Health Care Act 2010 - Going Forward.

[Steven]

I think Cindi is right, so I'm renaming the thread to aim at a positive direction without stifling strong opinions on all sides.

[Steven]

All posts to date under "Health Care Reform/Obamacare, 
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Its rare for Congress to vote to repeal any piece of legislation within 10 months of passage.

More rare would be 26 states suing the Federal Gov. in Fed court.

Rarer still would be a Federal judge declaring the whole law to be void because its central lynchpin violates the Constitution.

But, is anyone surprised?

What next?

I found this article informative & thoughtfully reflective.

oices.washingtonpost.com/right-turn/2011/01/left_unreasoned_and_unprepared.html

If we can all agree our current hodgepodge needs updating, reform, etc.

What next to counter the Court, for those who disagree?

What next if the ruling stands?

I've already signed a statement/petition urging my Congressman to support reforms should ObamaCare be repealed or judged unconstitutional.

Either way, this will affect just about all of us, one way or another.

I still see millions who are eligible for Medicaid & SChips but are not enrolled.  How do we increase participation as these folks are the most in need?  This problem will endure irrespective of Congressional or Court actions.


Blessings!


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CindiK
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I hear Tarshish is nice this time of year


Re: Health Care Insurance Reform/ObamaCare
« Reply #1 on: February 01, 2011, 10:46:05 PM »
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I wonder why you're using the term "ObamaCare" instead of "Affordable Care Act".
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Steven
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Re: Health Care Insurance Reform/ObamaCare
« Reply #2 on: February 01, 2011, 11:55:17 PM »
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Cindi:
  Very fair question! 
1. Lazy: Forgot & didn't take the extra 15 sec to look it up. 

2. Balance? 
  The 1st title & most productive focus needs to be discussing what public policy will best allow Americans to help Americans who need medical care and prevent as much illness as practical.
   I flipped a coin on "ObamaCare".  I first looked to see if there was an old thread to revive. I may not have looked deep enough, either. 
I'll restate from the outset, when Obama laid down 7 principles of health care reform in Feb 2009, I found myself in agreement with 6.5 out of 7.

For those with ruffled feathers, riled, perturbed & otherwise inflamed, "Obamacare" may serve as a may serve the same purpose as "Reaganomics" served a generation ago for Reagan's critics.  A supporter, I took no offense as Reagan took full responsibility for his economic strategy & policies.  "ACA" for Affordable Care Act might be a better shorthand for the Act itself. "ObamaCare" may also encompass the governing political philosophy surrounding the Act itself.  Fine, by me. 

But, IMO, those of us who wish to critique Obama's social & political views would be advised to address those concepts directly rather than with the shorthand of "ObamaCare".   

Of course, those fully supportive might take the moniker as a badge of honor to the extent the Affordable Care Act represents Obama's 1st major step in transforming American Society, as once suggested by the 1st Lady, I believe.

If we can treat ObamaCare as a value neutral short-hand for the whole ball of wax for both supporters & opponents, fine. If, not, in your opinion, I agree to let it go. 

Could we avoid the charges that ObamaCare includes "death panels" or repealing will cause people to die?
Here's a true story unfolding in my life that includes both "predictions".  My Payroll Dept's Manager's mother in her late 80's has been near death for 60 days. The committee of Dr's, Nurse's, Caregivers & "Nancy" have had to make life and death decisions multiple times. From some perspective, they are the "Death Panel".   If Medicaid won't pay for some meds, someone has signed her death warrant and we can blame the Tea Party for the budget cutbacks. While this is "TRUE", could we just not go there? 

So, I'm trying to eat better & excercise more to cut down my lifetime medical bills. 

Has anyone read any other useful articles, pro or con on the court ruling.  That's probably what I'm most interested in, myself as opposed as figuring out who's right/wrong or who's got the "best" ideas.  As stated, I agreed with 92% of Obama's stated principles for reform.  Let's not have a war over the 8% OK?

Blessings!

