Supreme Court Health Care Decision Thread

[AdMan]

I've been riding the fence on this thing the whole time...mainly because no one seems to have the answer to this question:

What is this going to cost me?

What does the Supreme Court's health-care ruling mean for me?

 

[Skeptic Ginger]

Don't know about you but I took some heat for that argument. I kept arguing that I didn't know if technically the mandate was unconstitutional but clearly had congress simply levied a tax it would be. Others seemed to know that it was unconstitutional. I wonder if they know still? Suppose so. Not sure why a split decision would change their minds. It's not that compelling in all honesty. I can't say for certain that I know one way or the other.

Definitely not changing minds. Has Rand Paul's comments been posted yet? He said, just because a couple people think it's Constitutional doesn't mean it is.

 

[Skeptic Ginger]

What does the Supreme Court's health-care ruling mean for me?

My insurance rates will go down according to that as long as the copays don't get too high. What a deal!

 

[Weak Kitten]

I know a lot of people have already said this but, "Woohoo, happy dance! My friends with preexisting conditions doesn't have to live in fear of losing their insurance any more!"

 

[Paul C. Anagnostopoulos]

Okay, okay, I get it. But could you just keep your government out of my medicare? It's one of the last vestiges of laissez-fair capitalism left. I paid for it out of each hard earned pay check and it belongs to me.

And so does my social security, damn it!

~~ Paul

 

[JoeTheJuggler]

OK. . .having read the actual opinion, now I understand the not a tax for purposes of the AIA but is a tax for constitutional purposes issue.

As I read it, the idea is that Congress of course can't create something that really is a tax and just call it something else wrt the Constitution. However, for purposes of a law written and passed by Congress, it can indeed do that if it pleases.

OK. I buy that. Well done, Justice Roberts.

 

[JoeTheJuggler]

So Congress could, under its Commerce Clause authority, have mandated that every farmer purchase X bushels of wheat on the open market regardless of their individual need?

No. In fact, their predictable need is just what they were counting on--but they were counting on them buying it from the within-quota market supply rather than satisfying that demand outside the market.

To the extent that farmers are participants in the wheat market, it's because of some affirmative commercial activity they have undertaken-- and whether you want to designate that as growing wheat, as the Wickard Court did, or raising livestock (i.e., the activity that defines them as "farmers" rather than ordinary citizens), I still see that as qualitatively different from being mere passive non-participants in the given market.

I disagree. Again, at the very least to assert that the plaintiffs were passive non-participants in the health insurance market they should at least have had to come up with plaintiffs who hadn't been migrating into and out of insurance coverage over time, and especially who hadn't in fact racked up healthcare costs that they couldn't afford to pay!

But IMO even if they had found such rare plaintiffs (if they exist at all), the fact that the health care system, which really is nearly 50% "socialized"--that is, almost 50% of healthcare costs are paid by public money--has to account for the known risk of the uninsured, taken in aggregate, of requiring federally mandated treatment regardless of their ability to pay that in fact they won't be able to pay for means that they really are participants in the system. The system really does have to provide for that risk. (And even if we managed to repeal EMTALA, we still have implied consent laws for unconscious accident victims.)

Again I think Roberts's opinion addresses this well. Look at his car analogy-- someone who purchased a car two years ago, and who might purchase another car again in a couple of years, is in no realistic sense an active participant in the car-buying market today.

That's easy enough to distinguish from health insurance. People who opt not to buy or own a car (even for a time), taken in aggregate, are not a cost to the auto industry.

Someone here suggested that a person who buys a gallon of milk once a week is only an active participant in the milk market for that brief minute when they're actually purchasing the milk. That doesn't make any sense. And people who want to consider themselves part of the healthcare system only in the brief times when they need it represent exactly the kind of "gaming" of the system this law is intended to thwart.

Again, I think the activity argument here hinges on the fact that it really is impossible to opt out of the health care system. You can have every intention of never needing legally required treatment that you can't afford to pay for, but if you turn up at the ER unconscious, you must get that treatment regardless of your ability to pay. The healthcare system has to account for that cost.

 

[boooeee]

Shameless.

ETA: Their headline now shows Obama signing the bill; over the picture they write:
Guess
what's
now a...
'TAX'

Shameless is the right word. They're venturing into Onion territory.

 

[Rolfe]

Crikey, I thought we could be superficial and sound-bitey, but this is surreal.

Rolfe.

 

[cwalner]

What does the Supreme Court's health-care ruling mean for me?

It looks to be close enough to a wash for me not to make much difference. The only confusing part is that the type of plan I have now (an HSA) may not be allowed because it says no plan can have deductibles over 30% of costs and HSA's have high deductibles (in exchange for lower premiums).

I know a lot of people have already said this but, "Woohoo, happy dance! My friends with preexisting conditions doesn't have to live in fear of losing their insurance any more!"

This is where the AHCA really benefits me. I have so many pre-existing conditions a friend of mine once quipped that it would be shorter to list my organs that actually function properly than the ones I seek treatment for.

 

[BStrong]

Lots of weeping and gnashing of teeth coming from the conservatives otj.

My natural inclination towards government programs runs from pessimism to indifference, but I hope they make an effort to get this deal right.

I started to wade through some of it when it was passed, and I thought my head was going to explode.

