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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.
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
Which is counterpoint to granting tax breaks to get people to do something.
If you don't do what the government wants, you will find a new "tax" will appear to make you do it.
Yes, especially when the government (AKA "we the people") wants you to stop freeloading on the health insurance system we're paying for.
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.
Which is counterpoint to granting tax breaks to get people to do something.
Carrot or Stick, you have your choice.
Don't like it? Blame those broad powers granted through phrases like "provide for the general welfare" in the Constitution.
A feeling of having made the same mistake before: Deja Foobar
Most people don't know what's in the ACA.
Most people like what's in the ACA.
What doesn't kill you only delays the inevitable
typical americans. like everything about it except the bill. I'm in favor of everything about it except that "I have to pay for it" part....
I work for the Department of Redundancy Department.
This is no different than a "tax break" for mortgage interest, or any other similar tax break, which is just a tax raise for the rest of us (i.e. people who rent their homes and therefore don't get the mortgage interest deduction) If the government can raise your taxes for not having a mortgage, it follows it can raise your taxes for not having health insurance. The Supreme Court decision is logical given prior precedent.
carrot for the top 1%, stick for the rest.
Yes, I'm left. You have a problem with that?
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.
Taxation has always been an instrument of social engineering how a society operates. By any other name, it's a behavior modifier. The fact many of you don't already know this is quite frankly, scary as hell!
Life is not for the lazy.
or bailing out banks ? "there is money for banksters, but not for sick people - just let them die!" *applause*
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.
I have health insurance. It is not a tax on me. It is a tax on the irresponsible Americans who decide to leech off of the system instead of getting health insurance. If you get sick (or in an accident) and do not have health insurance then I have to pay for it (the hospital will still treat you, and the costs will be passed on to me as higher premiums when you cannot pay and file for bankruptcy). So yes, it is a tax on dumb/irresponsible people.
When put that way, this starts to sound like a really good idea. Maybe we can find a way to expand it to other areas.
Yeah, this is a loser for all Americans. The majority of the country didn't want this legislation. It was voted down in congress and they had to resort to some trick to pass it. The entire time the Obama Administration kept saying that this was NOT A TAX ... that it was a Mandate. Now the SCOTUS says that it is unconstitutional as a Mandate, but it's ok at a TAX. So the bill that was passed was not only against the wishes of the majority of the people, it doesn't even work the way the minority said it would when it was voted upon.
Not really factually correct. A majority of Americans like a majority of the acts of this law. The 'no preexisting condition' portion is particularly popular as is the 'no lifetime maximum' and the 'no copay for preventative care' portions. The one part that more unpopular with most people is the 'must buy insurance part'. But the rest of it doesn't work without that.
"There are laws that enslave men, and laws that set them free. " - Sean Connery as King Arthur
Healthcare should be disconnected from employment....
Light travels faster than sound. This is why some people appear bright until you hear them speak.........
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?
While I agree that not having health insurance is really risky and dumb, taxing someone for not buying / wanting something goes against freedom.
It's only freedom if no-one else has to pay when you get sick or are in an accident. Otherwise you are just saving yourself some cash at other people's expense, taking away their freedom.
const int one = 65536; (Silvermoon, Texture.cs)
SJW, n: "Someone I don't like, and by the way I'm a fuckwit" - AC
If you thought that your premiums were not going up over the next two years anyway I have a bridge to sell you.
No, you don't. If you're in a low enough income bracket, you don't have to pay the penalty, and in fact get a subsidy to purchase insurance.
These aren't mysterious hidden details, unless you spend all of your time watching Fox News. They've been right up front about this the whole time. It amazes me how much general ignorance there is about the Affordable Care Act. There are legitimate gripes about the bill, but usually the people griping about it are just spewing complete bullshit like Grishnakh and sycodon here.
--Jeremy
Jesus was a liberal
Apparently you haven't been paying attention. Health care has gone up in cost every year, well over the cost of inflation. The only difference is that this year your insurer has a convenient scapegoat.