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Jeff Fairchild
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Re: Health Care Insurance Reform/ObamaCare
« Reply #3 on: Today at 12:27:49 AM »
Quote
Quote from: CindiK on February 01, 2011, 10:46:05 PM
I wonder why you're using the term "ObamaCare" instead of "Affordable Care Act".
I think technically, the correct term is the "Health Care and Education Reconciliation Act of 2010".  Maybe we should use the "HCAER Act" as shorthand.
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Denise Goodman
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Re: Health Care Insurance Reform/ObamaCare
« Reply #4 on: Today at 12:44:18 AM »
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I'm wondering how the courts parse mandatory participation in Medicare vs. mandatory participation in this legislation.  That is, anyone who has earnings -- either wages, salary or business net -- is required to pay in to Medicare.  So how is the mandatory participation in this legislation different?

I favor mandatory participation because someone has to pay for those who can't.  Now, those with health insurance pay through higher premiums and everybody pays through state and federal taxes that reimburse hospitals and support Medicaid.   It just seems to me that there is a point of no sustainability in the present (pre HCAER Act) situation in which premiums continue to increase for individual payers and emloyers to cover the uninsured -- and then more individuals and employers drop out meaning that premiums increase again with an ever-smaller pool of insured, whether privately paying or insured through jobs, ultimately not able to carry the load of an increasing pool of uninsured whose hospital bills must be paid by the insured or the government.
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CindiK
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I hear Tarshish is nice this time of year


Re: Health Care Insurance Reform/ObamaCare
« Reply #5 on: Today at 01:06:48 AM »
Quote
Quote from: Jeff Fairchild on Today at 12:27:49 AM
Quote from: CindiK on February 01, 2011, 10:46:05 PM
I wonder why you're using the term "ObamaCare" instead of "Affordable Care Act".
I think technically, the correct term is the "Health Care and Education Reconciliation Act of 2010".  Maybe we should use the "HCAER Act" as shorthand.

I'm good with HCAER Act, HCAER, HCAERA, HCAERA 2010, or anything like that. The subject line should let people know what it means.
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Jeff Fairchild
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Re: Health Care Insurance Reform/ObamaCare
« Reply #6 on: Today at 01:08:46 AM »
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Quote from: Denise Goodman on Today at 12:44:18 AM
I'm wondering how the courts parse mandatory participation in Medicare vs. mandatory participation in this legislation.  That is, anyone who has earnings -- either wages, salary or business net -- is required to pay in to Medicare.  So how is the mandatory participation in this legislation different?
Denise, the former is a tax paid to a governmental body, the latter is a mandatory requirement to purchase a service from a private provider.  Here is an example of a similar mandate to the latter: http://www.argusleader.com/article/20110131/UPDATES/110131031/Bill-would-require-all-S-D-citizens-buy-gun

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I favor mandatory participation because someone has to pay for those who can't.
I understand the logic, but don't think the Constitution granted the Federal Government the power to make all citizens buy goods/services from private providers.  On the other hand, I do think the Federal Government may consitutional authority to create a system where the government is the single payer and then to tax citizens to pay for the government single payer system.

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Now, those with health insurance pay through higher premiums and everybody pays through state and federal taxes that reimburse hospitals and support Medicaid.
Not a very efficient way to provide health care to those who cannot afford it.

Quote
It just seems to me that there is a point of no sustainability in the present (pre HCAER Act) situation in which premiums continue to increase for individual payers and emloyers to cover the uninsured -- and then more individuals and employers drop out meaning that premiums increase again with an ever-smaller pool of insured, whether privately paying or insured through jobs, ultimately not able to carry the load of an increasing pool of uninsured whose hospital bills must be paid by the insured or the government.
I agree. 

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Denise Goodman
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Re: Health Care Insurance Reform/ObamaCare
« Reply #7 on: Today at 01:26:48 AM »
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Jeff -- I agree. Have always thought the single payer system makes the most sense.  There's no way, for example that insurance companies can provide coverage for all pre-existing conditions with no cap if the young and healthy aren't part of the pay-in equation. 

It's funny -- or maybe not -- that I couldn't wait to hit the ripe old age of 65.  Before that I was self-employed and paid $250/month for a $5,000 deductible play (which today would cost two to four times as much) and never was reimbursed a dime.  It was, in effect, a home insurance policy to assure that if I had monstrous medical bills I wouldn't lose my home.  I hear more and more folks in their early 60s similarly impatient to reach that magic Medicare age as they simply cannot afford any health insurance.  Medicare for all -- regardless of age -- may be the best and most efficient solution.

