, one of two things would happen: either 1) the insurance companies would lower prices on their policies to reasonable levels to be more conducive for healthy people to buy, or 2) the insurance industry would basically petition government to expand Medicare to cover those that they don't want to. Either way, it would be win/win.
Ultimately, the only answer is a single-payer system. As long as you have private companies in the insurance business, there is a perverse incentive to screw their customers over. People whine and complain about government's incompetence, and I'd never say there's no waste or that government is perfect. However, I trust government a hell of a lot more than I trust the insurance industry, which has proven time and again that they're scum.
For political reasons, it couldn't be called a tax. The Supreme Court wasn't impressed by the semantics.
I don't practice what I preach because I'm not the kind of person that I'm preaching to.
Wow, are you likely to get an earful over this. Here's my perspective (not a neutral one):
The "individual mandate" part of the Affordable Care Act (ACA) requires you to carry health care insurance. However, supporters claim that because the risk associated to insurers is now spread out over a much larger segment of the population (those who would normally decline health insurance are obviously less likely to need it), the cost to individuals in terms of premiums is likely to decline. In other words, they're betting that the cost of your insurance is likely to decline. Personally, I think that's likely... for insurers, anyway. Whether insurers pass these cost savings to individuals is a craps shoot. When Massachusetts (under, ahem, Governor Romney) passed a law with an individual mandate, premiums fell something like 40% at the same time that it was rising nationally.
Another big part of the bill is the "pre-existing condition" clause: basically, an insurer cannot deny you coverage because you already have a medical condition that they don't want to cover. There was some worry among ACA boosters that the court might strike down the "individual mandate" part without the "pre-existing condition" part, which would have been catastrophic to the risk pools: seven states have tried passing pre-existing condition laws without the individual mandate, and it went very badly for all of them. So if it turns out that you come down with some kind of chronic or severe condition, it can no longer be used as a reason for an insurer to deny you insurance.
I assume to know who will get 'taxed' on this? There are swaths of exemptions, eg if you already have your own insurance you won't to pay the monthly $286 per family tax, military is exempt, VA exempt, religious organizations who oppose are exempt, the poor are exempt etc. The people who the tax is targeted at are those who can pay but refuse because they'd rather be parasites on the rest of us who do pay, such as yourself I can only assume.
is they can't get cheap preventive care
now they can
so they get $100 worth of care and stay healthy and stay working, rather than $100,000 worth of care later when they are already sick, because they don't have the financial resources to attend to their healthcare
sanity prevails
thank you justice roberts, you have a human conscience
we'll talk about the citizens united thing later
intellectual property law is philosophically incoherent. it is your moral duty to ignore it or sabotage it
You'll be subsidized if you can't afford it. Otherwise, it's pretty much like car insurance, so was the game already over decades ago?
"Obamacare" has a provision that forces insurance companies to spend at least 85% of their premiums on providing health care and limiting overhead to 15%. So even if the companies raise their premiums they're still stuck with spending it instead of just increasing profits. So any increase in premiums is probably related to increases in the underlying cost of health care. That may go down some or at least stop increasing so fast since there will be less unpaid for care in the first place. Did you know that about 60% of personal bankruptcies in this country are due to medical bills? Hopefully that will drop too.
You don't have to buy health insurance either. You will simply pay 2.5% more in income tax up to an extra $2,085 per year. But nobody is forcing you to purchase health insurance.
No sigs in BETA. Beta SUCKS.
You'll be subsidized if you can't afford it. Otherwise, it's pretty much like car insurance, so was the game already over decades ago?
Biggest piece of social legislation since FDR and it survives, which means we start moving people back into healtcare. Back when I started my first full-time job, the healtcare coverage was excellent and 60%+ americans had healthcare coverage though their employers. Then we dropped to about 30%, with ever increasing premiums and deductables, further, the grantors of coverage were weeding out the expensive applicants because of Pre-Existing conditions (and we now have technology available for them to spot people higher risk of certain conditions, that's stacking the deck against people if ever it were.) Now, with the full weight of law we return to First World Status, looking after our people (even if some don't think they want it, everyone really does benefit in one or more ways here.)
While I felt it was a Frankenstein bill, when going through the House and Senate, because one party chose to hold their breath until they turned blue rather than participate (even with provisions they once championed), we at least have something.
A feeling of having made the same mistake before: Deja Foobar
exactly. it's a religion based on myths that depends upon human beings behaving in ways they never have and never will. there is no such thing as a self-regulating marketplace. to be truly free and fair, a marketplace must be regulated. if it is not, the biggest players abuse the smaller ones. always have, always will. in societies with strong governments and regulated marketplaces where the largest players still get away with murder, this is a corruption of our government by those large players that is an argument for curing the sick patient, our government, rather than removing it and handing over the car keys to the sickness that is our enemy: entrenched rent seeking parasitical financial interests
intellectual property law is philosophically incoherent. it is your moral duty to ignore it or sabotage it
doing those things, then why shouldn't you have to pay it?
