Friday, February 13, 2015

King vs. Burwell. How will SCOTUS rule.


The main question in the King case is whether Congress intended for states using the federal exchange to have access to tax credits, or if the credits were meant to be a reward for creating a state-based exchange. Over the last few years, and especially in recent months, we’ve seen evidence from both sides attempting to prove what lawmakers intended.

Here are the facts: The Affordable Care Act amended the IRS tax code to provide subsidies for plans “which were enrolled in through an Exchange established by the State under 1311.” Section 1311 lays out guidelines for states to create their own exchanges, and doesn’t mention a federal exchange. The Obama administration argues that this is a drafting issue and that it was never Congress’s intent to deprive states of subsidies. A later section gives the Health and Human Services secretary the power to “establish and operate such Exchange within the State.” The conservative groups and people suing the administration, led by the Competitive Enterprise Institute, argue that Congress wanted to use the subsidies to reward states that built their own exchanges.

Each piece of evidence speaks to lawmakers’ intent, which is why the Gruber video was so powerful—here was the guy who helped create Obamacare saying the subsidies were a reward, or a threat to build an exchange, or else lose out on millions of federal dollars. But while Gruber got the most attention, there are also plenty of other things—e-mails between reporters and staffers, past statements from lawmakers, and votes in Congress—that give credence to the idea the bill was just sloppily written.


27 comments:

  1. Of course the bill was sloppily written. Democrats played a stupid game wherein they gave Republicans input, who weren't going to vote for it anyway, and ultimately let lobbyists create a horrible result, just like what happened with the drug fiasco under Bush. A simple system that provides basic checkups, some drug benefits and catastrophic insurance for everyone could have been created. Instead, we made sure that private insurance companies maintained their right to earn billions for doing nothing more than running a risk pool and denying coverage.

    As I go through my clinical work now and hear what classmates are going through, I'm finding that private insurance, from the provider standpoint, is no goldmine, unless you like seeing 25 patients a day and striving to spend as little time as possible with them. The doctor I am working with seems pretty unique in that he has been doing this a very long time and in quite a few cases, prefers straight medicare patients compared to those with supplemental plans because the supplemental providers are a major pain in the ass to deal with.

    If the goal had been to find a reasonable way to insure the 40 million uninsured people we had, I think we could have done that. Instead, the goal became to protect an extremely inefficient and wasteful system.

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  2. http://www.idahopca.org/files/images/myth_vs_truth_3_-_keep_it_in_idaho_coalition.pdf

    http://mn.gov/health-reform/images/Task-Force-2012-11-01-StateVsFederalExchange.pdf

    http://gov.idaho.gov/pdf/SBE%20v%20FFE.pdf

    http://www.politifact.com/truth-o-meter/statements/2014/may/05/rand-paul/rand-paul-says-40-times-more-kentuckians-have-gott/

    http://www.dailykos.com/story/2013/08/23/1233305/-Kentuckians-Hate-Obamacare-But-Love-It-By-Another-Name#

    http://www.msnbc.com/msnbc/it-turns-out-kentucky-does-want-obamacare

    http://www.webmd.com/health-insurance/20141201/more-competition-helps-restrain-premiums-in-federal-health-marketplace?src=RSS_PUBLIC

    http://www.webmd.com/health-insurance/id/20130807/red-state-idaho-embraces-obamacare-insurance-exchange--reluctantly?page=1&state=ID

    The rewards for opening a state exchange were and are obvious.
    Local state control, just what you red staters always want. local control.
    More people enrolled because more people trust their state government over the fed.
    Websites that work, there's a biggie.
    Even the red states of deeply red Idaho and Kentucky saw the advantages to doing it themselves.
    Kentucky senator Rand Paul makes his statement which was a lie that 40 times more Kentuckians were cancelled then enrolled during the first year which was false, actually double the number of Kentucky citizens now have insurance then those that were cancelled. Kentucky had 680,000 residents without affordable healthcare. Today despite the two crummy senators that they have 418,000 of those people now are insured through exchange plans, small business plans and medicaid.

    Yes lou the SCOTUS will rule against Obamacare on this one. But not for the reason of penalizing the states that didn't open an exchange.
    It was just more failed obstructionism by a bunch of red governors who cared more about politics then the people they were elected to serve.
    Obamacare isn't a pretty or perfect law. No one has ever said it was. Obama gave up to much during the years between passage and implementation, making it all the more messier. But it is the law and will be the law going forward. get over it and elect people who will improve the law to something that serves the purpose for which it was intended, affordable, controlled cost, health care for a majority of America. Messy as it is today it can be brought up to that noble ideal.

