Today’s Supreme Court arguments really get to the crux of the matter. They concern the constitutionality of the individual mandate, the part of the law that forces Americans in the individual marketplace with the ability to pay (there is a hardship exemption) to either purchase health insurance or pay a penalty.
The mandate, according to the insurance industry, is what allows them to offer coverage to anyone who seeks it, including those with a pre-existing condition. The government believes that it’s necessary and proper to the regulation of a huge part of the US economy to mandate and collect a fee for non-compliance, under the taxing power. They also argue that the fee helps to cover uncompensated care, and because everyone consumes health care at some point, it’s reasonable to collect money to pay for that through a mandate.
Detractors argue that the forced purchase of a product from a corporate entity violates personal liberty and takes us down a slippery slope where the government’s power borders on being unlimited. “Can the government force everyone to eat broccoli,” is the common trope asked by those opposed.
But because of the way in which the US health care system works – and because Obamacare by and large did not mess with that system – the mandate will only come into play for 2-5% of the total population.
Just 2 percent of the U.S. population would be subject to the aspect of health care reform at the center of a constitutional challenge before the Supreme Court this week — the individual mandate, a study released Monday by the Urban Institute found. The analysis said 98 percent of Americans would either be exempt from the mandate — because of employer coverage, public health insurance or low income — or given subsidies to comply.
Including those who are subject to the mandate, but would get subsidies, increases the total number of people affected to 5 percent of the population, according to the Urban Institute, a non-partisan policy research organization based in Washington, D.C. (Some of those subject to the mandate who get subsidies would still need to dig into their pocket to cover the difference.)
Now, as the US system evolves, and more companies drop health insurance and pay the employer mandate penalty – which is oddly not part of this challenge – perhaps that 2-5% number expands. But that’s all we’re talking about here.
Nevertheless, in figuring out this question, the Court will be ruling on the larger principle of governmental power and its limits. So it’s appropriate that they’ve scheduled 2 hours, twice the normal length, for the oral arguments.
What seems completely inappropriate in hindsight is why they scheduled yesterday’s hearings. Recall that yesterday, the question before the Court was whether or not they had the right to rule on the law, because if the individual mandate is associated with a tax, and the tax isn’t collected until 2014, then the Anti-Injunction Act of 1876 applies and plaintiffs must wait until they pay the tax to have standing. Neither side of the case agreed with that. The Court had to hire an outside counsel to argue the side that said the Anti-Injunction Act applied.
And then they pilloried the poor guy! Almost no Justice bought the argument that the mandate was a tax for purposes of that Act, and that they couldn’t hear and rule on the merits of the case. This begs the question of why they bothered with the arguments in the first place. They could have denied cert, which would have been especially appropriate, considering that neither side wanted to argue the point. One lower court said the Anti-Injunction Act applied, but several lower courts did not. There are other arguments among the many lower court rulings that will not get a hearing before the Court. So why schedule that day of arguments?
It looked suspiciously like a setup. Remember that today, part of the government’s argument will be that the mandate is a tax, for the purposes of being Constitutional under the taxing power of Congress. Justice Sam Alito made reference to this yesterday, saying that Solicitor General Donald Verrilli is trying to have things both ways. “Today you are arguing that the penalty is not a tax. Tomorrow you are going to be back and you will be arguing that the penalty is a tax,” Alito said. And there were references to this elsewhere.
The government’s argument doesn’t depend on the mandate being a tax – in my opinion the other arguments, like the invocation of the interstate commerce clause and the necessary and proper clause, are far more reasonable – but it’s certainly a part of it. And we had 90 minutes yesterday of practically every Justice saying over and over again that the mandate isn’t a tax (for purposes of the Act), that Congress never calls it a tax, and that the notion that they are blocked from ruling on the issue because the mandate is a tax is absurd. And today, Verrilli will walk in and argue that the mandate is a tax. It’s pretty clever to have scheduled that day’s worth of arguments to draw out the flaw in the government’s case.
Anyway, we’ll see how this plays out today. But to the layman’s ears (even to a layman well-versed in health policy), it seems absurd for the government to argue that the mandate isn’t a tax for the purposes of the Anti-Injunction Act but it is a tax under the Congress’ taxing power. And the Supreme Court made sure to highlight that absurdity.




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Hmm. Congress can define the federal and Supreme Court’s jurisdiction. It can say in one earlier statute, “if we create a tax for revenue purposes, you can’t sue on it until it hits you.” And it can turn around and say in another statute, “whatever we’re doing to assess fees, penalities, etc in this new statutue, that doesn’t trigger the “can’t sue” provisions in that earlier statute.”
