What'll happen to Marketplace people who lose subsidies?

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beneficii
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05 Feb 2015, 8:41 pm

SCOTUS is set to rule by June whether the law permits subsidies on federal-run state exchanges. The Administration argued that Congress, the CBO, and staffers had always worked under the assumption that subsidies would be permitted on exchanges in all states, regardless of which government ran them, but plaintiffs are arguing that the wording of the law permits subsidies only on state-run exchanges, which would strip most Americans of their subsidies if SCOTUS agrees.

http://thehill.com/policy/healthcare/23 ... -subsidies

As I'm having to go on a federal-run state exchange and would be looking forward to a large subsidy, I am concerned if SCOTUS agrees with the plaintiffs. What would I do? As I'm on SSDI and long-term disability from work for a mental disability, I'm supposed to keep seeing my mental health professionals on a regular basis and following their treatment plans. Removing the subsidies would make that much more difficult, as Medicaid in my state was not expanded and Medicare would not be available to me until October of next year.


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05 Feb 2015, 8:44 pm

HHS secretary refuses to answer what Administration would do if SCOTUS rules the subsidies for the federal-run state exchanges must go:

http://thehill.com/policy/healthcare/ov ... epublicans

My guess is that the Administration has no plan. I would not expect the Republican-led Congress to permit an amendment to the law clarifying that federal-run state exchanges would have subsidies, too.


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Jacoby
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05 Feb 2015, 8:52 pm

I think at that point, the mandate would have to be scraped or at least waived in those states. If there is no medicaid expansion and no subsidies in those states then it is an impossible burden to place on poor and working class people, it would hurt way more than it helps at that point. I don't expect the current congress as our prior one will be too inclined to fix this over the next 2 years.



beneficii
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05 Feb 2015, 8:59 pm

Jacoby wrote:
I think at that point, the mandate would have to be scraped or at least waived in those states. If there is no medicaid expansion and no subsidies in those states then it is an impossible burden to place on poor and working class people, it would hurt way more than it helps at that point. I don't expect the current congress as our prior one will be too inclined to fix this over the next 2 years.


Would the Administration have the authority to waive the penalties for individuals? Who knows? Another cynical lawsuit by the same people might argue that.


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beneficii
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05 Feb 2015, 9:02 pm

The back and forth is at this link:

http://insurancenewsnet.com/oarticle/20 ... 91397.html


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Jacoby
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05 Feb 2015, 9:06 pm

beneficii wrote:
Jacoby wrote:
I think at that point, the mandate would have to be scraped or at least waived in those states. If there is no medicaid expansion and no subsidies in those states then it is an impossible burden to place on poor and working class people, it would hurt way more than it helps at that point. I don't expect the current congress as our prior one will be too inclined to fix this over the next 2 years.


Would the Administration have the authority to waive the penalties for individuals? Who knows? Another cynical lawsuit by the same people might argue that.


I think they can, they've waived the business mandate before and obviously don't have an issue pushing the boundaries of their authority. Now whether or not they could do it only for states that haven't expanded medicaid or run their own exchange or whatever or just blanket one for everyone I dunno, maybe they'd just delay it whether than put the axe on it totally. I think if this SCOTUS decision comes to pass there would be a lot of political posturing from both sides and I doubt it gets resolved until after the 2016 elections.



beneficii
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05 Feb 2015, 9:46 pm

Jacoby wrote:
beneficii wrote:
Jacoby wrote:
I think at that point, the mandate would have to be scraped or at least waived in those states. If there is no medicaid expansion and no subsidies in those states then it is an impossible burden to place on poor and working class people, it would hurt way more than it helps at that point. I don't expect the current congress as our prior one will be too inclined to fix this over the next 2 years.


Would the Administration have the authority to waive the penalties for individuals? Who knows? Another cynical lawsuit by the same people might argue that.


I think they can, they've waived the business mandate before and obviously don't have an issue pushing the boundaries of their authority. Now whether or not they could do it only for states that haven't expanded medicaid or run their own exchange or whatever or just blanket one for everyone I dunno, maybe they'd just delay it whether than put the axe on it totally. I think if this SCOTUS decision comes to pass there would be a lot of political posturing from both sides and I doubt it gets resolved until after the 2016 elections.


I definitely agree with that last part.


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beneficii
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06 Feb 2015, 2:41 am

I think this is a good article on the subject:

http://www.scotusblog.com/2014/11/sympo ... n-correct/

Of course, people will complain about the "appeal to emotions" that occurs at the first when they discuss the negative impacts that would happen if SCOTUS sided against the government, but to be honest I would be tired of such people's constant endorsement of a heartless legalism. Yes, this was a messed up bill and yes needed fixing over the years, which pretty much most legislation in the past received, but this was a cynical effort by politicians to force it to come crashing down, rather than doing the usual, passing amendments here and there of a major piece of legislation, to smooth out its weak points, as has happened in the past. But of course, the failure to get to vote #60 after the Scott Brown election and the unanimous opposition from one party meant these fixes wouldn't happen.

Now it is a chance for the heartless legalists, who have come to dominate this country more and more, turning it more and more into a wretched mockery of what it was, to watch a major piece of legislation crash and burn, and not give a flip about the casualties.

The other articles that opposed the government's position seemed to care about procedure and principles more than people.

Will the heartless legalists win this time around? If they do, then what about all those people who would have to go without coverage for serious illnesses? Too bad, huh?

People talk about the need to bomb Iraq and Syria to root out ISIS and to bomb eastern Ukraine to root out those ol' pesky Rooskies, but if the heartless legalists take over, who would bomb this country to liberate us from them?


