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February 27, 2015

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Obama health care law survives Supreme Court review


David Goldman / AP

Supporters of President Barack Obama’s health care law celebrate outside the Supreme Court in Washington, Thursday, June 28, 2012, after the court’s ruling.

Updated Thursday, June 28, 2012 | 8:38 a.m.

Health Care Law Ruling

Supporters of President Barack Obama's health care law celebrate outside the Supreme Court in Washington, Thursday, June 28, 2012, after the court's ruling was announced. Launch slideshow »
Harry Reid

Harry Reid

Dean Heller

Dean Heller

President Barack Obama’s health care law has survived all legal challenges unscathed, with the Supreme Court ruling this morning that the individual mandate and all other parts of it are constitutional.

But it happened in a way few expected.

Chief Justice John Roberts carried the 5-4 decision, which hung on the rationalization that the mandate to carry insurance is constitutional under Congress’ authority to levy taxes.

It is an ironic outcome, considering the lengths the president and other supporters of the law initially went to characterize the mandate as anything but a tax.

The government had argued primarily the mandate was constitutional under the Commerce Clause, which gives Congress the power “to regulate commerce...among the several States.”

Health care, it argued, was a form of interstate commerce.

Justices Ruth Bader Ginsbrug, Stephen Breyer, Sonia Sotomayor, and Elena Kagan were convinced by that argument; Roberts wasn’t.

Instead, he relied on the government’s backup argument — that the mandate was a tax — in joining the majority to uphold the mandate, which in the bill comes under Section 5000A.

“Our precedent demonstrates that Congress had the power to impose the exaction in Section 5000A under the taxing power, and that Section 5000A need not be read to do more than impose a tax,” Roberts wrote. “This is sufficient to sustain it.”

The only penalty for not complying with the mandate, Roberts wrote, is a charge that effectively is a tax. The other four justices in the majority agreed.

The court also ruled that the expansion of Medicaid under the Affordable Care Act was legitimate — so long as the government doesn’t pull the entire Medicaid plug on states that resist fully complying.

“Nothing in our opinion precludes Congress from offering funds under the Affordable Care Act to expand the availability of health care and requiring that states accepting such funds comply with the conditions on their use,” Roberts wrote. “What Congress is not free to do is to penalize States that choose not to participate in that new program by taking away their existing Medicaid funding.”

The court did not consider the question of whether the mandate was severable from the rest of the bill, as they upheld the mandate.

That means people with preexisting conditions and individuals under the age of 26 will continue to be eligible for health care coverage uninterrupted.

With almost all parts of the law he spent more than a year carefully shepherding through Congress preserved, Senate Majority Leader Harry Reid of Nevada took a reserved victory lap Thursday morning, congratulating the court for eschewing politics and supporting the law.

“Our Supreme Court has spoken,” Reid said, a few minutes after the decision was announced. “The matter is settled.”

Republicans, however, don’t think so.

“This law has now been affirmed as a colossal tax increase on the middle class,” Nevada Sen. Dean Heller said in a statement. “This onerous law needs to be repealed and replaced with market-based reforms.”

But in the short term at least, repeal seems unlikely.

Even if Mitt Romney wins the presidency and Republicans gain a majority in the House and Senate, they are not poised to gain enough Senate seats to overcome the potential threat of filibuster to any repeal efforts. And if they try, Reid, who orchestrated the bill’s passage, will be leading the counter-offensive.

Reid, safe in the shadow of the Supreme Court’s ruling, is ignoring the sabre-rattling for now.

“It’s time, though, for Republicans to stop refighting yesterday’s battles,” he said. “Now that this matter is settled, let’s move on to other things, like jobs.”

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  1. Hmmmmmm........5 judges in office through Presidential appointment have sided with the President in mandating health care. Not like our elected or appointed officials have to worry, they have their health care taken care of by OUR TAX DOLLARS - FOR LIFE. Bad thing is that no one can do anything once the Supreme Court has handed down a ruling, with the exception of having the law rescinded by the same type of executive order that enacted it...

  2. It is now a full-fledged race to the bottom...enjoy!

  3. Chunky says:

    It didn't pass under a commerce ruling it passed as a tax... just what we need another tax and another bureaucracy within the government. Does this mean the IRS will now be enforcing healthcare?

    A great day to be an American for some people, a crummy day those of us who desire less government and taxation in our lives!