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    1. I could care less about your rant Rick. Kentucky means nothing to me as does Paul.

      The issue isn't about red, blue, pink or orange but what does the law say. Not what was intended. Not what they thought they were voting on but what does the law says The question is, will the SCOTUS rule on the law or what they think people want.

      Is this a nation of laws or what they want the law to be.

      As a side note, I would think you would be rooting for the ACA to go down in flames as it would put the GOP in an interesting position to fix it of find a suitable replacement.

      "If the goal had been to find a reasonable way to insure the 40 million uninsured people we had, I think we could have done that. Instead, the goal became to protect an extremely inefficient and wasteful system. "

      You hit the nail on the head Max. The costs would be far less should they have provided a basic plan instead of the mess provided. My physician brother in law is closing his practice at the end of this year. He cites the cost of providing care. He refuses all medicaid patients, ACA patients and only sees medicare patients if they are established patients today. Not to mention the cost to digitize all his records. Sister in law is looking at the same issues and may also close her practice at the end of the year.

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  3. I have been following your health care debate for some years. I understand only the fundamental concepts of Obamacare but I have the same degree of understanding of the systems which it replaced or perhaps competed with.
    Surely if you could remove the color of the ribbon tying up the bill it would immediately appeal to many on the right of the political divide. Do you not agree that health care is above politics?. Perhaps my interest is nourished by an understanding of our own system which although expensive to the nation is a genuine system of universal care supported by both political parties.

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    1. I will state it clearly.

      This isn't about healthcare or pink or green but about a law.

      Is this law being interpreted correctly today of not.

      Either we are a nation of laws or we are not. Either this is a decision on the content of the law or a wish list and politically driven. The law itself was written behind closed doors by one party which create the issue we have today. In the history of the US we have never had an entitlement program that was not bi-partisan. This is a historic first.

      Is healthcare above politics? No, not when it's crafted and passed by 1 party, no not when it is not supported by a majority of people. We badly need a restart. The cost of healthcare in the US for 2014, 900 billion dollars. The cost in 2015 projected to be 1 trillion dollars or 25% of projected spending for 2015. Think this is sustainable?

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    2. To some degree King, Lou is right in that interpretation here is being questioned. The motivation for the questioning, however, is purely partisan. It's kinda like passing local legislation to combat voter fraud when there is no proof that such fraud exists.

      To your last point Lou, I think that if we are being honest, there has to be some admission that the Republicans, except for those who existed 30 years ago, do not want universal coverage. For them to claim victim and cynically claim that only one party passed this is dishonest. They didn't want it, they have done everything possible to derail it and even Mitt Romney ran on saying he would repeal it on day one. It's not above politics.

      Discussions of cost, to me, are a shell game. My preceptor now has explained a lot to me about how the system works. Many providers make endless referrals, not just to cover their ass, but because they work in practices where they simply don't have the time to figure things and they also will order tests or give antibiotics to placate a patient who is demanding them. I've seen him tell some of his patients "no" and they don't like hearing it. I've felt for awhile that part of the problem is that we treat healthcare like everything else, which is to say we treat it as a commodity and when we have insurance, we expect to be allowed to consume as much of it as possible. The cost of health care went up every year before Obama care, and will continue to go up every year hence. The "market" answer for health care is the same as for anything else, consume less of it and the cost will go down

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    3. Hey Max.

      Of course it's political. What in Washington happens today that isn't.

      By the way, I love the voter fraud comment. There is no voter fraud if you don't look for it. It's naive at best to believe our elections are pristine. This past election year the dem's in Colorado passed a 100% mail in ballot. There was noting in the bill to cull the rolls for dead people, illegals or anything else. Just mail in voting.

      As far as cost, of course the costs are rising and will continue to rise. When we hit the breaking point, employers will dump the benefit and all will be under the auspices of the ACA.

      As far as the GOP and their part, they should have screamed to high heaven and taken part in the process but being a minority party has it's price. As far as not wanting coverage, I am clueless as to that as a real fact. Seems so with the rhetoric but is somewhat unrealistic.

