It is very difficult to understand why any group would do anything to take away the health insurance for millions of Americans.  Whether or not a party agrees or disagrees with this health insurance program it appears to be working for the millions who have already sighned up for it.  Is it perfect?  Probably not.  But show me anyone who is 100% happy with their health insurance, regardless of who, what, when or where. 

Pogo 






 

Last edited by tennyson (2/25/2015 9:19 pm)

Common Sense wrote:

“We have to have a contingency plan,” House Ways and Means Committee Chairman Paul Ryan, R-Wis., said last week.

The problem is that the American public was systemically lied to time after time.
The ACA would have never seen the light of day without the well-coordinated
Campaign of falsehoods from the Administration and Democrats.
We all know the lies that were told to the public!
 
You can keep your Dr. Not true!
You can keep your health care policy. Not True!
The average middle class family will save $2500 a year on healthcare! Not True!
 
Now people are finding out that if they do not have health insurance they will be paying a
penalty that will go up each year from now.
 
 The Supreme Court will decide whether the IRS illegally extended subsidies to millions of Americans in order to underwrite the cost of their health insurance policies under the ACA.
The language of the law says the subsidies will be awarded in states that set up their own exchanges, but more than three dozen states opted not to do that. Despite that fact, the IRS extended subsidies into those states.
And the spin on the story is the Republicans caused this mess?? What are you going to do republicans? Amazing stuff!
 

You are putting a lot of political talking points into a legal argument, Common.

King v. Burwell is simply about the plain text of the law versus the implied intent of Congress. 

In otherwords, an oversight. One that was based on some assumptions that Democrats made that ended up being very wrong. Primarily, that the states would create exchanges. 

And so yes, you cannot blame Republicans for the Democrats writing the law the way they did. This was clearly a potential f*ck up on thier part.

But, if SCOTUS takes the view that the plain text trumps intent, then the whole American health care payment system gets blown up. Because.....

1 - Millions with coverage lose their subsidy which may force them to drop coverage.

2 - States with exchanges are in compliance with the ACA and therefore would expect the status quo to remain in place for them

3 - Those not necessarily affected by the ACA, (those who get insurace through thier employers or those on private plans without subsidies) are going to get walloped at some point by a huge premium increases because the actuarial tables are out of whack because all those people on the federal exchange are dropping off.

At that point, with control of the House and Senate firmly in grasp, it's the GOPs time to shine. They better damn well have a plan in place. The easiest thing to do would be to amend the law to include the federal exchanges in the subsidies, and then from a GOP perspective, get what you can stripped out of it that you don't like. Employer mandate, or certain regualtions or whatever.

But if the Republicans think that the ACA will simply go away, or that the public who lost thier health care insurance is simply going to blame an outgoing president and his party, then they are out of thier minds.

The Republicans will need to come to the table with a legitimate proposal to fix it.

Ok, Common, let's suppose the ACA gets dumped, and millions of people lose their health insurance.  Now what?  What's the plan?

TheKaiser Family Foundation put an article out tonight that lays out how the the insurance markets could unravel should the SCOTUS rule in favor of King. Worth a read.....

<all emphasis mine>

.....The immediate effect of a Court decision in favor of the plaintiff <King> would be to cut off subsidies in affected states, which could happen within a month of the decision. Currently, in 34 states the federal government is operating the health insurance marketplace, including 7 states where the state is performing some functions. Fourteen states are fully operating state-based marketplaces. And, an additional 3 states – Oregon, New Mexico, and Nevada — are approved as state-based marketplaces but are using healthcare.gov to handle subsidy eligibility and enrollment. These 3 states, which are referred to as Federally-supported State-based Marketplaces, could potentially continue to provide subsidies. In the 34 federal marketplace states, 7.5 million people had signed up for coverage for 2015 as of mid-February and qualified for a subsidy. That figure is expected to ramp up significantly in the next year, assuming the Court does not invalidate the subsidies.

People receiving subsidies make up 87% of those who have signed up for coverage for 2015 in states using the federal marketplace. For the vast majority of them, coverage would be unaffordable without the subsidies. The subsidies average $268 monthly per person and cover 72% of the premium, leaving enrollees to pay for 28% of the premium (or an average of $105 per month). With the subsidies eliminated, those who had been receiving them would face an increase in their out-of-pocket premiums averaging 256%.

To encourage healthy people to buy coverage, the ACA includes not only a “carrot” in the form of subsidies but also a “stick” through the individual mandate. A Court decision to cut off the subsidies would eliminate the carrot and severely weaken the stick. The ACA exempts someone from the individual mandate if the lowest-cost insurance available would cost in excess of 8% of income. With subsidies available, less than 3% of uninsured people eligible for subsidies would be exempt. However, if the subsidies are invalidated, we estimate that 83% of those formerly subsidy-eligible uninsured people would end up being exempt from the individual mandate.

As a result, the elimination of the subsidies would destabilize the individual insurance markets in states not running their own marketplaces. Under the ACA, insurers would still be required to guarantee access to coverage irrespective of health status and prohibited from charging sick people more than healthy people. Even without the subsidies, many people who are sick would likely find a way to maintain their insurance in the face of substantial premium increases. However, people who are healthy would likely drop their insurance.

Insurers in the affected states would immediately find themselves in a situation where premiums revenues were insufficient to cover the health care expenses of the remaining enrollees, who would be far sicker on average than what insurers assumed when they set their premiums for 2015. This would trigger a classic adverse selection “death spiral,” where insurers would seek very large premium increases, which in turn would cause the healthier of the remaining enrollees to drop coverage.

These effects would occur for all ACA-compliant individual insurance products both inside and outside of the marketplaces in affected states because insurers are required to pool all of their individual enrollees when establishing premiums.

It is somewhat unclear how quickly insurers could respond by increasing premiums. Under ACA regulations, premiums for insurance sold inside the marketplaces are locked in for a full calendar year. So, the earliest those premiums could change would be January 1, 2016, though even that would be tricky since insurers will have already submitted proposed 2016 premiums to state insurance departments by the time the Court issues a decision. Depending on state laws, premiums for products sold outside of the marketplaces could potentially be increased more quickly. And even if insurers could adjust rates, establishing stable and sustainable premium levels in this type of environment is extremely difficult, because as rates move higher, more of the relatively healthy enrollees drop their coverage.

Because this may all happen very quickly, it is possible that many or all insurers would choose to exit the individual markets in these states rather than facing significant losses in a quickly shrinking market. Insurers that remain in the market risk being one of the only carriers continuing to guarantee access to coverage to people in poor health (since people who lose coverage from exiting insurers have special enrollment periods to choose new coverage). Leaving the market would not be an easy decision for insurers since many are counting on the marketplaces as an important source of future enrollment growth. And, under the ACA, they could not re-enter the individual market for five years. Their decision of whether to stick it out would depend in part on whether they believe that policy solutions that would establish a growing and healthy market were likely in the near future. While some large insurers might be willing to withstand losses for a short period, no insurer will want to cover a significant number of people with high health needs, particularly in a regulated market, out of fear that they may be pressured to sustain the coverage at inadequate premium levels.