Federal subsidies for the ACA struck down in federal appeals court

[Lord Thesaurian]

http://cnsnews.com/news/article/susa...dies-36-states
http://www.marketwatch.com/story/app...ies-2014-07-22
http://www.nbcnews.com/id/47918979/n.../#.U86A8U1OUdU


In a potentially landmark decision, a federal appeals court has declared that federal tax subsidies issued by the IRS through federal exchanges are illegal. In other words, for the 34 states that did not set up their own insurance exchanges, people who purchased insurance through the federal exchanges (about 4.5-5 million people or more) will experience significant premium hikes as the subsidies they were promised are no longer available. The subsidies were made available at varying degrees to those enrollees registering at 133%-500% of the FPL. Those below that level are eligible for Medicaid under the ACA, but many states declined to expand their Medicaid programs to enroll the newly eligible.

In spite of the decision, the President has already announced that these federal subsidies will continue to flow regardless of the court's decision.

http://news.yahoo.com/white-house-he...-politics.html

I have already voiced my opinions on the ACA in general at length as have many others in another thread. I would rather we not go there. Instead, where do you think we go from here? Do you think the full implications of this decision will go into effect, and what might those be? Or do you think other courts will produce competing decisions, prompting a possible SCOTUS case?

Additionally, given the Administration's prompt and stark statement on the issue, do you think this blatant disregard for the law will fuel critics' claims that the Obama White House is an "autocratic" or "lawless" administration?

[Sphere]

The Administration won the case in the lower courts, and most observers agree it will win the case when it is appealed to the full Circuit court.

Whether the Supreme Court elects to hear it is unknown, but probably not. The case hinges on ambiguous wording which the plaintiffs interpret as only allowing health insurance subsidies for state run exchanges, not the federally run exchanges set up in states which chose not to set up their own.

This was clearly never the intent of the law; to have subsidies in some of the exchanges but not others. As such it isn't much of a case.

[Gaidin]

ACA Subsidies were also upheld in another district anyway. Will landmark appeals case be so landmark? Potentially not. SCOTUS might be more interesting if it hears it.

[Big War Bird]

This was clearly never the intent of the law;

Prove it

The intent of the law is clear. "Through an Exchange established by the State under section 1311 of the Patient Protection and Affordable Care Act" appears nine times within the ACA. And no statement by any lawmaker at the time the ACA was being considered endorses the view that a federal exchange is equivalent to a state exchange. The federal exchange is established under section 1321. Nowhere in the bill is an equivalence drawn between the too in regards to subsidies.

[Sphere]

Prove it

The intent of the law is clear. "Through an Exchange established by the State under section 1311 of the Patient Protection and Affordable Care Act" appears nine times within the ACA. And no statement by any lawmaker at the time the ACA was being considered endorses the view that a federal exchange is equivalent to a state exchange. The federal exchange is established under section 1321. Nowhere in the bill is an equivalence drawn between the too in regards to subsidies.

That just doesn't hold much water.

The language says each state shall set up an exchange, if not the Feds will create "such exchange." The bill doesn't make any real distinctions between the two after that. Indeed introducing such a distinction would make much of the bill non-nonsensical, most noticeably nobody in states with federally run exchanges would be eligible to buy insurance on those exchanges. They would look pretty, but nobody would be legally able to buy into them. Here even plaintiffs have had to concede that when the bill says "state exchange" it means both federally and state run.

The plaintiffs main claim is that while yes, in that part of the bill about eligibility the term "state exchanges" also assumes the federally-run state exchanges, but when it comes to the subsidies section congress really wanted to give states an incentive to set up their own exchanges (set up your own, get subsidies). But Plaintiffs can offer no legislative history supporting that idea, and defendants offer plenty to the contrary.

In short the legal theory isn't an impossible one, but too much of a stretch to win out.

[Gaidin]

That's ok, we can drive Texas taxpayers even more into the ground until they force their legislature to enact an exchange because they're too damn poor not to have one for all I frakking care. In the end, when they're too poor to pay their rent because of of this ruling, they can blame their own damn state GOP party.

[Denny Crane!]

Is it not right that the administration is right to let funds continue to go in while the decision is on appeal?