      As we discussed before, the ACA is unworkable as prices rise and the taxes imposed via the ACA are not enough to cover the cost. 1 trillion will be spent on healthcare, 1 trillion on SS/retirement by the US government. Thinks this is sustainable? We will revisit this issue again and hopefully provide a catastrophic plan for all as well as a few basic necessary services. Nothing will change in healthcare until people can once again bend over and see their feet. Nothing will change as long as people can consume healthcare at little of no cost. Nothing will change as long as we continue the partisanship that has been the hallmark of politics for the last 20 years.




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    4. I was kind of ball busting on the voter comment in good fun, though I believe what I said. The stuff I'm reading for school right now says, "Don't go looking for zebra's in central park" meaning that the majority of stuff I am going to see everyday is not going to be a rare a disease. The Republican solution here, IMO, is like giving everyone an antibiotic for a headache because "it might be" something more serious is likely to only encourage fraud elsewhere, like by demanding we use voting machines that have little safeguards to them. Fraud has been looked for, and little has been found. Here and there, I'm sure we have dead people voting. 100k? I seriously doubt it. Enough to tip an entire election? I seriously doubt it.

      A tie in to be made here to the discussion is that we should pursue things that have some actual evidence as being useful or at least statistically look promising. You make the comment that the rhetoric seems to match a belief that Republicans, as a homogenous group, don't want universal coverage, but you don't really have anything that satisfies it as fact for you. I feel the same way about claims of voting fraud. In both cases, I believe the end result is that we have legislation that does not address a real problem and it is because of partisanship rather than any real hard evidence.

      I actually believe there are enough moderate Republicans in both houses to create something better than what we got, and I also believe that when you take away the word "Obamacare" and just poll Americans and straight provisions, there is a lot of support for something that looks like universal coverage. You mention that healhcare costs likely won't go down until fat American's can see their shoes again, which is a claim I could pull up a lot of research to back. Despite the science that supports that, we can't get a plan to address this because that would be support of a nanny stat and if people want to eat themselves into cardiac disease and diabetes, they should be allowed to do so without someone telling them that they are the cause of high healthcare costs.

      Republicans have successfully ran on a premise (not entirely true) that all taxation and all spending is the result of everything bad in the world. Here and there, the argument has it's merits but fails to hold up across the board. At the moment, no Republican is safe enough to suggest we should focus on what has merit and no waste time debating what doesn't. They aren't safe because they can be challenged by some whack group that airdrops millions of dollars into a local election. I don't see Democrat groups doing this now to instill communist legislators. I'm basically hoping that enough Republicans who are actually moderate get tired of being controlled by a tiny slice of wealthy people who basically buy elections. Both parties are owned by lobbyists of course, which is still it's own problem.

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    5. The problems are many in healthcare. The problem is the disparity in coverages. Unions have the gold plated plans negotiated through the years, Business has lesser coverage. Small business is spotty. Then we have the government setting standards for minimum coverage. Medicaid, Medicare with different standards for payments. The cash payers paying high prices. Those using the ER's and hospitals as their physician offices generally paying nothing. The cost is of course passed to the paying public.

      No wonder healthcare is a mess. Once again what is needed is a basic plan providing catastrophic coverage and moderate co-pays so people will think before going to the Doctor's for a cold. A national sales tax to pay for it. Everyone uses it, everyone should pay.

      Can the GOP come up with a plan? Think you could get it past Harry's filibuster? Think you could get the prezzy to sign it? In both cases nearly impossible.

      Face reality, government spending is generally inefficient with the use it of lose it philosophy in spending budgeted money. While in the glorious service to this country I saw it first hand in a back bay dump. Thousands of unused rakes, jet engines and everything in between as the bases had to many and an ORI at hand. Then you lose the inventory fast, The waste in government is well documented. Not all spending is bad and necessary however, not all spending meets that criteria. Do we really need to know about the mating of snails? Why overweight gay women have fewer dates? The list is endless. If they just made an effort to cut waste, duplication, fraud, it would make a serious impact on the integrity of this government. It resides at state levels as well as local levels.

      No voter fraud. To be an American citizen, it is a requirement to speak and read English. Ever wonder why we have bi-lingual ballots?

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    6. As I've read stuff for school, my thinking on some stuff has changed. The overuse of ER's is a more complex problem than I had previously though. It's not just that people don't have coverage, but there are also a lot of poor people who actually do work who go to the ER because they want their problem diagnosed in one shot. They don't have time to wait several days to see a doctor, then go for labs, then go back to the doctor for results and so on. I think we can all admit we have a deep cultural attitude that everything should be delivered on demand. If I get sick, I can call in and even if I miss a full week of work without getting paid, it's not going to bankrupt me. A lot of poorer people are not so fortunate.

