Obamacare - practical discussion

Yes, that was the closely argued point and final interpretation by the Supreme Court that allowed it to stay at the time. Since the tax was subsequently removed, the argument was it was no longer legal. It may still be illegal, but apparently a different group needs standing to sue for that.

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An interesting sidenote to the SCOTUS interpretation in this case.

SCOTUS found that being forced to do something you otherwise wouldn’t do, by a law that has no enforcement mechanism, isn’t an injury. That’s how SCOTUS was able to say that the people suing in this case had no standing. The claimants said they had to buy expensive insurance because the law told them they had to. They claimed that was their injury because without the law, they wouldn’t have bought the expensive insurance. By SCOTUS saying that wasn’t an injury is essentially giving everyone carte blanche to not follow laws that don’t have an enforcement mechanism.

What SCOTUS said with this decision is that if you follow a law that you believe is unconstitutional, you CANNOT sue and claim what the law forced you to do was injurious IF the law had no way to actually force you to follow it.

I personally don’t know many laws on the books that have no enforcement mechanism. But at the moment, there are a lot of emergency laws not on the books. I would venture to guess, several of them have no codified enforcement mechanism. What SCOTUS unintentionally just did was tell people that if your state or locality has a masking/capacity/COVID whatever mandate and the agency that setup that mandate didn’t put in an enforcement mechanism into the law, you don’t have to follow that law. That is because, if you do follow it, and claim that following it caused injury, and you think it was unconstitutional (at this point, any COVID law that wasn’t passed by the legislature is unconstitutional IMO), SCOTUS said you weren’t actually injured. So don’t injure yourself if you don’t want to - SCOTUS said so!

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Seems like a logical interpretation/extrapolation.

Government by executive order continues. There’s a lot in this latest batch of edicts but for this topic it looks like there will be soon fewer choices on the Obamacare markets as they try to make plans offered “simpler” and more comparable (last item below). anti trust scrutiny is heightened generally, and healthcare sector specifically, and some measures about prescription drugs are also included.

In the Order, the President:

  • Directs the Food and Drug Administration to work with states and tribes to safely import prescription drugs from Canada , pursuant to the Medicare Modernization Act of 2003.
  • Directs the Health and Human Services Administration (HHS) to increase support for generic and biosimilar drugs , which provide low-cost options for patients.
  • Directs HHS to issue a comprehensive plan within 45 days to combat high prescription drug prices and price gouging .
  • Encourages the FTC to ban “ pay for delay ” and similar agreements by rule.
  • Directs HHS to consider issuing proposed rules within 120 days for allowing hearing aids to be sold over the counter
  • Underscores that hospital mergers can be harmful to patients and encourages the Justice Department and FTC to review and revise their merger guidelines to ensure patients are not harmed by such mergers.
  • Directs HHS to support existing hospital price transparency rules and to finish implementing bipartisan federal legislation to address surprise hospital billing .
  • Directs HHS to standardize plan options in the National Health Insurance Marketplace so people can comparison shop more easily.
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One of those religious medical cost sharing programs, used by some as a voluntary and cheaper alternative to traditional health insurance, is facing bankruptcy. The fact they didn’t explicitly promise to pay your medical bills (members would be asked to make larger voluntary contributions if a large expense was incurred by someone sick) may leave them out cold as non-creditors in the bankruptcy process.

Shar­ity Min­istries Inc., a med­ical-cost-shar­ing non­profit for Chris­tians, has filed for bank-ruptcy pro­tec­tion in an ef­fort to keep op­er­at­ing amid ac­cu­sa­tions by state au­thor­i­ties that it de­ceived con­sumers by run­ning a sham health-in­sur­ance busi­ness.

The non­profit said it would use bank­ruptcy to break many of its con­tracts with Aliera Cos., which pro­vides ad­min­is­tra­tive, mar­ket­ing, sales and other ser­vices to Shar­ity, ac­cord­ing to pa­pers filed Thurs­day in the U.S. Bank­ruptcy Court in Wilm­ing­ton, Del.

In Oc­to­ber, New York state ac­cused Aliera and Shar­ity of run­ning a sham in­sur­ance busi­ness in a man­ner de­signed to evade reg­u­la­tion. Al­though Aliera and Shar­ity say they aren’t health in­sur­ers and don’t guar­an­tee the pay­ment of claims, they ad­ver­tise in New York as health­care al­ter­na­tives, state of­fi­cials said. A hear­ing on the New York mat­ter is sched­uled for this fall.

Chris­t­ian non­profit Shar­ity Min­istries Inc. is tak­ing steps to wind down its op­er­a­tions as the med­ical-cost-shar­ing group faces in­ten­si­fy­ing scru­tiny from Jus­tice De­part­ment bank­ruptcy mon­i­tors over how its mem­bers will be treated.

Shar­ity said it makes no prom­ise that a mem­ber’s med­ical ex­penses will be paid and there­fore doesn’t con­sider those in­di­vid­u­als to be cred­i­tors. Mem­bers won’t be pro­hib­ited from fil­ing claims in the bank-ruptcy, but Shar­ity said it ex­pects to ob­ject to such claims.

