Every political reporter in the country is anxiously awaiting the list of opinions from the Supreme Court every Monday and Thursday from now until the end of the month. At some point, the decision on the Affordable Care Act will come out. But that will actually not signal the fate for the law, or at least the entire fate.
UnitedHealth, one of the largest insurers in America, made the decision to retain several benefits from the law’s provisions, including allowing young people to stay on their parent’s policies until the age of 26 (which 6.6 million Americans have already taken advantage of), banning lifetime limits on benefits, making available free preventive services, and limiting rescission cases to intentional fraud (although that’s generally what insurers say now).
And many other insurers are following UnitedHealth’s lead, included Humana and Aetna. With these big insurers committed, it will be difficult for others to deny these benefits, or else they will lose market share. That’s particularly true if the smart shopping elements of the law come to pass. Many states have said they would continue to offer insurance exchanges even if the entire law were overturned.
This is not unique to insurance companies. The New York Times looked at Maimonides Medical Center and how they are preparing for a next stage of health care in America, emphasizing quality and delivery system reform:
Win, lose or draw in court, administrators said, the policies driving the federal health care law are already embedded in big cuts and new payment formulas that hospitals ignore at their peril. And even if the law is repealed after the next election, the economic pressure to care differently for more people at lower cost is irreversible.
“If the Supreme Court overturns this law — I pray it won’t — the world will go on changing,” Ms. Brier said. “In some ways, we’ve changed ahead of it.” But she added, “Trying to manage all these different aspects of the health care system as they are changing does make you crazy.”
Even if the individual mandate gets struck down, it will not unravel the law, as Pam Belluck argued. People will choose to get coverage under the regulate-and-subsidize framework, with or without a mandate.
I agree to some extent with Jon Cohn that this does not render the ACA irrelevant. UnitedHealth did not decide to keep the pre-existing condition exclusion for children, for example, or the 80-85% medical loss ratio mandated by the law. If the Supreme Court throws the whole law out, those regulations would go. And while the exchange structure could stay in place in select states, the coverage subsidies (and the Medicaid expansion) are the really important things to retain, and those hinge on the law being severable from the individual mandate, should that be found unconstitutional.
What I would say is that UnitedHealth will retain what it will because it’s extremely profitable. Their spokesman admitted to Bloomberg that the protections would add no more than “a couple of dollars” to premium costs. All of them are examples of common-sense provisions that lower costs by reducing the need for more costly care (in the case of free preventive services) or open up new markets by making insurance more attractive (the under-26 provision adds healthy people to the risk pool, for example).
Which makes you wonder why these insurance regulations a) were so hard-fought and b) were so touted as a central feature of the law. If the law wasn’t required for insurers to get on board with policies that will improve insurance and help their bottom line, then maybe the lawmakers needed to look at other options to really force their hand. Instead, they put forward choices that were both consumer-friendly and industry-friendly and called it reform.




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For those that still want to try and deny the mandate is unconstitutional, would you mind answering two questions?? Perhaps they are the key to our disagreement.
1) Do you believe something is unconstitutional if nearly every reasonable person looked at and concluded there is no way our founders intended for the government to have that power?
Because while the legalese involved is surely more complicated than that, can we at least agree that if nearly every reasonable person looks at something and agrees it’s not what our founders intended, that at least it SHOULD be UNconstitutional? If we agree on this premise, then question two is relevant. If we don’t agree on this premise, then don’t bother answering question 2 as it is completely irrelevent.
2) Do you believe those founders intended Congress to have the constitutional authority (this has NOTHING to do with whether is wise or stupid politially, constitutional authority merely implies it CAN happen) to mandate that people have children, or mandate they stop having children??
Because if you agree with the sentiment in 1 AND you agree that there’s no way possible our founders intended this limited powered federal government should have the authority to mandate something as personal as having kids or not having kids, then we agree this mandate is also going beyond what the founders intended because it’s legal arguments are being framed in a way that would mean not only can Congress mandate behaviour regarding purchasing something, they can mandate ANY behavior that might in almost any affect commerce. And there is almost literally NOTHING that has ZERO impact on commerce. Which means, the federal government could, in the guise of “regulating” commerce, mandate almost any kind of personal behavior it wants to as long as it can prove such behavior has some sort of an affect on the economy.
It’s an easy call for me. There is no fucking way our founders meant for the government to have this power, even if it polled at 60% approval.
Sure they will. I believe everything the med ins corps say.
I call bullshit. This is about influencing public opinion, nothing more. Unfortunately it will be lapped up.
Thanks David. I heard about this last night and I’ve been too busy to post this. I wanted everyone’s take on what the insurance companies play is here.
With several hours to think about this, I’m wondering if they’re doing this to possibly fend off calls for universal healthcare. By keeping some of the more popular aspects of ACA, it may reduce the movement towards single payer universal.
There’s nothing more to it than a publicity stunt, as Margaret sez.
Ah, but the Court is likely to rule that the mandate can’t be separated from the universal coverage requirement, and toss both. At that point, the insurance companies will again be free to pick and choose who they accept, and we’ll be back where we started.
I agree with Margaret that this is about influencing political opinion: make it easier for this very political court to find the health care law unconstitutional by pretending that there will be no problems.
