How will the Supreme Court's Health Care Reform ruling ...

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Now that the mandate issue has been settled, it gives the Democrats the opportunity to return the focus to the rest of the law -- the stuff people like, like not being denied health insurance because of a pre-existing condition.

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The Medicaid expansion would have offered health insurance coverage to 16 million people. Now states apparently can make up their own minds whether or not to accept the expansion – and that means if Florida, Texas and other big states knock it back, then there will be millions of Americans who will miss out on the healthcare reforms.

Then they can simply go be a drain in some other state.

Or, if you're really lucky, they can get catastrophically ill without health insurance, require vast amounts of emergency care done pro bono by the existing healthcare system (and thus, ultimately at your expense), then be unable to work afterwards. Because then they wouldn't be a drain at all.

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I mean, I don't even know where Lodz is! Is that Poland or the Ukraine? Or am I thinking of Lvov? Or is it Lviv? Was that part of interwar Poland? Wait, I think Lodz is in Poland. Fine, but still, I'm not even entirely certain where Lodz is!

Lodz is west of Warsaw, roughly south of G'dansk.  I thing it either on, or west of, the Vistula.

This is a victory for Obama, based on his signature issue being not being a violation of the Constitution.

The strength of the victory is weakened by his signature issue being a massive tax increase to fund an unpopular program, and with states being able to opt out of it.

Most individual provisions of the ACA (other than the mandate) are in fact quite popular -- like making sure that people can get insurance when they have pre-existing conditions, and allowing people to keep their kids on their insurance until they're 25. I'd expect that, with the Supreme Court out of the picture, the Democrats will return to those issues, and to the interesting question of what the Republican alternative is.

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I think Nate Silver gets it right. It's really hard to imagine how this isn't a (slight) net positive for Obama, just like it would have been a (huge) net positive for Romney if Obama's signature achievement had been declared unconstitutional.


fivethirtyeight.blogs.nytimes.com/2012/06/28/in-health-ruling-relief-for-obama-but-a-blow-to-conventional-wisdom/

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Um, the latest polling evidence suggests approval for the ACA is running about 43-48 against, which comes down to almost even when you consider that a few percentage points of the opposition still comes from the left. And, of course, many of the provisions of the ACA are in fact much more popular than the act itself. Hard to see, on that basis, why the issue would be such a big vote-winner for anybody.

http://www.people-press.org/2012/06/18/any-court-health-care-decision-unlikely-to-please/

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wow, the spin in this thread is making me dizzy.

Apparently what seems good for Obama now is actually bad in the long run (?), although I doubt many of the conservatives here would be spinning a struck down bill as ultimately bad for Romney.

Republicans who hated Obamacare still hate it and will vote against the president and his healthcare plan in November. But the SCOTUS is the only branch of Government in this country that has any amount of credibility these days, and today's ruling puts Obama on moral high ground. The idea that Obamacare is unconstitutional has been one of the most frequently used arguments against the bill. Today, the highest court in the land said that it IS constitutional. This sucks a lot of the wind out of the GOP's main argument, at least for moderates and swing voters.

But there is a very real and strong threat of anti-Health Care activists.  If 60% of the country disapprove of the Mandate Tax, then those 60% of voters will now have no reason to vote for Obama in November.  Obama has raised taxes on the middle class (those who are not poor enough to get medicare) but now have to pay the tax to get health insurance.  if they want to exercise their right not to have health insurance.

This is a tax that the middle class will pay.  The upper class can afford the tax.  The poor will get medicare.  The middle class get screwed, again, by Obama.

Fixed that for you.

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wow, the spin in this thread is making me dizzy.

Apparently what seems good for Obama now is actually bad in the long run (?), although I doubt many of the conservatives here would be spinning a struck down bill as ultimately bad for Romney.

Republicans who hated Obamacare still hate it and will vote against the president and his healthcare plan in November. But the SCOTUS is the only branch of Government in this country that has any amount of credibility these days, and today's ruling puts Obama on moral high ground. The idea that Obamacare is unconstitutional has been one of the most frequently used arguments against the bill. Today, the highest court in the land said that it IS constitutional. This sucks a lot of the wind out of the GOP's main argument, at least for moderates and swing voters.