      Statistically, poor people are flat out sicker than people who aren't poor. I'll concede the point it's Marxist to point this out. Still, I believe the data is there to show how we all end up paying more money for things like healthcare because there is such a disparity. Government can't fix market driven inequality, but it could start to shut the door on the arbitrage of third world labor. It could start to end subsidies to US businesses that clearly dont' need them. It all depends on what your goal is though. Your second para states it clearly, that's a plan that appears to have a real world solution, but to the purists, it's communism and therefore we can't have it.

      As to the filibuster, what I think doesn't really matter, but I'll say it again, votes should be allowed to happen. Your question though is kind of moot, we will never know if Republicans could draft a better plan because they won't even bother. Politically, if they did create a fix that allowed their constituents to keep what they didn't have before and then let it go through without a million riders to undue executive actions, they could make enormous political hay with that and show how the actually ARE for the little guy. It wont' happen though

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    7. Government can't fix market driven inequality, but it could start to shut the door on the arbitrage of third world labor. It could start to end subsidies to US businesses that clearly don't need them.

      Why subsidize any business. Government doesn't pick winners and losers very well. We have proven history to demonstrate that fact. We either subsidize or not, in any case either the consumer or the taxpayer pays the freight for government intervention and in some cases, both pay.

      Draft a better plan. I've heard that comment numerous times.
      A plan from 2009 ignored:
      http://www.cbsnews.com/htdocs/pdf/GOPHealthPlan_061709.pdf
      Another plan from 2014, ignored:
      http://www.forbes.com/sites/theapothecary/2014/01/27/senate-republicans-develop-the-most-credible-plan-yet-to-repeal-and-replace-obamacare/
      Yet another:
      http://www.americanhealthline.com/Todays-News/2013/09/19/House-GOP-Unveils-ACA-Repeal-and-Replace-Plan

      But then again,
      5 health reform proposals from the past that have actually been introduced in Congress—some well before President Obama even was nominated for president, and all months before the House (11/7/09) or Senate (12/24/09) voted on what eventually became Obamacare.

      Ten Steps to Transform Health Care in America Act (S. 1783) introduced by Senator Mike Enzi (R-WY) July 12, 2007.
      Every American Insured Health Act introduced by Senators Richard Burr (R-NC) and Bob Corker (R-TN) with co-sponsors Tom Coburn (R-OK), Mel Martinez (formerly R-FL) and Elizabeth Dole (formerly R-NC) on July 26, 2007.
      Senators Bob Bennett (R-UT) and Ron Wyden (D-OR) introduced the Healthy Americans Act on January 18, 2007 and re-introduced the same bill on February 5, 2009.
      Patients’ Choice Act of 2009 introduced by Senators Tom Coburn (R-OK) and Richard Burr (R-NC) and Rep. Paul Ryan (R-WI) and Devin Nunes (R-CA) on May 20, 2009. [See Update #1 for why this bill was of particular significance]
      H.R. 2300, Empowering Patients First Act introduced July 30, 2009 by Rep. Tom Price (R-GA).

      Comprehensive conservative Obamacare replacement plans

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    8. Likewise, conservative market-oriented health policy scholars have developed a rich menu of potential replacement plans for Obamacare:

      Individual Pay or Play proposed in 2005 by John Goodman; this is a minimalist version of a broader reform envisaged by Goodman built on converting the tax exclusion into universal tax credits.
      Health Status Insurance originally proposed by John Cochrane in 1995.
      Universal Health Savings Accounts proposed by John Goodman and Peter Ferrara in 2012. This combines fixed tax credits with individual pay or play and health status insurance concepts along with Roth-style Health Savings Accounts.
      Fixed tax credits. A variety of proposals have centered on using fix tax credits to replace the current inefficient and unfair tax exclusion for employer-provided health benefits. Two good explanations of how that would work are here:
      James C. Capretta and Robert E. Moffit, “How to Replace Obamacare,” National Affairs, no. 11 (Spring 2012).
      James C. Capretta. Constructing an Alternative to Obamacare: Key Details for a Practical Replacement Program. American Enterprise Institute, December 2012.
      Income-Related Tax Credits proposed by Mark Pauly and John Hoff in Responsible Tax Credits (2002) and endorsed by the American Medical Association. More recently, 8 scholars from Harvard, University of Chicago, and USC–Jay Bhattacharya, Amitabh Chandra, Michael Chernew, Dana Goldman, Anupam Jena, Darius Lakdawalla,Anup Malani and Tomas Philipson—released Best of Both Worlds: Uniting Universal Coverage and Personal Choice in Health Care (2013) which also is built around a model of individual health insurance subsidized with income-related tax credits.
      Flexible Benefits Tax Credit For Health Insurance by Lynn Etheredge in 2001.
      Near-Universal Health Insurance Exchanges proposed in 2001 by Sara Singer, Alan Garber and Alain Enthoven (covers only non-elderly).
      Universal Health Insurance Exchanges proposed in 2013 by former CBO director Douglas Holtz-Eakin and Avik Roy (covers Medicare and Medicaid in addition to privately insured).