Or do you think the rest of us should have to subsidize your desire to save a few bucks by destroying the earth and not pay a cent for your health care? Because I guarantee that when you have some devasting health problem you will show up at an ER and demand quality care.
You'll be subsidized if you can't afford it. Otherwise, it's pretty much like car insurance, so was the game already over decades ago?
Seriously?
Please name me the US Federal Government Car Insurance Mandate. Oh wait, there isn't one... because the Federal Government mandating car insurance would be unconstitutional. A mandate for car or health care insurance is properly the right of States, not of the Federal government.
Even 5 Supreme Court justices said the US Federal Government Medical Insurance Mandate is unconstitutional. The only reason this slid by is because A) CJ Roberts wanted to use this as a platform to tell Congress to quit using the SC as an alternative to a vote to repeal, and B) magical hand-waving by which the practical implementation of a tax burden to cover health care was enough to not strike down the underlying theory behind the Affordable Care Act.
Obama and the Democrats were idiots for not implementing the "insurance individual mandate" as a tax break / monetary payout to buy health insurance anyways. They could have avoided this entire debate by doing so.
Light a fire for a man and he'll be warm for a day. Light a man on fire and he'll be warm for the rest of his life.
Look, shit head, if you want to have that attitude, then wear a big wrist band that says "DO NOT PROVIDE ME WITH MEDICAL CARE UNDER ANY CIRCUMSTANCES". Add something about religious beliefs or some such nonsense so that when you get in an accident/get seriously sick/have a heart attack/whatever, you aren't forced into participating in the health care system to which you do not want to contribute.
The difference here between health care and auto insurance is that you can opt out of owning a vehicle and driving and not increase the cost for the rest of us. You can't opt out of ever getting sick or injured or otherwise needing medical attention for your entire lifetime. Society generally will not allow you to bleed to death on the side of the road just because you refused to pay for health insurance (or pay the fine/tax imposed by the new law). So whether you like it or not, you *are* participating in the health care system, and you *are* being a selfish asshole for refusing to acknowledge that.
And irony of ironies, getting yourself thrown in prison for refusing to pay for health care (or aforementioned fine/tax) provides you with a government-paid health care plan.
gasoline is already taxed (eventhough this tax doesn't cover the full society cost of gasoline): so isn't that tax an unfair imposition on your freedom in the same way that this health care tax is?
> If he doesn't have a tankless heater, he's the one paying the gas bills for the heater.
> If he doesn't have a programmable thermostat, he's the one paying the utility bills.
The taxes on those items don't cover their societal cost. If you think they do then you are naive.
> Yes, you mentioned the ER. The fix to that isn't to impose insurance, it's to remove the requirement that the ER treat those who won't pay their bills.
Now you've crossed from naive to stupid. I would bet every dollar I have that your opinion on this changes as soon as you or a loved one is in the position of needing emergency health care.
Or maybe we notice exactly what is going on, and since we voted Obama in, are quite happy with it. It's a grand day for those of us who voted in Obama...or maybe you forgot we exist?
Otherwise, it's pretty much like car insurance, so was the game already over decades ago?
Of all the lies spewed about this law, this is the most disingenuous. You can choose not to drive. Unless you put a gun to your head, you can't choose not to live.And that's precisely what this law is: a government mandated fee (NOT a tax, that's also BS) for simply being alive.
Life is hard, and the world is cruel
Except that it isn't public health care. It is private health care, mandated publicly. You'll notice private companies handle health insurance like Aetna, Blue Cross, and so on. And they still will. These companies are not going away.
Which is, ironically, why this legislation sucks.
Americans pay 16-18% of our per capita GDP in health care costs. France and Switzerland, the two consistently highest rated health care systems on planet Earth, which both offer true universal coverage to all their citizens, cost their people around 11% of per capita GDP.
You will not hear these numbers being touted by Democrats, Republicans, or the media. It isn't in there interests for you to understand how bad things have really gotten in the USA.
Public health care similar to socalled "Obamacare" is commonplace in most of Europe, where the costs are lower and quality is higher (citation needed? LMGTFY).
Why would costs rise and quality decrease in the US? Is there something inherently wrong with the US that they can't make this work as well as in Europe.
Slashdot social media options: AIM, ICQ, Yahoo, Jabber and Mobile Text. Why no MySpace?
When they can force you to buy something from a private company, game over.
Well of course they're not actually forcing you to buy anything. They're just taxing you if you decide to be an irresponsible fuck and plan to freeride on the rest of us if you ever get sick. But don't let reality get in the way of your paranoia.
Do you think part of this may be that the French and Swiss are on average much healthier than the typical U.S. citizen? Since our average population is so incredibly unhealthy the overall risk to insurance companies is much higher, causing costs to rise for all involved.
I'm not stating this as a fact, but asking the question.
