Obamacare, Healthcare, etc.

[Acturus]

Swampy, can you cite your source? I have absolutely no idea what you're talking about.

Also, the tax credit thing is interesting, and if the argument holds water, there will be a massive shitstorm on every governor who refuses to build an exchange and screwing the state's population out of a tax break.

[SwampdonkeyPLD]

Source of what? The challenge, i.e. the case cite? The source in the constitution?

And I said Death Panels so readers would know what I'm talking about.

Edit: I haven't seen a mainstream news story about it if that's what you're looking for.

Edit #2: Apparently it has a wiki: http://en.wikipedia.org/wiki/Coons_v._Geithner I didn't read the wiki article on it though. Okay, now that I read it, it doesn't help much.

[Melena]

If we want to talk about death panels, how about we talk about the wonderful insurance companies who delayed the replacing of my grandmothers pacemaker for over 5 years till she finally died almost two years ago because they were surprised she outlived the ten year battery on her pacemaker and didn't feel they would get the same investment a second time around.

[Acturus]

You said Death Panels to mislead, then? There are no death panels. It was a hoax when Palin dry humped it for the public eye, and it's a hoax now.

Any validation of this filing (which hasn't had movement since 2010), will be placed against the SCOTUS ruling from last month. There's no way it'll hold water.

[Tyche]

So in an unrelated thread, someone mentioned staffing services for finding employment. This made me wonder how those industries would work. Typically, staffing services charge employers 130-150% of the employees wages to handle the hiring, HR, documentation, payroll, etc. Employers love to utilize them because A. No overhead other than the wages. B. No benefits. How will these temp services work now? The temp services will be on the hook for the medical coverage, not the employer, which will lead to increased cost for the the employer to hire the temp employee. I mean, Obamacare does apply to temps, correct?

Edit: I don't want to watch this, someone sum it up:

[SwampdonkeyPLD]

You said Death Panels to mislead, then? There are no death panels. It was a hoax when Palin dry humped it for the public eye, and it's a hoax now.

Any validation of this filing (which hasn't had movement since 2010), will be placed against the SCOTUS ruling from last month. There's no way it'll hold water.

I already stated why I said death panels. IPAB ring a bell?

There's been no movement b/c it would be rendered moot if the SCOTUS decided the whole thing was unconstitutional.

It may not "hold water" but not for the reasons you stated. It may not hold water simply b/c of the "intelligible principle." SCOTUS hasn't invalidated anything on those grounds since 1936ish I believe. Here's an analysis of why the IPAB may be unconstitutional under that principle.

Spoiler: show

The section of the PPAHCA devoted to the IPAB makes its purpose clear. To "reduce the per capita rate of growth in Medicare spending." In accordance with the sections purpose, the PPAHCA provides, "The board shall develop detailed and specific proposals related to the Medicare program in accordance with the succeeding provisions of this section." Those proposals:
...shall be designed in such a manner that implementation of the recommendations contained in the proposal would not be expected to result, over the 10-year period starting with the implementation year, in any increase in the total amount of net Medicare program spending relative to the total amount of net Medicare program spending that would have occurred absent such implementation.

Coupled with each of these provisions are "requirements" and "considerations". The former outlines the requirements for proposals and the latter outlines what the IPAB, to the extent feasible, shall consider or take in account.

Difficulty arises when certain sections are analyzed under the scope of the entire section. The IPAB's purpose conflicts entirely with sections §§1395kkk(c)(2)(A)(ii) and (iii). Section §1395kkk(b) states, "it is the purpose of this section, to, in accordance with the following provisions of this section, reduce the per capita growth in Medicare spending." Section §1395kkk(c)(2)(A)(ii) states proposals may not ration care. Section §1395kkk(c)(2)(A)(iii) states, "In the case of proposals submitted prior to December 31, 2018, the proposal shall not include any recommendation that would reduce payment rates for items and services furnished, prior to December 31, 2019 by providers of services...and suppliers..." Both §§1395kkk(c)(2)(A)(ii) and (iii) defy the IPAB's purpose. When sections are at cross purposes, on what "intelligible principle" do they rely? How is the IPAB to comply with §§1395kkk(c)(2)(A)(ii) and (iii) and yet comply with its purpose? Without some guiding principle it cannot.

PART V: WHERE ARE THE LIMITS?