      Too many people conveniently ignore that in his 2007 State of the Union message President Bush proposed a sweeping health reform plan that would have replaced the current tax exclusion for employer-provided coverage with standard tax deductions for all individuals and families. The Bush plan called for a tax deduction that would have applied to payroll taxes as well as income taxes. Moreover, if one were worried about non-filers, the subsidy could easily have instead been structured as a refundable tax credit in which case even those without any income taxes would have gotten an additional amount. This is the kind of policy detail that easily could have been negotiated had the Democrats been in a cooperative mood in 2007. They were not. On the contrary, President Bush’s health plan was declared “dead on arrival” by Democrats in 2007. Yet it is Republicans who were tagged as being uncooperative and intransigent when they resisted the misguided direction that Obamacare seemed to be headed.

      What’s sad is that the Bush plan actually was superior to Obamacare when it comes to providing universal coverage. Remember, Obamacare actually does not provided universal coverage. The latest figures from CBO says that when it is fully implemented in 2016, Obamacare will cut the number of uninsured by only 45%, covering 89% of the non-elderly. Even if illegal immigrants are excluded, this percentage rises to only 92%. In contrast, the Bush plan (without a mandate!) would have cut the number of uninsured by 65%. But that’s ancient history. Consider one of the newest market-oriented health reform plans put on the table by Jim Capretta and Douglas Holtz-Eakin. Compared to Obamacare, this plan would cost roughly the same amount yet cover 22% more (8 million!) uninsured. If there’s a superior alternative to the slow-motion train wreck now being implemented, why wouldn’t the President and Democrats in Congress want to seriously consider it as a replacement?


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    9. I have to concede that I cannot answer point by point on this, but some general thoughts.....I believe Republicans were out ahead on this quite awhile ago and that has pretty much changed. They are all interested in doing something now because the passage of Obamacare let the genie out of the bottle. Both parties, IMO, have the same problem, their concern for actual health of the country comes second to ensuring their benefactors are protected. I read the Forbes link and the authors there admitted a few things, first of all, that plan won't satisfy those who want to return to pre obama care, and second, it does not force insurance companies to extend an offer to those who previously were uninsured. In short, it defends the status quo of favorable risk pools for insurance companies while letting tax payers eat the cheese for everyone else.

      There are a few realities here. Boehnor cannot pass a moderate Republican bill without getting Democrat support. In order to protect his leadership spot, he will honor the Hastert rule to keep the Tea Baggers in their cage. On the Senate side, Reid is not going to allow a vote that basically gives Republicans the chance to completely repeal Obama care, keep what they like, and then simply redraft a very similar policy and proclaim to the world how great they are. There is more than enough ego and partisanship to go around here.

      The term market reform to me means one thing, namely that buyers of health care (patients) want everyone to make less money so that care is cheaper. This is silly to me. As long as we view healthcare as a commodity, it will be consumed like everything else. If we want to reduce costs by encouraging health, that is a way way way different outlook and we are no where near that.

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    10. The term market reform to me means one thing, namely that buyers of health care (patients) want everyone to make less money so that care is cheaper.

      The only way to make it cheaper is by consuming less.
      1. Penalize people for poor habits affecting health. The government will never do that and say people cannot be obese.
      2. Make everyone pay for their healthcare via co-pays (50 buck minimum) which makes people think twice before wasting 50 bucks for a doctors visit. Can't have that because we have that bleeding heart disease.

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  5. How will the Supreme Court rule? It's anybody's guess. As noted, if they rule for the plaintiffs, the GOP is going to be stuck with doing what they promised, coming up with a better health care law. That will be truly interesting.

