Obamacare - practical discussion

Obamacare - practical discussion


More from the above article

No employer has used Erisa to challenge Massachusetts’ 2006 individual mandate, which includes reporting requirements, but that doesn’t mean it’s legal. Last month a Brookings Institution paper conceded that “state requirements related to employer benefits like health coverage may be subject to legal challenge based on ERISA preemption.”

A 2016 Supreme Court ruling would bolster such a challenge. In Gobeille v. Liberty Mutual , the court struck down a Vermont law that required employers to submit health-care payment claims to a state database. The court said the law was pre-empted by Erisa.

Writing for a six-justice majority, Justice Anthony Kennedy noted the myriad reporting requirements under federal law. Vermont’s law required additional record-keeping. Justice Kennedy concluded that “differing, or even parallel, regulations from multiple jurisdictions could create wasteful administrative costs and threaten to subject plans to wide-ranging liability.”

Justice Kennedy’s opinion provides a how-to manual for employers to challenge state-level insurance mandates. A morass of state-imposed insurance mandates and reporting requirements would unnecessarily burden employers with costs and complexity. It cries out for pre-emptive relief.

They also talk about how the various federal agencies that provide healthcare, military / disability Medicare / etc, can’t be forced to share info with the states, and large self-insuring corporations may pose difficulties as well.

Yes, the states can audit for it, but if they have to do that for every person, it won’t be cost effective since nearly everyone is already covered. The question is whether the states can impose all the compliance and reporting costs on the Feds or the companies just to push around the individual market in their state. More for the lawyers to argue about I guess.


Oh, fair, that’s all about erisa and whether they would be allowed to mandate which could very well be true.

But if they can legally mandate, the compliance aspect doesn’t seem that difficult to me. The IRS already receives health care coverage information. I’m not aware of any reason why that wouldn’t fall under an information sharing agreement.

With regard to an “honor system” that could sort of be true, but if you have to do something like check a box confirming you have health care, and you lie, that could potentially be tax fraud. In most cases, I think that would be enough of a deterrent.


Employees already pay for fringe benefits like social security and healthcare. It is part of their compensation.

Employers look at the full compensation cost when making hiring decisions and compare it against the productivity the worker will produce, so this money essentially comes straight out of their paycheck.


Kaiser on how expensive unsubsidized Obamacare has gotten, and how a few example people dealt with it. No good options generally for those in the Obamacare market, some less worse (short term policies, going without, insuring only certain family members, pay up way too much, etc).

McCabe is one of the 5 million people who buy their own coverage and pay the full cost. Her income is too high to qualify for a government subsidy to help defray the premium. McCabe this week settled on a $773-a-month policy that has a $4,000 deductible — the amount she’ll have to pay out-of-pocket before insurance kicks in. She estimates that will account for at least 15 percent of her income in 2019.

15% is nearly double the ACA’s “unaffordable” guideline of about 8%, but that only applies to penalties that have been removed anyway.


This was a good discussion of the state of the ACA and healthcare subsidies generally in CA, but applies more broadly. thanks @onenote for posting, originally on the “Medicare for all” thread.

http://www.benefit-revolution.com/2018/12/state-freedom-rankings-as-heard-on.html (see video)

In short, the CA government is already paying for much of the healthcare out of taxes, and it’s expensive. To curtail healthcare cost inflation, expensive doctors are cut from networks, wait times get longer, care gets worse. Trends seem to be continuing in this direction, both in the amount paid by the government and the level of care issues.


This is supposedly a practical discussion regarding Obamacare.

However, as a practical matter, Obamacare at this moment no longer exists:

Don’t mess with Texas


RIP: Obamacare


That’s incorrect, it still exists.


Perhaps you meant that as of now it is unconstitutional, but it was arguably unconstitutional the whole time. They’re keeping the policies around in the meanwhile until the court case gets resolved, likely at the Supreme Court eventually.