As my dental “benefits” for the year run out leaving work undone, and as my romantic partner goes without needed care for lack of insurance, I find it difficult to give a damn at all about the “Affordable Care Act” which should have been named the “Health Insurance Profit Protection Act”.
I generally agree. The government has no business trying to make a law that forces everyone in the country to purchase a private product or service on an ongoing basis, with no competing public alternative and even lacking any meaningful regulation of the private industry involved.
(And this doesn’t even TOUCH UPON the way the Obama Democrats gave PHRMA what it wanted in the form of an importation ban.)
Medicare for everybody. Why shouldn’t we all take care of each other? We are the government after all. And, for those who have been misled or who have forgotten, the government is us. It is inappropriate for anyone to profit from health care except the providers. Why in hell would we continue paying billions to insurance companies, which provide absolutely no care whatsoever, for nothing more than simple bookkeeping? Nixon started it. It’s time to finish it. Insurance has NOTHING to do with health care.
This “mandate” is dictatorial, especially when it directs everyone to purchase an overpriced product from a private, for profit entity. The only mandate I’d approve of would be to mandate that health insurance was a right and should be single-payer, affordable, and available to all.
The under 26ers and exchanges were often touted as urgent reasons to support ACA. No equivocation allowed, just watch those TV ads. It’s like being told you need an enema in order to get an aspirin.
These insurance spokespeople are bad actors. It’s the same with big pharma and the payoff for a Fed ban on reimportation of medicines — they seem oddly quiet at the moment, maybe wondering if they get the money back if ACA is tossed out.
I understand that there originally WAS a severability clause in ACA, and it was removed intentionally. It wasn’t a careless oversight. So one would wonder why it was taken out — to make it harder for SCOTUS, or something else?
Does anyone have clarification on this?
Why’d they hafta to go and make everything so compliacted?
Eliminate the age-65 requirement for Medicare.
It could be done, yes it could.
And question: what are health insurance companies but middle-men who profit off of the misery of others? I mean, what value do they add? None, as far as I can see; instead, they cream off dollars that could go directly to health care. Those top execs are doing fine, like all rich people.
Adequate health care is a human right. I wish Obama would publicly repeat that last sentence.
Right on holeybuybull
Health care should never be privatized in a for-profit market if there is to be any valuation of human life, I believe. And if that makes me a socialist, so be it.
Yes, they exist in a guaranteed for profit industry, sort of like banks and defense companies. And there is little pretense about regulating the millions these guys make or what they charge you. All that means is they just decide how much to pay themselves and their cronies, aka corruption.
Well,Scotus won’t tosse anything including the mandate for profit,people forget that AHCA was written for insurers and president Obama,meaning that big corporations are the main beneficiaries, Scotus and WH praise corporations.
3500 individual deductibles,8000 familiar deductibles,100 copayments for individual visits,80 copayments for every medication,900 premium for every healthy individual,prohibited medications prices(ask Big Pharma)and so forth.
No universal,no PO,no single payer,no medicare for all,ask president Obama and witch Pelosi why.
And now United is kind and generous?come on.!!!
The five right wing justices on the SCOTUS primarily will focus one thing in their so-called legal analysis: what can we do (again) to elect a republican as President? When original intent gets in the way of their primary goal to elect Romney this time, original intent will take the big hit, baby. Besides, what is original intent anyways? Remember that slavery was institutionalized in the constitution — slaves were counted as less than a full human being. Original intent sucks originally.
They never bother to answer the question of how useful an exchange could possibly be when there are no antitrust laws to protect consumers from price collusion?
Only single payer can help the American people.
Meanwhile some Senators feel woman are still inferior to men for doing I’m sure in some instances, better work than their male co worker, so woman should be paid less?
Its not about law protecting rights, its about buying, then using law, to protect business models and profit at another’s expense.
Yup. The original 11th Amendment proposed by Madison and Jefferson, rejected by the states is still pending?
1) Prohibiting Monopolies in Commerce and Trade
2) Prohibiting Corporate Campaign Contributions
3) Proposed “Artificial Set of “Right,” for Corporations.
4) etc….
Faster provided me this: Jefferson Cyclopedia
http://books.google.com/books?id=ZTIoAAAAYAAJ&printsec=frontcover&dq=jefferson+cyclopedia&hl=en&sa=X&ei=z3zYT6f9C4au9ATSx-mxAw&ved=0CDUQ6AEwAA#v=snippet&q=%22bill%20of%20rights%22&f=false
Call it the Curse of Dred Scott?
Consider it a a form of “corporate sponsored,” state based
segregationstratification, now leveraged under fear of tax penalty? Because your life needs to be insured like a piece of property, a car! Yup, Dred Scott was property also. See now we are all property, in servitude to corporations buying law to protect rancid business models, like a tea corp who had parliament’s blessing and a King’s backing? I’m certain Jefferson and Madison would be vomiting today!Well, yes, there would be no need for exchanges under single payer. My point was that you don’t have to have ACA to have exchanges, which the ACA boosters seemed to claim to encourage support.
Single payer would ultimately have the health care insurance corps wither away, or perhaps participate in managing single payer. The Feds already do that with TRICARE and USFHP, after a fashion.