What'll happen to Marketplace people who lose subsidies?

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beneficii
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06 Feb 2015, 2:23 pm

Why both the subsidies and the individual mandate are so important, from the definition of adverse selection:

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Adverse selection

When you do business with people you would be better off avoiding. This is one of two main sorts of market failure often associated with insurance. The other is moral hazard. Adverse selection can be a problem when there is asymmetric information between the seller of insurance and the buyer; in particular, insurance will often not be profitable when buyers have better information about their risk of claiming than does the seller. Ideally, insurance premiums should be set according to the risk of a randomly selected person in the insured slice of the population (55-year-old male smokers, say). In practice, this means the average risk of that group. When there is adverse selection, people who know they have a higher risk of claiming than the average of the group will buy the insurance, whereas those who have a below-average risk may decide it is too expensive to be worth buying. In this case, premiums set according to the average risk will not be sufficient to cover the claims that eventually arise, because among the people who have bought the policy more will have above-average risk than below-average risk. Putting up the premium will not solve this problem, for as the premium rises the insurance policy will become unattractive to more of the people who know they have a lower risk of claiming. One way to reduce adverse selection is to make the purchase of insurance compulsory, so that those for whom insurance priced for average risk is unattractive are not able to opt out.


http://www.economist.com/economics-a-to-z


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06 Feb 2015, 2:56 pm

For what it's worth, I haven't had medical insurance in the last 12 years. I only recently signed up for it.

In the last 12 years, my total medical expenditures consisted of 6 doctor's visits and prescription medications resulting from those visits. I figure maybe $750 tops. That's considerably less than one year's worth of premiums.



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08 Feb 2015, 7:44 am

States, including red states like Mississippi, file an amicus curiae brief supporting the ACA by saying it was never made clear to the states that by failing to establish the exchanges by themselves, their citizens would be deprived of subsidies, invoking the Pennhurst doctrine:

http://www.americanbar.org/content/dam/ ... eckdam.pdf


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08 Feb 2015, 7:47 am

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Petitioners’ construction would also violate basic principles of cooperative federalism by surprising the States with a dramatic hidden consequence of their Exchange election. 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 ACA as the availability of tax credits. Nothing in the ACA provided clear notice of that risk, and retroactively imposing such a new condition now would upend the bargain the States thought they had struck.


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09 Feb 2015, 12:41 am

Have you checked to see how much it would be for you to get it? Obamacare for my youngest son is free because he doesn't make a whole lot.


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09 Feb 2015, 8:47 am

OliveOilMom wrote:
Have you checked to see how much it would be for you to get it? Obamacare for my youngest son is free because he doesn't make a whole lot.


About $150 a month, so I can get low prices for doctors' and mental health visits and for prescriptions.


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09 Feb 2015, 8:48 am

(emphasis added):

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When we look at the ACA "as a whole," and read its parts in the context of the entire document, we can see why the challengers' position is untenable. They argue that the ACA's language proves that state exchanges can distribute tax subsidies to purchasers of health plans, but not federal exchanges. Here they draw upon the five words that link insurance subsidies to an "exchange established by the state." They also argue that these words are clear and have a plain meaning. That's all well and good, but the "plain meaning" of one part of a text becomes unclear when it is contradicted by another part of that text; in that event, the original plain meaning becomes ambiguous, and we have to somehow reconcile it with that other part of the text. King doesn't do this but relies upon a narrow "literalism," ignoring the "whole text" as well as Scalia's principles of textual interpretation.

Consider, for example, a section of the ACA that appears to directly contradict the five words that the challengers rely upon to deny tax subsidies to federal exchanges. Section 1401 requires both state and federal exchanges to report the subsidies that they distribute to individuals on their respective exchanges. This alone demonstrates that the ACA intended purchasers of health plans on both state and federal exchanges to receive subsidies. Even the challengers, one would think, would have to agree that the plain meaning of this section contradicts their claim that the ACA did not intend federal exchanges to receive subsidies.


http://www.thelegalintelligencer.com/al ... 0109082658


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09 Feb 2015, 8:52 am

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Finally, an additional argument against the challengers' claim comes from an unexpected source: four Supreme Court justices who voted against Obamacare in a joint dissent in National Federation of Independent Business v. Sebelius, 132 S. Ct. 2566 (2012). This case challenged the "individual mandate" and other provisions of the ACA. The joint dissent addressed many of these issues, but at one point it commented on a topic that, three years later, is now before the court in King: whether purchasers of health care plans from federal exchanges are entitled to receive tax subsidies. Here, in pertinent part, is what those justices said: "Without the federal subsidies, individuals would lose the main incentive to purchase insurance inside the exchanges, and some insurers may be unwilling to offer insurance inside of exchanges." In short, "With fewer buyers and even fewer sellers, the exchanges would not operate as Congress intended and may not operate at all."