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  6. http://www.washingtonpost.com/wp-dyn/content/article/2010/02/07/AR2010020703003.html


    http://www.huffingtonpost.com/2010/02/12/obama-health-care-summit_n_459651.html




    http://usatoday30.usatoday.com/news/washington/2010-02-07-obama-health-care_N.htm

    http://abcnews.go.com/blogs/politics/2010/02/president-to-host-bipartisan-health-care-reform-meeting-next-week/

    http://www.foxnews.com/politics/2010/02/07/obama-invites-gop-leaders-health-care-talk/

    http://www.boston.com/news/nation/washington/articles/2010/02/08/obama_invites_gop_leaders_to_health_care_reform_talk/


    Cut the crap Lou and tell the truth for once. Obama invited the GOP to summits on healthcare and because of the obstructionist nature of the current sitting members of that party few if any showed up. You had your chance, but your party put politics over the American people as it always does. Early in the writing Obama did take suggestions and in put from Olympia Snowe(R Maine), Susan Collins (R Maine) Mike Enzi (R Wyoming), Chuck Grassley (R Iowa), and Lisa Murkowski (R Alaska), and admit it Lou each one was ostracized by the republican party for even considering working with the president.

    http://www.washingtonpost.com/opinions/olympia-snowe-why-im-leaving-the-senate/2012/03/01/gIQApGYZlR_story.html



    http://voices.washingtonpost.com/ezra-klein/2009/12/susan_collins_health_care_wish.html

    http://www.huffingtonpost.com/2009/08/26/mike-enzi-gang-of-six-rep_n_269447.html

    http://www.newsmax.com/Politics/enzi-cheney-ad-security/2013/11/27/id/538925/

    http://talkingpointsmemo.com/dc/grassley-look-how-great-this-health-care-bill-is


    KIng Please read the links, Lou, King is a man trying to understand or country and government. Just once just once why can't you give him an unbiased truth?

    As for your bro and sis in law, if they choose to end their practice don't blame it on the law but their lack of desire to conform to the law. Doctors and hospitals all over the nation are conforming and staying in business. just because they possess the defeated "I am not changing with this" attitude which caused you to buy insurance off the exchange for more money then on, millions of Americans and thousands of doctors possess the progressive minds that will eventually see this reform work.
    I for one like it. After my sickness last year it is wonderful to sit at home and be able to look at my records, converse with the doctor's office by email, fill out anything they need before I go, and pay any co pays easily, all direct results of healthcare reform. My premiums have not increased any more then ever over the last few years, although I did have to pay a smoking penalty for my spouse this year but I totally get that. Wake up to the future Lou.



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    1. Rick,
      Thanks for your support but it is not necessary in this case. Lou is my friend and, like you he has contributed much to my understanding of your county, its politics and customs. It was Lou who cleared my mind in relation to the recall of the Wisconsin Governor and the more obscure composition and rulings of the Supreme Court. You may recall giving me some clarification of several points including my struggle to understand the Filibuster rules in congress. To you both I owe so much and I have the advantage of being able to cherry pick your opinions and to accept that which is factual. I disagree with Lou in that I support what I know of Obama care, it will however never weaken our friendship and I hope I can claim the same with you if we find something on which we cannot agree.
      Cheers from Aussie.

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    2. Guess you don't get it do you Rick.

      The court case isn't about the merits of the ACA, good or bad. Healthcare in America, good or bad.

      The court case refers to a possible over reach by government in the interpretation of the law. The law as written or the law as intended or interpreted by the IRS and the administration. In any case, the laws written by congress if open to interpretation can be subverted to what the acting authority wants it to say. This is exactly what is being done, what we really meant not what we wrote and passed.

      As to the rest of your post, tell the truth Rick, you took a massive increase in healthcare cost when your employer dumped spousal benefits. One of the effects of the high cost of healthcare caused by the ACA. Free is never free, someone always pays for it.

      As to my Brother in Law, he has an offer to do research for a pharmaceutical which he has accepted. Sister in Law also has an offer from a different Pharma doing clinical testing.

      p.s. My contribution to your corrupt government, 25% tax bracket this year, my reward for 4 months of work. Won't happen this year. I'm taking the FREE ride.

      The mountain is high, the valley is low
      And you're confused 'bout which way to go
      So I flew here to give you a hand
      And lead you into the promised land

      Sounds like something from Barry.