Again, the IPAB's purpose is straightforward, "reduce the per capita growth in Medicare spending." To achieve that purpose Congress laid out a broad framework. First, the Chief Actuary of the Centers for Medicare and Medicaid Services determines the projected per capita growth rate under Medicare for the second year following the determination year. Second, the IPAB—if the projection for the determination year exceeds the target growth rate—is to develop proposals containing recommendations to reduce the Medicare per capita growth rate. And third, the Secretary [of Health and Human Services] is to implement the IPAB's proposals. Guiding this framework are a list of requirements and considerations that the IPAB proposals must meet.

The requirements include the limitation on rationing and the limitation on reductions in payment rates for the first few years. The full list of considerations is contained in sections §§1395kkk(c)(2)(B)(i) through (vii) and the board must only follow their directives to the "extent feasible". As example, section §1395kkk(c)(2)(B)(i) states the board shall give priority to recommendations that extend Medicare solvency.

In light of the fact that that the limit on reduction on services only applies until 2018 and the considerations are only that, the only tangible "intelligible principle" guiding the IPAB in its proposals is that it not "ration" care. Yet, the word "ration" is hardly an "intelligible principle". Rationing is undefined leaving it entirely up to the IPAB to define rationing. If the IPAB decides a medicine is too costly and does not issue reimbursements, has it violated §1395kkk(c)(2)(A)(ii)? What if the IPAB engages in an entirely different type of decision making and decides that certain treatments are not necessary? For example, reimbursements for pain medications for minor injuries such as a broken bone. These are two distinct types of decision making that carry very different consequences. If a definition could be adapted to justify either decision, a definition that does so would be without any "intelligible principle". It would instead be nothing more than a arbitrary principle.

Further, in Panama Refining the Court stated "Congress has declared no policy, has established no standard, has laid down no rule. There is no requirement, no definition of circumstances and conditions in which the transportation is to be allowed or prohibited" That is exactly what Congress has done here. By creating only one requirement, a requirement that the IPAB may define itself, Congress has implicitly given the IPAB free reign to accomplish its purpose. The IPAB can deny services, it can reduce payments, it can affect any industry in any way, so long as it "relates to" the Medicare program.

An obvious response to this argument lies in Mistretta. There, the Court recognized that in applying the "intelligible principle" test to congressional delegations, its jurisprudence has been driven by a practical understanding that in our increasingly complex society, replete with every changing and more technical problems, Congress simply cannot do its job absent an ability to delegate power under broad general directives. Even Panama Refining recognized this principle stating, "The constitution has never been regarded as anything denying to the Congress the necessary resources of flexibility and practicality, which will enable it to perform its function." In Mistretta the Court thus concluded developing proportionate penalties for hundreds of different crimes by a virtually limitless array of offenders is precisely the sort of intricate, labor-intensive task for which delegation to an expert body is especially appropriate.

Medicare policy could be another "labor-intensive task for which delegation to an expert body is especially appropriate." In 2009 it covered an estimated 45 million people and by 2030 is expected that 80 million people will be enrolled. It also consists of four separate parts all of which are funded differently. With those complexities in mind, Medicare policy very well could be a candidate for Congressional delegation, but no matter of complexity exempts Congress from respecting the Constitution. The guidelines provided the sentencing commission in Mistretta provide a stark contrast to the guidelines provided the IPAB in the PPAHCA.

In Mistretta Congress prescribed the "specific tool—the guidelines systems—for the commission to use in regulating sentencing." Congress further directed the Sentencing Commission to develop a system of sentencing ranges applicable to each category of offense involving each category of defendant. Congress then proscribed specific limits on the Sentencing Commission. Sentences could not exceed statutory maximums. The maximum of the ranges established for sentencing ranges could not exceed the minimum of the that range by more than the greater of 25 percent or six months, except that, if the minimum term of the range is 30 years or more, the maximum may be life imprisonment. In addition to its tool, and the limits to which it was to abide by, Congress also provided the Sentencing Commission with seven factors it was to consider.

In the PPAHCA Congress has provided the IPAB with hardly any of this special direction. There is no tool, only a mechanism—the proposals. And these proposals need only relate to the "Medicare Program." There are no factors for the IPAB to consider. And, the only discernible limits are that the IPAB may not "ration" care and not immediately reduce payment rates for items and services by providers of services and suppliers. By leaving the rest of the statute void of any constraints on the IPAB the only conclusion is that absent these two limits, the IPAB may create proposals that carry out policies however it sees fit. The crafting of the IPAB shows none of the careful consideration shown in Mistretta. By eliminating judicial review, Congress seems to have tacitly admitted its guilt. That alone could provide the basis for a constitutional violation because "all agree that Congress cannot bar all remedies for enforcing constitutional rights".