    That's what Chunky thinks!

  4. Shocking that Bush's appointee Chief Justice Roberts sided with the liberals in upholding the Affordable Care Act.

    6 million young adults 18-26 can celebrate they will have insurance through their parents policies.

    Millions with pre-existing conditions can celebrate being able to obtain health insurance.

    The insurance companies are crying that 85% of all premiums collected must be spent on healthcare or refunded back to policy holders and not paid out in excessive executive salaries.

    This is a great day in America.

  5. @Xtlman (Mark Dunton)

    Just the same as how Republican presidents have stacked the Supreme Court with sympathetic Justices for their causes to stop small businesses from budding while large ones continue to function unopposed. What exactly is supposed to be so unusual here?

    Do you also even understand the full ramifications of what this means? By mandating health care it means that if someone has a job where they are offered health insurance they need to take it instead of simply going onto government subsidized health care. This helps taxpayers who foot the bill for when people choose welfare health care instead of paying their own way, which lots of people currently do with WIC and other programs.

  6. Yowzah!!!

    Who'd of thunk it, eh?

    Looks like the future may be bright for America after all...

    regardless of the attempts to make it otherwise by the...U-NO-HOO's.

    Oh, they were so SURE of themselves!

    4 more years; etched in stone.

  7. The individual mandate was a GOP idea, championed and introduced into Congress by GOP senators and representatives, signed into law by a GOP presidential candidate in Massachusetts, and found constitutional by a GOP-appointed Chief Justice.

    Cry me a river, tea party.

  8. Good Lord, Future...

    Is that English???

  9. HappyLeper, you seem to forget history. Let me refresh your memory:

    The individaul mandate was introduced into Congress and supported by 20 GOP senators in 1994. It was the fundamental idea of the GOP in 1994... and now some of those same people and party leaders who supported it in the 90's claim it's unconstitutional.

    In 1993, during the health care reform debate under President Clinton, Rhode Island republican John Chafee introduced the GOP alternate plan for health care reform, co-sponsored by 20 other GOP senators, demanding a federal individual mandate for health insurance. It was supported by other republicans like Orrin Hatch and Chuck Grassley.

    The individual mandate to purchase insurance was the centerpiece of the GOP's alternative to Hillarycare.

    It's plain you don't want to admit the past policy positions of your own party.

  10. "But it does have the power to tax you. And you will be taxed."

    Actually I won't be paying any additional taxes because I'm not one of the freeloaders who goes without insurance then expects others to pay the bill when I get sick or injured.

    I carry health insurance because I like being healthy and I'm responsible. I'm not a freeloader who tries to exploit loopholes in the system.

  11. Ball Spike!

    I said the ACA's individual mandate was really a tax measure back in 2010:

  12. stephenrblv: "Now all you poor people hear this, "you must buy health insurance or we will impose a tax penalty on you"!"

    Debunking 101: what happens when those who are ignorant of the ACA chime in? They lie.

    The tax penalty will be applied to those without health care coverage. Luckily for the poor, we have Medicaid. Individuals who are truly poor are covered by Medicaid and thus will not be penalized.

    Furthermore, middle-class families who are not currently insured will be eligible for subsidies that will greatly reduce their out-of-pocket costs for insurance.

    The tea party freeloaders who go to the emergency room and expect the rest of us to pay for their quadruple bypass because they want the freedom to have free medical care? They will suffer, and rightly so.

  13. I love watching the right wing twisting themselves into knots trying to think up some new propaganda about the Affordable Care Act.

    What really troubles me is the usual gaggle of politicians here in Nevada are STILL fighting the Affordable Care Act.

    Sandoval, Krolicki, Heck, and Heller all act like they will fight to reform it. So, basically, they are saying they are disregarding what the highest court in the land, the U.S. Supreme Court, has handed down, claiming it is un-Constitutional yet AGAIN. Not sure if they see this, but they are basically doubling down and proclaiming they are un-American. So, following this logic, are they communists?

    DAMNIT, Sandoval, expend more energy trying to set this up for Nevada than fighting it! We are almost last in the nation in education, now you want us last in health care too. They should be setting up health care exchanges, ways to improve the Affordable Care Act on the State level, rather than continuing with this rightwing nutball speak.

    Obama/Biden 2012 and I'm going to throw every single Tea/Republican Party politician in Nevada out with my vote. Tired of these silly stupid games.