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    3. Hum, well Louman my employer never dumped spousal benefits. Only a tobacco surcharge was added because she smokes. I still have her covered, as well as our 25 year old son who couldn't afford insurance right now. Hopefully in a year he will be able to. My premiums were about $220 a month in 2010 today they are about 250, 20 of that is the tobacco surcharge. you see when you work someplace that isn't political, isn't obstructionist, and takes time to understand the law, it really isn't all that different. So although you represented the doctors in the family as quitting because of the law they are in fact hanging up their stethoscopes for a better job with big pharma. And of course you continue to bring up your tax bracket because I guess you assume that I am among the 47% who pays nothing. Fat chance Lou, I am in the 28% tax bracket lou my reward for working my ass off for the WHOLE YEAR. Of course I realize that my effective rate is going to be more around 19-20% because that's how our tax code works for the lesser among us, it works much better when you can show even more income.

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  7. As always your completely clueless as to the intent of the post.

    The post is about:

    The law as written or the law as intended or interpreted by the IRS and the administration. In any case, the laws written by congress if open to interpretation can be subverted to what the acting authority wants it to say. This is exactly what is being done, what we really meant not what we wrote and passed.

    The issues at hand:
    One view:
    In an effort to get people into the system and make health insurance affordable, the law provides subsidies to low-income families to help cover part of the cost of their premiums.

    The size of your subsidy, the law says, is based on each month that you were enrolled in coverage "through an Exchange established by the State under [section] 1311 of the Patient Protection and Affordable Care Act."

    This line is the heart of the challengers' argument. As they see it, if you weren't enrolled in an exchange "established by the State," your coverage doesn't meet the formula's definitions and you shouldn't be receiving a subsidy. Thus, the IRS is breaking the law by providing subsidies in all 50 states.

    "Precisely because the Act directs two distinct entities to establish Exchanges, 'Exchange established by the State’ cannot be read to include an Exchange established by HHS," the challengers wrote in their brief to the Supreme Court.

    The opposing view point:

    Although the law said states “shall” establish exchanges, it also set up a backup plan: If a state did not "elect" to establish its own exchange, the statute says, the Health and Human Services Department “shall (directly or through agreement with a not-for-profit entity) establish and operate such Exchange within the State.”

    There it is: such Exchange.

    To the Justice Department and other ACA supporters, “such Exchange” is a critical phrase. It shows, they argue, that Congress saw the federally run exchanges as essentially identical, in their purpose and their responsibilities, to state-run exchanges.

    As to my sister and brother in law, they chose not to play anymore, pay more to conform, provide substandard care with PA's and NP's, as did my family doctor.

    p.s. This reform will not work as it's unsustainable at 900 billion for 2014 and 1 trillion dollars for 2015. Add in 1 trillion for SS in 2015 and you have 50% of government spending on 2 entitlement programs which are increasing in cost every year.

    Pay attention as it's not only about healthcare but cost. We will eventually have a workable bare bones healthcare package that can be supported by a sales tax or a value added tax. Nothing is free in life as progressives like to believe.

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    1. Master Roberts found a way to validate Obamacare the first time around. I trust he will contort the English language to promote the progressive holy grail once again.

      As for mick's worry that the House will have to produce a replacement program I suggest he realize that they already have. Tort reform and enabling the selling of insurance products across state lines have already been approved and buried in the hundreds of Bills buried in Harry Reid s senate black hole.

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    2. "Tort reform and enabling the selling of insurance products across state lines have already been approved and buried in the hundreds of Bills buried in HARRY REID'S SENATE BLACK HOLE."

      Waaaaaaah. If American wanted tort reform, they would have given the Republicans supermajorities in both house. This is what you like William, governance being blocked from happening.

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    3. Seems Americans like dysfunctional government.

      They tried the Repub model and were dissatisfied. The tried the Dem's model and were dissatisfied.

      Hence the gridlock in Washington today.

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    4. Even with gridlock since 2010 Obama will still amass over 10T in additional debt before he is through. Fact is the DEM and GOP leaders do not want to reduce their cherry pie.

      I wonder what HRC ideas are for reducing the debt? I wonder if she has and ideas at all?

      In the mean time the HSA gets funded this week and the big spenders continue on their merry way.

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    5. There is no political will to reduce spending. 60% of Americans receive gifts from the Federal Government from healthcare to housing to educational benefits. The hands extended to get the freebies are many.

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