Political & Elections

Cardinal Fang · Senior Member

RE: Judge Calls Health Law Unconstitutional

SamuraiLandshark · Guru

But they are doing that right now, Cardinal. They may not be able to in 2014, but have open season on denying coverage to folks until then. In 2014, they will have to take everyone and who knows what their premiums will be jacked up to by then.

New insurance companies that spring up during 2014 and later won't have this option, but in the meantime, it's open season on denying coverage and probably will remain so in the next three years.

So what happens when everyone gets insurance? Will they get the highest level of treatment for their maladies? The rationing of care is the only logical solution.

Cardinal Fang · Senior Member

Soon, everyone will have to have insurance. The question I ask is, can they afford the premiums? Will the insurance companies be able to continue recission and denying coverage for treatments when you get sick?

At the very least, they won't be able to rescind-- because having a pre-existing condition that wasn't disclosed won't be grounds for recission. That is, the insurance companies will have to take everybody.

Now let's think about the affordability of premiums. As of 2014, everyone of the same gender and age will pay the same premium for health insurance from an insurance company-- whatever that premium turns out to be. Let's be like conservatives and consider market forces-- remember, the individual mandate was originally a conservative idea, precisely because market forces can lead to optimal pricing.

Suppose I'm setting up an insurance company, FangCo. I want to figure out what premiums to charge women who are 50 years old. I'm soulless, and just want to make money. How can I do this? Right now, what I want to do is make sure I only sell insurance to women who aren't sick, so I can take their money but not give them any care. If one of my insured women does get sick, I want to stop giving her insurance so I don't have to pay. If a woman who has previously been sick tries to buy insurance from me, I'll charge her a lot of money, because I think she'll cost me a lot. And that's just what current insurance companies are doing.

But FangCo is starting up in 2014, after ACA has come into force. So I can't cherrypick, and only sell insurance to well women and avoid sick women; that's illegal. And I can't charge a lower price to well women; that's also illegal. Fortunately for me, everyone is required to buy insurance, so I have a guaranteed market. Unfortunately for me, they're not required to buy my insurance. Also, unfortunately for me, I can't get together with all the other insurance companies and agree that we'll all charge high prices, because we are now legally required to use something like 85% of premium money to actually provide care for the people we insure.

What if I write some bogus insurance, that is dirt cheap, but only insures against hangnails and dandruff? Healthy people could buy it instead of real insurance, and I'd rake in the bucks! Oops, no good. People are required to buy actual insurance that insures against actual illness.

So my incentive is to figure out a way to charge lower premiums than the other guys, and yet provide care. I need to figure out a way to provide the same care for less money. And that's just the incentive we want insurers to have. They can't just randomly charge high premiums when everyone else charges lower premiums, because no one would buy their insurance. They can't all charge high premiums and pocket the profits, because they're required to use the premiums to provide care for the insured.

SamuraiLandshark · Guru

Yes, they can be sleazy bastards.

And yet, in the infinite wisdom of those drafting the bill, they did nothing to prevent the companies from continuing these practices. Yes, they will have to take everyone in 2014. That is a plus.

Soon, everyone will have to have insurance. The question I ask is, can they afford the premiums? Will the insurance companies be able to continue recission and denying coverage for treatments when you get sick?

If they can find a loophole, they will.

Cardinal Fang · Senior Member

I have another quick comment about insurance companies.

A few weeks before the Affordable Health Care Act was passed, we saw an expose of shady insurance company practices. For example, we discovered that Wellpoint, a large insurer, had a policy of trying to rescind the policy of every single woman who developed breast cancer. As soon as the woman was diagnosed, a heartless clerk would go through her records, trying to find the flimsiest pretext to cut off her insurance just when she needed it most. And they did, indeed, manage to rescind many many women for ridiculous, trivial reasons or no reason at all.

That's just one example of typical industry practice. Recall, also, that the executives of the top three insurance companies testified right in Congress that they had no intention of stopping their cruel and often fraudulent recission policies.

So, we knew well before ACA was passed that insurance companies were carefully, and sometimes extra-legally, doing everything they could to avoid insuring anyone who might get sick, and cancel the insurance of anyone who was so bold as to get sick.

Now, they are continuing to do the exact same thing, but now they're blaming it on ACA. They're sleazy liars. They were going to do this anyway, whether or not ACA was passed.

Cardinal Fang · Senior Member

The execution of this entire thing is incredibly faulty. 1. start taxing for years before providing benefits.

Wait. What tax are you talking about? No tax has been imposed as of now.

ACA will (in 2014) require everyone to buy health insurance. If you don't buy insurance, you will have to pay a fine. Some people call that a tax, but in any case, it is not in force right now.