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09 Feb 2015, 8:58 am

The battle lines are drawn by the amicus briefs:

http://www.nationallawjournal.com/supre ... 0109085214


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09 Feb 2015, 3:10 pm

Do some of these plaintiffs even have standing?

http://www.motherjones.com/politics/201 ... -obamacare

Also, there's this, LOL:

Quote:
The oral arguments before the 4th Circuit Court of Appeals highlighted many of the weaknesses of King, particularly with regard to the plaintiffs. Judge Andre Davis repeatedly expressed skepticism about the plaintiffs and quizzed the lead lawyer on the case, Michael Carvin, on why he hadn't brought the suit as a class action—the traditional vehicle for public interest litigation. Davis suggested that the reason was that "nobody wants what you're after here!" The appellate court ruled unanimously against the plaintiffs, with Davis writing in a concurring opinion that Carvin's case turned on "a tortured, nonsensical construction of a federal statute whose manifest purpose…could not be more clear."

Carvin, an attorney at the law firm of Jones Day, bristled when I asked him whether the difficulty in securing solid plaintiffs suggested that there are not many Americans interested in wiping out health coverage for millions of their fellow citizens. "Linda Brown was the only plaintiff in Brown v. Board of Education," he retorted, invoking the famous Supreme Court case that led to school desegregation. "Does that suggest there weren't a lot of people who supported her point of view?" (In fact, Linda Brown was one of 13 plaintiffs in that case, which was filed as a class action. The Supreme Court decision in Brown also included four other cases dealing with public school segregation that had been consolidated. The combined cases in Brown involved dozens of plaintiffs.)*


Comparing this attempt to strip access to healthcare for millions of people to Brown v. Board of Education sickens me.


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09 Feb 2015, 3:26 pm

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We still have the puzzle: why did Congress choose to use the phrase “established by the state”, if not to limit subsidies to policies bought on state exchanges? Members of Congress (who seem to be in a position to know) expose the petitioners’ hypothesis as specious, but the government’s contention that the phrase was selected as a “term of art” is rather precious. When the government says that its interpretation of the ACA “allows the Act to function as a ‘symmetrical and coherent regulatory scheme,’ with no need to rewrite, explain away, or ignore any of its provisions,” it seems to be lending the text of Obamacare an each-word-is-holy internal logic that it cannot quite bear. As Abbe Gluck, a law professor at Yale, has argued, the ACA is hardly an airtight tome. It is, in her view, “a very badly drafted statute”:

Quote:
And it’s badly drafted for a simple reason that turns out to be important to understanding how the pending litigation should be resolved: Because Senator Ted Kennedy died in the middle of the legislative process and was replaced by Republican Scott Brown, the statute never went through the usual legislative process, including the usual legislative clean-up process.


But though “the statute is sloppy," Ms Gluck writes, "I think its meaning is plain.” This, in the end, is what King v Burwell comes down to: the Supreme Court will decide whether to let millions of Americans pay the price for their legislators' shoddy draftsmanship.


http://www.economist.com/blogs/democrac ... reme-court

Basically, Republicans aren't going to permit the ACA to be cleaned up as most major legislation is because of their rigid opposition to it. They demand only repeal or to see it crash and burn, even if that means taking thousands, tens of thousands of people with it.

f**k you, Republicans. By not permitting the usual legislative fixes to take place, as with most major legislation, you may ensure that millions will be hurt.


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09 Feb 2015, 3:37 pm

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Is there anyone left? Look, we understand that it's nigh impossible to talk about healthcare without talking about politics. Anyone who can read knows who is in favor of the ACA and who is not, but the 11 groups above don't care. They represent liberals and conservatives, as well as people who don't identify as either, and they are using their collective voices to state the obvious: Making a key funding portion of a law that is already in effect illegal will leave millions at risk without healthcare coverage and without treatment options. It will create a mess in which people may well die.


http://www.healthcaredive.com/news/why- ... ll/361998/


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09 Feb 2015, 3:46 pm

On the absolute importance of the word such:

http://www.nationaljournal.com/health-c ... e-20150208


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10 Feb 2015, 5:02 pm

From The Wall Street Journal on questions regarding the standing of the plaintiffs in this case:

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The fourth plaintiff in the case, Ms. Levy, is a 64-year-old substitute teacher who will turn 65 and become eligible for Medicare in June, the month the Supreme Court is expected to rule on the case. She said at her Richmond home Saturday that she couldn’t recall how or when she had become involved in the case and said several times that she and the other plaintiffs had been told not to talk about it. She said she had little knowledge of the case’s progress, including when it had been filed, guessing only that she had become a participant before that date. Ms. Levy’s log cabin-style home in a wooded suburban drive is about 15 minutes away by car from the federal courts where the case was initially heard.


http://www.wsj.com/article_email/new-qu ... OTYwNzkwWj


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10 Feb 2015, 6:17 pm

I basically had three objections to the way that insurance was done in the US prior to ObamaCare. As far as I'm concerned, we didn't need all the extra crap that ObamaCare foist upon us.

My objections were:

1) The non-coverage of preexisting conditions.
2) Insurance costs weren't deductible when buying your own but were deductible if a company bought it for you -- a clear and serious case of discrimination.
3) If you had a serious enough problem, the insurance company would drop your coverage at the first legal opportunity so they wouldn't have to pay for the coverage you had been paying for all that time.

All they had to do was fix those three conditions.

If they really want to fix the costs, insurance is not the way to do it. Insurance causes higher prices not less since the health care consumer is not the one paying for it. Do away with healthy insurance entirely and prices would be forced down in order because of the lower demand as people paid for it out of their own pockets. The other major step would be to remove the health care monopoly from doctors. Introduce a free market in health care instead.