That is the point most of the Justicies and the other parties were making. Alito says, but gosh, this is a tax, and that earlier statute was about suing about a tax, so how can you say sometimes a tax is a tax and sometimes it’s not? To which the reply is, you’re very confused, Sam. Congress can prevent jurisidction in some cases and allow it in others, because the Constitution gave them the power to define jurisidiction in federal courts. Either Alito was just giving counsel a chance to answer and get this dodge out of the way, or he will be on the wrong end of the split on this issue.
My guess on why they did this? Not to trap people on the mandate, but rather to get the jurisdictional/premature suit arguments out of the way to clear all the time they wanted to spend on the mandate issue. Nothing wrong with that. They dealt with it; it’s now out of the way.
At first, since I have a decent job with pretty good health insurance i wasnt really thinking that the mandate was going to affect me. But then i started thinking what would happen if I still waited tables. There would be no way i could afford insurance. I dont think the mandate should stand up in court without a public option available to people who need it.
there are subsidies.
The 2-5% is incorrect. The mandate applies to almost 100% of the population.
Have you bothered to look how low the subsidies are?
If you are making 300% of the poverty line, it is down to only 25%.
So someone in that position will still need to cough up 75% of the cost, not something most of them can do.
I hope the mandate is overturned. If it is upheld, it leaves the door wide open for other mandates, such as a requirement to use IRA funds to purchase an annuity – a sop to the financial services industry. The connected industries will use their influence to mandate purchases of their products.
That analysis is of course wrong on its face. Being “given subsidies to comply” in fact is restating that is indeed a mandate, just a mandate with a carrot. Even if there’s cost-shifting going on – which actually serves as a form of corporate welfare – with the subsidies, it doesn’t change that there’s a mandate that you must “comply” with.
Medicare for all would have been the simple solution but then the insurance oligarchs had to get their cut hence the “mandate.” Obama is hardly a visionary.
In the following year’s income tax but you still have to pony up full freight during the first year.
That’s lie,mandate is for 100 % of US population,who is the illiterate that
believes that?
You’re right, of course. But let’s be fair. Substitute ” insurance oligarchs ” with this ” as head of one of the five families ” ala The Godfather movie. ” And Obama…visionary. ” Most American visionaries, the best of the lot to my way of thinking, are buried with coins over the place where their eyes used to be. If Obama was a baseball team he’d be the Dodgers and not the Giants. And sometimes I don’t blame him.
I think you’ve hit the nail on the head. The single biggest reason most Americans oppose the ACA is due to the fact the mandate would force us to purchase a product from an industry that we have no faith in, and the government has shown no desire to regulate for fair marketplace practices. The philosophical argument of mandates can then be used to force us into purchasing and directly subsidizing other industries and corporations that do not have the people’s interests at heart. The ACA is, and always has been, Obama’s biggest sellout to Corporatism and Neo-Liberalism.
Actually in hearing so far about today’s arguments, I’m optimistic that it will be at least 5-4 against. Kennedy seems pretty strongly against it and actually Ailito nailed Verrilli:
Last I checked family members and taxpayers were others – if neither your family nor everyone else who is a taxpayer aren’t “others,” then I don’t know who else would be.
Verrilli seems totally overwhelmed and just making stuff up as he goes, but he’s clear he’s working for corporate interests, like he didn’t like Breyer talking about Medicare/Medicaid. It seems like the other Justices are better at defending the law than Verrilli.
totally agreee, spanishinquisition. Is the Urban Institute just carrying the admin’s water here with those weak arguments? Many of those who qualify for the subsidies may still not be able to afford the payments. The mandate does affect much more than 2%-5% of the population.
It’s so comforting to know the government is going to write a check to me for a nebulous amount, so that I can turn around and write another check to an insurance company for an over-priced piece of crap product that has co-pays, deductables, and red tape in every fucking envelope they send to me in the mail.
Obamacare, where we pay you to pay the extortionists. (Hopefully, the price is fair, and if it’s not, well tough shit.)
Points to ponder:
If the Court strikes down the Rube Goldberg Health Insurance “Reform” Act of 2010, Obama will have zero major accomplishments. Not many presidents manage to whiff on an entire term.
This crap sandwich of a law, prepared by Chef Baucus and his line cooks from K Street, cost the Democrats 63 seats in the 2010 election, energized the right wing, and killed the Democratic base’s enthusiasm. It’s hard to get much stupider than that in the political strategy department.
I’m following the arguments with interest. Armando (Big Tent Democrat) has a good run down of the law on the Daily Kos site, as does bmaz at Emptywheel.
On a personal note, I really hope the Supreme Court supports the act. Not that I love the insurance companies, but I hate to see so many without any health insurance at all. With the subsidies, and the expansion of Medicaid, a greater number will have access to health care. And preventative health is required to have no copays. There will be more regulation of the insurance industry.
In MA, the law has helped most people afford insurance. It’s not perfect, but it’s a step in the right direction.