    Very, very dumb move to fight it tooth and nail STILL, even when it has been decided DEFINITIVELY that the Affordable Care Act is supposed to happen. There are things that should have been done already, but Sandoval hasn't done a damn thing.

    Here we go again. Nevada is dead last. People don't matter here. Only the rich in the casinos and the mining consortiums. Everybody else can gargle with their own vomit.

    Our Tea/Republican Government has failed us. And is now CONTINUING to fail us. They're gone. All of them. Soonest possible instance I can vote them out.

  14. The Mandate is a Tax under the broadest definition.
    Roberts said, "A person who does not wish to carry health insurance is left with a "lawful choice to do or not do a certain act, so long as he is willing to pay a tax levied on that choice." the colonies before the Revolution, a person who did not attend church was "taxed" (i.e a person who does not wish to carry health insurance or do or not do an action deemed "good" such as attending Church or not smoking) is left with a "lawful choice to do or not do a certain act, so long as he is willing to pay a tax levied on that choice." The tax collected for choosing not to attend Church was used for the roads.
    When the Constitution was written, this "broadest definition" was an anathema because that is an Involuntary Tithe..not a "tax."
    It is a sad day when the Court cannot tell the difference between a tithe and a tax.

  15. The Mandate is a tax under the broadest definition of tax

    Roberts said, "A person who does not wish to carry health insurance is left with a "lawful choice to do or not do a certain act, so long as he is willing to pay a tax levied on that choice."

  16. So if Nevada doesn't expand Medicaid as ACA is designed, then Nevadans are not subject to the additional tax?

  17. As TEA has pointed out, once again, the "middle class" must pay for dependent classes. And for those who don't "know" each State sets some of the limits on what kind of care you can obtain on Medicaid--you get your leg amputated while the "rich guy" gets microscopic surgery and a cane.

    So now, do the ER's and health care in general turn away the illegals in severe medical distress--but they don't have insurance? That would save our property taxes big time.

  18. I don't believe too many individuals posting here (including myself) would be considered those of "high net worth." So taxes aren't really the issue. However, the quality of health care is. The government can't run a choo choo train so what kind of quality are we to expect from hospitals in the future? My guess is that they'll be run like the DMV or the V.A. Hospital. See for yourself. Once you do, the last thing you'll be concerned about is taxes.

    City of Houston passed a Pole Tax.
    There is a tax of $5 per customer in strip clubs to pay for rape kits. The City said the strips clubs choose to foster an unhealthy attitude toward women and should pay a tax for that choice.
    Chief Justice Roberts said, "A person who does not wish to carry health insurance is left with a "lawful choice to do or not do a certain act, so long as he is willing to pay a tax levied on that choice."
    It is now constitutional to levy taxes for choosing to do and choosing not to do lawful acts.
    You all agree with that?

  20. Since parts of the ACA was allowed, I just wonder IF, this is one reason the CCSD went to impasse. Dumping the current use of Teachers Health Trust and having teachers use insurance offered through the ACA, would save THEM all kinds of $$$$$$. Random wondering here.

    BTW: I am all for eliminating PRE-existing conditions and being allowed to carry children up to 26 years old on parent's insurance. The rest of the ACA seems up for debate until rulings take hold.

    Blessings and Peace,

  21. The penalty is a tax because it is levied on a lawful choice. It is a tax levied on a lawful choice to influence behavior, not raise revenue.
    Sin taxes were levied for choosing to take action. This tax is levied for choosing not to take action.
    This tax cannot be challenged in Court until 2015, after the penalty kicks in..but I bet it will be challenged..

  22. A very sad day for America unless you are an illegal immigrant or on wellfare. Your going to PAY MORE for insurance, and GET LESS care. Now people can be healthy and broke. That is, if you can get to see a dr while the bums are clogging the system to get free meds they do not need. The question is, will you get the Red or Blue pill?

  23. Tea
    Roberts understands sin taxes and involuntary tithes.
    He may be looking for a case down the road to limit the governments power of taxation as he limited the commerce clause today..
    But then, Obama just lost the election is moot as the Congress will repeal it.

  24. Mitt Romney, in an op-ed suggesting advice to Obama:

    "...the lessons we learned in Massachusetts could help Washington find [the solution.]"