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JonInIowaCity
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It's not a cold sore! I bumped my lip on a biscuit
   

Re: Health Care Insurance Reform/ObamaCare
« Reply #8 on: Today at 02:14:44 AM »
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Maybe they should make it optional for hospitals and ERs to refuse treatment for people who choose against obtaining medical insurance.  Or at least, the government should make it optional for the rest of us to pay for uninsured patients.
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Students: Stop by the nurse's office after lunch to pick up your free uniforms. And then stop by my office to pick up the nutty goodbars that you'll all be selling to pay for your free uniforms.
Steven
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Re: Health Care Insurance Reform/ObamaCare
« Reply #9 on: Today at 07:01:09 AM »
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Cindi:

Well, having spent 4 hours taking one of my daughters for a physical that wouldn't end, my feelings about our local expression of health care are somewhat raw just now.     

THANKS for questioning my title.  There's been more than one healthy discussion here marred by poor titles. Count me "guilty" on this one.     

I'm inclined to restart this under: Health Care Act 2010 - Going Forward. But I'm going to wait a few minutes....

This subject is not leaving the stage of our Nat'l debate and may easily stretch past the next election.
I take it the following for granted, un-proven, non-debatable (on this thread anyways  )
1. Our current system needs new ground-rules.
2. The Health Care Reform Act faces several challenges among them being
    A. Constitutional challenges
    B. Attempts to repeal or amend
    C. Challenges of administration
    D.  Challenges of enforcement.
    Any of which have the capacity to dramatically alter the law as passed last year.  How the Law will survive these challenges is anybody's guess.
3. These challenges face any legal reform of our Health Care Insurance and delivery systems and is not unique to the Health Care Act of 2010 (H-Care2010)
4. Every proposed solution will involve compromises and flaws, thus taking any proposal to its "logical" extreme will sink every idea. So, let's not expect anyone to have worked out all the consequences.
5. All of us want a healthier future for all. The real challenge is how to get "there" and negotiating the obstacles facing us.
7. NONE OF US ARE EXPERTS, but we do have passion, faith, viewpoints and information sources others can learn from, among other strengths, in spite of ourselves some days!

Thanks for all views offered thus far.

Blessings!


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Grant
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Re: Health Care Insurance Reform/ObamaCare
« Reply #10 on: Today at 07:07:58 AM »
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Jeff,
The constitution gives congress the power to regulate interstate commerce.  Therefore, as long as private providers engage in interstate commerce, the congress has the power to require citizens to buy products from private providers.

[Steven]

Grant:
 

The constitution gives congress the power to regulate interstate commerce.  Therefore, as long as private providers engage in interstate commerce, the congress has the power to require citizens to buy products from private providers.

Well, right now, health insurers can not market any particular health care plan across state lines. Each version must be separately approved by each State's Insurance regulators.  My health insurance plan can not be bought by non-Ohio residents. 

I disagree, but I'd like to read on this more deeply.

So, Congress can require US Citizens to buy products from producers who engage in interstate commerce.
Are there any products Congress could not compel us to purchase?  Or is this an unlimited power?

But, have you read any articles that are helpful on this aspect? 

http://voices.washingtonpost.com/right-turn/2011/01/left_unreasoned_and_unprepared.html

In defense, I found this from one of Obama's advisors:
http://www.whitehouse.gov/blog/2011/01/31/judicial-activism-and-affordable-care-act

What bothers me is the bulk of the article does not address the Constitutional issues directly.  On appeal and at the Supreme level, the side arguments don't matter.

Blessings!

[Grant]

Steven,
According to the constitution, there are no products provided by companies which engage in interstate commerce which congress couldn't legally require people to buy.

The members of my churches live in Minnesota but often go to the hospital in North Dakota.  Their Minnesota based health insurance covers their hospitalization.  That is interstate commerce.

[Steven]

Grant:
  Thanks!

I think I understand what you're saying.

The Minnesota Health Insurance is paying a North Dakota health care provider for services rendered to a Minnesota resident.  That's got to be common in many Tri-state areas.

No question, the medical services are being marketed and paid for across state lines.

The insurance policy itself can not be purchased outside of Minnesota.  The Minnesota division receives no sales or fees outside of Minnesota, as I understand the gig. 

(although I hold a license to sell group & individual health insurance & take CE regularly, sadly, I don't qualify as an "expert" here, much to my own frustration!    ) 

State laws, as I understand them, forbid interstate selling of health insurance, generally. (Unions & plans like the UCC's fall under an exemption somewhere but they aren't marketed either)

So, if the policy only paid for health care bills generated in Minnesota, would that be non-interstate commerce?  My own policy, on close examination is actually 3 or 4 separate contracts only 1 of which covers out of state med. bills.