Other than that, I'm out on this topic, getting into the legalities rather than the broader debate on the ACA is to deep for me (and possibly a bit shallow, kinda get the feeling its getting forced through no matter what sorry LI - though I did post your pro but in the ethos thread).

[Gaidin]

Is it not right that the administration is right to let funds continue to go in while the decision is on appeal?

Best guess? Fundamentally treating it as a stayed decision as another appellate district is in direct conflict with a similar case, each effecting more than just their districts.

[Denny Crane!]

s what I figured roughly.

[Lord Thesaurian]

That just doesn't hold much water.

The language says each state shall set up an exchange, if not the Feds will create "such exchange." The bill doesn't make any real distinctions between the two after that. Indeed introducing such a distinction would make much of the bill non-nonsensical, most noticeably nobody in states with federally run exchanges would be eligible to buy insurance on those exchanges. They would look pretty, but nobody would be legally able to buy into them. Here even plaintiffs have had to concede that when the bill says "state exchange" it means both federally and state run.

The plaintiffs main claim is that while yes, in that part of the bill about eligibility the term "state exchanges" also assumes the federally-run state exchanges, but when it comes to the subsidies section congress really wanted to give states an incentive to set up their own exchanges (set up your own, get subsidies). But Plaintiffs can offer no legislative history supporting that idea, and defendants offer plenty to the contrary.

In short the legal theory isn't an impossible one, but too much of a stretch to win out.

It does appear that way

http://housedocs.house.gov/energycommerce/ppacacon.pdf

On pages 85-86, the HHS Secretary is given the authority to establish "such exchanges" and enforce "such requirements" in states that don't set up their own. So far the decisions in district courts have been split along party lines (party appointees), though the language does seem ambiguous in the feds' favor, equating federal with state exchanges in states that don't set up their own. My own bias hopes the subsidies will be struck down in a court high enough to force total federal compliance, if only so that more people will directly bear the reality of rising premiums and decreasing consumer choice under the ACA and perhaps something might finally be done about the monstrosity.

Is it not right that the administration is right to let funds continue to go in while the decision is on appeal?

Given the conflicting opinions in the district court, the Administration certainly has plenty of room to play the wait and see game. It just irks me that immediately, within hours of the decision, the Admin was already publicly telling the court(s) in no uncertain terms to shove it. Given the Admin's track record on defying (and at times directly so) the law and the courts to suit its own agenda, I don't see this latest snub as a good sign moving forward.

That's ok, we can drive Texas taxpayers even more into the ground until they force their legislature to enact an exchange because they're too damn poor not to have one for all I frakking care. In the end, when they're too poor to pay their rent because of of this ruling, they can blame their own damn state GOP party.

Or perhaps they could consider urging change/repeal of a law that forces people into cookie-cutter plans with increasingly limited care options and tries to mask rising premiums/costs with federal subsidies and employer contributions, thereby making it more difficult for people to find affordable health insurance that suits their choices as consumers.

[justicar5]

It does appear that way

http://housedocs.house.gov/energycommerce/ppacacon.pdf

On pages 85-86, the HHS Secretary is given the authority to establish "such exchanges" and enforce "such requirements" in states that don't set up their own. So far the decisions in district courts have been split along party lines (party appointees), though the language does seem ambiguous in the feds' favor, equating federal with state exchanges in states that don't set up their own. My own bias hopes the subsidies will be struck down in a court high enough to force total federal compliance, if only so that more people will directly bear the reality of rising premiums and decreasing consumer choice under the ACA and perhaps something might finally be done about the monstrosity.

Given the conflicting opinions in the district court, the Administration certainly has plenty of room to play the wait and see game. It just irks me that immediately, within hours of the decision, the Admin was already publicly telling the court(s) in no uncertain terms to shove it. Given the Admin's track record on defying (and at times directly so) the law and the courts to suit its own agenda, I don't see this latest snub as a good sign moving forward.

Or perhaps they could consider urging change/repeal of a law that forces people into cookie-cutter plans with increasingly limited care options and tries to mask rising premiums/costs with federal subsidies and employer contributions, thereby making it more difficult for people to find affordable health insurance that suits their choices as consumers.

yay lets force people into the 'market' so they can get their insurance rescinded at whim! Youy could cure that by making the board directly responsible so that rescission of care becomes conspiracy to murder I guess wouldn't take more than a dozen coked up millionaires going to a supermax for the message to sink in...or you could go to the far cheaper and more efficient single payer model, and save a huge amount on health care...