For years, insurance companies have been dumping people who get sick, often using ridiculous pretexts. She didn't tell us she had acne! Dump her! He didn't disclose that as a nine-year-old he got hit in the head with a soccer ball! Dump him! They have been refusing to cover people with pre-existing conditions-- and the pre-existing condition could have been something as normal as having had a Caesarean birth.

Insurance companies are continuing with their sleazy ways, but now they're blaming it all on ACA. Well, maybe insurance companies are even more sleazy now, but they were already extremely sleazy. It's untrue that "Absolutely NO method to "keep insurance companies honest" is in place right now;" the ACA contemplates insurance companies trying to sleaze around the law, and Sebelius and the Department of Health and Human Services are on the case. It may be true that they are not doing enough.

SamuraiLandshark · Guru

The prevailing consensus from the insurance agents I spoke over the last several months (I have dealt with three), that the insurance companies are dumping even slightly risky patients in the underwriting process. Women tend to have more potential for this than men. Why? Women seek care at higher levels than men, and women between the ages of 35 - 60 can have potentially expensive health issues. If it has the potential to be expensive, they don't want to care for you. If they do write a policy, it will be uprated if you have had certain issues over the last 5 years (it's a huge list, btw.)

Previously, you might have been underwritten, but with a rider for a certain amount of time. No care for that particular recurring ailment until the waiting period was up. If after so many months you haven't had problems with that issue, than coverage would resume at full force.

Some of the major insurance carriers also limit the maternity care you receive. If you bought a policy and get pregnant within a waiting period, you may not be covered, at all. I saw policies that had a 6 month waiting period.

If you have group coverage from large employers, most of these issues won't affect you. It's the individual and family market that seem to have these kinks. There should be the ability for individuals to buy into a larger group. Even the alumni associations that both my husband and I belong to allow you to get "discounts" when buying from their agents, but it's not group coverage.

Seems to unfairly target small businesses, or those - like mine, that are sole proprietors. Until I can get two full time employees, I am out of luck on that market.

What was it like before? We had individual coverage for several years when I had my daughter and for about five years after that. Prices were fair, service was great and no issues in underwriting, even though I had a son with moderate to severe asthma, my husband had a chronic back problem, my other son had a history of a heart problem and I was of childbearing age.

There is absolutely no way that my family would have been underwritten today with those ailments.

What's changed?

Has actuarial science changed that much in the last decade? Or has care gotten more expensive? What role has the new law made in these changes? Are the insurance companies seizing on the opportunity to gouge patients or deny coverage to protect their bottom line?

My situation isn't unique. I have several friends IRL dealing with these same challenges.

poetgrl · Senior Member

The execution of this entire thing is incredibly faulty.

1. start taxing for years before providing benefits.
2. Absolutely NO method to "keep insurance companies honest" is in place right now.
3. They are raising the rates at exponential levels in order to be "ready" for the whole thing.
4. No public option.
5. Politicking in order to "not call it a tax" so that we have all these legal battles which may mean we have to go back to the drawing board and will end up with nothing but higher insurance rates (the insurance companies will never lower their rates.)

Regulation of insurance companies is what we should have started with if this was the kind of thing we were going to do. Otherwise, the only way this really works is with a public insurance option like the options offered to public employees. There is no reason, AT ALL, that US citizens should not have been offered the opportunity to participate in the pools of state and federal employees. The execution is horrendous and way more complicated and political than it needed to be.

If you think it was a good solution, more power to you. I simply think it is a mess, which, so far, benefits nobody but insurance companies, pharma companies, and the public employees who will be hired to police the industry compliance. Effectively, we have a program which raises rates and creates less choice.

Cartera · Guru

It is currently MORE difficult to get individual health insurance with a pre-existing condiition than it WAS.

How so? What was available to those with pre-existing conditions before that was better?

poetgrl · Senior Member

Anything which makes something more expensive without providing any actual services makes something worse. Whether it is worse in the long run or worse in the short term (though who would call three years in terms of health insurance short term is someone who is being disingeniuos)

It is currently MORE difficult to get individual health insurance with a pre-existing condiition than it WAS. It is only possible if you have been uninsured for 6 months....gread Samurai...please buy an oxygen bubble and wear a helmet...thankyouverymuch.

More expensive. Less services. Worse.

Acting as if this is not the case is just playing a game. Even Obama knows this. Plus, since nothing has been actually implemented but the taxes this year, who even knows what we'll really "get"

The bill is impossible to read. I've tried. I am happy to report, however, there IS money for parks in some states.

Cardinal Fang · Senior Member

I'm not understanding how ACA made things worse.

SamuraiLandshark · Guru

I think you might be mistaken, Cardinal. These pools have been around for a long time. They aren't great, but they didn't just go into effect.

