SCOTUS hears arguments for/against Healthcare bill
 

Washington (CNN) -- The Supreme Court concluded a marathon public debate on health care Wednesday with justices signaling an ideological divide that could topple some or all of the the sweeping reform bill championed by President Barack Obama.

On the third day of oral arguments on legal challenges to the 2010 Affordable Care Act, the justices tackled the question of what would happen if they ruled that the heart of the law, the individual mandate that is its key funding mechanism, was unconstitutional.

The six hours of hearings over three days provided an extended public view of the high court in action on one of the most controversial issues of the day, touching on legal concepts involving federal and state powers, individual rights and legislative intent.

At stake is the survival of the signature legislation of Obama's presidency as he seeks re-election in November: the health care reform law that requires most Americans to have health coverage as part of a systemic overhaul intended to lower costs.

At issue Wednesday morning was whether all the law's 450 or so provisions would have to be scrapped if the individual mandate were found unconstitutional.

A separate session Wednesday afternoon looked at whether states would be "coerced" by the federal government to expand their share of Medicaid costs and administration by the risk of losing federal funding if they refuse.

To CNN senior legal analyst Jeffrey Toobin, the questioning by justices Wednesday signaled they are ready to invalidate the individual mandate, a step he said could put the entire law in jeopardy.

"I think the individual mandate is gone, based on the questioning," Toobin said after the morning session. "It sure looks like there are at least five votes to get rid of ... the individual mandate."

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What would you keep or get rid of?

Is it possible for the health care reform bill to go into effect without the individual mandate, like an alternative to the individual mandate that may be more constitutionally sound?

It would bankrupt the insurance companies.

Any insurance depends on a large pool of both high and low risk customers. If you didn't have to have insurance, but could buy it at any time if you needed it, then people would only buy it when they needed it and the risk pool would be skewed. It's like saying that you don't need auto insurance or home owners insurance unless you have an accident or disaster and can buy it at that time to cover the damage that has been done already.

The "conservative" position requires legislation from the bench. Essentially stating that the government has the power to regulate interstate commerce, except now the government's power will be limited by some unseen principle which says that citizens can't be forced to participate in commerce. Doncha love how the Constitution becomes a living/breathing document when it helps to meet our political ends and that we must look to the founders' intent otherwise?

I suspect we don't agree on much politically, but this ^^^ I agree with 100 percent.

ACA will be ruled unconstititutional because of the individual mandate, primarly because of the poor, poor staff work of the presdiden't people. Taken together, ACA has 47 percent approval. But when you separate out and poll ACA's individual elements, (i.e., allowing kids to stay on longer, pre-existing coverage, they have high 60+, 70+ plus approval)

The president allowed his opponents to define the issue (death panels, etc...) and his signature domestic accomplishment may be overturned because of it.

What that does to the general election is another matter, but with a more aggressive political campaign to inform and explain, I don't think we're on the verge of a 5-4 reversal, which is what's likely.

*bump* Because the decision is being announced today. Having worked in health care my entire career and now for an insurance company, I admit I'm quite worried about what a reversal would mean. We have been in a hiring freeze for over a month in anticipation of having to redeploy people in our National Health Reform division into other positions in the company. This day could be financially devastating for us and for the health care industry as a whole. I don't think people understand just how fragile our health care system truly is or how badly we need PPACA.

I'm in tears, I'm so happy, and so surprised.

Whew! I'm so thrilled at this news! While the Affordable Care Act is not perfect, I believe that it's a step closer to ensuring all Americans are covered, which should be a humanitarian and economic goal for all of us. I know that the individual mandate is controversial, but I see it as both a matter of personal responsibility and a realistic way to lower health insurance premiums for everyone.

As many people have already pointed out, folks without health insurance still get care when they need it - in the form of Emergency Room visits that are ultimately paid by the rest of us anyway.

Ditto! Especially the surprised part. And our health care reform division is breathing easier too. We are a humane and compassionate country after all.

Question for smarter people than me: just saw a conservative ad complaining that health care reform has already negatively impacted doctors and their patients and all. Obviously the ad had bias, but, I was under the impression that this bill won't go into effect for some time now- were there other health care changes that have already gone into effect, or was that commercial just completely wrong?

Some parts of it have already. I believe the pre-existing conditions part, maybe, and definitely the carrying dependents until they're 26. It was a staggered rollout of the bill, I believe the individual mandate kicks in in 2013 or 2014 but I can't remember now. It's a big law.

That makes sense, thank you

Some parts are in effect. Parents can insure their children up to age 26, insurance has to cover pre-existing conditions, and cannot charge more for premiums due to prior health history. Those are all part of that law.

I am making my comment (example) without actually knowing all the minute details of what is required to be considered 'insurance' per this mandate (like auto insurance that require certain minimum coverages?). I had 'insurance' a few years ago when I fell and hit my head on the floor. bruised my brain and knocked my spinal fluid production and absorption out of whack until it affected my vision (turns out I had 4x the normal level). Well, had to see specialists and all that with head MRIs. Turns out my 'insurance' only covered $100 of the office visit, $100 of the spinal tap, and $100 of the MRI - basically $300 of an approx. $6000 bill - which I'm still paying on 5 years later!