I don’t see any scenario where something like Medicare for all is enacted if this goes down, short of a massive backlash against the right wing and a total collapse of the Republican party.
I agree that the mandate is reprehensible.
The insurance industry is flat-out evil.
Still, this is constitutional. The Founders did indeed provide Congress with broad powers, with the understanding that the people have a greater influence on their representatives than any other branch of government, and that the proper remedy in situations like this is for the people to vote out the representatives who make unpopular laws.
Whether the Founders got it right or not is an entirely different question, but this is constitutional.
Ok. So it is clear that everyone at the Lake is against the Health Care Bill. It looks like it is going to get struck down so now what? What is going to happen now? We go back to the beginning….our kids are going to be kicked off our insurance….preexisting conditions will be dropped and no one is going to touch this issue again for a long time.
I don’t see myself retiring soon because I will need to continue working to stay on the company health insurance.
what makes you think it will be struck down?
also, IF the mandate was struck down, I would LOVE it for the other parts such as preexisting conditions to be kept….then we MIGHT see the insurance companies actually lobbying for some real fix to the entire thing, because the status quo wouldn’t work for them.
there would at least be a possibility that that’s what could happen.
Unfortunately, that’s only up to the same crew who think corporations are citizens to decide.
CNN and MSNBC are both predicting that the law is in trouble after todays hearing. However, those political hacks in the Supreme Court are unpredictable so who knows. But the conversation now is that this should lead to Universal Health Care. The media is saying “don’t hold your breath”. I would be very surprised if anyone has the appetite to resurrect the Single Payer issue.
Indeed there are subsidies. Not sure it matters much though. If you get a subsidized policy, the policy has capped OPE but in exchange they have jacked the deductible. Which requires people of modest means who need subsidies to pony up with a *much* bigger chunk of initial cash in order to even use health care services than holders of non-subsidized policies.
So basically, we are requiring the people with the least money to come up with the biggest chunk of upfront CASH in order to actually translate one of these policies into physical health services. Taken to the logical extension, that means many many poor people won’t actually be able to USE their policies for much of anything … while we pay month after month after month of free money to the insurance industry for damn near worthless insurance.
Not sure that has anything to do with the legal argument, but it certainly makes me imagine those who are parroting the line that ACA provides “health care” to poor people are bleeding idiots.
kgb999–
You know your facts.
Reference: your statement “it certainly makes me imagine those who are parroting the line that ACA provides “health care” to poor people are bleeding idiots.”
When it comes to the Washington Elite, I’d say that “sociopathy,” not ignorance, is the problem.
When it comes to the American people, I believe most of them are ignorant of how this bill works, and the harm it will do, especially to working class individuals and families. Any bill that was written ostensibly to cover the “poor and working class,” but which according to CBO’s own analysis and estimates, will leave approximately 30 million of these folks uninsured, can’t possibly be taken seriously.
End of story.
Thanks for your comment.
Blue
Having Healthcare insurance does not mean having access or being able to pay for healthcare. Everything about this bill is about looting the American people in order to pay the private healthcare insurance corporations. There is no substitute for single payer health care, not even Medicare, nor Medicaid. Each time there is a middle man, there are services to the patients which are compromised and cut. That’s how insurance companies make their profit; it is part of their DNA to deprive patients of care, whether the insurer is a private corporation or a government agency.
Single Payer would have needed to be alive within the policy discussion at some point to qualify for a resurrection. Don’t get me wrong, I was never that big a Single Payer advocate, but when are you imagining that Single Payer was *ever* promoted as policy?
To my recollections, the Democrats NEVER pretended to advance a single payer policy … didn’t mention it, didn’t argue for it, didn’t even try to make a nominal case for it. Certainly the GOP never did. At least seemingly not in my lifetime. Maybe I missed it.
Fact is Democrats are total losers and Republicans suck. Since everyone is apparently locked in to the idea of voting for one or the other, we’re guaranteed a government of losers who suck. Don’t come crying to me about it. If you plan to vote for Obama, you are every bit as much a part of the problem as any teabagger.
Right…..so the alternative is Paul Ryan and his Medicare and SS Plan to finish us off. I don’t disagree with your opinion on the parties but its lose lose for me whatever way it goes. At least with the Dems I might be able to get some Food Support.
People hate this law because they understand they ‘re being FORCED to buy a terrible over priced product from a so called Industry that wouldn’t even exist if it wasn’t for political corruption. I hope the SCOTUS over turns the mandate and I don’t care why. It sucks and its a slippery slope indeed. If Health Care is so important and we all need to have it then make it a Nat’l program to provide it, funded by taxes and administered by the existing Nat’l health program Medicare. It’s so easy a fool could figure that out, but its impossible politically under our present system of Crony Capitalism AKA Corporatism. Figuring a way out of the later is our real problem here not Health care.