There is a separate plan that did go into effect in 2010, but it's the one that requires you to be uninsured for 6 months before you are eligible to apply. It's actually being under-utilized. I believe it's because of this requirement to be uninsured for that long.

From wiki:

State risk pools

In 1976, some states began providing guaranteed-issuance risk pools, which enable individuals who are medically uninsurable through private health insurance to purchase a state-sponsored health insurance plan, usually at higher cost. Minnesota was the first to offer such a plan; 34 states^[which?] now offer them. Plans vary greatly from state to state, both in their costs and benefits to consumers and in their methods of funding and operations. They serve a very small portion of the uninsurable market—about 182,000 people in the U.S. as of 2004,^[16] and about 200,000 in 2008.^[17]

These risk pools allow people with pre-existing conditions such as cancer, diabetes, heart disease or other chronic illnesses to be able to switch jobs or seek self-employment without fear of being without health care benefits.^[18] However, the plans are expensive, with premiums that can be double the average policy, and the pools currently cover only 1 in 25 of the so-called "uninsurable" population.^[19] Additionally, even plans which are not expensive can leave those enrolled with little real health insurance beyond "catastrophic" insurance; for example, one insurance plan through Minnesota's high-risk pool, while costing only $215 per quarter, includes a $10,000 deductible with no preventative or other health care covered unless and until the enrollee has spent $10,000 of their own money during the year on health care.^[20] Very sick people can accumulate large medical bills during mandatory waiting periods before their medical expenses are covered, and there are often lifetime expenditure caps (maximums), after which the risk pool no longer pays for any medical expenses.^[21]

Efforts to pass a national pool have been unsuccessful, but some federal tax money has been awarded to states to innovate and improve their plans. With the Patient Protection and Affordable Care Act, effective by 2014, it will be easier for people with pre-existing conditions to afford regular insurance, since all insurers will be fully prohibited from discriminating against or charging higher rates for any individuals based on pre-existing medical conditions.^[22]^[23]

[edit]

-- Edited by SamuraiLandshark on Saturday 18th of December 2010 10:47:32 PM

Cardinal Fang · Senior Member

Before ACA passed, you couldn't get health insurance if you had a pre-existing condition. Now, some people with pre-existing conditions can get individual health insurance but many can't. When the ACA comes into force in 2014, everybody with a pre-existing condition will be able to get health insurance, at the same price as people with no pre-existing condition.

SamuraiLandshark · Guru

It's not really more "access" if you can't get insured with fairly minor medical issues, is it?

Or if you can't afford it, if you do qualify?

Or if the provisions of the bill allow those who have NO insurance for 6 months to buy into a group plan, without allowing for those who have not lapsed to NOT purchase this plan.

With no cost provisions and a captive audience, it will be even harder for people to buy insurance as the implementation of this plan continues.

If you don't believe me, talk to an insurance agent. Health insurance companies are dumping sick people or not insuring them in advance of the full scope of the legislation.

In the next few years, it will be increasingly difficult to buy individual plans unless you have a spotless medical record for the last five years.

Any time you go to a doctor and they recommend a treatment - even if you don't take it - it's part of the record. Every time you get a prescription or blood test or MRI, that's part of the record. It may disqualify you for individual insurance. Things will change in 2014, but we have to get to that point first.

Cardinal Fang · Senior Member

But how does this limit your access, compared to what you would have had if ACA hadn't passed?

SamuraiLandshark · Guru

Effective June 21, 2010

Adults with pre-existing conditions will be eligible to join a temporary high-risk pool, which will be superseded by the health care exchange in 2014.^[51]^[56]To qualify for coverage, applicants must have a pre-existing health condition and have been uninsured for at least the past six months.^[57]There is no age requirement.^[57] The new program sets premiums as if for a standard population and not for a population with a higher health risk. Allows premiums to vary by age (4:1), geographic area, and family composition. Limit out-of-pocket spending to $5,950 for individuals and $11,900 for families, excluding premiums.^[57]^[58]^[59] As of November 2010, enrollment in high risk pools, a temporary solution in the Act but a permanent solution in Republican alternative policy, is running behind the levels anticipated at this time. HHS had predicted that 375,000 people would be enrolled by November 2010 but the actual number by that time was only 8,011. ^[60]

Immediately, you have people like me who are going to be under-insured because I can't participate in this plan until I have been uninsured for 6 months.

I have a choice.

1) Let the COBRA lapse, don't go into HIPAA.

2) Go into HIPAA and then reapply for cheaper individual coverage at a later date.

3) Don't buy insurance, at all and take my chances.