 

[AdMan]

It looks to be close enough to a wash for me not to make much difference. The only confusing part is that the type of plan I have now (an HSA) may not be allowed because it says no plan can have deductibles over 30% of costs and HSA's have high deductibles (in exchange for lower premiums).

Interesting. I was given the choice, and I also opted for an HSA. We'll see if that needs to change at some point.

 

[The Dark Lord]

Hmm, my deductible is like 700% what I pay in premiums. I can afford to pay the deductible, so why should the government care? If it is necessary to help other people get insurance, I have no complaint. But is it?

 

[JeanFromBNA]

Conservative messaging often impresses me, and their quick, unified response to this is no exception. Everybody just gets on board.

Then how do you explain Justice Roberts?

 

[Skeptic Ginger]

Shameless is the right word. They're venturing into Onion territory.

Again.

 

[Skeptic Ginger]

It looks to be close enough to a wash for me not to make much difference. The only confusing part is that the type of plan I have now (an HSA) may not be allowed because it says no plan can have deductibles over 30% of costs and HSA's have high deductibles (in exchange for lower premiums).

My understanding of a Health Savings Account is simply that it's untaxed dollars used for health care. What is the HSA you are referring to?

 

[The Dark Lord]

My understanding of a Health Savings Account is simply that it's untaxed dollars used for health care. What is the HSA you are referring to?

Yeah, but you have to be enrolled in a high deductible health plan to get one. Then you use that money to pay for health expenses, up to the deductible.

 

[cwalner]

My understanding of a Health Savings Account is simply that it's untaxed dollars used for health care. What is the HSA you are referring to?

Yeah, but you have to be enrolled in a high deductible health plan to get one. Then you use that money to pay for health expenses, up to the deductible.

What Darklord said.

However, my initial confusion was that the website (linked by AdMan) was actually vague. I don't know what the mean by costs. It could be premiums, in which case HSA's may have to be phased out, or it may be total costs.

The problem for me is that my HSA has an out of pocket cap of $3k/yr. However, to reach that, the total costs must be over $9k and if my costs are over $9K/yr that is completely covered, so that may still qualify under that 30% rule.

For me, I like the plan because it somewhat simulates having UHC. I have an additional $2.5k taken out of my paycheck over the course of the year (company chips in another $500), and I get a Debit Card to withdraw from my HSA to pay the $1500 deductable and copays of 20% up to another $1500. The end result is not very different than paying higher taxes for UHC and having everything covered since the money is taken directly out of my weekly paycheck and I never have dip into my general finances for medical expenses. I just use the debit card linked to the HSA.

 

[Meadmaker]

My understanding of a Health Savings Account is simply that it's untaxed dollars used for health care. What is the HSA you are referring to?

You are probably thinking of a Flexible Spending Account. With an FSA, you contribute money to a plan. It isn't taxed, and you use it for health care. If you don't use it in a given year, it's lost.

An HSA is a bit different. Many companies, including mine, offer an HSA based insurance plan. In it, the premiums are very low compared to traditional plans, and the deductibles are very high. For example, in our company, the premium for the "traditional" plan was around 250 per month, and there was a 1000 dollar deductibel. In the HSA, the premium was around 60 dollars per month, and there was a 3,000 dollar deductible. In other words, until you racked up 3,000 dollars in medical bills, the insurance company didn't pay one red cent.

Meanwhile, you get to open up an HSA. Money you put into it is tax deductible, and there's no tax if you spend it on medical expenses. Unlike an FSA, if you haven't spent it by the end of the year, you keep it, and can spend it in future years. As long as you evenually use it for health care, there's no tax.

The company was obviously pushing us to join the HSA plan, so I did the math as to which one would cost more depending on what sort of medical expenses, and the HSA was always cheaper for me. That puzzled me until I thought about it a bit more. Why would the company want me to take a plan that provides the same benefits to me, but at lower cost? The answer is that ever since I joined the HSA, I actually pay attention to how much I'm spending. Until I hit 3,000 bucks, which in most years, I don't, that's my money I'm spending. Now, when the doctor gives me a prescription for a test, I try to find a lab that will do the same test more cheaply, or I simply ask the doctor how much it costs and is it really necessary.

Basically, it replaces traditional insurance with catastrophic insurance, which, frankly makes a lot of sense.

 

[The Dark Lord]

What Darklord said.

However, my initial confusion was that the website (linked by AdMan) was actually vague. I don't know what the mean by costs. It could be premiums, in which case HSA's may have to be phased out, or it may be total costs.

The problem for me is that my HSA has an out of pocket cap of $3k/yr. However, to reach that, the total costs must be over $9k and if my costs are over $9K/yr that is completely covered, so that may still qualify under that 30% rule.

For me, I like the plan because it somewhat simulates having UHC. I have an additional $2.5k taken out of my paycheck over the course of the year (company chips in another $500), and I get a Debit Card to withdraw from my HSA to pay the $1500 deductable and copays of 20% up to another $1500. The end result is not very different than paying higher taxes for UHC and having everything covered since the money is taken directly out of my weekly paycheck and I never have dip into my general finances for medical expenses. I just use the debit card linked to the HSA.

I got my policy on my own. I just fund the maximum amount per year allowed. I think that is $3100 this year. Then I use the Visa debit card linked to the HSA to pay for any healthcare that I might need, up to the deductible. Unless something unexpected happens to me, I won't actually meet the deductible, which is $5500 (highest I could get). But all medical costs are covered 100% after that.