    "Our experience also demonstrates that getting every citizen insured doesn't have to break the bank. First, we established incentives for those who were uninsured to buy insurance. Using tax penalties, as we did, or tax credits, as others have proposed, encourages "free riders" to take responsibility for themselves rather than pass their medical costs on to others. This doesn't cost the government a single dollar."

    This was Romney's explicit endorsement of using tax penalties to discourage free riders and to ensure universal coverage.

    That's your candidate for President.

  25. Ksand99
    For the States..I am not certain but I don't think the Feds can tax legal choices to influence behavior. The Supremes will probably waffle this one also..because of tobacco but..there is a can of worms there..Such As..what if the Feds impose a tax on all gambling, strip, clubs..putting a tax on customers like houston did, $5 a head because the clubs choose to promote unhealthy attitudes toward women and use the money for abused women? Vegas would pay a huge tax while other States would get the revenue.
    The States can and do have sin taxes (or has that been adjudicatet?) but..the Feds?

  26. This is not only great news for the Greatest President of the 21st Century it is also the Vindication of all his efforts in this area.

    Soon, very soon, there will be Five images carved into Mount Rushmore, mark my words.

  27. Comment removed by moderator. Inappropriate

  28. Who is going to pay for those 30 million uninsured, mostly black and illegals? Next mission, amnesty for illegals. They already made it harder to go BK. Now they put us in checkmate by destroying the economy with this + amnesty next year. There goes the neighborhood. There goes the country. There goes freedom.

  29. The Supreme Court has finally handed down not only the constitutionally right decision but also the morally right decision, especially for the 50 million uninsured people.

    There is nothing unconstitutional about affordable health care. This does not mean a guaranteed kidney transplant but regular checkups and preventative medicine. If a person breaks their arm, they should not have to go bankrupt to pay the medical bills. If medical care takes away a person's life to save it, like it can in this country on a routine basis, then that must be changed.

    The health care law is based on a principle that as a nation, we should care for those who are less fortunate as well as respect individual rights. We should spend less money on worrying about the Chinese Navy and more about making America a place to live, not sweat and die.

  30. Barry S
    No government in the history of the world has been able to "make freeloaders payup."
    The people this will affect are working class families who live clean healthy lives and can't afford health insurance because they don't need it..and they would have to do without other things to budget health insurance.
    These people will be determined.."able to afford it" for themselves and the freeloaders.
    That is a tax on the middle class.

  31. When this country has $4 trillion to throw away on the Iraq war - which never had a single point of justification and the majority voice remains silent, affordable health care is an urgent and Constitutional necessity.

  32. It is one thing to be taxed for choosing to do something, such as smoking or drinking (the so-called sin taxes.) It is quite another to define a tax for NOT doing something, and in particular for not buying something. (Can anyone list some good examples of this kind of tax already in existence?)

    Of more interest is just what Chief Justice Roberts did in the political arena.

    While many on the left would see this as a victory, it is in fact a masterful "punt" down the road to 2015 when the tax will be imposed for the first time. When that happens, the entire issue can be brought back up for review (because a tax can not be litigated before it is imposed.)

    Beyond that, this might well *hurt* Obama instead of helping him because there are such strong feelings on the issue. One poll I saw (CNN, I think) showed that about 75% of people thought this might hurt Obama.

    I think that Roberts had real problems with the Commerce Clause being abused in this fashion and wanted to strike down the mandate, but to do so he would have had to agree with his conservative brothers on the Court and strike down the entire law, some of which I think he likes. By officially ruling this as a tax and explicitly saying the Commerce Clause was *not* to be used in this, he has curbed future abuses and at the same time left the door open for further court battles when the tax actually takes effect.

    (And it is a brilliant piece of political strategy if it does in fact hurt Obama.)

  33. Xtra...the federal prison system is filled to the brim with freeloaders and tax evaders. Visit Wesley Snipes.
    123 million emergency room visits last year and aggregate medical costs of $250 billion a MONTH. Its not unreasonable to expect all to participate in the funding process.

  34. bofpx
    I hope we are right.
    I think Roberts limited the Commerce Clause and set up a case in 2015 to review Congress's unlimited power of taxation
    Taxing the choice to do or not to do legal behavior..
    I am so far left, I am right..and I don't like taxing choices to modify behavior at all, at all

  35. Nearly every major hospital in the country is nearly bust due to uncompensated care. Only a handful still make money.
    The woman that brought the healthcare suit went bust due to medical bills. Now she sits in bankruptcy court begging for relief.
    Ron Paul's 49 year old campaign manager died due to lack of coverage. He listened to Ron and now he is DOA.