Personally, there needs to be tort reform before mandating everyone has to have insurance (or concurrent reforms/mandates). The insurance industry is even more 'broken' and not much is being done other than to make everyone buy their product of pay a tax penalty. . . . (The ENTIRE healthcare system is disfunctional!)

I've seen sources saying we will have mandatory health insurance requirements, and others that say that part was not upheld. Does anyone know the real deal on that?

It sounds like Chief Justice Roberts started out by saying "No, the federal government cannot force people to get health care" and those in the room jumped the gun and assumed that meant it was deemed unconstitutional, but he then continued with "but, the federal government absolutely has the right to tax those who don't have it". I believe the whole law was upheld.

http://www.healthcare.gov/law/timeline/

Here's a good overview of the whole shebang, for whomever was asking upthread.

WTF does tort reform have to do with anything? You had crappy insurance, and it didn't cover stuff.

A lot of folks are in favor of tort reform, but they don't have a clue what it means.

That is terrible, and I'm sorry that you have to go through that. I agree with you that many aspects of the healthcare system aren't working, and I'm particularly angered to hear about folks who HAVE coverage (in many cases, damn expensive coverage) and are still saddled with massive bills after a catastrophic incident.

What I would ideally like to see is a universal healthcare system that ensures a basic, free, level of coverage for all Americans, administered through a combination of private and public entities. For those who want a faster or fancier policy, they can purchase it, or have their employer provide it as part of a compensation package. And by "faster", I don't mean that you get your transplant or emergency surgery faster, I mean that you get your non-emergent doctors appointment with your preferred physician scheduled sooner. I mentioned that this law is not perfect, but I believe it is a step in the direction of universal healthcare, which would NEVER have passed if it were attempted in one fell swoop.

Many folks may be asking "what about cost?", and I think that's a very valid question. While I'm loathe to talk about life-saving technology that's "too expensive" to administer, I think there can be cost savings that we could realize through streamlined billing and files management, greater focus on early prevention and intervention of serious acute and chronic diseases, somehow reigning in the obesity epidemic, and a realistic, human approach to end-of-life and palliative care.

I heard a doctor on NPR recently say that money could be saved in many practices if doctors were allowed more time with each individual patient rather than sending them off to diagnostic tests right away. Instead, she argued, doctors are squeezed to see as many patients as possible in a day, so it's more cost-effective for them to see a patient for 5 minutes and then send them off to a multi-thousand dollar diagnostic test, rather than spend 30 minutes with the patient to narrow down the possible issues. (Those in the healthcare industry - please pipe up here; I've been fortunate to not have many of these rushed doctor visits and therefore can't vouch for this phenomenon personally).

I also recall President Clinton giving a speech a few years ago where he said that Canada spends less per capita on health care than we do in the U.S., and that their administrative costs per dollar were about half of what ours are (it was something like $0.15 to our $0.30 on the dollar spend in admin costs). This is purely remembered information, and I welcome corrections.

I think that we have a lot of public services like police, fire protection and education that are centered around the idea that our society is better served when each individual has certain protections and opportunities. To me, access to affordable, humane healthcare should be one of the primary pillars of a system that provides opportunity to "life, liberty and the pursuit of happiness".

The individual mandate was upheld, but as an issue of federal taxation, which is different than how it was originally presented by Congress/The Obama Administration (I think it was originally argued as constitutional under interstate commerce?).

Here's an example of a cost problem that is easily fixed:

I was having stomach problems, and fell into the demographic at high risk for Crohn's. I went to the doctor, and he said that he wanted to do a colonoscopy. He then explained that the insurance company won't let him do that unless he put me through cheaper tests first. He also said that the cheaper test always comes back "inconclusive -- do the colonoscopy", so I should just go ahead and schedule the colonoscopy right away.

So, in the doctor's opinion, the cheaper test was NEVER able to rule out Crohn's, but the insurance company mandated that I have the cheaper test anyway. That is really dumb.

ETA: I honestly don't know who was right, between the doc and the ins. co. Insurance companies obviously want cheaper tests, but there are also doctors who over-treat. The point is that there are conflicting incentives, here, and best practices in medicine need to be the winner.

http://www.buzzfeed.com/daves4/peopl...e-of-obamacare

I'm posting this out of sheer amusement...people ACTUALLY threatening to move to Canada (land of what they're running from, might I add) because of this ruling. Ignorance is bliss, right?

Congress, as it does presently, can offer money to the states to expand Medicaid and can attach conditions to such grants. But Congress cannot penalize states that choose not to participate in aspects of programming by taking away their existing Medicaid funding.

But I had insurance - which isn't what this whole 'healthcare' debate is about?! How many people don't have insurance in this country?! Having insurance or not doesn't mean much if you still can't afford to go to the doctor when it is necessary (or can't afford the fees charged for tests which you pretty much HAVE to have because of various conditions/illnesses).

And tort reform (and insurance industry reform) have a LOT to do with this whole mess called a 'healthcare system'. . . .