[Lord Thesaurian]

yay lets force people into the 'market' so they can get their insurance rescinded at whim! Youy could cure that by making the board directly responsible so that rescission of care becomes conspiracy to murder I guess wouldn't take more than a dozen coked up millionaires going to a supermax for the message to sink in...or you could go to the far cheaper and more efficient single payer model, and save a huge amount on health care...

Your rabid hyperboles aside, yes, "forcing" people to take the horse pill that is the ACA rather than sugar-coating it with federal and employer subsidies will at least spare people from the illusion that they are getting "free" healthcare. Under the current system, the ACA will exacerbate rising healthcare expenditures nationwide while insurers limit care providers further and further in order to remain profitable while compliant with the ACA coverage regulations. Rural hospitals are projected to face greater intensity of the existing threat of fiscal insolvency as Medicaid traffic increases, forcing more and more Americans to travel greater distances for emergency care....etc etc

Spoiler Alert, click show to read: 

This phenomenon is already well documented in the track record of Medicare, which for decades has increased healthcare expenditures/costs nationwide and limited care options, effects that trickle down to affect non-seniors thanks to the sheer size of the impact of Medicare on healthcare markets; 50% of total annual healthcare expenditures in 2003 alone. Seniors themselves are shielded from the direct cost of these impacts because they are covered mostly or completely by Medicare, incentivizing increased consumption of products and services in a vicious cycle. This is all well-documented over the 5 decades Medicare has been in place, leading to the current untenable situation with tens of trillions of dollars in unfunded Medicare liabilities.

As a massive extension of Medicare/Medicaid, the ACA will exacerbate all these problems and more, though I suppose by now I'm breaking my own rule and venturing into general discussion of the legislation. All my commentary and sources can be found in my posts in the "I Hate Obamacare" thread.

Long story short, yes, if people are not aware of the costs of their decisions, costs will rise with little or no foreseeable tether. That's just basic economics and is supported by observations of Medicare and CBO projections for the ACA. Shielding people from these costs is a major factor in the debt bomb that is Medicare and the ACA will be no different. Therefore I hope the subsidies are struck down, the current ACA is declared insolvent/defunded by the House, and actual healthcare reform is brought to the table. As far as a single-payer system, all I can say is if the US Government can't even retain anything resembling fiscal viability providing care to seniors and the poor, how could it ever do so for the entire country? Are there functional single-payer systems in Europe? Sure, plenty. Do I see any such system ever coming to the US? No. The feds can't even run a public insurance program. Ideology such as yours, untethered to anything but the vaguest of moral imperatives, is part of how this mess was made. I can scarcely imagine how it would improve things now.

[I WUB PUGS]

I despite being mostly conservative am I huge proponent of a single payer system and totally against the nightmare that is the ACA.

However I don't think that the US government is at all capable of delivering a single payer system. Just incompetent as hell when it comes to this for some reason.

California had a single payer option get put on the docket for the legislature for like 20 straight years or something. Never passed, but it was gaining in popularity and looked like it could actually be accomplished with some marketing. Oddly, this year it was dropped by the representative that had been filing for it over the years. Speculation here is that the DNC doesn't need a Democratic stronghold state actively subverting the ACA with a single payer system ran by the state. Leverage was applied. This is very upsetting to me. As most that follow me here know, I am a BIG proponent of States Rights/Initiatives and I do not believe that more money should ever be paid to D.C. in the form of taxes than any of us pay to our respective State Capitals.

Hope I'm not getting too far off topic.

Am I right in saying that this goes to SCOTUS eventually? I swear I read somewhere that Obama was saying that the day of this ruling.

[Gaidin]

Am I right in saying that this goes to SCOTUS eventually? I swear I read somewhere that Obama was saying that the day of this ruling.

If both Appeals Courts end up agreeing in whatever fashion they agree in the SCOTUS might not give a damn.