Mr. Luria said in court pa­pers that Shar­ity is in­ves­ti­gat­ing whether Aliera owes money to health­care providers. An Aliera spokesman said Fri­day that Aliera em­phat­i­cally dis­agrees with the as­ser­tions made by Shar­ity. Aliera af­fil­i­ates, as ser­vice providers, aren’t re­spon­si­ble for any amounts to health­care providers who serve Shar­ity mem­bers un­der any con­tract, the spokesman said.

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The ones I’ve heard of are pretty clear that when you sign up, other members will “gift” you money for medical expenses, and you agree to gift others money for theirs. It’s essentially a gofundme clearinghouse with reciprocity for medical expenses. If you did not understnad this, it’s because you’ve bought into the new-age ‘make up your own definition for words’ philosophy.

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I don’t think the NY regulators are doing this because some customers might have been mislead. You can tell they just don’t like people having a choice other than comprehensive full coverage super expensive health insurance plans regulated by the state, and anything else, in their words is “junk”. Typical “government knows best” approach, as expected from NY.

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There’s something missing here. This doesn’t make sense. If they don’t continue to pay “claims” of its members and use bankruptcy to get out of paying those in addition to its main reason (getting out of bed with Aliera), they won’t emerge from bankruptcy - because they won’t have any customers. Every single current member will leave and never return and only people living under a rock without the ability to google would ever join in the future.

Sharity isnt trying to emerge from bankruptcy, and they arent using bankruptcy to get out of paying claims.

The article says they are in the process of winding down their operations. And their position is that the “claims” are not debts that need discharged in bankruptcy.

They’re just trying to conserve company assets to pay other creditors, by minimizing how many hands are taking a piece of the remaining pie.

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I have not read the articles, so this is all guesswork, but from the @xertman’s quotes, it seems more that they are not going to throw money at fighting insurance regulators. It doesn’t seem that they’ve defaulted on anything, or absconded with any funds. It does seem that NYS has a h̶a̶r̶d̶ problem with them. It’s not clear from the quotes whether that problem is from complaints.

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Sorry if my quotes were a bit unclear. There were two articles, and the source is hard to quote from and paywalled. As I understand it, the health sharing ministry Sharity / Trinity Healthcare has a 5 year term contract with their claims admin Aleria and due to legal harassment by various states like NY, Sharity lost the ability to advertise in some areas and had their reputation damaged leading to a drop by about 75% in revenues.

the original point of the BK was to break the administration contract with Aleria and pick a smaller, more affordable vendor and continue their business
 half way through they seem to have given up on that and are now in liquidation (2nd article, quotes were a mix from each which may have added to the confusion). You can see the BK filing here

https://pdf.courtdrive.com/pacer/debke/185773/dockets/5.00000/1-3942DE60-E0B3-11EB-87EE-7133B5677B47

The unpaid claims in question are some that apparently the admin Aleria may not have paid even though they’re supposed to (ie that Sharity paid them to), or that they didn’t yet tell Sharity about, with the goal of paying those people before winding down operations. This is why there are comments about maybe Aleria being on the hook for some claims.

So it’s a mess, but it’s mainly a “we sued you out of existence” situation rather than a “we’re stiffing our customers in BK” situation. Sounds like the customers are probably getting paid but I guess if it takes too long, the lawyers and settlements might steal money that would have gone to paying member claims.

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The first line that xerty quoted after posting the links says “Shar­ity
 has filed for bankruptcy pro­tec­tion in an ef­fort to keep op­er­at­ing.” My mistake for not realizing that had changed.

Okay, I suppose that’s technically true that they aren’t trying to get out of paying past claims. But Sharity isn’t stopping members from filing claims that they just incurred, AND doesn’t plan to pay them. So they aren’t going into bankruptcy in order to get out of paying claims, but it just so happens that’s exactly what the result will be. Seems like a difference without a distinction.

Kinda sort of? If they’re claiming the claims are not debt obligations, the bankruptcy is irrelevant to them being paid.

I’d guess this is a rather key detail in the fraud claims calling them a scam. They cant accept that the claims are debt obligations without also accepting that they were selling insurance illegally. Insisting that all “claims” were submitted merely with the hope that other plan members would voluntarily contribute to share the cost is what makes their operation not subject to insurance regulations.

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Yeah, I get it. They have to say that there is no guarantee your bills will be paid in order to not be considered insurance, but at the same time, they have to make sure all bills get paid or else no one would be their customer.

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Obamacare recap 12 years in. Promises made, promises broken.

Higher premiums, higher costs, lower choices, and the only people who take it are paid to.

“If you think healthcare’s expensive now, wait til you see what it costs when it’s free”

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I imagine the republicans didn’t intend to give early retirees with assets but low taxable income a massive subsidy. I’ve personally saved just over 100k on premiums since the ACA began. So, thanks Obama!

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Despite it’s shortcomings, just remember 
 If you like your doctor, you can keep your doctor. It’s a promise made, promise 


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I did indeed keep my Drs.

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Wait, which Republicans? :slight_smile:

True. I meant the Dems. The Republicans didn’t want it at all.

Xertys point is apt. The happiest people with the ACA are those getting the subsidy. Although god help you if you get sick on a bronze plan only making 40k/year and no assets :frowning:

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