[Cantih]

So in an unrelated thread, someone mentioned staffing services for finding employment. This made me wonder how those industries would work. Typically, staffing services charge employers 130-150% of the employees wages to handle the hiring, HR, documentation, payroll, etc. Employers love to utilize them because A. No overhead other than the wages. B. No benefits. How will these temp services work now? The temp services will be on the hook for the medical coverage, not the employer, which will lead to increased cost for the the employer to hire the temp employee. I mean, Obamacare does apply to temps, correct?

Dunno how healthcare will apply to the temp situation, but, considering
http://www.motherjones.com/politics/...-investigation
http://www.motherjones.com/politics/...rehouses-labor
means they're probably going to get screwed over like they already are.

[gt_killa]

An arguement against Obama health care is this " I just don't agree in forcing other people to pay for the treatment of the members of society that don't contribute. Why is it my responsibility to pay for another person's health care? I'm working to pay for my own, they can do the same."

What can I say to smack some sense in them?

[Kyte]

Talk about preventive care.

[Ksandra]

Also mention that they are technically already paying for other people's health care. Since emergency rooms can't turn people away and those people end up not paying the bill (or get the hospital to greatly reduce the amount) it causes them to raise the amounts on other people to recoup the money.

[Cream Soda]

Now what do you actually need to qualify for obamacare? I figured I just don't since if they won't give me a couple dollars for food, they sure as fk ain't gonna give me any more for healthcare lol

[Jonny]

poor cream

[Kohan]

Now what do you actually need to qualify for obamacare? I figured I just don't since if they won't give me a couple dollars for food, they sure as fk ain't gonna give me any more for healthcare lol

http://thinkprogress.org/health/2012...n-some-states/

http://www.medicare.gov/sign-up-change-plans/index.html

[Ksandra]

http://thinkprogress.org/health/2012...n-some-states/

http://www.medicare.gov/sign-up-change-plans/index.html

those are under the current system irrc. Obamacare doesn't really kick in until 2014

http://www.best-insurance-deals.net/...Obamacare.html

[Cream Soda]

http://thinkprogress.org/health/2012...n-some-states/

http://www.medicare.gov/sign-up-change-plans/index.html

Way over my head. Income wise, I certainly make less than the low requirement there, but was just asking if there were any cock blocks, like food stamps (where I'm not making any income but still getting denied)

[Kohan]

those are under the current system irrc. Obamacare doesn't really kick in until 2014

That's true, but he may be able to use those resources now. If he can't get them currently, he will find out why, and will know whether impending Obamacare changes will make him eligible in the future.

Way over my head. Income wise, I certainly make less than the low requirement there, but was just asking if there were any cock blocks, like food stamps (where I'm not making any income but still getting denied)

That's not over your head. You're a dedicated college student who isn't failing their classes. You can figure it out, especially since you dealt with the phenomenal headache that is food stamps.

[Ksandra]

That's true, but he may be able to use those resources now. If he can't get them currently, he will find out why, and will know whether impending Obamacare changes will make him eligible in the future.

very true, though I don't know if your link addressed the changes in the future (I skimmed, so sorry if they did). If you don't qualify for medicare now, that doesn't mean you won't be able to get the tax credit in the future.

I tried to find a good link about the upcoming breakdowns, but this is the best I got:

http://www.forbes.com/sites/advisor/...to-your-taxes/

Folks in the lower strata of incomes (generally less than household income of around $96,000) will receive tax credits to help them pay for insurance coverage. The way this credit works too complicated to go into here, but an example would be for a family of four with an income of $48,000 would receive a credit of roughly $11,000 toward healthcare insurance coverage.

I hope they come up with a simple guide for the average person when it gets closer. They had to layer that shit with so much it is going to be complicated to a lot of people.

[Kohan]

very true, though I don't know if your link addressed the changes in the future (I skimmed, so sorry if they did).

It's fine. That's why I provided both; the first explains the changes, while the second lets him check his eligibility.

Considering that he's concerned about conflict with existing benefits (e.g., Pell Grants), he'll have to do the in-depth research himself.

EDIT: Oh, as an aside: when I was young, members of my family simultaneously benefited from food stamps and Medicaid. I do not know what would happen in your case today, but there's a tale of simultaneously-received benefits nonetheless.

[Synbios]

Sorry for the necro...

http://www.forbes.com/sites/aroy/201...res-exchanges/

"Don't worry guys, it's good for you, but we just don't want to follow the rest of the American public".

[archibaldcrane]

Nothing prevents an employer from providing more than the bare minimum of Obamacare coverage.