ETA: looking back at the convoluted justification for the ACA at the US SC level last time, government mandated buying wasn’t allowed unless it could be viewed as a tax, which was why the proponents reasoned that the penalty for non-buying was a tax. Now with the penalty gone, the logic from the last round fails.


OMG is that true!!

It surely does! But here’s betting the RINOs on the Court will find another cockamamie excuse to keep the ACA in force regardless.

Since when does a little thing like The Constitution of the United States of America get in the way of today’s socialists/globalists doing whatever they please!


Weren’t you so upset about the Wayfair decision because the court overturned its prior decision and stare decisis should always prevail?


I disagreed with Wayfair because the case was wrongly decided.


Everything will be free for the poor in NYC just ask the mayor:

He must have he magic touch if he can cover healthcare for anyone on under $200/year/person, let alone in NYC!


he believes the program will pay for itself because fewer residents would have to rely on costly emergency room visits to get treatment.

Ok, so this sounds nice in theory. But the city is paying the bill, while the hospitals are reaping the savings from fewer ER visits. What is completing that circle?

Besides, the cost of using an ER is high, but the cost of an ER providing treatment is pretty marginal. When we pay for an x-ray, we’re paying for the machines and facilties and staff; when someone doesnt pay their bill, it’s really only costing the hospital the material cost of taking that one x-ray. So 80% (or 70%, or 90%, or whatever the number actually is) of what’s being “saved” by people not using the ER is still being spent anyways, since the equipment and facilities and staff are still being paid for.

I’m also confused as to why these 600,000 people in NYC not have any type of health insurance? With everything that is already available, I have to think it’s mostly their own choice, even if it’s the choice to be too lazy to enroll in something. Besides, what happens when 1 million other NYC residents who are struggling to be responsible and maintain their own health coverage, decide to drop their policies so they’re uninsured and eligible for free care under NYC Cares?


NYC has a massive public hospital system. So the benefits to the hospitals would actually go back to the city.

As for the rest of your post, what you say makes sense to me from a lay standpoint, but I would imagine they would have considered this. The system has been in trouble for a while, I think they were planning on laying people off or actually did, so maybe this would alleviate problems associated with a staff shortage? Just guessing here.


Sure - it’ll move uncompensated care to the compensated side of the ledger, appearing to boost system revenues and justify the restoration of the positions that had been cut. No more staff shortages! :slight_smile:


I think that was what another New York mayor was looking for … never mind, that was their governor.

Also, this was a first draft. The final draft begins with “Once upon a time”


A Canadian cautionary perspective on the flaws in their healthcare system.

Noted issues include very high costs to government budgets, long wait times, and lack of freedom to seek better or prompter care outside the government system.


The Epoch Time is a news paper run by the quasi-religious group Falun Gong. While I feel for their suppression by the Chinese govt. they also got some crazy conspiracy theories and are 110% behind Trump.

Canadian system got a lot of problem so does any health-care system. For example, they don’t make any mention of the one-payer system in Taiwan.


New study proving this is false.

I think there are problems with this study where the percentage of bankruptcies caused by medical bills is likely overstated, which was my criticism of the Warren study Joe Friday kept citing as gospel. But regardless of the numbers as a correct depiction of what is really happening at any one point in time, the data didn’t point to any differences in the overall numbers before the ACA and after. I do see use in it for comparison sake.

“The study, which is one component of the CBP’s ongoing bankruptcy research, provides the only national data on medical contributors to bankruptcy since the 2010 passage of the ACA.”

It was interesting that @JoeFriday made his claim so long ago that the ACA has helped with bankruptcies when this brand new study says it’s the first to measure this. It’s almost like he pulled the claim completely out of his ass.


Thanks for the background on Epoch as a source. I knew they were right leaning politically, but the article was more of a personal blog post about the state of Canadian healthcare. I’m not sure why the author chooses to publish there sometimes instead of his own blog.