According to the constitution, there are no products provided by companies which engage in interstate commerce which congress couldn't legally require people to buy.

So, Congress could make us buy Cadillacs or picnic tables from any interstate producer? 
That's an incredible amount of power. 

So, the only limit would be a product or service offered by a company that currently does not buy or sell anything across state lines??? 

I suspect this will be argued in deep detail before the Supreme Court. Thus, I'm not going to go beyond understanding your view. 

How much snow/ice are you getting?  Our power has flickered. Ambulance sirens are fairly constant.  Freezing rain & ice everywhere. Akron City Schools & some others are already closed.  This is bad but what Robert's facing looked worse.

Blessings!

[Jeff Fairchild]

Steven,
According to the constitution, there are no products provided by companies which engage in interstate commerce which congress couldn't legally require people to buy.

Grant,  The Supreme Court has never interpreted the constitution as you suggest and it is very unlikely that it was ever intended to grant the Federal Government such power.  The questions Steven ask point out the problem in giving such power to the Federal Government.

[Grant]

Steven,
We carefully choose who we elect, with the intent that we will not elect anyone who would vote to require us to buy automobiles.  Constitutionally, There are many laws congress could legally pass which we would not want them to pass.

Jeff,
There have been many times throughout history when congress passed legislation which was unlike any passed before.  If the founding fathers had intended to exclude insurance from the interstate commerce clause, they would have done so.

We were on the northern tip of the storm and only got one inch of new snow.  (New snow is the key word.  We have plenty already.  There could be a repeat of 1997 in the Red River Valley.  This year will be different for me.  Now that I have retired from the National Guard, I am no longer subject to call up.)

[Jeff Fairchild]

Jeff,
There have been many times throughout history when congress passed legislation which was unlike any passed before.

Yes Grant, and there have been many times when those laws have been held unconstitutional. 

If the founding fathers had intended to exclude insurance from the interstate commerce clause, they would have done so.

It's not a matter of excluding insurance, it's a matter of granting the Federal Government the power to tell citizens that they must purchase goods or services from a private provider.  If the founding fathers had intended to grant such an extensive power to the limited Federal Government they were attempting to form, the would have been very express about it.  In short, they would have said so, but they didn't.

[Steven]

Grant:
 

Constitutionally, There are many laws congress could legally pass which we would not want them to pass.

Agreed!  Polls & the fall elections suggest the 2010 Health Care Act was/is unwelcome to a majority of voters. 

One part of this thread may focus on action in Congress now & in the months ahead.  The GOP appears ingenious, innovative and determined in its approach. I expect no less from the Dems.   


Commerce Clause
I'm quoting from Cornell U. Law School.  I have no idea whether it leans "left/right"  or whatever.

http://topics.law.cornell.edu/wex/commerce_clause

The Commerce Clause refers to Article 1, Section 8, Clause 3 of the U.S. Constitution, which gives Congress the power “to regulate commerce with foreign nations, and among the several states, and with the Indian tribes.”

The article references Supreme Court decisions which have broadened the understanding and some which have shown limitations.

More to the point, you're holding Congress can compel individuals to engage in interstate commerce with all of the enforcement powers at their disposal.  Millions do not have life insurance or wills putting the economic status of their offspring at risk which will eventually affect interstate commerce.  Lawyers & insurance companies would love more customers.  Dr.s would love more annual physicals & plastic surgery.  But, if this is the most sensible reading of the Constitution, live with it.

So, "regulate commerce...among the several states" means "compel consumption of goods or services" as well as "determine the legal framework within which economic activity can occur across state lines."

Obviously there is a substantial body of opinion who views Congress' powers as limited to the ones names, each with their own limited sphere of influence. 

What would be important here, IMO anyways, is not "proving" who is right but rather, understanding each other's views as well as the strengths and limits of our own positions.

On another facet entirely, my staff looked at the new Small Business Health Care Tax Credit of up to $3500+. I"ll get $0. Not because we're too big or profitable but just the opposite.      Color me grumpy as I fiddled with the new forms and will come up short.   To whom do I send my bill for my wasted time? I hope your company/employer does better.

Blessings!