I'm actually moving to England for school - and looking forward to being in the national health insurance system. I know that some of my medications are not covered (and not readily available there so I'm bringing them with), but from talking with other Americans there, they say it is a really good system for the basics (with a wait for non-emergency surgeries, etc).

Do tell? Can you explain that one? I know the Chamber of Commerce types claim this is true, but any sort of peer-reviewed study of the whole system has found that malpractice liability has a small to negligible effect on healthcare cost.

That aside, do you not think that patients should be able to sue medical providers who kill and maim them due to professional negligence?

No it doesn't. That's just what some politicians would like everyone to believe. You know what does, though? People going to the hospital for basic and emergency care who don't have insurance. Congress already mandated that hospitals care for patients regardless of coverage or none - they made their bed, now they need to lay in it! Do you know how much emergency surgery costs? People with insurance have overpaid to make up for the people without insurance. THAT is what drives costs up, not the few people suing doctors for doing things like amputating the wrong leg.

In regards to the bold maybe we should get away from seeing the doctor for minor illnesses and rely more on nurses and PA's for our treatments of minor illnesses and check-ups. IIRC that's what they do in Canada. They also make a smaller salary compared to American health professionals.

So now I/you can be taxed for something we do not do or do not consume. I.E. - buy health insurance

What if the Congress and Senate decides everyone should own a gun? They can now tax you/me/he/she for not owning said gun. There are now no limits to the power of the Federal Government. They must simply tax ones actions or inactions in order to exert control. Scary stuff. The Genie is out of the bottle.

Ultimately, if the voters thought the gun law was a dumb law, they'd vote for someone else. Eventually, the government is accountable.

And of course there are limits. If you don't want a gun, just pay the tax. Easy peasy.

Yes! I loved this part of Roberts' majority opinion: "[Justices] possess neither the expertise nor the prerogative to make policy judgments. Those decisions are entrusted to our Nation’s elected leaders, who can be thrown out of office if the people disagree with them. It is not our job to protect the people from the consequences of their political choices.”

See "Militia Act of 1792".

The government already MAKES you do plenty of things: pay/file taxes, obey laws, sign up for selective service if you're male and over 18, go to some kind of school for a certain number of years, etc.

Like others have said, the limits are set by the representatives WE elect to office. They are responsible to us, and therefore WE are the ones who ultimately decide those limits.

Yea - I agree with that, too. This same doctor mentioned the burdens of having to type up and input patient's records into the new(ish) universal electronic medical records system, and my first thought was "get a clerk or receptionist to do that!". Doctors are valuable, use their time wisely.

Well, one of the reasons taxes/subsidies exist is to account for external forces in the economy that aren't accounted for otherwise. Example, pollution is bad for society as a whole, so there's a tax on companies that produce whatever amount of pollution. Alternate example, raising children is important to society so the government offers a tax credit if you used child care services. These benefits/problems are not reflected in supply/demand or anything like that, so the government steps in to apply them and encourage practices that are good for all of us.

When someone goes to the emergency room with no insurance, our tax dollars pay for it in at least some part and usually in a large part after they can't afford to pay. This desire from the "we" to not pay for "their" lack of insurance, coupled with the widely held idea that having healthcare is a vital part of life, has lead to this decision that it is okay for the government to penalize via tax those who don't have healthcare.

"We can be taxed even if we don't use it"
Same with public schools, police stations, firemen, public transportation, unemployment, my issued AF uniforms (thanks though!), my mother's salary as a state employee, clean water, trash pick up, road repair, street lights, power plants, etc. It is in the best interest of the country at large for these things to be easily accessible by all, even if the individual doesn't use it.

"What if congress decides that we should buy (whatever item, in this scenario a gun)"
Well then congress would have to say that it is of vital national importance for every citizen for be armed, prove that taxpayers are already paying for those who aren't armed, and make it easy to provide access to guns. This extrapolation argument is about as strong as the "If we let the gays get married than what if someone wants to marry a goat!!!!" one, as guns and healthcare are two totally different things (though I suppose the use of one could lead to a need for the other ;)).

The federal government has historically stepped in to force the states to do things (see: 13th, 14th, 15th amendments) and other states have plans like this one (see: Governor Romney's Massachusetts Health Care), so no, this is not something new or something majorly terrifying signaling the end of the world as we know it. I'm not going to pretend to know how this'll play out or end, but I'm also not going to act like I know more about the constitution than the Supreme Court. There are reasons the founding fathers instituted a republic not a direct democracy (and that the people only directly elected the House of Representatives at first).

Your first paragraph I referenced above concerns, primarily, local and state governments. I have no problems with this type taxation. Massachusetts should be free to have any kind of health care they wish. Other states should be free to not have such if that is their decision.

In the second paragraph referenced you state that something must be of vital national importance for it to be taxed. There is no requirement of this in the ruling. The Legislative Branch must only decide to tax it. This is a huge expansion of taxing power of our Federal Government.

It comes down to whether one wants a large central government or not.

Nice talking point but it doesn't have much bearing on "precedent" as it relates to the health Care debate. The "Militia Act of 1903" replaced it with a state controlled National Guard.

Congress has had, for over two hundred years, the right to make someone buy something, and it has not caused the demise of society. Neither will today's ruling.