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beneficii
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06 Feb 2015, 2:42 am

It's like in Star Wars Episode I where the Senate cared more about procedure than saving the lives of a whole people and liberating them!


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06 Feb 2015, 1:15 pm

A ruling in favor of the plaintiffs, according to the NEJM, would destabilize the insurance markets in many states as adverse selection comes about; sick patients will keep their insurance and healthy patients would drop it:

http://www.nejm.org/doi/full/10.1056/NEJMp1414191


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beneficii
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06 Feb 2015, 1:26 pm

Quote:
The precise statutory issue is the validity of the Internal Revenue Service rule that makes the tax subsidies available to those who qualify by virtue of their income, regardless of whether the federal government or a state set up the exchange on which the insurance was bought. The challengers’ argument that the rule is invalid depends on the significance of two sub-clauses of the act that refer to “an exchange established by a state,” seemingly to the exclusion of the federally established exchanges.

But other parts of the complex and interlocking description of how the subsidies work suggest no such limitation. They point strongly in the opposite direction. For example, if a state chooses the option not to set up its own exchange, an option 34 states have exercised, the law requires the United States Department of Health and Human Services to “establish and operate such exchange within the state.” (Justice Antonin Scalia loves to quote dictionaries, and the government’s brief obliges him by quoting the definition of “such” from Black’s Law Dictionary, a standard legal reference: “that or those, having just been mentioned.”) The government argues that in this exercise of “cooperative federalism,” the federal government simply acts as the state’s surrogate; functionally, the federal exchange “is an exchange established by the state.” The law’s other relevant sections support that interpretation. For example, one section provides that any “applicable taxpayer,” defined by income, will be eligible for the subsidy, making no reference to where the taxpayer purchased the insurance.


Quote:
Beyond what various people hoped or expected, there is a deeper issue that the challengers ignore but on which the government’s briefs are utterly persuasive. A fascinating brief filed in support of the government by an unusual coalition of 23 red-state and blue-state attorneys general (some from states with their own exchanges and others from federal-exchange states) maintains that the challengers’ narrative would “violate basic principles of cooperative federalism by surprising the states with a dramatic hidden consequence of their exchange election.”

This brief, written in the Virginia attorney general’s office, continues: “Every state engaged in extensive deliberations to select the exchange best suited to its needs. None had reason to believe that choosing a federally facilitated exchange would alter so fundamental a feature of the A.C.A. as the availability of tax credits. Nothing in the A.C.A. provided clear notice of that risk, and retroactively imposing such a new condition now would upend the bargain the states thought they had struck.”


http://www.nytimes.com/2015/02/05/opini ... .html?_r=0


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06 Feb 2015, 1:46 pm

Then your insurance premium will go up because the price you pay is based on the subsidy paying the rest of it. You probably won't be required to have it then, so you could more than likely drop it without penalty. The whole thing would go back to the drawing board and my Blue Cross that I can afford will be like a dream I was woken up from.

I thought that everyone on disability or with no income and not on disability would be eligible for Medicaid. I know that is run by the states, so it's different everywhere, but it's logical to provide the free insurance to people on disability. Your health prevents you from working, and there is a program in place to provide free care, so giving it to those who can't work because of their health seems like a no brainer.

Did they say why you aren't eligible for Medicaid there? Also, what state do you live in, if you don't mind my asking?


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beneficii
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06 Feb 2015, 1:51 pm

OOM,

The SSDI payment alone is too much for me to get on my state's Medicaid, and I have to be on SSDI for at least 2 years before I can get Medicare.

------

Quote:
Thus, if 9.6 million people lose their insurance, between 4,800 and 8,600 of them would die needlessly every year.

Conservatives get quite heated during these discussions, understandably. They would very much like to avoid being perceived as being responsible for thousands of pointless deaths. In particular, many quibble on causality grounds. But studies of the Medicaid expansion found that getting covered reduced mortality rates, as did a study of universal coverage in Massachusetts. Relying on such reasoning, a brief submitted to the Supreme Court argued that striking down the subsidies would kill 9,800 people annually. Even if the number is closer to the bottom end of my range, it's still a lot of people to kill because #Obummer.


http://theweek.com/articles/537919/obam ... reme-court


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06 Feb 2015, 1:53 pm

I would switch to the much cheaper non-compliant plans that bar pre-existing conditions. As I understand it, they must be renewed each year and so anything from one year becomes a pre-existing condition for the next year (but I'm not completely positive about this).

So if something serious happens, when it came time to renew, I would switch to one of the comprehensive plans that does include pre-existing conditions.



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06 Feb 2015, 2:08 pm

OliveOilMom wrote:
Then your insurance premium will go up because the price you pay is based on the subsidy paying the rest of it. You probably won't be required to have it then, so you could more than likely drop it without penalty. The whole thing would go back to the drawing board and my Blue Cross that I can afford will be like a dream I was woken up from.


It would likely cause major disruptions in insurance markets. No replacement will be passed before the end of Obama's term, as I have read and seen in quotations of politicians, to either rectify the issue or to replace it.


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06 Feb 2015, 2:17 pm

eric76 wrote:
I would switch to the much cheaper non-compliant plans that bar pre-existing conditions. As I understand it, they must be renewed each year and so anything from one year becomes a pre-existing condition for the next year (but I'm not completely positive about this).

So if something serious happens, when it came time to renew, I would switch to one of the comprehensive plans that does include pre-existing conditions.


Hello, adverse selection!


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