  36. @Colin...

    "I love watching the right wing twisting themselves into knots trying to think up some new propaganda about the Affordable Care Act."

    "It's a new tax on the middle class! can't ya see it? Yer all gonna PAY for it! It's gonna cost you LOTS of MONEY!"

    Are you KIDDING???
    That's so LAME!!!

    The middle class has been HAMMERED by health care costs. They've gone through the roof, and are ruinous for the economy, as they chop away at the middle class's budgets.
    It's called THE AFFORDABLE CARE ACT for a reason.
    This is a step in the right direction for relieving the pressure on middle class budgets, not hurting them.

    Poor Mittens...
    He's in a box, and cannot get out. His own words will be his death knell. "For it, before I was against it", Willard Howell-Romney.
    He's TOAST.

  37. By the way, I find Reid's statement to be particularly repugnant since he, Pelosi and Obama chose to focus on the ACA instead of jobs.

    It is perfectly correct to say the House Republicans are not doing enough about jobs, but Reid's track record says he hasn't done very much in the Senate to help.

    Why would a 49 year old healthy guy need insurance? $400,000.00 for pneumonia might be a reason. Who got stuck with the bill???? MOM...a dead son and 400K bill...great system!!

  39. One more point. I've said in the past that one of the main reasons I was upset with ACA was its abuse of the Commerce Clause.

    The ruling today just might give some brilliant attorney with the ACLU an opening to start chipping away at some of the federal marijuana laws that are based in part on the Commerce Clause. Chief Justice Roberts didn't hand down a reversal, but he put definite limits in place and it should raise questions about other laws already in place.

  40. Nevada has among the highest number of uninsured and highest costs in the country. Nearly every hospital is in trouble. Education and health go hand in hand. Cost containment will be next. With $150 trillion in med bills coming due in the next few decades there wont be money for anything else. Read the article from 2005.

    Socialized medicine has no place in a free and vibrant society but charging working families $20,000.00 a year for medical does.
    Our society is being strangled by special interest groups.
    Currently 95% of financial assets are in the hands of 5% of the population. 95% of folks have very little money but we charge $400K for a bad case of pneumonia and over $200k for heart surgery in Vegas. Our society may be free but vibrant????Give me a break. Half the country is receiving govt. aid. Mostly for medical.

  42. gmag...Jean Schmidt had to take her orgasm back!!!

  43. zippert1,

    There is almost nothing in ACA that addresses the issue of medical cost containment other than what some have called the "Death Panel" provision.

    The ACA is essentially a gift to the insurance companies, pure and simple. I wish I had the funds available to buy stock in some of the health insurance companies who went down today. I predict we will see them be making more money than ever as a result of this.

    As the actual cost of medicine and medical care continues to rise, we will see ever-increasing government subsidies to cover those costs.

    The very first comment on this story (in the "untrusted" section") hoped that now we could move on to a single-payer system. The ACA will put the brakes on that until people become fed up with its failure to achieve its stated purpose and live up to its name.

    Yes, many of the provisions try to accomplish good things, but at what cost? As long as the actual costs of medical care continue to rise, premiums will, too, and we will continue to have to make ever-more difficult decisions about what we will pay for.

  44. You are absolutely correct. Very little cost containment. That has to be next. Healthcare isn't finished, its just beginning. The German system was put into place in 1865. The are still making adjustments as circumstances dictate.
    If you put enough good things into the pot you end up with something good. Millions go broke over medical issues and for the 150 million that have chronic conditions getting proper coverage is nearly impossible if your employer doesn't provide it.
    Cost, quality and access for those who need it are the three big issues. ACA takes care of the third. Cost and quality will be next.

  45. Real reform would completely remove health insurance as a job benefit.

    Think about it, would you expect to receive auto insurance as a job benefit? Would you want to change auto insurance companies every time you change jobs?

    It is insane that health insurance depends upon where you work in most circumstances. I think that unions have done the entire population a great disservice by making this the accepted norm.

    It would be okay to negotiate with an employer to pay for your insurance (or a percentage of it) but it is quite different to allow them to *provide* your insurance and have it go away if you change jobs.

    I say this is one of the fundamental flaws in our system today.

