By John Ballard
Opponents of the new health care law experienced a federal appeals panel's ruling-gasm yesterday when a three-person court in Atlanta decided the so-called individual mandate of the ACA is -- wait for it -- UNCONSTITUTIONAL. The media politely reported the news, mostly overlooking a couple of federal rulings elsewhere concluding otherwise.
The federal appeals court in Cincinnati upheld the individual mandate in June, and an appeals court in Richmond has heard similar challenges to the law. Several lower court judges have also issued differing opinions on the debate.
Legal observers long expected the case would ultimately land in the Supreme Court, but experts said Friday's ruling could finally force the justices to take the case.
Interested observers can check out these commentaries.
?Health-care law ruling: what happens next
No matter how the two undecided cases go, there�s enough disagreement already for the case to be taken up by the Supreme Court, which opens its next term in October. Many expect that the Supreme Court will consider the case this term, which means it has to issue a decision no later than June, 2012. Supreme Court experts expect the justices will take up oral arguments for the case in late spring, leaving enough time to issue a decision in June - right as the presidential election gets into full swing.
?11th Circuit � Broccoli wins!
No one should report this decision as �ObamaCare is unconstitutional.� The most you can say is �two judges decided the individual mandate is unconstitutional under the Commerce Clause, but would have been constitutional if it had been more explicitly designed as a tax. The rest of health care reform is constitutional.�
?Affordable Care Act predictions by Orin Kerr at SCOTUSblog
Predicting the future is hard, but SCOTUSblog isn�t paying us the big bucks for nothing. To make things interesting, I�ll hazard a guess of how seven of the nine Justices will vote (assuming all nine are still on the Court when the case is heard).
Here are my guesses. Justices Breyer and Ginsburg are pretty obvious votes for the mandate, as they dissented in United States v. Lopez. Justices Kagan and Sotomayor seem like safe votes for the mandate, even if only for the reason that there is almost no opposition to the constitutionality of the mandate in the Democratic establishment from which they were appointed. Chief Justice Roberts will likely vote to uphold the mandate given the very expansive views of the Necessary and Proper clause that he signed on to just recently in United States v. Comstock. I suspect Justice Kennedy will vote to uphold the mandate given his concurring opinion in United States v. Lopez. And I�m pretty sure Justice Thomas will vote to strike down the mandate given his views of the Commerce Clause. In contrast, I don�t have good sense of where Justices Scalia and Alito might come out.
Putting the numbers together, I expect 6 votes for the mandate, 1 against, and 2 uncertain. If my numbers are right, the mandate will be upheld by a vote of anywhere from 6-3 to 8-1.
?I just love that on the same day all this hoop-la breaks out
...the Departments of Health and Human Services and Treasury (Internal Revenue Service) issued three notices of proposed rulemaking (NPRM) as part of their continuing effort to implement the Affordable Care Act (ACA). The proposed rules will be formally published in the Federal Register on August 17 for comment.
Dr. Timothy Jost, a glutton for punishment if ever one was born, reports the result of his due diligence at Health Affairs blog, linking and explaining federal documents numbering 67, 203 and 139 pages respectively in a single blog post.
The irony is delightfful, that on the same day that political grandstanding captures the media, HHS chugs along as though nothing happened, putting one foot in front of another just as letter carriers deliver the mail in all kinds of weather. (Perhaps that's not a good comparison, but you the idea.)
Readers are invited to wade through the tedious details, drilling into the links, but to save time, this last item (Thanks, Dr. Jost) is a summary directly from HHS...
?Affordable Insurance Exchanges: Seamless Access to Affordable Coverage - Overview
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In the midst of the current storm of idiocy and extremism, I have almost started to believe the idiots digging in their heels may actually destroy all the hard work that went into health care reform. I like to think that behind the scenes are technocrats and senior politicians who grasp what is happening. But in a climate where a serious presidential candidate (Bachmann) is appealing to voters who find Sarah Palin too intellectual and when Newt Gingrich is the smartest guy in the crowd my faith in the democratic process is getting weak.
That said, I picture a moment in the future when the consequences of the current madness comes into focus. The delays and counterproductive, even destructive moves now taking place will be shown for the stupidity they really are and those responsible will suffer a series of oh-shit moments as their ignorance comes back to haunt them.