But there is a very real and strong threat of anti-Health Care activists.  If 60% of the country disapprove of the Mandate Tax, then those 60% of voters will now have no reason to vote for Obama in November.  Obama has raised taxes on the middle class (those who are not poor enough to get medicare) but now have to pay the tax to get health insurance.  if they want to exercise their right not to have health insurance.

This is a tax that the middle class will pay.  The upper class can afford the tax.  The poor will get medicare.  The middle class get screwed, again, by Obama.

Fixed that for you.

If your job does not provide health insurance, you will be forced to pay for it yourself out of pocket.  The monthly premiums will still be high.  If you think the health care corporations have now forced a mandatory purchase of their products, then you are correct.  The corporations have won again.  Now they get more customers.  It is a good day to buy stock in HMO conglomerites. 

Also, think about a poor person in Alabama without health insurance being forced to pay the same rates as someone in NYC.  The rural hicks get screwed again by the fed.

All of that is why the ACA brings in the exchanges, co-op plans, tax incentives to small businesses to offer health insurance, the Pre-Existing Condition insurance plan, the option to keep kids on parents' plans till they're 25...

I'll agree that it's not an ideal system. My own preference would have been for lowering the eligibility age for Medicare from 65 to 0, rather than all of these bits and pieces, which together will cover almost, but not quite, everybody. But Republicans and conservative Democrats kept insisting they wanted more expensive plans covering fewer people, so that's what we've got.

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The Supreme Court does leave Romney in a bit of a bind, too. Up till now, he's argued that the reason a mandate was great in Massachusetts, but terrible nation-wide, was that it was unconstitutional at the federal level. Now that the constitutionality of the measure has been reinforced, he's just left saying it's bad policy (which he said today). Which brings us back to the question of how, on a policy level, something could possibly be so awful federally that it needs to be repealed, when at the state level it was actually kinda good.

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The other point, about the "poor person in Alabama." The ACA also provides for money to encourage states to expand the coverage offered by Medicaid for people up to 133% of the poverty line. The Supreme Court struck down the part of the ACA which would have penalized states for not expanding medicaid, but left standing the part of the law providing generous subsidies to states for Medicaid expansion (100% of costs now, eventually coming down to 90%).
In other words, after 2014, if that "poor person in Alabama" isn't covered by Medicaid, it won't be because of Obama, but rather because the state of Alabama has decided to refuse the federal money that would have given her Medicaid.
Now, I suspect Alabama just might be dumb enough to turn down that money, but if they do, we'll know who to blame, right?

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This whole thing is kind of entertaining. I'm a huge Romney fan, but I can at least admit that this turn of events was nowhere near ideal. I was shocked by the SCOTUS decision and instantly felt demoralized.

The only way this works to Romney's advantage is if he stresses that mandates ARE unconstitutional, but that the Obama mandate is a actually a tax hike. Unfortunately... Romney has never been very good at spinning. There's wiggle room here, but Obama has to be pretty happy.

Except that mandates aren't unconstitutional -- if the Supreme Court says something is constitutional, then it is.
And while the mandate penalty will hit some people, and have the effect of a tax increase, it won't hit very many people -- an estimated 4 million, including dependents as well as adults.

 Half of those paying will make more than three times the poverty level, and that half will pay eighty percent of the penalty (a full 55% of the penalty will come from those making more than 5x the poverty level, which means, roughly, $55 000 for an individual, or $120 000 for a family of four). It only affects those who are not eligible for Medicaid, who don't have insurance from work, and who don't buy insurance on their own, and the cost is capped at the average cost of an insurance plan. Oh, and anyone who doesn't make enough income to file a tax return is exempted, as is anyone for whom the penalty would exceed 8% of their income, or anyone who is granted a financial hardship waiver, or who can be exempted because of their religious beliefs, or are members of Indian tribes.

http://cbo.gov/sites/default/files/cbofiles/ftpdocs/113xx/doc11355/individual_mandate_penalties-04-22.pdf

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Let me rephrase: The Court ruled that the government cannot force anyone to purchase a product. That is the definition of a mandate. What's at issue here is that you are not being forced to buy health insurance, but you will be taxed if you don't.

Also, I read an interesting article that I think some people here might enjoy.

"Chief Justice Roberts Is A Genius"
http://whitehouse12.com/2012/06/28/chief-justice-roberts-is-a-genius/

Certainly, the restrictions on the use of the commerce clause are significant, and do mark a potential setback for certain kinds of expansion of the welfare state -- those which involve requiring citizens to purchase private services. As a good social democrat, I'd rather the government taxed people and provided services, and that's never going to be unconstitutional.