  46. Sorry, Jeff, I prefer Scotch to wine.

    I blame unions in that it is ironic that what they did was seen as a benefit but has turned out to be a severe handicap to workers being able to move from one job to another freely. Health insurance perks are indeed an anchor today. Not only that, but I suspect that private health insurance prices are somewhat higher in order to compensate for the lower prices that company group plans can receive.

    Having a company car as a perk is a far cry from having your auto insurance provided by the company. It should be the same for health insurance. You have your own and you negotiate what you think is a fair wage that will allow you to pay for it.

    Single payer might be the way to go. The only real argument against treating medical care the same as police, fire, roads, education or any other infrastructure is that there needs to be some way to limit the benefits of such to citizens to whatever extent is possible.

    But going beyond that, even in countries that have single-payer or even fully socialized medical care the problem of ever-increasing costs of that remains.

    It is particularly painful here because we can see the price differences for various prescriptions. Why does the exact same pill cost $10 here and only $2 in Canada?

  47. Here is a real example of the price difference. I pay $240/mo for Plavix. That is the full retail price (there is no generic for Plavix as of yet and my insurance won't cover brand-name drugs.)

    I can Google Canadian Plavix and see prices ranging from $40 to $70 (US) for the same supply.

    How can such a differential be justified if resellers are all buying from the same manufacturer?

  48. botfx
    You Know..Roberts did set up a 1st Amendment involuntary tithe argument for the Catholic Church in regards to the "reproductive rights" argument. In the Colonies, a person who attended a different Church was allowed to attend..only if that person paid a tax to the Anglican (official) Church on that involuntary tithe. The question is..can an individual who doesen't attend any Church ..or buy insurance use the 1st Amendment arguments to keep from paying for charity health care?
    Also, Roberts said the commerce clause did not apply to individuals who could be predicted to participate in a market." Therefore, did Roberts strike down "Wickard v. Filburn"?

  49. I see the root cause of health insurance being tied to your job as being a result of unions negotiating for that as a benefit. It is an unforeseen side-effect that has had profound consequences.

    I think that the issue of health care might be better framed as being one of providing social infrastructure such as public education.

  50. xtra,

    I had the same thought with regard to Wickard. I simply can not reconcile the reasoning behind that decision with the ideals of a free society. The logic doesn't stand up.

    Keeping in mind that the Court is loathe to reverse itself, I think Roberts came as close as he could to doing so without actually stating it.

    With regard to the involuntary tithe, I think that argument goes away if we look at health care (not health insurance) as part of our infrastructure. That puts it in an entirely different light and removes some of the moral issues from it.

  51. Boftx
    Here is a real example of the price difference. I pay $240/mo for Plavix. That is the full retail price (there is no generic for Plavix as of yet and my insurance won't cover brand-name drugs.)


    I don't want to be rude and I don't mean to be intrusive, but there is a generic drug for Plavix. It was released in May. I would contact your pharmacist and check out the site below. I hope you will benefit from this information.

  52. kepi,

    Thanks for the information. The last I had heard was that the generic would not be out until the fall of this year.

  53. botfx
    Infrastructure: Roads are paid for by the people who use them..highway use taxes. All other infrastructure that I can think of is State/City/County and not Federal.
    Education is not infrastructure and were paid for by "school sections" and local taxes. There are now tax credits for people opting out of the system, at least at a local level (vouchers)
    It is not a moral issue..It is a tax issue...although sin taxes are moral..and now "health"..for your own good :)

  54. kepi,

    I went to the site and found this on the page giving more information about the program that allows eligible people to pay only $37/mo for name-brand Plavix:

    Eligibility: Patients are not eligible if their prescriptions are paid in part or in full by any state or federally funded programs, including but not limited to Medicare or Medicaid, Medigap, VA, DOD or TRICARE. Offer not valid in Massachusetts or where prohibited by law, taxed or restricted. Offer only good in the USA and Puerto Rico."

    That statement says a lot about why some people are opposed to the ACA.

  55. botfx
    I know..ACA is supposed to make it better, not more worse..
    I hope you find your drug at an affordable price.

  56. Boftx,
    The generic version is available now. Forget the Eligibility Requirements; call your pharmacist. Ask your pharmacist if they carry the generic and the price under your insurance. I just called mine. I really don't want to engage on ACA with you. I just wanted to help you out if I could. When I learned there was a generic drug available, I wanted to share that with you. I know I was butting in where I was not invited, but I just thought I could help you.
    I will have to say "Good Evening" I will be off of the computer until tomorrow.