This is one way that this provision has limited access. Best of intentions. It will help those who have gone without, but not necessarily the ones trying to avoid going without for even one day. More and more people will fall through the cracks.

My agent sent me the pricing for the premium. It was so much lower than HIPAA or the MRMIP in California. (About $325 per month, instead of the possible $500 + I think I will get with HIPAA.) Unfortunately, she realized after looking at my file that I was ineligible because I HAVE coverage today.

It's a loophole. It definitely is one of those things that should have been "tweaked".

-- Edited by SamuraiLandshark on Saturday 18th of December 2010 10:14:28 AM

Cardinal Fang · Senior Member

How does the Affordable Care Act limit access?

geeps20 · Senior Member

^ maybe true but Dems plans limit access..which is worse?

Tom1944 · Senior Member

If the Supreme Court deems this portion of the HC act unconstitutional so that coverage is not mandatory how will that actually hurt those of us that want a national plan?
Will the R's vote to do away with the section dealing with pre-existing condition/denying coverage. I have trouble seeing that.
So if you can not deny coverage based on pre-existing conditions and you can not force healthy people to be insured what can HC companies do. I see only one thing raise premiums to cover the cost.
As the costs get pushed higher and more people feel the pinch the tide will turn for the government to do something.
None of the solutions the R's propose make a dent in the cost of insurance it is all nibbling around the edges stuff.

hayden · Senior Member

I'm not an attorney, but I read this piece this morning:

"I've had a chance to read Judge Hudson's opinion, and it seems to me it has a fairly obvious and quite significant error," writes Orin Kerr, a professor of law at George Washington University, on the generally conservative law blog The Volokh Conspiracy.

Kerr and others note that Hudson's argument against Congress' power to require people to purchase health insurance rests on a tautology.

The key portion of the ruling reads:

If a person's decision not to purchase health insurance at a particular point in time does not constitute the type of economic activity subject to regulation under the Commerce Clause, then logically an attempt to enforce such provision under the Necessary and Proper Clause is equally offensive to the Constitution.

Kerr notes that this is all wrong. The Necessary and Proper Clause allows Congress to take steps beyond those listed in the Constitution to achieve its Constitutional ends, including the regulation of interstate commerce. Hudson's argument wipes a key part of the Constitution out of existence. Kerr says Hudson "rendered [it] a nullity."

Kerr's co-blogger, Case Western Reserve University Law Professor Jonathan Adler agreed, though he cautioned that Hudson's error doesn't necessarily imply that the mandate is constitutional. "

Anyone have any thoughts on this? Cartera?

Abyss · Senior Member

Cartera wrote:

Judicial activism the Republicans can get behind in an opinion by a well known Republican activist - no surprise.

And, why exactly do you think it's activism?

poetgrl · Senior Member

Well, there is certainly medicare as an example of how withholding can be used as a tax. For health insurance.

But, who knows?

Without the public option the whole thing seems doomed to fail, anyway. JMO

ETA: there is also the example of public education, for which everyone pays, whether they utilize it or not.

-- Edited by poetgrl on Monday 13th of December 2010 04:15:44 PM

Razorsharp · Guru

Calling it a tax would certainly change the debate, but President Obama has already stated that it was not a tax.

Even if a court said it was a tax, would that make any difference? The federal government has lots of authority to tax, but usually it taxes income earned or transactions or death. Can the federal government tax you simply because you exist?

poetgrl · Senior Member

All they have to do is stop with the idiotic politicking and call it a tax.

Intrepid1 · Veteran Member

Thank goodness.

Cartera · Guru

Judicial activism the Republicans can get behind in an opinion by a well known Republican activist - no surprise.

poetgrl · Senior Member

pima wrote:

VA has recently become a bell weather state. This issue is going to get even bigger from a 12 political standpoint. The administration needs to get ahead of this and quick if they don't want to be bogged down with it as a campaign issue.

VA is no longer red or blue, it is purple.

What do you mean "get ahead of this?" They can't get ahead of it. It's either constitutional or it is not constitutional.

pima · Guru

VA has recently become a bell weather state. This issue is going to get even bigger from a 12 political standpoint. The administration needs to get ahead of this and quick if they don't want to be bogged down with it as a campaign issue.

VA is no longer red or blue, it is purple.

Razorsharp · Guru

A federal court ruled Monday that a central plank of the health law violates the Constitution, dealing the biggest setback yet to the Obama administration's signature legislative accomplishment.
In a 42-page ruling, U.S. District Judge Henry E. Hudson said the law's requirement that most Americans carry insurance or pay a penalty "exceeds the constitutional boundaries of congressional power."

http://online.wsj.com/article/SB10001424052748703727804576017552229615230.html?mod=djemalertNEWS

Finally a federal judge gets it right.