Well I don't really care because all that ACA has done for me so far is add a $1600 annual fee from my primary care physician two years ago, add 25% to my health insurance premium last year, add 30% to my health insurance premium this year, and cause both my pulmanologist and cardiologist to cancel annual checkups despite my emphysema, and ongoing tacycardia and atrial fibrillation. The primary, meanwhile, collected the $1600 annual fee in January and closed his practice in June. I do still get annual checks for my Parkinson's with my neurologist, but I have not seen a pulmanologist or cardiologist for three years now, and the heart and lung medications I am taking have not been reviewed in that time.
ReplyDeleteNot a big fan of "health care reform."
Sounds like your PCP tried the concierge route and didn't make it. He either retired or is working elsewhere. The doc my wife went to over twenty years dropped her as a Medicare patient so she reluctantly found another PCP.
ReplyDeleteHigher fees, charges and insurance premiums, however, reflect anticipated healthcare inflation, not the ACA. Those charges come from the private sector, not the government. We ain't seen nothing yet. When Medicare begins tightening the screws it's simply doing precisely what the Tea Party has been yelling about, cutting costs. Payroll taxes only stretch so far.
Nobody is a big fan of health care reform, least of all many providers whose revenue stream of tax money is getting pinched. The government (read "tax money") now pays 45% of all healthcare. And that leaves many millions not insured. When the individual mandate starts (2014) most of those uninsured will be covered, but tax money will then swell to about half of all healthcare spending.
It's the oldest argument in history -- don't raise my taxes but if there isn't enough to go around, don't pinch ME.
Where did I say anything about taxes? I actually advocate raising taxes, and not just on the rich. I have argued for years that this American "value" of wanting services and not being willing to be taxed for them is a sickness.
ReplyDeleteI am saying that the "health care reform" that was supposed to "bend the cost curve" of health care costs has done nothing of the sort. Health care costs have risen even faster, and the year-long argument about costs has driven clinics to reduce care in the name of reducing costs. We are promised that the cause of that is that it has "not taken effect" yet, but why the hell not? Why was it passed with an effective date that was after Obama was safely into his second term? Because the main beneficiaries are the drug companies (with no Medicare price negotiation or reimportation), insurance companies (with a "mandate" and government subsidies), and hospitals and doctors (with no single payer or public option).
I'm not complaining about the higher cost, and I'm not even complaining about the poorer care, although I by no means think those things are good outcomes. I'm complaining about the people of this nation being lied to, about legislation being passed that is supposedly to the people's benefit and which is being touted as an liberal accomplishment even as results are dismal in the present tense and mere promises for some future which may very well never come to pass.
I'm complaining about being given little trivial anecdotes about a clinic in Podunk saving eighty-five cents and being told that it proves that ACA is working wonderfully, while millions are still without insurance and those who have it are still paying usurious prices for it, and while insurance companies and medical providers are still stealing sick people blind because the administration gave them a four year grace period to do so.
So don't sit there and accuse me of wanting something for nothing while you are selling Koolaid for an administration that is pillaging the public to maintain itself in power.
Further, "Higher fees, charges and insurance premiums, however, reflect anticipated healthcare inflation, not the ACA."
ReplyDeleteA 65.5% increase in two years? The ACA was supposed to "bend the cost curve" and you think that it is a success if a 62.5% in crease is "a reflection of health care cost inflation"? Really? If that is a succesfuul result of ACA, what would you suggest that "health care cost inflation" would be without ACA?
Bill H.
ReplyDeleteIf I said anything to suggest I think ACA is a success that needs correcting. I was simply trying to explain what is happening to costs. Insurance is going up because regulations have been changed and the time delay was more an accommodation to the private sector than politics. Taking away lifetime caps and pre-existing conditions is gonna cost for-profit insurance companies a bunch of money. (That's part of the reason medical care is so expensive in America and why I'm in favor of all providers being non-profit and a nationalized single-payer reimbursement system.) "Bending the cost curve" was never one of the big selling points for ACA. It was more about insurance reform and administrative details than actual medical care. That word affordable is to health care what the word smooth is to cigarette smoke.