As for the tax, I think the best analogy would be excise taxes on tobacco and alcohol. Don't like those taxes? Then don't buy cigarettes or booze. Don't like the health care mandate penalty? Then get health insurance.

The people who will be most adversely affected by this tax are relatively well-off people, who choose not to buy health insurance, presumably because they're healthy and would rather save a little bit of cash and gamble that they don't need it. This will nudge more of them into buying health insurance -- the penalty will always be less money than health insurance would cost, but at the margins it might persuade those people to buy. That's probably a good thing. In the process, the actuarial economics of health insurance will improve, to everyone's benefit. There are pretty elaborate provisions in place to make sure that people who can't afford to buy health insurance will either be covered under Medicare, or at least exempted from the penalty.

I really don't understand what's so scary here.

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The other point, about the "poor person in Alabama." The ACA also provides for money to encourage states to expand the coverage offered by Medicaid for people up to 133% of the poverty line. The Supreme Court struck down the part of the ACA which would have penalized states for not expanding medicaid, but left standing the part of the law providing generous subsidies to states for Medicaid expansion (100% of costs now, eventually coming down to 90%).
In other words, after 2014, if that "poor person in Alabama" isn't covered by Medicaid, it won't be because of Obama, but rather because the state of Alabama has decided to refuse the federal money that would have given her Medicaid.
Now, I suspect Alabama just might be dumb enough to turn down that money, but if they do, we'll know who to blame, right?

And you don't think that as part of some future DC budget deal, the Feds might not decrease their share to something less than 90%? I certainly do. so I won't blame States for being worried that the expanded Medicaid could turn into a budget trap.

Ah, but are they worried that expanded Medicaid could turn into a budget trap, or that expanded Medicaid would give more health insurance to the working poor? Because they seem to view the latter as the real problem.

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This isn't over. The states could nullify it.

The states can't nullify federal law.

Actually they can and they have done it in the past.

Cooper v. Aaron?

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If someone does not want to buy a product, it is their individual right to refuse to do so. End of discussion. It's about liberty.

And you might be able to pass the mandate off as a tax, but it punishes people for choosing an option that the government doesn't like. How is that a good thing.

"If you do not buy an apple a day, you will be taxed." That is ridiculous.
"If you buy this unhealthly product, you will be taxed." Now that sounds a little less abstract.

Taxing someone for not having something is just so strange.

Doesn't the government already give out tax credits for all sorts of things?  Can't you just think of the mandate as a tax on everyone, with the people who have health insurance getting an exemption (equivalent of a tax credit)?

I guess you could look at it that way, but it still wouldn't be the reality of the Obamacare situation.

The analogy to excise taxes on alcohol and cigarettes is a good one, I think. Consumption of alcohol and tobacco are both legal and pervasive, but impose significant negative externalities. It would be misguided (and yes, a violation of liberty) to ban them outright just because of the harm that they do, but the excise taxes, in effect, capture some percentage of the added cost that the alcohol/tobacco consumption of some imposes on all of us (higher Medicare/Medicaid expenses, court costs, higher auto insurance premiums, etc).

Of the forty million-odd Americans who currently don't have health insurance, many would like to have it but have trouble affording it -- their employer doesn't offer it, they have a pre-existing condition that makes the cost of insurance prohibitive, whatever. Most of what the ACA does is to provide incentives that make insurance affordable for many of those people.

But there is a pool of people out there who can afford health insurance, but choose not to buy it, mostly younger people who are in good general health and are gambling that they'll never need it. Their choice not to buy health insurance imposes a negative externality on the rest of us, since our premiums are higher than they would be if there were more young healthy people buying health insurance.

The ACA's mandate penalty is targeted at those people (fairly precisely targeted, if you look at the details; http://cbo.gov/sites/default/files/cbofiles/ftpdocs/113xx/doc11355/individual_mandate_penalties-04-22.pdf). Nobody is forced to buy health insurance, but a small number (perhaps 4 million out of the 40 million + without insurance; that includes dependents, so the number of people whose taxes will go up is even smaller) will have to pay a penalty for not having insurance. That penalty will amount to less money than buying insurance would, but will act as a marginal incentive to encourage those who can afford insurance to buy it. And that will help to keep the costs of insurance lower in the future than they would otherwise be.