  57. xtra,

    I am using the term "infrastructure" in a broader than usual context. I think that many of the liberals here would agree with me (and possibly gag on it that they did) that every single person in this country benefits from having an educated populace, especially when it comes time to vote. This is the same in essence as how every single person benefits from having good roads, whether they drive or not.

    That is how I am using the term "infrastructure" for this discussion. Schools and roads can be thought of as being equivalent in that all people benefit equally from their presence whether or not they use them directly.

    If it is possible to place health care (and I do NOT mean health insurance) in the same light, then I think a more meaningful discussion about "reform" can take place.

    As an aside, you and I both recognize that what Roberts said today said nothing about whether or not the ACA was a good bill, only that it was Constitutional with regard to Congress' power to tax. Whether or not this particular tax is Constitutional can not be decided until it has actually been imposed. I expect to see another battle on this based on it be discriminatory.

    The law will probably need to be rewritten to say that ALL people must pay the tax but those who have coverage (or who pay for coverage of others, i.e. employers) can take a deduction based on how much they pay up to a stated limit.

    At that point it is no longer a penalty but a true tax.

  58. kepi,

    I sent you a private message saying this, but I will say it publicly as well.

    Thank you for the information. I was not aware of the generic being available yet and will ask my pharmacy when I call them in a few days for a refill. They know very well that I pay full retail and will probably mention it to me without my asking.

    Again, thank you and rest assured that you are not "butting in" by providing useful material.

  59. @ ColinFromLasVegas, June 28 @ 11:01 a.m.

    Right on, Colin, and I second that emotion. Best post on this website I've seen in years.

  60. botfx
    I agree..hat health care needs reform..tbut the States have or did have control over education. It was funded by local taxes and under local control.
    The Federal Highways are a separate trust fund and are Interstate Commerce. All other roads are State.
    To lump all functions of government into one pot for the purpose of "reform" or management is dangerous ground and rank federalism.
    I was surprised that the Courts restrained the Feds even so mildly as today. The Courts have an almost perfect record of upholding every agency, every regulation and every fee/fine/penalty/tax that comes before them..Oh..Gee..what am I saying..they did that today...If they can't uphold it one way..they go down the list and uphold it another..
    But I was surprised and pleased that the Courts have acknowleged that the commerce act is not unlimited..but the powers to tax are..
    That is news..bad news.

  61. My healthcare career experience has made me go even further than the ACA, which still keeps alot of control in the hands of the healthcare industry.

    There will still be people working for the insurance companies looking for every way they can to deny benefits. That is what they are supposed to do. It will just be more difficult.

    I support a single payer national healthcare plan to get control of the runaway costs of the healthcare industry as a whole, without the loss of quality and probably an improvement.

    This industry is shameful in its hunger for more and more money, with everyone profiting more each year. That is the way it operates, with very few exceptions.

    Even with the ACA, they had their hands in the pie to dilute what it could have been.

    My experience has shown me that the industry will not do anything that serves the public good unless they are forced or if it brings them big profits.

    Some of the comments that are so angry and insulting to your fellow citizens display the reality that we have a serious moral crisis in our country.

    The fact that the middle class has shrunk is not do to the ACA, it is due to the banks, financial investment firms, and corporations that have brought havoc to our country. Anything that gets in their way is marked for destruction. Why? Because it cuts into their profits which they don't use to create jobs in our country, if they can help it.

    As has been said over and over, when people are asked about individual provision, the majority agree with them. But when they hear the hot button word ACA, their programming goes into effect and they go bananas.

    If there wasn't so much obstructionism in our Legislature, and if our representatives were not embroiled in ideological battles, we might have some real progress in our county, in many areas. Then, maybe the middle class would start growing again.

    I guess it is my wishful thinking, because it will take an awful lot of changing for the moral crisis to end.