--Jeremy
Jesus was a liberal
This is about taxes. "General welfare" or "regulation of interstate commerce" (which was rejected) don't apply. If congress wants to tax people who don't enter into a business agreement with a third party, they can (and, did).
This specific part is about fixing the pre-existing loophole that someone who decides not to pay for insurance but piggy backs on the healthcare system by using the ER (which is more expensive than regular visits and pushes the burden on the rest of us through higher medical and insurance costs). As costs got higher, more and more people made this decision (or it was made for them). This isn't the primary reason for health care costs going up, but it's contributing to it.
At some point in time, this gap was going to need to be filled in some way (otherwise you and I will continue to pay for their insurance). I would have preferred a carrot rather than a stick (or a stick disguised as a carrot), but I personally can't think of a better solution. Can you?
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
Yeah but then we will have to -- gasp -- cover the medical expenses of people who are just above the poverty line (and think of how terrible it is that we cover the costs of people who are below the poverty line!).
The popular sentiment these days is that everyone should just fend for themselves, compete with each other as vigorously as possible, and those who are unable to compete do not deserve to live in our society. The entire outlook can be summarized in just three words: greed is good.
Welcome to America!
Palm trees and 8
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.
that's awesome
so when you break your arm, and you have no insurance, and you go to the hospital, and avoid the bill because you don't have a $50,000 healthcare fund in your checking account and you live paycheck to paycheck like most americans, the rest of us will have to pay that $3,000 to fix your arm
to people like you, freedom means freedom from responsibility
you're a freeloader
go ahead, vote for romney. and if enough vote for romney for the same reason, that they don't want to take responsibility for financing their own healthcare, then this country is doomed to ever increasing healthcare costs
i however have faith that most americans are more intelligent and responsible than you are, and with single payer, we will eventually bring our healthcare costs in line with most other modern countries in this world, who have unviersal healthcare, and spend far less per capita than the usa does. because how they finance their healthcare system is predicated on common sense and economies of scale, and not predicated on satisfying corporate rent seeking parasites like healthcare corporations, whose talking points you apparently swallow hook line and sinker like a good little faithful propagandized moron
intellectual property law is philosophically incoherent. it is your moral duty to ignore it or sabotage it
You don't get it. The "mandate' or more appropriately described tax penalty is accompanied by tax credits which means if you truly cannot afford the premiums, they will be partially or fully offset by a lower withholding from your paycheck or even a tax refund beyond withholdings for the extremely poor. If you can afford it, you should have insurance lest you offload your emergency care costs and overall higher cost of servicing to those who do. You are not required to but if you don't, it is entirely reasonable you pay a tax to support the higher cost of service you are imposing upon the rest of us.
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You notice how much of the criticism of the law comes from sheer ignorance about what it actually does? Even on Slashdot.
Check out my world simulator thingy.
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.
You've got two choices.
Choice 1) You need hospitals and doctors who will throw you out and let you die if you can't pay for your care, and will do a credit check or check your bank account before they begin providing care.
Choice 2) Some form of universal insurance, whether it's a 'tax', an individual mandate in a private system (What we have now), or a true public option (More like what you have in other countries).
There is no other option. Medical care isn't free. Someone has to pay for the doctors, for the drugs, for the operating rooms, for the sterilization, all of it. This is not a theoretical problem, either. We've waited long enough with our current slapdash system - where the insured subsidize the uninsured - that it's already in the midst of collapse, and is slated to collapse within 15 years. The bills are too high. Giving care to everyone without insurance for everyone is just wrecking us, especially because the only care you get while uninsured - emergency care - is the most expensive kind.
Do you want to die on the hospital floor, do you want to be forced to show the minimal planning that health insurance -is- (Providing for your ability to continue living), or do you want to continue to throw a tantrum like a five-year-old?
Why, with all that extra money, you could pay to send your kids to school, hire a policeman to protect you, hire some firemen to keep your house from burning down, build some roads (if you can get your neighbors to chip in)...
-- Sent from a computer.
You really think the cost of losing weight is more than the cost of being obese? Really?
I live ze unknown. I love ze unknown. I am ze unknown.
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.
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.