Oh I agree. But even the little baby steps we're taking with Obama's health care reform act are being met with all kinds of illogical resistance. It boggles me. People standing in the streets with signs wanting to repeal Obamacare. Even though it has provisions like how you can't be dropped or denied for a pre-existing condition. How in the world could someone be against that? I could see a CEO of a health care company not liking it, but the rest of us? How?
We're so screwed up in this country that you can actually get nearly half the people in the streets shouting that this is a bad idea. I have no idea how you accomplish that, but there you go.
So yeah, anything more invasive like what France has and it's ARRGH SOCIALISM and people would totally lose their minds. Even though it would be in their best interests.
Weaselmancer
rediculous.
Well, with Obamacare, NDAA, PATRIOT Act, DHS/TSA, etc etc etc now a fact, your first line about driving becomes:
Remember, in the New USA your continued existence as a non-imprisoned and still-living, breathing, human being is a Privilege, not a Right and can be revoked at any time without due process.
I weep for my country, for it is dead. We now have a "ruling regime", not a government of, by, and for the People. And because I know God is just, I also tremble in fear for my country.
Strat
More hysteria -- I often wonder where such thinking comes from. Now I've got a front row seat.
A feeling of having made the same mistake before: Deja Foobar
And you still didn't prove the "right to drive"! You have the right to use the highways, you have the right to move around freely, in neither of the cases you cited does it ANYWHERE say a person has the "right to drive a motor vehicle".
People do not like not being excluded due to pre-existing conditions.
People do not like being force to buy insurance.
Sorry, you can't have it both ways. Otherwise young healthy people wait until they have a problem and then expect to start paying the same rate as everyone else. The function of insurance is to amortize the costs of unexpected (randomly occurring?) events over time and over population. This is broken both by people selectively participating and by companies selectively allowing people to participate. You must eliminate the cheaters on both sides or you really screw one side.
Not passing judgement, just pointing out one of the fundamental issues this law attempts to address.
Well two things.
First thing, if you don't have health insurance and you get sick, who pays? That's right - I do. And everyone else who contributes to the system. But you don't. It's not fair.
Second thing. Health insurance just got a whole lot less scammy now that the reform act is in place. Go read it - you'll see. There's a ton of lousy crap they're not allowed to do now.
Weaselmancer
rediculous.
You could brand that on your forehead but if you are unconscious they are obligated to save your life. DNR (Do Not Resuscitate) orders have to be given to ANYONE that could be called to make decisions, this typically means, spouses, parents, children and filed with every single hospital, clinic, ambulance or EMT service you could be serviced by before they would even consider obeying them.
The immense liability of allowing someone to die absolutely guarantees that unless there is someone there with notarized copy of the DNR AND a family relationship that would grant power of attorney that the order will be ignored. Until you deal with this and an elderly or terminal patient you don't realize how hard it is to get medical personal to honor this request. (I understand why, if the document was fake the medical personal would still be liable).
Son, if all it takes to "trample" the "principles upon which the nation was based" is a law that requires people to have medical insurance, then those were some weak-ass "principles" to begin with.
Now, if you can get up off the fainting couch and stop clutching your pearls for a minute, you might realize that the exact same hysterical sisters were claiming that Social Security was also going to "trample the principles upon which the nation *was* based". And still, the greatest decades of this Nation's history followed that law, too. We ended up as a stronger nation, with more enduring principles because we decided that we were going to make sure that people didn't have to eat cat food when they got old.
Maybe take a minute and realize I'm trying to talk you down off the ledge here. The "principles" that hold this country together were never "The Constitution" or some Burkean fantasy of the Right. The principles that have always held this country together are the ones that say, "We're all in this together" and "Let's get this done" and "Things work better when people aren't selfish assholes".
Until that sinks in, stay in your bunker. I'll knock twice when the zombie health care apocalypse is over and you can come out again and go back to getting your health care from the emergency room. It's really not healthy to live your life in such fear and dread, you know.
You are welcome on my lawn.
You answered your own question: USA *has* world-class healthcare for the most affluent people, those who have top-notch insurance or can afford to pay.
But on the *average* US healthcare is both more expensive, and poorer than that of all other similarly wealthy democratic countries I can think of. This makes a lot of sense: benefits of healthcare is diminishing-return, i.e. you get more additional health by spending $1000 more on someone who has no or very limited access to healthcare than you get by spending the same $1000 on someone who already have very good healthcare.
USA does the latter. The very good are turned into EXCELLENT. That's fine and good for those people who belong to that segment.
Meanwhile most other wealthy democracies are much better at turning poor into good. And this gives more benefits for less money. You do more for public health by going poor to good than by going very_good to excellent, it's also cheaper.
The main reason USA doesn't have socialized healthcare long ago, is that essentially all of the people with power and influence in USA belong to the "very good" category. For *them* it makes perfect sense to prefer very good to excellent instead of poor to good.