  62. One would think all the freedom-loving tea partiers would want single-payer, such as making Medicare available and optional, for a reasonable premium, to anybody who wants to opt into it, regardless of age. This would give employees the freedom to change jobs without worrying about health insurance and give employers the freedom of offering group plans or not. It would also benefit self-employed and small businesses. And having younger people paying into Medicare would "strengthen Medicare", as the House Republicans say they want to do. Employer-provided health insurance always was a bad system and is an even worse system today. Even worse is 50 million uninsured, without health care. Not only is that a national disgrace, it is dangerous to public health! It was my understanding that the Affordable Care Act provides tax incentives for employers who offer group plans, and subsidies to low-income individuals who cannot afford the low-cost plans through "insurance exchanges" that are supposed to be set up in the States. ACA is so complicated because Obama insisted on bipartisanship and in his effort to please everyone, the ACA was worked on by special interests, such as the insurance and pharmaceutical industries' lobbyists, and deals had to be made to get it passed. So if you are unhappy with the ACA, put the blame where it belongs, i.e. the entire monster for-profit medical system, the middlemen insurance companies, lobbyists, and the politicians the monster buys.

  63. @ Gerry - "Cost, quality and access for those who need it are the three big issues. ACA takes care of the third. Cost and quality will be next."

    It doesn't take a great deal of effort to come up with those aspects. They are already present in Medicare and the private insurance companies who administer Medicare have to comply with them.

    It would be easy to simply include the ACA in those standards, which are more stringent than most private insurance.

    Private insurance contains cost and increases profits by finding ways to deny benefits, even when they exist. They are experts at this.

    Medicare contains costs by going after the fraudulent billing practices in the healthcare industry. Rick Scott has personal experience of that, as does one of our local hospitals.

    The latest figure I heard of was $6 billion returned to Medicare.

    Other ways are through having capitation contracts. Those exist in private insurance and Medicare Advantage.

    In many instances there is better quality care in Medicare because of the standards that are set by the program.

    There are also some things that private insurance has influenced in Medicare, like getting people out of the hospital as fast as possible to save money. This is an area that I believe is a negative too often. So it is on a par with private insurance in that category.

    The difference is that in Medicare there is after care available for those too frail to care for themselves. This saves money over longer stays in the hospital.

    For Medicare, it is a cost saving that goes back into the program. For private insurance, it is a cost saving that goes toward profits.

    I would expect some transition difficulties due to the way our system now functions, but over the long term it should iron out many of the difficulties, and new entrants into the medical field will become a part of the government system and will easily deal with the new ways things work.

    It isn't the end of America, it is a new beginning.

  64. At one time during my healthcare career I worked in private insurance. My job was to find ways to not pay for services.

    I was so good that I was transferred to a certain unit that dealt with complaints of non payment of service from policy holders.

    I audited the charges in question to determine if they were correctly paid. Sometimes they were not and the insured was due an additional payment. However, my audit didn't stop there. I went further into past payments of services and inevitably found even more that were paid too much. 90%+ of the complaints ended with a request for a refund to the insurance company for over payments.

    Later, I worked in reviewing doctors and hospital charges for accuracy. They were a mess of overcharges and inappropriate care.

    That led to working in Medicaid reviewing the same, and preparing cases for the Board of Medical Examiners against physicians.

    The amount of fraud in both the private and government healthcare system by providers is a scandal and has been for many decades.

    I worked for a hospital that was investigated for fraudulent billing and had to pay million back to the government.

    Tricky accounting practices have been used by many hospital corporations and some have been caught, even more than once.

    So don't think that private healthcare is wonderful. It is a big scam in many instances and the premium payer pays for it in more ways than one.

    At least, with a government system the audits and investigations are for cost savings that benefit the people.

    People are being fed with half truths and no truths at all in many instances by people who represent the money making scam of private health insurance.

    This is the part of the ACA that I don't like. Only a single payer national health plan will be able to clean up the mess of a system we have now. However, it will take time to get there because of all the obstructionism and protectionism that exists.

    We still must begin the process and the ACA is the beginning. That is why it is feared so much by the healthcare industry and why they work hard to make people think it is bad. It is tragic that their strategy has worked with so many, because they cause the current system to perpetuate, and the people are the losers.

  65. I'm watching and listening to Republicans, Tea Party people and right wing nut jobs such as Michael Savage collectively going insane. They are screaming and running about with their hair on fire. Upholding the United States Constitution isn't good enough for them. They now want to change it because the Constitution doesn't suit their needs, hypocrites! I'm soooo reminded of the Birchers insanity of the sixties.

  66. Vernos - Yes, what you describe is exactly the "Bircher" mentality and emotional response.

    I can say that since I was one at the time. It only took 2 months for me to see the error of my ways. Right wing extremism was too much for me.