[Grant]

Jeff,
By the kind of strict interpretation of the constitution you are advocating, many of the current functions of the federal government would be held unconstitutional.  For instance, printing paper money and establishing an Air Force are not mentioned in the constitution.

[Richard]

Jeff wrotejust quoted, after Grant wrote:

If the founding fathers had intended to exclude insurance from the interstate commerce clause, they would have done so.

Maybe they intended to and just forgot because they were reall busy- maybe just as they were about to type it up, somebody yelled "the Redcoats are coming"- what would you have done-- typed up your notes, or headed out the back door to go get a musket?

Anyway, the Constitution is "a living, breathing, organism" which is how we get it to say the stuff now that didn't get written down then.

This could fix all kinds of problems.

Homelessness- Make people buy a house
Poverty- Make people  buy food and clothes
Illiteracy- make people buy books **
We could even fix lots of natural disasters

Floods- Make people buy boats
Fires- Make people buy fire proof houses
Auto accidents-  make people buy tanks- they don't go fast enough to have really bad accidents and get all bashed in.
Riots-  See above- plenty of tanks all over to help put down riots 
Over-crowded Mass Transit-- make people buy busses and subway cars


**Obviously, the first one has to be an audio book- "Learn How to Read". If they don't have a tape-recorder, you just make them buy one. After they learn to read, they have to subscribe to Readers Digest at least a couple of years to learn stuff.

[Denise Goodman]

What suggestions do you have that would ensure folks with pre-existing conditions are covered, would not limit life-time benefits for catastrophic cases and would not send premiums sky-high for the insured to cover those who cannot afford insurance?

[Steven]

Grant:
 

Jeff,
By the kind of strict interpretation of the constitution you are advocating, many of the current functions of the federal government would be held unconstitutional.  For instance, printing paper money and establishing an Air Force are not mentioned in the constitution.

It might be helpful to reread the text of Article 1 of the Constitution which includes the Commerce Clause and other specific powers.
http://www.usconstitution.net/xconst_A1Sec8.html

I see clear authority to coin money and raise & fund armies without specifying their mode of transportation or weaponry.

To coin Money, regulate the Value thereof, and of foreign Coin, and fix the Standard of Weights and Measures;

The Congress shall have Power To lay and collect Taxes, Duties, Imposts and Excises, to pay the Debts and provide for the common Defence....
To raise and support Armies, but no Appropriation of Money to that Use shall be for a longer Term than two Years;
To provide and maintain a Navy;.............
To provide for calling forth the Militia to execute the Laws of the Union, suppress Insurrections and repel Invasions;
To provide for organizing, arming, and disciplining, the Militia, and for governing such Part of them as may be employed in the Service of the United States,..................
 

IMO, the rulings of the Supreme Court over 200 yrs carries more weight than mine or yours.  Thus, what seems like poppycock in my eyes can be quite constitutional or non-constitutional in the eyes of the SCOTUS. 

But, if I understand it correctly, your main point is that the Commerce Clause governs commerce as well as limiting the freedom of citizens to refrain from engaging in commerce.

If the SCOTUS upholds this view & allows the individual mandate, I predict the Tea Party folks favoring limited government will respond with something less than cheers and applause, to put it gently.   IOW, the challenges will not end.

If the individual mandate fails to find SCOTUS support in the Commerce Clause, what then for those of us favoring reform of some form? 

My main point is that regardless of who is "right" and regardless of the current status, the status quo seems likely to change. Few of us are likely to be hunky-dory with the final shape of "reform" in all of its parts.  So, if the choices are complete repeal or compromise, what would be our priorities.  Fall back, regroup & plan a new strategy to achieve universal care?

Meanwhile about 1 person dies of lung cancer about every 68 seconds, more or less.       Millions eligible for government aid aren't signing up.  There has to be a better way. I pray for church folks like us to help find that path.

Blessings!

[Jeff Fairchild]

Jeff,
By the kind of strict interpretation of the constitution you are advocating, many of the current functions of the federal government would be held unconstitutional.

I don't think I am talking about a "strict" interpretation of the constitution.   

For instance, printing paper money and establishing an Air Force are not mentioned in the constitution.

See Steven's comments

[Jeff Fairchild]

Jeff wrote:

If the founding fathers had intended to exclude insurance from the interstate commerce clause, they would have done so.

Grant wrote that, Jeff just quoted it.