[Admiral Piett]

I despite being mostly conservative am I huge proponent of a single payer system and totally against the nightmare that is the ACA.

However I don't think that the US government is at all capable of delivering a single payer system. Just incompetent as hell when it comes to this for some reason.

California had a single payer option get put on the docket for the legislature for like 20 straight years or something. Never passed, but it was gaining in popularity and looked like it could actually be accomplished with some marketing. Oddly, this year it was dropped by the representative that had been filing for it over the years. Speculation here is that the DNC doesn't need a Democratic stronghold state actively subverting the ACA with a single payer system ran by the state. Leverage was applied. This is very upsetting to me. As most that follow me here know, I am a BIG proponent of States Rights/Initiatives and I do not believe that more money should ever be paid to D.C. in the form of taxes than any of us pay to our respective State Capitals.

Hope I'm not getting too far off topic.

Am I right in saying that this goes to SCOTUS eventually? I swear I read somewhere that Obama was saying that the day of this ruling.

This basically my exact views on the subject. It's made me a bit of a pariah when I go to my Williamson County Libertarian meet-ups. I always contend that even a Dutch-like system where both public and private means exist to make sure everyone's healthcare is always covered 100% results in far less money being spent on the issue and makes life a lot easier for everyone. ACA has been a disaster for my family where my father's employer dropped his previous plan for a $3200 deductible plan with a smaller network coverage.

[I WUB PUGS]

The only people I know of that have greatly benefited from the ACA are ones with pre-existing conditions. But that could have been added with a simple change to licensing insurance companies. Simple "can't sell insurance in the USA if you don't offer coverage for pre-existing conditions".

Everyone else I know that's been forced into it has been burdened financially.

I am so fortunate to have an employer that has kept our plan with Kaiser.

Thank's Gaidan. But if they differ at on to a decent degree then SCOTUS probably takes it up and we get round two of ACA rulings...

[Gaidin]

The only people I know of that have greatly benefited from the ACA are ones with pre-existing conditions. But that could have been added with a simple change to licensing insurance companies. Simple "can't sell insurance in the USA if you don't offer coverage for pre-existing conditions".

But ahh, you can't really force coverage onto the insurance companies without forcing coverage onto the healthy. The sword, as they say, has to be double edged for that kind of system to work. Even now, the healthy that are skipping coverage are paying a bill into the system that gets bigger every year until they do get coverage. We can argue all day long describing other systems and how they could've been better(if a law could've would've should've been passed), and all things being equal, you and I might agree, but I want to avoid that, I just want to describe this system, if you don't mind.

[Lord Thesaurian]

But ahh, you can't really force coverage onto the insurance companies without forcing coverage onto the healthy. The sword, as they say, has to be double edged for that kind of system to work. Even now, the healthy that are skipping coverage are paying a bill into the system that gets bigger every year until they do get coverage. We can argue all day long describing other systems and how they could've been better(if a law could've would've should've been passed), and all things being equal, you and I might agree, but I want to avoid that, I just want to describe this system, if you don't mind.

The unhealthy disproportionately sign up for health insurance relative to the healthy as it is. It's a simple matter of information asymmetry. Consumers know more about their own health and history than do the health insurance companies, and thus the healthy will avoid buying coverage they don't want whereas the unhealthy will sign up for more. This is the reality of health insurance, so supposing that a mandate is necessary to prevent unhealthy people from bankrupting the system is fairly disingenuous IMO.

No. Only reactionary extremists would see this as 'autocratic' or 'lawless'.

And only trolls post baited appeals to ridicule...... As I mentioned, I think that while the Admin is obviously well within its bounds here, its nonchalant " off" response to the court's decision is worrisome moving forward.

[chilon]

And only trolls post baited appeals to ridicule...... As I mentioned, I think that while the Admin is obviously well within its bounds here, its nonchalant " off" response to the court's decision is worrisome moving forward.

Meh, its a non-issue to me. They won in lower court and likely will win again. Would be ridiculously cumbersome to attempt to stop payments and would simply harm citizens and benefit no one. Pretty meaningless to even call Obama out on this.

Calling it "autocratic" is just political opponents doing what they do: sensationalizing...

[I WUB PUGS]

True I suppose. I hate the law anyway. Genuinely hate it.